Maricopa Community Colleges  GBS266   19886-20086 
Official Course Description: MCCCD Approval: 07/22/08
GBS266 19886-20086 LEC 3 Credit(s) 3 Period(s)
Liability Claims Adjusting I
Principles of liability claims adjusting which includes study of legal liability loss, investigative techniques, evaluation and settlement methods of injury claims with emphasis on adjustment of automobile liability. Also includes insurance rate making, insurance regulations, and human behavior influences upon claim adjustments.
Prerequisites: GBS259.
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MCCCD Official Course Competencies:
 
GBS266   19886-20086 Liability Claims Adjusting I
1. Identify claim department functions and describe the role and responsibilities of the claim adjuster. (I)
2. Apply contract analysis techniques to the personal automobile policy. (I)
3. State the difference between coverage and legal liability. (II)
4. Describe the influence of civil and tort law on liability claims handling. (II)
5. Identify types of imperfections in the tort liability system and applyappropriate methods of remedy. (II)
6. Complete an investigative process cycle. (III)
7. Locate sources of information, use expert witnesses, conduct and/or interpret written reports, and take written or recorded statements during the investigative process. (III)
8. Describe techniques for handling different types of claims including: automobile, public liability, products liability, professional liability and worker's compensation. (IV)
9. Identify evaluation and settlement methods associated with injury claims. (V)
10. Describe the steps to follow when negotiation breaks down. (V)
11. List the objectives of a rehabilitation program and attributes of rehabilitation services. (V)
12. Describe the relationship between communication, listening and motivational skills and the claims adjusting field. (VI)
13. Determine the following rates: judgement, manual and merit. (VII)
14. Determine the profitability of property-liability life insurers. (VIII)
15. Describe the types of insurance regulations imposed through federal and state guidelines. (VIII)
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MCCCD Official Course Outline:
 
GBS266   19886-20086 Liability Claims Adjusting I
    I. Claims Adjusting
        A. Functions and Responsibility
          1. Claim Department Functions
          2. Adjuster Role, Responsibilities
          3. Coverage Interpretation
        B. Personal Automobile Policy Contract Analysis
          1. Insuring Agreement
          2. Terminology
          3. "Covered" Person
          4. Duties of Insured
          5. Exclusions
          6. Payments
          7. Limits
          8. Out of State
          9. Other Insurance
        C. Coverage
          1. Legal Decisions
          2. Coverage Problems
          3. Tools for Coverage Disputes
          4. Excess Liability
          5. Punitive Damage
      II. Legal Liability
          A. Legal Categories
            1. Interpretation
              a. Coverage
              b. Liability
            2. Common Law
            3. Statutory Law
            4. Criminal Law
            5. Civil Law
            6. Torts
          B. Negligence
            1. Elements
            2. Determining
            3. Other factors
          C. Tort Liability Systems
            1. Imperfections
            2. Remedies
            3. Bad Faith, Excess Liability
            4. Process of Law
          D. Defenses
          E. Damages
        III. Investigative Process
            A. Liability Categories
            B. Telephone Adjusting
            C. Planning
              1. Sources of Information
              2. Coverage Question Procedures
              3. Work Schedule
              4. Interview
              5. Contacts
            D. Use of Experts
            E. Injury Investigation
            F. Claim Reports
              1. Types
              2. Problems
              3. Underwriting
            G. Statement Taking
              1. Written
              2. Recorded
              3. Special Problems
          IV. Claims Investigation Types
              A. Automobile Claims
                1. Uninsured Motorists
                2. Underinsured Motorists
                3. Damage Claims
                4. Theft Investigation
                5. Arson
                6. Flood
                7. No-Fault
              B. Public Liability Claims
                1. Falls
                2. Ice, Snow
                3. Lighting
                4. Debris
              C. Products
              D. Professional Liability Claims
              E. Workers' Compensation Claims
            V. Injury Claims
                A. Evaluation
                  1. Factors Considerations
                  2. Medical Terminology
                  3. Evaluation Methods
                  4. Sample Claim Evaluations
                B. Settlement
                  1. Negotiations
                  2. Offer
                  3. Closing Claim/Release
                  4. Reducing Claim Costs
                C. Negotiation Breakdown
                  1. Disputes
                  2. Investigation
                  3. Arbitration
                  4. Legal Process
                  5. Claim Reserve
                  6. Claim Department Role
                D. Rehabilitation Process
                  1. Objectives
                  2. Interpretation
                    a. General
                    b. Specific
                  3. Rehabilitation Services
                  4. Workers' Compensation
                  5. Liability Claims Potential
                  6. Identifying Rehabilitation Cases
                  7. Rehabilitation Plan
                  8. Team Concept
                  9. Vocational Pursuits
              VI. Human Behavior Influences
                  A. Factors
                    1. Human Relations
                    2. Scientific Factors
                    3. Imperfect Human
                  B. Communication in Claims Adjusting
                    1. Importance
                    2. Climate
                    3. Mechanics
                    4. Distortion
                  C. Listening Skills
                    1. Good Habits
                    2. Claims Representative
                    3. Negative Habits
                    4. Developing Skills
                  D. Influencing People
                    1. Communications Techniques
                    2. Motivation
                    3. Motive
                    4. Wants vs. Needs
                    5. Frustration
                    6. Conflict
                  E. Organization of Insurers
                    1. Motivation of Principles
                    2. Philosophy
                    3. Internal Organization
                    4. Cooperative Insurer Organizations
                VII. Insurance Rate Making
                    A. Characteristics
                      1. Required by Law
                      2. Other Desirable Characteristics
                    B. Types
                      1. Judgement
                      2. Manual
                      3. Merit
                    C. Methods
                      1. Pricing Property Insurance
                      2. Underwriting Life Insurance
                      3. Assets
                      4. Reserves
                      5. Earned Surplus
                      6. Profitability
                      7. Investment Practices
                      8. Financial Reporting
                  VIII. Insurance Regulation
                      A. Objectives
                      B. Methods
                      C. History
                      D. Financial Regulation
                        1. Property-Liability Rate Regulation
                        2. Expenses
                        3. Reserves
                        4. Capital Stock
                        5. Dividends
                        6. Organization, Licensing Insurers
                        7. Annual Reports
                        8. Liquidation of Insurers
                      E. Policy Form Approval for Product Regulation
                      F. Business Methods Regulation
                      G. Taxation
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