ID Claims Adjuster cheat sheet

Indemnity restores the insured to approximately the pre-loss financial position; the payment equals loss minus deductible, capped at the policy limit.

Insurable interest must exist at policy inception for property coverage and at the time of loss for life coverage.

Utmost good faith imposes disclosure duties on both parties; material misrepresentation by the insured can void coverage.

Actual cash value (ACV) = replacement cost minus depreciation; replacement cost value (RCV) pays new-for-old without depreciation deduction.

Coinsurance formula for property: payment = (limit required by coinsurance percentage ÷ limit carried) × loss, never exceeding the policy limit.

Proximate cause is the dominant, uninterrupted cause of loss; remote causes do not trigger coverage under named-peril forms.

Subrogation transfers the insured's recovery rights against a negligent third party to the insurer after payment, preventing double recovery.

A deductible is subtracted before applying the limit; a self-insured retention applies to liability claims and is not insurance.

The Idaho Department of Insurance, headed by the Director of the Department of Insurance, regulates insurers, producers, and adjusters under Idaho Code Title 41.

Idaho resident adjuster applicants must pass the required examination, file a fingerprint-based background check, and pay the license fee; licenses renew on a biennial cycle tied to the licensee's birth date.

Adjusters must notify the Department of a change of address or legal name within the timeframe set by rule and report administrative actions or criminal convictions.

Continuing education for licensed adjusters must be completed each renewal period, with a portion dedicated to Idaho-specific law and ethics as prescribed by rule.

Idaho's unfair claim settlement practices statute (Idaho Code § 41-1329) prohibits misrepresenting policy provisions, failing to acknowledge claims promptly, and offering unreasonable settlements.

Acting as an adjuster without a license, or misappropriating premium or claim funds, is grounds for license suspension, revocation, and civil penalties.

Idaho's standard fire policy provisions and the 1-year suit limitation for property claims apply unless a statute or endorsement provides otherwise.

The Director may examine insurer and adjuster records; licensees must keep claim records available for the period required by Idaho rule.

HO-3 covers the dwelling on an open-peril basis and personal property on a named-peril basis; HO-5 covers both on an open-peril basis.

Coverage A is the dwelling, B is other structures, C is personal property, D is loss of use, E is personal liability, and F is medical payments to others.

Standard HO percentages of Coverage A are typically 10% for other structures, 50-70% for personal property, and 30% for loss of use, subject to endorsement.

The CGL occurrence form covers bodily injury and property damage during the policy period; the claims-made form requires the claim be reported within the retroactive date and extended reporting period.

Business income coverage pays net income loss plus continuing operating expenses during the period of restoration, often with a 72-hour waiting period for civil authority.

Commercial property causes-of-loss forms include basic, broad, and special; the special form covers all risks except those excluded.

Flood is excluded under standard homeowners and commercial property forms and is written separately through the NFIP or private flood insurers.

Workers' compensation provides statutory benefits for work-related injury regardless of fault; employers' liability covers the employer's tort exposure.

Claim handling sequence: acknowledge, investigate, evaluate coverage and damages, negotiate, settle, and document the file.

Reservation-of-rights letters preserve the insurer's coverage defenses while investigation continues and must state the specific policy provisions at issue.

Proof of loss is a sworn statement of the insured's claim; the insurer may require it within a stated period after loss.

A claim is payable when the insured has complied with all policy conditions; payment timing follows the state's prompt-pay statute and policy terms.

Comparative negligence reduces a claimant's recovery by their percentage of fault; Idaho follows modified comparative negligence with a 50% bar.

Salvage is property remaining after a loss that the insurer may take and sell; subrogation is recovery from a liable third party.

A total loss on a vehicle is generally declared when repair cost exceeds the actual cash value or a state-set percentage of it.

Documentation should include photographs, witness statements, estimates, and a claim log recording every contact and decision.

An adjuster owes a fiduciary duty to the insurer and a duty of good faith and fair dealing to the insured and claimants.

Idaho law prohibits an adjuster from representing both the insurer and the claimant in the same claim due to conflict of interest.

A public adjuster represents the insured for compensation; a company or independent adjuster represents the insurer.

Bad-faith exposure arises from unreasonable delay, denial without investigation, and failure to explain the basis for a denial.

Privacy laws require safeguarding nonpublic personal information and limiting disclosure to those with a legitimate claims need.

Statements made during a claim investigation may be discoverable; adjusters must avoid speculation about fault or coverage in written communications.

Unfair trade practice statutes prohibit coercion, intimidation, and misrepresentation of policy terms during claim negotiation.

Adjusters must disclose any financial interest in a repair facility or contractor and must not steer insureds for personal gain.