HI Claims Adjuster flashcards

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

Hawaii Insurance Division

The division of Hawaii's Department of Commerce and Consumer Affairs, headed by the Insurance Commissioner, that licenses insurers and producers and enforces the state Insurance Code in HRS chapter 431.

Hawaii PIP minimum limit

Hawaii's no-fault law requires at least $10,000 per person of personal injury protection, which pays reasonable medical expenses and lost wages regardless of who caused the accident.

Hawaii minimum liability limits

$20,000 per person and $40,000 per accident for bodily injury, plus $10,000 for property damage, are the minimum auto liability limits required of Hawaii vehicle owners.

Hawaii Prepaid Health Care Act

HRS chapter 393 requires Hawaii employers to provide health insurance to employees who work 20 or more hours per week, making Hawaii the only state with such a mandate.

Hawaii Insurance Guaranty Association

A statutory entity that pays covered property and casualty claims of insurers declared insolvent, funded by assessments on member insurers and limited by statutory per-claim caps.

Hawaii Property Insurance Association

Hawaii's residual property market, which offers basic homeowner coverage to owners unable to obtain insurance in the voluntary market, such as in high-risk lava or hurricane areas.

Hawaii unfair claim practices

Acts defined in HRS 431:13-103, including failing to acknowledge claim communications promptly and denying claims without a reasonable investigation, which the Insurance Commissioner may penalize.

Insurable interest

A financial stake in the person or property insured such that the insured suffers actual loss from damage; it must exist at inception for life and at the time of loss for property.

Principle of indemnity

The rule that a property settlement may not exceed the insured's actual financial loss, preventing profit from insurance while recovery remains capped by the policy limit.

Actual cash value

Replacement cost minus depreciation, reflecting the used value of damaged property at the time of loss; many policies define it as replacement cost less physical deterioration.

Coinsurance penalty formula

Payment equals (insurance carried divided by insurance required) times the loss, where insurance required is the coinsurance percentage multiplied by the property value at loss.

Subrogation

The insurer's right, after paying a covered loss, to pursue a legally liable third party in the insured's name; the insured must not impair that right by releasing the tortfeasor.

HO-3 policy

A homeowners form covering the dwelling on an open-peril basis and personal property for named perils only; it is the most common form for owner-occupied homes.

Efficient proximate cause

The doctrine that when a covered and an excluded peril combine to cause a loss, the loss is covered if the covered peril is the dominant, initiating cause.

Reservation of rights letter

A written notice that the insurer will defend a claim while continuing to investigate coverage, preserving its right to deny indemnity later without waiving defenses.

Non-waiver agreement

A document signed by the insured acknowledging that the insurer's investigation or defense does not waive any coverage defense, performing a function similar to a reservation of rights.

Duty of good faith

The insurer's obligation to deal fairly and promptly with its insured; breach can expose the insurer to damages beyond policy limits in a bad-faith action.

Examination under oath

A policy condition allowing the insurer to question the insured under oath about the loss; unreasonable refusal to submit can bar recovery when the insurer is prejudiced.

Proof of loss

A sworn statement, usually on the insurer's form and due within a specified period after request, itemizing the amount claimed and the circumstances of the loss.

Conflict of interest defense

When coverage depends on facts the insurer must litigate while defending the insured, the insured may be entitled to independent counsel paid by the insurer.

Replacement cost coverage

Pays the cost to repair or replace damaged property with new material of like kind and quality without deducting depreciation, subject to the policy limit and replacement conditions.

Ordinance or law coverage

An endorsement that pays the extra cost of repairing or rebuilding in compliance with current building codes, an expense that base dwelling coverage does not provide.

Percentage hurricane deductible

A deductible calculated as a stated percentage of the dwelling limit and applied to losses from a named storm, instead of the flat dollar deductible used for other perils.

Flood versus wind

Standard homeowners forms exclude flood and storm surge, which require a separate flood policy; wind-driven rain is covered only when it enters through an opening made by wind.

Period of restoration

The time reasonably needed to repair or replace damaged property with due diligence, during which business income coverage pays lost profits and continuing normal expenses.

Lava as earth movement

Most standard property forms treat volcanic lava flow as earth movement and exclude it, so Hawaii coverage depends on specific endorsements or residual-market policy forms.

Negligence elements

Duty owed, breach of that duty, causation both actual and proximate, and damages; a claimant in a casualty claim must prove all four elements to recover.

Comparative negligence

A doctrine that reduces a claimant's recovery in proportion to the claimant's own share of fault, rather than barring the claim entirely as contributory negligence would.

Special versus general damages

Special damages are measurable out-of-pocket losses such as medical bills and lost wages; general damages compensate non-economic harm such as pain and suffering.

Claims-made policy

Coverage is triggered by the claim being made or reported during the policy period rather than the injury occurring during it, and the form often includes a retroactive date.

Underinsured motorist coverage

Pays an insured's damages that exceed the at-fault driver's liability limits, up to the UIM limit; Hawaii requires insurers to offer it unless rejected in writing.

Tender of policy limits

An insurer's offer to pay its full liability limit to settle a claim, which can protect the insurer against a later bad-faith claim for an excess judgment.