Ch 5 Flashcards
Why do special form policies have broader coverage than specified-peril policies?
They cover any loss unless specifically excluded
What are three sources of an adjusters duty of good faith?
Policy or contract
Law of bad faith
Unfair claim practices act
What damages beyond an insurer’s contractual Obligation can be awarded in bad faith claims?
Extracontractual damages such as punitive damages, emotional distress, lost profits, or consequential loss.
What are five areas in which an insurer’s beach of its good-faith duties usually occurs?
Inadequate investigation Improper denial of coverage Unreasonable delay in payment Unreasonable compromise Withholding payment of undisputed portions of the claim
What are four major areas of unfair or deceptive claim practices that most unfair claims practices acts prohibit?
Delays
Failures to act
Failure to communicate
Denials
What info does an adjuster hope to get from an EUO?
A parody issues sufficiently to recommend acceptance or denial of the claim May obtain information leading to new avenues of investigation.
Before an EUO, what should the adjuster and the insurer’s attorney agree on?
The areas of questioning and the objectives.
What rationale supports the opinion that a signed, sworn proof of loss be submitted before the EUO is scheduled?bonei
It is a policy condition so the insured is committed to the facts sworn to in the proof of loss.
Who has to submit to an EUO, if demanded?
Insured and anyone claiming benefits under the policy.
What must occur be got an EUO?
Must have an adequate investigation to base the EUO on. Most adjusters get a sworn proof of loss.
What does letter demanding EUO contain?
Demand
Date, time, place
List of documents and records the examiner must bring
Name, address, phone of person to contact if they can’t make it.
How does the EUO procedure go?
Swearing in
Insurer’s attorney asks questions
Transcribed
Subject reviews statement and signs.
What does insurer do if the insured is a no-show?
Do nothing
Send letter telling insured to call to reschedule
Send ROR
What does insurer do if the insured fails to bring requested documents to an EUO?
Proceed without and continue on later date with documents.
Record that they appeared without documents and reschedule.
What does insurer do if the insured wants to sit in on another insured’s testimony?t one I
Depends on the law. ISO policies allow adjuster to exclude any other insured.
