NV Claims Adjuster cheat sheet

The Nevada Division of Insurance (NVDOI), headed by the Commissioner, licenses insurers, producers, and adjusters and enforces NRS Title 57 and NAC 686.

Nevada adjuster licenses include staff, independent, public, and crop categories; a license requires prelicensing education, an exam, fingerprinting, and a fee, and must be renewed biennially.

Continuing education for Nevada adjusters is 24 credit hours per two-year license term, including 3 hours of ethics; excess credits do not carry over beyond statutory limits.

Nevada requires the Commissioner to approve policy forms and rates for most property and casualty lines; rates must not be excessive, inadequate, or unfairly discriminatory.

Producer and adjuster licenses may be denied, suspended, or revoked for misappropriation, fraudulent practices, or rebating; the Nevada Insurance Guaranty Association handles claims of insolvent insurers.

Nevada law prohibits rebating any part of premium or commission not specified in the policy, and prohibits misrepresentation of policy terms to induce a sale.

A person may not act as a public adjuster in Nevada without a license, and public adjusters may not solicit a client within a specified period after a loss while the insured is represented by counsel.

Nevada's prompt payment statute requires an insurer to acknowledge a claim within 15 days and to pay an accepted claim within 30 days of settlement agreement, with statutory interest on late payments.

Insurance transfers risk from an insured to an insurer in exchange for premium; insurable risk requires a large number of similar exposure units, accidental loss, determinable and measurable loss, and no catastrophic concentration.

Indemnity principle: the insured should be restored to approximately the pre-loss financial position, no better and no worse; valued policies and replacement cost coverage are exceptions to strict indemnity.

Insurable interest must exist at the time of loss for property insurance and at the time of policy inception for life insurance.

Utmost good faith underlies both parties' duties; material misrepresentation, concealment, or warranty breach can void coverage.

Adhesion contract: the insurer drafts the policy and the insured accepts or rejects it; ambiguities are construed against the drafter (contra proferentem).

Law of large numbers allows insurers to predict aggregate losses; underwriting selects and classifies risks by expected loss characteristics.

Risk management techniques are avoidance, retention, transfer, and loss reduction/prevention; insurance is a transfer technique.

Hazards are conditions that increase the chance or severity of loss: physical (icy steps), moral (intent to defraud), and morale (indifference to loss).

Declarations state named insured, policy period, limits, deductibles, and property description; insuring agreement states the insurer's promise; conditions state duties of each party; exclusions remove coverage.

Definitions section controls meaning of terms throughout the policy; endorsements amend the policy and control over conflicting printed provisions.

A binder is temporary evidence of coverage pending policy issuance; it is subject to the same terms as the policy it precedes.

Waiver is voluntary relinquishment of a known right; estoppel prevents a party from asserting a right after conduct led another to rely on it to their detriment.

Coinsurance clause (property) requires the insured to carry insurance equal to a stated percentage of value; recovery = (carried / required) x loss, capped at the limit.

Deductibles are subtracted before applying coverage; a franchise deductible pays the entire loss once the threshold is exceeded.

Pro rata (contribution) and other insurance clauses allocate loss among multiple policies; excess coverage applies only after primary limits are exhausted.

Subrogation transfers the insured's right to recover from a third party to the insurer after payment, preventing double recovery.

HO-2 broad form and HO-3 special form cover the dwelling (Coverage A), other structures (B), personal property (C), loss of use (D), and liability (E) and medical payments (F); HO-3 covers dwelling on an open-peril basis and personal property on named perils.

HO-5 comprehensive form covers both dwelling and personal property on an open-peril basis; HO-4 (renters) and HO-6 (condo) cover personal property and improvements, not the building structure.

Coverage A limit sets the basis for other limits: typically 10% for other structures, 50-70% for personal property, and 30% for loss of use.

Replacement cost on dwelling and actual cash value on personal property is the standard HO-3 structure; ACV = replacement cost minus depreciation.

Standard HO property exclusions include earth movement, flood, water damage from sewer backup (unless endorsed), ordinance or law, intentional loss, and neglect.

