CT Public Adjuster flashcards

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

Indemnity principle

The rule that an insurance payment restores the insured to the approximate pre-loss financial position. It justifies deductions for depreciation and betterment so the insured does not profit from a loss.

Insurable interest

A financial stake in the property or person insured such that the insured suffers a loss from the event. It must exist at policy inception for property coverage and at loss for life coverage.

Utmost good faith

The mutual duty of insurer and insured to deal honestly and disclose material facts. A material misrepresentation by the insured can allow the insurer to rescind the policy.

Subrogation

The insurer's right, after paying a claim, to pursue a negligent third party in the insured's place. It prevents the insured from recovering twice for the same loss.

Actual cash value

Replacement cost minus depreciation. It is the most common valuation basis for older property and reflects what the damaged item was worth just before the loss.

Coinsurance formula

Loss payment equals limit carried divided by limit required, multiplied by the loss, capped at the policy limit. The required limit is the coinsurance percentage times the value at loss.

Deductible

The amount of a covered loss the insured absorbs before the insurer pays. It applies per occurrence or per policy period as the form states.

HO-3 policy form

A homeowners form covering the dwelling and other structures on an open-peril basis, while personal property is covered only for named perils listed in the form.

HO-5 policy form

A homeowners form that covers both the dwelling and personal property on an open-peril basis, subject to the exclusions stated in the policy.

Coverage C personal property

The homeowners coverage for the insured's household contents, usually subject to special limits for categories such as jewelry, cash, and silverware.

Coverage D loss of use

Pays additional living expenses and fair rental value when a covered loss makes the residence uninhabitable, typically for a stated time period after the loss.

Business income coverage

Pays net income plus continuing normal operating expenses during a period of restoration, less any expenses that stop while the business is closed.

Occurrence trigger

Liability coverage is triggered by bodily injury or property damage that occurs during the policy period, regardless of when the claim is later reported.

NFIP waiting period

Flood coverage under the National Flood Insurance Program generally takes effect 30 days after purchase, with limited exceptions such as lender-required coverage at a new loan closing.

Difference in conditions policy

A form that fills gaps left by a standard property policy, covering perils such as flood or earthquake that the underlying form excludes.

Workers compensation employer liability

The part of a workers compensation policy that responds to third-party suits against the employer arising from a work-related injury, beyond statutory benefits.

Prompt claim investigation

The adjuster's duty to begin investigating promptly after notice, verifying coverage, inspecting the loss, and documenting damage before evidence deteriorates.

Proof of loss

A sworn statement by the insured setting out the amount claimed and supporting facts. The policy sets a deadline for submitting it after the insurer requests it.

Reservation of rights

A written notice that the insurer is investigating or paying a claim while preserving the right to deny coverage later for reasons still under review.

Claim file documentation

The record of photographs, measurements, inventories, pricing sources, depreciation, and correspondence that supports each payment or denial decision in the claim.

Salvage recovery

The value recovered by selling or disposing of damaged property after the claim is paid. The insurer's salvage rights must be preserved during the adjustment.

Partial payment without waiver

An advance payment on an undisputed portion of a claim that does not waive the insurer's right to dispute or deny the remaining amount.

Scope of damage

A line-by-line listing of damaged items with quantities and unit costs for labor and materials, forming the basis for the repair or replacement estimate.

Connecticut public adjuster license

A credential issued by the Connecticut Insurance Department after application, examination, and fee payment, authorizing representation of insureds in first-party claims.

Written adjuster contract

A signed agreement between the public adjuster and the insured that states the services and the compensation as a percentage of recovery or fixed fee.

Solicitation at loss scene

Connecticut restricts public adjusters from soliciting business at the scene of a loss before a reasonable time has passed, protecting distressed insureds.

Unfair trade practices

Statutorily prohibited conduct including misrepresenting policy terms, unreasonably delaying payment, and failing to investigate a claim reasonably.

Department enforcement authority

The Connecticut Insurance Department may examine licensees, accept consumer complaints, and suspend or revoke a license for dishonest or fraudulent practices.

Fiduciary duty to insured

The public adjuster's obligation to act in the insured's interest and to handle claim proceeds and client funds without creating a conflict of interest.

Disclosure of financial interest

A public adjuster with an ownership or compensation interest in a contractor or vendor on the loss must disclose it in writing before the insured signs.

Confidentiality of client information

Client records and personal information may not be disclosed without authorization, except where law or regulation requires disclosure.

Claim inflation

Deliberately overstating damage or accepting a knowingly inflated estimate. It is fraud and grounds for license discipline and criminal liability.