CT Claims Adjuster cheat sheet

Indemnity restores the insured to the pre-loss financial position, subject to limits, deductibles, and valuation; it does not permit profit from a loss.

Insurable interest for property exists when the insured would suffer financial loss from damage; it must exist at the time of loss.

A contract of adhesion is drafted by the insurer; ambiguous language is generally construed against the drafter and in favor of coverage.

Subrogation gives the insurer rights against a responsible third party after paying a loss; it prevents double recovery.

Coinsurance formula for property: payment = (limit carried ÷ limit required) × covered loss, minus deductible, capped by policy limit.

Actual cash value is typically replacement cost minus depreciation; replacement cost pays new property without depreciation.

Occurrence policies are triggered by injury or damage during the policy period; claims-made policies are triggered by a claim first made during the period.

Duty to defend is broader than duty to indemnify; a potential for coverage can trigger defense even if indemnity is later denied.

CUIPA prohibits unfair claim settlement practices such as misrepresentation, unreasonable delay, failure to investigate, and failure to explain denial.

Connecticut is a tort/at-fault auto state; it does not use a no-fault PIP system for private passenger auto.

CT minimum private passenger auto liability limits: 25,000 dollars per person/50,000 dollars per accident bodily injury and 25,000 dollars property damage.

Connecticut law requires uninsured/underinsured motorist coverage in private passenger auto policies; policy limits, conditions, and rejection rules must be checked.

Public adjusters representing insureds for compensation must be licensed in Connecticut; adjusters must follow state licensing and market-conduct rules.

The Connecticut Insurance Department enforces insurance laws and can examine claim practices; claim files should support compliance.

The Connecticut Workers' Compensation Commission adjudicates contested workers' comp claims; exclusive remedy is subject to statutory exceptions.

Connecticut uses modified comparative negligence; a plaintiff generally cannot recover if plaintiff's fault exceeds 50 percent.

First notice of loss: verify policy status, named insured, loss date, location, cause, coverage, deductible, and limits; set initial reserves.

Keep coverage investigation separate from damages investigation; no payment should be made until coverage is established.

Document all contacts, statements, evidence, coverage analysis, reserves, decisions, and payments contemporaneously.

A reservation-of-rights letter identifies coverage issues and preserves the insurer's right to deny coverage later.

A proof of loss is a formal, often sworn, statement of loss; policy deadlines and state rules govern its use.

Denial letters should identify the policy provisions and factual basis and comply with state notice requirements.

Refer suspected fraud to SIU based on objective indicators; document facts without accusing the insured.

Identify subrogation potential early, preserve evidence, and avoid prejudicing recovery against third parties.

Ethical handling requires confidentiality, conflict avoidance, accurate records, and no unauthorized legal advice.

PAP liability covers BI/PD for which the insured is legally liable; intentional acts, racing, and certain business uses are excluded unless endorsed.

CT minimum liability is 25/50/25; higher limits are available by endorsement and affect UM/UIM limits.

Collision covers damage to the insured auto from collision or upset regardless of fault; deductible applies.

Other-than-collision/comprehensive covers theft, fire, vandalism, weather, and glass; separate deductible often applies.

UM covers injury/property damage from an uninsured motorist; UIM covers insufficient limits; policy terms and CT law control.

Connecticut does not require no-fault PIP; medical payments coverage is optional when offered.

Rental reimbursement, towing, and loss-of-use are optional coverages; check declarations.

Exclusions commonly include intentional damage, use without permission, carrying passengers for a fee, and delivery use.

HO-3 insures the dwelling on an open-peril basis and personal property on a named-peril basis; HO-5 uses open perils for both.

Coverage A dwelling; B other structures; C personal property; D loss of use; E personal liability; F medical payments.

Replacement cost pays new without depreciation; actual cash value pays replacement cost minus depreciation.

Dwelling coinsurance: if the limit is below the required percentage of replacement cost, settlement is reduced by limit carried ÷ limit required.

Sudden accidental water discharge may be covered; flood, repeated seepage, and long-term leakage are typically excluded.

Ordinance or law, sewer backup, earthquake, and flood are commonly excluded or require endorsements.

HO-6 covers condo unit owner's personal property, improvements, loss of use, and liability; association covers common elements.

Medical payments to others is no-fault and does not require proving liability; liability coverage requires legal liability.

CGL occurrence coverage is triggered by BI/PD during the policy period; claims-made coverage is triggered by a claim first made during the period.

CGL limits include each occurrence, general aggregate, products-completed operations aggregate, and personal/advertising injury limits.

CGL covers premises/operations and products/completed operations; it excludes professional liability, pollution, auto, and workers comp.

A BOP combines commercial property and general liability for eligible small businesses, with built-in limits and endorsements.

Commercial property coinsurance reduces payment if the carried limit is below the required percentage of value.

Business income covers lost net income and continuing expenses during restoration; extra expense pays additional costs to resume operations.

Commercial auto uses covered-auto symbols to define owned, hired, and nonowned autos; liability and physical damage are separate.

Inland marine covers mobile or in-transit property, such as contractors' equipment and bailee exposures.

Negligence elements: duty, breach, actual cause, proximate cause, and damages; plaintiff generally bears the burden.

Standard of care is the reasonable person; professionals are held to the skill and care of their profession.

Connecticut uses modified comparative negligence; recovery is reduced by plaintiff's fault and generally barred if plaintiff's fault exceeds 50 percent.

Premises liability duty varies by entrant status; trespassers receive the lowest duty and invitees the highest.

Negligence per se uses a statute violation as breach when the statute protects the class and type of harm involved.

Res ipsa loquitur permits an inference of negligence when the instrumentality was under defendant's control and the accident ordinarily would not occur without negligence.

Duty to defend is broader than duty to indemnify; potential coverage triggers defense.

Joint and several liability may make multiple defendants liable for the whole judgment; state law governs reallocation.

CT workers' comp is a no-fault system and generally the exclusive remedy for work-related injury or illness.

Connecticut generally requires employers with one or more employees to carry workers' comp coverage or self-insure, with limited exemptions.

Compensability requires injury arising out of and in the course of employment; occupational disease follows statutory rules.

Benefits include medical care, temporary total/partial disability, permanent partial/total disability, and death/dependents' benefits.

Wage replacement is statutory and often based on average weekly wage, subject to waiting periods and maximum rates.

Independent contractors are generally not covered; misclassification can create employer liability.

Willful misconduct or intoxication may bar or reduce benefits under statutory conditions.

The Connecticut Workers' Compensation Commission adjudicates disputes; intentional torts may fall outside exclusivity.