Certified Claims Adjuster- Florida Exam Questions And Answers, Exams of Insurance law

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Questions And Answers

Repair, replacement and recovery of injured lives and damaged property falls to? - - - correct answer ✅Insurance Adjusters, CAT Troopers, Field Investigators, Property Appraisers and Front Line Supervisors Insurance Transaction includes: - - - correct answer ✅-Solicitation of insurance -Negotiations; -Binding, underwriting and sale of insurance; -Handling or "adjusting" of claims The Role of Insurance is: - - - correct answer ✅- Essential Product -Financial Product

• Purchase of a Promise -Purchase based on TRUST The different types of insurance are: - - - correct answer ✅-Health -Life -Property -Casualty

Questions And Answers

When you buy insurance, you are buying: - - - correct answer ✅Peace of Mind Insurance is a Purchase based on: - - - correct answer ✅Trust The most important factor in the purchase of insurance is: - - - correct answer ✅Trust An assertion of an alleged legal right against a person, entity, company or insurer that carries with it a demand for relief is: - - - correct answer ✅Claim Is the same as a request, demand, a letter requesting action, a bill submitted for payment: - - - correct answer ✅Assertion Means that the claim may or may not be valid or legitimate, or that there may not be any legal right for belief: - - - correct answer ✅Alleged Relief: - - - correct answer ✅Compensation or payment. Can also mean: -restitution

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-return -recovery -replacement Takes form in property or money Third Party Claim: - - - correct answer ✅A claim made by a third party against an "insured" person or entity First Party Claim: - - - correct answer ✅A claim made by a policy holder against his/her own insurance company for recovery under the policy (contract) for which a premium has been paid Carrier's Claim Handling Goal #1: - - - correct answer ✅To help those who have been injured or who have suffered loss for which the insured is responsible or which is covered by the insurance contract Carrier's Claim Handling Goal #2: - - - correct answer ✅To minimize loss for the insured party and the carrier. To fairly evaluate the legitimacy and legality of a claim and its value and resolve satisfactory

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Carrier's Claim Handling Goal #3: - - - correct answer ✅-To comply with the requirements of the law or terms of the insurance contract -To pay claims fairly and adequately Carrier's Claim Handling Goal #4: - - - correct answer ✅To maintain friendly and satisfactory relations between the injured party, the employer or policy holder, the insurance company an the public Carrier's Claim Handling Goal #5: - - - correct answer ✅To satisfy the company's moral and ethical obligation to the public and conduct business (claims) in a friendly, helpful manner An individual who, for compensation, fee or commission, investigates and settles claims arising under property, casualty or surety contracts on behalf of the insurer or the insured: - - - correct answer ✅Adjuster The process, or art, of investigating, evaluating, reporting on, negotiating and resolving claims under a policy, or claims against your client, the insurance company or the company for which you work or represent: - - - correct answer ✅Adjusting Types of Adjusters: - - - correct answer ✅-Staff Adjusters

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-Independent Adjusters

• Public Adjusters Work for Insurance Companies: - - - correct answer ✅Staff Adjusters Self Employed or employed by an independent adjusting firm: - - - correct answer ✅Independent Adjusters Represents the insured, typically seen in the property lines of business: - - - correct answer ✅Public Adjusters Can be inside adjusters, field adjusters or both: - - - correct answer ✅Property Adjusters Property Adjusters handle: - - - correct answer ✅-ONLY physical damage claims -Automobile Physical Damages Claims -Damages to homes, buildings, personal property Evaluate legal liability, cause of loss, damages and bodily injury: - - - correct answer ✅Liability Adjusters

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Provide medial and wage replacement benefits for injured workers

• • • correct answer ✅Worker's Compensation Adjusters Handle various types of losses and may earn the right to a field position: - - - correct answer ✅Multi-Line Adjusters Insurance that is compromised of liability and worker's compensation claims: - - - correct answer ✅Casualty Insurance Involves relative degrees of legal responsibility, the evaluation of damage or injury and determination of legal rights and remedies: - -
• correct answer ✅Casualty Claims Adjusting Liability and Worker's Compensation Adjusters do most of the following: - - - correct answer ✅-Verify coverage -Investigate facts by securing testimony and evidence -Determine liability
• Determine the amount of loss in terms of property damage, medical expenses, loss of wage, etc. -Determine intangibles, such as pain and suffering, discomfort and inconvenience

