Section 1: Lesson 3 Claims Practices: The work of an Adjuster

Question 1

Before he leaves the office, Rodney gathers copies of the policies for the fire claim and roof damage. He wants to review the covered perils. He then heads off to inspect the damage and determine the causes of loss for both claims. What element of investigation is Rodney trying to complete?

Answer 1

Coverage

Question 2

Eter investigating the fire and roof damage losses, Rodney meets with the insured and takes a statement regarding the fact of the automobile accident. He than drops by the sheriff’s office and picks up a copy of the police report. What area of claims investigation is Rodney trying to complete on this claim?

Answer 2

Liability

Question 3

After picking up the police report, Rodney makes an appointment to meet with the claimant to inspect the damage to her vehicle and find out if she was injured and to what extent. What area of claims investigation is Rodney now trying to complete?

Answer 3

Damages

Question 4

Rodney then visits with each of the eployers of the two injured claimants and drives to the employees home to verify the facts regarding how they were injured. What are of investigations Rodney to complete here?

Answer 4

compensability

Question 5

To determine the liability or compensability of a clim is to:

Answer 5

Establish the existence of legal responsibility or the lack of any legal responsibility of an insured, person, business or employer

Question 6

Managing one case is not too hard, but managing many cases requires a certain degree of skill and critical talents. What are these critical talents?

Answer 6

Multi-tasking and time management

Question 7

Claims management involves not only managing the direction and progress of the cases themselves but, even more importantly, it requires the effective management and influence of:

Answer 7

people, particularly the parties to a claim

Question 8

The evaluation process in claims adjusting is best described as:

Answer 8

Establishing the dollar value of a claim

Question 9

Every claim, regardless of its legitimacy, has:

Answer 9

A value that reflects the validity of the arguments facing the claim and the chance that such a claim might be successfully prosecuted or defended

Question 10

Social, financial and judicial economy requires that the parties to a claim or litigation:

Answer 10

Seek a compromise value that reflects the strength of weakness of the respective arguments on which both parties should agree.

Question 11

While very thorough in his content, Rodney is always careful about what he says and how the says it in his claim notes and reports. He’s learned that an adjuster’s claim file is not considered “work product’. Why does Rodney take such care to do this?

Answer 11

An adjuster’s claim file is lost always subject to production and examination by opposing counsel, and used as evidence against an adjuster or carrier at trial.

Question 12

After several months of negotiation, Rodney eventually concluded the claim for roof damage and , in preparation for closing his claim file, completed a detailed explanation of how the claim was ultimately concluded. This type of documentation is called:

Answer 12

The final report

Question 13

The ultimate goal in handling any claim is to get it closed…for good. Which of the following is not an appropriate end to a claim?

Answer 13

Denying a claim in hopes that the claimant will go away, and if not, forcing the claimant to go to trial in hopes of compromising the case for a smaller percentage of the claim.

Question 14

After several months of negotiation, Rodney eventually concluded the claim for roof damage and , in preparation for closing his claim file, completed a detailed explanation of how the claim was ultimately concluded. This type of documentation is called:

Answer 14

The final report

Question 15

The ultimate goal in handling any claims to get it closed.. for good. Which of the following is not an appropriate end to a claim?

Answer 15

Denying a claim in hopes that the claimant will go away, and if not, forcing the clamant to go to trial in hopes of compromising the case for a smaller percentage of the claim

Question 16

Which of the following is not a true statement?

Answer 16

the adjuster has no authority and cannot legally obligate the insurance company for them he works.

Question 17

Which of the following would be considered “work product”?

Answer 17

written communication between an adjuster and defense counsel.

Question 18

After completing his investigation the automobile accident and appraising the damage to the claimants automobile, Rodney decided that his insured was in fact, legally responsible for the accident. he met with the claimant, paid for the damage to the vehicle and also reimbursed her for herder her out of pocket medical expenses and a day of lost wages. When she indicated that she was feeling all right and appreciated his help, Rodney decided it was best to leave his card and bid her “Good Day” ! He left her with the suggestion that if she needed anything else to just give him a call. What kind of settlement is this known as?

Answer 18

No Release/Walk Away

Question 19

After Rodney completed his investigation of the slip and fall at the the grocery store, he met with the claimant and talked to her about her injuries. He was not very impressed with her story and did not feel the grocery tore was totally responsible for there fall. After a month of medical treatment, he paid her another visit, and after some discussion, they agreed that Rodney would pay her $1,575.00 and she would sign an agreement not to pursue the claim any further and forfeit her right to do so, thereby relieving the grocery store of any further liability. What kind of settlement is this?

Answer 19

Full Release

Question 20

Rodney’s fire claim din not go so well. The homeowner retained a public adjuster who estimated that repairs would be substantially higher than the estimate Rodney had prepared. After checking his assessment of damage and repair costs,Rodney decided to hold his ground. Consequently, Rodney and the public adjuster agreed to secure and independent appraiser to assess the repair costs and see if hey could come to an agreement. If they could not agree on a cost, the each party would share in the cost of an umpire. The umpire would consult withe the appraisers and the final amount agreed to by two out of the three would be the final decision. What kind of settlement alternative is this?

Answer 20

Appraisal

Question 21

One of Rodney’s workers compensation claims resolved quickly when the employee returned to work. the other did not. After a year o disability and disputes over the extent of the injury and his ability to return to work the employee’s attorney admitted to Rodney the he had little control over his client. He and Rodney agree to retain the services of a 3rd party in hopes that this intermediary could assist them all in settling the dispute.What kind of settlement alternative is this known as?

Answer 21

Mediation

Question 22

Rodney goes forward with mediation in hopes of setting the worker’s compensation claim. An agreement is reached to settle the lost time portion of the claim; however the claimant still wants to still be entitle to true medical care. What kind of settlement is this?

Answer 22

open-ended release