Coverage
What is a CC33?
A. Policy was cancelled
B. Vehicle not listed
C. Accident happened during the rain
D. Policyholder made changes to coverage within 30 days of an accident
D. Policyholder made changes to coverage within 30 days of an accident.
The insured and the claimant were both changing lanes. The insured was found to be 45% at-fault and the claimant was found to be 55% at-fault. The loss happened in a contributary state. What percent of the claimant’s damages would GEICO pay for?
0%
What is the Policy Index in the Family Auto Policy Contract?
This document gives an outline of how the policy, or contract, is organized.
In a pure state, policyholder is 70% responsible and claimant is 30% responsible. Policy holder’s damages are $5,800. How much can GEICO recover?
$1,740.00
Proximate cause is helpful for determining the reason for the loss because…?
A. It is like a witness to the accident.
B. It ties the duty that was breached to the cause of the accident.
C. It’s a word we can use to explain our liability decision.
D. It is a fancy insurance word.
B. It ties the duty that was breached to the cause of the accident.
What is the proper procedure if an insured reports a loss involving rideshare, but after they found out there was a coverage issue they change their story and advise no ridesharing occurred.
A. Resolve the ridesharing coverage issue.
B. Confirm if the insured has any additional insurance policies.
C. Confirm if they were signed into the rideshare application by gathering supporting documentation or by contacting the rideshare company.
D. Refer the claim to SIU and take no further steps in ICS.
C. Confirm if they were signed into the rideshare application by gathering supporting documentation or by contacting the rideshare company.
What is the 1st step the adjuster must complete in ClaimIQ (CIQ)?
Selecting the loss scenario on the Investigation tab that best fits the loss description.
Definitions on the policy contract have specific meanings and will appear in bold and italics in each section. Is this statement True or False?
True.
Claimant called in to advise our driver rear ended them. You have a fatal CC on the policy. You have policyholder’s recorded interview, submitted the CPW and have received confirmation from the CSCA that the policy was cancelled at the time of loss. What is the next thing you need to do?
A. Call policy holder to advise no coverage.
B. Call claimant and advise no coverage.
C. Call policy holder and claimant to advise there is no coverage and send them both a denial letter.
D. Call policy holder and claimant to advise there is no coverage.
C. Call policy holder and claimant to advise there is no coverage and send them both a denial letter.
Fill in the blank: _______________=vehicle or property damages and the physical injuries received to each party.
A. Compensatory damages
B. Damages
C. Punitive damages
D. Liability
B. Damages
The adjuster just received a CPW complete activity. The CSCA advised the loss could not be covered under the policy contract because the vehicle was actively being used for ridesharing purposes at the time of the loss. The adjuster called and sent letters to the policyholder and the claimant. This is a coverage__________________. Fill in the blank.
A. Disclaimer
B. Denial
C. Afford
D. Pending
A. Disclaimer
Our insured was driving on Pipkin RD when they collided with a Toyota in front of them. The claimant advised they were rear ended. The insured said they were trying to look at the GPS and impacted the claimant. Which duty did the insured breach?
A. None
B. Stopping at the traffic signal
C. Maintain proper lookout
D. Observe right of way
C. Maintain proper lookout
Amendments add coverage to a policy contract, while an endorsement changes the language of the policy contract. Is this statement true or false?
False.
If our insured is concerned about their rates increasing, what is the proper verbiage to address them?
“GEICO carefully considers many factors about your individual policy including other accidents and moving violations that you may have before changing your rate. You will receive your new policy information and premium about 30 days prior to your renewal effective date. Once you receive the renewal information, you may contact our customer service department with any questions or concerns, and they will be glad to help you.”
The claimant was exiting a gas station when they hit the policyholder who was traveling straight. The policyholder stated that they tried to slow down. The claimant said that they thought they had enough time to turn. What possible duties did the claimant breach?
A. Maintain a safe vehicle
B. None
C. Maintain a safe speed
D. Observe right of way
D. Observe right of way
The adjuster takes a FNOL and a CC33 generates. The insured collided with a cement pilar. The adjuster reviews EDGE and there was a recent change to the comprehensive coverage (deductible went from $1,000 to $250). What are the next steps?
A. Ask if there are any witnesses or a police report.
B. Clear the CC33 as the change in deductible does not affect the loss.
C. Send the claim to CDU.
D. Transfer the call to SIU.
B. Clear the CC33 as the change in deductible does not affect the loss.
Coby Dalton, insured driver, was driving his 2010 Ford F150 when he did not realize the claimant, Sally Henderson, had stopped in front of him. Mr. Dalton struck the rear center of Mrs. Henderson’s vehicle. Which party is CBP in ClaimIQ?
Coby Dalton
Fill in the blank: our insured Pedro rented a vehicle because his auto was in ACME auto repair after an incident, the rental vehicle is considered a____________.
A. Owned Auto
B. Utility Auto
C. Non-owned Auto
D. Temporary Substitute
D. Temporary Substitute
The insured is using their coverage to repair the vehicle after the claimant rear ended them. They have a $1000 Collision deductible and a $500 Comprehensive deductible. Using the coverages mentioned, what is the best way to respond to the insured?
A. Yes, the damage to your vehicle is covered under your collision coverage which carries a $1,000 deductible.
B. Yes, the damage to your vehicle is covered under your collision coverage which carries a $500 deductible.
C. Yes, the damage to your vehicle is covered under your comprehensive coverage which carries a $1,000 deductible.
D. Yes, the damage to your vehicle is covered under your comprehensive coverage which carries a $500 deductible.
A. Yes, the damage to your vehicle is covered under your collision coverage which carries a $1,000 deductible.
What are the 4 basics that will guide you through any investigation?
Determine what needs to be investigated, Gather evidence, Analyze and Make a decision.
There is a "fatal" CC (coverage concern) on a claim reported by our insured. The policy was canceled for non-payment. What steps should the adjuster take to work the claim towards completion?
A. Inform the policyholder of the coverage issue and gather a recorded interview if the customer disputes the policy cancelling for non-payment.
B. Obtain PORS/CANS.
C. Complete the Coverage Problem Worksheet, submit to supervisor for review. Then, CSCA for a review for a denial.
D. All of the above.
D. All of the above.
The policyholder was at Target, backing out of a parking space when they collided with the claimant who was also backing out of a parking space. Neither driver saw each other. What possible duties did each driver breach?
A. None
B. Maintain a safe speed
C. Maintain proper lookout
D. Maintain safe vehicle or bicycle/moped
C. Maintain proper lookout
How do we determine if a party meets the definition of an insured?
A. By checking the declarations page.
B. Reviewing the contract to determine if the vehicle they were driving was an owned or non-owned vehicle.
C. If the party tells you they were insured.
D. The contract will not define an insured.
B. Reviewing the contract to determine if the vehicle they were driving was an owned or non-owned vehicle.
What do we need to do before taking a recorded interview with a minor?
A. Get permission from their parent or guardian.
B. Get permission from parent or guardian, document the permission in notes, announce on the RI that you got permission from the parent/guardian.
C. Get permission from the parent or guardian and document the file that you got permission from the parent/guardian.
D. Get a LOR.
B. Get permission from parent or guardian, document the permission in notes, announce on the RI that you got permission from the parent/guardian.
Insured and his family are visiting on vacation from Florida. They rented a vehicle to be able to drive to Disneyland in Anaheim. This vehicle is considered a:
A. Owned Auto
B. Temporary Substitute Auto
C. Non-Owned Auto
D. Utility Auto
C. Non-Owned Auto