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...
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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