LETTERS
You would send this letter to the insured on day one if you identify any coverage issues, such as damage to their vehicle due to repossession or misrepresentation.
Reservation of Rights Letter (ROR)
Name two types of "Roundtable Files" that must be complete for an assessment.
Photos of damage, diagrams, police reports, street views, witness statements (any two).
LACK OF COOPERATION
COVERAGE RECAP
When closing a claim, what call must an adjuster make to all parties?
A closing call.
If a vehicle is predicted to be a total loss, or if it's repairable and located at a tow yard (even with unknown damages), this letter should be sent.
Storage Cut-Off Letter or a Repairable Storage Cut-Off Letter
Your Insured turned left on a green light and was hit by Claimant, who a witness stated ran a red light. Assign liability percentages.
0% \ 100%
What document should be on file to help determine if an intentional act occurred?
This type of transfer will apply if Property Damage (PD) limits are reached, there are multiple PDs, or the Estimate of Repairs (EOR) on file is 50% of limits.
PRO RATA
This type of transfer will apply if another company has paid for damages and is requesting payment from FLI, or if an ISO Claim is found under a vehicle or driver search
SUBROGATION
If a claimant's coverage is denied because the damages claimed occurred outside of the policy territory, or the statute of limitations has expired you would send them this specific letter.
Coverage Denial Letter - Claimant Letter
Your Insured changed lanes into Claimant lane on a highway, with no witnesses or police report. Damages are consistent with Insured merging into Claimant. Assign liability percentages.
100% \ 0%
For a first-party claim, if a MOI (Method of Inspection) is set up, what possible bucket should the claim be categorized?
IVAP - insured vehicle appraisal (pending for completion of estimate)
If a vehicle is used for services like UBER, LYFT, or DOORDASH, what type of exclusion might apply?
BUISNESS USE
When handling vehicle appraisals, what specific item should always be completed for all vehicles (if applicable)?
DTE
This letter is sent to the insured when they are at least 51% at fault and the property damage exceeds $1,000 combined, or if a BI claim is paid.
Principally at Fault (PAF) letter
Your Insured and claimant ran a stop sign at a two-way stop intersection, colliding with Claimant on the through street. Police report confirms Insured's stop sign. Assign liability percentages.
100% / 0%
80% \ 20%
Which type of transfer applies if possible medicals or injuries have been provided during calls with a claimant?
EBI (Early Bodily Injury) transfer \ ONE SHOT TEAM - Frontline adjusters
If a driver is not listed on the policy, what must be gathered from the insured to confirm coverage?
permissive use
Name 2 specific items adjusters are looking for and should provide when reviewing a Police Report.
Witness, Injuries or EMS Transport, Citations, Accident Summary, Vehicles and Parties
A Team Lead would issue this letter to a third-party PD claimant, explaining the pending documentation or reasons for settlement.
10 Day Letter
Your Insured was backing out of a driveway and struck Claimant, who was illegally parked directly across the street. The Insured claims a large bush obstructed their view. Assign liability percentages.
100% / 0%
Besides "Heavy Damage" and "Severe Injuries Sustained," name two other specific aggravating factors that would trigger an LV3 transfer.
DUI, Hit and Run, DWI, Claimant vehicle rollover, or Insured vehicle with passenger rollover (any two).
Why would we transfer a claim to the frontline one shot team?
for claimed injuries/ soft tissue injuries by cv/ passengers
For any payments made to an insured under first-party coverage, what potential outcome should always be reviewed?
SUBROGATION POTENTIAL
OR OPEN FOR DISCUSSION.