Good Faith and Fair dealing only apply when an insured has actually performed their Duties After a Loss in FULL. Even the "suggested ones'. Especially the "SUGGESTED ONES"!
The use of PWI (Paid When Incurred) in today’s claims environment, is mostly illegal. July 2022 Camp
The use of PWI (Paid When Incurred) in today’s claims environment, is mostly illegal. July 2022 Camp
Class will be held July 25th-29th, 2022
902 51st Street
Galveston, Texas 77551
The use of PWI (Paid When Incurred) in today’s claims environment, is mostly illegal.
Illegal in the incorrect application of policy language.
Almost all items that would be on a PWI basis would fall under “additional coverages.” Most, not all, but most items would require that the policy first be exhausted, then “if” the additional coverages were needed, they were available under certain circumstances, on a cost incurred basis.
Again, there is a very limited number of times this scenario is needed, where the coverage is needed under that portion of the policy.
General rule of thumb, if there is still funds remaining on the aggregate limit of the policy, the item/amount being withheld is probably not correct.
We will use one of the most common I see. Dumpsters, being paid on a cost incurred basis, then alluding to “additional coverages” section, specifically Debris Removal, claiming that is where the right to withhold is coming.
See the attached actual policy language and the highlighted areas of when that coverage would actually exist. On the frontend, unless… the aggregate is exhausted, and the additional coverage is needed. At which time we would separate the debris removal, and put it under that category of coverage, and it would be ABOVE the policy limit.
There are many key points here… Number one, none of this language comes into play unless the coverage is triggered… Otherwise, the basic coverages of the policy, and when to pay, are outlined in general conditions, are owed, depending on what state you are in, we will use Texas…
Within five business days of the day you knew you owed, and the insured has complied with all policy provisions…
See you July 25th, in camp.
We teach a diverse, national audience. What we attempt to teach spans that process and attempts to incorporate universal practices that are not central to any particular state, but a road map to any of them.
Correct Proof of Loss does not fluctuate, unless the facts dictate. Second part of that, we, nor the attorneys, have the power to “settle” a claim. Only the insured has that right. Follow up to that, and reasoning… does the insured understand what was removed, how it affects them, and what are the long term consequences on one of their largest, most coveted possessions? If you threw dookie on the wall, and demanded items that were not… “reasonable or necessary”… That is a whole different conversation.
If we are to expect professionalism, ethics, and due diligence, we must be prepared to give those things, and more. One of the strongest principles we teach, is to expect exactly what you give. That starts by not calling the process of handling insurance claims a “game”. It is not a game, and not something to be won. Suggesting it is, is trivializing the very existence of the insurance, the sacrifices made to have it, and keep it, as well as the tragedy that befalls an insured after a loss. If you do it, you allow them to do it.
I cannot recall a single thing I have lost by keeping this philosophy. I can, and will teach you everything I can about what is has given me. Melanie and Shaun will do the same. That I know of, all past graduates feel the same… we want… no NEED to see you persevere when the odds are against you, and your back is up against the wall, you will no longer be alone. Not only us… a small army has already graduated.
We are, afterall, practitioners, not academics. We must make sure not to harm our clients while trying to help them.
Zoom… We will do Zoom again on this one class, with strict rules, and an understanding that you do not get access to the full Graduate’s Network unless you are present the whole time.
There will be only (2) two Zoom participants, they will be unmuted upon entry, and remain that way. (Unless folks are in and out, doing laundry, and the like, coming in and forcing class to revisit. It is as simple as that.)
Price will be the same. There are no discounts for taking camp via Zoom.
No recording. Period. Everyone deserves to speak freely, and without fear of a recording, taking something entirely out of context, and using it. Part 2 of that, we cannot respond to a subpoena to produce a video that does not exist.
We have another network that is growing, it is for those who have completed an online class through anything the PABC does.
Zoom participants will still receive a certificate of completion, it will just be via Zoom.
The class is made up of three parts.
Everyday Shaun Hodge is in legal mode from 8 am to 10 am.
Melanie takes over from 10 am – Noon with Contracts/Administrative/Front office.
I, Cal, take the helm from 1 pm to 5 pm with policy, and actual practice.
While our specific class topic may have one focus, the class will go over all the items listed below, just not necessarily in that order. (Why we don’t offer CE’s. We can, it is just scripted, with no variance, and not a ton of actual practice.)
