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Certification

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Instructor
Barry Zalma, Instructor - Investigating the Property Claim

Barry Zalma

Barry Zalma is an insurance coverage consultant and Certified Fraud Examiner. Founder of Barry Zalma, Inc., a California law firm whose practice emphasized the representation of insurers and those in the business of insurance.

Instructor: Barry Zalma

How an insured and insurer deal with the investigation of a property claim.

Learn about Excellence in Claims Handling and these courses prepare you how to be an insurer. 

Instructor Barry Zalma is an insurance coverage consultant and Certified Fraud Examiner.

Course Description

The Excellence In Claims Handling program provides everything the insurance claims person needs to properly represent the insurer when presented with a first-party property claim. It also provides the person or entity insured, its risk manager or CFO with everything needed to present a claim to effectively present the claim and provides the information needed to obtain the maximum indemnity promised by the insurance policy. A key to every insurance claim is the thorough investigation required by law where the insurer's adjuster or claims person works with the insured or his, her or its representative, to gather sufficient facts to determine the cause and origin of the claimed loss, whether the loss was due to a cause, the risk of loss of which was insured, and if so to determine the extent of the loss and the indemnity owed by the insurer to the insured. This program provides the insurer's representative the tools needed to complete a thorough investigation and the insured's representative with the tools to assist the adjuster to complete the needed investigation promptly so that the insured and the insurer are satisfied with a prompt and complete payment of the indemnity promised by the policy.

What am I going to get from this course?

Either conduct a thorough investigation of a property insurance claim or be ready and able to assist the insurer's representative in the need to complete a thorough investigation of a property insurance claim.

Prerequisites and Target Audience

What will students need to know or do before starting this course?

That they want to be a professional who can complete a thorough and effective investigation of a property insurance claim. 

Who should take this course? Who should not?

The course should be taken by risk managers, corporate counsel, insurance claims management, insurance claims executives, insurance claims adjusters, insurance claims representatives, insurance special investigation unit investigators, public insurance adjusters, insurance coverage lawyers, insurance paralegals, and claims personnel of insurance agencies or insurance brokerages.

Curriculum

Module 1: Investigating the First Party Property Policy

Lecture 1 The First Party Property Policy

A policy of insurance that insures against the risk of loss to real or personal property described in the contract of insurance.

Lecture 2 Understanding how Insurance is acquired

The student will understand what is necessary to acquire a policy of first-party property insurance. This is useful for the policyholder and the insurance claims person since it is the first action of the policyholder's contact with the insurer. The first contact is an expression of the good faith of the insured. It also assists the claims person in completing a thorough investigation into how the policy was acquired.

Lecture 3 How to Acquire a Policy of First Party Property Insurance

The student will understand what is necessary to acquire a policy of first-party property insurance. This is useful for the policyholder and the insurance claims person since it is the first action of the policyholder's contact with the insurer. The first contact is an expression of the good faith of the insured. It also assists the claims person in completing a thorough investigation into how the policy was acquired.

Lecture 4 How an Insured Acquires a Policy of First Party Property Insurance

The student will understand what is necessary to acquire a policy of first-party property insurance. This is useful for the policyholder and the insurance claims person since it is the first action of the policyholder's contact with the insurer. The first contact is an expression of the good faith of the insured. It also assists the claims person in completing a thorough investigation into how the policy was acquired.

Lecture 5 How to Acquire a Policy of First Party Property Insurance

The student will understand what is necessary to acquire a policy of first-party property insurance. This is useful for the policyholder and the insurance claims person since it is the first action of the policyholder's contact with the insurer. The first contact is an expression of the good faith of the insured. It also assists the claims person in completing a thorough investigation into how the policy was acquired.

Lecture 6 How to Acquire a Policy of First Party Property Insurance - Part 2

The student will understand what is necessary to acquire a policy of first-party property insurance. This is useful for the policyholder and the insurance claims person since it is the first action of the policyholder's contact with the insurer. The first contact is an expression of the good faith of the insured. It also assists the claims person in completing a thorough investigation into how the policy was acquired.

Lecture 7 How to Acquire a Policy of First Party Property Insurance - Part 3

The student will understand what is necessary to acquire a policy of first-party property insurance. This is useful for the policyholder and the insurance claims person since it is the first action of the policyholder's contact with the insurer. The first contact is an expression of the good faith of the insured. It also assists the claims person in completing a thorough investigation into how the policy was acquired.

Lecture 8 Conclusion

The student will understand what is necessary to acquire a policy of first-party property insurance. This is useful for the policyholder and the insurance claims person since it is the first action of the policyholder's contact with the insurer. The first contact is an expression of the good faith of the insured. It also assists the claims person in completing a thorough investigation into how the policy was acquired.

