AINS 21 Segment B (Chapters 4-6)
Rated A+
claim a demand by a person or business seeking to recover from an insurer for a loss that
may be covered by an insurance policy
claimant anyone who submits a claim to an insurer
first party the insured in an insurance contract
third party a ...
AINS 21 Segment B (Chapters 4 -6) Rated A+ claim ✔✔a demand by a person or business seeking to recover from an insurer for a loss that may be covered by an insurance policy claimant ✔✔anyone who submits a claim to an insurer first party ✔✔the insured in an insurance contract third party ✔✔a pers on or business who is not a party to the insurance contract bu who asserts a claim against the insured claim representative (or adjuster) ✔✔a person responsible for verifying coverage, determining the cause of loss, determining the amount of damages or ex tent of loss, and settling or otherwise concluding a claim types of adjusters ✔✔staff claim representatives (inside and outside); independent adjusters; producers; public adjusters staff claim representative ✔✔an insurer employee who performs some or all of the insurer's claim handling activities inside claim representative ✔✔an insurer employee who handles claims that can be settled by phone, mail, or email from inside the insurer's office outside (or field) claim representative ✔✔an insurer employee w ho handles claims that cannot be handled easily by phone, mail, or email independent adjuster ✔✔a claim representative who offers claim handling services to insurers for a fee settlement authority ✔✔authority expressly given to a producer by an insurer t o settle and pay certain types of claims up to a specified limit public adjuster ✔✔a person hired by an insured to represent the insured in handling a claim self-insurance plan ✔✔an arrangement in which an organization pays for its losses with its own resources rather than by purchasing insurance third -party administrator (TPA) ✔✔an organization that contracts to provide administrative services, including cla im handling, to other businesses steps in claim handling ✔✔verifying coverage; determining the cause of loss; determining the amount of damages or extent of loss; negotiating and settling (or denying) the claim reservation of rights letter ✔✔a notice sen t by the insurer advising the insured that the insurer is proceeding with a claim investigation but that the insurer retains its right to deny coverage later coverage questions for property claims ✔✔does the insured have an insurable interest in the prope rty; is the damaged property covered by the policy; is the cause of loss covered by the policy; do any additional coverages, endorsements, or coverage limitations apply insurable interest ✔✔a coverage verification criterion that exists when a person or ot her entity would suffer a financial loss if the subject property were damaged property valuation methods ✔✔actual cash value; replacement cost; agreed value actual cash value (ACV) ✔✔the cost to replace property minus an allowance for the property's depreciation depreciation ✔✔the allowance for physical wear and tear or technological or economic obsolescence replacement cost ✔✔the cost to repair or replace property using new materials of like kind and quality with no deduction for depreciation agreed v alue ✔✔a method of valuing property in which the insurer and the insured agree, at the time the policy is written, on the maximum amount that will be paid in the event of a total loss subrogation ✔✔the insurer's right, assumed from the insured, to recover payment from a third party that is legally responsible for the loss salvage rights ✔✔the insurer's rights to recover and sell or otherwise dispose of insured property on which the insurer has paid a total loss or a constructive total loss
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