Insurance Claims and Negotiations Flashcards
6 cards from real accident attorney practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Insurance Claims and Negotiations flashcards as text
What is 'coverage dispute' in an accident claim and how is it typically resolved?
Answer: A disagreement between insurer and insured over whether the policy covers the claim, resolved by declaratory judgment or negotiation
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.
What is an 'insurance adjuster's' role in a personal injury claim?
Answer: To investigate the claim, assess liability, evaluate damages, and negotiate settlement on behalf of the insurance company
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.
What is 'coordination of benefits' (COB) in multi-insurance accident claims?
Answer: Rules determining which insurer pays first (primary) and which pays any remaining balance (secondary) when a claimant has multiple policies
COB rules prevent double recovery by designating primary and secondary insurers, ensuring total payments do not exceed actual losses.
What is 'lost future earnings' and how is it typically calculated in a serious injury case?
Answer: Compensation for the reduction in earning capacity due to permanent disability, calculated using actuarial life tables, vocational analysis, and economic expert testimony
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.
What is 'interinsurer arbitration' and when is it used?
Answer: A process where two insurance companies arbitrate which of them bears liability or owes contribution, rather than litigating in court
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.
What is a 'consent to settle' clause in a liability policy and how does it affect plaintiffs?
Answer: A clause requiring the insured's agreement before the insurer can settle a claim, which can delay or block settlement
Consent-to-settle clauses give the insured veto power over settlements, which can complicate negotiations if the insured refuses to consent for personal reasons (e.g., to protect their reputation).