Liability Claims Investigation Flashcards

What is the purpose of a 'reservation of rights' letter in a liability claim?

Answer: To notify the insured that the insurer is investigating while preserving the right to deny coverage later

A reservation of rights letter allows the insurer to investigate and defend without waiving coverage defenses that may be applicable.

A premises liability claim arises at a rental property. The landlord argues the tenant was responsible for maintenance. Which legal concept determines who owes the duty of care to the injured visitor?

Answer: Control and possession of the property at the time of the accident

Liability generally follows control and possession; the party who had control over the dangerous condition at the time of the accident typically owes the duty of care.

Which investigative tool allows an adjuster to examine social media posts from a claimant alleging permanent disability who is photographed hiking?

Answer: Social media investigation and open-source intelligence (OSINT)

Social media and OSINT searches are legitimate investigative tools that can uncover publicly available information inconsistent with claimed injuries.

What is 'negligence per se' and when does it apply in a liability investigation?

Answer: Negligence established as a matter of law when a defendant violates a statute designed to protect the class of persons harmed

Negligence per se is automatically established when a defendant violates a safety statute (such as a traffic law) and that violation causes harm to a person the statute was designed to protect.

During a coverage investigation, the adjuster discovers the insured intentionally caused the accident. What coverage defense applies?

Answer: The intentional acts exclusion bars coverage because insurance does not cover deliberate harm

Liability policies contain intentional acts exclusions because public policy prohibits insuring deliberate wrongdoing.

A claimant in a multi-vehicle accident claims injuries from both the first and second impacts. What investigative analysis helps allocate damages between the two collisions?

Answer: Biomechanical analysis and medical evidence to apportion injuries to each impact

Biomechanical analysis combined with medical evidence helps adjusters determine which injuries were caused by each separate collision for proper damage allocation.

What is the 'made whole' doctrine and how does it affect subrogation in a liability claim?

Answer: It provides that the insurer cannot pursue subrogation until the insured has been fully compensated for their total loss

The made whole doctrine holds that an insured must be fully indemnified for all losses before the insurer can recover subrogation proceeds.