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Model Laws - ️️NAIC develops that they feel is an appropriate law related to insurance/risk management Conflict of Interest - ️️a situation that occurs when a decision makers personal interests interfere to the extent that he/she makes decisions that adversely affect the customer, claima...

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  • September 12, 2024
  • 14
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers

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  • AIC 30

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AIC 30
Model Laws - ✔️✔️NAIC develops that they feel is an appropriate law related to insurance/risk
management



Conflict of Interest - ✔️✔️a situation that occurs when a decision makers personal interests interfere to
the extent that he/she makes decisions that adversely affect the customer, claimant, or employer



Four Parts of Negligence - ✔️✔️- a duty owed to protect (or not go out of your way to harm) another
party. - a breach of that duty - damage or injury occurs, - the damage or injury was a direct result of the
breach of the duty.



Ex Parte Contract - ✔️✔️contracts in which only 1 party is heard. discussing the claim with the
represented person without benefit of their attorney being involved. this is not illegal, but its not ethical.



Reservations of Rights Letter - ✔️✔️an insurer's letter that specifies coverage issues and informs the
insured that the insurer is handling a claim with the understanding that the insurer may later deny
coverage should the facts warrant it.



Third Party Administrator (TPA) - ✔️✔️an organization that provides admin services associated with risk
financing and insurance. They handle claims and risk management for self-insured organizations



First Party Focus - ✔️✔️Coverage and Amount of damage



Second Party - ✔️✔️Insurance Company



First Party - ✔️✔️Insured



Third Party - ✔️✔️Claimant



Third Party Focus - ✔️✔️Liability, Coverage, and Amount of damage

, Independent Adjuster - ✔️✔️handles claims for the insurer for a fee. Works for the insurer



Public Adjuster - ✔️✔️an outside organization that is hired by the insured to represent the insured in
the claim for a fee. Works for the public



Quantitative Measures - ✔️✔️can have actual numbers assigned, such as number of claims opened and
percentage of subrogation recovery



Qualitative Measures - ✔️✔️related to intangible measures. nothing concrete, did they do a good job?
do they have good negotiation skills?



Ethics - ✔️✔️the study of what constitutes good and bad behavior, dealing with the moral duty and
obligation



Fraud - ✔️✔️an intentional misrepresentation resulting in harm to another person or organization



Code of Ethics - ✔️✔️professional guidelines of behavior within an organization or profession



N.A.I.C - ✔️✔️The National Association of Insurance Commissioners



Model Laws - Goal - ✔️✔️to standardize the laws related to insurance, to address issues related to
insurance



Unfair Claims Settlement Practice Act - ✔️✔️to prevent insurance companies from taking unfair
advantage of the insured/claimants



Waiver - ✔️✔️the intentional/unintentional relinquishing (give up) of a known right. (written, verbally,
or by actions taken)

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