Coverage

Question 1

Application - Drivers

Answer 1

Covered under policy
Specifically excluded under the policy
Affiliations (Affinity for Discounts and Surcharges)
Accidents
Violations
Non-chargeable Incidents

Question 2

Application - Vehicles

Answer 2

Year
Make
Model
Usage (business, personal, racing, hauling, etc.)
VIN
Garaging Address
Alterations to vehicle

Question 3

Application - Producers Statement

Answer 3

All information to questions is applicant’s responses
All information in the application is true, correct and complete

Question 4

Application - Statement/Signature

Answer 4

Information in app true/Consequences of misinformation
Duty to notify company if facts change
Warning of giving fraudulent info

Question 5

Application - Financial

Answer 5

Terms of policy (period)
Premiums
Payment Options

Question 6

Application - Coverages

Answer 6

Types
Limits
Deductibles

Question 7

Policy Jacket - Definitions

Answer 7

To eliminate any ambiguity in the policy, certain words denoted in bold are given specific meaning.

Question 8

Policy Jacket - Insuring Agreement

Answer 8

Promise made by the insurance company for coverage under the policy. The insuring agreement may be modified by definitions, exclusions, and conditions that appear in the policy. It’s where the applicable coverage is given.

Question 9

Policy Jacket - Exclusions

Answer 9

Language in the policy which takes away or limits coverage that may have been provided in the insuring agreement.

Question 10

Policy Jacket - Gen Conditions/Provisions

Answer 10

Describes the duties and rights of the insured and the insurer in the contract.

Question 11

Supplementary Payment - Policy

Answer 11

coverages that are paid in addition to the limit of liability.

Question 12

Limit of Liability - Policy

Answer 12

maximum amount the policy will pay for bodily injury and property damage.

Question 13

Bankruptcy

Answer 13

insurance company is not relieved of the terms of the policy contract if the insured files bankruptcy

Question 14

Our right to recover payment

Answer 14

company’s right to collect damages paid to the insured that resulted from and are owed by an at-fault third party

Question 15

Part A

Answer 15

Liability (coverage for 3rd party)

Question 16

Part B

Answer 16

Medical Payment

Question 17

Part C

Answer 17

Uninsured

Question 18

Part D

Answer 18

Damage to Auto

Question 19

Part E

Answer 19

Duties after Accident

Question 20

Part F

Answer 20

General Provisions

Question 21

Representation

Answer 21

information provided by the insured

Question 22

Insolvent

Answer 22

company goes bankrupt

Question 23

Self Insured

Answer 23

personal money to insure themselves

Question 24

Arbitration

Answer 24

Mainly a liability dispute
Companies disagree about who is at fault

Question 25

Diminution

Answer 25

value of vehicle decreases due to accident (claimants only)

Question 26

Mitigate damage

Answer 26

try to prevent further damages Such as cover broken window with trashbag

Question 27

First Hurdle

Answer 27

coverage

Question 28

Our Goal

Answer 28

LOOK FOR COVERAGE

Question 29

The LAW requires

Answer 29

Good Faith and Fair

Question 30

Reservation of Rights (ROR)

Answer 30

To the INSURED and ANYONE SEEKING INSURED (driving the car) May NOT be coverage ANYTHING misrepresented Ex somebody driving a car without notifying insurance company advise the insured of the existence of the coverage ISSUE in detail including the specific language from the policy that has created the issue of coverage

Question 31

Waiver (followed by estoppel)

Answer 31

intentional or voluntary relinquishment of a known right For example, if the claim representative were to inadvertently tell the insured he can go ahead and have the vehicle repaired, the company could no longer demand the carrier has the opportunity to inspect the vehicle prior to the repairs.

Question 32

Estoppel (can't have this without waiver 1st)

Answer 32

the legal result of a waiver or of the conduct which implies a waiver. It prevents the party from asserting the original right * A person intentionally or unintentionally creates the impression that a fact exists. * The innocent party relies on that impression. * The innocent party is harmed by that same reliance.

Question 33

First Question to Ask?

