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227 Cards in this Set
- Front
- Back
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1-1 What are the 2 civil law systems operating in Canada that concern the private rights of individuals?
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1-2 Why is knowledge of contract law useful to adjusters?
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1-3 What does privity of contract mean?
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1-4 What are 5 essential elements of any contract under the common law?
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1-5 What are 4 essential elements of any contract under the Civil Code of Quebec?
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1-6 What are 3 additional legal requirements that apply only to insurance contracts?
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1-7 What is insurable interest?
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1-8 Under what circumstances is a loss adjuster likely to be held personally liable for his or her conduct?
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1-9 What must a loss adjuster establisk to show that a representation made by an insured was a material fact?
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1-10 How is material change described in provincial insurance statutes?
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1-11 What is a warranty in relation to an insurance policy?
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1-12 What are the 3 typical remedies available to insurers when an insured is in breach of policy obligations?
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1-13 What is the principle of equity as it relates to the common law?
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1-14 What criteria are outlined in the IBC claims agreements that support a signatory insurer's decision to gorgo the requirement for a formal sworn completed proof of loss?
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1-15 When intending to present a claim, what must an insured do to mitigate damages?
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1-16 What regulatory body oversees federally chartered insurance companies?
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1-17 What does PACICC do?
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1-18 What must a loss adjuster do to obtain the private financial, emplyment, or medical records of a claimant?
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1-19 What does the claims department do?
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1-20 What are 2 main methods used to set up reserves for claims?
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1-21 Name 3 IBC claims agreements.
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1-22 Explain how the Canadian Inter-Company Arbitration Agreement operates to resolve claims.
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1-23 Provide an example of how fraud may occur in a claims situation.
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1-24 What services would you expect a special investigation unit to provide?
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1-25 Through what activities does the Canadian Independent Adjusters Association (CIAA) provide leadership for adjusters?
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2-1 What knowledge must a loss adjuster have of insurance policies in general to analyze coverage?
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2-2 What must a loss adjuster ask to assess whether or not an insured has an insurable interest in damaged or lost property?
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2-3 What is proximate cause in relation to an insurance claim?
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2-4 What is a remote cause? Give an example.
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2-5 How do the courts rule on concurrent causation as it applies to insurance policies?
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2-6 Why do most insurance policies use a "clear language" style?
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2-7 What are the main parts of a standard insurance policy wording?
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2-8 What does the declarations page of an insurance policy provide?
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2-9 What does the insuring agreement describe?
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2-10 What part of the policy would you consult to determine what is not covered?
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2-11 What does the residential policy wording 1153 04.03 provide under Notice to Authorities?
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2-12 Explain the contra proferentem rule.
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2-13 What is a contract of adhesion
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2-14 Generally, how are coverage provisions construed?
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2-15 Generally, how are exclusion construed?
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2-16 When a policy wording is ambiguous, which analysis is used to interpret the wording?
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2-17 In a contract of adhesion in Quebec, what type of clause may be ruled as null or its obligation reduced?
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2-18 How does legislation affect coverage under a policy?
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2-19 Explain how a decision tree model is useful to analyze policy coverage.
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2-20 In liability insurance claims situations, once it is determined that coverage is available under the policy where must the loss adjuster turn her attention?
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3-1 Define rapport and how it can be cultivated.
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3-2 Identify 2 factors that influence human behaviours from a cultural point of view
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3-3 What is the key to overcoming falling into a potentially inappropriate habituated or automatic response when communicating with people?
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3-4 Identify and briefly explain 4 personality types.
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3-5 Explain how a person whoe dominant thought style is visual thinks.
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3-6 What does body language reveal about a person? Give an example of a gesture and how it can be interpreted.
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3-7 Through observation and self-analysis we can choose to respond in a positive way in a claims encounter. How would you handle a tense situation where a claimant is being demanding or aggressive as a reaction to the stress of a loss.
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3-8 Provide an example of what you could do to build your self-esteem.
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3-9 How and why do we project aspects of ourselves onto other people?
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3-10 Describe the process of active listening.
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3-11 How can we show someone that we are listening to what they are saying?
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3-12 What factors can act as barriers to effective listening?
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3-13 There are many opportunties within the communication process when information can become distorted. Identify 5 of them.
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3-14 What defence mechanisms do people use to help them recover from painful or strong emotiions?
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3-15 Suggest how a loss adjuster could approach delivering bad news to an insured.
