AIC 39 Flashcards
(127 cards)
1
Q
Compensatory Damages
A
Awarded by a court to reimburse a victim for actual harm
2
Q
Special damages
A
Specific identifiable expense, e.g. medical bills, wage loss
3
Q
General damages
A
Pain and suffering. Does not involve a measurable expense
4
Q
Diminution in value (DV)
A
The loss in value of an item as a result of the damage and repair to the item (only available in some jurisdictions)
5
Q
Remittitur
A
When a judge reduces an excess injury verdict reward
6
Q
Additur
A
When a judge increases a jury verdict award that is deemed too low
7
Q
Collateral source rule
A
Legal doctrine. Damages owe should not be reduced just b/c the victim is able to recover from other sources such as an insurance policy
8
Q
Mitigation of damages
A
Duty owed by the injured party to avoid or minimize additional injury or loss
9
Q
Significant contacts rule
A
A rule that specifies the substantive law of the state having more significant contacts to the parties could apply even when the tort occurred elsewhere
10
Q
Forum shopping (jurisdiction shopping)
A
The legal strategy of using the significant contacts rule to seek jurisdictions that offer the most favorable substantive law
11
Q
Diversity of citizenship
A
Indicates that the parties to a lawsuit are from different states the case is “removed” from the state court to a Federal District Court
12
Q
Punitive damages (exemplary damages)
A
A payment awarded by court to punish a defendant for reckless malicious or deceitful act to deter similar conduct; the award need not bear any relation between parties actual damages
13
Q
Hedonic damages (loss of enjoyment damages)
A
Damages associated with the loss of physical and intellectual gratification and other lifestyle losses
14
Q
Loss of consortium
A
The loss of benefits that one spouse is entitled to receive from the other including companionship affection and sexual relations resulting from the injury or death of a spouse
15
Q
Eggshell claimant
A
A person who is in poor but functioning health at the time of the loss, but after the loss, he/she became severely disabled and dysfunctional
16
Q
Decedent
A
The deceased claimant in a death claim
17
Q
Estate
A
The sum total of all types of property owned by a person at the time of death, including businesses, profits, savings accounts, stocks, and other financial assets
18
Q
Survival action
A
Legal causes of action that existed for the deceased before his or her death
19
Q
Wrongful death action
A
A legal cause of action that exists for the survivor of deceased
20
Q
Pecuniary loss
A
The monetary economic loss of the survivors
21
Q
Household services
A
Services that would’ve been performed by the injured party prior to injury such as cooking and cleaning
22
Q
Intrinsic value of children
A
The assumption that parents make rational financial decisions in having children, knowing that the investment in the expense of raising children will provide companionship and comfort as a return when the children are older
23
Q
Aggravating circumstances
A
Circumstances surrounding a loss that elicit emotional responses that influence the jury’s assessment of damages
24
Q
Best alternative to a negotiated agreement (BANTA)
A
The most that an insurer will pay for a loss after considering all the facts. The claim representative determines the highest probable award (as from a trial or arbitration), then add the cost of the action.
25
Expert systems (artificial intelligence systems)
Software systems the duplicate the decision making process
26
Alternative dispute resolution ( ADR)
Procedures to help settle disputes without litigation, including arbitration, mediation, and negotiation.
27
Mediation
And alternative dispute resolution method by which disputing parties use a neutral outside party to examine the issues and develop a mutually agreeable settlement
28
Caucus
A private meeting with the mediator away from the opposing party
29
Mediator
A person who acts as a referee to the parties in a dispute and can even assist in negotiating issues such as chiropractic and medical treatment fees
30
Telemediation
Mediation over the phone. Useful when only a few issues are in dispute
31
Arbitration
An alternative dispute resolution method by which disputing parties using neutral outside party to examine the issues and develop a settlement, which can be final and binding
32
Binding arbitration
Requires the parties to an arbitrated disputes to accept the arbitrator's decision
33
Nonbinding arbitration
A practice in which neither party is forced to accept the arbitrator's decision; however, the decision provides the "winner" with leverage for future negotiation
34
High low agreements
Agreements in arbitration stipulate that no matter what the arbitrator decides, the insurer will not pay more than the high specified amount and the claimant will not receive less then that the low specified amount
35
Baseball arbitration
A process in which each side present its case to the arbitrator along with its final, realistic monetary offer. The arbitrator then reviews the facts and evidence presented, then chooses one of the two figures.
