HI Claims Adjuster key terms

The state agency, part of the Department of Commerce and Consumer Affairs, that licenses insurers, producers, and adjusters, enforces Hawaii's insurance code, and investigates consumer complaints about claims handling.

Hawaii's insurance code. It sets the statutory rules for insurer licensing, policy forms, rates, trade practices, and claim conduct, and it is the source of most Hawaii-specific material tested on this exam.

Conduct prohibited by Hawaii law, such as misrepresenting policy terms, failing to investigate promptly, or offering unreasonably low settlements; the Insurance Division may investigate and penalize insurers that engage in it.

A Hawaii residual-market insurer created by statute to offer basic property coverage, including hurricane and lava risk, to owners who cannot buy insurance from ordinary carriers.

A state fund created after Hurricane Iniki to make hurricane insurance available in Hawaii when private insurers will not write it, and to support the property residual market.

Hawaii's motor vehicle insurance statute (HRS chapter 431:10C) requiring owners to carry personal injury protection, which pays medical and wage-loss benefits regardless of fault and restricts lawsuits unless a threshold is met.

First-party no-fault coverage that pays the insured's own medical bills, lost wages, and related expenses after a motor vehicle accident, up to the policy limit, no matter who caused the crash.

The no-fault limit on the right to sue for pain and suffering. In Hawaii, a crash victim generally must show medical expenses above a set amount or a serious injury before filing suit.

A statutory association of insurers that pays certain claims of policyholders when a member insurer becomes insolvent, up to the limits set in Hawaii law, so covered claims are not left unpaid.

The credential Hawaii's Insurance Division issues to independent and public adjusters who investigate, negotiate, or settle claims for compensation; salaried company staff adjusters are generally exempt from the requirement.

The principle that insurance should put the insured back in roughly the same financial position as before the loss, no better and no worse, and never allow a profit from a claim.

A financial stake in the person or property insured, such that the insured would lose money if it were damaged or destroyed. It must exist at the time of loss for a claim to be paid.

The value of damaged property at the time of loss, commonly calculated as replacement cost minus depreciation. Policies that do not promise replacement cost settle claims on this basis.

The amount needed to repair or replace damaged property with new materials of similar kind and quality, with no deduction for depreciation. Many policies pay it only after repairs are completed.

A property policy condition requiring the insured to carry limits equal to a stated percentage of the property's value; if coverage falls short, the claim payment is reduced by a penalty.

The portion of a covered loss the insured must pay before the insurer pays anything. It can apply per occurrence, per policy period, or per peril, as the policy specifies.

The insurer's right, after paying a claim, to stand in the insured's place and pursue the party that caused the loss, recovering what was paid and preventing double payment.

The event that sets in motion an unbroken chain of events producing a loss, without which the loss would not have happened. Adjusters use it to decide whether a covered peril caused the damage.

The liability insurer's obligation to provide and pay for a lawyer to defend the insured against claims that could fall within coverage; it is broader than the duty to pay damages.

A written notice telling the insured that the insurer will defend a claim but keeps the right to deny coverage later, which protects coverage defenses from being waived.

The adjuster's duty to investigate thoroughly, evaluate fairly, explain decisions honestly, and pay covered claims promptly; failing this standard can expose the insurer to bad-faith liability.

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

A sworn statement from the insured setting out the details and amount of a claim, usually required within a stated time after the insurer requests it and a common condition of property policies.

A formal interview of the insured, conducted under oath as the policy requires, used to gather facts about a claim that is complex, suspicious, or unusually large.

The continuing written record of a claim: contacts, investigation, estimates, coverage analysis, reserves, and payments, which supports each decision and shows compliance during a review.

The maximum amount an adjuster may offer or pay on a claim without getting approval from a supervisor or the insurer, set by company guidelines and the adjuster's experience.

A situation where an adjuster's personal, financial, or family ties could improperly influence claim decisions; it must be disclosed and avoided so handling stays fair and unbiased.

A policy that pays only for the causes of loss it lists, such as fire, windstorm, or theft. The insured must show that a listed peril caused the damage.

A policy that covers all risks of direct physical loss except those it specifically excludes, so the insurer, not the insured, must show that an exclusion applies.

A separate deductible, often a percentage of the dwelling limit, that applies to hurricane losses. It is common in Hawaii policies and can be much larger than the standard deductible.

Coverage that pays the extra cost of temporary housing, meals, and similar needs when a covered loss makes the insured's home unfit to live in.

The policy process for settling a dispute over the amount of a loss, in which each side picks an appraiser and the appraisers choose an umpire if they disagree.

The decrease in property value caused by age, wear and tear, or obsolescence. It is subtracted from replacement cost to calculate actual cash value.

Physical harm, sickness, disease, or death sustained by a person, as liability policies define it. Most forms do not treat emotional distress alone as bodily injury.

A claim made by someone other than the insured against the insured for injury or damage, handled under liability coverage and requiring both a defense and possible payment.

A rule that reduces an injured person's recovery by their own share of fault. Hawaii's modified version bars recovery when the plaintiff's negligence is greater than the defendants' combined negligence.

Coverage that pays the insured's damages when the driver who caused the crash has no insurance or limits too low to cover the loss.

The adjuster's estimate of what a claim will ultimately cost, set when the claim is opened and changed as facts develop; reserves drive the insurer's financial reporting.

The deadline for filing a lawsuit. In Hawaii it is generally two years for personal injury and property damage claims and six years for written contracts.