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30 Cards in this Set
- Front
- Back
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Direct loss |
A reduction in value of the damaged property |
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Indirect loss |
A loss that arises as a result or consequence of the DIRECT LOSS |
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Pro rata contribution |
Each Insurer contributes a portion of the loss that is proportional to the amount of the policy |
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Insurable interest |
An interest in the SUBJECT that is insured, that would cause the interested party to suffer financial loss if an insured event occurred |
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Compensatory damages |
COMPENSATORY INCLUDE SPECIAL & GENERAL DAMAGES. Its a payment awarded by court to reimburse a victim for actual harm |
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Special damages |
Awards a sum of money for specific identifiable expenses associated with injured person's loss. |
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General damages |
Monetary awsrd to comoensate for non economic damages, such as mental anguish, disfigurement, inconvenience, loss of enjoyment of life. |
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Punitive damages |
A payment awardes by court to punish a defendant for reckless, malicious act to deter similar conduct. |
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Coinsurance clause |
A clause that requires a home to be insured for a % of its total cash value or replacement value. |
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Summary jury trial |
ADR ( ALTERNATIVE DISPURE RESOLUTION method ) the disputing parties participate in an abbreviated trial, presnting evidence of witnesses to a mock juror who decide the case. |
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Peremptory challenge |
A lawyer's ability to object to a potential juror's placement on the jury w/o having a specific reason |
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Loss ratio |
a ratio that measures loss & loss adjustment expenses vs. Premiums = % of premiums being consumed by the losses. |
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Individual case method |
A method of setting RESERVES bases on the claim circumstances & claim rep experience in handling similar claims |
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Reserve |
The amount the insurer estimates and sets aside to pay on an existing claim that has not been settled |
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Arbitration |
ADR - disputing parties use a neutral party to examine the issue and develop a settlement which can be final |
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Mediation |
ADR disputing parties use an outside neutral party to examine the issue and develope a MUTUALLY AGREEABLE SETTLEMENT |
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Roundtable method |
A method of setting reserves by using the consensus of 2 or more claims personnel who have independently evaluated the claims file. |
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Average value method |
A case reserving method that establishes a predetermined $$ amount of reserve for each claim as it is reported |
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Formula method |
A method of setting claim resrves by using a mathematical formula |
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Expert system method |
A method of setting reserves with a software application that estimates losses & LAE |
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Breech of contract |
The failure without legal excuse to fulfill a contractual promise |
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ADR- ALTERNATIVE DISPUTE RESOLUTION |
Procedures to help settle disputes, such as arbs, mediation and negotiation WITHOUT LITIGATION. |
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Bad faith |
An insuree denial of coverage without cause |
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Good faith |
Handling claims that require an insurer to give consideration to the insured's interest that is equal to consideration it gives to the insurer |
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HIPAA |
Federal legislation standards for health insurance information exchanges & health coverage protection when jobs are lost or changed. |
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Deposition |
A pretrial oral examination (testimony) under oath to produce a written verbatim record .......may be used as evidence |
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Independent medical examination |
Direct intervention technique includes a review of patients history and treatment and physical exam to determine cause, cureent physical impairment and the need for future treatment |
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Examination under oath |
Statement given by a person who sworn to tell the truth before an officer of the court |
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Sarbanes oxley act of 2002 |
A fedeal law that governs corporate directors, in areasof investors protection, internal controls, penalties, both civil and criminal |
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Third party administrators TPA |
An organization that provides administrative services associated with risk financing and insurance. |