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-Determine if litigation is eminent and estimate defense costs and the probability of success in the event of a law suit -Determine if other parties to the loss might be responsible under any one of a number of legal theories -Pay claims or benefits as owed under various theories of liability or statute Property Claims Adjusting is: - - - correct answer ✅The evaluation of damage to real or personal property resulting from various perils such as: -fire -wind -theft -explosion An assessment of available policy limits for each involved peril A determination of how much should be paid under policy Property Adjusters do the following: - - - correct answer ✅-Verify coverage

Questions And Answers

-Investigate the facts of loss to determine the proximate cause of loss -Verify if the policy covers the involved peril -Assist the insured in mitigating the loss by providing assistance and guidance -Determine the extent of damage and the cost to repair or replaced damage property -Verify the insured's "insurable interest" in the property, as well as that of the mortgage What umbrella does Automobile Physical Damage Adjusting fall under? - - - correct answer ✅Property Adjusting Automobile Physical Damage Adjusting deals with: - - - correct answer ✅handling and resolution of claims for collision, comprehensive and mechanical breakdown Automobile Physical Damage Adjusters do the following: - - - correct answer ✅-Verify coverage -Investigate the facts of loss and legal responsibilities of the involved parties

• Determine the amount of the loss by appraisal of the cost to repair or replace the damage

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-Apply appropriate deductibles and make payment to those with an insurable interest -Determine the potential of subrogation and recovery of the payments made, including the insured's deductible Fiduciary Duty: - - - correct answer ✅Representing the financial/ and or property interests of another under the confidence and trust of others, to whom the fiduciary owes the highest degree of loyalty and good faith Basic Adjusting Functions are: - - - correct answer ✅-Investigation -Claims management -Evaluating -Reporting -Negotiation & Resolution Components of the investigation process: - - - correct answer ✅- Inquiry -Verification -Comparison

Questions And Answers

Inquiry is: - - - correct answer ✅Obtaining the facts surrounding the claim Verification is: - - - correct answer ✅Checking facts and details for accuracy Comparison is: - - - correct answer ✅Constantly comparing facts and evidence as they are obtained for similarities or differences The three major areas of claims investigation are: - - - correct answer ✅-Coverage -Liability or Compensability -Damages Adjusters investigate by: - - - correct answer ✅-Confirming the loss by verifying bills and statements -Taking detailed statements -Completing scene investigations -Securing photographs or creating diagrams -Canvassing neighborhoods for witnesses -Accident reconstruction

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-Testing an allegedly defective product Coverage refers to: - - - correct answer ✅the insurance contract Define the Doctrine of Proximate Clause: - - - correct answer ✅When an initial loss caused by an insured peril that triggers one or more subsequent losses, the peril causing the initial loss is the "proximate cause" of both initial and subsequent losses An insurance company has many goals and standards for claim handling. One of the most important goals of an insurance company is: - - - correct answer ✅Help those who have suffered loss for which the insured is legally responsible In the property/casualty industry, a claim is defined as: - - - correct answer ✅An assertion of an alleged legal right against a person, entity, company or insurer that carries with it a demand for money as compensation for injuries or damage Which of the following would be considered "work product?" a) An adjuster's claim file notes b) A recorded statement from the claimant

Questions And Answers

c) Written communication between an adjuster and defense counsel. d) An estimate for repairs to damaged property - - - correct answer ✅ There are many differences between adjusting claims in the healthcare industry and in the property/casualty (i.e. workers' compensation, liability, etc.) industry, one of the fundamental differences is: - - - correct answer ✅ Which of the following is NOT a defense to a claim of negligence? a.)Breach of Warranty b.)Comparative Negligence c.)Assumption of the Risk d.)No Negligence - - - correct answer ✅a.) Breach of Warranty Which of the following is NOT one of the four critical elements of a contract? a.)A mutual understanding and agreement with the terms of the contract. b.)Written evidence of the agreement and its terms. c.)Consideration, consisting of money or a promise of performance.

