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Associate In Claims > AIC 39 > Flashcards

AIC 39 Flashcards

1
Q

Compensatory Damages

A

Awarded by a court to reimburse a victim for actual harm

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2
Q

Special damages

A

Specific identifiable expense, e.g. medical bills, wage loss

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3
Q

General damages

A

Pain and suffering. Does not involve a measurable expense

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4
Q

Diminution in value (DV)

A

The loss in value of an item as a result of the damage and repair to the item (only available in some jurisdictions)

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5
Q

Remittitur

A

When a judge reduces an excess injury verdict reward

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6
Q

Additur

A

When a judge increases a jury verdict award that is deemed too low

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7
Q

Collateral source rule

A

Legal doctrine. Damages owe should not be reduced just b/c the victim is able to recover from other sources such as an insurance policy

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8
Q

Mitigation of damages

A

Duty owed by the injured party to avoid or minimize additional injury or loss

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9
Q

Significant contacts rule

A

A rule that specifies the substantive law of the state having more significant contacts to the parties could apply even when the tort occurred elsewhere

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10
Q

Forum shopping (jurisdiction shopping)

A

The legal strategy of using the significant contacts rule to seek jurisdictions that offer the most favorable substantive law

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11
Q

Diversity of citizenship

A

Indicates that the parties to a lawsuit are from different states the case is “removed” from the state court to a Federal District Court

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12
Q

Punitive damages (exemplary damages)

A

A payment awarded by court to punish a defendant for reckless malicious or deceitful act to deter similar conduct; the award need not bear any relation between parties actual damages

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13
Q

Hedonic damages (loss of enjoyment damages)

A

Damages associated with the loss of physical and intellectual gratification and other lifestyle losses

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14
Q

Loss of consortium

A

The loss of benefits that one spouse is entitled to receive from the other including companionship affection and sexual relations resulting from the injury or death of a spouse

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15
Q

Eggshell claimant

A

A person who is in poor but functioning health at the time of the loss, but after the loss, he/she became severely disabled and dysfunctional

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16
Q

Decedent

A

The deceased claimant in a death claim

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17
Q

Estate

A

The sum total of all types of property owned by a person at the time of death, including businesses, profits, savings accounts, stocks, and other financial assets

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18
Q

Survival action

A

Legal causes of action that existed for the deceased before his or her death

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19
Q

Wrongful death action

A

A legal cause of action that exists for the survivor of deceased

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20
Q

Pecuniary loss

A

The monetary economic loss of the survivors

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21
Q

Household services

A

Services that would’ve been performed by the injured party prior to injury such as cooking and cleaning

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22
Q

Intrinsic value of children

A

The assumption that parents make rational financial decisions in having children, knowing that the investment in the expense of raising children will provide companionship and comfort as a return when the children are older

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23
Q

Aggravating circumstances

A

Circumstances surrounding a loss that elicit emotional responses that influence the jury’s assessment of damages

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24
Q

Best alternative to a negotiated agreement (BANTA)

A

The most that an insurer will pay for a loss after considering all the facts. The claim representative determines the highest probable award (as from a trial or arbitration), then add the cost of the action.

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25
Q

Expert systems (artificial intelligence systems)

A

Software systems the duplicate the decision making process

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26
Q

Alternative dispute resolution ( ADR)

A

Procedures to help settle disputes without litigation, including arbitration, mediation, and negotiation.

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27
Q

Mediation

A

And alternative dispute resolution method by which disputing parties use a neutral outside party to examine the issues and develop a mutually agreeable settlement

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28
Q

Caucus

A

A private meeting with the mediator away from the opposing party

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29
Q

Mediator

A

A person who acts as a referee to the parties in a dispute and can even assist in negotiating issues such as chiropractic and medical treatment fees

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30
Q

Telemediation

A

Mediation over the phone. Useful when only a few issues are in dispute

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31
Q

Arbitration

A

An alternative dispute resolution method by which disputing parties using neutral outside party to examine the issues and develop a settlement, which can be final and binding

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32
Q

Binding arbitration

A

Requires the parties to an arbitrated disputes to accept the arbitrator’s decision

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33
Q

Nonbinding arbitration

A

A practice in which neither party is forced to accept the arbitrator’s decision; however, the decision provides the “winner” with leverage for future negotiation

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34
Q

High low agreements

A

Agreements in arbitration stipulate that no matter what the arbitrator decides, the insurer will not pay more than the high specified amount and the claimant will not receive less then that the low specified amount

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35
Q

Baseball arbitration

A

A process in which each side present its case to the arbitrator along with its final, realistic monetary offer. The arbitrator then reviews the facts and evidence presented, then chooses one of the two figures.

