DE Claims Adjuster key terms

A state-issued credential authorizing a person to investigate, evaluate, and settle insurance claims. Requirements vary by state and by license class, such as public, independent, or company adjuster.

An adjuster hired by and paid by the policyholder to represent the insured's interests in valuing and negotiating a claim against the insurer.

An adjuster who is not an employee of the insurer but contracts with one or more insurers to handle claims on their behalf, often on a per-claim or catastrophe basis.

A staff adjuster employed directly by an insurer and authorized to handle claims arising under that insurer's policies, typically with limited settlement authority set by the employer.

A cooperative arrangement in which one state recognizes another state's adjuster license as satisfying its own licensing requirement, often based on substantially similar standards.

A license issued by a state to an adjuster who lives elsewhere, allowing lawful claim handling within that state, usually applied for through a reciprocal or uniform application process.

A mandated number of approved credit hours an adjuster must complete during each renewal cycle to keep a license active and current on laws and practices.

A model state law, adopted in varying form, that defines prohibited claim conduct such as unreasonable delay, failure to investigate, and bad-faith offer tactics, and authorizes penalties.

A financial stake in the person or property insured such that the insured suffers genuine economic loss if a covered event occurs. It must exist at policy inception and, for property, at the time of loss.

The core insurance concept that a claimant should be restored to roughly the same financial position held before the loss, neither profiting nor losing from it.

A valuation method measuring loss as replacement cost minus depreciation, reflecting what the damaged property was worth immediately before the loss.

The amount needed to repair or rebuild damaged property with new materials of like kind and quality at current prices, without deducting for age or wear.

The reduction in an item's value caused by age, wear and tear, or obsolescence, subtracted from replacement cost to arrive at actual cash value.

A property policy provision requiring the insured to carry coverage equal to a stated percentage of the property's value; failing that, a penalty reduces the claim payment proportionally.

The amount of a covered loss the insured must absorb before the insurer pays, shifting small losses to the policyholder and lowering premium.

The maximum amount an insurer will pay for a covered loss under a given coverage, which caps the claim payment even when the measured loss is higher.

The event or condition that activates a policy's coverage, such as an occurrence during the policy period or a claims-made reporting requirement.

A liability policy covering claims first made or reported during the policy period, regardless of when the underlying incident occurred, subject to any retroactive date.

A liability policy covering injury or damage that takes place during the policy period, no matter how much later the claim is filed against the insured.

A policy provision that removes specified perils, property, persons, or circumstances from coverage, shifting that risk back to the insured.

A situation where covered and excluded perils combine to produce a single loss, forcing the adjuster to apply policy language or state rules to decide how much, if anything, is payable.

Policy wording stating that loss caused by an excluded peril is not covered even if a covered peril also contributed, regardless of the sequence of events.

The dominant, efficient cause that sets in motion an unbroken chain of events leading to a loss, used to determine which peril actually produced the damage.

The mutual duty of insurer and insured to deal honestly and disclose material facts, forming the foundation of insurance contracts and supporting doctrines like misrepresentation and concealment.

A false statement of fact on an application or claim that would have influenced the insurer's decision to issue coverage or pay a claim, potentially voiding the policy.

The voluntary relinquishment of a known right, such as an insurer's right to deny a claim after missing a policy deadline or continuing to handle a claim without reservation.

A legal doctrine preventing a party from asserting a right or defense when its earlier conduct led another party to reasonably rely on it to that party's detriment.

A written notice in which an insurer agrees to defend or investigate a claim while expressly preserving the right to deny coverage later, pending further facts.

An insurer's unreasonable or dishonest handling of a claim, such as denying without investigation or delaying payment without justification, which can expose it to extra-contractual damages.

The standard of prompt, thorough, objective, and documented claim investigation and evaluation owed to insureds, including timely communication of decisions and their bases.

The complete record of a claim, including reports, correspondence, photographs, estimates, notes, and payment records, which documents the investigation and supports the final decision.

A formal, often sworn statement from the insured detailing the date, cause, and amount of loss, submitted within a policy-specified deadline as a condition of payment.

The insurer's right, after paying a claim, to pursue the responsible third party for reimbursement, standing in the insured's shoes and preventing double recovery.

Damaged property the insurer takes over or sells after paying a total loss, with its recovery value offsetting the claim payment.

An improvement in the property's condition resulting from repair with new materials, which the insurer generally does not pay for because it exceeds restoring the pre-loss value.

A law setting the deadline for filing a lawsuit or, in some states, submitting a claim, after which the right to recover is barred.

A regulatory review of an insurer's or adjuster's business practices, including claim handling, underwriting, and complaint records, to test compliance with state law.

The increased likelihood of loss or inflated claiming caused by insurance protection reducing the insured's incentive to avoid or minimize damage.