Introduction to Claim Adjusting-A

Third-party claim

A demand against an insured by a person or organization other than the insured or the insurer, seeking to recover damages that may be payable by the insured's liability insurance.

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.

Fiduciary Agent

Agent for a principal/Client. The legal or special relationship of trust, confidence, or responsibility between 2 or more parties.

Indemnify insurance, inc. is deploying adjuster to an area recently hit by a hurricane. The company has 25 employee adjuster who are ready to deploy but they need 25 more. Carol is a licensed adjuster who signs a contract with indemnify insurance, inc. to work on their behalf during this deployment. carol is acting as:

An independent adjuster

A formal request to an insurance company requesting a payment according to the terms of an insurance contract is known as?

An insurance claim

Public Adjuster

An outside organization or person hired by an insured to represent the insured in a claim in exchange for a fee.

Skye is an insured under an insurance policy that covers both the insured and the insured's actions for which they can be held liable. Which of the following statements is NOT true in this situation?

Any claim submitted against the policy for an act of negligence accidentally committed but Skye is a first- party- claim.

Which of the following is NOT considered to be a "specificality adjuster"?

Casualty adjuster

Kelly, Vince, Ed, and Ginny are all staff adjusters. Which of these adjusters is acting appropriately as a fiduciary agent?

Ed knows the claimant can't possibly afford to pay for their extensive damage, but he denies the claim anyway because the cause of loss was not covered by the policy.

The authority that is specifically provided to an adjuster (orally or in writing) by the insurance company who has appointed that adjuster is:

Express authority

The type of "agent authority" that allows an adjuster to exercise his/her express authority is?

Implied authority

Independant adjuster

May work for adjusting company that deploy teams of adjusters to work on behalf of an insurer in the case of a catastrophe such as hurricanes, flood, or tornados.

Lawrence holds both an independent staff adjusters license and a public adjusters license as permitted by law in his state. He is employed by Binders Keepers, Inc. and regularly adjusts claims for the company that arise from Homeowners policies. Lawrence has been hired by Kelli to act as a public adjuster on her behalf to present a claim under her Homeowners policy that was issued by Binders Keepers, Inc. If Lawrence accepts the contract with Kelli, it may:

Present a conflict of interest

A persons, firm, or corporation that, for compensation, acts on behalf of an insured in negotiating the settlement of certain claims for loss or damage to properly is knows as a/an:

Public adjuster

Fiduciary Agent

The adjuster acts on behalf of principal and must protect the principal's interests

All od hit following statements are TRUE regarding the fiduciary responsibilities of an adjuster, EXCEPT:

The adjuster must make statements in writing before they will bind the principal.

Apparent Authority

The appearance or the assumption of authority based on the actions, words, or deeds of the principal or because of circumstances the principal created.

An independent adjuster acts on behalf of his or her principal. Which of the following is the principle of an independent adjuster?

The insurer

Implied Authority

an agent's authority to do things not specifically authorized in order to carry out express authority

Staff (Company) Adjuster

employed by one insurer, salaried, can work locally, regionally, nationally ex. State farm

insurance claim

formal request to the insurance company for reimbursement for a covered loss

Express Authority

the authority of an agent, stated in the document or agreement creating the agency