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TCR2 School > TCR2-Preschool Final > Flashcards

TCR2-Preschool Final Flashcards

1
Q

How are meniscal tear generally caused?

A

Twisting or turning quickly with foot planted and knee bent

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2
Q

Define negligence

A

Failure to exercise the standard of care required by law to protect others from harm

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3
Q

What is the period in which a lawsuit or a claim resolved after a loss?

A

Statute of limitations

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4
Q

Who is barred from recovery in a “not greater than” comparative negligence state?

A

Person who is 51% or more negligent

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5
Q

Who is barred from recovery in a “less than” comparative negligence state?

A

Person who is 50% or more negligent

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6
Q

Who is barred from recovery in a pure comparative negligence state?

A

No one unless you are 100% negligent

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7
Q

Who is barred from recovery in a contributory negligence state?

A

Anyone who has any negligence

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8
Q

What does the Company agree to pay in the Family Auto Policy under section 1?

A

We will pay damages for bodily injury or property damage for which any covered person becomes legally responsible because of an auto accident

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9
Q

Describe chondromalacia

A

Runner’s knee

Pain and swelling at front of the knee especially over and around the kneecap

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10
Q

What is GEICO’s policy for settlement of claims?

A

Settle all claims fairly and promptly

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11
Q

What is an example of a collateral source?

A

Worker’s compensation
Health insurance
PIP/MedPay

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12
Q

What does it mean when the patient has a “soft tissue injury-sprain/strain?

A

Damage of muscles, ligaments, and tendons

One off blow resulting in a contusion

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13
Q

What is the most common used method for treating soft tissue injuries?

A

Rest
Ice
Compression
Elevation

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14
Q

You have completed a coverage investigation and found that the insured violated a condition precedent to coverage, after receiving approval what would you send?

A

Disclaimer

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15
Q

Damages intended to punish the wrongdoer is what kind of damages?

A

Punitive damages

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16
Q

The wrongful act of two or more individual last combined to produce a single result is called a

A

Concurrent tortfeasor

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17
Q

Explain why the FTCA is important to insurance companies

A

Federal Tort Claims Act

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18
Q

What is a dermatome?

A

An area of skin supplied by the cantaneous branch of a spinal nerve

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19
Q

Ligaments connect what to what?

A

Bones to bones

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20
Q

Tendons connect what to what?

A

Connects muscle to bone

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21
Q

What is function of cartilage

A

Flexible connective tissue
Can bend but resist stretching
Provides support
Sliding area of joints

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22
Q

What is a DJ and describe why it would be used

A

Declaratory judgment

Ask courts to decide the parties’ obligations under insurance contracts

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23
Q

What is misrepresentation for claims purposes?

A

Misstatements given to the company to induce it to write a policy

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24
Q

What is the initial task of an examiner?

A

Verify proper coverage

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25
Q

When should a feature be established?

A

As soon as it is probable that a claim may be made

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26
Q

What are the primary duties of an attorney?

A

Advise & counsel
Prepare legal instruments
Perform services in courts of justice

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27
Q

What file contents can be released without the consent of the insured?

A

Property damage estimates/appraisals/repIr bill on insured’s vehicle to support our subrogation claim
Medical bills, lost of wages or income statements of insured when it is necessary to support our subrogation claim under MedPay, PIP or UM
Requests from government agency or by a valid subpoena properly served on us (Claims Legal must be consulted before complying)

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28
Q

What is a lien?

A

Charge or encumbrance upon property

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29
Q

What formula does GEICO use to evaluate claims?

A

No formula

We use judgment and experience

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30
Q

What type of damages is pain and suffering?

A

General damages

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31
Q

Grade 1 Sprain

A

Mild

Slight stretching and some damage to the fibers of the ligament

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32
Q

Grade 2 Sprain

A

Moderate
Partial tearing of the ligament
Abnormal looseness in the joint

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33
Q

Grade 3 sprain

A

Severe
Complete tear of the ligament
Causes significant instability and makes joint nonfunctional

34
Q

Tendinitis

A

Inflammation or irritation of a tendon or covering of tendon

35
Q

Bursitis

A

Bursae are small jelly like sacs located throughout the body

This is inflammation of bursa

36
Q

MRI

A

Uses a strong magnetic field around the patient and pulses of radio waves sent from a scanner
Can take 30 minutes
Is more costly than a CT scan

37
Q

CT scan

A

Uses radiation

Is cheaper than MRI

38
Q

GEICO’s policy for settling claims

A

Settle claims fairly and promptly

39
Q

As per claims manual, what is the company policy about paying claims?

A

It is as wrong to pay claims we should not be paid as it is to not pay claims which should be paid

40
Q

What is the basic responsibility of a claims adjuster?

A

Act in a professional manner that will reflect positively on themselves and the companies
Equitable outcome

41
Q

Who does the responsibility of the proper disposition of the claim rest on?

