N.C. Claims Adjuster License Exam:
329 Q & A Latest/Updated A+ Guide
Solution.
Inception/Expiration Date - -an insurance policy covers the
insured starting at 12:01am on the day on which coverage begins
and expires at 12:01am on the expiration day of the policy.
-Occurrence Date - -Date of which the loss occurred
-Identification of parties involved - -The loss report should
include the names and addresses of the parties involved in the
loss, the names and addresses of any injured person(s) and the
names and addresses of any witness(s).
-Policy Form/Number - -Identifies the type of coverage
purchased (policy form) and the policy number for the particular
policy purchased by the insured.
-Description of the Loss - -Information concerning how, when
and where the accident or loss happened is an essential element
in any loss report.
-Coverage - -Shows the type of coverage(s) purchased as well as
the limits of coverage purchased.
-Damages - Special Compensatory damages - -Are amounts paid
to compensate the plaintiff for direct expenses such as medical
treatment, lost wages (both past and future), funeral expenses
and rehabilitation expenses required because of bodily injury.
Special damages are paid for losses that can be determined and
documented. They are often referred to as "out-of-pocket"
expenses.
-Damages - General Compensatory Damages - -Are paid for
losses that cannot be specifically measured and itemized in order
to compensate the plaintiff for things such as pain and suffering,
,loss of the use of an arm or leg, loss of vision, physical
disfigurement and/or loss of consortium.
-Damages - Punitive Damages - -Are typically awarded to the
plaintiff in addition to compensatory damages when the
defendants conduct has been especially malicious. Punitive
damages are awarded to punish the defendant and to deter
others from engaging in similar actions.
-Unfair Claims Settlement Practices - -1. Knowingly
misrepresenting relevant facts or policy provisions relating to the
coverage at issue. 2. Failing to acknowledge with reasonable
promptness communications pertaining to claims. 3. Failing to
adopt and implement reasonable standards for the prompt
investigation of claims. 4. Arbitrary and unreasonable refusal to
pay claims. 5. Failing to affirm or deny coverage of claims within
a reasonable time after proof of loss has been completed. 6. Not
attempting in good faith to make prompt, fair and equitable
claims settlement when the insurer's liability has become
reasonably clear. 7. Compelling insureds to institute suits to
recover amounts due under a policy by offering substantially less
to settle immediately. 8. Attempting to settle claims for less than
the amount for which a reasonable person would believe one was
entitled based on written or printed advertising material
accompanying or made a part of an application. I. Attempting
settlement of claims on the basis of applications that were
altered without notice to knowledge of or consent of insureds.
-Total Losses on Motor Vehicles/Miscellaneous Provisions - -1. If
the insurer and the claimant are unable to reach an agreement
as to the value of the vehicle, the insurer shall base any further
settlement offer not only on the published regional average value
of similar vehicles, but also on the value of the vehicle in the
local market. 2. Local market value shall be determined by using
either the local price of a comparable vehicle or if no comparable
vehicle can be found, quotations from at least two qualified
dealers within the local market area. Additionally, if the claimant
represents that the vehicle was in better than average condition,
the insurer shall give due consideration to the condition of the
,claimant's vehicle prior to the accident. 3. When a motor vehicle
is damaged in an amount which equals or exceeds 75 percent of
the preaccident actual cash value, an insurer shall "total loss"
the vehicle by paying the claimant the preaccident value and in
return, receiving possession of the legal title for salvage
purposes. 4. The insurer will be responsible for all reasonable
towing and storage charges until three days after the owner and
the storage facility are notified in writing that the insurer will no
longer reimburse the owner or storage facility for storage
charges. 5. Loss and claims payments shall be mailed or
otherwise delivered within 10 business days after the claim is
settled.
-After Market Parts - -An after market part is any part made by
a non original manufacturer.
-Speculative Risk - -When there is a chance of gain as well as a
chance of loss. Insurance is not intended to protect against this
type of risk.
