AIC 30
Direct Loss
A reduction in the value of property that results directly and often immediately from damage to that property
Sworn statement
A signed record of events surrounding an event as told by the interviewee that contains language attesting that it's true
initial credibility
The degree of credibility an individual has before interpersonal communication begins
service of process
The delivery of a summons and complaint to a defendant by an authorized person
Negotiation Techniques for claimants w/ representatives
using info obtained from the claim evaluation, establishing strengths and weaknesses, using timing in negotiation, making the first offer, making concessions
Roundtable method
A method of setting reserves by using the consensus of two or more claims personnel who have independently evaluated the claim file
Expert system method
A method of setting reserves with a software application that estimates losses and loss adjustment expenses
General Damages
A monetary award to compensate a victim for losses, such as pain and suffering, that does not involve specific, measurable expenses
Jurisdiction
A particular court's power or authority to decide a lawsuit of a certain type or within a certain territory
Claimant
A party that makes a claim and that can be either first party claimant or a third party claimant
Punitive Damages
A payment awarded by a court to punish a defendant for a reckless, malicious, or deceitful act to deter similar conduct; the award need not bear any relation to a party's actual damages
Direct Question
A question that seeks specific information and that can often be answered with a short phrase or a yes or no response
Loss ration
A ratio that measures losses and loss adjustment expenses against earned premiums and that reflects the percentage of premiums being consumed by losses
request for production of documents
A request made by either the plaintiff or defendant in a lawsuit to the opposing side to provide all the documents and other tangible evidence it has in its possession relating to the facts of the case.
Non Waiver agreeement
A signed agreement indicating that during the course of investigation, nether the insurer nor the insured waives rights under the policy
Lose Lose
When the negotiator has little concern either for obtaining the best outcome or for achieving rapport
Lose-Win
When the negotiator is primarily concerned with achieving rapport with the other party male and obtaining the best out come is a low priority
win-win
When the negotiator seeks both to obtain the best outcome and to achieve rapport with the other party, resulting in a settlement that is satisfying to all parties
Special Damages
a form of compensatory damages that awards a sum of money for specific, identifiable, expenses associated with a persons loss such as medical expenses or lost wages
Fraud
An intentional misrepresentation resulting in harm to a person or an organization
Complaint
The allegations made by a plaintiff in a lawsuit.
Decoding
The process by which a receiver interprets a senders message
Maslow Hierarchy of Needs Theory
(From bottom to top) Physiological, safety and security, belongingness and love, esteem, self actualization
Ex Parte Contacts
Contacts in which only one party is heard
First Party Claim
A demand by an insured person or organization seeking to recover from its insurer for a loss that its insurance policy may cover
Boulwarism
A bargaining style named for Lemuel Boulware, former CEO of General Electric, in which one's first offer is one's final offer.
Average Value Method
A case reserving method that establishes a predetermined dollar amount of reserve for each claim as it is reported
4 steps of negotiation
1. preparation 2. Develop and evaluate alternative outcomes 3. identify and evaluate each party's interests 4. make concessions and create appropriate resolutions
Allegation
A claim made in the complaint by the plaintiff, specifying what the plaintiff expects to prove to obtain a judgment against the defendant.
Coinsurance Clause
A clause that requires the insured tp carry insurance equal to at least a specified percentage of the insured property's value
Contributory Negligence
A common law principle that prevents a person who has been harmed from recovering damages if that persons own negligence contributed in any way to the harm
Comparative Negligence
A common law that requires both parties to a loss to share the financial burden of the bodily injury or property damage according to their respective degrees of fault
Counterclaim
A complaint brought by the defendant against the plaintiff
Third party claim
A demand against am insured by a person or organization other than the insured or the insurer, seeking to recover damages that may be payable by insureds liability insurance
Independent Medical Examination
A direct intervention technique that includes a brief review pf the patients history and treatment and a physical examination of the patient. Insurers use this technique in disputed claims for determining causation, current physical impairment, and the need for present or future treatment
Answer
A document filed in court by a defendant responding to a plaintiff's complaint and explaining why the plaintiff should not win the case.
Summons
A document that directs a sheriff or another court-designated officer to notify the defendant named in the lawsuit that a lawsuit has been stated and that the defendant has a specified amount of time to answer the complaint
Misrepresentation
A false statement of a material fact on which a party relies.
Pleading
A formal written statement of the facts and claims of each party to a lawsuit.
Loss history
A listing of past claims, including the date of occurrence, the line of business, the type or description of the claim, the date of the claim, the amount paid, the amount reserved, and the claims current status
Indirect Loss
A loss that arises as a result of damage to property other than the direct loss to the property
Formula Method
A method of setting claim reserves by using a mathematical formula
Compensatory Damages
A payment awarded by a court to reimburse a victim for actual harm
Claims representative
A person responsible for investigating, evaluating, and settling claims
Appraisal Clause
A policy provision that prescribes a method for resolving a disputed claim about the value of property or the amount of a property loss
Deposition
A pretrial discovery tool involving oral examination of a witness to produce a written verbatim record
Discovery
A pretrial exchange of all relevant information between the plaintiff and defendant.