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d.)A legal purpose. - - - correct answer ✅b.)Written evidence of the agreement and its terms. Which of the following statements is NOT true? a.)A carrier has the right, but not the duty, to settle any claim if it deems reasonable and prudent to do so. b.)Under a liability insurance policy, a carrier's duty to defend is greater than its duty to pay. c.)If a question of coverage arises and cannot be swiftly resolved in favor of the insured, the carrier should immediately tender the claim to its defense attorney and deny the claim. d.)If a lawsuit is filed and served upon an insured, the insured must immediately tender the lawsuit to the insurer or it may jeopardize the carrier's ability to defend the claim, and the insured's rights to coverage under the policy. - - - correct answer ✅c.)If a question of coverage arises and cannot be swiftly resolved in favor of the insured, the carrier should immediately tender the claim to its defense attorney and deny the claim.

Questions And Answers

An adjuster has many responsibilities. The adjuster's responsibility as a fiduciary means: a.)Once an adjuster makes a promise, the company is bound by that promise. b.)The adjuster is required to document all activities and continuously report to the company of the progress of claims. c.)The adjuster represents, and controls, the property and financial interests of the client, to whom he/she owes a high degree of loyalty and good faith. d.)The adjuster cannot obligate the insurance company. - - - correct answer ✅ What is the difference between a peril and a hazard? a.)A peril is a cause of loss, like fire. A hazard is a condition that exists beforehand that increases the likelihood of such a loss, like a messy storeroom or garage that contains lots of toxic chemicals, oily rags, etc.

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b.)A peril is a hazard gone wrong. c.)When someone drives too fast, that's a peril. When they get into an accident and kill someone, that's a hazard d.)A hazard is a cause of loss and a peril is the condition that created it. - - - correct answer ✅a.)A peril is a cause of loss, like fire. A hazard is a condition that exists beforehand that increases the likelihood of such a loss, like a messy storeroom or garage that contains lots of toxic chemicals, oily rags, etc. The primary difference between a staff adjuster and an independent adjuster is: a.)A staff adjuster works for an insurance company and an independent adjuster works independently for themselves or for adjusting firms who represent many clients. b.)A staff adjuster works independently or for adjusting firms who represent many clients and an independent adjuster works for an insurance company.

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c.)A staff adjuster represents property owners in claims against their own insurance companies and an independent adjuster works independently or for adjusting firms who represent many clients. d.)A staff adjuster works for an insurance company and an independent adjuster represents property owners against their own insurance companies. - - - correct answer ✅a.)A staff adjuster works for an insurance company and an independent adjuster works independently for themselves or for adjusting firms who represent many clients. Negligence can best be described as: a.)Liability imposed by jury verdict. b.)Fault that arises from doing something you shouldn't have done, or not doing something you should have done. c.)Liability arising from statutorily imposed liability regardless of fault. d.)Fault imposed on you because you have a greater ability to pay. -

• • correct answer ✅b.)Fault that arises from doing something you

Questions And Answers

shouldn't have done, or not doing something you should have done. A couple has insured their home for $250,000. A fire ensues and guts their home, resulting in a total loss. An appraisal of the home prior to loss results in a value of $180,000, yet the adjuster is required by law to pay the couple $250,000. This is known as the application of: a.)Actual cash value b.)Payment of policy limits plus a penalty for over-insuring the home. c.)The valued policy law. d.)Replacement cost value - - - correct answer ✅c.)The valued policy law. Which of the following is NOT an example of "compensatory damages":

Questions And Answers

a.)Pain and suffering b.)A jury verdict of $1,000,000 against the defendant to punish them for their reprehensible actions in causing the loss. c.)Medical bills for treatment of injuries sustained in an accident. d.)Wages lost by the injured party due to inability to work because of injuries sustained in an accident. - - - correct answer ✅b.)A jury verdict of $1,000,000 against the defendant to punish them for their reprehensible actions in causing the loss. An insurance policy is often referred to as a contract of adhesion. This means: a.)The policy is strictly interpreted in favor of the party who had control over its creation. b.)The insurance company is required by law to unilaterally waive any policy requirements that are deemed vague or ambiguous.

