NY Claims Adjuster key terms

Restoring the insured to roughly the financial position held before a loss, no better and no worse; this principle is why insurance cannot produce a profit.

A genuine financial stake in the property or person insured, so the insured would suffer real economic loss if a covered event occurred; property policies require it when coverage begins.

The rule that insurer and insured must deal honestly and disclose material facts, because the insurer depends on information about the risk that only the applicant possesses.

A policy drafted entirely by the insurer and offered on a take-it-or-leave-it basis, so courts generally resolve unclear wording against the party who wrote it.

An agreement in which the amounts exchanged are unequal and depend on chance, since the premium paid may be far smaller or larger than the loss later paid.

After paying a claim, the insurer's right to step into the insured's shoes and pursue the party that caused the loss, preventing double recovery and holding wrongdoers accountable.

The unbroken sequence of events started by a covered peril that produces the loss; the damage must be a foreseeable result rather than remote or unrelated.

The portion of each covered loss the insured must absorb before the insurer pays anything, which lowers premium and discourages small claims.

An accident, including continuous or repeated exposure to substantially the same harmful conditions, that causes bodily injury or property damage during the policy period.

Coverage triggered when a claim is made or reported during the policy period, regardless of when the underlying act or injury happened; common in professional liability.

The cost to replace damaged property with new property of like kind and quality, minus depreciation; the default valuation method for most property policies.

The amount needed to repair or rebuild with new materials of comparable quality, with no deduction for depreciation, usually paid only after repairs are completed.

A property policy condition requiring the insured to carry limits at least equal to a stated percentage of the property's value, or claim payments are reduced proportionally.

Reasonable extra costs for temporary housing, meals, and similar needs when a covered loss makes the home uninhabitable, paid in addition to the dwelling limit for a stated period.

A provision giving the lender its own rights to loss payments and to notice of cancellation, protecting the mortgagee even when the insured's own acts would bar recovery.

Optional coverage paying the added cost of rebuilding to current building codes after a covered loss, because standard policies exclude the extra expense of code compliance.

Damaged property or its remains that the insurer takes after paying a total loss; its resale value offsets the claim and reduces the net payment.

Coverage for lost net income and continuing expenses while a covered property loss halts operations, often with a waiting period and a restoration-period limit.

A policy dispute process where each side names a competent appraiser, those two choose an umpire, and the panel sets the amount of loss when value is disputed.

A sworn statement from the insured detailing the date, cause, and amount of a claim, usually due within a set period such as sixty days after the insurer's request.

Formal recorded questioning of the insured under a policy condition, used to verify facts, resolve inconsistencies, and support a coverage decision before payment.

A written notice stating that the insurer will investigate or defend while it keeps questioning coverage, preserving its right to deny the claim later.

A document signed by the insured acknowledging that the insurer's continuing investigation or defense does not waive any right to deny coverage later.

The initial report of a claim, recording date, location, parties, and a preliminary description so the insurer can start investigating and set reserves.

A policy or statutory deadline for the insured to sue the insurer over a claim, usually running from the date of loss or from denial.

New York's first-party system paying up to $50,000 for medical costs and lost wages from motor vehicle injuries regardless of fault, with narrow exceptions allowing lawsuits.

Supplementary uninsured/underinsured motorist coverage that pays an insured's damages when the at-fault driver lacks insurance or has limits too low, up to the purchased limit.

New York's pure comparative fault rule, under which a claimant's recovery is reduced by their own share of fault but is never barred entirely.

Liability imposed on a bar or social host that serves alcohol to a visibly intoxicated person or minor who then injures someone, under New York's General Obligations Law.

Coverage paying reasonable medical expenses for injured persons regardless of fault, up to a modest limit, without any finding of legal liability.

Commercial general liability coverage for offenses such as libel, slander, wrongful eviction, and use of another's advertising idea, separate from bodily injury or property damage.

Prohibited conduct listed in New York law, such as failing to investigate promptly, denying without a reasonable basis, or delaying payment, which can draw regulatory penalties.

Unfairly handling a claim, for example denying without reasonable basis or offering far less than owed; in New York it is generally a breach of contract claim, not a separate tort.

The adjuster's obligation to act honestly and loyally for the insured and insurer, including safeguarding and properly accounting for claim funds handled.

Any personal, financial, or professional interest that could improperly sway an adjuster's decisions, which must be disclosed and often requires reassignment.

New York law criminalizing knowingly false or inflated insurance claims and requiring insurers to run fraud-prevention programs and report suspected fraud to authorities.

New York regulation (11 NYCRR 65) setting claim handling standards, including prompt investigation, written status updates, and time limits for paying settled claims.

A licensed professional hired by the insured, usually for a percentage fee, to prepare, document, and negotiate a property damage claim.

The principle that benefits a claimant receives from other sources, such as health insurance or sick pay, generally do not reduce what the liable party owes.

A signed document in which the claimant gives up all further claims related to the incident in exchange for the settlement amount, ending the dispute.