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Adjuster Pro
State Insurance Claims Adjuster-Pro Certification
Insurance Claims Adjuste-Pro Exam
Course Title and Number: Insurance Claims Adjuste-Pro Exam Exam Title: Board Exam Exam Date: Exam 2024- 2025 Instructor: [Insert Instructor’s Name] Student Name: [Insert Student’s Name] Student ID: [Insert Student ID]
Examination
180 minutes
Instructions:
**1. Read each question carefully.
- Answer all questions.
- Use the provided answer sheet to mark your responses.
- Ensure all answers are final before submitting the exam.
- Please answer each question below and click Submit when you have** **completed the Exam.
- This test has a time limit, The test will save and submit automatically** **when the time expires
- This is Exam which will assess your knowledge on the course Learning** Resources.
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State Insurance Claims Adjuster-Pro Certification 2024- Adjuster-Pro Exam Section 2 Comprehensive Review Study Guide | 100% Pass Guaranteed | Graded A+ | Read All Instructions Carefully and Answer All the Questions Correctly Good Luck: - Agent - =Answer>> one who receives the authority to act on behalf of someone else Sales agent - =Answer>> Contracted to sell and service insurance policies on behalf of the insurer Adjusters - =Answer>> Contracted to settle claims that arise against the insurer Power to bind - =Answer>> What the agent says or does can bind the insurer Agents should take the utmost care in what they do and say Even if the agent makes mistakes, the insurer may have to accept them Responsibilities of an Agent - =Answer>> Adhere to or follow the contract Use reasonable judgement Provide all necessary information and documentation to the insurer Need Writing 🤔Help? We've Got You Covered! ✍️ 100% NO A I or Plagiarism Guaranteed🤔
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General agent Direct writer Independent agent - =Answer>> -self employed -offer insurance from more than one company at a time -they can compare and give rate quotes from different companies -find a policy that suits the customer Exclusive agent - =Answer>> -Also called captive agent -Commissioned -Represents only one insurer and only their policies General agent - =Answer>> -works for one insurance company -trains and supervises agent for that company Direct writer - =Answer>> -salaried employee -works for one company Claimant - =Answer>> an individual or business that makes a claim for payment after a loss occurs Claim Function - =Answer>> The part of the insurance contract that lets the insurer fulfill its promises to the insured. Adjusting - =Answer>> The process of comparing a claimant's losses to the promises made in an insurance policy Need Writing 🤔Help? We've Got You Covered! ✍️ 100% NO A I or Plagiarism Guaranteed🤔
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Insurance adjuster - =Answer>> An agent who processes insurance claims for a salary, a fee, or commission Who does the adjuster work for? - =Answer>> -an insurer -a private company -an adjusting company (adjusting bureau) -the claimant adjusters can work for the insured or the insurer Staff Adjuster - =Answer>> -employed by only one insurer -salaried employees -can work locally, regionally, or nationally -also called "company" adjusters -work for insurers such as State Farm, Nationwide Insurance, and Aetna Independent Adjuster - =Answer>> - Also called "fee adjuster" or "bureau adjuster"
- Not contracted to any particular insurer
- Self-employed
- Processes claims, sometimes for multiple insurers at the same time
- Paid by fee schedule, daily rate, or time + expense
- Sometimes paid on a commission basis (percentage of the final settlement amount) Public Adjuster - =Answer>> *Hired by policyholder (the claimant) *Represents the policyholder in the claim *Charges a commission, usually about 10% of settlement Need Writing 🤔Help? We've Got You Covered! ✍️ 100% NO A I or Plagiarism Guaranteed🤔
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-never act if a conduct of interest exist The Power to Bind - =Answer>> the principal is bound by the adjuster's decisions and actions. This authority:
- is granted to adjuster in writing
- means the adjuster may act on behalf of the employer
- binds the employer More on the power to bind - =Answer>> The adjuster is expected to: -take the utmost care in written and verbal communications -take special care with determining the exact value of loss Report to the principal - =Answer>> Who is the principal:? -the source of authority -the contracted employer -insurer -and/or whomever contracts the adjuster Reporting to the principal - =Answer>> initial, interim, and final reports Initial Report - =Answer>> Required after 15 days -also called "preliminary report" or "filed report" -time lines and dead lines (expediency issues) -apparent losses -liability issues -applicable coverages -initial claim reserve Need Writing 🤔Help? We've Got You Covered! ✍️ 100% NO A I or Plagiarism Guaranteed🤔
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Interim Report - =Answer>> -Update on claim progress -due at set intervals as long as claim is open -new evidence -medical information -repair estimates Final Report - =Answer>> -all facts and evidence of the claim -policy coverages -adjusted losses -final claim disposition Claim - =Answer>> a formal request to settle the damage -a claimant must prove loss and submit the total to insurer -insurer sends adjuster, who must decide whether claimant has adequately proven the loss The Steps of the Claim Process - =Answer>> 1. Acknowledge the claim
- Establish lines of communication
- Prepare necessary paperwork
- Determine insurer's liability in the claim
- Investigate the losses
- Determine the time and cost of repairs
- Apply all policy coverages and provisions
- Negotiate a settlement
- Prepare final reports acknowledge the claim - =Answer>> -respond within required amount of time -contact via letter or phone call -keep track of date of first contact Need Writing 🤔Help? We've Got You Covered! ✍️ 100% NO A I or Plagiarism Guaranteed🤔
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do any other parties have insurable interest? (mortgage company, etc.) -Does the policy cover the type of damage or injury being claimed?Does the policy cover the proximate cause of the loss?