We combine them for everyday use in our field, to everyday issues you have in the field. We are you…
I have no idea what the text of the previous post was… so I didn’t try to recreate it… just like a claim. Simply explained my issue, acknowledged that issue, and started over.
As promised, we will choose one Veteran that meets the criteria posted in this video. Veteran Qualifications for free Class.
If you would like to sponsor a Veteran, just reach out to us.
Below is the general syllabus. I say general because the class normally takes on a life of its own, based upon the class as a whole.
While we are certified to teach the full 24 hour class for CE, no one has ever chosen it over the nuts and bolts, so we are no longer using it as an option. It will come back later in individual modules.
Our Texas State Credentials, found @ hyper-link below.
Type of Study: Classroom
Location 902 51st Street, Galveston, Texas 77551
Course length: Course will be five consecutive days, beginning Monday. Course will be eight hours per day, for a total of 40 hours. We understand that the minimum requirement for our profession is 24 hours. We are not trying to reach the minimums, we are going to exceed them, thereby assuring that anyone who has attended, and passed, will be more than capable of performing the duties of a Licensed Public Insurance Adjuster. For those who need CE, they will receive the hours credited through Sircon and a certificate of completion for 24 hours as well as a certificate of completion for the full 40-hour course.
Time Activity Classroom Hours
08:00 am – 10:00 am Ethics and Law 2.0 hours
10:00 am – 10:15 am Morning Break
10:15 am – 12:00 pm Policy and Interpretation 1.45 hours
12:00 pm – 12:30 pm Lunch
12:30 pm – 02:45 pm Policy and Interpretation 2.15 hours
02:45 pm – 03:00 pm Afternoon Break
03:00 pm – 05:00 pm Application of lesson to a claim 2.0 hours
The following course topics and discussions will be gone through, thoroughly, beginning to end for the Ethics and Law portion:
- Texas Prompt Payment of Claims
Acceptance/Rejection/Additional Information Request
Payment of claim
Court decisions on Texas Prompt Payment of Claims
- Ethical duties in adjusting a claim and submitting documents on behalf of an insured.
Prior loss history
Duty to fully investigate
Sworn Proof of Loss
Examination Under Oath
- Texas Insurance Code Chapters 541 & 542
Duty of Good Faith and Fair Dealing
Unfair Claims Settlement Practices
Deceptive and false information regarding policy coverage.
Statutory Bad Faith
False, misleading information, failure to disclose known facts impacting the claims adjustment
Recent court decisions interpreting Chapters 541 & 542
- Public Adjusting 101
Public Adjuster Rules
Public Adjuster Obligations
Ethical and Legal Requirements of Public Adjusters
Conflicts of Interest and prohibited conduct
Unauthorized Practice of Law
Unauthorized Practice of Public Adjusting
- Recent appellate decisions concerning Public Adjusters and the appraisal process
Public Adjuster liens
Endorsement of claims check (fiduciary duties)
Rights of Public Adjusters
Interpretation of appraisal provisions (competent and independent)
Survival of bad faith and prompt payment of claims post appraisal
Allowed compensation of appraiser’s expert witness
The following course topics and discussions will be gone through, thoroughly, beginning to end for the general knowledge portion:
- Insurance fundamentals – Updated 03/03/2018
Insurance Defined & the Principle of Risk
Elements & Characteristics of Insurance Contracts
Important Terms Pertaining to Insurance Contracts
The State Insurance Department
- Insurance Companies – Updated 01/19/2018
Insurance Companies – Classifications
Insurance companies – Agents, Producers, Brokers
- Property Insurance Concepts – Updated 03/08/2018
Property Insurance Concepts
Loss Valuation & Settlement methods
- Liability Insurance Concepts – Updated 01/05/2018
Liability Insurance Concepts- Updated 01/05/2018
- Unfair Claim Settlement Practice Act – Updated 10/23/2017
Unfair Claim Settlement Practice Act – Updated 10/23/2017
- Standard Fire Policy
Standard Fire Policy- Module A
The Standard Fire Policy – Module B
- Dwelling Insurance
Dwelling Insurance – A
Dwelling Insurance – B
Dwelling Insurance – C
Dwelling Insurance – D
Dwelling Insurance – E
- Homeowners Insurance Texas – Updated 3/28/2018
Eligibility & Definitions
The Homeowner Forms
Exclusions; Section I in Detail
Exclusions; Limits of Liability; Coverage D
Section I – Property Conditions
Section II – Liability Coverages and Exclusions
Liability Exclusions and Additional Coverages
Section I and II Conditions
- Personal Inland Marine Insurance
Personal Inland Marine Insurance