Loss of use pays additional living expense and fair rental value for the shortest time to repair or relocate, with a stated time limit.

Commercial property forms use coinsurance, blanket limits, and agreed value; business income coverage pays net income loss plus continuing expenses during restoration.

Duties after loss include prompt notice, proof of loss, protection of property, cooperation, and submission to examination under oath.

CGL Coverage A (bodily injury and property damage liability) and Coverage B (personal and advertising injury) apply to third-party claims; Coverage C is medical payments.

Occurrence vs. claims-made trigger: occurrence policies respond to injury during the policy period; claims-made policies respond when the claim is made, subject to retroactive date.

Comparative negligence reduces a claimant's recovery by their percentage of fault; contributory negligence (limited use) bars recovery entirely.

Absolute liability applies to ultra-hazardous activities and products; strict liability applies to defective products regardless of fault.

CGL exclusions include expected or intended injury, contractual liability, liquor liability, workers' compensation, pollution, and damage to the insured's own product or work.

Aggregate limits cap total payments per policy period; per-occurrence limits cap each claim; the general aggregate usually does not apply to products-completed operations.

Personal and advertising injury covers libel, slander, invasion of privacy, and wrongful eviction, not bodily injury or property damage.

Supplementary payments (defense costs, bonds, expenses) are paid in addition to limits under standard CGL forms.

Nevada requires liability coverage for private passenger autos; minimum limits are set by statute and must be verified against current NRS 485 figures before quoting.

Personal auto policy parts: A liability, B medical payments, C uninsured/underinsured motorist, D damage to your auto, and E duties after an accident.

Collision covers damage from impact with another object; other than collision (comprehensive) covers theft, fire, vandalism, glass, and weather.

Uninsured motorist coverage applies when the at-fault driver has no insurance; underinsured motorist applies when the at-fault driver's limits are insufficient.

PAP excludes intentional damage, racing, and vehicles used for livery or delivery; business use may require a commercial auto policy.

Medical payments coverage pays regardless of fault for the insured and passengers; PIP (in no-fault states) adds wage loss and rehabilitation benefits.

Nevada requires insurers to offer uninsured motorist coverage; the insured may reject it in writing.

Rental reimbursement and towing/labor are endorsement coverages, not included in the base PAP.

Commercial general liability, commercial property, commercial auto, workers' compensation, and businessowners policy (BOP) are core commercial lines.

BOP combines property and general liability for small businesses, with eligibility limited by size, occupancy, and class; it uses business income and replacement cost provisions.

Workers' compensation is statutory and no-fault; Part One covers statutory benefits, Part Two employer's liability, and Part Three other states coverage.

Commercial auto uses symbols to designate covered autos; hired and non-owned auto liability is often added by endorsement.

Commercial package policies combine property and casualty coverages with a single aggregate limit and shared deductible options.

Business income coverage requires a period of restoration and pays continuing expenses and net income; extra expense pays costs to avoid shutdown.

Equipment breakdown, inland marine, and crime coverages fill gaps left by standard commercial property forms.

Builders risk covers structures under construction; installation floater covers property being installed.

Claim handling steps: acknowledge and verify coverage, investigate, evaluate damages, negotiate, settle, and document the file.

Coverage analysis compares the date of loss, insured status, covered property or peril, exclusions, and limits before any payment decision.

Investigation tools include recorded statements, examinations under oath, scene inspection, photographs, police and fire reports, and public records.

Reservation of rights letters preserve the insurer's coverage defenses while investigation continues; a denial must cite specific policy provisions.

Damages valuation: ACV deducts depreciation; replacement cost requires repair or replacement; total loss auto uses actual cash value based on market comparables.

Settlement authority follows company guidelines; releases should be signed and unambiguous, and lienholders and mortgagees must be included on property payments.

Subrogation should be pursued promptly, with notice to the at-fault party and preservation of evidence before the statute of limitations runs in Nevada.

Claim files must document every contact, decision, and payment; bad-faith exposure arises from unreasonable delay or denial without reasonable basis.

