Study 9 - Automobile Physical Damage Claims Flashcards
What must an adjuster have knowledge of to handle first party and third party claims?
- Civil Code of Quebec or the applicable provincial or territorial common law system
- Provincial or territorial automobile insurance legislation
- Highway safety legislation
- Specialty agreements derived from legislation (for example, direction compensation agreements)
- Policy wordings and endorsements
- Reciprocal claims agreements among provinces and territories
What do private insurers offer in BC?
Section A: excess third party liability
Section C: coverage for loss or damage
Section D: excess underinsured motorist protection
What acts as proof of insurance in Saskatchewan?
Registration and drivers license
What do private insurers offer in Saskatchewan?
Optional and excess
What do private insurers offer in Manitoba?
Optional and excess
How does insurance in Quebec work?
Injury is through SAAQ
Damage is through private; can also offer excess AB
What five provinces have direct compensation?
New Brunswick, Nova Scotia, Ontario, PEI & Quebec
What are the government insured provinces?
Manitoba, Saskatchewan, BC
Quebec for bodily injury
What provinces does apply the auto deductibles for fire and lightning?
Saskatchewan
What is considered illegal use of the auto?
Convicted cause death or bodily injury due to criminal negligence
Failing to stop at an accident
Driving while impaired
Refusing to comply with breath sample
Operating auto when disqualified from doing so
Under the influence, unable to maintain proper control, using the car in a race or illegal activity, and driving when not authorized by law
Provinces w/ DCPD do not carry the exclusions
What are some common endorsements that may related to auto damage?
Loss of use Limitation of amount Waiver of depreciation Liability for damage to non-owned Blanket-basis fleet Ridesharing
What does IBC do in relation to clains?
Data collection, compilation & reporting
Receives info from insurance companies
Maintains database of stolen automobiles
What are the four types of Appraisal programs?
Appraisers
Appraisal Centres
Direct Repair Programs
Garage Estimates
What are the minimum standards for a repair facility to qualify for direct repair programs?
Having well-trained staff
Adequate office space
Capacity to do the number of jobs
What should a diagram of an auto accident include?
- Identify accident locus to show type of intersection (T, Angular, Fourway, Fiveway, Sixway, None, lane markings)
- Location of accident, label each street
- Stop, slow or any other traffic signs
- Directions, including compass directions
- If a parking lot, show how configured
- Do not use terms such as ‘insured’ or ‘third party’ for impartiality, use a legend
What can be included on written statements from police?
- Position of autos when police arrived
- Tire tracks
- Was it asphalt surface
- Nature and location of debris
- Snow, ice, other surface elements
- Layout of the scene
- Existing weather conditions
What three things are typically in automobile claim statements?
- Discrepancies between application/policy
- Representations by insured when policy was issued
- Material changes during the policy period
What physical aspects of the accident may be included in the statement?
- State of the weather
- Conditions affecting visibility
- Surface, markings, grade and bend of the road
- Road signs and speed limit postings
- Obstruction of lines of sight by trees, bushes, or other landscape features
What are the typical items in the sequence of events reviewed?
- Direction of travel
- Speeds
- Where impact occurred
- Final resting location of autos
How may you use experts in automobile claims?
- Accident reconstruction can be used to determine how an accident happened / determine fault
- Cause and origin engineer can investigate fire, accelerants, equipment failure (could lead to subro)
- Mechanic may be asked to report on state of auto, to establish value
- Antique car specialist can be asked to evaluate a total loss when conflict of value is anticipated
- Surveyor may be required to check topography of roadway, if defect in road caused against recovery could be possible
What is typically included in the investigation reported?
- Signed statements
- Police reports
- Photographs
- Experts reports
- Documents to support recommendations
Why do most insurers prefer to pay for auto repairs directly?
- Safety of auto could be impaired if insured fails to have damage repaired immediately
- Insured has another accident, overlapping damages could be paid twice, increasing claim costs
- Psychologically, tendency may exist for people to exercise less care with a damage auto
- Repair is considered to be a return to pre loss condition, thus discouraging fraud
How are total losses treated in Quebec?