- Is there history of similar claims? If so, have they reduced the policy limit available for this loss?
- Will any other policies cover this loss?
- Has insure met all requirements of the contract?
if covered move on to next stepif NOT covered, deny the claim with a full explanation Investigation: property claims - =Answer>> -Inspect damages -Take photos -Interview claimant and witnesses -Review police report -Consult with professionals Claims Investigation - =Answer>> -liability claim -critical evidence -official reports -other evidence -written statements -recorded statements Investigation: Liability Claims - =Answer>> Bodily Injury: type of injury, copies of all medical bills & receipts, documentation of lost wages, severity of injury, are general damages covered? pre existing conditions that contributed to the injury? Need Writing 🤔Help? We've Got You Covered! ✍️ 100% NO A I or Plagiarism Guaranteed🤔
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Other Liability Claims: is the policyholder liable? is there anyone else partially responsible? is there a lawsuit? how much would defending the lawsuit be? what are the chances of winning? Investigation: Critical evidence - =Answer>> -examine scene of loss or damage -photograph damage -sketch property -take statements from claimant and at-fault party (if applicable) -inspect and photograph damaged cars -document skid marks to help find point of impact Investigation: Official Reports - =Answer>> - Police reports
- Fire department reports
- Death certificates
- Autopsy reports
- Coroner's inquests
- Medical reports
- Weather reports from the time of the loss
- School records
- Court records from previous crimes
- Birth and marriage certificates
- Coast guard reports (boating incidents)
- Civil Aircraft Board (C.A.B) reports (aircraft) Investigation: Other evidence - =Answer>> Documentary / Visual Evidence: deeds/leases, diagrams, sketches, photos, x-rays, contracts for construction or repairs, employer records for wage loss claims Need Writing 🤔Help? We've Got You Covered! ✍️ 100% NO A I or Plagiarism Guaranteed🤔
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Evaluation pt 1 - determine time and cost of repairs - =Answer>> -cost to repair or replace damaged property -additional expenses caused by loss -any applicable medical bills -lost wages -time frame of repairs Evaluation pt 2: apply policy coverages and provisions - =Answer>> -relevant deductibles -coinsurance penalty is applicable -policy limits -policy valuation: is depreciation a factor? -coverage exclusions or extensions -other policies that may cover the same losses Evaluation step 2: common settlement options - =Answer>> Property claims: -repair property -replace with like kind and quality -replace with new -pay fair value for damaged property Liability claims: -special damages: medical bills, repair bills, loss wages -general damages: intangible losses like pain and suffering, loss of use, etc. -punitive damages: typically not covered Negotiable and resolution - =Answer>> -to find a settlement amount that is fair and equitable for all parties Need Writing 🤔Help? We've Got You Covered! ✍️ 100% NO A I or Plagiarism Guaranteed🤔
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-the adjuster proposes a settlement to claimant -if claimant doesn't accept the amount, the adjuster will need to negotiate a sum they both find acceptable Negotiation *sometimes negotiations are not necessary: -if the value of the insured item is pre-established Prepare Final Adjustment Reports - =Answer>> -Provide final settlement documents to claimant -Explain settlement documents -Inform claimant of repair deadlines -Explain depreciation recovery (if applicable) -Store related claim documentation -Close the claim Responding to the claim - =Answer>> -accept and pay -refuse and deny -Negotiate -Is negotiation possible? -Dispute resolution Accept the request and pay the claim - =Answer>> -claimant has proven damages -adjuster determines settlement amount based on investigation -if amount is close to claimant's offer, adjuster comes to agreement with claimant issues settlement check *small differences should be settled in favor of the claimant Need Writing 🤔Help? We've Got You Covered! ✍️ 100% NO A I or Plagiarism Guaranteed🤔
