ch 5 auto adjusting
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Amount agreed upon by the insurer and insured as to reasonable cost to repair damages without any deductions
Person designated by the insured to represent them in negotiations with the insurer
Substantially Similar Vehicle
Motor vehicle of the same make, model, year and substantially the same condition. Mileage must not exceed that of the insured vehicle by 4,000 miles
Subrogation recoveries are shared on a proportionate basis with the insured, unless the deductible has already been paid.
If an insurer prepares an estimate of the cost of repairs, it must be a reasonale estimate. Insurer must give copy of estimate to insured and may offer a list of shops to receive repairs
If the insured goes to a repair shop recommended by the insurer and the vehicle is not satisfactorily repaired, the insurer will cover the cost to repair the vehicle at no cost to the insured.
Deductions for betterment or depreciation are permitted only for parts normally subject to repair and replacement during the useful life of the insured vehicle. Calculations must be included in claim file
Previous Damage/Prior Condition
Deductions for previous damage or prior condition of the vehicle must be measurable and specified as to dollar amount and detailed in claim file
If the insurer does not perform its own physical inspection, it's still bound by all the applicable requirements
Generally found in uninsured motorist coverage in auto policies. Similar to appraisal clause, but arbitrators are used to pass on facts
Full Release Settlement
Imediate payment when the claimant signs a release giving up their right to sue
Scheduled Payment Release (Open-Ended Release)
General and special damages incurred to date are paid immediately but the claim is left "open" for payment of future "specials" such as follow up doctor visits
Payment of Physical Damage, Bodily Injury Pending
Insurer relieves the claimant's financial burden somewhat by agreeing to pay the property damage on the claim while leaving the bodily injury claim open until it can be negotiated
No Release or Walk Away
Bills presented are paid without attempting to obtain a separate release. After a certain time with no contact from the claimant, the file is considered closed.
Relieves financial burden on claimant bu making certain payments to the claimant before the claim can be negotiated. They are subtracted from the final settlement
Generally reserved for large settlements. Claimant receives set installments over a period of time instead of a lump sum
Includes provisions for rehabilitative treatment of the claimant
Adjusters can speed up the payment of claims. Normally limited in terms of the limit that can be paid and lines of insurance to which it applies
Insurer holds the rights to recover damages from a third party. The adjuster determines the amount to collect from the third party and show just cause against the third party who caused the loss.
Obtaining estimates of damaged property before payments can be made
Reservation of rights letter
If the insured doesn't report a claim on time, this advises the insured that the insurance company will investigate the claim but may deny coverage if it determines the claim has been "damaged" because of the insured's late reporting.
Rention of a known right. If insurer or adjuster claims something by mistake, they have waived the exclusion. I.E. an adjuster tells an insured that something is covered under their policy when it isn't, the exclusion is waived
Binding judgement issued by the court that defines legal relationships between parties and their rights with respect to the matter brought to court
Diminuation in Value
If after making repairs to a vehicle, the owner has still suffered a loss because of a lower market value for their wrecked vehicle, the owner is entitled to compensation for the diminuation in value
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