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3-16 Give an example of 2 statements providing the same response but one positively stating the information and the other negatively stating the information. Use a statement that you would expect a loss adjust to use.
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3-17 Identify 3 characteristics in how people think, uncluding their attitudes that would negatively affect their ability to communicate effectively.
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3-18 Inc communication, what do we mean by "calibrate behavious"?
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3-19 How would you deal with a yes-person striving for harmony and being too quick to respond in the affirmative?
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3-20 Why are people skills more critical on the telephone than with someone face-to-face?
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4-1 The claims handler who takes the first report of the claim from the insured does an initial check of policy coverage. What are the 3 coverage questions to be answered?
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4-2 Identify 2 other terms used to denote a loss adjuster.
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4-3 How does legislation define an adjuster who must be licensed in the common law provinces?
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4-4 Who is exempt from the deginition of adjuster in legislation applicable to the common law provinces?
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4-5 Why would an insurance company hire an independent adjuster to handle a claim?
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4-6 Give an example of provincial legislation which a loss adjuster must be familiar with.
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4-7 Why must the claims handler take note of who reports a claim?
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4-8 A broker must be familiar with the course of action prescribed by the insurer for that particular type of claim. For example, upon the report of an automobile collision claim, what are 2 courses of action that may be prescribed by the insurer for the broker taking the claim?
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4-9 Supporting services are used by the insurer in order to settle a claim. For example, an appraiser is used to assess damage. Name another support service provider.
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4-10 What is the recommended response to an insured who is very upset about a loss event?
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4-11 What must temper the use of soft skills in claims handling?
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4-12 Why must care be taken in the choice of words to acknowledge the insured's feelings when a claim is reported?
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4-13 Why is it best to avoid using phrases that may imply coverage when a claim is first reported?
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4-14 What is a common question posed by an insured upon reporting a claim?
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4-15 What is involved in triagin a new claim report?
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4-16 Explain any 4 duties an insured has when a cliam arises under a policy.
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4-17 What is the term that describes the insurer's position when it is unable to assess a claim because the insured delated the report of a cliaim?
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4-18 What condition applies to the insured's property policies in Quebec when he or she is a victim of a crime?
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4-19 When a claim is reported, why does the insuer have the right to ask whether any changes have occured in the property since the policy was issued?
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4-20 Who is the "first party" in an insurance contract?
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5-1 What is the purpose of investigating a claim?
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5-2 What effects the scope of an investigation planned by the insurer?
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5-3 What kind of investigation occurs when a fraudulent claim is suspected?
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5-4 When a loss adjuster must inspect the scene of a loss, what responsible action must be taken with respect to safely?
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5-5 What is the different between a non-waiver agreement and a reservation of rights letter?
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5-6 What does the indemnity clause accomplish in a non-waiver agreement and a reservation of rights letter?
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5-7 What are some advantages to properly preparing for an interview?
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5-8 Why are checklists used in an interview?
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5-9 How should a loss adjuster deal with a situation when the person being interviewed made an obvious error?
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5-10 Under what circumstances might the loss adjuster begin an interview with a short answer question?
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5-11 Give an example of a direct question asked by a loss adjuster to draw out more information.
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5-12 What can a loss adjuster do when he or she recognizes the person being interviewed is in distress?
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5-13 Define witness.
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5-14 What strategies could a loss adjuster employ to get an interview with an uncooperative independant witness?
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5-15 What are the 3 categories for classifying admissible evidence?
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5-16 Explain the difference between direct evidence and circumstantial evidence.
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5-17 Explain how photographs and similar documentation help a claim investigation.
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5-18 What are the drawbacks associated with writing on or otherwise altering claims documentation?
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5-19 What is spoliation of evidence?
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5-20 Define expert.
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5-21 Define forensic.
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6-1 What does a loss adjuster consider when comparing repair estimates?
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6-2 How does a loss adjuster handle the overhead and profit portion on work to be done by an insured?
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6-3 What can a loss adjuster do to verify the authenicity of invoices?
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6-4 In a judicial setting, what are the 2 main elements to the issue of credibility in proving a loss?
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6-5 List 8 bases of evaluation used in claims.
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6-6 List 3 methods used to determine actual cash value.
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6-7 How would a loss adjuster settle a claim under a property policy for a pair of matching chairs when only one was damaged?
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6-8 How would a loss adjuster resolve a claim subject to the parts clause of a property policy?