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-easiest, lowest - cost option Alternative dispute resolution methods -arbitration -mediation appraisal declaratory judgement -litigation (going to court) Last Resort litigation should be last resort -can be expensive and unpredictable -adjusters primary motivation: settle claim promptly and efficiently without 'litigation' Arbitration - =Answer>> -arbitrator is a neutral third party -arbitrator's decision is legally binding -costs less to taxpayers than a court of law -less formal atmosphere allows more evidence -arbitrators often have more expertise than juries Mediation - =Answer>> -mediator is a neutral third party -mediator only advises in the negotiation -mediators decision is not legally binding -settlement is only legally binding if both parties agree to it -either party may walk away (impasse) Consequences for failure to appear at mediation: -severe for the insurer - contempt of court and/or penalties -mild for the plaintiff - no penalty or minor penalty Need Writing 🤔Help? We've Got You Covered! ✍️ 100% NO A I or Plagiarism Guaranteed🤔
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Appraisal - =Answer>> -a definite disagreement must exist prior to appraisal -each side chooses an appraiser -both appraisers agree to an umpire -agreement by any two of the three is binding -appraisal only decides the settlement amount, not whether coverage exists in the first place Declaratory Judgement Action - =Answer>> -court declares the legal rights of both parties -court does NOT decide how to resolve the case -disputing parties then use the court's decision to come to settlement Litigation - =Answer>> -last resort, method of claim resolution -taking a claim to court can be: expensiveunpredictable `possible even after binding negotiations Settlement - =Answer>> When two parties in a dispute reach an agreement The insurer and claimant agree on: -how much will be paid -terms and conditions of payment When a settlement is reached, the claimant: -gives up her right to seek any further damages -gives up the right to sue Need Writing 🤔Help? We've Got You Covered! ✍️ 100% NO A I or Plagiarism Guaranteed🤔
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No Release Settlement - =Answer>> -Also called "walk away" Settlement -Insurer pays the bills submitted by the claimant -Signing and cashing a check substitutes for the Release Form Structured Settlement - =Answer>> - series of smaller payments over time
- reserved for largest claims
- insurer often must pay a portion up front Negotiation - =Answer>> a process by which two opposing parties attempt to merge their respective interests in order to yield a balanced and beneficial outcome for both parties Liability vs Property Claims - =Answer>> Liability: -harder to assign dollar amounts -Factor in issues like mental duress and comparative negligence Property Claims: -cost to repair or replace is simple and straightforward Negotiation: the preliminaries - =Answer>> Before negotiations begin, an adjuster must determine: -is there coverage?
Peril is covered, policy is active, etc. -what is the insured liability? (liability claims only) -what are the damages?special damages `general damages Need Writing 🤔Help? We've Got You Covered! ✍️ 100% NO A I or Plagiarism Guaranteed🤔
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*Remember: no negotiating punitive damages Preparing to Negotiate - =Answer>> -complete investigation -complete estimate -know the circumstances -be clear about objectives -understand possible obstacles -know the maximum amount insurer will pay -have an idea of the minimum amount the claimant will accept Negotiation Tips - =Answer>> -Minor details: solving simple, trivial matters can get negotiations unstuck -Give and Take: approach negotiations with an open mind; impossible to prevail on every point; conceding some points increases likelihood of opposing party conceding points; inflexibility prevents negotiation and causes frustration -Develop Trust: trustful claimant + trustful adjuster = Better Negotiations -Create a good first impression: professional appearance, respectful attitude, neatly groomed, good hygiene -Have a positive attitude: humble and understanding; willing to listen; open to new facts; take claimants perspective *An arrogant or "win-at-all-costs" attitude can torpedo negotiations Need Writing 🤔Help? We've Got You Covered! ✍️ 100% NO A I or Plagiarism Guaranteed🤔
