LA Claims Adjuster common mistakes
LA Claims Adjuster · Understand the traps and how to avoid them.
Computing a coinsurance penalty on a commercial property or business-income loss without first confirming that the form actually contains a coinsurance clause and what percentage applies - then deducting the 'penalty' from the payment as if it were a second deductible.
Candidates drill the coinsurance formula (limit ÷ required limit × loss) until it becomes reflex, so on exam items built around agreed value, blanket limits, or reporting forms they apply the formula to a policy that has no coinsurance obligation.
What to do instead
Before any math, write the coverage trigger chain in the margin: does the form require a limit of insurance equal to a stated percentage of value? If not, the penalty is zero. Practice five fact patterns where the correct answer is 'no coinsurance applies' and five where it does, and label which line the penalty is charged against (the loss, not the deductible).
Answering questions about the measure of loss by defaulting to the policy limit, or by defaulting to full replacement cost, instead of deriving the payment from the indemnity principle as modified by the form (ACV, RCV, agreed value, functional replacement, other insurance, salvage and subrogation recoveries).
Policy limits are the most visible number in a scenario, and candidates under time pressure anchor on them rather than reading which valuation clause the scenario supplies.
What to do instead
Build a one-page 'measure of loss' decision tree and rehearse it: trigger of coverage → valuation clause named in the form → deductions → other-insurance allocation → recoveries that reduce the net loss. For each practice question, write the valuation clause you relied on before choosing an answer.
Beginning investigation, taking recorded statements, or making a good-faith payment before reducing the coverage analysis to writing - so the file shows activity but no documented determination of which insuring agreement applies and which exclusions are in play.
Candidates treat claims handling as a linear checklist starting with 'contact insured and inspect,' mirroring how the exam's procedural questions are worded, and underestimate how often the answer turns on the order of operations.
What to do instead
Adopt the sequence coverage → damages → payment for every scenario. On the exam, before evaluating damages, state in one sentence which insuring agreement is triggered and whether any exclusion or condition could bar or limit payment; if the answer choices include an activity that precedes coverage analysis, treat it as suspect.
Leaving the claim file without a dated reservation-of-rights or coverage-position letter, without a diary entry for the next required action, and without documentation of what the adjuster actually did on each contact.
Candidates memorize the definition of a reservation of rights but not the fact patterns built around missing documentation, and they answer with what the adjuster 'should have thought' rather than what the file proves.
What to do instead
For each claim-handling question, ask what a regulator or opposing counsel would see in the file on the day of the exam. Any time a question describes a coverage question or a delay, test whether a written, dated communication and a follow-up diary entry exist; if not, that gap is usually the tested error.
Treating the proof of loss as either purely optional or as a hard trigger, and skipping other contractual deadlines - the suit-limitation clause, the examination-under-oath condition, the duties-after-loss list - when answering timeliness questions.
Candidates conflate the proof-of-loss requirement with the statutory payment clock and assume one date drives everything, so they miss items where a contractual condition, not the statute, controls.
What to do instead
Maintain a deadline table per claim type: date of loss, date of notice, date satisfactory proof of loss is received, contractual condition deadlines, and the suit-limitation date. In practice items, identify which document starts which clock before evaluating whether the insurer was late.
Resolving hurricane and storm claims by picking a single 'efficient proximate cause' without checking whether the policy contains an anti-concurrent-causation clause, and without a documented basis for any wind-versus-flood allocation.
Candidates learn one causation rule in the principles domain and carry it into coverage analysis, where the policy wording - not the general rule - governs, and where causation questions are the most heavily examined fact pattern.
What to do instead
Read the lead-in wording of the exclusions in the form. If the clause bars loss 'regardless of whether any other cause contributed concurrently,' state that and apply it before discussing proximate cause. When both perils are present, require an itemized, evidence-based allocation (inspection findings, engineering report, interior-water-line evidence) instead of an unsupported percentage.
Assuming that any total loss becomes payable at the policy limit under Louisiana's valued policy statute, including for personal property, for losses caused by excluded perils, and for losses where the limit exceeds the true value of the structure.
The valued policy rule is memorable and candidates over-apply it, forgetting that it is limited to total loss of the insured immovable property from a covered cause and that covered-cause and exclusion analysis still comes first.
What to do instead
Apply a three-part gate before invoking the statute: is the insured property immovable, is the loss total, and was the cause covered? If any answer is no, return to the actual-loss provisions of the form. Practice two contrast items - one total fire loss of a dwelling, one partial or excluded-cause loss - and write the gate out each time.
Answering that a policy's suit-limitation clause cuts off the insured's claim on whatever date the clause states, without checking whether the clause attempts to shorten the right of action below the period Louisiana law permits in a policy delivered in this state.
Candidates see a date in the form and a date in the scenario and stop there, forgetting that Louisiana restricts contractual shortening of prescription and that the clause may be unenforceable as written.
What to do instead
For every deadline question, ask two things separately: what the policy says, and what Louisiana law allows the policy to say. If the clause shortens the period below the statutory floor, the law controls - verify the current statute and any recent amendment before finalizing the answer.
Applying a single prescriptive period to every Louisiana claim - usually the one-year tort period, or sometimes the ten-year contract period - instead of matching the period to the theory of the claim, including third-party liability claims asserted directly against the insurer.
Candidates learn prescription as one fact to memorize, and the direct-action setting makes it look like the claim against the insurer is 'contractual' when the period is borrowed from the underlying tort.
What to do instead
Classify the claim first: first-party claim on the policy (contract) versus third-party liability claim asserted directly against the insurer (measured by the underlying tort). Write the classification next to the prescription figure every time, and confirm the current Civil Code article and direct-action statute rather than relying on memory.
Missing the start date of the statutory bad-faith clock after satisfactory proof of loss, and therefore failing to recognize when the insured can claim the statutory penalty on the amount due plus attorney fees.
Candidates confuse the bad-faith payment deadline with the proof-of-loss requirement or with a general 'investigate promptly' standard, so they evaluate the insurer's conduct instead of counting days from the right document.
What to do instead
Fix the anchor: the clock runs from receipt of satisfactory proof of loss, not from first notice and not from the inspection. For each scenario, write the receipt date, add the statutory number of days, and compare to the payment or written denial date; then note that a second, separately triggered bad-faith statute carries its own remedy and should be analyzed on its own terms.
Overlooking Louisiana-specific claims-practice and licensing requirements - that persons adjusting claims in the state must be licensed (with temporary or emergency permits available around declared disasters), and that the unfair trade practices law enumerates specific prohibited claims conduct such as failing to acknowledge and act promptly on communications, failing to conduct a reasonable investigation, and offering substantially less than the amount ultimately due.
Candidates treat the law-and-regulations domain as general ethics and skip the enumerated lists, then cannot recognize a fact pattern that maps directly onto one of the listed prohibited acts.
What to do instead
Memorize the enumerated prohibited acts as a checklist and run every 'bad insurer conduct' scenario against it. Separately, confirm licensing status and any emergency-permit bulletin in force on the date of the scenario, since disaster-period rules differ from the standing requirement.