36
Mediation-arbitration
Involves the parties agreeing in advance to use mediation to resolve their dispute, with the understanding that, if they failed to reach an agreement, they must proceed directly to arbitration
37
Arbitration-mediation
A process in which the parties present to an arbitrator who decides a confidential award amount. Then proceed to mediation, if they reach agreement the award is never revealed
38
Inter-company arbitration
Used to settle disputes between insurance companies
39
Paper arbitration
A type of inter--company arbitration that occurs when each side writes its contentions and send them to the arbitration service with supporting documentation
40
Mini-trial
An alternative dispute resolution method by which a case undergoes an abbreviated trial before a panel or advisor who poses questions and offers opinions on the outcome based on evidence presented
41
Neutral expert
Impartial expert who analyzes a specific issue in question
42
Summary jury trial
Alternative dispute resolution method by which parties participate in an abbreviated trial, presenting the evidence and witnesses to mock jurors who decide the case
43
Pretrial conference
Legal proceeding in which the judge acts as a mediator encourages litigants to try one last time to resolve their differences before trial
44
Settlement days
Hosted by alternative dispute resolution firms, parties from several smaller less complicated disputes come together on the same day to conference center. Allows attorneys to block out time for face-to-face negotiations.
45
Online settlement forums
Settlement forms that include arbitration and dispute resolution services Thru Virtual courts that are offered through the Internet
46
Blind bidding
Common feature of online alternative dispute resolution in which parties make series of offers and demands. Neither knows what the other is offering or demanding but are notified if figures overlap
47
Structured settlement
Agreement and settlement of the claim involving specific payments made over a period of time
48
Settlement agreement
Oral or written contract by which parties compromise a disputed matter. Often a release document is included with this agreement
49
Release
a legally binding contract between the parties to a dispute that embodies their agreement, obligated each to fulfill the agreement, and release both parties from further obligation to one another that related to the dispute.
50
Covenant not to sue
Agreement that states in exchange for a specified sum of money, the claimant will not sue one of the joint tortfeasors
51
Uninsured motorist release
A type of release used when an insurer pays the insured through the uninsured motorist coverage, then seeks recovery from the tortfeasor through subrogation. It does not release the tortfeasor from liability.
52
Policyholder release
Type of release used when an insurer makes a payment to third party on behalf of the insured to avoid litigation on a claim that may not be covered
53
Minor
The person who has not attained the legal age (18 years old in most states)
54
Parent guardian release and indemnity agreement (PG release)
Special release that can be used to settle claims of appear in the child in claims involving a relatively small dollar amount and little chance of permanent injury.
55
Court approved settlement
Legal proceeding in which the court reviews all details of settlement, the determines whether it is in the best interest of the minor
56
Nuisance settlement
Payment made for a nominal amount to conclude a doubtful liability claim
57
First-call settlement
Settlement made upon first contact with claimant
58
Drop draft
A draft and release sent to the claimant for an amount the claim representative things would settle the claim
59
Advance payment
Payment made to a claimant following a loss to cover immediate expenses resulting from that loss
60
Lien
A credit towards legal right or interest in another's property, usually lasting until satisfaction of the specific debt or duty that the lien secures
61
Perfected lien
Exists when the insurer responsible for paying the loss has been formally placed on notice of me
62
Medicare liens
These can be claimed by the government if circumstances indicate that the insurer should have known that Medicare was involved, such as in a claim involving elderly person
63
Contribution
The right of a tortfeasor who has paid more than his or her proportionate share of the damages to collect from other tortfeasors responsible for the same tort
64
Indemnity
Restoring the insured to the same financial position held immediately before a loss
65
Salvage
Process by which an insured takes possession of damage property for which it has paid a total loss and recovers a portion of the lost payment by selling the damage property
66
Collateral sources
Nonliability insurance sources of recovery at reimburse claimants for all or some of their medical expenses, wage-loss or disability. Examples include healthcare insurance, no-fault auto insurance, and Worker's Compensation
67
Tripartite relationship
Relationship between the insurer, the insured, and defense counsel. Both the insurer and defense counsel have obligations to protect the interests of the insured and bailiffs them with the interest of the insurer.
68
Excess verdict
A jury award that exceeds the insured's limit of insurance
69
Excess exposure
The possibility a jury award might exceed the limit of liability, exposing the insured's personal assets
70
Pleading
Formal written statement of facts and claims of each party to a lawsuit
71
Discovery
A pretrial exchange of all relevant information between the plaintiff and defendant
72
Summons
a document that directs a sheriff or another court appointed officer to notify the defendant named in the lawsuit that the lawsuit has been started and that the defendant has a specified amount of time to answer the complaint
73
Parol evidence rule
A rule of evidence that limits the terms of the contract evidenced by a writing to those expressed in writing
74
Express contract
A contract whose terms and intentions are explicitly stated
75
Implied contract
A contract whose terms and intentions are indicated by the actions of the parties to the contract and the surrounding circumstances
76
Contract of adhesion
Any contract in which one party must either accept the agreement as written by the other party or reject it
77
Statutes of fraud
A collection of laws that help prevent parties from becoming involved in fraudulently formed contracts
78
Unenforceable contract
A contract that is a valid contract but that because of a technical defect cannot be enforced
79
Voidable contract
A contract that one of the parties can reject (avoid) based on some circumstances surrounding its execution
80
Void contract
An agreement that, despite the parties intentions, never reaches contract status and is therefore not legally enforceable or biking
81
Valid contract
A contract that meets all of the requirements to be enforceable
82
Acceptance
The assent to an offer that occurs when the party to whom an offer has been made either agrees to the proposal or does what has been proposed
83
Breach of contract
The failure, without legal excuse, to fulfill a contractural promise
84
Offeree
The party to a contract who makes a promise or acts in return for something offered by another party.