- Personal Watercraft & Yacht Policies – Updated 7/27/2017
The Personal Watercraft & Yacht Policies – Updated 7/27/2017
The Yacht Policy – 7/27/2017
- Insurance Claims Adjusting
Introduction to Claims Adjusting – Updated 11/01/2017
Adjusting Insurance Claims — Updated 11/01/2017
- Adjusting Property Loss Claims – Updated 03/02/2017
Adjusting Property Loss Claims – A
Adjusting Property Loss Claims – B
- Texas Public Adjuster Law
Texas Public Adjuster Law – Updated 08/03/2018
- Personal Automobile Insurance
Personal Auto Policy, Eligibility, Rating Factors
Part A Liability Coverage and Exclusions
Part B Medical Payments; Part C Uninsured Motorist; Part D Coverage for Damage to your Auto
Limits of Liability; Parts E and F Conditions; Other Provisions; Endorsements
- Commercial Package Policies & The Business Owners Policy – Updated 11/10/2017
Introduction to Commercial Package Policies and the BOP
BOP Eligibility and Coverages
Additional Coverages; Extensions of Coverage
Liability Coverage; Optional Coverages and Endorsements
- Commercial Property Insurance – Updated 6/1/2017
Introduction to Commercial Property Insurance
Property not covered
Commercial Property Conditions
Cause of Loss Forms
Business Income (Time Element)
Miscellaneous Property Forms and Endorsements
- Equipment Breakdown Coverage
Coverages and Extensions
Deductibles, Endorsements, Exclusions
- Umbrella & Excess Liability Coverage
Personal and Commercial Insurance
- Commercial Inland Marine Insurance
Commercial Inland Marine
Commercial Property Floaters Risks
Bailee Forms and Dealers Policies
Conditions (cont.); Exclusions
- Ocean Marine Insurance
Introduction to Ocean Marine Insurance; Implied Warranties
Cargo & Freight Insurance; Ocean Marine Forms, Perils & Exclusions
Ocean Marine Claims Handling and Payment of Premium
- Aviation Insurance
Aircraft Hull Policies, Aircraft Liability Coverages, Definitions
Admitted Aircraft Liability, Hangar keeper’s Liability, Exclusions
- Bonding & Surety – Updated 06/01/2017
Bonding & Suretyship, Fidelity Bonds and Surety Bonds
Contract Surety Bonding and Financial Institution Bonds
All course work will be performed through the online version of Insurance-Schools.com Public Insurance Adjuster course in an open discussion classroom setting. This is being done for many reasons, I will list just a few.
- We have administrative rights to all tests and scores taken, and can submit those, as needed by the department, to confirm the effectiveness, participation, and general amount of time spent by time logged in, and tests taken. (Attendance, roll call, and exit.)
- The material provided by Insurance-Schools.com has already been approved by the department and will not be changed or deviated from in our classrooms. We will actually discuss them in great detail, with different scenarios.
- Insurance-Schools.com incorporates any new legislation affecting the rules that govern us, as you can see, all versions above carry the latest updates.
- We used the very same program to obtain our initial Texas license, and have used them whenever necessary to obtain licensure in other states.
- Courses will be administered via laptops we provide, specifically and solely for this purpose, and will remain in our possession at all times, save for theft, or any other instance out of our control.
What can you expect from this Session?
Students who have taken and successfully completed our course should be able to read and understand common policy language and conditions. This would include exclusions, endorsements, and claim filing procedures. After each 6-hour class day, there will be an additional 2 hours dedicated to the open discussion, and actual application, based off our collective knowledge in the field. This equivalates to 40 actual classroom hours, more than the required 24. Finally, if the student is not already licensed, that student should be able to schedule, take, and pass the exam provided by Pearson VUE, then be capable of performing their duties once a license is obtained.
We look forward to helping insurance professionals maintain the highest standards possible, by raising those very standards.
CANCELLATION – REFUND POLICY
All cancellations must be received in writing on or before the 14th day prior to the commencement of the course. Cancellations requests received in writing on or before the 14th day will result in a refund of the registration fee less a 20% administrative charge. Any cancellations less than 14 days prior to the course will result in the forfeiture of the registration fee. Cancellation requests must be made in writing to the registrar at Public Adjuster Boot Camp Attention: Melanie Spoon at 902 51st Street, Galveston, TX 77551-4110.
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