accident attorney Insurance Claims and Negotiations 3

Question 1

What is 'coverage dispute' in an accident claim and how is it typically resolved?

Accepted Answer

A disagreement between insurer and insured over whether the policy covers the claim, resolved by declaratory judgment or negotiation

Answer

Coverage disputes arise when an insurer claims an exclusion applies or coverage conditions were not met; they are resolved through declaratory judgment actions or coverage arbitration.

Question 2

What is an 'insurance adjuster's' role in a personal injury claim?

Accepted Answer

To investigate the claim, assess liability, evaluate damages, and negotiate settlement on behalf of the insurance company

Answer

Adjusters work for the insurer and are trained to settle claims for as little as possible — their goal is cost containment for their employer, not fair compensation for the claimant.

Question 3

What is 'coordination of benefits' (COB) in multi-insurance accident claims?

Accepted Answer

Rules determining which insurer pays first (primary) and which pays any remaining balance (secondary) when a claimant has multiple policies

Answer

COB rules prevent double recovery by designating primary and secondary insurers, ensuring total payments do not exceed actual losses.

Question 4

What is 'lost future earnings' and how is it typically calculated in a serious injury case?

Accepted Answer

Compensation for the reduction in earning capacity due to permanent disability, calculated using actuarial life tables, vocational analysis, and economic expert testimony

Answer

Lost future earning capacity requires expert testimony from vocational rehabilitation specialists and economists who project the plaintiff's pre- and post-injury earning trajectories over their work-life expectancy.

Question 5

What is 'interinsurer arbitration' and when is it used?

Accepted Answer

A process where two insurance companies arbitrate which of them bears liability or owes contribution, rather than litigating in court

Answer

When two insurers dispute responsibility for a claim (e.g., in hit-and-run or employer/personal vehicle overlap cases), they may use inter-company arbitration through organizations like Arbitration Forums.

accident attorney Practice Test

accident attorney Practice Test

accident attorney Insurance Claims and Negotiations 3