Answer 33

Is the policy in force

Question 34

Policy Verification

Answer 34

Is the policy in force? Is the date of loss within the effective and expiration dates of the policy? Is the vehicle involved in the accident or loss listed on the policy? Is the person driving the insured vehicle at the time of the accident listed on the policy as a listed driver and not an excluded driver?

Question 35

Misrepresentation

Answer 35

when there is an omission, concealment or an incorrect/fraudulent statement

Question 36

Policy Out of Force

Answer 36

policy not active

Question 37

Material Misrepresentation – MMR

Answer 37

Examples Providing incorrect garaging location of the vehicles when requested. Providing incorrect indicated use of the insured vehicle (business vs. personal use) when requested. Failure to report accidents and violations as requested on the application. Uber

Question 38

Material Misrepresentation – MMR Effect on Policy

Answer 38

Would this have caused a change in the policy

Question 39

ULHHM

Answer 39

Unlisted household members

Question 40

TLNP (connected to policy out of force)

Answer 40

take loss no policy

Question 41

Material Misrepresentation – MMR Requirements

Answer 41

Is there a written and signed application or a recording of a verbal application that we can produce? Did the insured state that the facts in question were told to the agent? If yes, does the agent state the same? If the agent knew about the facts and did not disclose it on the application, no MMR exists.

Question 42

Material to Risk

Answer 42

In this situation, the unlisted driver would not have to be involved in the accident to pursue MMR. If there was an accident and the insured confesses to allowing someone else drive their car

Question 43

Material to Loss

Answer 43

MMR is material to the loss when the misrepresented fact specifically impacts the particular claim. That is, the unlisted driver would have to be involved in the accident to proceed with the MMR. If there was an accident and the other person was driving the car

Question 44

Rescind/Void Policy (MMR has occurred)

Answer 44

The policy is voided to inception and all premiums are fully and timely returned to the insured. The impact of this is that the policy never existed.

Question 45

Reformation (MMR has occurred)

Answer 45

The liability limits only are changed to provide the minimum financial responsibility limits and first-party coverages are voided back to the policy inception, as if they never occurred.

Question 46

Denial of the Claim (MMR has occurred)

Answer 46

Even when a rescission or reformation may not occur, the policy language may still support the denial of coverage for the particular claim.

Question 47

Cancellation (MMR has occurred)

Answer 47

Every state provides for cancellation in the future (prospective cancellation) for specific reasons, including fraud or misrepresentation in the presentation of the claim.

Question 48

MMR Steps

Answer 48

Statements Signed Application Review policy Underwriting re-rate Underwriting response Notify manager MMR summary

Question 49

ROR Mailing Specifics

Answer 49

Certified ALL known addresses ASA practical P Policy and Application language

Question 50

ROR if Coverage is Found

Answer 50

Send rescission letter

Question 51

Coverage Denial Letter Considerations

Answer 51

Everything included in a ROR Must be sent to all potential insureds Must contain the facts of the loss Must contain the policy provisions that supports the denial Must contain the investigative facts that support the policy provisions Asks for additional information that the insured may have that could impact our decision Advise the insured what to do if suit is filed by third party claimants (if applicable)

Question 52

Coverage Denial Letter Authority (insured or claimant)

Answer 52

The claim representative should secure authority from their manager prior to any coverage denial. If the claim is one that triggers a Large Loss Notification, the claims attorney must be involved in the coverage denial.

Question 53

Excess Letters (we have coverage but...)

Answer 53

Damages in loss may exceed limits of policy Policy and Claim Number Date of Loss Insured Bodily injury and/or property damage limits of liability The fact that the exposure could exceed the policy limits The amount of any demands and offers Advising the insured that he will have responsibility for any judgment or award in excess of policy limits Right to retain counsel, at his own choosing and cost, to represent any uninsured interests

Question 54

2 Duties

Answer 54

Indemnify and Defend

Question 55

Policy out of Force

Answer 55

policy page police report cancellations (exact) contact agent contact insured time of accident (exact)