Lecture 9 The Convenant of Good Faith and Fair Dealing With Regard to the Application for Insurance

The covenant of Good Faith and Fair Dealing is a covenant, an agreement, courts imply exist in every contract of insurance. It requires that each party to the contract - the insurer and the policyholder - will do nothing that will deprive the other of the benefits of the contract.

Lecture 10 How to Read a Policy of Insurance

To read a policy of insurance the reader must overcome the bad publicity that suggests they are written in a manner that only a well trained lawyer can understand. In modern times all policies are written in "easy to read" language that should be understandable to anyone with a fourth grade education and who is able to read the entire contract before making any decisions concerning coverage.

Lecture 11 The Elements of a Contract

To read a policy of insurance the reader must overcome the bad publicity that suggests they are written in a manner that only a well trained lawyer can understand. In modern times all policies are written in "easy to read" language that should be understandable to anyone with a fourth grade education and who is able to read the entire contract before making any decisions concerning coverage. Each element, the declarations page, the insuring agreement, conditions and exclusions are described.

Lecture 12 The Elements of a Contract - Part 2

To read a policy of insurance the reader must overcome the bad publicity that suggests they are written in a manner that only a well trained lawyer can understand. In modern times all policies are written in "easy to read" language that should be understandable to anyone with a fourth grade education and who is able to read the entire contract before making any decisions concerning coverage. Each element, the declarations page, the insuring agreement, conditions and exclusions are described.

Lecture 13 The Elements of a Contract- Declarations Page

To read a policy of insurance the reader must overcome the bad publicity that suggests they are written in a manner that only a well trained lawyer can understand. In modern times all policies are written in "easy to read" language that should be understandable to anyone with a fourth grade education and who is able to read the entire contract before making any decisions concerning coverage. The declarations page is discussed in detail.

Lecture 14 What rules must be followed when reading a Policy

To read a policy of insurance the reader must overcome the bad publicity that suggests they are written in a manner that only a well trained lawyer can understand. In modern times all policies are written in "easy to read" language that should be understandable to anyone with a fourth grade education and who is able to read the entire contract before making any decisions concerning coverage. Each element, the declarations page, the insuring agreement, conditions and exclusions are described. To assist in reading and understanding the policy are court decisions and rules on the interpretation of the policy.

Lecture 15 The Elements of a Contract- Over the Statements of a declaration page

To read a policy of insurance the reader must overcome the bad publicity that suggests they are written in a manner that only a well trained lawyer can understand. In modern times all policies are written in "easy to read" language that should be understandable to anyone with a fourth grade education and who is able to read the entire contract before making any decisions concerning coverage. Each element, the declarations page, the insuring agreement, conditions and exclusions are described.

Lecture 16 Conditions suspending or restricting Insurance

To read a policy of insurance the reader must overcome the bad publicity that suggests they are written in a manner that only a well trained lawyer can understand. In modern times all policies are written in "easy to read" language that should be understandable to anyone with a fourth grade education and who is able to read the entire contract before making any decisions concerning coverage. Conditions and exclusions are described in detail.

Lecture 17 The Business Owners Policy

A specific type of first-party property policy that insures a business against the risk of loss of certain real and personal property owned or controlled by the policyholder.

Lecture 18 The Business Owners Policy - Conditions

A specific type of first-party property policy that insures a business against the risk of loss of certain real and personal property owned or controlled by the policyholder. The course then details the conditions that must be fulfilled by the insured to be entitled to the benefits of the policy.

Lecture 19 The Business Owners Policy- Additional Coverages

A specific type of first-party property policy that insures a business against the risk of loss of certain real and personal property owned or controlled by the policyholder. This lecture covers the various coverages provided by a business owners policy.

Lecture 20 Insurance Claims Handling

This lecture deals with the obligations of the insurance claims person when investigating a property insurance claim.

Lecture 21 Investigating of a First Party Property Insurance Claim

A lecture with details on the obligations of the insurance claims person in completing an investigation of a property claim.

Lecture 22 Investigating of a First Party Property Insurance Claim- Part 2

More details on the obligations of the insurance claims person in completing an investigation of a property claim.

Lecture 23 Processing a Claim

A lecture with details on the obligations of the insurance claims person in completing an investigation of a property claim with details on how the claim is resolved and payment made if the cause of the loss is covered by the policy.

Lecture 24 Some exclusions include

An explanation of some exclusions contained in first-party property policies and how they may effect a claim.

Lecture 25 Determine if the policy is Valid

The first obligation of a claims person is to establish that the insured has a valid policy whose premium has been paid and who has done nothing to cause the policy to be void.

