CT Claims Adjuster key terms

A core insurance principle holding that an insured should be restored to roughly the same financial position as before a loss, but never better off. Recovery is therefore limited to the actual amount of the loss.

A financial stake in the person or property insured such that the insured would suffer a real economic loss if a loss occurred. Property insurance requires it to exist at the time of loss.

The principle that insurer and insured must deal honestly and disclose material facts to each other. It underlies the doctrines of misrepresentation, concealment, and warranty that can void coverage.

The insurer's right, after paying a claim, to stand in the insured's shoes and pursue the party that caused the loss. It prevents double recovery and shifts the cost to the responsible party.

The value of damaged property calculated as replacement cost minus depreciation, or sometimes as fair market value. It is the valuation method used when a policy settles losses on an ACV basis.

The cost to repair or replace damaged property with new materials of like kind and quality without deducting for depreciation. Payment is often conditioned on the property actually being repaired or replaced.

A property policy condition requiring the insured to carry insurance equal to a stated percentage of the property's value. If the insured carries less, claim payments are reduced proportionally.

The state agency that regulates insurers, producers, and adjusters in Connecticut. It licenses adjusters, examines market conduct, and enforces the state's insurance statutes and regulations.

A licensed adjuster hired and paid by the insured to prepare, document, and negotiate a first-party property claim. Connecticut licenses public adjusters separately from company and independent adjusters.

Acts prohibited under Connecticut insurance law, such as misrepresenting policy provisions, failing to investigate promptly, or denying a claim without a reasonable basis. Violations can bring regulatory penalties and bad-faith exposure.

A statutory entity that pays covered claims of policyholders of insolvent insurers, funded by assessments on member insurers. It is not a state agency, and the claims it pays are subject to limits.

A claim by an insured against their own insurer for their own loss or injury, such as a fire damage claim presented under a homeowners policy.

A claim brought against an insured by another person seeking compensation for bodily injury or property damage, handled under the insured's liability coverage.

A written notice in which the insurer agrees to investigate or defend a claim while preserving the right to deny coverage later. It is used when coverage facts are unclear or disputed.

A formal, usually sworn statement by the insured describing the date, cause, and amount of a loss. Policies require it within a stated period as a condition of payment.

An insurer's unreasonable or dishonest handling of a claim, such as denying without adequate investigation or delaying payment without cause. It can expose the insurer to damages beyond policy limits.

The standard policy covering private passenger autos, typically including liability, medical payments, uninsured and underinsured motorist, and physical damage coverages, along with exclusions and conditions.

Coverage for the insured's bodily injury and, in some states, property damage caused by a driver who has no liability insurance or who leaves the scene of a hit-and-run.

Coverage that pays the insured's uncompensated damages when the at-fault driver's liability limits are too low to cover the loss. Connecticut requires insurers to offer it.

Physical damage coverage for damage to, or loss of, the insured auto caused by striking another object or by overturn, subject to a deductible and policy limits.

Combining uninsured or underinsured motorist limits from more than one covered vehicle or policy to increase available benefits. Whether it is permitted depends on policy language and state law.

The most widely used homeowners form. It insures the dwelling and other structures on an open-peril basis and personal property against listed named perils.

Homeowners coverage for household contents, both on and off the residence premises, usually on a named-peril basis and subject to special dollar limits for categories such as jewelry, cash, and silverware.

Homeowners loss of use coverage that pays the extra cost of temporary housing and normal living costs when a covered loss makes the residence uninhabitable, usually for a stated time period.

A policy dispute resolution method for the amount of loss. Each party selects a competent appraiser, and an umpire resolves differences, producing an award that settles the value question.

The standard commercial liability policy covering sums the insured becomes legally obligated to pay for bodily injury and property damage arising from covered occurrences involving premises, operations, products, or completed work.

Occurrence policies respond to injury or damage that takes place during the policy period, whenever a claim is later made. Claims-made policies respond to claims first made during the period, subject to any retroactive date.

Commercial property coverage that replaces net income and continuing normal operating expenses, such as payroll and rent, during the period a business is shut down by a covered loss.

A person or organization, such as a landlord or general contractor, given coverage under another party's liability policy by endorsement, usually limited to liability arising from the named insured's work or premises.

Failure to use the degree of care a reasonably prudent person would use under similar circumstances, resulting in harm. Its elements are duty, breach, causation, and damages.

A fault-sharing rule that reduces an injured party's recovery by their own percentage of negligence but bars recovery entirely once their negligence reaches 51 percent or more. Connecticut follows this approach.

The area of law governing a property owner's or occupier's duty to persons on the property, with the duty varying by the visitor's status as an invitee, licensee, or trespasser.

Legal responsibility imposed on one party for the negligent acts of another, such as an employer's liability for an employee's conduct under the doctrine of respondeat superior.

The insurer's obligation to provide a legal defense for a claim that potentially falls within coverage. It is broader than the duty to indemnify and is triggered by the allegations, not the final outcome.

The rule that workers' compensation benefits are an injured employee's exclusive remedy against the employer for a work-related injury, replacing tort suits except in limited circumstances such as intentional acts.

The two-part test for compensability: the injury must result from a risk connected with the employment and must occur within the time, place, and activities of the job.

Wage-replacement benefits paid to an injured worker who is unable to work at all during recovery. Payments are a percentage of the worker's average weekly wage, subject to a state maximum.

The state agency that administers the Connecticut Workers' Compensation Act, resolves disputes through informal and formal hearings, and enforces compliance by employers and insurers.

An illness or condition caused by work-related exposure or repetitive activity over time rather than a single accident, compensable when the employment is a substantial contributing factor.