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36
Q

Mediation-arbitration

A

Involves the parties agreeing in advance to use mediation to resolve their dispute, with the understanding that, if they failed to reach an agreement, they must proceed directly to arbitration

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37
Q

Arbitration-mediation

A

A process in which the parties present to an arbitrator who decides a confidential award amount. Then proceed to mediation, if they reach agreement the award is never revealed

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38
Q

Inter-company arbitration

A

Used to settle disputes between insurance companies

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39
Q

Paper arbitration

A

A type of inter–company arbitration that occurs when each side writes its contentions and send them to the arbitration service with supporting documentation

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40
Q

Mini-trial

A

An alternative dispute resolution method by which a case undergoes an abbreviated trial before a panel or advisor who poses questions and offers opinions on the outcome based on evidence presented

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41
Q

Neutral expert

A

Impartial expert who analyzes a specific issue in question

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42
Q

Summary jury trial

A

Alternative dispute resolution method by which parties participate in an abbreviated trial, presenting the evidence and witnesses to mock jurors who decide the case

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43
Q

Pretrial conference

A

Legal proceeding in which the judge acts as a mediator encourages litigants to try one last time to resolve their differences before trial

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44
Q

Settlement days

A

Hosted by alternative dispute resolution firms, parties from several smaller less complicated disputes come together on the same day to conference center. Allows attorneys to block out time for face-to-face negotiations.

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45
Q

Online settlement forums

A

Settlement forms that include arbitration and dispute resolution services Thru Virtual courts that are offered through the Internet

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46
Q

Blind bidding

A

Common feature of online alternative dispute resolution in which parties make series of offers and demands. Neither knows what the other is offering or demanding but are notified if figures overlap

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47
Q

Structured settlement

A

Agreement and settlement of the claim involving specific payments made over a period of time

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48
Q

Settlement agreement

A

Oral or written contract by which parties compromise a disputed matter. Often a release document is included with this agreement

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49
Q

Release

A

a legally binding contract between the parties to a dispute that embodies their agreement, obligated each to fulfill the agreement, and release both parties from further obligation to one another that related to the dispute.

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50
Q

Covenant not to sue

A

Agreement that states in exchange for a specified sum of money, the claimant will not sue one of the joint tortfeasors

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51
Q

Uninsured motorist release

A

A type of release used when an insurer pays the insured through the uninsured motorist coverage, then seeks recovery from the tortfeasor through subrogation. It does not release the tortfeasor from liability.

52
Q

Policyholder release

A

Type of release used when an insurer makes a payment to third party on behalf of the insured to avoid litigation on a claim that may not be covered

53
Q

Minor

A

The person who has not attained the legal age (18 years old in most states)

54
Q

Parent guardian release and indemnity agreement (PG release)

A

Special release that can be used to settle claims of appear in the child in claims involving a relatively small dollar amount and little chance of permanent injury.

