SC Claims Adjuster flashcards
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32 cards. Read the term and the definition here. The deck at the top of this page is optional.
- Insurable interest
- A financial stake in the subject of insurance such that a loss causes the insured monetary harm; required at inception for life insurance and at the time of loss for property.
- Indemnity principle
- The concept that insurance restores the insured to approximately the financial position held before the loss, no better and no worse, preventing profit from loss.
- Actual cash value
- Replacement cost minus depreciation; the valuation method reflecting the reduced value of used or aged property at the time of the loss.
- Replacement cost
- The cost to repair or replace damaged property with new property of like kind and quality without deduction for depreciation, usually subject to policy limits.
- Adverse selection
- The tendency of higher-than-average risks to seek or retain insurance more readily than low risks, which can push loss costs and premiums upward.
- Moral hazard
- Dishonest or careless behavior created by the presence of insurance, such as intentionally causing a loss or exaggerating a claim in order to collect.
- Proximate cause
- The dominant and efficient cause that sets in motion an unbroken chain of events producing a loss, used to decide whether a covered peril applies.
- Subrogation
- The insurer's right, after paying a claim, to step into the insured's shoes and pursue recovery from the party legally responsible for the loss.
- HO-3 special form
- A homeowners form covering the dwelling and other structures on an open-peril basis while personal property is covered for named perils only.
- Coverage C
- Homeowners personal property coverage, typically a percentage of the Coverage A limit, insuring the insured's belongings on and off the premises subject to special limits.
- Coinsurance clause
- A property provision requiring the insured to carry at least a stated percentage of the property's value or face a reduced payment on partial losses.
- Occurrence policy
- Liability coverage that responds to bodily injury or property damage that takes place during the policy period, regardless of when the claim is reported.
- Claims-made policy
- Liability coverage responding to claims first made during the policy period, with a retroactive date that limits coverage for acts occurring earlier.
- Business income coverage
- Pays lost net income and continuing normal operating expenses during the period of restoration following covered property damage, restoring the business's earnings stream.
- Personal auto liability
- Coverage for damages an insured becomes legally obligated to pay because of bodily injury or property damage caused by an auto accident.
- Umbrella policy
- Excess liability coverage applying above underlying auto, homeowners, or commercial liability limits that may also fill certain gaps in underlying coverage.
- Reservation of rights
- A letter stating the insurer will continue investigating or defending a claim while coverage questions remain open, preserving the right to deny coverage later.
- Proof of loss
- A sworn statement from the insured detailing the amount, date, and circumstances of a loss, usually required within a policy-specified period after the loss.
- Examination under oath
- A formal, recorded question-and-answer session with the insured conducted under policy conditions, often in the presence of a court reporter.
- Burden of proof
- The insured must generally show the loss falls within the policy's coverage, while the insurer bears the burden of proving that a policy exclusion applies.
- Salvage
- Damaged property the insurer takes ownership of after paying a total loss, which the insurer may sell to offset the amount of the claim payment.
- Betterment
- The increase in value when a repair or replacement leaves the insured with newer or superior property than was damaged, often deducted in claim settlements.
- Bad faith
- An insurer's unreasonable denial, delay, or failure to settle a claim where liability is clear, exposing the insurer to extra-contractual damages.
- Total loss threshold
- The percentage of a vehicle's value at which damage makes repair uneconomical and the vehicle is declared a total loss, set by state law.
- South Carolina Department of Insurance
- The state agency that licenses insurers, producers, and adjusters, examines market conduct, and enforces South Carolina's insurance laws and regulations.
- SC minimum auto limits
- South Carolina's compulsory liability minimums of $25,000 per person and $50,000 per accident for bodily injury and $25,000 for property damage.
- Modified comparative negligence
- The South Carolina rule barring a claimant's recovery when the claimant's own fault exceeds 50 percent, with damages otherwise reduced by the claimant's share.
- Uninsured motorist coverage
- Coverage South Carolina insurers must offer that pays damages an insured would be legally entitled to recover from an at-fault driver with no liability insurance.
- South Carolina adjuster license
- A credential issued by the South Carolina Department of Insurance that a person must hold before investigating or settling claims on behalf of an insurer.
- Public adjuster
- A licensed representative who contracts with and is paid by the insured, rather than the insurer, to prepare, present, and negotiate a claim.
- SC Workers' Compensation Commission
- The state agency that administers South Carolina's workers' compensation system and resolves disputes between injured workers, employers, and carriers.
- SC limitations period
- South Carolina's three-year window for filing suit on personal injury, property damage, and written contract claims, after which the right to sue is barred.