Study 6 - Loss Investigation

Question 1

What is included in a non-waiver agreement?

Answer 1

Identified parties
Date of loss
Location of loss
Issues that gave rise to insurers stance on coverage
Type of claim

Notice that investigation is underway, requires signature of insured

Question 2

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

Answer 2

Reservation of rights letter

Question 3

What is an indemnity clause?

Answer 3

Used in non-waivers on liability claims, insured agrees to pay back insurer for the fees

Question 4

How much a reservation of rights letter be delivered?

Answer 4

Served by hand, registered mail

Question 5

What are the five question types?

Answer 5

Open
Closed
Leading
Prosecutorial
Judgmental

Question 6

What is the model interview approach?

Answer 6

• 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 7

What are the steps in taking a statement?

Answer 7

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 8

What are the three types of evidence?

Answer 8

Oral
- From interviewing a witness

Physical
- Tangible objects, ‘real evidence’

Secondary
- Reports from an expert presenting an opinion of value

Question 9

What is the difference between direct evidence and circumstantial evidence?

Answer 9

Direct is from the witness experience

Circumstantial can be inferred from other evidence

Question 10

What are the two definitions of spoilation?

Answer 10

1) destruction of evidence

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

Question 11

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

Answer 11

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

Question 12

What independent reports may be helpful?

Answer 12

Fire service reports
Police reports
Medical reports
Coroner reports

Question 13

What is a proof of loss form?

Answer 13

• 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 14

What steps should you take in preparing for an interview?

Answer 14

• 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.