Lecture 26 Mutual Rescission

The first obligation of a claims person is to establish that the insured has a valid policy whose premium has been paid and who has done nothing to cause the policy to be void. When the insured and the insurer agree that there are grounds for rescission they can agree to rescinding the policy with a mutual agreement where the insured returns the policy and the insurer returns the premium.

Lecture 27 Processing a Claim

The first obligation of a claims person is to establish that the insured has a valid policy whose premium has been paid and who has done nothing to cause the policy to be void.

Lecture 28 Establish the Amount of the Loss and Claim

The claims person working with the policyholder determine the amount necessary to return the policyholder to the same condition, using material of like kind and quality, as they were before the loss.

Lecture 29 Photograph the Scene

Part of a claim investigation always requires photographs of the entire scene, both damaged and undamaged.

Lecture 30 Write the Captioned Report

The claims person is required to prepare a report that explains everything needed for insurance management to understand the claim and the adjustment.

Lecture 31 Adjusting the Commercial Loss

An explanation on how the claims person resolves a commercial property loss.

Lecture 32 The Public Adjuster

An insurance adjuster who only works for policyholders and acts with the company adjuster to obtain the indemnity the policy promised by standing in for the insured.

Lecture 33 Common Mistakes and Omissions for an Adjuster to avoid

An explanation of the mistakes or omissions a claims person can make - and must avoid - when dealing with a property claim.

Lecture 34 Processing a Claim

The first obligation of a claims person is to establish that the insured has a valid policy whose premium has been paid and who has done nothing to cause the policy to be void. The lecture discussing the use of experts and consultants to assist the adjuster and the policyholder to reach an agreement as to the amount of the claim.

Lecture 35 The " Loss in Progress " Rule

An explanation why insurance is not available for a loss that occurs, or was in progress, before the policy came into effect since the loss was neither contingent nor unknown to the insured.

Lecture 36 Fortuity

A legal doctrine that explains the need for all insurance claims to be accidental.

Lecture 37 Equitable Tolling

A doctrine that allows a time limit in the policy to be held in abeyance and unenforceable if, to do so, is fair to both parties.

Lecture 38 Determine the Amount of the Loss

This is the creation of a statement of loss where the claims person identifies the agreements made between the insured and the claims person as to the amount of loss and claim.

Lecture 39 Appraisal

A method of arbitration that allows a dispute between an insured and the insurer to determine the amount of loss and claim by each appointing a disinterested appraiser and the two appraisers appointing a disinterested and competent umpire. The decision of two is binding on both.

Lecture 40 The Claim File

This is a collection of documents or computer based documents that detail everything that was done in the investigation and resolution of the claim.

Module 2: Interviewing Techniques

Lecture 41 What is an Interview?

A method of obtaining information from an individual by conducting a formal conversation that is usually recorded on a tape recorder or electronic recording device.

Lecture 42 Interviewing Techniques for the Insurance Professional

An explanation of the various techniques available to a claims person to obtain all of the information required to complete the thorough investigation required by the policy, state law, and state regulations.

Lecture 43 Interviewing is an Art Form

Why and how interviewing is an art form that borrows from scientific investigations and interrogations used by police agency. An interview is informal and non-confrontational.

Module 3: The Scope of Loss

Lecture 44 The Creation of Scope, Statement and Proof of Loss

Lecture 45 The Creation of a Scope of Loss

An explanation on how a claims person, working with the policyholder or the public adjuster, creates a scope of loss that establishes the method to determine the amount of loss.

Lecture 46 The Creation of a Scope of Loss - Part 2

An explanation on how a claims person, working with the policyholder or the public adjuster, creates a scope of loss that establishes the method to determine the amount of loss.

Lecture 47 The Creation of a Scope of Loss - Part 3

An explanation on how a claims person, working with the policyholder or the public adjuster, creates a scope of loss that establishes the method to determine the amount of loss.

Lecture 48 The Creation of a Statement of Loss

A Statement of Loss is a summary of the findings of the claims person showing, in numerical fashion, the conclusions reached by the investigation and the agreements made with the insured as to the cause, origin, amount of loss and application of deductibles and conditions if needed.

Lecture 49 The Creation of a Proof of Loss

A Proof of Loss is a summary of the findings of the insured showing, in numerical fashion, the conclusions reached by the investigation and the agreements made with the insured as to the cause, origin, amount of loss and application of deductibles and conditions if needed. The Proof of Loss statements of fact must be sworn to under oath by the insured stating the insured's claim.

