MOI
WHO IS RESPONSIBLE FOR SETTING UP THE METHOD OF INSPECTION?
FNOL CLERK OR FRONT LINE ADJUSTER
What letter must be issued to all parties at start of claim?
Ack Letter/ Contact Letter
INSURED was proceeding straight through an intersection on a green light. CLAIMANT, approaching from the intersecting street to IV right, failed to stop for its red light and entered the intersection, striking the passenger side of IV
WHAT IS YOUR LIABLITY ASSESSMENT:
100% CLAIMANT VEHICLE
Failure to Obey Traffic Signal
Failure to Yield Right-of-Way
WHAT WOULD BE A PRIMARY COVERAGE ISSUE?
EXCLUDED DRIVER
UNLISTED VEHICLE?
BOTH!!!! THEY ARE BOTH IMPORTANT!!
WE MUST VERIFY AND DENY.
Personal Information
DRIVABLE VEHICLES LOCATED AT A BODY SHOP WILL BE MOVED WHERE?
THEY WILL STAY THERE. MITIGATING STORAGE FEES.
what letter should be sent to the first party when they decide they do not want to file claim with FLI or they do not hold first party coverage.
identify the PROPER LETTERS....
Reason for Unpaid Letter:
a. You are filling a claim with the other party's insurance company.
b. Your coverage is liability only. There is no coverage for damage to your auto.
Insured was making a left turn from a main road into a driveway, across one lane of oncoming traffic. Claimant, approaching from the opposite direction, collided with the passenger side of Insured's vehicle as it was completing the turn. Insured's driver claims the Claimant was speeding. The Claimant's driver alleges Our Insured turned suddenly with no warning.
50% OR 100% INSURED
FAILURE TO YIELD THE RIGHT OF WAY
Duty to Maintain Proper Lookout
WHAT TYPE OF PERILS WILL COMPREHESIVE COVERAGE COVER FOR?
Hail
Floods
Hurricanes
Tornadoes
Earthquakes
Windstorms
WHAT TYPE OF BASIC QUESTIONS ARE ASKED DURING THE FACTS OF LOSS?
TIME/ SPEED/ DISTANCE
IF THE INSURED CARRIED FIRST PARTY COVERAGE WE WILL ONLY SET UP "PHOTOS ONLY" DRIVE IN WHY, EXPLAIN.
THAT IS WRONG. IF INSURED WANTS TO FILE CLAIM WITH OC/CL WE WILL DO A COMPLETE ESTIMATE BASED OF DRIVE IN PHOTOS.
"PHOTOS ONLY" Apply if insured does not carry first party coverage.
what letter must be sent if the insured is not cooperating with the claim?
SITE SPECIFIC LETTER
ROR: Duties Section
Insured Cooperation
Insured is traveling in the center lane of a three-lane highway. CV1 , in the right lane, attempts to change lanes into the center lane, sideswiping Insured. This initial impact causes the driver of Insured Vehicle to lose control and swerve into the left lane, where it then collides with CV2 , which was properly traveling in the left lane.
100% CV1 (Claimant Vehicle 1)
Unsafe Lane Change
Failure to control Speed
IF FIRST PARTY DOES NOT HOLD FIRST PARTY COVERAGE WHAT CAN BE DONE ABOUT REPAIRS?
REVIEW FOR UM/UIM
ADVISE FIRST PARTY TO FILE CLAIM WITH ADVSERSE CARRIER FOR CLAIM SETTLEMENT.
ISSUE "REASON FOR UNPAID LETTER"
WHAT IS AN ADJUSTER DUTY AFTER COLLECTING THE FINAL STATEMENT FROM INSURED/ CLAIMANT?
REVIEW QUESTIONS ASKED, CONFIRM STATEMENT GIVEN MAKES SENCE, CREATE ROUNDTABLE FILE.
WHAT IS THE NEXT STEP AFTER IDENTIFYING PREDICTABLE VEHICLE OPTION.
COLLECT ESTIMATE AND ISSUE PAYMENT IF APPLICABLE.
What letter must be sent after 60 days of not receiving any statement or the driver is unk at this time.
Status Letter
a. A statement is needed from you.
b. The driver of our vehicle is unknown at this time and needs to be identified.
Insured and CV1 , collided at an uncontrolled intersection (no stop signs or traffic signals for any direction). Both drivers claim they arrived at the intersection first and proceeded with caution. The impact was to the front passenger side of Our Insured's vehicle and the front driver's side of CV1's vehicle.
50/50 IV and CV
FAILURE TO YIELD THE RIGHT OF WAY
Duty to Maintain Proper Lookout
WHAT SHOULD BE DONE IF UNLISTED DRIVER IS IDENTIFIED?
PLACE CALL TO MAIN INSURED OR REGISTERED OWNER OF VEHICLE TO GET PERMISSIVE USE, CONFIRM 515A, AND COLLECT POLICE REPORT
WHAT TWO ROLES SHOULD BE USED WHEN IDENTIFYING PARTIES DURING YOUR STATEMENTS?
INSURED or CLAIMANT
VEHICLE WITH AIRBAGS DEPLOYED AND WINDOW MECHANISM FAILURE WILL MOST LIKELY LEAD TO A...
What letter must be issued if coverage is denied due to VEHICLE INVOLVED IS OWNED BY A FAMILY MEMBER.
General Coverage Concerns - Definitions
"MAY NOT BE A COVERED AUTO"
WHY IS IT IMPORTANT TO KNOW THE DISTANCE OUR INSURED VEHICLE TRAVELED AFTER IMPACT?
Estimating Speed at Impact
Corroborating or Contradicting Statements
Understanding the Severity and Dynamics of the Impact
Determining Area of Impact and Final Rest
WHAT SHOULD BE REQUESTED FROM INSURED IF THE VEHICLE WAS JUST BOUGH AND HAD NOT BEEN ADDED TO THE POLICY?
IF INSURED DOES NOT HAVE DOCUMENT'S WILL WE PAY?
BILL OF SALE. VEHICLE INVOICE, LOAN AGREEMENTS
BY PROCESS: INSURED WOULD NOT HAVE COVERAGE DUE TO UNLISTED VEHICLE
WHAT WILL BE USED IF NO LOCATION OF THE ACCIDENT WAS IDENTIFIED AND A DIAGRAM MUST BE MADE?
LIABILITY ADVISOR DIAGRAM