Basics
$2, $3, $4... These are examples of what?
Signal Reserves
CDW. What is it and do we owe it?
Collision Damage Waiver. No.
You identify a coverage issue. You loop in CIU and should next do this in your file...
Set an alert- DO NOT PAY. Coverage pending.
Insured driver ran a red light and passed away upon impact. The claimant is seeing a chiropractor.
Keep.
Last binged South Park
Rob!
This is when money is set aside to cover the Company’s liability to pay the ultimate probable loss and expense that will be incurred on a claim.
Reserving
If these aren't to be found within T Docs, the Agent's office or anywhere... You may just score free PIP and or UM/UIM.
Declination Forms
So we're double covered- both vehicle and driver have insurance. We secure a copy of their policy, compare with our policy language and both read excess... We'll be paying...
pro rata!
We extended 18,000 to the claimant attorney and now he won't call back. We search online and find he filed suit last week. Do we keep it?
No, transfer to Lit even if insured has NOT been served quite yet.
Lives outside the smallest national park...
Jodi!
The smallest national park in the United States is Gateway Arch National Park in St. Louis, Missouri, which is 91 acres in size
You present a value to the attorney and he promptly drops the client. Send this back to unrep. True or False?
Nope. If eval completed, keep it and settle direct with claimant. Don't forget a release prior to payment!
You can sue for damages if you are partially at fault for an accident, but you cannot recover damages if you are more than 51% at fault. This is also known as the "51% bar" or "proportionate responsibility". Texas is a x x state.
Comparative Negligence
For extra cash, insured works part time out of her own car dropping packages. She was on her way to a customer's home when she rear ends the claimant... Is she covered?
Yes.
Going through demand and learn claimant's ACL is torn. Records state she is a soccer player and injury occurred prior to MVA. Transfer it?
No. If attorney is NOT relating the injury to the MVA and there is no complication or aggravation, we keep it and make note in our EA and Negotiations.
Does not indulge, but would prefer bacon for breakfast if it did our body good...
Bill
If its not a clear liability loss. You need what?
Recorded statements.
Even from claimant! Ultimately, its OK if attorney denies, but we need to ask and document we asked either by phone or email... We can further inquire on a written statement, loss facts and or what does client intake state etc.
ID caused an accident. ID's husband was her passenger. They retained an attorney to help with the BI and we evaluated his claim to be worth $100k and the policy limits are 250,000/500. What will his settlement payout be?
Due to resident relative exclusion, max payout is capped at $30,000.00
5. bodily injury to you or any resident relative, except to the extent of the minimum limits of Liability Coverage required by Transportation Code Sec. 601.071, entitled ‘‘Texas Motor Vehicle Safety-Responsibility Act.’’
Jep lives in New Orleans and carries LA state minimum insurance. He's here in Houston visiting friends when he rear ends someone on the US's widest highway. We value the claimant's eval at $40,000.00. What are we paying?
30,000.00
We need to deem the limits.
250/500 limits. Claimant mom broke her wrist, no surgery. Her 3 children in the car all went to the ER to get checked out and they are OK. They are all represented by Jim Adler. Do we keep it?
No MCIL here, however resident relatives should remain together with the same adjuster for claim handling. Send all 4 to complex. Similarly...
When there is a combination of unrepresented and represented resident relatives, all the unrepresented injured parties will be handled by the same claim handler in the unrepresented segment and all the represented injured parties will be handled by the same claim handler in the represented segment.
Katie's 3 monkeys are...
Avery, Rocco and Tallulah
30/60/25- Hidalgo County. Insured fell asleep and rear ended a G Wagon that got pushed into a Tesla that in turn hit a 1989 Mustang. What should you be thinking?
PD limits issue.
Notify insured. Explain to claimants: No payments until we have all final estimates or values. Encourage them to use their own carriers for collision/UIM.
Texas wise we work with how many policies? Double jeopardy if you can name them...
3!
AU is the Original Gangster
ACR: Auto Contract Rewrite
ASC: Affordable Simple Connected
Insured is driving through Hill Country. It's dark. A herd of deer come dashing across the roadway. Insured totals his new car, kills 4 deer and his passenger is really banged up. The attorney sends in the passengers $48,000 ER bill. Policy limits are 30/60. Just do a manual- true or false?
False. This is a comprehensive loss and BI does not apply to comprehensive losses.
However, if the injuries or risk is high: we do need to take a second look at any negligence we may have contributed and reconsider denials, our authority and home office referrals.
250/500 policy with a PUP. Insured was on his second DUI and you're evaluating this claim that's due on Wednesday when you notice in the MRI report an annular tear to C5 and a horizontal tear in posterior horn of medial meniscus to right knee. Do we keep it?
Kind of sorta, NO!
Best case: we need to secure an extension for 10 business days and get this transferred over to complex.
Name the 3 that we can thank our West Texas office for...
Katie, Nikita and Komal