55
Q

Court approved settlement

A

Legal proceeding in which the court reviews all details of settlement, the determines whether it is in the best interest of the minor

56
Q

Nuisance settlement

A

Payment made for a nominal amount to conclude a doubtful liability claim

57
Q

First-call settlement

A

Settlement made upon first contact with claimant

58
Q

Drop draft

A

A draft and release sent to the claimant for an amount the claim representative things would settle the claim

59
Q

Advance payment

A

Payment made to a claimant following a loss to cover immediate expenses resulting from that loss

60
Q

Lien

A

A credit towards legal right or interest in another’s property, usually lasting until satisfaction of the specific debt or duty that the lien secures

61
Q

Perfected lien

A

Exists when the insurer responsible for paying the loss has been formally placed on notice of me

62
Q

Medicare liens

A

These can be claimed by the government if circumstances indicate that the insurer should have known that Medicare was involved, such as in a claim involving elderly person

63
Q

Contribution

A

The right of a tortfeasor who has paid more than his or her proportionate share of the damages to collect from other tortfeasors responsible for the same tort

64
Q

Indemnity

A

Restoring the insured to the same financial position held immediately before a loss

65
Q

Salvage

A

Process by which an insured takes possession of damage property for which it has paid a total loss and recovers a portion of the lost payment by selling the damage property

66
Q

Collateral sources

A

Nonliability insurance sources of recovery at reimburse claimants for all or some of their medical expenses, wage-loss or disability. Examples include healthcare insurance, no-fault auto insurance, and Worker’s Compensation

67
Q

Tripartite relationship

A

Relationship between the insurer, the insured, and defense counsel. Both the insurer and defense counsel have obligations to protect the interests of the insured and bailiffs them with the interest of the insurer.

68
Q

Excess verdict

A

A jury award that exceeds the insured’s limit of insurance

69
Q

Excess exposure

A

The possibility a jury award might exceed the limit of liability, exposing the insured’s personal assets

70
Q

Pleading

A

Formal written statement of facts and claims of each party to a lawsuit

71
Q

Discovery

A

A pretrial exchange of all relevant information between the plaintiff and defendant

72
Q

Summons

A

a document that directs a sheriff or another court appointed officer to notify the defendant named in the lawsuit that the lawsuit has been started and that the defendant has a specified amount of time to answer the complaint

73
Q

Parol evidence rule

A

A rule of evidence that limits the terms of the contract evidenced by a writing to those expressed in writing

74
Q

Express contract

A

A contract whose terms and intentions are explicitly stated

75
Q

Implied contract

A

A contract whose terms and intentions are indicated by the actions of the parties to the contract and the surrounding circumstances

76
Q

Contract of adhesion

A

Any contract in which one party must either accept the agreement as written by the other party or reject it

77
Q

Statutes of fraud

A

A collection of laws that help prevent parties from becoming involved in fraudulently formed contracts

78
Q

Unenforceable contract

A

A contract that is a valid contract but that because of a technical defect cannot be enforced

79
Q

Voidable contract

A

A contract that one of the parties can reject (avoid) based on some circumstances surrounding its execution

80
Q

Void contract

A

An agreement that, despite the parties intentions, never reaches contract status and is therefore not legally enforceable or biking

81
Q

Valid contract

A

A contract that meets all of the requirements to be enforceable

82
Q

Acceptance

A

The assent to an offer that occurs when the party to whom an offer has been made either agrees to the proposal or does what has been proposed

83
Q

Breach of contract

A

The failure, without legal excuse, to fulfill a contractural promise

84
Q

Offeree

A

The party to a contract who makes a promise or acts in return for something offered by another party.

85
Q

Offer

A

A promise that requires some action by the intended recipient to make an agreement

86
Q

Escape clause

A

an other-insurance provision that relieves the insurer of any obligation to pay a claim for which other insurance applies

87
Q

Pro-rata contribution

A

an approach to other insurance by which the insurers contribute to the loss payment in the proportion to which they contribute to the total amount of coverage purchase (their limits of liability)

88
Q

contribution by equal shares

A

method of sharing loss when tow of more policies apply in which each insurer pay and equal amount until the claim is fully paid of until one insurer exhausts its limit, in which case the other insured party the remainder of the claim (up to its limit)

89
Q

derivative claim

A

a consortium type claim

90
Q

material misrepresentation

A

a fact that has bee misstated or omitted and that could be reasonable considered as affecting the insurer’s decision to enter into the contact, the insurer’s evaluation of the degree or character of the risk, or the calculation of the premium

91
Q

concealment

A

an intentional failure to disclose a material fact

92
Q

damages trigger

A

when UIM coverage is determined by the deficiency of limits to a person’s damages