Nevada unfair claims practice statutes prohibit misrepresenting policy provisions, failing to acknowledge claims promptly, and failing to conduct a reasonable investigation.

Adjusters may not pay or accept any commission, kickback, or inducement not specified in the policy; rebating is prohibited.

Conflict of interest rules bar an adjuster from handling a claim in which the adjuster has a financial interest or represents both insurer and insured.

Adjusters must not advise an insured to accept less than the policy provides or to sign a release without explaining its effect.

Nevada requires written notice of claim denial stating the policy provision relied upon and information about the appeals or complaint process.

Licensees must report address changes and criminal convictions to the Division; licenses are subject to suspension for fraudulent claim practices.

Unfair discrimination in claims settlement based on race, religion, or national origin is prohibited; claim decisions must rest on underwriting and loss facts.

Adjusters must protect confidential insured information and may disclose it only as necessary to process the claim or as required by law.

Nevada issues adjuster licenses by category: staff, independent, public, and crop; each category has distinct scope and sponsorship requirements.

Applicants must complete approved prelicensing education, pass the Nevada exam, and submit fingerprints for a background check.

Nonresident adjusters may qualify through reciprocity if their home state license is in good standing.

License renewal occurs every two years with 24 CE hours, including 3 hours of ethics; records must be retained for audit.

Acting without a license or misrepresenting license status is grounds for administrative action and civil penalties.

Insurable risk requires accidental, measurable loss across many similar exposure units with no catastrophic concentration.

Adverse selection occurs when poor risks buy coverage disproportionately; underwriting and exclusions mitigate it.

Moral hazard is the intentional creation of loss; morale hazard is carelessness that increases loss frequency.

Indemnity restores the insured to pre-loss financial position, subject to policy limits and deductibles.

Declarations, insuring agreement, conditions, exclusions, and definitions form the standard policy structure.

Endorsements modify the policy and prevail over conflicting form language.

Waiver and estoppel can prevent an insurer from enforcing a known right after conduct inducing reliance.

Contra proferentem construes ambiguity against the drafter, which is usually the insurer.

HO-3 covers the dwelling on an open-peril basis and personal property on named perils; HO-5 covers both on an open-peril basis.

Coinsurance recovery formula: (insurance carried / insurance required) x loss, capped by the policy limit.

ACV equals replacement cost minus depreciation; replacement cost pays without depreciation after repair or replacement.

Standard property exclusions include earth movement, flood, neglect, and ordinance or law.

Occurrence policies respond to injury during the policy period; claims-made policies respond to claims made during the period, subject to a retroactive date.

CGL Coverage A covers bodily injury and property damage; Coverage B covers personal and advertising injury.

Comparative negligence reduces recovery by the claimant's fault percentage; contributory negligence bars recovery.

CGL exclusions include intended injury, contractual liability, pollution, and damage to the insured's own work.

PAP parts: A liability, B medical payments, C uninsured/underinsured motorist, D damage to your auto, and E duties after an accident.

Collision covers impact with another object; other than collision covers theft, fire, and weather.

UM coverage applies to at-fault drivers with no insurance; UIM applies when limits are insufficient.

Nevada requires insurers to offer UM coverage, which the insured may reject in writing.

The BOP combines property and general liability for small businesses with eligibility limits.

Workers' compensation is statutory and no-fault; Part Two covers employer's liability.

Business income pays net income loss and continuing expenses during the period of restoration.

Commercial auto uses covered-auto symbols; hired and non-owned auto liability is added by endorsement.

Verify coverage first, then investigate facts, evaluate damages, negotiate, and document the file.

Recorded statements, examinations under oath, and scene inspections are core investigation tools.

Reservation of rights letters preserve coverage defenses while investigation continues.

Total loss auto valuation uses actual cash value based on market comparables.

Nevada prohibits misrepresenting policy provisions and failing to acknowledge claims promptly.

Rebating and kickbacks are prohibited; payments must follow the policy terms.

Denials must cite the specific policy provision relied upon and explain appeal rights.

Confidential insured information may be disclosed only as necessary to process the claim or as required by law.