FREE Claims Adjuster Handling Procedures Questions and Answers
Within 15 days after receiving a claim, the insurance carrier must take a number of actions according to Texas insurance law. Of the following, which is NOT necessary within 15 days?
"Pay the settlement amount of the claim" is NOT necessary within 15 days after receiving a claim according to Texas insurance law.
Because Anna recently submitted a fraudulent claim, ABC Insurance has decided to cancel Anna's homeowner's policy. There had barely been three months of the policy's existence. What grounds would ABC Insurance use to give Anna her unused premium returned?
ABC Insurance would likely use the "pro rata" basis to calculate and return Anna's unused premium after canceling her homeowner's policy due to a fraudulent claim. Pro rata is a term used in insurance to describe the method of calculating a refund of the premium when a policy is canceled before its expiration date.
What is the primary reason for an adjuster using a Reservation of Rights letter rather than a Non-waiver Agreement?
A "Reservation of Rights" letter is a communication from an insurance company to its policyholder or claimant, informing them that the insurance company is investigating a claim but has not yet made a decision regarding coverage. The letter "reserves" the right of the insurer to deny coverage or to limit coverage based on the findings of the investigation. On the other hand, a "Non-waiver Agreement" is a document that the insurance company may ask the insured to sign, stating that the insured acknowledges that any investigation or payment made by the insurance company does not waive any of its rights under the policy.
Who handles the insurance sector's primary regulation?
The primary regulation of the insurance sector is typically handled by the State Department of Insurance in the United States. Each state has its own Department of Insurance (or a similar regulatory body with a different name) responsible for overseeing and regulating insurance activities within that state.
Jessica unexpectedly suffered a loss to her house. After the defeat, Jessica has the following obligations, EXCEPT:
Insurance claims involve a process that requires active participation and cooperation from the policyholder. While the insurance company is there to assess the situation and provide compensation as appropriate, policyholders have certain responsibilities to ensure a smooth claims process.
Tom recently purchased a yacht. Despite never having owned a boat before, he invested a significant amount of money in it. He worries that his brand-new boat may get stolen or damaged. What should he do to take care of his boat?
To take care of his newly purchased yacht and protect it against theft and damage, Tom should find an insurance policy specifically designed to cover boats, often referred to as "boat insurance" or "yacht insurance." Boat insurance provides coverage for a range of risks that Tom might face as a boat owner, including theft, damage, accidents, liability, and more.
Recently, Princess misplaced one of her 1-carat emerald earrings. How would her insurance provider possibly make a settlement offer?
If Princess misplaced one of her 1-carat emerald earrings and filed a claim with her insurance provider, the insurance provider might make a settlement offer by paying a portion of the total value of the lost earring.
Last night's hailstorm caused damage to Kate's home. What should she accomplish first this morning?
It's important to initiate the claims process as soon as possible to ensure a timely assessment of the damage and to start the necessary repairs or restoration.
Andrew was the owner of a little mail facility. The building's interior was destroyed by fire, rendering it unusable. Andrew must now set aside some time to move his business. This cost him a month's worth of business revenue. His loss of revenue would be classified as what kind of loss?
Indirect losses, also known as consequential losses or time element losses, are losses that result from a covered direct loss. In this case, the direct loss is the destruction of the building's interior by the fire, while the indirect loss is the loss of revenue Andrew experiences as a consequence of the fire. The inability to operate his mail facility due to the fire damage causes him to lose a month's worth of business income.
Paul recently purchased a new auto insurance coverage. The coverage start date on his policy is August 18, yet he paid his premium on August 5, the day he received the policy. He was involved in an accident on August 16. Is he protected?
No, Paul is not protected in this scenario. While Paul paid his premium on August 5 and received the policy, the coverage start date specified in the policy is August 18. This means that his auto insurance coverage does not come into effect until August 18. Therefore, the accident that occurred on August 16 would not be covered under his policy since the coverage had not yet started.
What is the National Association of Insurance Commissioners (NAIC) primary function?
The NAIC serves as a forum for insurance regulators from all 50 states. The NAIC plays a central role in fostering collaboration among state insurance regulators, developing consistent regulatory practices, and ensuring that the insurance industry operates in a manner that protects consumers and promotes fair and effective insurance markets.
XYZ Insurance Company informed Marlin that he lacked the legal competence to enter into an insurance agreement. Which of the following scenarios could explain why the insurance provider said that?
Marlin lacking the legal competence to enter into an insurance agreement may be due to the fact that he was not sober at the time of making the agreement. When entering into a contract, including an insurance agreement, both parties must have the legal capacity to do so.
Joe had bought a new house, so he visited an insurance agency to have his house insured. What will Joe receive as evidence of insurance up until the delivery of his policy?
The binder serves as evidence that the home is insured and outlines the basic terms and conditions of the coverage. It typically includes essential information such as the effective date and time of the coverage, the name of the insured (Tom), a description of the property being insured (his new home), and the types of coverage and limits provided.
Ralph recently had a fire demolish his garage at his house. Ralph immediately contacted ABC Insurance about his loss, but they are not returning his calls or contacting him in any other way. To get some action, Ralph would contact whom?
The State Insurance Commissioner is a government official responsible for overseeing insurance activities within the state and ensuring that insurance companies operate ethically, fairly, and in compliance with state laws and regulations. If Ralph is experiencing difficulties in getting a response from ABC Insurance regarding his claim, the State Insurance Commissioner's office can be a valuable resource.
Which of the following situations is NOT a representation of a hazard?
Fire that destroys personal property in a building is NOT an example of a hazard. Instead, it is an example of a "peril."
Within _____ days of receiving notice of a claim, an insurer is required by the immediate contact rule to acknowledge receipt of the claim and request any additional information.
This rule is designed to ensure timely communication between the insurer and the policyholder after a claim has been filed.