SC Claims Adjuster key terms

A financial stake in the person or property insured, meaning the insured would suffer a real economic loss if a covered event happened. In property insurance it must exist when the loss occurs.

The principle that insurance should restore the insured to about the same financial position held before a loss, no better and no worse. It keeps recoveries tied to the actual amount of loss.

The mutual duty of the insurer and the applicant to deal honestly and to disclose material facts when a policy is applied for and administered. Concealment or misrepresentation can affect coverage.

After paying a claim, the insurer's right to step into the insured's shoes and pursue the party that caused the loss, recovering what it paid and preventing the insured from collecting twice.

The tendency for people with higher-than-average risk to seek or keep insurance more eagerly than low-risk people. Careful underwriting and rating are used to keep this from driving up premiums.

The specific cause of a loss, such as fire, wind, theft, or collision. Policies either list the perils they cover or, in special forms, cover all risks except those excluded.

A condition that increases the chance a loss will happen or makes it more severe, such as faulty wiring, icy steps, or careless habits. A hazard is not the cause of loss itself.

The dominant, unbroken cause that sets a loss in motion and produces the result without a new, independent cause intervening. Adjusters use it to decide whether a loss is covered.

Insurance that an insurance company buys from another insurer to transfer part of its risk. It protects the company's financial strength and lets it write more and larger policies.

The written contract between an insurer and an insured. It states what is covered, what is excluded, the limits, the duties of each party, and the policy period.

The page of a policy that names the insured, describes the covered property or risk, and shows limits, deductibles, premium, and policy dates. It tailors the contract to that account.

The central promise of a policy describing what the insurer agrees to cover, such as listed perils or all risks of direct physical loss, subject to the other terms.

Policy provisions setting out rules both parties must follow, such as duties after a loss, proof of loss, and cancellation. Breaking a condition can affect the claim.

Policy language that removes certain losses, property, or people from coverage. Exclusions define the edges of the insuring agreement and help keep coverage affordable.

A written amendment attached to a policy that adds, removes, or changes coverage. It becomes part of the contract and controls over conflicting language in the original form.

The part of a covered loss the insured must pay before the insurer pays anything. A higher deductible usually lowers the premium and discourages very small claims.

A property valuation method that pays replacement cost minus depreciation, reflecting what the damaged item was worth in its used condition just before the loss.

A property valuation method that pays what it costs to repair or replace damaged property with new property of similar kind and quality, with no deduction for depreciation.

A property policy requirement that the insured carry coverage equal to at least a stated percentage of the property's value; if coverage falls short, the claim payment is reduced proportionally.

An accident, including continuous or repeated exposure to substantially the same harmful conditions, that causes bodily injury or property damage during the policy period.

A failure to use the care a reasonable person would use in similar circumstances. It is the legal basis for most liability claims brought against an insured.

A request by an insured, or by a person harmed by the insured, for payment under a policy for a loss that may be covered.

The initial report of a loss to the insurer, usually by phone, app, or online form, capturing when, where, and how the loss happened so handling can begin.

A written notice to the insured or claimant that the insurer will investigate or defend a claim while leaving open whether coverage applies, preserving its coverage defenses.

A formal statement, often sworn, in which the insured sets out the date, cause, and amount of loss and attaches supporting documents, as the policy requires.

A policy condition letting the insurer question the insured under oath about a loss during the investigation. The transcript can later be used in coverage disputes.

A method in property policies for resolving disagreements about the amount of loss, in which each side names an appraiser and an umpire settles differences. Coverage disputes are not decided this way.

A signed document in which a claimant gives up further claims against the insurer or insured in exchange for a settlement payment, ending the matter.

An insurer's unreasonable or dishonest handling of a claim, such as denying coverage without a reasonable basis or delaying payment. It can lead to damages beyond the policy limit.

The money an insurer spends investigating, evaluating, defending, and settling claims, kept separate from the amount paid to the claimant.

A licensed professional hired and paid by the insured to document and negotiate a property claim. The public adjuster works for the policyholder, not the insurer.

The state agency that licenses insurers, agents, and adjusters in South Carolina, enforces insurance laws, examines market conduct, and handles consumer complaints about claims and policies.

The credential South Carolina requires before a person may investigate or settle claims for compensation. Applicants must meet education, exam, and application requirements set by state law.

Insurer conduct the state prohibits, such as misrepresenting policy terms, unreasonably delaying a claim, or failing to settle when liability is clear. Violations can bring fines and license action.

State rules requiring insurers to acknowledge, investigate, and decide claims within set time frames and to give written reasons when a claim is denied or delayed.

Knowingly giving false or exaggerated information to an insurer to obtain payment, or similar dishonest insurer conduct. It is a crime and can also cost a license.

An entity created by state law and funded by insurers that pays covered claims of insolvent member companies, up to statutory limits, so policyholders are not left with nothing.

State rules limiting how and when an insurer may end a policy, generally requiring written notice within set periods and a stated reason for cancellation.

South Carolina rules requiring drivers to show they can pay for damage they cause, usually by carrying liability insurance, before a vehicle can be registered.