-Pure Risk - -When there is a chance of loss only.
-Insurable Risk - -One that an insurance company is willing to
accept.
-Characteristics of Insurable Risk - -1. Low probability of loss
occurring, 2. Less than catastrophic results, 3. The loss must be
measurable, 4. The loss must be significant, 5. The loss must be
accidental and unintended.
-Probability - -Measures the chance of an event occurring, it is
the measure of uncertainty (risk).
-Law of Large Numbers (Law of Averages) - -Mathematical
principle that makes it possible to predict future losses based
upon prior experience.
-Spread of Risk (Geographic Dispersion) - -Also used to
decrease loss probability. This process involves spreading the
, company's policies (exposures) over a broad geographical area in
order to avoid large losses in the vent of a catastrophic event. An
example is a hurricane.
-Adverse Selection - -Adverse selection occurs when insureds
with a high risk of loss attempt to purchase insurance and are
successful in obtaining insurance.
-Perils - -Are the actual cause of loss such as a fire, theft, wind,
hail, etc.
-Hazards - -Increase the probability of a peril occurring. Bald
tires on an automobile increase the chance of a wreck
happening. The tires are the hazard, the wreck is the peril.
-Property Insurance - -Indemnified (repays) a person or
business with an interest in the physical integrity of tangible
property for its loss or the loss of income produced by that
property.
-Casualty Insurance - -Provides protection to meet the
unexpected costs imposed by law due to acts that have caused
bodily injury or property damage to another individual. Included
isn't he field of casualty (liability) insurance are automobile,
crime and surety bonds.
-Private or Voluntary Insurance - -Portion of the insurance
industry where individuals seek coverage to meet recognized
needs. These coverages are neither required nor made available
by government. An example would be collision insurance in a
personal automobile insurance policy.
-Social Insurance - -Programs either required or made available
by government.
-Reinsurance - -Filed of the industry where insurers sell
portions of their individual contracts of insurance to other
companies. This activity helps with the spread of risk and/or
improves cash positions by lowering reserve requirements for
329 Q & A Latest/Updated A+ Guide
Solution.
Inception/Expiration Date - -an insurance policy covers the
insured starting at 12:01am on the day on which coverage begins
and expires at 12:01am on the expiration day of the policy.
-Occurrence Date - -Date of which the loss occurred
-Identification of parties involved - -The loss report should
include the names and addresses of the parties involved in the
loss, the names and addresses of any injured person(s) and the
names and addresses of any witness(s).
-Policy Form/Number - -Identifies the type of coverage
purchased (policy form) and the policy number for the particular
policy purchased by the insured.
-Description of the Loss - -Information concerning how, when
and where the accident or loss happened is an essential element
in any loss report.
-Coverage - -Shows the type of coverage(s) purchased as well as
the limits of coverage purchased.
-Damages - Special Compensatory damages - -Are amounts paid
to compensate the plaintiff for direct expenses such as medical
treatment, lost wages (both past and future), funeral expenses
and rehabilitation expenses required because of bodily injury.
Special damages are paid for losses that can be determined and
documented. They are often referred to as "out-of-pocket"
expenses.
-Damages - General Compensatory Damages - -Are paid for
losses that cannot be specifically measured and itemized in order
to compensate the plaintiff for things such as pain and suffering,
,loss of the use of an arm or leg, loss of vision, physical
disfigurement and/or loss of consortium.
-Damages - Punitive Damages - -Are typically awarded to the
plaintiff in addition to compensatory damages when the
defendants conduct has been especially malicious. Punitive
damages are awarded to punish the defendant and to deter
others from engaging in similar actions.
