FL Claims Adjuster flashcards

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

Chief Financial Officer

Elected Florida Cabinet officer who heads the Department of Financial Services, which licenses insurance agents and adjusters and oversees consumer services for insurance.

Office of Insurance Regulation

Florida agency under the Financial Services Commission that regulates insurer solvency, rates, forms and market conduct; its Commissioner is appointed rather than elected.

Florida Insurance Guaranty Association

FIGA pays covered claims of insolvent Florida property and casualty insurers, generally up to $300,000 per claim, and is funded by assessments on member insurers.

All Lines Adjuster 6-20

Florida license class authorizing a person to investigate and settle property and casualty claims for insurers; an appointment by an insurer is needed to act.

Public Adjuster Fee Cap

Florida limits a public adjuster's fee to 20 percent of the claim payment, reduced to 10 percent for claims arising from a declared state of emergency.

Continuing Education Requirement

Florida agents and adjusters generally complete 24 hours of approved continuing education every two years, including a 4-hour Law and Ethics Update course.

Indemnity Principle

Insurance restores the insured to approximately the same financial position held before the loss and does not allow the insured to profit from a claim.

Insurable Interest

A financial stake in the subject matter such that a loss causes real monetary harm; required at inception for life and at time of loss for property.

Actual Cash Value

Replacement cost of the damaged property minus depreciation, often calculated as replacement cost times a depreciation factor; it indemnifies for used value.

Coinsurance Formula

Payment equals the insurance carried divided by the insurance required, multiplied by the loss, then reduced by any deductible; it applies when limits are inadequate.

Moral Hazard

A hazard arising from the insured's dishonest tendencies, such as intentionally causing a loss or exaggerating its value to collect insurance money.

Adverse Selection

The tendency of poorer-than-average risks to seek or keep insurance, which can push losses beyond premiums collected unless insurers underwrite carefully.

Subrogation Right

The insurer's right, after paying a loss, to step into the insured's shoes and pursue recovery from the party legally responsible for the damage.

Declarations Page

Policy section identifying the named insured, policy period, limits, deductibles and insured property; it personalizes the contract and controls over conflicting forms.

HO-3 Policy Form

Homeowners form insuring the dwelling on an open-peril basis while personal property is covered for named perils only; the most widely used homeowners form.

Coverage B Other Structures

Homeowners coverage for structures detached from the dwelling, such as fences, sheds and detached garages; the limit is typically 10 percent of Coverage A.

Loss of Use Coverage

Coverage D pays additional living expenses and fair rental value when a covered loss makes the residence premises uninhabitable for a period of time.

Hurricane Deductible Disclosure

Florida requires a residential hurricane deductible, stated as a percentage of Coverage A, to be disclosed conspicuously on the declarations page of the policy.

Mortgagee Clause

Provision giving the lender rights to loss payments and notice, and protecting the lender's interest even when the insured's acts would otherwise void coverage.

Duties After Loss

Policy conditions requiring the insured to give prompt notice, protect property from further damage, cooperate, submit proof of loss and permit inspection.

Replacement Cost Coverage

Pays the cost to repair or replace damaged property with new property of like kind and quality without deducting depreciation, usually after repair is completed.

Reservation of Rights

Written notice that the insurer will continue to defend or investigate a claim while preserving its right to later deny coverage, avoiding a waiver argument.

Proof of Loss

A sworn statement from the insured documenting the date, cause and amount of loss; most property policies require it before payment is made.

Examination Under Oath

A policy condition allowing the insurer to question the insured under oath about a claim; an unjustified refusal can bar recovery under the policy.

Civil Remedy Notice

A notice filed with Florida DFS and the insurer alleging bad faith; the insurer has 60 days to cure before a suit may be filed.

Appraisal Clause

Method for resolving disagreements about the amount of loss, where each party selects a competent appraiser and an umpire resolves differences between them.

Claim File Documentation

Contemporaneous notes, photographs, correspondence and reports kept by the adjuster; Florida market conduct examinations review files for promptness and proper handling.

Fraud Red Flags

Indicators such as recent policy inception, prior losses, inflated inventories, altered documents and inconsistent statements that prompt closer claim investigation.

Twisting

Inducing a policyholder to lapse, surrender or replace an existing policy through misrepresentation in order to sell a new policy; a prohibited trade practice.

Rebating

Offering an inducement not specified in the policy, such as cash or gifts, to persuade a buyer to purchase insurance; prohibited under Florida law.

Unfair Claim Practice

Misrepresenting policy provisions to a claimant or refusing to pay a claim without a reasonable investigation, both violations of Florida trade practices law.

Fiduciary Premium Duty

Licensees who handle premium money hold it in trust for the insurer or insured; commingling it with personal or business funds is prohibited.

Insurance Fraud Reporting

Suspected fraudulent claims are referred to the insurer's special investigation unit and reported to Florida's fraud division; good-faith reports carry immunity.