Chapter 6 Flashcards
Define non-waiver agreement
An agreement signed by the policyholder after a loss, agreeing that the investigation and determination of the amount of the damage by the insurance company shall not be construed as an admission of liability.
It is used when the insured is in violation of a policy condition and there is a question as to whether or not the company is liable for a loss but it wishes to investigate the loss and determine the amount of the damage
Define reservation of rights letter
An insureds notification to an insured that coverage for a claim may not apply. Such notifications allows an insurer to investigate a claim to determine whether coverage applies without waiving its right to later deny coverage based on information revealed by the investigation
Define spoliation
The destruction of evidence
The alteration of a policy by a party other than the insurer or the insured without consent
Define forensic expert
Someone connected to a court of law who can be hired by an insurer or an insured to appear in court as a witness. This expert combines knowledge of legal cases with the principles of a profession. The expert can help to prove or contradict the cause of a claim
What are ways to prepare to conduct interview?
Review documents
Have checklist
Listen: identify gaps in information
Anticipate coverage issues/questions: deductibles, terms, conditions
Schedule: ASAP after loss
Location: suits purpose, minimize interruptions
Allocate enough time
Questions: obtain information
Explain the model interview approach
- Opening- intros
- Open open-ended questions
- Listen patiently
- Seek explanation questions
- Insurer template: specific questions, form completion
- Comfortable pace
- Maintaining composure
- Evaluating body language
- Document
What are the different types of evidence?
Oral- example interview
Physical (real)- tangible objects, example accident scene photos
Secondary- example expert reports
What is the difference between direct and circumstantial evidence?
Direct: based on witness’s own experience
Circumstantial: inferred from other evidence
What factors are taken into consideration for expert witnesses?
Reputation
Stable
Properly qualified
Educated
Experienced
What are some categories of experts?
Appraisers-estimate cost, value
Property restoration contractors: repair, restore, remediate
Suppliers- personal property retailers
Engineers- analyze/reconstruct to determine cause, origin
Accident reconstruction- specialists (engineer, physicist, police)
Origin and cause specialist- fire forensics- where, why, how (ignition)
Doctors-physical exam
Accountants
Lawyers- specialize in claim defence
Independent reports- coroners, fire, medical, police
