Introduction to Property-Casualty Insurance 4 Flashcards
A demand by an insured person or organization seeking to recover from its insurer for a loss that its insurance policy may cover.
First-Party Claim
A demand against an insured by a person or organization other than the insured or the insurer, seeking to recover damages that may be payable to the insured’s liability insurance.
Third-Party Claim
A party that makes a claim and that can be either a first-party claimant or a third-party claimant.
Claimant
A person responsible for investigating, evaluating, and settling claims.
Claim Representative
The insurer function that processes demands for payments.
Claim Handling
An estimate of the amount of money the insurer expects to pay in the future for losses that have already occurred and been reported, but are not yet settled.
Loss Reserve
A paper or an electronic file that contains information for a loss.
Claim File
The process by which an insurer can, after it has paid a loss under the policy, recover the amount paid from any party (other than the insured) who cased the loss or is otherwise legally liable for the loss.
Subrogation
An insurer employee who handles claims that can be settled by phone, mail, or e-mail from inside the insurer’s office.
Telephone Claim Representative, or Inside Claim Representative
An insurer’s employee who handles claims that are best handled in person; much of the field claim representative’s time is spent visiting the scene of a loss; interviewing witnesses; investigating damage; and meeting with insureds, claimants, lawyers, and other persons involved in the claim.
Field Claim Representative (Outside Claim Representative)
A book that describes procedures for estimating the cost to repair damage to vehicles and that lists auto part prices and typical labor times to repair or replace the part.
Crash Manual, or Estimating Guide
An organization that provides administrative services associated with risk financing and insurance.
Third-Party Administrator (TPA)
A loss that exists when the cost to repair a damaged vehicle (or other property) equals or exceeds the value of the vehicle.
Total Loss
The authority expressly given to an agent by an insurer allowing the agent to settle and pay certain types of claims up to a specified limit.
Draft Authority
The financial statement that reports the assets, liabilities, and owners’ equity of an organization as a specific date.
Balance Sheet
