21 Questions
What is the first activity in the claims handling process?
Acknowledging receipt of the claim and assigning it to an adjuster
How is the claims handling process triggered?
Through a loss notice form that includes basic information about the loss
What is crucial to a property adjuster's ability to help insureds’ lives return to normal after their possessions have been damaged?
Promptly resolved, equitable claim settlements
What does the claims handling process involve after identifying the policy?
Investigating and documenting the claim
What is the typical fee charged by public adjusters for acting on behalf of insureds?
10 to 15 percent of the amount paid under the policy
What does the National Association of Public Insurance Adjusters (NAPIA) aim to establish?
Ethical and professional standards for representing insureds before insurers
What may incentivize some public adjusters to inflate the claim?
A percentage of the claim settlement
What role do public adjusters play in presenting fire claims to insurers?
They analyze the scene and prepare a scope of the loss
What is a potential negative impact of some public adjusters' conduct on the claims process?
Causing distrust in the insurer
What is the primary duty of public adjusters when handling property losses caused by various perils?
Assisting insureds in documenting and presenting claims
What impact can public adjusters' conduct have on the claims process?
Varied, either facilitating or hindering efficient claims processing
What does the adjuster do after receiving the assignment?
Identifies the policy in force on the date of the loss and reviews the policy
What is the adjuster's responsibility during the initial contact with the insured?
Learning essential facts about the loss and the extent of damage
What should the adjuster avoid during the initial contact with the insured?
Giving the impression that a claim will be paid when there may be grounds to deny it
When can the adjuster make preliminary decisions about the need for outside vendors?
During the initial contact with the insured
What does the adjuster review carefully after receiving the assignment?
Applicable policy forms, considering coverage questions, limitations, and exclusions
What is the adjuster's responsibility regarding policy defenses?
The adjuster should avoid waiving any policy defenses if coverage verification and review cannot be completed before contacting the insured
What should the adjuster be prepared to explain during the initial meeting with the insured?
The adjustment process, necessary forms and instructions, and potential coverage questions or policy limitations
What does the adjuster need to determine before scheduling the first meeting with the insured?
Issues such as the cause of loss
What does the adjuster need to explain to the insured during the initial meeting?
The adjustment process, necessary forms and instructions, and potential coverage questions or policy limitations
What should the adjuster avoid when explaining the policy and its meaning in relation to the loss?
Giving the impression that a claim will be paid when there may be grounds to deny it
Study Notes
Insurance Claim Adjustment Process
- Insurers have different processes for acknowledging and assigning claims, some based on adjuster availability, geographic territory, and type and size of the claim.
- Insurers have time requirements for acknowledging and assigning claims, in accordance with state requirements.
- After receiving the assignment, the adjuster identifies the policy in force on the date of the loss, reviews the policy, and determines coverage.
- The adjuster reviews the applicable policy forms carefully, considering coverage questions, limitations, and exclusions.
- The adjuster may need to consult with an expert to determine issues such as the cause of loss, and if necessary, schedule the first meeting with the insured for the expert to attend.
- The adjuster should avoid waiving any policy defenses if coverage verification and review cannot be completed before contacting the insured.
- The adjuster's initial contact with the insured sets the tone for the adjustment process and involves learning essential facts about the loss and the extent of damage.
- During the initial contact, the adjuster may also learn if the insured has retained a public adjuster or an attorney, and should discuss claim-related issues with them.
- The adjuster must explain the policy and its meaning in relation to the loss and should avoid giving the impression that a claim will be paid when there may be grounds to deny it.
- At the initial meeting, the adjuster should explain the adjustment process, provide necessary forms and instructions, and explain potential coverage questions or policy limitations.
- The adjuster should be prepared to explain the time involved in processing and concluding the claim and assist the insured in protecting the property.
- The adjuster can make preliminary decisions about the need for outside vendors, such as a restoration company, to assist with the loss adjustment during the initial contact with the insured.
Test your knowledge on subrogation and the role of public adjusters in insurance claims with this informative quiz. Learn about the processes, potential challenges, and best practices for dealing with public adjusters to ensure fair and efficient claims handling.
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