Claims Adjuster Course

Lesson 1 • Types of Insurance Claims

Surveys property, liability, auto, workers' compensation, and specialty claim categories. Provides a taxonomy students reference throughout the course.

Lesson 2 • Role and Responsibilities of an Adjuster

Defines the adjuster's duties, authority limits, and ethical obligations. Connects professional standards to daily claim-handling tasks.

Lesson 3 • Regulatory and Licensing Framework

Introduces licensing requirements, continuing education obligations, and regulatory oversight bodies. Grounds students in compliance expectations before technical training begins.

Lesson 1 • Anatomy of an Insurance Policy

Breaks down declarations, insuring agreements, conditions, exclusions, and endorsements. Understanding policy structure is prerequisite to any coverage determination.

Lesson 2 • Coverage Triggers and Conditions

Examines occurrence, claims-made, and discovery triggers alongside conditions precedent to coverage. Students learn to verify whether a loss event activates the policy.

Lesson 3 • Exclusions, Limitations, and Sublimits

Analyzes common exclusions, coverage sublimits, and deductible structures that reduce or eliminate payment. Prepares adjusters to communicate coverage gaps clearly.

Lesson 4 • Interpreting Policy Language

Teaches rules of construction, ambiguity resolution, and plain-meaning analysis. Equips adjusters to apply policy terms consistently and defensibly.

Lesson 1 • Evidence Collection and Preservation

Teaches methods for securing physical, digital, and documentary evidence. Proper preservation prevents spoliation and supports defensible claim outcomes.

Lesson 2 • Using Expert Resources in Investigations

Explains when and how to engage engineers, medical professionals, and forensic specialists. Expert input strengthens technical findings and supports complex claim decisions.

Lesson 3 • Recorded Statements and Interviews

Develops skills for conducting structured interviews with claimants, witnesses, and insureds. Effective statements capture facts that guide coverage and liability analysis.

Lesson 4 • First Notice of Loss Procedures

Covers intake protocols, initial contact requirements, and early claim triage. Proper first notice handling sets the foundation for every subsequent investigation step.

Lesson 1 • File Documentation Standards

Defines what must be documented, how to write effective file notes, and how to organize supporting materials. Strong documentation is the adjuster's primary defense in disputes.

Lesson 2 • Audit Readiness and Quality Review

Prepares adjusters for internal audits, regulatory examinations, and quality assurance reviews. Files that meet audit standards reflect professional competence and reduce liability.

Lesson 3 • Diary and Workflow Management

Teaches diary scheduling, task prioritization, and workload balancing to meet regulatory and internal deadlines. Consistent diary discipline prevents missed obligations.

Lesson 4 • Reserve Setting and Management

Explains how to set initial reserves, adjust them as facts develop, and document reserve rationale. Accurate reserves protect insurer solvency and regulatory compliance.

Lesson 1 • Bodily Injury Evaluation

Covers medical record review, injury classification, and general and special damages quantification. Accurate bodily injury valuation requires integrating medical and economic data.

Lesson 2 • Valuation Disputes and Appraisal Process

Addresses disagreements over loss amounts and the formal appraisal mechanism available under most property policies. Prepares adjusters to manage and resolve valuation conflicts.

Lesson 3 • Vehicle and Auto Damage Appraisal

Teaches total loss thresholds, repair vs. replace decisions, and diminished value concepts. Auto appraisal skills apply to both first-party and third-party auto claims.

Lesson 4 • Property Damage Estimation Methods

Introduces replacement cost, actual cash value, and functional replacement cost approaches. Selecting the correct method depends on policy language and property type.

Lesson 1 • Documenting and Communicating Liability Decisions

Teaches how to write clear, evidence-based liability summaries and communicate decisions to all parties. Proper documentation protects the insurer and supports fair outcomes.

Lesson 2 • Auto Liability and Accident Reconstruction

Applies traffic laws, physical evidence, and reconstruction principles to determine fault in vehicle accidents. Accurate auto liability findings reduce litigation exposure.

Lesson 3 • Comparative and Contributory Fault

Explains how shared fault affects liability exposure and claim payment under different fault allocation systems. Adjusters must apply the correct system to each claim.

Lesson 4 • Negligence and Legal Liability Principles

Establishes duty, breach, causation, and damages as the four elements of negligence. These principles underpin every liability determination an adjuster makes.

Lesson 1 • Mediation and Alternative Dispute Resolution

Explains mediation, arbitration, and neutral evaluation as alternatives to litigation. Adjusters who understand these processes resolve disputes more efficiently.

Lesson 2 • Settlement Value Analysis

Teaches how to establish a defensible settlement range using damages, liability, and coverage data. A well-supported value range anchors every negotiation.

Lesson 3 • Negotiation Strategies and Tactics

Introduces interest-based negotiation, anchoring, and concession management techniques. Effective tactics lead to faster resolution and reduced indemnity spend.

Lesson 4 • Settlement Agreements and Releases

Covers drafting, reviewing, and executing settlement agreements and releases of liability. Proper release language prevents future claims arising from the same loss.

Lesson 1 • Special Investigations Unit Referrals

Explains when and how to refer a claim to a special investigations unit and what to expect from the process. Proper referrals ensure thorough investigation without claim delay.

Lesson 2 • Understanding Insurance Fraud

Defines hard and soft fraud, explains fraud's financial impact, and surveys common fraud schemes by line of business. Awareness is the first step in effective fraud detection.

Lesson 3 • Fraud Reporting and Legal Obligations

Outlines mandatory fraud reporting requirements, cooperation with law enforcement, and civil remedies. Adjusters must understand their legal duties when fraud is confirmed.

Lesson 4 • Investigative Tools and Surveillance

Covers database searches, social media analysis, and surveillance techniques used in fraud investigations. Each tool must be applied within legal and ethical boundaries.