AZ Claims Adjuster flashcards
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32 cards. Read the term and the definition here. The deck at the top of this page is optional.
- Arizona DIFI
- The Arizona Department of Insurance and Financial Institutions licenses adjusters and insurers, investigates complaints, and enforces Arizona Revised Statutes Title 20.
- Public adjuster
- An adjuster who represents the insured for compensation, rather than the insurer, in preparing, presenting, and negotiating a first-party claim.
- Pure comparative negligence
- Arizona's rule that reduces a claimant's recovery by the claimant's percentage of fault; even a claimant 90 percent at fault may recover.
- Arizona minimum auto limits
- Required private passenger auto liability coverage of $25,000 per person and $50,000 per accident for bodily injury, plus $15,000 for property damage.
- Notice-prejudice rule
- Arizona generally requires an insurer to show actual prejudice before denying a liability claim solely because the insured gave late notice of the claim.
- Several liability
- Arizona's rule that each defendant pays only its own percentage of fault, except when defendants acted in concert or are jointly liable by statute.
- Indemnity principle
- Insurance restores the insured to the pre-loss financial position, not better; policy limits, deductibles, and actual cash value prevent a profit from loss.
- Insurable interest
- A financial stake in the person or property insured; it must exist at policy inception for life insurance and at the time of loss for property insurance.
- Occurrence policy
- A liability policy that covers injury or damage occurring during the policy period, regardless of when the claim is later reported to the insurer.
- Actual cash value
- The replacement cost of damaged property minus depreciation; it is the standard measure for many property losses unless replacement cost coverage applies.
- Coinsurance formula
- Payment equals insurance carried divided by insurance required, multiplied by the covered loss, minus the deductible, and capped by the policy limit. Required insurance equals the coinsurance percentage times replacement cost.
- Recorded statement
- A documented interview with a claimant or witness covering the loss facts, prior damage, injuries, and other insurance; consent is obtained and the recording preserved.
- Examination under oath
- A formal sworn interview conducted under the policy's cooperation condition, often used when fraud or a coverage question exists.
- Reservation of rights
- A letter that preserves the insurer's coverage defenses while the investigation continues; it is not a denial of the claim.
- ISO ClaimSearch
- An industry database of insurance claims that can reveal prior claims and patterns; entries must be independently verified before they affect a claim decision.
- Chain of custody
- A documented record of who handled physical evidence and when; it preserves admissibility and helps rebut allegations that evidence was lost or altered.
- Fraud indicators
- Facts such as late reporting, staged accidents, exaggerated damages, prior similar claims, and refusal to provide records that warrant referral to a special investigation unit.
- Efficient proximate cause
- The dominant cause of a loss; when it is a covered peril, coverage may apply even though an excluded peril also contributed to the damage.
- Replacement cost
- The cost to repair or replace damaged property with like kind and quality, without deduction for depreciation, subject to policy limits and conditions.
- Business income
- Net income plus continuing normal operating expenses during the period of restoration, subject to the policy's waiting period and limit.
- Ordinance or law coverage
- Coverage that pays additional costs required by building codes after a covered loss, which standard property policies otherwise exclude.
- Loss of use
- Coverage that pays necessary increased living expenses or fair rental value while the insured's home is uninhabitable, subject to time and dollar limits.
- Settlement authority
- The maximum amount an adjuster may pay on a claim without obtaining supervisor approval; payments above that amount require escalation.
- Release
- A signed agreement ending a claim in exchange for consideration; it should identify the parties, the claim, and the amount paid.
- Medicare lien
- A statutory reimbursement right for medical costs paid by Medicare; it must be identified and resolved in a liability settlement.
- Subrogation receipt
- A signed document acknowledging the insurer's payment and transferring the insured's recovery rights against the responsible party to the insurer.
- Loss payee
- A party, such as a lender, with a right to insurance proceeds to the extent of its interest; payment must include the correct payee.
- Unfair claims practice
- Under Arizona law, prohibited conduct includes misrepresenting policy terms, unreasonable delay, and failing to attempt a prompt, fair settlement once liability is reasonably clear.
- Fiduciary duty
- A duty to act in the principal's best interest; public adjusters owe this duty to the insured and must disclose their compensation and conflicts.
- Conflict of interest
- A financial or personal interest that could bias claim decisions; it must be disclosed and avoided when it affects the adjuster's objectivity.
- Insurance fraud
- An intentional misrepresentation of a material fact made to obtain insurance benefits; mistake, negligence, or exaggeration without intent is not fraud.
- SIU referral
- A referral of suspected fraud to a special investigation unit for further inquiry; the claim continues to be handled under a reservation of rights.