Insurance Claims

Answer the following questions in short-answer essay format. Each short-answer essay must address all relevant parts of each question and include examples where appropriate. Make sure to cite any references you use. Proper citation format for a reference includes the name of the author(s), the title of the work, the date of the publication, and the page number. 1. Alan insures his residence on a standard homeowner’s policy. He comes home from work one day and finds that a burglar has broken in and stolen some of his possessions. He immediately contacts his police and his insurance company to report the claim.  a. List and explain the six steps the claims adjuster will take to handle this claim. Be sure to discuss why each of the steps is important. b. Assume the claims adjuster for Alan’s insurance company does not feel that Alan is entitled to any money after a brief review of his initial report of the loss. She issues a denial letter stating that the company is not going to pay anything for his claim. Do you feel the adjuster has engaged in good faith claim handling practices? Explain why or why not. 2. Poor Alan! After his claim is settled, he invites a few close friends over for dinner. As his guests are leaving for the evening, one of them trips and falls down the stairs leading to the sidewalk. It does not appear that the person is injured too badly but, just to be safe, Alan takes his guest to the emergency room. She is released to go home later that night so things appear to be just fine. Two days later, Alan gets a call from the law firm representing his injured guest, and the attorney states that they will be filing a claim seeking both special and general damages.  a. Define special damages and general damages and give an example of both special and general damages. b. Do you think the insurance company will set up a reserve for this loss? Why or why not? c. Why is it important for the claims representative to contact the insured or injured party shortly after being notified of a loss? 3. Alan’s homeowner policy provides coverage for his contents on a replacement cost basis. In your mind, which is better: coverage based on replacement cost or actual cash value (ACV)? Please explain the rationale for your answer. 4. One of the challenging tasks facing claims adjusters is establishing reserves for losses that have occurred.  a. Define the term reserve b. Do you feel it is more difficult to establish a reserve for property losses or liability losses? Be sure to discuss the reasons for your answer.

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