They may still proceed with repairs
What are the typical steps in an automobile fire investigation?
- Obtain statements from owner and person last possession of auto
- Interview firefighters, police, tow truck driver and any other witnesses
- Hire an expert to determine the cause if required
- Check maintenance records of auto
- Review insured’s finances, including any liens on the auto
- Determine whether insured had other insurance losses
- Check for any reent changes in policy, such as reduced deductible or increase in coverage
Explain signs of electrical fire in an auto
- Shorted wire shows beads at end of bridge
- Burned wire sharply pointed
- Should cause damage to battery and motor
- Seldom pass into passenger compartment
Who oversees the direct compensation agreement in Quebec?
GAA
Groupement des assureurs automobiles
When does DCA apply to collisions in Quebec?
On public highways, two or more identified drivers
What issues does the DCA driver fault chart ignore?
- Actions of pedestrians
- Speed
- Weather conditions
- Road conditions
- Light sound or hand signals
- Marked or unmarked road lines
What are the three steps to making a claim in Quebec?
1) Indemnification under auto policy under first party coverages purchased by the insured
2) Application of DCA to determine fault and pay the insured under Section A-Civil Liability, according to percentage of fault assessed against third party
3) Pursuit of any opportunity to recover from third party
What is the basic deductible in Saskatchewan?
$700
Explain temporary substitute automobile
- When the insured is driving a temporary substitute vehicle, the insured’s own policy may provide coverage.
- If the deductible under the insured’s policy is a lower amount than the deductible under the insurance carried by the owner of the temporary substitute automobile, such an additional insuring agreement covers the difference in the deductibles.
- If the owner of the temporary substitute automobile does not carry physical damage coverage, and if the loss is covered by the insured’s policy, then there is coverage for the damage to the temporary substitute automobile subject to the provisions of the insured’s policy.
- Many credit cards now offer insurance on substitute or rental vehicles, so no additional coverage is required on the insured’s own policy.
- For example, if the insured carries a collision deductible of $100 and the owner of the temporary substitute automobile carries a collision deductible of $250, the maximum amount payable by the insured’s policy is $150.
When the insured is suspected of having a breached policy condition and might be denied coverage,
what action should the loss adjuster take in order to avoid estoppel?
Issue a non-waiver agreement.
Issue a reservation of rights letter.
Alert the underwriting department of any misrepresentation and material change of risk.
The insurer may be permitted to reduce the amount of insurance applicable or to charge additional premium to reflect the risk undertaken.
Who must provide an automobile loss theft statement and what details are listed on it?
• The person last in possession of the automobile, if not the owner, must prepare the statement.
• Information required in the statement includes the following:
o Who last had the automobile?
o When and where was it last known to be?
o What are the details of all special equipment installed on the automobile?
o Is there any pre-existing mechanical or body damage?
• The adjuster can interview other family members or witnesses to confirm the information received.
• The police investigation may be another helpful source of information.
If a car theft is not recoverable, what are the steps?
- If the automobile is not recovered and all appears to be in order, the actual cash value of the automobile is the basis of settlement.
- The ownership and keys are turned over to the insurer.
- The police are advised in case the automobile is later recovered.
- When the entire automobile is stolen and the appropriate coverages are carried, most policies cover substitute transportation beginning after a period of 72 hours and continuing for a limited period of time until a settlement is reached.
- The insured will want to know how long payments will continue and how much will be paid on a daily basis for a rental automobile.
Would a deductible apply to a theft claim? How would the policy respond?
- Would pay a deductible. In Ontario, the deductible under the comprehensive own vehicle damage coverage applies in such claims.
- The loss adjuster must make certain that any specific equipment stolen is covered.
- Some policies specify that audio equipment must have been attached to the automobile for the policy to cover its theft.
- The loss adjuster should verify the quality of the equipment.
- Merchants who sell and install equipment can be very helpful in confirming how certain equipment is installed.
