KY Claims Adjuster flashcards
KY Claims Adjuster · Build recall with a focused review session.
32 cards. Read the term and the definition here. The deck at the top of this page is optional.
- Insurable interest
- A financial stake in the subject matter such that loss causes economic detriment; property insurance requires it at policy inception, life insurance at the insured's death.
- Actual cash value
- Indemnity valuation equal to replacement cost minus depreciation; used when the policy does not provide replacement cost or the insured fails to repair or replace.
- Proximate cause
- An unbroken chain of events in which a covered peril sets an excluded peril in motion, bringing the resulting loss within coverage.
- Subrogation
- After paying a covered loss, the insurer acquires the insured's legal rights against the responsible third party, preventing double recovery by the insured.
- Coinsurance clause
- Property condition requiring the insured to carry insurance equal to a stated percentage of replacement cost; a penalty applies when the limit is inadequate.
- Replacement cost coverage
- Pays the cost to repair or replace damaged property with new property of like kind and quality, without depreciation, if the insured repairs or replaces.
- HO-3 policy
- Homeowners form insuring the dwelling and other structures on an open-peril basis and personal property on a named-peril basis.
- Loss payable clause
- Policy provision protecting a lender's interest by allowing the lender to receive loss payments up to its interest and often to receive notices.
- Business income coverage
- Covers lost net income and continuing normal operating expenses during the period of restoration after a covered property loss.
- Ordinance or law exclusion
- Excludes increased costs to repair or rebuild required by building codes or laws, unless limited coverage is added by endorsement.
- Occurrence policy
- Liability policy responding to bodily injury or property damage that occurs during the policy period, regardless of when the claim is reported.
- Claims-made policy
- Liability policy responding to claims first made during the policy period, subject to any retroactive date and reporting requirements.
- Additional insured
- A person or organization granted insured status by endorsement, usually for liability arising from the named insured's operations or premises.
- Pure comparative negligence
- Kentucky rule reducing a claimant's recovery by the claimant's percentage of fault; recovery is not barred unless the claimant is 100 percent at fault.
- Personal injury protection
- Kentucky no-fault auto coverage, commonly $10,000, paying medical expenses, lost wages, and certain other economic losses without proving fault.
- Kentucky adjuster license
- A license issued by the Kentucky Department of Insurance authorizing a person to investigate or settle claims for compensation; public adjusters represent insureds.
- Public adjuster
- An adjuster licensed in Kentucky who contracts with and represents the insured, rather than the insurer, in preparing and negotiating a claim.
- KRS 304.12-230
- Kentucky's Unfair Claims Settlement Practices Act; it defines unfair claim practices and supports regulatory action and bad-faith litigation.
- Continuing education requirement
- Kentucky adjusters complete 24 credit hours every two years, including 3 hours of ethics, to renew their licenses.
- Emergency adjuster license
- A temporary Kentucky license issued during a declared catastrophe that allows limited claims adjusting for a specified period.
- Commissioner of Insurance
- Kentucky's chief insurance regulator, appointed to administer the insurance code, issue licenses, examine insurers, and enforce unfair practice laws.
- First notice of loss
- Initial claim report documenting date, time, policy, insured, loss location, cause, injuries, witnesses, and police or fire report information.
- Reservation of rights
- Letter preserving the insurer's coverage defenses while investigation continues; it does not deny the claim or waive coverage defenses.
- Proof of loss
- A sworn statement from the insured stating the amount, cause, and circumstances of loss, required by policy conditions within a stated deadline.
- Nonwaiver agreement
- A signed agreement allowing the insurer to investigate and defend without waiving its right to deny coverage later.
- Claim diary
- A scheduling record in the claim file that sets follow-up dates for investigation, coverage decisions, payments, and communications.
- Total loss valuation
- For a vehicle, actual cash value based on market value, plus applicable taxes and fees, less deductible and salvage value.
- Unfair claim practice
- Under Kentucky law, conduct such as misrepresenting policy terms, delaying investigation, refusing to pay without reasonable basis, or failing to explain denial.
- Bad faith
- An insurer's breach of the duty to act in good faith and fair dealing; Kentucky first-party bad faith requires obligation, breach, causation, and damages.
- Settlement release
- A written agreement ending the claim in exchange for payment; it identifies parties, claim, amount, and scope of release.
- Time-limit demand
- A claimant's offer to settle within policy limits if accepted by a stated deadline, creating excess exposure if the insurer unreasonably fails to respond.
- Lien resolution
- Identifying and satisfying Medicare, Medicaid, ERISA, workers compensation, or other liens from settlement proceeds before final distribution.