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.
This program allows the student to learn about problems that arise as a result of a first party property claim and how each problem can be resolved with information learned from the course and other Excellence in Claims Handling programs.
What am I going to get from this course?
Excellence in First Party Property Insurance Claims
The insured, risk manager, or corporate counsel will be able to present a first party property claim - whether a fire, theft, or windstorm or some other insured against cause - with little difficulty and professionalism and present a sworn proof of loss acceptable to an insurer.
The insurance claims person completing the course will be able conduct a thorough investigation of the policy and claim. The insurance claims person will also be able to assist an insured to fulfill all of the promises made by the insured to the insurer and the insurer to provide the indemnity promised by the insurance policy.
Each person completing the course will be able to claim that he or she is a professional first party property claims person ready to provide excellence in claims handling and be ready to resolve any claims problem that arises for the benefit of the insurer and the policy holder.
Prerequisites and Target Audience
What will students need to know or do before starting this course?
The course is capable of providing information needed without the assistance of material or software. However, it can be supplemented by books written by the author and available at
http://www.zalma.com/blog/insurance-claims-library/ with materials like
The Homeowners Insurance Policy,
Zalma on Insurance Claims - ten Volumes,
Construction Defects and Insurance,
Mold Claims, and “Insurance Fraud & Weapons to Defeat Insurance Fraud,” The Compact Book of Adjusting Property Insurance Claims-Second Edition; Construction Defects and Insurance (eight volumes); Mold Claims (four volumes); Ethics for the Insurance Professional; Rescission of Insurance; The Insurance Examination Under Oath; Zalma on Property and Casualty Insurance; Insurance Law Deskbook; Insurance Bad Faith and Punitive Damages Deskbook; The Commercial Property Insurance Policy Deskbook; The Insurance Fraud Deskbook; Diminution in Value Damages; and Property Investigation Checklists Uncovering Insurance Fraud, 12th Edition.
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: Ethics for the Insurance Professional
Lecture 1
Ethics for the Insurance Professional
Since the first insurance contract was scratched into a clay tablet in ancient Sumeria more than 3,000 years ago insurance has been considered a business of the utmost good faith. Each party to the insurance contract must, therefore, deal with the other ethically, fairly and in good faith. This lecture explains how the various ethical concepts can be applied to the contract of insurance by the representatives of the insurer and the policyholder and his, hers, or its representatives.
Lecture 2
Course Overview and Objectives
Lecture 3
Ethics for the Insurance Professional
Lecture 4
Ethical Behavior is Mandatory
Lecture 5
The Convenant of Good Faith and Fair Dealing
Lecture 6
Insurance Professional shoyuld be objective and not allow:
Lecture 7
Ethics for the Insurance Professional
Lecture 8
Applying Ethics to the work of the Insurance Professional
Lecture 9
Ethics and the Insurance Product
Lecture 10
Ethics and the Insurance Product - Part 2
Lecture 11
The Concept of Ethis that is best fit for any Insurance Professional
Lecture 12
The Insurance professional must avoid threats to Ethical Behavior
Lecture 14
Ethical Norms can be breached when:
Lecture 15
The Insurance Professional must ensure that:
Module 2: Insurance Fraud
Lecture 17
Insurance Fraud
Lecture 18
What is Insurance Fraud?
Lecture 19
The problem with fraud
Lecture 20
Evidence Required to Prove Insurance Fraud
Lecture 21
The Problem with Fraud - Part 2
Lecture 22
The Problem with Fraud - Part 3
Lecture 23
The Problem with Fraud- Part 4
Lecture 24
The Problem with fraud- Part 5
Lecture 25
The Problem with Fraud- Part 6
Lecture 27
The Ethical Fraud Investigator
Lecture 28
The Ethical Fraud Investigator- Examples
Lecture 29
Investigation of a Suspected Insurance Fraud
Lecture 30
Red Flags of fraud
Lecture 31
Red Flags of Fraud - Part 2
Lecture 32
Red Flags of Fraud - Part 3
Lecture 33
Property Insurance Fraud Red Flags
Lecture 34
Property Insurance Fraud Red Flags
Lecture 35
Red Flags of Fraud- Vehicle
Lecture 36
Investigation needed to prove insurance fraud
Module 3: The Equitable Remedy of Rescission
Lecture 37
The Equitable Remedy of Rescission and The Claims Handler
Lecture 38
The Equitable Remedy of Rescission
Lecture 39
The Equitable Remedy of Rescission - Part 2
Lecture 40
The Equitable Remedy of Rescission - Part 3
Lecture 41
A ground for Rescission
Lecture 42
Fraud is not required
Lecture 43
Materiality is required
Lecture 44
Only three elements must be met to effect a Rescission
Lecture 45
The Applellate Court
Lecture 46
Barrera Vs State Farm Mutual Automobile Insurance dispute
Lecture 48
The court exercised the decision
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