OR Claims Adjuster cheat sheet

Oregon's insurance regulator is the Division of Financial Regulation (DFR) within the Department of Consumer and Business Services (DCBS); it enforces ORS Chapters 731–746.

ORS 746.230 defines unfair claim settlement practices, including misrepresenting policy provisions, failing to acknowledge claim communications promptly, and refusing payment without a reasonable investigation.

ORS 742.061 allows an insured to recover reasonable attorney fees when the insurer fails to settle within six months after proof of loss, subject to statutory exceptions.

Oregon minimum auto liability is 25/50/20: $25,000 per person, $50,000 per accident bodily injury, and $20,000 property damage; PIP minimum is $15,000 per person.

Oregon requires uninsured/underinsured motorist coverage at 25/50 unless the insured rejects it in writing; UM/UIM applies to hit-and-run and insufficient-limits drivers.

Resident producer licenses renew every two years; 24 CE hours are required, including 3 hours of ethics.

Public adjusters must be licensed by DFR and represent the insured; their written contract must disclose compensation.

OIGA pays covered claims of insolvent member insurers up to statutory limits; producers may not advertise OIGA protection as a reason to buy.

Oregon's standard fire policy language governs property policies; it includes appraisal, proof-of-loss, and suit-limitation provisions.

Indemnity: the insured is restored to pre-loss financial condition, no better and no worse; ACV and policy limits implement this principle.

Insurable interest must exist at the time of loss for property insurance; a person with no legal or economic interest cannot collect.

Utmost good faith requires both parties to disclose material facts; concealment or misrepresentation can support rescission.

Adhesion: the insurer drafts the policy; ambiguities are construed against the insurer (contra proferentem).

Aleatory: performance depends on a chance event, so premiums and claim payments are not equal.

Subrogation: after payment, the insurer acquires the insured's rights against a third party to prevent double recovery.

Contribution: when multiple insurers cover the same loss, each pays its share under its policy, preventing overpayment.

Proximate cause: an unbroken chain from peril to loss; an intervening cause can break the chain and defeat coverage.

Coinsurance formula: (limit carried ÷ limit required) × loss = recovery, before deductible.

HO-3 Coverage A is the dwelling; B other structures is typically 10% of A; C personal property is typically 50%–70% of A; D loss of use is typically 30% of A.

HO Coverage C special limits apply to money, jewelry, firearms, silverware, and business property; amounts vary by form.

Replacement cost pays to repair or replace with new property of like kind and quality without depreciation, up to the limit.

Actual cash value = replacement cost − depreciation; it reflects the property's value at the time of loss.

Commercial property coinsurance requires a limit of at least 80% of value; otherwise the recovery ratio reduces payment.

Causes of loss forms: Basic and Broad are named-peril; Special is all-risk except exclusions.

Percentage wind/hail deductibles apply to the dwelling limit, often 1%–5% in coastal or windstorm areas.

Mortgagee clause protects the lender's interest; the insurer pays the mortgagee to its interest and gives notice of cancellation.

Business income pays net income plus continuing expenses during the period of restoration; extra expense pays costs to resume operations.

CGL Coverage A covers bodily injury and property damage caused by an occurrence; Coverage B covers personal and advertising injury; Coverage C pays medical expenses.

CGL limits include each occurrence, general aggregate, products-completed operations aggregate, personal/advertising injury limit, and damage to premises rented.

Occurrence-trigger policies respond when injury or damage occurs; claims-made policies respond when the claim is made during the policy period.

Negligence elements: duty, breach, actual causation, proximate causation, and damages.

Oregon comparative fault reduces damages by the plaintiff's percentage; recovery is barred at 51% or more plaintiff fault.

Split limits 25/50/20 mean $25,000 per person, $50,000 per accident bodily injury, and $20,000 property damage.

UM/UIM covers hit-and-run, uninsured, and underinsured drivers; Oregon requires it unless rejected in writing.

PIP pays medical, lost wages, and essential services without regard to fault; Oregon minimum is $15,000 per person.

Workers compensation is the exclusive remedy for work-related injuries and provides no-fault medical and wage-loss benefits.

First notice of loss: record date, time, parties, policy number, and loss facts; verify coverage and set reserves.

Reservation of rights: accept defense while reserving the right to deny coverage; must be timely and identify specific issues.

Proof of loss: a sworn statement of amount, date, and supporting documents; the standard fire policy requires it within 60 days after loss unless extended in writing.

Examination under oath: a recorded formal questioning of the insured; refusal can bar recovery.

Appraisal: each party selects an appraiser; an umpire resolves disagreements on the amount of loss.

Subrogation: identify the third-party tortfeasor, preserve evidence, send notice, and avoid releasing the tortfeasor.

Salvage: the insurer may take title to damaged property; salvage value offsets the claim payment.

Denial letter: cite specific policy provisions, facts, and reasons; an unexplained denial risks an unfair-claims-practice claim.

Claim file documentation: contemporaneous notes, photos, estimates, and correspondence support the coverage decision and bad-faith defense.