N.C. Claims Adjuster License Exam

N.C. Claims Adjuster License Exam

Inception/Expiration Date

(Ans- an insurance policy covers the insured starting at 12:01am on the

day on which coverage begins and expires at 12:01am on the expiration

day of the policy.

Occurrence Date

(Ans- Date of which the loss occurred

Identification of parties involved

(Ans- The loss report should include the names and addresses of the

parties involved in the loss, the names and addresses of any injured

person(s) and the names and addresses of any witness(s).

Policy Form/Number

(Ans- Identifies the type of coverage purchased (policy form) and the

policy number for the particular policy purchased by the insured.

Description of the Loss

(Ans- Information concerning how, when and where the accident or loss

happened is an essential element in any loss report.

Coverage

(Ans- Shows the type of coverage(s) purchased as well as the limits of

coverage purchased.

Damages - Special Compensatory damages

(Ans- Are amounts paid to compensate the plaintiff for direct expenses

such as medical treatment, lost wages (both past and future), funeral

expenses and rehabilitation expenses required because of bodily injury.

Special damages are paid for losses that can be determined and

documented. They are often referred to as "out-of-pocket" expenses.

Damages - General Compensatory Damages

(Ans- Are paid for losses that cannot be specifically measured and

itemized in order to compensate the plaintiff for things such as pain and

suffering, loss of the use of an arm or leg, loss of vision, physical

disfigurement and/or loss of consortium.

Damages - Punitive Damages

(Ans- Are typically awarded to the plaintiff in addition to compensatory

damages when the defendants conduct has been especially malicious.

Punitive damages are awarded to punish the defendant and to deter others

from engaging in similar actions.

Unfair Claims Settlement Practices

(Ans1. Knowingly misrepresenting relevant facts or policy provisions relating to

the coverage at issue. 2. Failing to acknowledge with reasonable

promptness communications pertaining to claims. 3. Failing to adopt and

implement reasonable standards for the prompt investigation of claims. 4.

Arbitrary and unreasonable refusal to pay claims. 5. Failing to affirm or

deny coverage of claims within a reasonable time after proof of loss has

been completed. 6. Not attempting in good faith to make prompt, fair and

equitable claims settlement when the insurer's liability has become

reasonably clear. 7. Compelling insureds to institute suits to recover

amounts due under a policy by offering substantially less to settle

immediately. 8. Attempting to settle claims for less than the amount for

which a reasonable person would believe one was entitled based on written

or printed advertising material accompanying or made a part of an

application. I. Attempting settlement of claims on the basis of applications

that were altered without notice to knowledge of or consent of insureds.

Total Losses on Motor Vehicles/Miscellaneous Provisions

(Ans1. If the insurer and the claimant are unable to reach an agreement as to

the value of the vehicle, the insurer shall base any further settlement offer

not only on the published regional average value of similar vehicles, but

also on the value of the vehicle in the local market. 2. Local market value

shall be determined by using either the local price of a comparable vehicle

or if no comparable vehicle can be found, quotations from at least two

qualified dealers within the local market area. Additionally, if the claimant

represents that the vehicle was in better than average condition, the insurer

shall give due consideration to the condition of the claimant's vehicle prior

to the accident. 3. When a motor vehicle is damaged in an amount which

equals or exceeds 75 percent of the preaccident actual cash value, an

insurer shall "total loss" the vehicle by paying the claimant the preaccident

value and in return, receiving possession of the legal title for salvage

purposes. 4. The insurer will be responsible for all reasonable towing and

storage charges until three days after the owner and the storage facility are

notified in writing that the insurer will no longer reimburse the owner or

storage facility for storage charges. 5. Loss and claims payments shall be

mailed or otherwise delivered within 10 business days after the claim is

settled.

After Market Parts

(Ans- An after market part is any part made by a non original manufacturer.

Speculative Risk

(Ans- When there is a chance of gain as well as a chance of loss.

Insurance is not intended to protect against this type of risk.

Pure Risk

(Ans- When there is a chance of loss only.

Insurable Risk

(Ans- One that an insurance company is willing to accept.

Characteristics of Insurable Risk

(Ans1. Low probability of loss occurring, 2. Less than catastrophic results, 3.

The loss must be measurable, 4. The loss must be significant, 5. The loss

must be accidental and unintended.