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Who mandates auto insurance policy wordings?
Provincial law
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Why are accident benefits referred to as "no-fault"?
They are payable to policy holders regardless of who is at fault.
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What medical knowledge does a policy adjuster have to possess in order to assess auto injury claims?
- medical terminology
- optimum course of tx
- limitations injuries could impose
- length of time injury could affect individual
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How are auto injury victims compensated in your province? What rights does the insd have?
Ontario: against one's own insurer; private insurers; mandatory medical, rehab, funeral, disability and death benefits; only cat injuries can sue for pain and suffering
NB: under liability section of policy; private insurers; mandatory medical, rehab, funeral, disability and death benefits; right to sue for pain and suffering (with cap) and economic loss in excess of no-fault benefits
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Commuted value
the amount that it would take today to pay off an accrued benefit that is due in the future
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When auto accidents occur out of province, what arrangements must the adjuster determine?
Any Reciprocal arrangements for a claims settlement
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Why is it important for the adjuster to meet with the injured party asap after the claim filed?
- get details of:
- accident,
- injury,
- clmt activity,
- employment history
- clmt may lawyer up
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Rehabilitation expenses and steps
- Review: original invoices for PT, medical aids, prosthetics, rx, DC, dental
- Steps: assessment, goal setting, planning, training, placement, follow up
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Claims of wage loss. What should adjuster review?
- Employment history
- salary/wage
- benefits
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General criteria for collecting wage loss?
- clmt must be unable to perform the usual duties of his occupation
- eventually will be tested if he is unable to do any occupation
- family doctor records required
- independent medical assessment
- employ a private investigator possibly
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Death benefit calculation
- calculated based on the status of the insd in the household
- death certificate
- proof that the death was a result of the injuries
- proof of relation (ie. marriage certificate)
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How are damage amounts usually calculated?
- the total of:
- out-of-pocket expenses
- temporary total and partial disability (wage loss)
- permanent disability (wage loss and loss of use)
- pain and suffering
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Define insurance fraud and describe how governments discourage it.
- knowingly make a false or misleading statement or representation (including documents) to an insurer or willfully fail to inform an insurer of a material change
- heavy fines and jail time are possible outcomes of insurance fraud
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Under what circumstances are outside experts brought in to evaluate, produce, and preserve evidence of cause and fault?
the greater the value of a claim, the greater the justification for hiring an appropriate expert
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What info is included in a loss report?
- name & address of insd
- drivers licence
- policy #
- date, time, place of accident
- description of accident
- damage sustained by insd
- id of TP
- witnesses
- names of all parties who sustained injuries
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What type of benefits could be deducted from an automobile settlement in your province?
Collateral benefits
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What is the effect of signing a settlement release?
gives up any rights to make further claims for the injury, now or in the future
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What should the loss adjuster advise the claimant before signing the release?
To seek expert legal advice
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What is uninsured motorist coverage?
Allows for an insured's own policy to provide compensation if an injury is caused by an uninsured or unidentified vehicle.
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What coverage does a non-owned automobile policy provide?
- It is an endorsement that covers an insured that drives a vehicle for business not owned by the insured.
- This covers an insured if the at fault vehicle is uninsured or underinsured, defence costs are also covered.
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Uninsured Motorist Coverage
- Even though auto insurance is compulsory in Canada, some motorists drive without insurance and cause accidents
- Uninsured Motorist coverage allows the insureds own policy to provide compensation if an injury is caused by an uninsured or unidentified vehicle
- Physical damage to the vehicle, however, is only recovered if the other party is identified
- An insured is entitled to claim the amount legally recoverable from the uninsured motorist
- Coverage is limited to the minimum third party liability policy requirements in each jurisdiction
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Non-Owned Automobile Policy
- Is sold as an endorsement to the CGL policy
- Protects the insured when an at-fault vehicle is uninsured
- Defence costs for the insured is covered
- Will respond to the personal or vicarious liability imposed upon the insured
- Typical exposure is drivers using their own vehicles on company business
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Which of the following statements is correct ...
...In each province where no-fault injury regime is not in play, injury claims are handled according to contract law
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Accident benefits coverage is compulsory except in...
…. Newfoundland and Labrador
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Which of the following statements is incorrect in regards to automobile insurance in Nova Scotia?
Automobile in Nova Scotia is administered by the government
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QEF 34 Accident Benefits endorsement can be purchased to supplement the government compensation plan in...
… Quebec
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When a person is injured in an automobile accident, he or she may be eligible to receive compensation under private insurance plans other than under an automobile insurance policy. Such benefits are known as...
...collateral benefits
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EQ: Compare uninsured motorist coverage with non-owned auto policy.
10 marks - 10 points required
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EQ: List the items that should be included in a loss report.
10 marks – 10 points required
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Peter Piper has been involved in a serious car accident resulting in extensive bodily injury including soft tissue injury. He is currently recovering in St. Abbs General Hospital and has already missed one week of work. Describe the injury claim process that you will follow to adjust this claim.
20 marks – 20 points required
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EQ: No-fault benefits are payable...
...to the policyholder regardless of fault
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EQ: In BC, automobile insurance is administered by...
...a government insurer
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EQ: In ON, a catastrophic injury would most likely include...
...a permanent serious disfigurement
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EQ: Typical expenses associated with auto bodily injury losses are out-of-pocket expenses. These expenses may include...
...ambulance and home care costs
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EQ: Collateral benefits are...
...other benefits payable under a government plan or private insurer
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EQ: In Alberta, auto insurance is administered by...
...private insurers
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EQ: Commuted value is...
...the amount it would take today to pay off an accrued benefit that is due in the future
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EQ: Uninsured motorist coverage provides compensation under the insd's own policy when...
...there is an injury caused by an unidentified vehicle
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EQ: No-fault benefits are payable...
...to the policyholder regardless of fault
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EQ: In BC, auto insurance is administered by...
...a government insurer
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EQ: In ON, a catastrophic injury would most likely include...
...a permanent serious disfigurement
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