Unit 2

Question 1

fiduciary responsibilities

Answer 1

hold a position of trust

Question 2

adjents

Answer 2

sell polocies - they may assist the adjuster in settling the claim, but never make a decision about whether a claim is paid

Question 3

adjusters

Answer 3

handle claims, but should never give legal advice. Attornes should not be adjusting claims because they are not licensed

Question 4

Unfair claim Settlement practices are

Answer 4

actions dealing with the claims process that are unfiar to the consumer such as:

• misrepresenting facts regarding coverage
• failing to promptly acknowledge communications (15 days)
• failing to adopt reasonable standards for handling of claims
• not attempting in good faith to have prompt, fiar, and equitable settlement of a clain in which libility has become reasonable clear
• compelling policy holders to sure because they cannot recover amounts due by offering substantially less than the amounts ultimately recovered

Question 5

Good faith and fiar dealing

Answer 5

are implied in every contract. The insurance company and adjusters have an extremely high duty to protect the interests of the insured

Question 6

Bad faith

Answer 6

when the insurer does not abide by the terms and spirit of the policy. (The essence of bad faith is that the insured must prove that the insurance co had no reasonable basis for denying the claim or delaying payment)

Question 7

adjusters render decisions where…

Answer 7

liability based on the totality of the circumstances of the case, has become reasonably clear (but…they CANNOT make legal decisions as this is reserved for courts and legal fact finders)

Question 8

claim

Answer 8

a request for indemnificaion under an insurance contract due to a financial loss. They are paid bu the insurer to indemnify losses to the 1st-party or to others who have experienced losses for which the insured is legally liable (3rd-party)

Question 9

claimant

Answer 9

a person making a claim

Question 10

15 DAYS (the adjuster must…)

Answer 10

• acknowledge receipt of the claim
• commence any inestifation of the claim
• forward any paperwork to the claimant (e.g. proof of loss) requesting necessary info

Question 11

15 Business Days (the adjuster must…)

Answer 11

-notify a claimant in WRITING of the acceptance/rejection of a claim

Question 12

5 Business days

Answer 12

once the adjuster agrees to pay the claim, the check or draft must be sent in 5-business days