NH Claims Adjuster key terms

The principle that insurance restores a policyholder to roughly the same financial position held before a loss, no better and no worse. It limits recovery to actual loss and underpins most property claims settlements.

A financial stake in the person or property insured such that the policyholder benefits from its continuing existence and suffers loss from its damage. It must exist at policy inception and, for property, at the time of loss.

The mutual duty of insurer and insured to deal honestly and disclose material facts. Breach, such as concealing a known hazard, can give the insurer grounds to rescind coverage.

A false statement on an application or claim that would have influenced the insurer's decision to issue coverage or set its price. Materiality, not intent, generally determines the insurer's remedy.

The intentional withholding of information that the insured has a duty to disclose. In insurance it can void coverage even without a direct false statement, especially where the hidden fact affects risk.

The risk that a person behaves less carefully, or acts dishonestly, because insurance removes some of the financial consequence. Insurers screen for it through underwriting questions, inspections, and claims investigation.

The dominant, efficient cause that sets in motion an unbroken chain of events leading to a loss without interruption. It decides whether a loss falls within an insured peril.

A cause of loss specifically listed in the policy, such as fire, windstorm, or theft. Losses from unlisted causes are generally not covered under a named-peril form.

A coverage form that insures risks of direct physical loss unless the cause is specifically excluded. The burden falls on the insurer to show an exclusion applies rather than on the insured to show coverage.

A policy provision that removes specified losses, property, or persons from coverage. Common examples include intentional acts, earth movement, and ordinance or law costs.

The amount of a covered loss the insured absorbs before the insurer pays. It reduces premium and discourages small claims, and it is applied before applying coverage limits.

A property provision requiring the insured to carry limits equal to a stated percentage of property value. If limits fall short, recovery is reduced proportionally, penalizing underinsurance.

The value of damaged property measured as replacement cost less depreciation, reflecting its condition and age at the time of loss. It is the default valuation method in many property forms.

The cost to repair or rebuild with new materials of like kind and quality, without deducting for depreciation. It often requires carrying adequate limits and may be capped by a percentage of coverage.

The reduction in property value from age, wear, use, or obsolescence. Adjusters calculate it to convert replacement cost to actual cash value.

Coverage that pays additional living expenses, or fair rental value, when a covered loss makes the dwelling uninhabitable. It typically applies for a stated time or dollar limit.

The reasonable increase in living costs, such as temporary housing and meals, incurred while a residence is unusable after a covered loss. Receipts are required and normal expenses are subtracted.

Coverage for lost net income and continuing expenses when a covered physical loss shuts down operations. The period of restoration and a waiting period usually define the payout.

The time reasonably required to repair or replace damaged property so business resumes, beginning after the loss and ending when operations could continue with reasonable speed. It caps business interruption recovery.

A loss produced by two or more causes acting together, where one may be excluded and another covered. Policies and case law use anti-concurrent causation language or efficient-cause analysis to resolve it.

An accident, including continuous or repeated exposure to substantially the same general harmful conditions, that results in bodily injury or property damage. It triggers liability coverage under occurrence-based forms.

Liability coverage that responds to claims first made against the insured during the policy period, regardless of when the injury occurred. A retroactive date limits how far back coverage reaches.

The earliest date from which covered acts or injuries are eligible under a claims-made policy. Losses from conduct before that date are excluded.

A demand by someone other than the insured, alleging the insured caused injury or damage and seeking payment. The insurer owes duties to defend and indemnify under liability coverage.

A claim by the policyholder against their own insurer for damage to their own property or for their own injury. Payment is governed by the property or medical payments provisions.

The insurer's obligation to provide legal counsel and pay defense costs for covered claims. It is broader than the duty to indemnify and can apply even when coverage is uncertain.

A written notice that the insurer will handle a claim while continuing to investigate coverage, preserving its right to deny later. It avoids waiver of coverage defenses.

Unreasonable or dishonest handling of a claim, such as delaying without cause or denying without a reasonable basis. It can expose the insurer to extra-contractual damages.

Statutorily prohibited conduct such as misrepresenting policy terms, failing to investigate promptly, or offering far less than a reasonable evaluation. New Hampshire regulates these acts under its insurance trade practices law.

A sworn statement from the insured detailing the amount, date, and circumstances of a loss, often required within a set period after the insurer's request. It supports the claim and can be a condition precedent to payment.

The insurer's settlement of a covered claim, including the amount and timing of payment after valuation, deductible, and limits are applied. Prompt payment duties are set by policy and state law.

The insurer's right to recover paid claim amounts from a third party who caused the loss, after the insured has been made whole. It prevents double recovery and shifts cost to the responsible party.

Damaged property the insurer takes title to after paying a total loss claim, then sells to offset its payout. The salvage value reduces the net claim cost.

A loss where repair cost approaches or exceeds the property's value, or where the item cannot be restored. Insurers may settle at actual cash value and take salvage.

A team within an insurer that investigates suspected fraudulent or exaggerated claims. Adjusters refer suspicious indicators, such as inconsistent statements or staged accidents, to the unit.

Intentional deception for financial gain in obtaining or claiming insurance benefits, such as inflating damages or staging a loss. It is a crime and grounds for denial and referral to authorities.

A regulatory review of an insurer's sales, underwriting, and claims practices for compliance with state law. Findings can lead to fines, corrective orders, or license action.

The requirement that individuals selling or negotiating insurance hold a state license, meet prelicensing education and exam requirements, and complete continuing education. New Hampshire licenses producers through its insurance department.

The license an insurer must obtain from a state to transact insurance there. Operating without one is unauthorized insurance and can affect claim obligations and penalties.