ID Claims Adjuster flashcards

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

Indemnity principle

Insurance restores the insured to approximately the pre-loss financial condition, no better and no worse. Payment equals covered loss minus deductible, capped by the policy limit.

Insurable interest

A financial stake in the person or property insured such that loss would cause monetary harm. Required at policy inception for property and at loss for life insurance.

Actual cash value

The replacement cost of damaged property minus depreciation for age and condition. It is the default valuation method in many property policies unless replacement cost is endorsed.

Coinsurance clause

A property provision requiring the insured to carry a minimum percentage of value. Payment is reduced proportionally when the carried limit falls short of that requirement.

Proximate cause

The dominant, efficient cause that sets the loss in motion without interruption. Coverage under named-peril forms depends on this cause being a covered peril.

Subrogation right

After paying a claim, the insurer acquires the insured's legal rights to recover from the negligent third party responsible for the loss, preventing double recovery by the insured.

Idaho Department of Insurance

The state agency headed by the Director that licenses insurers, producers, and adjusters, examines records, and enforces Idaho Code Title 41 insurance laws.

Idaho adjuster licensing

Resident adjuster applicants must pass the examination, submit fingerprints for a background check, pay fees, and renew biennially to remain authorized to adjust claims in Idaho.

Unfair claim practices

Idaho Code section 41-1329 bars misrepresenting policy provisions, failing to acknowledge claims promptly, and offering settlements without reasonable investigation of available evidence.

License discipline grounds

Acting without a license, misappropriating funds, fraud, and material misrepresentation on an application are grounds for suspension, revocation, and civil penalties by the Director.

Continuing education requirement

Licensed Idaho adjusters must complete continuing education each renewal period, including Idaho-specific law and ethics hours, and retain completion records for audit.

Suit limitation period

The contractual deadline for an insured to sue the insurer over a claim, typically one year after loss under Idaho property forms unless altered by statute.

HO-3 policy form

A homeowners form covering the dwelling on an open-peril basis and personal property on a named-peril basis, with liability and medical payments coverage included.

Coverage A through F

Homeowners coverages: A dwelling, B other structures, C personal property, D loss of use, E personal liability, and F medical payments to others.

Claims-made liability form

Liability coverage triggered when the wrongful act occurs after the retroactive date and the claim is reported during the policy period or extended reporting period.

Occurrence liability form

Liability coverage triggered by injury or damage that happens during the policy period, regardless of when the claim is later reported to the insurer.

Business income coverage

Pays lost net income and continuing operating expenses during the period of restoration after a covered loss, often with a waiting period for civil authority actions.

Flood exclusion

Standard homeowners and commercial property forms exclude flood and surface water. Coverage must be purchased separately through the NFIP or a private flood insurer.

Workers compensation coverage

Provides statutory benefits for work-related injury or disease without regard to fault, plus employers liability coverage for tort suits arising from workplace injury.

Causes of loss forms

Commercial property forms graded by breadth: basic lists named perils, broad adds perils such as water damage, and special covers all risks except exclusions.

Claims handling sequence

Acknowledge the claim, investigate facts and coverage, evaluate damages, negotiate, settle, and document each step in a dated claim file log.

Reservation of rights

A letter preserving the insurer's coverage defenses while investigation continues. It identifies the specific policy provisions in question without denying the claim outright.

Proof of loss

A sworn statement from the insured detailing the amount, date, and cause of loss. The insurer may require it within a stated period after the loss.

Modified comparative negligence

Idaho reduces a claimant's recovery by their percentage of fault and bars recovery entirely when the claimant's fault is 50 percent or greater.

Salvage versus subrogation

Salvage is damaged property the insurer takes and sells after payment. Subrogation is the insurer's recovery right against a liable third party.

Total loss threshold

A vehicle is typically declared a total loss when repair cost exceeds actual cash value or a state-set percentage of that value, triggering salvage title rules.

Claim file documentation

Photographs, estimates, witness statements, coverage analysis, and a contact log recording every communication and decision made during the claim.

Good faith and fair dealing

An implied duty requiring the insurer and its adjuster to handle claims honestly, investigate thoroughly, and communicate promptly with the insured and claimants.

Public versus company adjuster

A public adjuster is hired by and represents the insured for a fee. A company or independent adjuster represents the insurer that assigned the claim.

Conflict of interest

A situation where the adjuster's personal or financial interest could bias claim decisions, such as ownership of a repair shop used for estimates.

Bad faith exposure

Liability arising from unreasonable delay, denial without adequate investigation, or failure to explain the basis for a coverage denial to the insured.

Privacy of claim information

Adjusters must safeguard nonpublic personal information and share it only with parties having a legitimate need related to handling the claim.

Unfair trade practices

Statutes prohibiting coercion, intimidation, misrepresentation of policy terms, and other deceptive conduct during the solicitation and settlement of insurance claims.