AR Claims Adjuster flashcards
AR Claims Adjuster · Build recall with a focused review session.
32 cards. Read the term and the definition here. The deck at the top of this page is optional.
- Adjuster license requirement
- Arkansas requires a license before a person investigates or settles claims for compensation on behalf of another; unlicensed adjusting is a violation subject to penalties.
- Public adjuster
- A licensed adjuster who contracts with and is paid by the insured to prepare, present, and negotiate a claim; fees are limited and the contract must be written.
- Independent adjuster
- An adjuster who works for multiple insurers on a contract basis through an adjusting firm, rather than as a salaried employee of one insurer.
- Company adjuster
- A salaried employee of an insurer who investigates and settles claims on that insurer's behalf and represents only that company.
- Continuing education requirement
- Adjusters must complete a set number of CE hours each renewal cycle, including ethics, to maintain an active Arkansas license.
- License renewal cycle
- Arkansas adjuster licenses renew every two years; renewal requires CE completion and payment of fees, with late penalties for lapses.
- Nonresident reciprocity
- A nonresident adjuster may obtain an Arkansas license by showing a comparable home-state license in good standing, without retaking the exam.
- License revocation grounds
- Grounds include fraud, misrepresentation, failure to complete CE, and violations of insurance law; the Department may suspend, revoke, or fine.
- Unfair claims practices
- Prohibited conduct such as unreasonable delay, misrepresenting policy terms, failing to investigate, and offering inadequate settlements without explanation.
- Prompt denial notice
- When denying a claim, the insurer must provide a written explanation citing the specific policy provision relied on for the denial.
- Arkansas Insurance Department
- The state agency that licenses adjusters and insurers, enforces insurance laws, and investigates consumer complaints and unfair trade practices.
- Trade Practices Act
- Arkansas law prohibiting unfair or deceptive acts in the business of insurance, including misleading advertising and improper claim settlement conduct.
- Consumer privacy protection
- Adjusters must safeguard nonpublic personal financial and health information and share it only with parties having a legitimate need.
- Conflict of interest prohibition
- An adjuster may not represent both insurer and insured on the same claim or accept undisclosed compensation from multiple parties.
- Administrative penalties
- Violations of insurance law can result in fines, cease-and-desist orders, license suspension or revocation, and restitution to consumers.
- First notice of loss
- The initial report of a claim; the adjuster records date, location, parties, and reported cause and assigns a claim number.
- Reservation of rights
- A letter preserving the insurer's right to deny coverage later while the investigation into coverage and facts continues.
- Proof of loss
- A sworn statement by the insured detailing the amount and cause of loss, often required by policy conditions within a specified time.
- Subrogation
- The insurer's right to recover claim payments from a liable third party after indemnifying the insured, standing in the insured's shoes.
- Actual cash value
- Replacement cost of damaged property minus depreciation; the standard valuation method unless the policy provides replacement cost coverage.
- Claim file documentation
- A complete record of contacts, evidence, decisions, and payments that supports good-faith handling and defends against bad-faith allegations.
- Comparative fault
- A liability rule allocating damages based on each party's share of responsibility, affecting settlement value in Arkansas claims.
- Indemnity principle
- Insurance restores the insured to the pre-loss financial position and does not allow the insured to profit from a loss.
- Insurable interest
- A financial stake in the property or person insured; required at policy inception for life and at time of loss for property.
- Utmost good faith
- The mutual duty of insured and insurer to disclose material facts honestly; concealment or misrepresentation can void coverage.
- Policy structure
- Declarations, insuring agreement, conditions, exclusions, and definitions together define what is covered and the insured's duties.
- Coinsurance clause
- A provision requiring the insured to carry insurance equal to a stated percentage of property value or face a reduced claim payment.
- Duties after loss
- Policy conditions requiring prompt notice, proof of loss, protection of property from further damage, and cooperation with the investigation.
- Waiver and estoppel
- Waiver is voluntary relinquishment of a known right; estoppel prevents denial when the insurer's conduct induced the insured's reliance.
- Fiduciary duty of adjuster
- Adjusters must handle claim funds honestly, account for money received, and act in the interest of the party they represent.
- Insurance fraud reporting
- Suspected fraudulent claims, such as staged losses or inflated damages, must be reported; adjusters may not conceal or participate in fraud.
- Ethics CE requirement
- Arkansas requires a portion of continuing education hours in ethics, reinforcing honesty, confidentiality, and fair claim handling.