Misc
What does the declarations page do?
Gives details about the policy coverage choices.
Why do we want to select the correct person as a CBP in Claim IQ?
Because we want to access possible duties breach against the driver of the policy holder’s vehicle.
What is the Policy Index in the Family Auto Policy Contract?
This document gives an outline of how the policy, or contract, is organized.
What is a CC33?
Policyholder made changes to coverage within 30 days of an accident
Proximate cause is helpful for determining the reason for the loss because…?
It ties the duty that was breached to the cause of the accident.
Fill in the blank: _______________=vehicle or property damages and the physical injuries received to each party.
Damages
Who is CBP? (Covered By Policy)
Insured Driver
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?
Call policy holder and claimant to advise there is no coverage and send them both a denial letter.
GEICO and ABC Insurance both agree on liability, coming to the decision of: GEICO - 40%, ABC Insurance - 60%. This type of negligence is called:
Comparative/Shared Negligence
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?
Yes, the damage to your vehicle is covered under your collision coverage which carries a $1,000 deductible.
What is the 1st thing you need to do when accessing Claim IQ?
Select correct loss scenario on the investigation tab
How do we determine if a party meets the definition of an insured?
Reviewing the contract to determine if the vehicle they were driving was an owned or non-owned vehicle.
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.
Confirm if they were signed into the rideshare application by gathering supporting documentation or by contacting the rideshare company.
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
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:
Non-Owned Auto
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?
Observe right of way
True or False. An endorsement changes the language of the policy.
False
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?
Inform the policyholder of the coverage issue and gather a recorded interview if the customer disputes the policy cancelling for non-payment.
Obtain PORS/CANS.
Complete the Coverage Problem Worksheet, submit to supervisor for review. Then, CSCA for a review for a denial.
Mickey was traveling northbound on 2nd St. Ian was stopped at the light southbound on 2nd St, waiting to make a left hand turn onto H St. In his recorded interview, Ian stated he saw Mickey's vehicle approaching but thought he had enough time to clear the intersection when he made his turn. The point of impact to Ian's vehicle was the front bumper, and the point of impact to Mickey's vehicle was the passenger side front fender. What breach did the responsible party fail to follow?
Ian failed to yield the right of way.
What do we need to do before taking a recorded interview with a minor?
Get permission from parent or guardian, document the permission in notes, announce on the RI that you got permission from the parent/guardian.
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?
Maintain proper lookout
This section details circumstances that the contract doesn’t provide coverage.
Exclusions
What are the steps in a CPW escalation?
Complete the CPW and submit it to your Supervisor for review. Then, your Supervisor will escalate the CPW to a CSCA/RLA for review.
Jenn, our insured, states she was stopped at the intersection for about 1-2 minutes as the lights were cycling. When the light turned green, she checked to make sure no vehicles were in the intersection, then proceeded forward. She states she was about 50% of the way through when Bobby approached from the right, colliding into her passenger side front door. Jenn stated she knows Bobby must have had the red light because she had the green light. Bobby, the claimant, states he was approaching the intersection when he saw the lights cycle from red to green. He slowed his vehicle and made sure nobody was in the middle of the intersection before entering. He states he was about 50%-75% of the way through the intersection when Jenn approached from his left and pulled in front of his vehicle. Bobby confirms the damage is to his front bumper, and Jenn's passenger side front door. Bobby insists he had the green light, and Jenn had the red light. What type of loss is this?
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