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6-9 What procedure would a loss adjuster follow when the replacement clause of a property policy was invoked?
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6-10 How does the loss adjuster prepare for negotiating the value of a claim with the insured?
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6-11 Explain the win-win approach to negotiating.
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6-12 Discuss the issue of making concessions during a claim negitiation.
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6-13 Why is selling salvage back to an insured preferred for small claims?
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6-14 Identify 4 tips usefulto resolving conflicts in claims negotiations?
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6-15 How is a person's judgment affected when he or she is angry?
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6-16 How does offending a party's dignity affect negotioations?
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6-17 What is the role of a mediator?
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6-18 What happens when an offer is not accepted in mediation?
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6-19 How is arbitration given legal effect?
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6-20 What are the rules of evidence in an arbitration proceeding?
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6-21 How does the statutory condition of appraisal work in a property policy?
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6-22 Identify each step in the two-part test used to determine whether an insuer can claim privilege over a document.
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7-1 In first party losses, what provides the basis for settlement?
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7-2 What date is used as the basis to evaluate property for placement cost coverage for a building loss under a property policy?
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7-3 How does replacement cost coverage operate in a personal lines property policy?
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7-4 How are deductibles most commonly applied to loss settlements?
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7-5 Explain how a total loss would be settled under a valued policy.
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7-6 Explain how a claim would be settled under two policies of insurance covering the same property when one of the policies schedules and describes the property specifically. (Use the Agreement of Quiding Principles to answer this question)
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7-7 How would a claim be settled under two policies when both of them cover the property specifically? (Use the Agreement of Guiding Principles to answer this question)
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7-8 How would a claim be settled when coverage is available under two policies: one that specifically covers baggage on a holiday; and the other a homeowner's policy? Use the agreement of guiding principle to answer this question.
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7-9 Explain the limit of liability rule as it applies to overlapping coverage settlement calculations.
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7-10 What legal steps could an insurer take to enforce judgment in a subrogation situation?
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7-11 In subrogation situations, what are some particular issues of importance to the adjuster when it comes to providing notice to an entity responsible for the damages?
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7-12 What issues may arise with respect to salvage and the insurance adjuster?
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7-13 What options does an insurer have once an insured submits a proof of loss?
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7-14 Describe 3 possible reasons why the loss adjuster may be faced with additional cost on a claim from a contractor.
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7-15 Identify an effective technique a loss adjuster might use to deny a claim to an insured.
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7-16 What contractual rights does the insuer lose once a claim is denied?
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7-17 How can the loss adjuster relieve tension when denying a claim?
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7-18 What is a release and what is its purpose?
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7-19 What are the limitations imposed upon an insured with respect to litigation against the insurer?
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7-20 What is the discoverability rule?
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7-21 Why would an adjuster preface the contents of a letter with the words " without prejudice"?
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7-22 What do pleadings accomplish in civil procedure?
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7-23 Why is a court search performed?
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7-24 What 2 types of legal costs are incurred in litigation?
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8-1 What 6 areas must a loss adjuster have knowledge of in order to handle automobile claims?
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8-2 What type of coverage is provided by the specified perils insuring agreement under the automibile policy?
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8-3 What type of coverage is provided by the all perils insuring afreement under the autmobile policy?
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8-4 In what way can policy coverage change when an insured is driving a temporary substitute vehicle?
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8-5 What coverage does a loss of use endoresement entitle the insured to?
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8-6 Explain what coverage a blanket basis fleet endoresement provides?
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8-7 What is the purpose of an absolute liability provision in provincial insurance legislation?
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8-8 What role does an appraiser play in assessing automobile damage?
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8-9 What are direct repair programs used by insurance claim departments?
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8-10 When are estimates from repair garages appropriate?
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8-11 Why does a loss adjuster visit the scene of an accident as soon as possible?
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8-12 Why should a loss adjuster maintain impartiality when drawing a diagramof an accident scene? How should the loss adjuster indicate parties involved in the accident in his or her diagram?
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8-13 What is the purpose of inter-company settlement charts?
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8-14 Explain what a loss adjuster would do if there independent witnesses to an accident being investigated.
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8-15 When might a loss adjuster decide to hire an expert in an automobile claim? Give an example of an expert that might be used.
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8-16 Why do most insurer prefer to have an insured's automobile repaired as opposed to making a cash settlement?
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8-17 How does a loss adjuster assess an automobile's worth in the case of a total loss?