A

The claims associate who is assigned the claim

42
Q

The only products we have are

A

Service

Protection

43
Q

Who can waive statue of limitations?

A

VP of Claims Home Office

AVP of Claims Home Office Legal

44
Q

Who should the claims associate deal with once a letter of representation is received?

A

The attorney

45
Q

When should the claims examiner settle a claim?

A

As promptly as possible

Earliest practical time whenever possible

46
Q

What is a reserve?

A

Dollar amount that the company can reasonably expect to pay for a completed settlement of the claim, including anticipated allocated expenses

47
Q

Claim reserves must be established on what?

A

Probable costs based on present values

48
Q

When should a reserve be established

A

As soon as it is probable that a claim may be made

49
Q

When should a reserve be adjusted

A

Timely as the facts of each case warrant

50
Q

2 types of reserves

A

Average

Case

51
Q

Average reserve

A

Actuary determines average reserve amount by calculating actual loss experienced under each coverage

52
Q

Care reserve

A

Requires establishment of a dollar reserve under each feature

53
Q

Reserves should be changed if the value of the claim changes by:

A

$300

54
Q

What would you do if the BI exposure on a claim was more than $50,000?

A

Place a case reserve on all exposures

55
Q

When is the claims examiner responsible for the accuracy of reserves?

A

Every time you are in the file

56
Q

When are property damage features changed to case reserves?

A

When expected expenses are $10,000 or more

57
Q

What 3 pieces of information are needed to establish accurate BI reserves?

A

Detailed facts about the precise nature of injuries
Treatment
Prognosis

58
Q

Parts of C71 summary

A 
Loss description 
Coverage
Liability
Damages
Course of action
59
Q

What does IBNR mean?

A

Incurred but not reported claims
Claim files that have not been established although the accident or loss has occurred and we may or may not have the report at the company
Determined by the actuary

60
Q

The key to coverage decisions making is ______ and _____ investigation

A

Prompt and appropriate

61
Q

Who should be consulted for permission to deny coverage?

A

RLA

Claims home office attorney

62
Q

Two types of coverage questions

A

No company policy on force at time of loss

Policy in force but the loss is not covered by that policy under the particular factual situation

63
Q

5 types of coverage questions

A 
Policy expiration and cancellation 
Is the vehicle covered
Is the driver or passenger covered
Is it a covered loss
Has the insured can't movies with the policy conditions
64
Q

Cases involving permissive use issues, which involve personal injury must be seen by the

A

RLA

65
Q

2 types of driver exclusions

A

Voluntary

Involuntary

66
Q

What is a waiver?

A

Relinquishment of a known right

67
Q

What is estoppel?

A

May prevent a valid denial or disclaimer of coverage if the company fails act or acts in such a manner that would lead the insured to believe that coverage was in order or the insured acts to his/her detriment in reliance on that belief

68
Q

What is an ROR and when should it be sent?

A

Informs insured that a coverage question has risen concerning his/her claim and that we require time to fully investigate the question

No significant delay to send

69
Q

Types of special damages

A

Loss of earning
Medical expenses
Loss of services of child or spouse

70
Q

What is loss of consortium and who is normally involved?

A

Sex
Society
Services

Spouse

71
Q

A claim for pain and suffering is a example of

A

General damages

72
Q

Property damage consist of

A

Damage to car
Loss of use
Damage to other property

73
Q

An injury the claimant was treating for prior to the loss is an a half example of

A

Pre-existing injury

74
Q

GEICO adjusters use ____ and _____ when determine fair settlements

A

Judgement and then experience

75
Q

2 types of Compensatory Damages

A

General

Special

76
Q

Rule of certainty

A

Requires plaintiff to establish his or her damages, without recourse to speculation or conjecture and must offer evidence as to exactly what damage he or she is claiming

77
Q

A defendant would be held responsible for an injury that is superimposed over a pre-existing injury

A

A defendant would be held responsible for an injury that is superimposed over a pre-existing injury

78
Q

What are the 3 measurements that must be made with respect to permanent disability cases?

A

Value of the medical attention that the person may have for the rest of his/her life or for the period of time that it would be necessary
Value of the impairment to his/her enjoyment of life
Value of the loss of earnings capacity

79
Q

Medicare is what type of lien?

A

Super lien

80
Q

A workers compensation carrier claim is neither a federal Leon nor a subrogation claim.

A

A workers compensation carrier claim is neither a federal Leon nor a subrogation claim.

81
Q

The rule of certainty would apply to a situation where the plaintiff claims, as an item of damage, the value of lost opportunity, such as an opportunity of employment or contract

A

The rule of certainty would apply to a situation where the plaintiff claims, as an item of damage, the value of lost opportunity, such as an opportunity of employment or contract

82
Q

Where in the Family Auto Policy can yo find information about the insured’s policy confirming to the state statutes?

A

Section V
General Provisions
Paragraph 12

TCR2 School (2 decks)

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