ME Claims Adjuster flashcards

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

Maine auto liability minimums

Maine requires 50/100/25: $50,000 per person and $100,000 per accident for bodily injury, plus $25,000 for property damage. Uninsured motorist coverage must be offered unless rejected in writing.

Maine comparative negligence rule

A claimant 50% or more at fault recovers nothing. If less than 50% at fault, recovery is reduced by the claimant's percentage of fault.

Unfair Claims Settlement Practices Act

Maine statute 24-A M.R.S. §2436-A listing prohibited claims practices, including unreasonable delay, failure to investigate, and misrepresenting policy provisions.

Actual cash value

Replacement cost minus depreciation. It reflects the pre-loss value of the damaged property rather than the cost to buy new property of like kind and quality.

Coinsurance formula

Recovery equals (limit carried divided by limit required) times the loss, capped by the policy limit, then reduced by the deductible.

HO-3 special form

Covers the dwelling on an open-peril basis and personal property on a named-peril basis. It is the most common homeowners form for owner-occupied dwellings.

Coverage C personal property

Homeowners coverage for personal property, typically 50-70% of the Coverage A limit, with special sublimits for money, jewelry, silverware, and firearms.

Loss of use coverage

Pays additional living expenses and fair rental value when the residence is uninhabitable because of a covered peril, subject to a time or dollar limit.

CGL occurrence trigger

Coverage A of the commercial general liability policy is triggered by bodily injury or property damage caused by an occurrence, meaning an accident or continuous exposure.

Claims-made policy

Coverage applies when the claim is made during the policy period, regardless of when the act occurred, often with an extended reporting period option.

Umbrella versus excess policy

Umbrella policies sit above underlying coverage and may drop down for gaps. Excess policies follow the underlying terms and generally do not fill coverage gaps.

BOP eligibility

Businessowners policies target small-to-medium businesses such as offices, retail, and apartments. Certain classes, including some restaurants and auto dealers, are ineligible.

Business income period of restoration

The period beginning 72 hours after the physical loss and ending when the damaged property is repaired or replaced with reasonable speed.

Equipment breakdown coverage

Covers loss from mechanical or electrical breakdown of covered equipment, a cause typically excluded by property policies as wear and tear.

Workers compensation exclusivity

The exclusive remedy rule bars most employee tort suits against the employer in exchange for no-fault statutory benefits for work-related injuries.

Employer's liability coverage

Part Two of a workers compensation policy covers tort suits by employees not barred by exclusivity, with limits per accident, per employee, and policy aggregate.

Experience modification factor

A premium adjustment based on the employer's loss history compared to its classification average. A factor above 1.0 increases premium; below 1.0 reduces it.

Reservation of rights letter

A written notice preserving the insurer's right to deny coverage later while the investigation continues, identifying the coverage issues under review.

Subrogation

The insurer's right to pursue recovery from a negligent third party after paying the insured's claim, preventing the insured from recovering twice.

Insurable interest

A financial stake in the property or person insured such that loss causes economic harm. Required at the time of loss for property insurance.

Proximate cause

The dominant, efficient cause of a loss. Concurrent causation clauses address losses with both covered and excluded contributing causes.

Open-peril versus named-peril

Open-peril forms cover all risks except those excluded. Named-peril forms cover only the perils specifically listed in the policy.

Mortgage clause

Provides that loss payment goes to the mortgagee to the extent of its interest and grants the mortgagee rights to notice and claim proceeds.

Flood coverage

Water damage from flooding is excluded by standard property policies and must be insured separately through the NFIP or a private flood insurer.

Medical payments coverage

Auto coverage paying medical expenses for the insured and passengers regardless of fault, up to a stated limit per person.

Uninsured motorist coverage

Covers bodily injury caused by a hit-and-run, uninsured, or underinsured driver. Maine requires it unless the insured rejects it in writing.

Personal injury coverage

Liability coverage for offenses such as libel, slander, invasion of privacy, and wrongful eviction, distinct from bodily injury coverage.

Ordinance or law exclusion

Bars payment for increased costs of repairing to current building codes. Endorsements such as HO 04 77 add limited coverage.

Maine adjuster licensing

Adjusters must be licensed under 24-A M.R.S. Chapter 16 to investigate or settle claims for a fee, with limited statutory exceptions.

Maine workers compensation board

The state agency that adjudicates benefit disputes under 39-A M.R.S., separate from the Bureau of Insurance that regulates carriers.

Total loss valuation

Settles a totaled vehicle at market value using comparable vehicle data, not replacement cost, with disclosure of the valuation method to the claimant.

Bad faith claim handling

Unreasonable delay, failure to investigate, or denial without a reasonable basis can expose the insurer to statutory penalties and bad faith liability.

Additional insured endorsement

An endorsement extending liability coverage to another party, such as a general contractor. The scope depends on the endorsement wording.