Claims Handling and Adjusting Practices
Claims practice questions test process discipline: investigation, coverage analysis, communication, documentation, settlement, and recovery. Examiners favor scenarios containing both a coverage question and a deadline.
Investigation and documentation
Confirm coverage first: policy in force, insured status, loss date, location, and the property or exposure at issue. Then investigate-recorded statements, photographs, scene inspection, receipts, expert reports, and a sworn proof of loss where the policy requires one. Every contact, decision, and payment belongs in the claim file, because the file becomes the evidence in any later bad-faith or market-conduct review.
Coverage analysis and communication
When coverage is unclear, send a reservation-of-rights letter identifying the specific provisions at issue, stating that the insurer continues to investigate without waiving any defense, and requesting the information needed. Denials must be written, cite policy language, and state the facts relied on. Late notice is evaluated for prejudice. Disputes about the amount of loss may go to appraisal; disputes about coverage go to court.
Settlement and recovery
Settle within documented authority, obtain a full release, and protect subrogation-never sign a release that waives the insurer's recovery rights against a third party. Account for salvage, pursue subrogation promptly, and refer suspected fraud with documented indicators.
Worked example
A burst supply line causes $20,000 of damage; $6,000 of mold remediation is claimed under a policy excluding mold unless it results from a covered peril. The adjuster pays the undisputed $14,000 immediately, sends a reservation letter on the $6,000 mold portion citing the mold exclusion and ensuing-loss language, and requests the remediation protocol and drying records. This preserves goodwill and avoids the ORS 742.061 fee exposure created by unexplained delay.
Traps
Using a reservation letter as if it were a denial; handling a claim for months without reserving a known defense, which can waive it; denying without citing the policy; releasing a tortfeasor before subrogation is preserved.