93
Q

limits trigger

A

when UIM coverage is determined by the limit of the other motorist being less than the insured’s limit

94
Q

premium rule

A

allows the insured to add separate UIM coverage amounts on separate vehicles when insured pay separate premiums on each vehicle

95
Q

stacking

A

when insured having more than one vehicle may add the limits of liability together to obtain a higher limit

96
Q

arbitration clause

A

a clause in an agency contract that provides a formal method for the agency and insurer to resolve disagreements under the contract

97
Q

corroborative evidence

A

Supports the evidence of a phantom vehicle. Evidence to establish negligence of an unidentified vehicle.

98
Q

phantom vehicle

A

an unidentified vehicle that leaves no physical contact

99
Q

hit-and-run vehicle

A

a vehicle whose operator cannot be identified

100
Q

co-owner liability

A

a legal obligation of one spouse for damaging the other spouse’s auto

101
Q

sufficient geographic proximity

A

a term that refers to being close to but not necessarily touching an auto

102
Q

residence

A

implies a permanent abode

103
Q

family member

A

a person who is related to the claimant and is a resident of the claimant’s household

104
Q

public policy

A

in a given country, state, or other jurisdiction is the set of assumptions and principles (often unstated) on which the laws and court decisions of that jurisdiction are based.

105
Q

doctrine of reasonable expectations

A

a legal doctrine that provides for an ambiguous insurance policy clause to be interpreted in a way that an insured would reasonable expect.

106
Q

condition

A

any provision in an insurance policy that qualifies an otherwise enforceable promise of the insurer

107
Q

named driver exclusion

A

an endorsement added to an auto policy that excludes coverage for damages and injuries caused by a specified driver

108
Q

exclusion

A

a policy provision that eliminates coverage for specified exposures

109
Q

Comprehensive Coverage

A

coverage for direct and accidental loss or damage to a covered auto by any peril except collision or overturn or a peril specifically excluded

110
Q

Waiver

A

The voluntary and intentional relinquishment of a known and existing right

111
Q

Detrimental reliance

A

A situation in which an insured relies on the words or actions of an insurer and that reliance harms the insured’s financial position

112
Q

Estoppel

A

A legal principle that prevents an insurer from claiming it’s right, privilege, or defense if it would be in equitable to do so because of the insurers conduct towards the insured

113
Q

Nonwaiver agreement

A

An agreement signed by both insurer and insured that notifies the insured that any action taken by the insurer is not intended to waive or invalidate any policy condition and is to permit an investigation of the claim

114
Q

Reservation of rights letter

A

Serves the same purpose as a nonwaiver agreement but is typically in letter form, used when obtaining an insured’s signature is not reasonable

115
Q

Declaratory judgment action

A

A legal action in which the insurer (or insured) presents a coverage question to the court and asks the court to declare the rights of the parties under the applicable insurance policy

116
Q

First party bad-faith

A

The insurer’s mishandling every first party claim I can result in extracontractual damages

117
Q

Extracontractual damages

A

A payment awarded by a court that exceeds the usual contract damages for breach of contract

118
Q

Origin

A

The location of a fires ignition

119
Q

Cause

A

The mechanism or event that provided he and fuel for a fire

120
Q

Arson

A

The deliberate setting of a fire to property for a fraudulent or malicious purpose

121
Q

Incendiary fire

A

An intentionally set fire

122
Q

Alibi

A

An assertion that the party in question was elsewhere at the time the crime occurred

123
Q

Property damage

A

Physical injury to, destruction of, or loss of use of tangible property

124
Q

Diminished value loss

A

The real or perceived loss in market or resale value that results from a direct and accidental loss.

125
Q

Special investigation unit (SIU)

A

A division set up to investigate suspicious claims, premium fraud, application fraud

126
Q

Vehicle identification number

A

A unique number assigned to each vehicle that identifies certain vehicle characteristics

127
Q

At what point in the claims process are the various types of claims in an auto accident identified?

A

Either by initial reporting of the claim or after the adjuster has been assigned.

Associate In Claims (3 decks)

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