-Unfair Claims Settlement Practices - -1. Knowingly
misrepresenting relevant facts or policy provisions relating to the
coverage at issue. 2. Failing to acknowledge with reasonable
promptness communications pertaining to claims. 3. Failing to
adopt and implement reasonable standards for the prompt
investigation of claims. 4. Arbitrary and unreasonable refusal to
pay claims. 5. Failing to affirm or deny coverage of claims within
a reasonable time after proof of loss has been completed. 6. Not
attempting in good faith to make prompt, fair and equitable
claims settlement when the insurer's liability has become
reasonably clear. 7. Compelling insureds to institute suits to
recover amounts due under a policy by offering substantially less
to settle immediately. 8. Attempting to settle claims for less than
the amount for which a reasonable person would believe one was
entitled based on written or printed advertising material
accompanying or made a part of an application. I. Attempting
settlement of claims on the basis of applications that were
altered without notice to knowledge of or consent of insureds.
-Total Losses on Motor Vehicles/Miscellaneous Provisions - -1. If
the insurer and the claimant are unable to reach an agreement
as to the value of the vehicle, the insurer shall base any further
settlement offer not only on the published regional average value
of similar vehicles, but also on the value of the vehicle in the
local market. 2. Local market value shall be determined by using
either the local price of a comparable vehicle or if no comparable
vehicle can be found, quotations from at least two qualified
dealers within the local market area. Additionally, if the claimant
represents that the vehicle was in better than average condition,
the insurer shall give due consideration to the condition of the
,claimant's vehicle prior to the accident. 3. When a motor vehicle
is damaged in an amount which equals or exceeds 75 percent of
the preaccident actual cash value, an insurer shall "total loss"
the vehicle by paying the claimant the preaccident value and in
return, receiving possession of the legal title for salvage
purposes. 4. The insurer will be responsible for all reasonable
towing and storage charges until three days after the owner and
the storage facility are notified in writing that the insurer will no
longer reimburse the owner or storage facility for storage
charges. 5. Loss and claims payments shall be mailed or
otherwise delivered within 10 business days after the claim is
settled.
-After Market Parts - -An after market part is any part made by
a non original manufacturer.
-Speculative Risk - -When there is a chance of gain as well as a
chance of loss. Insurance is not intended to protect against this
type of risk.
-Pure Risk - -When there is a chance of loss only.
-Insurable Risk - -One that an insurance company is willing to
accept.
-Characteristics of Insurable Risk - -1. Low probability of loss
occurring, 2. Less than catastrophic results, 3. The loss must be
measurable, 4. The loss must be significant, 5. The loss must be
accidental and unintended.
-Probability - -Measures the chance of an event occurring, it is
the measure of uncertainty (risk).
-Law of Large Numbers (Law of Averages) - -Mathematical
principle that makes it possible to predict future losses based
upon prior experience.
-Spread of Risk (Geographic Dispersion) - -Also used to
decrease loss probability. This process involves spreading the
, company's policies (exposures) over a broad geographical area in
order to avoid large losses in the vent of a catastrophic event. An
example is a hurricane.
-Adverse Selection - -Adverse selection occurs when insureds
with a high risk of loss attempt to purchase insurance and are
successful in obtaining insurance.
-Perils - -Are the actual cause of loss such as a fire, theft, wind,
hail, etc.
-Hazards - -Increase the probability of a peril occurring. Bald
tires on an automobile increase the chance of a wreck
happening. The tires are the hazard, the wreck is the peril.
-Property Insurance - -Indemnified (repays) a person or
business with an interest in the physical integrity of tangible
property for its loss or the loss of income produced by that
property.
-Casualty Insurance - -Provides protection to meet the
unexpected costs imposed by law due to acts that have caused
bodily injury or property damage to another individual. Included
isn't he field of casualty (liability) insurance are automobile,
crime and surety bonds.
-Private or Voluntary Insurance - -Portion of the insurance
industry where individuals seek coverage to meet recognized
needs. These coverages are neither required nor made available
by government. An example would be collision insurance in a
personal automobile insurance policy.
-Social Insurance - -Programs either required or made available
by government.
-Reinsurance - -Filed of the industry where insurers sell
portions of their individual contracts of insurance to other
companies. This activity helps with the spread of risk and/or
improves cash positions by lowering reserve requirements for
