Chapter 3 - Who does what? Broker, underwriter and adjuster responsibilities Flashcards
Define broker
A licensed independent person or firm who acts on behalf of an insured in placing business with insurance companies
What four ways may a broker prevent insurance fraud?
- Public outreach
- Prescreening & qualifying potential applicants
- Preventing fraud arising from broker operations
- Complying with applicable legislation, codes of conduct and codes of ethics
Define book of business
The collection of client business an agent or broker has placed with insurers. Generally, a broker owns her book of business, while the agent’s book of business is owned by the insurer
What details may a broker want to note about the source of new business?
- Is it a referral?
- Who is the contact?
- What is the profile of the contact?
- Can the broker “take or leave” the contacts business?
Define E&O insurance
Errors and omissions insurance
- An insurance form that protects the insured against liability for committing an error or omission in the performance of professional duties. Generally, such policies are designed to cover financial losses rather than liability for bodily injury or property damage
What law must brokers follow?
The Insurance Act
What are the common code of conduct themes for brokers?
- Integrity
- Competence
- Conscientious & Quality of Service
- Financial Reliability, safekeeping & preserving clients property
- Privacy
Define underwriter
1) The insurance company or group that underwrites or insures a particular risk
2) The individual within an insurance company whose responsibility it is to accept or reject business or modify submissions in the particular line in which he or she specializes and in this way, choose the risks the principals are prepared to underwrite
What are the three typical rate falsification techniques?
1) Fronting - False statement of who is the principal driver
2) Garage flipping - Address change for rating purposes of the vehicle
3) Manipulation - Rating factors such as driving distance, age of PD and education levels
Define adjuster
One who investigates insurance claims, makes recommendations regarding the payment of benefits from insurance policies and negotiates payments and settlements
The choice of term for an “adjuster” differs on what four criteria?
- Corporate environment
- Local usage
- Legislation
- Specific licensing regulations
What two key ways can adjusters combat insurance fraud?
- Proper investigation and settlement of claims
- Gathering evidence of fraud or potential fraud
What are some examples of an adjusters duties to an insured?
- Properly identify yourself, principal and your role as an adjuster
- Adjust claims promptly and fairly
- Protect the insured’s confidential info
- Fully disclose info material to insured’s coverage, rights and obligations
What needs must an adjuster be careful to balance?
Needs of:
- Insurance company
- The insured
- Claims department
- Broker
What are the two major kinds of adjusters?
- Company adjuster
- Independent adjuster