Study 6

Question 1

What is The non-waiver agreement

Answer 1

An agreement signed by the policyholder after a loss, agreeing that the investigation and determination of the amount of damage by the insurance company shall not be construed as an admission of liability.

Question 2

When should the insurer present the non-waiver agreement?

Answer 2

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 damage.

Question 3

What is included in a non-waiver agreement, in general?

Answer 3

Identified parties
Date of loss
Location of loss
Issues that gave rise to insurers stance on coverage
Type of claim
States that the insurer reserves the right to deny a claim
Requires the insured’s signature to give it legal effect.

Question 4

What can you send in a non-waiver agreement is not signed?

Answer 4

Reservation of rights letter

Question 5

For liability claim, what is typically included in the non-waiver agreement? and why

Answer 5

1) an indemnity clause requiring the insured to repay the insurer the amount of any settlement or judgment, plus the insurer’s costs of handling and defending the claim.
2) in TP liability claim, the insurer must provide a defence under the terms of the policy before coverage has been confirmed. It may only become clear later that there is no coverage for the loss under the policy.

Question 6

Define ROR

Answer 6

An insurer’s notification to an insured that coverage for a claim may not apply.
ROR allows an insurer to investigate (or even defend) a claim to determine whether coverage applies (in whole or in part) without waiving its right to later deny coverage based on information revealed by the investigation.

Question 7

Does ROR bind the insured?

Answer 7

No, because it is not a contractual agreement

Question 8

What is an indemnity clause?

Answer 8

use in non-waivers on liability claim;
requiring the insured to repay the insurer the amount of any settlement or judgment, plus the insurer’s costs of handling and defending the claim.

Question 9

How is a reservation of rights letter be delivered?

Answer 9

Served by hand, registered mail to the last known address

Question 10

What are the 5 possible question types for interview?

Answer 10

Open
Closed
Leading
Prosecutorial
Judgmental

Question 11

What type of question is this?
“Can you please tell me what happened?”

Answer 11

open

Question 12

What type of question is this?
“Did you lock the door when you left?”
“What time did you leave?”

Answer 12

Closed

Question 13

“Would you say that you were feeling distracted that evening?”

Answer 13

Leading

Question 14

“So you left the house in darkness, even though you knew perfectly well that there was a stranger acting suspiciously nearby?”

Answer 14

Prosecutorial

Question 15

“You felt like going out for a nice dinner in spite of that terrible news about your friend’s health?

Answer 15

Judgmental

Question 16

Which two types of question do loss adjusters seldom benefit from ?

Answer 16

prosecutorial or judgmental questions

Question 17

What is the model interview approach?

Answer 17

Introduce yourself and your role
Start discussion with open ended question that encourages person to begin narrative
Listen patiently, a lull does not necessarily need action
Ask for explanation when something is unclear or there is a gap
Insurance company may have a general set of questions or forms
Adequate waiting between questions
Maintain composure in all circumstances
Evaluate body language
Note taking and allow them to amend info, as long as they initial
This will help guide further investigation

Question 18

What are the steps in taking a statement?

Answer 18

1) Before starting the statement, adjuster discusses what info must be included in it

2) Adjuster writers the statement on behalf of the statement giver, relating it in the first person as a narrative
- Recording of convo can be made with permission from the statement giver

3) Statement giver reviews statement
- If required, make changes and initial them

4) Adjuster or another person present the witness the statement

Question 19

What are the three types of evidence?

Answer 19

Oral
- From interviewing a witness

Physical
- Tangible objects, ‘real evidence’

Secondary
- Reports from an expert presenting an opinion of value

Question 20

What is the difference between direct evidence and circumstantial evidence?

Answer 20

Direct is from the witness experience

Circumstantial can be inferred from other evidence

Question 21

What are the two definitions of spoilation?

Answer 21

1) destruction of evidence

2) alteration of a policy by a party other than the insurer or insured without consent

Question 22

What are some of the experts that adjusters may rely on?

Answer 22

Appraisers
Property restoration contractor
Suppliers
Engineers
Accident reconstruction specialists
Origin and cause specialists
Investigative specialists
Photographers
Doctors
Accountants
Lawyers

Question 23

What independent reports may be helpful?

Answer 23

Fire service reports
Police reports
Medical reports
Coroner reports

Question 24

What is a proof of loss form?

Answer 24

A formal statement of facts about a loss.
The form must be attested to by the claimant.
The form is specified by the insurer.
A proof of loss may need to be notarized.
An insurer must respond to a proof of loss after a specified time period with a formal disposition of the claim (approved or denied).

Question 25

What steps should you take in preparing for an interview?

Answer 25

• An action plan will focus on the task at hand.
• Schedule the interview as soon as possible following the loss.
• Review existing documentation to help focus the questioning:
  o background information from police reports
  o newspaper accounts
  o a prior visit to the accident scene
• Prepare a checklist of what must be accomplished.
• Anticipate any coverage issues and be prepared to answer questions about deductibles and other relevant terms and conditions of coverage.
• Allow enough time to properly conduct the interview.
• Conduct the interview in a professional setting in order to minimize interruptions.

Question 26

What is the primary determinant of the scope of an investigation

Answer 26

The magnitude of the loss

Question 27

What are the types of expert common used by adjuster?

Answer 27

Appraiser
Property Restoration contractors
Engineers
Accident Reconstruction Specialist
Cause and origin Specialist
Investigative Specialist
Photographers
Suppliers
Forensic Accountants
Doctors
Lawyers