The Evolving Role of the Claims Professional
To restore a party who has sustained a loss to the same financial position that party held before the loss occured.
What is Indemnify?
The initial report notifying the insurer of a claim.
What is FNOL?
(First Notice of Loss)
An approach to other insurance by which the insurers contribute to the loss payment in the proportion to which they contribute to the total amount of coverage purchased (their limits of liability).
What is Pro Rata Contribution?
A pretrial exchange of all relevant information between the plaintiff and defendant.
What is Discovery?
A ratio that measures losses and loss adjustment expenses against earned premiums and that reflects the percentage of premiums being consumed by losses.
What is Loss ratio?
- Coherence - The statement follows a logical sequence.
- Completeness - The statement is thorough
- Objectivity - The statement contains facts relevant to the loss expressed in the interviewee's own words.
What are Keys to Effective Statements
A payment awarded by a court to punish a defendant for a reckless, malicious, or deceitful act to deter similar conduct; the award need not bear any relation to a party’s actual damages.
What is Punitive Damages?
The delivery of a summons and complaint to a defendant by an authorized person.
What is Service of Process?
An outside organization or person hired by an insured to represent the insured in a claim in exchange for a fee.
What is a Public adjuster?
The amount the insurer estimates and sets aside to pay on an existing claim.
What is Reserve?
A form of compensatory damages that awards a sum of money for specific, identifiable expenses associated with the injured person's loss, such as medical expenses or lost wages.
What are Special Damages?
The principle that lower courts must follow precedents set by higher courts.
What is Stare Decisis?
This term includes agents, brokers, sales representatives, and intermediaries who place insurance with insurers.
What is a producer?
A method of setting reserves by using the consensus of two or more claims personnel who have independently evaluated the claims file.
What is the Roundtable Method?
A clause that requires the insured to carry insurance equal to at least a specified percentage of the insured property's value.
What is a Coinsurance Clause?
A request that a court terminate an action because of settlement, voluntary withdrawal, or procedural defect.
What is Motion to Dismiss?
Methodical examination of a policyholder's operations, records, and books of account to determine the actual exposure units and premium for insurance coverages already provided.
What is a Premium audit?
A method of setting claim reserves by using a mathematical formula.
What is the Formula Method?
A monetary award to compensate a victim for losses, such as pain and suffering, that do not involve specific, measurable expenses.
What are General Damages?
A pretrial request that certain evidence be excluded from the trial.
What is Motion in Limine?