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What should the adjuster understand about the insured’s frame of mind immediately following a loss?
The insured may feel vulnerable or traumatized. The insured may display strange and unpredictable behaviour
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What situation may indicate a conflict of interest situation for loss adjusters?
A conflict of interest may arise if the adjuster has a stake in the business or the same adjuster (company) represents two opposing claimants.
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How will an insured’s multiple types of insurance affect a loss investigation?
A loss adjuster may need to hire an expert to deal with separate issues and be prepared to explain how each claim will be handled and what kind of information is required for each.
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What questions will be answered to determine whether a claim of bad faith against an insurer is valid?
- Did the adjuster act promptly?
- Did the adjuster act competently?
- Was the loss investigated thoroughly?
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Why should internal criticism of claims handling not be included in a claims file?
All claims file information is available to the insured. If uncorrected criticism is included in the file, the insured will have greater evidence for liable against the adjuster/insurer (bad faith).
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What governs the insurer’s right of entry into a loss site?
Statutory conditions
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List FOUR (4) possible sources of information in a fire claim?
- Insured statement,
- witness statements,
- Fire/police reports/statements,
- expert reports,
- financial information/history
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What stipulations will a replacement cost endorsement often be subject to?
- replacement to occur with due diligence and dispatch;
- replacement to take place on the same site or an adjacent site;
- settlement on a replacement cost basis to occur once the replacement has been effected by the insured;
- if the insured fails to comply with the terms and conditions of the replacement cost endorsement then the basis of settlement reverts to the original policy terms.
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How is the “income approach” used in determining the value of a property?
The value of a property is based on the income produced by the property
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When might an appraisal help to expedite a claims process?
An appraisal can expedite a claims process when the value of the claim is in dispute.
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Who may invoke the appraisal clause?
The appraisal clause can be invoked by either party to contract
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What is the umpire’s role in an appraisal?
- umpire controls the appraisal process;
- asks for all documentation (narrative
- umpire will hear arguments from both sides, and will usually allow controlled debate on the issues;
- it is up to the umpire to limit the discussions to the area the appraisal concerns
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What potentially useful records are available from the city or town hall?
Building code and repair violations as well as permits and original plans/documents.
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What is the privacy officer’s role?
Privacy’s officer role is to protect personal information collected by the organization.
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What are the THREE (3) classification types for fire origins, according to the NFPA?
- Incendiary,
- Accidental, and
- Unknown
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Why is it important to try to obtain the insured’s and any witnesses’ statements promptly?
Statements should be taken as soon after incident as possible so that recollection does not fade
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What determines the time frames for payment of claims?
Policy or statute conditions
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Why might an insurer choose to pay the balance of a mortgage, and assume the position of mortgagee?
An insurer can recoup some losses from a fraudulent insured by becoming the mortgagee and selling the property when the insured defaults.
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What restitution is available to the insurer if a claim is paid and later discovered to be fraudulent?
Ask for an order of restitution or launch civil action against insured
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If an insurer rejects a proof of loss, what obligation is owed to the insured?
The insurer must show the insured what is deficient in the proof of loss and ask the insured to rectify the situation.
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What are the stages of a polygraph test?
- pre-test interview;
- collection of data;
- analysis of the data
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What is the public adjuster’s role in a claims process?
Public adjusters represent the insured’s interest with their insurer when a loss has occurred.
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If an insured refuses to sign a statement, would you...
...read it back to him and ask if it is a true representation of the facts
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If a public adjuster is appointed by an insured, which of the following would not be appropriate conduct...
...asking him/her to prepare the specification of repair for you
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Of the following, which is the most likely to trigger an assessment of punitive damages, by a court, against an insurer...
... An adjuster, suspecting fraud, refuses to contemplate and insured claim. To get rid of the claim, he offers a settlement based on a grossly inflated figure for depreciation
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An insured must undergo a polygraph test under which of the following circumstances...
...Never, it is entirely voluntary
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In dealing with appraisals under the Statutory Conditions, which statement is correct...
...If the appraisers on each side fail to reach an agreement, the process is terminated
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EQ: The most common way of evaluating actual cash value is...
...to subtract a depreciation factor from the replacement cost of an item
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EQ: When valuing destroyed property based on the income approach...
...the true value of a property to the insured may be the income produced by the property
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EQ: Appraisal is an alternative dispute resolution tool that...
...provides a speedy and efficient means of settling disputes between parties
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