CT Claims Adjuster flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Indemnity principle

Insurance indemnifies the insured by restoring the pre-loss financial position, subject to policy limits, deductibles, and valuation methods; the insured should not profit from a loss.

Insurable interest

A person has insurable interest when they would suffer financial loss from damage to or loss of the insured property; property insurance requires it at the time of loss.

Subrogation

After paying a covered loss, the insurer may step into the insured's legal rights against a responsible third party to recover payments, preventing double recovery by the insured.

Actual cash value

Actual cash value is generally replacement cost minus depreciation, reflecting the damaged property's value at loss time; policy language controls the exact method.

CUIPA

The Connecticut Unfair Insurance Practices Act prohibits unfair or deceptive insurance acts and unfair claim settlement practices, including misrepresentation, unreasonable delay, and failure to investigate.

Connecticut UM/UIM

Connecticut auto policies must provide uninsured and underinsured motorist coverage under state law; adjusters verify limits, rejection or reduction rules, and policy conditions before paying.

CT auto minimum limits

Connecticut's minimum private passenger auto liability limits are 25,000 dollars per person, 50,000 dollars per accident for bodily injury, and 25,000 dollars for property damage.

CT public adjuster license

Connecticut requires public adjusters who represent insureds for compensation to be licensed by the Insurance Department; company and independent adjusters must follow applicable state licensing rules.

Reservation of rights

A letter that identifies coverage questions and tells the insured the insurer will investigate and defend while preserving the right to deny coverage later; it prevents waiver.

Proof of loss

A formal, often sworn statement from the insured detailing the date, cause, and amount of loss; policies may require it within a stated period before payment.

SIU referral

A referral to a special investigation unit when objective indicators suggest possible insurance fraud; the adjuster documents facts and avoids accusing the insured without evidence.

Claim file documentation

A contemporaneous record of contacts, statements, evidence, coverage analysis, reserves, decisions, and payments; it supports good-faith handling and regulatory review.

Collision coverage

Personal auto coverage for damage to the insured vehicle caused by collision or upset, regardless of fault, subject to the deductible and policy limit.

Other than collision

Personal auto coverage for theft, fire, vandalism, weather, and glass damage, often called comprehensive; a separate deductible usually applies.

UM/UIM coverage

Auto coverage for bodily injury or property damage caused by an uninsured or underinsured motorist, subject to policy limits, conditions, and state law.

PAP liability coverage

Personal auto liability pays damages for bodily injury or property damage the insured becomes legally liable to pay because of an auto accident, up to policy limits.

HO-3 policy

A homeowners form insuring the dwelling on an open-peril basis and personal property on a named-peril basis, with liability and medical payments coverage.

Coverage D loss of use

Homeowners coverage that pays additional living expenses when a covered loss makes the residence uninhabitable, and may pay fair rental value for a rented home.

Dwelling coinsurance

If the dwelling limit is below the required percentage of replacement cost, property claims may be reduced by the ratio of carried limit to required limit.

HO-6 condo coverage

A condominium unit-owner policy covering personal property, unit improvements, loss of use, and liability, while the association insures common elements.

Occurrence CGL

Commercial general liability coverage triggered by bodily injury or property damage that occurs during the policy period, even if the claim is made later.

Claims-made CGL

Commercial general liability coverage triggered when a claim is first made during the policy period, often subject to a retroactive date and extended reporting period.

Products-completed operations

CGL coverage for bodily injury or property damage arising from the insured's products or completed work away from the premises, subject to its aggregate limit.

Business income coverage

Commercial property coverage that replaces lost net income and continuing expenses during the period of restoration after a covered loss, often with extra expense.

Negligence elements

A negligence claim requires duty, breach of that duty, actual and proximate causation, and damages; the plaintiff generally bears the burden of proving each element.

Modified comparative negligence

Connecticut's modified comparative negligence rule reduces a plaintiff's recovery by the plaintiff's percentage of fault and generally bars recovery when plaintiff's fault exceeds 50 percent.

Duty to defend

A liability insurer's duty to defend is broader than the duty to indemnify and arises when the complaint alleges facts potentially within coverage, even if groundless.

Res ipsa loquitur

A doctrine allowing an inference of negligence when the injury-causing instrumentality was in the defendant's control and the accident would not ordinarily occur without negligence.

Exclusive remedy

Workers' compensation generally provides the employee's exclusive remedy against the employer for work-related injury, barring a tort suit except for limited intentional-tort exceptions.

Arising out of employment

A workers' compensation test requiring the injury or illness to have a causal connection to the employment, not merely occur at the workplace.

Temporary total disability

Workers' compensation wage-replacement benefit paid while an injured employee is unable to work at all during recovery, subject to statutory waiting periods and duration rules.

CT workers comp coverage

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