Study 5 - First Notice of Loss

Question 1

What steps are involved in the claims process?

Answer 1

• Insured reports loss to broker, agent or insurer
• Claims handler records prelim info and asks for details, insured may complete questionnaire
• Claims info is reviewed by claims handler or AI software; which policy or policies apply to the property or incident? Does the policy period cover the loss? Is the cause of loss potentially covered?
• Claims handler identifies possible coverage issues that will require investigation/review
• If broker is involved, may accept loss report and pass this along to insurer of record
• Loss adjuster is assigned the claim and proceeds

Question 2

What steps does the loss adjuster follow once taking over the claims process?

Answer 2

• Verifies coverage
• Investigates the loss
• Evaluates and assesses damage
• Negotiates as necessary or denies the claim
• Arrives at a settlement
• Recommends payment
• Pays the claim

Question 3

What are other key functions of the claims process?

Answer 3

• Investigate to gather required info and document the loss
• Evaluate the amount of damage
• Negotiate and agree upon the value of the insured damage
• Settle the loss

Question 4

What are the ways an insured may report a claim?

Answer 4

• Call or visit the offices of the insurer, broker or agent
• Email the broker, agent or insurer
• Use a web based form provided
• Use an app

Question 5

What are some examples of supporting service providers?

Answer 5

Appraisers, estimators, surveyors, restoration contractors, automobile body shops, forensic accountants, police, firefighters, witnesses, doctors, rehabilitation service providers, private investigators, lawyers, arbitrators and mediators

Question 6

What can supporting service providers help with?

Answer 6

• Assess the damage
• Determine the cause of the loss
• Estimate the cost of repairs and carry them out
• Supply products or services
• Assist in resolving claim disputes

Question 7

What are some examples of info the insured must provide in writing if requests?

Answer 7

• How and why did the loss originate?
• Did the insured intentionally cause the loss?
• Where was the property at the time of the loss?
• What are the damage items and the details of purchase, age and value?
• Is there another policy that provides coverage for the loss?
• What are the details of any such policy?
• Who owns or has an interest in the property?
• Supply a detailed inventory of undamaged property
• Complete a proof of loss form and if requested, have it notarized
• Submit documentary evidence such as invoices, warehouse receipts or books of account