OR Claims Adjuster flashcards

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

Oregon insurance regulator

Oregon's insurance regulator is the Division of Financial Regulation within the Department of Consumer and Business Services. It enforces the Insurance Code found in ORS Chapters 731 through 746.

ORS 746.230

Oregon's unfair claim settlement practices statute. It prohibits conduct such as misrepresenting policy provisions, failing to acknowledge claim communications promptly, and refusing payment without a reasonable investigation.

Six-month attorney fee rule

Under ORS 742.061, an insured may recover reasonable attorney fees if the insurer does not settle a claim within six months after proof of loss, subject to statutory exceptions.

Oregon minimum auto liability

$25,000 per person and $50,000 per accident for bodily injury, plus $20,000 per accident for property damage. Oregon also requires $15,000 PIP per person.

Oregon producer continuing education

Oregon resident producer licenses renew every two years. Producers must complete 24 continuing education credit hours, including three hours of ethics, before renewal.

Public adjuster licensing

Oregon requires public adjusters to be licensed by the Division of Financial Regulation. Public adjusters represent insureds, not insurers, and must disclose their compensation in the written contract.

Oregon Insurance Guaranty Association

The Oregon Insurance Guaranty Association pays covered claims of insolvent member insurers up to statutory limits. It may not be used as an inducement to purchase insurance.

Indemnity principle

Insurance restores the insured to approximately the pre-loss financial position, no better and no worse. Actual cash value and policy limits enforce this principle.

Insurable interest

A legal or economic interest in the person or property insured that would be harmed by a loss. It must exist at the time of loss for property insurance.

Utmost good faith

Both insurer and insured must disclose material facts and avoid misrepresentation. A breach can allow rescission of the policy or denial of a claim.

Contract of adhesion

An insurance policy drafted by the insurer and offered on a take-it-or-leave-it basis. Ambiguities are construed against the drafter under contra proferentem.

Subrogation

After paying a loss, the insurer acquires the insured's legal right to recover from the responsible third party. This prevents double recovery by the insured.

Proximate cause

The dominant, uninterrupted cause that produces a loss in a natural and continuous sequence. An intervening cause can break the chain and defeat coverage.

HO-3 other structures limit

Other structures coverage is typically 10% of Coverage A dwelling. It covers detached structures such as garages, fences, and sheds, subject to policy terms.

HO personal property coverage

Personal property coverage is usually 50% to 70% of Coverage A. It covers the insured's belongings worldwide, with special sublimits for items such as jewelry and cash.

Replacement cost

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

Actual cash value

Actual cash value equals replacement cost minus depreciation. It reflects the property's value at the time of loss and supports the indemnity principle.

Commercial coinsurance clause

Commercial property policies may require a limit equal to at least 80% of value. If the insured carries less, recovery is reduced by the ratio of carried to required insurance.

Causes of loss forms

Basic and Broad causes of loss forms cover named perils only. The Special form covers all risks of direct physical loss unless a peril is specifically excluded.

Mortgagee clause

A mortgagee clause protects the lender's interest in insured property. The insurer pays the mortgagee to the extent of its interest and gives notice of cancellation or nonrenewal.

CGL Coverage A

Commercial general liability Coverage A pays sums the insured becomes legally obligated to pay as damages because of bodily injury or property damage caused by an occurrence.

Negligence elements

A claimant must prove duty, breach of that duty, actual causation, proximate causation, and damages. All elements are required for a liability claim.

Oregon comparative fault

Oregon reduces a plaintiff's damages by the plaintiff's percentage of fault. Recovery is barred when the plaintiff's fault is 51% or more.

Split liability limits

25/50/20 means $25,000 per person and $50,000 per accident for bodily injury, plus $20,000 per accident for property damage.

UM/UIM coverage

Uninsured motorist coverage pays for damages caused by a hit-and-run or uninsured driver. Underinsured motorist coverage applies when the at-fault driver's limits are insufficient.

PIP coverage

Oregon personal injury protection pays medical expenses, lost wages, and essential services regardless of fault, with a minimum limit of $15,000 per person.

First notice of loss

The initial report of a claim. The adjuster records the date, time, parties, policy number, and loss facts, then verifies coverage and sets reserves.

Reservation of rights

A letter in which the insurer accepts defense of a claim while reserving the right to deny coverage later. It must be timely and identify specific coverage issues.

Proof of loss

A sworn statement from the insured stating the amount of loss, the date, and supporting documentation. The standard fire policy requires it within 60 days after loss unless extended.

Examination under oath

A formal, recorded questioning of the insured under policy provisions. Refusal to submit to an examination under oath can bar recovery under the policy.

Appraisal clause

A dispute-resolution method for the amount of loss. Each party selects an appraiser, and an umpire resolves differences if the appraisers do not agree.

Denial letter

A written claim denial must cite the specific policy provisions and facts relied on, so the insured understands the basis and can challenge the decision.