ch 5 auto adjusting

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ch 5 auto adjusting
2011-09-20 16:08:49
adjusting auto losses

Chapter 5 - Adjusting Automobile Losses
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  1. Agreed Price
    Amount agreed upon by the insurer and insured as to reasonable cost to repair damages without any deductions
  2. Designated Representitive
    Person designated by the insured to represent them in negotiations with the insurer
  3. 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
  4. Subrogation demands
    Subrogation recoveries are shared on a proportionate basis with the insured, unless the deductible has already been paid.
  5. Repair Estimate
    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
  6. Insatisfactory Repair
    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.
  7. Betterment/Depreciation
    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
  8. 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
  9. Physical inspection
    If the insurer does not perform its own physical inspection, it's still bound by all the applicable requirements
  10. Arbitration Clause
    Generally found in uninsured motorist coverage in auto policies. Similar to appraisal clause, but arbitrators are used to pass on facts
  11. Full Release Settlement
    Imediate payment when the claimant signs a release giving up their right to sue
  12. 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
  13. 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
  14. 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.
  15. Advanced Payment
    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
  16. Structured Settlement
    Generally reserved for large settlements. Claimant receives set installments over a period of time instead of a lump sum
  17. Rehabilitation
    Includes provisions for rehabilitative treatment of the claimant
  18. Draft Authority
    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
  19. Subrogation Procedures
    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.
  20. Appraisal Process
    Obtaining estimates of damaged property before payments can be made
  21. 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.
  22. Non-waiver
    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
  23. Declaratory Judgement
    Binding judgement issued by the court that defines legal relationships between parties and their rights with respect to the matter brought to court
  24. 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