NC Claims Adjuster key terms

A principle holding that an insured should be restored, financially, to roughly the same position as before a loss, no better and no worse. It underlies policy limits, deductibles, and actual cash value settlements.

A financial stake in the person or property insured such that the insured suffers a genuine economic loss if a covered event occurs. For property claims it generally must exist at the time of loss.

The mutual duty of insurer and insured to deal honestly and to disclose material facts when applying for coverage and when handling a claim. A serious breach can let the other party rescind or deny coverage.

The insurer's right, after paying a claim, to step into the insured's shoes and pursue recovery from the party who caused the loss. It helps hold down premiums and prevents double recovery.

The dominant, uninterrupted cause that sets a loss in motion and produces the result without which the loss would not have happened. It determines whether a loss falls within a policy's covered perils.

The cost to repair or replace damaged property minus depreciation, often described as replacement cost less depreciation. Most property policies use this method unless replacement cost coverage is purchased.

The amount needed to repair or replace damaged property with new materials of like kind and quality, without deduction for depreciation. Payment is still capped by the policy limit.

The portion of each loss the insured must absorb before the insurer pays anything. Deductibles reduce small claims, control premiums, and are subtracted before policy limits apply.

A property policy provision requiring the insured to carry insurance equal to a stated percentage of the property's value. Carrying less triggers a penalty that reduces the claim payment proportionally.

The tendency of higher-risk people or businesses to buy or keep insurance more readily than lower-risk ones. Insurers counter it through underwriting, exclusions, and premium classification.

A license issued by the North Carolina Department of Insurance permitting an insurer to transact specified lines of insurance in the state. Transacting insurance without one is unlawful.

Coverage placed with an eligible non-admitted insurer when admitted carriers decline the risk. Producers placing it must hold the proper license and follow North Carolina eligibility and reporting rules.

A state-created organization that develops and files rates and rating rules, mainly for workers' compensation and property insurance, for review and approval by the Commissioner of Insurance.

A statutory entity that pays covered claims of insolvent member insurers, up to stated limits, protecting policyholders and claimants when an admitted carrier becomes financially unable to pay.

The state credential an individual or business must hold to solicit, negotiate, or sell insurance in North Carolina, obtained by examination and application and usually requiring an insurer appointment.

Offering part of a commission, premium, or other valuable inducement to a buyer to persuade the buyer to purchase insurance, when the inducement is not stated in the policy. It is an unfair trade practice.

Ongoing approved coursework that licensees must complete during each renewal period to keep a North Carolina license active and stay current on laws, products, and ethical requirements.

Statutorily prohibited business and claim conduct, such as misrepresentation, coercion, improper delay or denial of claims, and unfair discrimination. Violations can bring fines and license action.

The obligation of a licensee who handles other people's money, such as premiums or claim settlement funds, to hold and account for it properly and never mix it with personal funds.

The most common homeowners form. It covers the dwelling and other structures on an open-peril basis, while personal property is covered only for the named perils listed in the form.

The standard family auto form covering liability, medical payments, uninsured motorists, and physical damage for owned vehicles and, in limited situations, borrowed or rented ones.

A liability form for businesses covering bodily injury and property damage arising from premises, operations, products, and completed work, written on either an occurrence or claims-made basis.

A liability policy that covers claims first made against the insured during the policy period, no matter when the injury happened, usually limited by a retroactive date.

A person or organization, such as a landlord or general contractor, added to another party's policy and given coverage for liability arising out of the named insured's operations or premises.

Pays reasonable medical expenses for injured persons regardless of fault, up to a stated limit, typically for guests on an insured premises or passengers and others hurt in an insured vehicle.

Coverage that pays extra costs to rebuild to current building codes, or to demolish and clear undamaged remnants, after a covered loss. It is often added by endorsement to property forms.

Pays lost net income and continuing normal operating expenses while a business is shut down by a covered property loss, usually during a defined period of restoration.

Coverage for loss from rising water, generally provided through the National Flood Insurance Program or private markets, and excluded by standard homeowners and commercial property forms.

A policy providing liability limits above the underlying auto, homeowners, or commercial policies, and sometimes dropping down to fill gaps in the primary coverage.

Auto physical damage coverage for damage to the insured vehicle caused by striking another object or by overturning, regardless of fault and subject to a deductible.

The credential North Carolina requires of persons who investigate and settle claims for insurers, obtained through application, examination, and compliance with education and conduct requirements.

A written notice telling the insured that the insurer will investigate or defend a claim while leaving open whether coverage applies, so the insurer does not waive policy defenses.

A signed statement from the insured giving the details, amount, and supporting documentation of a claim, typically required within a set period after the insurer requests it.

A formal, recorded questioning of the insured under oath about a claim, authorized by policy conditions, used to gather facts and test the claim's validity.

A policy clause allowing the insurer and insured to each select a competent appraiser when they disagree only about the amount of loss, with an umpire deciding if the appraisers differ.

Damaged property that the insurer takes ownership of after paying a total loss and then sells to recover some value. Salvage proceeds offset the net claim payment.

A common-law rule followed in North Carolina that generally bars a claimant from recovering any damages when the claimant's own negligence contributed to the injury, subject to limited exceptions.

Insurer conduct that unreasonably delays, denies, or underpays a valid claim, or places its own interests above the insured's, exposing the insurer to damages beyond the policy.

The dollar amount an adjuster may offer or pay on a claim without getting further approval from a supervisor or carrier, set by company guidelines and the adjuster's experience level.