Chapter 5 Flashcards
Define third party
A claimant under a liability policy, so called because that party is not one of the two parties who has entered into the insurance contract that pays the claim
Define intermediary
The agent/broker negotiating insurance or reinsurance contract for another
Any party representing another party, in negotiation with a third party
Define insurtech
An enterprise that introduces innovative technology and business models to the insurance sector
What is the outline of the claim process?
- Loss report: agent/broker, insurer call centre or mobile app or website
- Handler: records information
- Review information: policy responding, policy period, covers cause of loss
- Identify coverage issues: further investigation
- Intermediary: if authorized accepts loss report, submits to insurer
Once an adjuster is assigned to a claim what do they do?
Verifies policy coverage
Investigates loss
Damage- evaluates, assesses
Negotiates as necessary
Denies claim- if event, cause clearly not covered
Arrives at settlement
Recommends payment
Pays claim
What are the elements of sound responses to report of loss?
Acknowledge insureds feelings
Needs to feel
Enhance relationship
Tact and diplomacy
Temper soft skills
Avoid offending insured
Manage expectations
Timelines
Be prepared
Assess coverage
Define contribution
When more than one policy has been issued to insure a given risk, a loss must be divided equally among the various policies. According to their amounts and terms, each “contributes” its share of the loss
