NH Claims Adjuster cheat sheet

Indemnity: the insured is restored to pre-loss financial position, no better and no worse; actual cash value and replacement cost are two valuation methods used to measure that position.

Insurable interest must exist at the time of loss for property insurance; for life insurance it must exist at policy inception. Without it, the contract is void.

Utmost good faith imposes a duty of disclosure on both parties; material misrepresentation by the applicant can void coverage, and concealment is treated the same as misrepresentation.

Fortuity: coverage applies to accidental, unforeseen events. Intentional acts by the insured are excluded, and known pre-existing damage is not a covered loss.

Actual cash value = replacement cost minus depreciation. Replacement cost pays the cost to repair or replace with new property of like kind and quality, without depreciation.

Coinsurance clause: payout = (carried limit / required limit) x loss, capped at the policy limit. Underinsurance reduces recovery proportionally.

Deductible applies per occurrence and reduces the payable loss; a percentage deductible is computed on the Coverage A dwelling limit, not on the loss amount.

Subrogation transfers the insured's right of recovery against a negligent third party to the insurer after payment, preventing double recovery.

Proximate cause is the initiating cause that sets the loss in motion without a break in the chain; it determines whether the peril is covered.

Claim lifecycle: acknowledgment, investigation, coverage determination, damage evaluation, negotiation, payment or denial, and file documentation. New Hampshire requires prompt acknowledgment and a written response to any claim inquiry within a reasonable time.

Reservation of rights letter preserves the insurer's right to deny or limit coverage later while investigation continues; it is not a denial and must state the specific policy provisions at issue.

Proof of loss is a sworn statement of the amount and cause of loss; the policy sets the deadline (commonly 60 days after insurer request), and failure to submit may bar the claim.

First-party bad faith exposure arises from unreasonable delay or denial without reasonable basis; third-party exposure arises from failure to settle within limits when liability is clear.

Comparative negligence in New Hampshire: a claimant more than 50 percent at fault recovers nothing; at 50 percent or less, recovery is reduced by the claimant's percentage.

Documentation standards: photograph damage, record measurements and moisture readings, retain estimates and invoices, and log every contact with the insured and witnesses.

Salvage and subrogation recoveries offset the gross paid loss; net loss = gross loss minus deductible minus salvage minus subrogation recovery.

Total loss settlement uses the vehicle's actual cash value, determined by comparable market data; betterment and prior damage adjustments must be itemized.

Statements must be taken without coercion; recorded statements require consent, and the adjuster should separate factual questions from opinions about fault.

HO-3 covers the dwelling on an open-peril basis and personal property on a named-peril basis; HO-5 extends open peril to personal property. HO-2 and HO-8 are named-peril forms.

HO-3 Coverage A is the dwelling structure; Coverage B is other structures on the residence premises; Coverage C is personal property at 50 percent of Coverage A unless endorsed; Coverage D is loss of use.

HO-3 exclusions include earth movement, flood, ordinance or law, intentional loss, neglect, and wear and tear; flood requires a separate policy or endorsement.

Personal auto policy Part A is liability, Part B is medical payments, Part C is uninsured/underinsured motorists, and Part D is physical damage (collision and other than collision).

Commercial general liability Coverage A covers bodily injury and property damage; Coverage B covers personal and advertising injury; Coverage C covers medical payments regardless of fault.

Business income coverage pays net income plus continuing normal operating expenses during the period of restoration, beginning 72 hours after the loss under many forms.

Umbrella liability sits above underlying auto, general liability, and employers liability limits and may drop down when underlying coverage is exhausted.

Replacement cost on a dwelling policy requires carrying at least 80 percent of the dwelling's replacement cost; below that, settlement is reduced.

Workers compensation is statutory and provides medical benefits and lost wages without regard to fault; employers liability covers suits outside the statutory benefit scheme.

The New Hampshire Insurance Department regulates insurers and producers; RSA 400-A governs insurance department powers, and RSA 402 governs producer licensing.

Producer licenses require prelicensing education, a passing exam, a background check, and continuing education (typically 24 credit hours every two years, including ethics) for renewal.

New Hampshire is a competitive rating state; rates must not be excessive, inadequate, or unfairly discriminatory, and file-and-use procedures apply to many lines.

Unfair claim settlement practices under RSA 417 include misrepresenting policy provisions, failing to act promptly on communications, and refusing to pay without reasonable investigation.

New Hampshire requires insurers to give at least 45 days' written notice of premium increase or cancellation for nonpayment, and 30 days for other cancellation reasons, consistent with policy terms.

Cancellation and nonrenewal must state the specific reason; insureds may request department review, and the commissioner may examine insurer conduct.

New Hampshire has a guaranty association (RSA 404-B) that pays covered claims of insolvent insurers up to statutory limits, funded by assessments on member insurers.

Insurance fraud is a crime under RSA 638; adjusters must report suspected fraudulent claims to the insurer's special investigation unit and cooperate with the insurance fraud bureau.

Commissioner rules on producer conduct prohibit rebating, commingling of premium funds, and misrepresentation of policy terms; commissions must be disclosed on request.