Lecture 50 The creation of a Proof of Loss - Part 2

A Proof of Loss is a summary of the findings of the insured showing, in numerical fashion, the conclusions reached by the investigation and the agreements made with the insured as to the cause, origin, amount of loss and application of deductibles and conditions if needed. The Proof of Loss statements of fact must be sworn to under oath by the insured stating the insured's claim.

Lecture 51 The Proof of Loss

A Proof of Loss is a summary of the findings of the insured showing, in numerical fashion, the conclusions reached by the investigation and the agreements made with the insured as to the cause, origin, amount of loss and application of deductibles and conditions if needed. The Proof of Loss statements of fact must be sworn to under oath by the insured stating the insured's claim.

Lecture 52 The Proof of Loss - Part 2

A Proof of Loss is a summary of the findings of the insured showing, in numerical fashion, the conclusions reached by the investigation and the agreements made with the insured as to the cause, origin, amount of loss and application of deductibles and conditions if needed. The Proof of Loss statements of fact must be sworn to under oath by the insured stating the insured's claim.

Lecture 53 The Proof of Loss- Part 3

A Proof of Loss is a summary of the findings of the insured showing, in numerical fashion, the conclusions reached by the investigation and the agreements made with the insured as to the cause, origin, amount of loss and application of deductibles and conditions if needed. The Proof of Loss statements of fact must be sworn to under oath by the insured stating the insured's claim.

Lecture 54 The Subgrogation Agreement

Once settlement has been reached, if the insurer determines that the cause of loss was due to the tortious conduct of a third person or entity the claims person obtains from the insured a signed agreement allowing the insurer to - as authorized by the policy - to sue the responsible party as the insured to recover the amounts paid.

Module 4: Duties of the Insured

Lecture 55 Introduction

An introduction to the duties of the insured.

Lecture 56 The Duties of an Insured Presenting a First Party Property Claim

The lecture explains the various duties of the insured when presenting a claim including cooperation in the investigation of the insurer, production of the property for inspection, providing documents required, submitting to an examination under oath, and presentation of a sworn statement in proof of loss, among others.

Lecture 57 The Duties of an Insured Presenting a First Party Property Claim - Part 2

The lecture explains the various duties of the insured when presenting a claim including cooperation in the investigation of the insurer, production of the property for inspection, providing documents required, submitting to an examination under oath, and presentation of a sworn statement in proof of loss, among others.

Lecture 58 The Duties of an Insured Presenting a First Party Property Claim - Part 3

The lecture explains the various duties of the insured when presenting a claim including cooperation in the investigation of the insurer, production of the property for inspection, providing documents required, submitting to an examination under oath, and presentation of a sworn statement in proof of loss, among others.

Lecture 59 The Duties of an Insured Presenting a First Party Property Claim - Part 4

The lecture explains the various duties of the insured when presenting a claim including cooperation in the investigation of the insurer, production of the property for inspection, providing documents required, submitting to an examination under oath, and presentation of a sworn statement in proof of loss, among others.

Lecture 60 The Duties of an Insured Presenting a First Party Property Claim - Part 5

The lecture explains the various duties of the insured when presenting a claim including cooperation in the investigation of the insurer, production of the property for inspection, providing documents required, submitting to an examination under oath, and presentation of a sworn statement in proof of loss, among others.

Lecture 61 The Duties of an Insured Presenting a First Party Property Claim - Part 6

The lecture explains the various duties of the insured when presenting a claim including cooperation in the investigation of the insurer, production of the property for inspection, providing documents required, submitting to an examination under oath, and presentation of a sworn statement in proof of loss, among others.

Lecture 62 The Duties of an Insured Presenting a First Party Property Claim - Part 7

The lecture explains the various duties of the insured when presenting a claim including cooperation in the investigation of the insurer, production of the property for inspection, providing documents required, submitting to an examination under oath, and presentation of a sworn statement in proof of loss, among others.

Lecture 63 The Duties of an Insured Presenting a First Party Property Claim - Part 8

The lecture explains the various duties of the insured when presenting a claim including cooperation in the investigation of the insurer, production of the property for inspection, providing documents required, submitting to an examination under oath, and presentation of a sworn statement in proof of loss, among others.

Lecture 64 The Duties of an Insured Presenting a First Party Property Claim - Part 9

The lecture explains the various duties of the insured when presenting a claim including cooperation in the investigation of the insurer, production of the property for inspection, providing documents required, submitting to an examination under oath, and presentation of a sworn statement in proof of loss, among others.

Lecture 65 The Duties of an Insured Presenting a First Party Property Claim - Part 10

The lecture explains the various duties of the insured when presenting a claim including cooperation in the investigation of the insurer, production of the property for inspection, providing documents required, submitting to an examination under oath, and presentation of a sworn statement in proof of loss, among others.

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