Important!

If pop-ups are blocked for the website, please allow them in your browser and restart the course. Continue the course from the new tab, and do not close this tab until you have completed the course.

Current Status
Not Enrolled
Price
Free
Get Started

The “Underwriting Issues in Insurance Claims” course teaches insurance professionals how to identify and address underwriting issues, when to work with underwriting, and how to handle related claims. The module is presented by Jody Ochsner and Chris Owenson of IMT Insurance, and Sean M. O’Brien of Dickinson Bradshaw Law.

This course uses true-to-life scenarios to explore how underwriting issues can arise in property insurance claims, and identify strategies for effective communication and coordination between underwriting and claims departments. In the first scenario, the presenters discuss the function of the underwriting department, when to communicate across departments, and a case that turned on the falsity and materiality of claims made during renewal. The presenters discuss Certificates of Insurance, actual vs. apparent authority, and recording vs. soliciting agents. Another scenario features a negligent loss prevention inspection that leads to injury, and the next examines whether a sublimit applies where an endorsement modifies an exclusion. In a scenario where a worker’s compensation claim is denied, the presenters delve into multi-factor tests to determine if there was an employer/employee relationship, or an independent contractor relationship. In the next scenario, an appraiser provides a different actual cash value for the the “cost approach” and the “comparable sales approach.” The scenario leads the presenters to discuss ACV definitions in statutes, valued policy laws, and the cost approach vs. comparable sales approach. The final scenario explores the requirements for certified or registered mail for cancellation notices, and how to establish an evidentiary presumption of receipt for cancellation notices.

After completing the course, the attendee will be able to

  • describe the function of the underwriting department,
    communicate across departments,
  • understand how to determine if an agent has actual or apparent authority,
  • identify the difference between recording and soliciting agents,
  • navigate complex sublimit issues, apply multi-factor employment tests,
  • distinguish between appraisal approaches,
  • and determine whether statutory tests apply in cases involving receipt of mail

The course is designed for insurance professionals working in the area of property adjusting.

What CE Credit is available?

Note: To qualify for credit, you must submit completion (including a passed final exam if required) within five days of completing the last quiz. No partial credits will be awarded.

State:
Adjuster General
CE Hours:
Adjuster Ethics
CE Hours:
Attorney General
CLE Hours:
State's Course ID:
FL * ( Provider Number: 364169 ) 1.0 1207595
NC 2.0 220468
NH 2.0 6000179225
OK 2.0 6000180433
TX (classroom equivalent) 2.0 141482
WY 2.0 37142
IL 2.0 0.0 621553

* This course has been approved by the Florida Department of Financial Services for insurance continuing education credit.