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8-18 What details should be included in statements about autmobile theft loss?
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8-19 Why does an autmobile fire loss require careful scrutiny by a loss adjuster?
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8-20 List the steps involved for a loss adjuster when investigating an automobile fire.
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8-21 Give an example of a clue that might indicate to a loss adjuster that a fraudulent automobile fire claim has been made.
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8-22 In Quebec, when does a loss adjuster apply the Direct Compensation Agreement to a collision?
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8-23 When assessing liabilty, what issues should be ignored according to the DCA's Driver Fault Chart?
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8-24 How is recovery under the Direct Compensation - Property Damage agreement determined?
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9-1 What are the 4 parts of the framework of a homeowner's policy?
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9-2 How is a tenant's package policy different from a homeowner's policy?
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9-3 How is personal property defined by insurers? Give some examples of items that are considered personal property.
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9-4 Explain the difference between losses qualified under building coverage, and those qualifified under personal property coverages.
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9-5 What does "fire" mean in the context of an insurance policy?
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9-6 How does the National Fire Protection Association define combustable?
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9-7 What is a hostile fire?
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9-8 What is a friendly fire?
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9-9 Why is it difficult to assess damage caused by lightening?
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9-10 What is water hammer? Is damage cause by water hammer included in the explosion peril?
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9-11 Explain what is covered under the falling object peril. What are some common falling objects known to cause damage?
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9-12 What qualifies as a riot under the riot peril of a property policy? What losses are excluded in the peril?
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9-13 What are grow ops? How do they pose a threat to the safety of a loss adjuster?
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9-14 What precautions must be taken by an insured before an insuer will cover damage caused by water escaping from frozen pipes?
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9-15 What kind of evidence on roofing shingles suggests damage other than that caused by a windstorm?
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9-16 What are some common roof problems that have nothing to do with hail damage?
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9-17 When is off-premises property in the insured's possession eligible for coverage?
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9-18 Identify 4 extensions of coverage under the personal lines property policies that provide coverage for the consequential damage.
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9-19 What is the difference between vacant and unoccupied?
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9-20 What are additional living expenses? What is the typical coverage during a mass evacuation situation?
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9-21 How does a loss adjuster determine actual cash value on property?
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9-22 What does scoping damage involve?
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9-23 What characteristics of broadloom are important to consider when it is being replaced?
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9-24 What characteristics of shingles are important to consider when they are being repaired or replaced?
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9-25 What should a loss adjuster keep in mind when assessing computer damage claims?
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9-26 What is a single-limit option under a personal lines property policy? What is a guaranteed replacement cost option?
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10-1 What are the 4 insuring agreements under the personal lines package policies under the Section II liability coverages?
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10-2 How is "occurance" defined under the liability policy?
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10-3 What questions would a loss adjuster want to have answered to ensure that the occurrence falls within the ambit of coverage?
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10-4 What are the two separate duties of the insurer towards the insured that are independent of each other but apply to the same claim?
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10-5 Identify 5 exclusions under the personal lines liability policy.
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10-6 Describe voluntary medical payments coverage included under personal liability package policies.
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10-7 Describe the voluntary payment for damage to property coverage under the personal liability package policies.
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10-8 What types of perils would be excluded under the voluntary payment for damage to property coverage?
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10-9 What is tort?
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10-10 Under our legal system, what is negligence?
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10-11 Under our legal system, what is nuisance?
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10-12 What are the 3 elements required to constitute an actionable tort?
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10-13 What is the duty of care concept?
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10-14 What is a standard of care?
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10-15 Who is an "occupier" according to occupier's liability legislation?
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10-16 What is premises liability?
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10-17 Give examples of each of the following defences to a liability claim 1: denial 2: emergency 3: act of God 4: Statute degence 5: contributory negligence and 6: voluntary assumption of risk
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10-18 How does the concept of joint and several liability affect how a wronged part can recover his loss?
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10-19 Explain how the burden of proof shifts under the common law system.
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10-20 Explain the concept of strict liability
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10-21 Explain the concept of absolute liability
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10-22 In Quebec, what are the 3 required elements to successfully insistute a legal action
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10-23 Explain the duty and standard of care required by law in Quebec.
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10-24 Discuss the standard of conduct outlined in Article 1457 concerning liability for one's negligence.
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a
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10-25 Under what circumstances will a person be liabile for the negligence of others in Quebec?
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a
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