Claims investigation, settlement negotiation, and adjuster ethics concepts tested on state insurance adjuster licensing exams.
35 cards · basic cards · AI-written, checked twice. Edit anything.
- What is the primary responsibility of an insurance adjuster?
- To investigate insurance claims fairly and determine coverage eligibility and benefit amounts.
- Name the three main types of adjusters categorized by employment status.
- Staff adjusters (employed by insurer), independent adjusters (contract workers), and public adjusters (represent claimants).
- What is the adjuster's duty of investigation?
- To conduct a thorough, prompt, and reasonably diligent investigation of all material facts relevant to the claim.
- What is a deposition in the claims context?
- Sworn, out-of-court testimony recorded by a court reporter, used to preserve evidence or discovery.
- Define subrogation in insurance.
- The right of an insurer to pursue a third party responsible for a loss to recover amounts paid to the insured.
- What is the difference between first-party and third-party claims?
- First-party: the insured files against their own insurer. Third-party: someone else files against the insured's liability insurance.
- What does the duty of good faith and fair dealing require of an adjuster?
- To act honestly, investigate thoroughly, communicate promptly, and not act in bad faith or with malice toward the claimant.
- What is a conflict of interest in claims adjustment?
- A situation where an adjuster's personal financial interest or relationship could influence their claim decision or investigation.
- When must an adjuster disclose information about a conflict of interest?
- Immediately upon discovery or when it becomes reasonably apparent, before continuing the claim investigation.
- What is the purpose of an Independent Medical Examination (IME)?
- To have a neutral physician evaluate the claimant's injuries and medical treatment for accuracy and medical necessity.
- What documents must an adjuster retain in a claim file?
- All investigation notes, photographs, medical records, repair estimates, correspondence, and settlement agreements.
- How long must claim files typically be retained by an insurer?
- Generally three to six years from claim closure, or as required by state law.
- What is a coverage investigation?
- An investigation to determine whether the policy covers the loss, including policy limits, exclusions, and conditions.
- Define the duty to defend in liability insurance.
- The insurer's obligation to provide legal defense for the insured in covered claims, regardless of ultimate liability.
- What is comparative negligence?
- A legal doctrine allowing liability and damages to be apportioned between parties based on their percentage of fault.