85
Offer
A promise that requires some action by the intended recipient to make an agreement
86
Escape clause
an other-insurance provision that relieves the insurer of any obligation to pay a claim for which other insurance applies
87
Pro-rata contribution
an approach to other insurance by which the insurers contribute to the loss payment in the proportion to which they contribute to the total amount of coverage purchase (their limits of liability)
88
contribution by equal shares
method of sharing loss when tow of more policies apply in which each insurer pay and equal amount until the claim is fully paid of until one insurer exhausts its limit, in which case the other insured party the remainder of the claim (up to its limit)
89
derivative claim
a consortium type claim
90
material misrepresentation
a fact that has bee misstated or omitted and that could be reasonable considered as affecting the insurer's decision to enter into the contact, the insurer's evaluation of the degree or character of the risk, or the calculation of the premium
91
concealment
an intentional failure to disclose a material fact
92
damages trigger
when UIM coverage is determined by the deficiency of limits to a person's damages
93
limits trigger
when UIM coverage is determined by the limit of the other motorist being less than the insured's limit
94
premium rule
allows the insured to add separate UIM coverage amounts on separate vehicles when insured pay separate premiums on each vehicle
95
stacking
when insured having more than one vehicle may add the limits of liability together to obtain a higher limit
96
arbitration clause
a clause in an agency contract that provides a formal method for the agency and insurer to resolve disagreements under the contract
97
corroborative evidence
Supports the evidence of a phantom vehicle. Evidence to establish negligence of an unidentified vehicle.
98
phantom vehicle
an unidentified vehicle that leaves no physical contact
99
hit-and-run vehicle
a vehicle whose operator cannot be identified
100
co-owner liability
a legal obligation of one spouse for damaging the other spouse's auto
101
sufficient geographic proximity
a term that refers to being close to but not necessarily touching an auto
102
residence
implies a permanent abode
103
family member
a person who is related to the claimant and is a resident of the claimant's household
104
public policy
in a given country, state, or other jurisdiction is the set of assumptions and principles (often unstated) on which the laws and court decisions of that jurisdiction are based.
105
doctrine of reasonable expectations
a legal doctrine that provides for an ambiguous insurance policy clause to be interpreted in a way that an insured would reasonable expect.
106
condition
any provision in an insurance policy that qualifies an otherwise enforceable promise of the insurer
107
named driver exclusion
an endorsement added to an auto policy that excludes coverage for damages and injuries caused by a specified driver
108
exclusion
a policy provision that eliminates coverage for specified exposures
109
Comprehensive Coverage
coverage for direct and accidental loss or damage to a covered auto by any peril except collision or overturn or a peril specifically excluded
110
Waiver
The voluntary and intentional relinquishment of a known and existing right
111
Detrimental reliance
A situation in which an insured relies on the words or actions of an insurer and that reliance harms the insured's financial position
112
Estoppel
A legal principle that prevents an insurer from claiming it's right, privilege, or defense if it would be in equitable to do so because of the insurers conduct towards the insured
113
Nonwaiver agreement
An agreement signed by both insurer and insured that notifies the insured that any action taken by the insurer is not intended to waive or invalidate any policy condition and is to permit an investigation of the claim
114
Reservation of rights letter
Serves the same purpose as a nonwaiver agreement but is typically in letter form, used when obtaining an insured's signature is not reasonable
115
Declaratory judgment action
A legal action in which the insurer (or insured) presents a coverage question to the court and asks the court to declare the rights of the parties under the applicable insurance policy
116
First party bad-faith
The insurer's mishandling every first party claim I can result in extracontractual damages
117
Extracontractual damages
A payment awarded by a court that exceeds the usual contract damages for breach of contract
118
Origin
The location of a fires ignition
119
Cause
The mechanism or event that provided he and fuel for a fire
120
Arson
The deliberate setting of a fire to property for a fraudulent or malicious purpose
121
Incendiary fire
An intentionally set fire
122
Alibi
An assertion that the party in question was elsewhere at the time the crime occurred
123
Property damage
Physical injury to, destruction of, or loss of use of tangible property
124
Diminished value loss
The real or perceived loss in market or resale value that results from a direct and accidental loss.
125
Special investigation unit (SIU)
A division set up to investigate suspicious claims, premium fraud, application fraud
126
Vehicle identification number
A unique number assigned to each vehicle that identifies certain vehicle characteristics
127
At what point in the claims process are the various types of claims in an auto accident identified?
Either by initial reporting of the claim or after the adjuster has been assigned.