Estoppel
A principle that prohibits a party from asserting a claim or right that is consistent with with that party's past statement or conduct on which another party has detrimentally relied
Open-ended question
A question that seeks an answer that explains or elaborates on the circumstances under consideration
Leading Question
A question that seeks or suggests a particular answer
Conflict of Interest
A situation that occurs when a decision maker's personal interests interfere to the extent that he or she makes decisions that adversely affect customers or employers
Examination Under Oath
A statement given by a person who has sworn to tell the truth before an officer of the court
Proof of Loss
A statement of facts abut a loss for which the insured is making a claim
Hard Fraud
Actions that are undertaken deliberately to defraud.
STAGED ACCIDENT
An accident deliberately caused by a person who intends to feign injury and collect on the ensuing claim.
Mini Trial
An alternative dispute resolution method by which a case undergoes an abbreviated version of a trial before a panel or an advisor who poses questions and offers opinions on the outcome of a trial, based on the evidence presented
Summary Jury Trial
An alternative dispute resolution method by which disputing parties participate in an abbreviated trial presenting the evidence of a few witnesses to a panel or mock jurors who decide the case
Mediation
An alternative dispute resolution method by which disputing parties use a neutral outside party to examine the issues and develop a mutually agreeable settlement
Arbitration
An alternative dispute resolution method by which disputing parties use a neutral outside party to examine the issues and develop a settlement, which can be final and binding
Pro Rata Contribution
An approach to other insurance by which the insurers contribute to the loss payment in the proportion to which they contribute to the total amount of coverage purchased
Loss reserve
An estimate of the amount of money the insurer expects to pay in the future for losses that have already occurred and been reported, but are not yet settled
Independent Adjuster
An independent claims representative who handles claims for insurers for a fee
terminal credibility
An individuals perceived credibility after interpersonal communication in a given situation situation has occurred
derived credibility
An individuals perceived credibility during interpersonal communication
Insurable Interest
An interest in the subject of an insurance policy that is not unduly remote and that would cause the interested party to suffer financial losses if an insured event occurred
Third Party Administrator (TPA)
An organization that provides administrative services associated with risk financing and insurance
Public adjuster
An outside organization or person hired by an insured to represent the insured in a claim in exchange for a fee
Insurance fraud
Any deliberate deception committed against an insurer or an insurance producer for the lurpise of unwarranted financial gain
Substituted service (constructive service)
Any method of notifying a defendant of a lawsuit other than personal delivery of a summons and complaint
nonverbal communication
Communication that is not spoken or written, including eye movement, kinesics, appearance, and time and space
Good faith
Consideration given to the insureds interest that is at least equal to that given to the insurers interests in handling the claim
Negotiation variables
Financial needs, claimants negotiation phase, tie pressures, claimants emotional reaction to the loss, claimants experience or knowledge w/ claims, personality
Soft Fraud
Fraud that occurs when a legitimate claim is exaggerated
Actual Service
Hand delivery of a summons and complaint to a defendant.
Material Fact
In insurance, a fact that wohld affect the insurers decision to provide kr maintain insurance or to settle a claim
Reservation of Rights letter
Insurer's letter that specifies coverage issues and informs the insured that the insurer is handling a claim with the understanding that the insurer may later dent coverage should the fact warrant it
Reserve
The amount the insurer estimates and sets aside to pay on an existing claim that has not been settled
Trading Dollars
Negotiation about demand/ amount rather than about claim facts
Forms of Representational Documentation
Photographs, Maps, Diagrams, Video footage
Alternaive Dispute Resolution
Procedures to help settle disputes without litigation, including arbitration, mediation, and negotiation
Interrogatories
Specific written questions or requests raised by one party to a lawsuit that the opposing party must answer in writing.
Statutory Law
The forma laws, or statutes, enacted by federal, state, or local legislative bodies
Waiver
The intentional relinquishment of a known right
Legal Liability
The legally enforceable obligation of a person or an organization to pay a sum of money to another person or organization
Venue
The locale in which the lawsuit may be brought
Medium
The means by which a message is transmitted from sender to receiver
Receiver
The person who chooses from the verbal and non verbal symptoms in the senders message to interpret the messages meaning
Sender
The person who initiates the communication process
Subrogation
The process by which an insurer can, after it has paid a loss under the policy, recover the amount paid from any party who caused the loss or is otherwise legally liable for the loss
active listening
The process of listening with mental and physical openness to more clearly determine a messages meaning
Encoding
The process of translating a message into words
Ethics
The study of what constitutes good and bad behavior, dealing with moral duty and obligaiton
Message
The words a sender uses in the communications process and their underlying theme
win-lose
When a negotiator seeks only the best outcome for their side and not the others
Individual case method
a method of setting reserves based on the claims circumstances and the claims representatives experience in handling similar claims
default judgement
an automatic judgement against a party to a lawsuit who fails to appear in court or to answer a pleading
Concealment
an intentional failure to disclose a material fact
Extraneous information
extra, unnecessary information
Negligence
the failure to exercise the degree of care that a reasonable person in a similar situation would exercise to avoid harming others
Spoilation
the failure to preserve property for another's use in litigation