Course Content

Lesson Content
  1. Introduction & Roadmap (00:00 – 01:24) (Transcript Page 1)
  2. Policy Selection & Classification (01:43 – 02:55) (Transcript Page 1)
  3. Policy Servicing & Retention (02:55 – 03:40) (Transcript Page 2)
  4. Reinsurance & Underwriters (03:40 – 04:24) (Transcript Page 2)
  5. Renew Redo Scenario Facts (04:51 – 08:05) (Transcript Page 3)
  6. Question: Can Walk Away walk away? (08:31 – 08:43) (Transcript Page 4)
  7. Audience: Walk Away can rescind the policy. (09:08 – 10:00) (Transcript Page 4)
  8. Audience: Fines or Disciplinary Action vs. a Cease-and-Desist Notice (10:00 – 11:28) (Transcript Page 5)
  9. Utica Mut. Ins. Co. v. Stockdale Agency, 892 F.Supp. 1179 (N.D. Iowa 1995) (11:53 – 12:07) (Transcript Page 5)
  10. Cause of Action for Fraudulent Induction into a Contract (12:07 – 12:52) (Transcript Page 5)
  11. Elements to Establish Right to Equitable Relief (12:52 – 13:21) (Transcript Page 6)
  12. Review of Application Text (13:21 – 14:18) (Transcript Page 6)
  13. Recap (15:58 – 18:10) (Transcript Page 7)
Lesson Content
  1. Introduction (00:00 – 01:20) (Transcript Page 8)
  2. Uncovered Scenario (01:20 – 03:13) (Transcript Page 8)
  3. Question: Can Cover It be held liable for Say Anything’s Representations? (03:33 – 03:45) (Transcript Page 9)
  4. Audience: It was implied that there was coverage. (04:32 – 04:58) (Transcript Page 9)
  5. Audience: It’s the duty of the insured to read the policy. (04:58 – 05:31) (Transcript Page 10)
  6. Audience: The fair result would be to pay the insured. (05:31 – 05:58) (Transcript Page 10)
  7. Actual vs. Apparent Authority (05:58 – 07:07) (Transcript Page 11)
  8. Brown & Brown of Texas, Inc. v. Omni Metals, Inc., 317 S.W.3d 361 (Tex. Ct. App. 2010) (07:18 – 08:05) (Transcript Page 11)
  9. Acts of the Principal (08:05 – 08:28) (Transcript Page 11)
  10. Recording vs. Soliciting Agents (08:28 – 09:19) (Transcript Page 12)
  11. Audience: Does this open us up to an E&O (Errors & Omissions) claim? (09:24 – 10:22) (Transcript Page 12)
  12. Recap (10:27 – 12:38) (Transcript Page 13)
Lesson Content
  1. Introduction (00:00 – 00:45) (Transcript Page 14)
  2. Eyes Wide Shut Scenario (00:45 – 01:32) (Transcript Page 14)
  3. Question: A Negligent Loss Prevention Inspection? (01:44 – 01:56) (Transcript Page 14)
  4. Workers Compensation vs. Liability Claim (02:29 – 03:17) (Transcript Page 14)
  5. Slater v. Farmland Mut. Ins. Co., 334 N.W.2d 728 (Iowa 1983) (03:43 – 04:52) (Transcript Page 15)
  6. Royal Indem. Co. v. Factory Mut. Ins. Co., 786 N.W.2d 839 (Iowa 2010) (04:52 – 05:59) (Transcript Page 15)
  7. Unlimited Scenario (06:12 – 08:23) (Transcript Page 16)
  8. Question: Does the Sublimit Apply? (08:27 – 08:39) (Transcript Page 17)
  9. Dream Spa, Inc. v. Fireman’s Fund Ins., No. 06-CV-13142 (KMK), 2008 WL 355458 (S.D.N.Y. Feb. 6, 2008) (08:56 – 09:29) (Transcript Page 17)
  10. Recap (10:15 – 12:27) (Transcript Page 18)
Lesson Content
  1. Introduction (00:00 – 00:37) (Transcript Page 19)
  2. Employ Me Scenario (00:37 – 01:45) (Transcript Page 19)
  3. Question: Is Bob an Employee under the Workers Compensation Act? (02:01 – 02:13) (Transcript Page 19)
  4. Audience: He filed taxes as an independent contractor. (02:45 – 03:46) (Transcript Page 20)
  5. Audience: Did the company issue him a 1099 or a W-2? (03:46 – 05:53) (Transcript Page 20)
  6. Premium Calculation for Workers Compensation (05:53 – 07:27) (Transcript Page 21)
  7. Audience: Over 50% of his payroll came from Holmes. (07:27 – 07:56) (Transcript Page 21)
  8. Stark Construction v. Lauterwasser, 847 N.W.2d 612 (Iowa App 2014) (08:47 – 09:01) (Transcript Page 22)
  9. Test for Employee-Employer Relationship (08:47 – 09:01) (Transcript Page 22)
  10. Test for an Independent Contractor (09:01 – 10:27) (Transcript Page 22)
  11. Outcome of Lauterwasser Case (10:27 – 12:01) (Transcript Page 23)
  12. Recap (12:35 – 14:47) (Transcript Page 24)
Lesson Content
  1. Introduction (00:00 – 01:09) (Transcript Page 25)
  2. Hot Coffee Scenario (01:09 – 02:46) (Transcript Page 26)
  3. Question: Did the Court Properly Determine ACV? (03:44 – 03:56) (Transcript Page 26)
  4. Audience: We thought it might lean towards market value. (04:07 – 04:59) (Transcript Page 27)
  5. Farmers Casualty Ins. Co. v. Birkby, 746 N.W.2d 280 (Iowa App 2008) (unpublished) (04:59 – 05:30) (Transcript Page 27)
  6. Statutes, Regulations, and Case Law (04:59 – 05:30) (Transcript Page 27)
  7. Iowa Administrative Code Rule 191-15.44(2) Actual cash value (05:30 – 07:17) (Transcript Page 28)
  8. Valued Policy Lite (07:17 – 07:46) (Transcript Page 28)
  9. Valued Policy Statutes (07:46 – 08:02) (Transcript Page 28)
  10. Insurer Input into Limit Amount (08:02 – 09:30) (Transcript Page 28)
  11. Recap (09:29 – 11:40) (Transcript Page 29)
Lesson Content
  1. Introduction (00:00 – 00:40) (Transcript Page 30)
  2. Electronic Amish Scenario (00:40 – 02:47) (Transcript Page 30)
  3. Question: Can Farmers R Us be held liable? (02:53 – 03:05) (Transcript Page 31)
  4. Audience: Did Farmers R Us have proof that anyone received the notice? (03:11 – 04:08) (Transcript Page 31)
  5. Yoder v. First Security Bank and Trust et al., Iowa District Court for Story County Case No. LACV047882 (04:08 – 04:32) (Transcript Page 32)
  6. Establishing Presumption of Receipt (04:32 – 05:58) (Transcript Page 32)
  7. More Than Mere Denial of Receipt (05:58 – 06:35) (Transcript Page 32)
  8. How the Case Played Out (06:35 – 09:08) (Transcript Page 33)
  9. Recap (09:39 – 11:51) (Transcript Page 34)