OK Claims Adjuster flashcards

34 cards. Read the term and the definition here. The deck at the top of this page is optional.

Oklahoma Insurance Commissioner

Elected statewide official who heads the Oklahoma Insurance Department and enforces Title 36, with authority to examine insurers, license producers and adjusters, and impose penalties.

Producer license renewal

Oklahoma resident producer licenses renew every two years and require 24 continuing education hours per term, including at least 3 hours of ethics instruction.

Unfair claims practice

Under Oklahoma law, misrepresenting policy provisions, failing to acknowledge claim communications, or unreasonably delaying or denying a claim constitutes a prohibited unfair settlement practice.

Cancellation notice period

An insurer cancelling a policy in force more than 60 days must mail written notice at least 30 days before the effective date, or 10 days for nonpayment of premium.

Oklahoma prompt payment

Oklahoma law requires insurers to acknowledge claim notice and to pay or deny a clean claim within the statutory period, with penalties for unreasonable delay.

File-and-use rating

A rate filing method in which an insurer files rates with the Commissioner and may use them immediately, subject to later regulatory review and disapproval.

Public adjuster

A licensed adjuster who represents the insured, not the insurer, in preparing, presenting, and negotiating a first-party property claim for a fee.

Department examination

The Commissioner may examine an insurer's books, records, and claim files to verify solvency and compliance with Oklahoma insurance statutes and regulations.

Claim handling sequence

Acknowledge and verify coverage, investigate facts, document the file, evaluate damages, negotiate settlement, and close with a written record of the payment basis.

Actual cash value

ACV equals replacement cost minus depreciation for physical, functional, and economic obsolescence, reflecting the property's value immediately before the loss.

Replacement cost value

The cost to repair or replace damaged property with new materials of like kind and quality, without deduction for depreciation, often paid after repairs are completed.

Coinsurance formula

Recovery equals (insurance carried divided by insurance required) times the loss, capped by the policy limit, where insurance required is the coinsurance percentage times property value.

Reservation of rights

A written notice preserving the insurer's right to deny coverage later while investigation continues, without waiving any policy defenses.

Subrogation

The insurer's right, after paying a covered loss, to pursue the responsible third party in the insured's name to recover amounts paid.

Burden of proof on exclusions

Once the insured shows a loss falls within the insuring agreement, the insurer bears the burden of proving an exclusion applies to bar coverage.

Percentage wind deductible

A deductible stated as a percentage, commonly 1 to 5 percent, of the Coverage A dwelling limit, applied before the policy limit in wind or hail losses.

Claim file documentation

Photographs, measurements, scope of loss, statements, expert reports, and a diary of every contact, decision, and payment supporting the claim determination.

Insurable interest

A financial stake in the property such that the insured suffers economic loss from its damage; required at the time of loss for recovery.

HO-3 special form

A homeowners policy covering the dwelling and other structures on an open-peril basis and personal property on a named-peril basis.

HO-4 renters policy

A homeowners form covering a tenant's personal property, loss of use, and liability, but not the building structure owned by the landlord.

Coverage C personal property

The homeowners coverage for household contents, typically limited to 50 to 70 percent of the Coverage A dwelling limit, with special sublimits for items like jewelry.

Coverage D loss of use

Pays additional living expenses and fair rental value when a covered loss makes the residence uninhabitable, subject to a stated time or dollar limit.

Flood exclusion

Homeowners and commercial property policies exclude flood and surface water; coverage requires a separate NFIP or private flood insurance policy.

Business income coverage

Commercial coverage for lost net income and continuing normal operating expenses during the period of restoration after a covered property loss.

CGL occurrence form

Commercial general liability coverage for bodily injury and property damage occurring during the policy period, with an aggregate limit capping total payments.

Split liability limits

Auto liability limits stated as per-person bodily injury, per-accident bodily injury, and per-accident property damage, such as 25/50/25.

Negligence elements

A claimant must prove duty, breach of that duty, proximate cause, and actual damages to recover in a liability claim.

Comparative negligence

A doctrine reducing a claimant's recovery in proportion to the claimant's own share of fault for the injury or damage.

Fiduciary duty of adjuster

The adjuster owes good faith and loyalty to the insurer while treating claimants fairly, promptly, and honestly, never misstating policy provisions.

Written denial notice

Oklahoma requires a denial to state the specific policy provisions relied upon and inform the claimant of any right to Insurance Department review.

Privacy of claim information

Adjusters must safeguard nonpublic personal information and share claim details only with parties having a legitimate need to know.

Vendor conflict of interest

An adjuster with a financial interest in a repair vendor must disclose it and may not steer repairs to an affiliate without the insured's informed consent.

Bad faith exposure

An insurer that unreasonably refuses a settlement demand within policy limits may face a bad-faith action; the claim file must show reasoned evaluation.

Fraud referral

Suspected insurance fraud is referred to the insurer's special investigation unit and may be reported to the Oklahoma Insurance Department fraud unit.