A claim file raises a question about “special damages.” Which statement should guide the adjuster?
A. General damages include non-economic harm such as pain and suffering where legally recoverable
B. Comparative fault allocates responsibility among parties under applicable law
C. Premises liability claims involve injury allegedly caused by conditions or activities on premises
D. Special damages are measurable economic losses such as medical bills or lost wages
Show answer and reasoning
Correct answer: D. Special damages are measurable economic losses such as medical bills or lost wages
- A: This states the rule for general damages: General damages include non-economic harm such as pain and suffering where legally recoverable. The question instead asks about special damages, which has a different trigger or coverage function.
- B: This states the rule for comparative fault: Comparative fault allocates responsibility among parties under applicable law. The question instead asks about special damages, which has a different trigger or coverage function.
- C: This states the rule for premises liability: Premises liability claims involve injury allegedly caused by conditions or activities on premises. The question instead asks about special damages, which has a different trigger or coverage function.
Source: National Association of Insurance Commissioners — Glossary of Insurance Terms; entry/locator 'Special Damages'; https://content.naic.org/glossary-insurance-terms
An adjuster encounters an issue involving “adjuster role.” Which explanation is accurate?
A. An adjuster investigates claims, evaluates coverage and damages, and helps determine the insurer's claim obligation under the policy
B. An independent adjuster is typically contracted to handle claims for insurers rather than being a company employee
C. A public adjuster generally represents the insured or claimant, not the insurer, subject to state licensing rules
D. A denial letter should explain the factual and policy basis for denying all or part of a claim
Show answer and reasoning
Correct answer: A. An adjuster investigates claims, evaluates coverage and damages, and helps determine the insurer's claim obligation under the policy
- B: This states the rule for independent adjuster: An independent adjuster is typically contracted to handle claims for insurers rather than being a company employee. The question instead asks about adjuster role, which has a different trigger or coverage function.
- C: This states the rule for public adjuster: A public adjuster generally represents the insured or claimant, not the insurer, subject to state licensing rules. The question instead asks about adjuster role, which has a different trigger or coverage function.
- D: This states the rule for denial letter: A denial letter should explain the factual and policy basis for denying all or part of a claim. The question instead asks about adjuster role, which has a different trigger or coverage function.
Source: NAIC Unfair Claims Settlement Practices Act, Model 900 — Sections 3-4, claim investigation, communications, settlement, and documentation standards; locator 'Adjuster Role'; https://content.naic.org/sites/default/files/model-law-900.pdf
A claim file raises a question about “independent adjuster.” Which statement should guide the adjuster?
A. A staff adjuster is employed by an insurer to handle claims for that insurer
B. Claims should be acknowledged and handled within applicable timeframes and company procedures
C. An independent adjuster is typically contracted to handle claims for insurers rather than being a company employee
D. The claim file should document facts, contacts, coverage analysis, damages, decisions, and payments
Show answer and reasoning
Correct answer: C. An independent adjuster is typically contracted to handle claims for insurers rather than being a company employee
- A: This states the rule for staff adjuster: A staff adjuster is employed by an insurer to handle claims for that insurer. The question instead asks about independent adjuster, which has a different trigger or coverage function.
- B: This states the rule for claim acknowledgment: Claims should be acknowledged and handled within applicable timeframes and company procedures. The question instead asks about independent adjuster, which has a different trigger or coverage function.
- D: This states the rule for claim file documentation: The claim file should document facts, contacts, coverage analysis, damages, decisions, and payments. The question instead asks about independent adjuster, which has a different trigger or coverage function.
Source: NAIC Unfair Claims Settlement Practices Act, Model 900 — Sections 3-4, claim investigation, communications, settlement, and documentation standards; locator 'Independent Adjuster'; https://content.naic.org/sites/default/files/model-law-900.pdf
During claim evaluation, “staff adjuster” becomes relevant. Which conclusion is correct?
A. A public adjuster generally represents the insured or claimant, not the insurer, subject to state licensing rules
B. A reservation of rights lets the insurer investigate or defend while preserving possible coverage defenses
C. A staff adjuster is employed by an insurer to handle claims for that insurer
D. Good faith claim handling requires fair, prompt, and honest evaluation of coverage and damages
Show answer and reasoning
Correct answer: C. A staff adjuster is employed by an insurer to handle claims for that insurer
- A: This states the rule for public adjuster: A public adjuster generally represents the insured or claimant, not the insurer, subject to state licensing rules. The question instead asks about staff adjuster, which has a different trigger or coverage function.
- B: This states the rule for reservation of rights: A reservation of rights lets the insurer investigate or defend while preserving possible coverage defenses. The question instead asks about staff adjuster, which has a different trigger or coverage function.
- D: This states the rule for good faith claim handling: Good faith claim handling requires fair, prompt, and honest evaluation of coverage and damages. The question instead asks about staff adjuster, which has a different trigger or coverage function.
Source: NAIC Unfair Claims Settlement Practices Act, Model 900 — Sections 3-4, claim investigation, communications, settlement, and documentation standards; locator 'Staff Adjuster'; https://content.naic.org/sites/default/files/model-law-900.pdf
Which statement correctly distinguishes “public adjuster” from related claim-handling concepts?
A. A public adjuster generally represents the insured or claimant, not the insurer, subject to state licensing rules
B. Claims should be acknowledged and handled within applicable timeframes and company procedures
C. A coverage letter should clearly explain the insurer's coverage position using policy language and claim facts
D. Unfair claims practices can include unreasonable delay, misrepresentation, inadequate investigation, or improper denial
Show answer and reasoning
Correct answer: A. A public adjuster generally represents the insured or claimant, not the insurer, subject to state licensing rules
- B: This states the rule for claim acknowledgment: Claims should be acknowledged and handled within applicable timeframes and company procedures. The question instead asks about public adjuster, which has a different trigger or coverage function.
- C: This states the rule for coverage letter: A coverage letter should clearly explain the insurer's coverage position using policy language and claim facts. The question instead asks about public adjuster, which has a different trigger or coverage function.
- D: This states the rule for unfair claims practice: Unfair claims practices can include unreasonable delay, misrepresentation, inadequate investigation, or improper denial. The question instead asks about public adjuster, which has a different trigger or coverage function.
Source: NAIC Unfair Claims Settlement Practices Act, Model 900 — Sections 3-4, claim investigation, communications, settlement, and documentation standards; locator 'Public Adjuster'; https://content.naic.org/sites/default/files/model-law-900.pdf