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c.)If any of the wording or language in the policy is vague or ambiguous, if the meaning of the wording is difficult to understand or interpret, or if what is written can be interpreted to have different meanings, the law is well settled that the interpretation shall be in favor of the party who did not control its terms...in this case, the policyholder. d.)Both parties are required to strictly adhere to the specific wording of the policy. - - - correct answer ✅ A couple has Coverage A limits of $250,000 on their home located in Miami, FL. They suffer a wind loss to their roof from a tornado spawned by Hurricane Irma that results in an estimate of $12,700.00 for repairs. The adjuster deducts the Florida hurricane deductible of $5,000 from the estimate and pays them $7,700 in settlement of their property claim. This is known as the application of: a.) A percentage deductible b.) Depreciation c.)A franchise deductible

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d.)A straight deductible - - - correct answer ✅a.) A percentage deductible Whether it is done by a carrier or its adjuster, a breach of contract is taken very seriously. This could be done through non-payment, or even non-compliance with policy requirements. Which of the following consequences would a carrier face due to a breach of contract? a.)If sued, the carrier could be required to pay the claim and return the paid-up premium to the insured. b.)The insured could have the state withdraw the carrier's license to conduct business. c.)If the carrier has just cause for the breach, its denial may be justified and the insured would have to accept it. d.)If found guilty of a breach of contract, the carrier could be punished with a "bad faith" verdict that would cost it millions of dollars. - - - correct answer ✅d.)If found guilty of a breach of

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contract, the carrier could be punished with a "bad faith" verdict that would cost it millions of dollars. The most important factor to consider when purchasing an insurance policy is: a.)The ability to buy it online. b.)The size and financial stability of the insurance company. c.)Trust d.)The proximity of the insurance agent to one's home. - - - correct answer ✅c.)Trust Describe the coverages provided in a split limit policy of 10/20/10. a.)The coverage provides $10,000 for bodily injury to one individual, $20,000 for property damage, and $10,000 for bodily injuries to each additional person injured.

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b.) $10,000 of liability protection for bodily injury to any one individual, an aggregate of $20,000 for all bodily injuries regardless of how many individuals, and $10,000 for medical payments. c.)The coverage provides $10,000 in property damage limits, $20,000 in bodily injury for any one individual, and $10,000 for bodily injuries to each additional person injured. d.)Up to $10,000 of liability protection for bodily injury to any one individual, $20,000 for all bodily injuries regardless of how many individuals, and $10,000 for property damage. - - - correct answer ✅ Under Florida's Unfair Insurance Trade Practices Act, which of the following would not be considered a preferred claims practice? a.)Contacting an insured or claimant immediately upon receipt of a claim for property damage or bodily injury. b.)Not responding to an insured's calls because you haven't made up your mind yet. c.)Contacting a witness the day after receiving the claim and getting additional facts about the accident.

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d.)Sending a letter to a claimant explaining why you can't pay their claim, or offering a compromise based on specific facts and legal issues. - - - correct answer ✅b.)Not responding to an insured's calls because you haven't made up your mind yet. Assume that five years ago a couple insured their home for [its then appraised value of] $60,000. Two weeks ago they had a stove fire resulting in an estimated loss of $15,000 for repairs. The adjuster finds that the value of their home is now $100,000, but the home is still only insured for $60,000 and has a deductible of $500. The policy has an 80% coinsurance clause. How much should the adjuster pay to the couple? a.)$15,000 b.)$10,875 c.)$14,500 d.)$11,500 - - - correct answer ✅b.)$10,875

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The basic and primary functions of an adjuster are: a.)Processing and filing mail. b.)Filing special forms for the insurance company and regulatory bodies. c.)Investigating, managing, evaluating, reporting on, and negotiating and disposing of claims. d.)Making payments and recording claim status claims for property damage, vehicle repairs, damages, medical bills, wage loss and compensation. - - - correct answer ✅c.)Investigating, managing, evaluating, reporting on, and negotiating and disposing of claims. After a loss, an Insured has certain responsibilities laid out within the insurance contract. Which of the following is one of the responsibilities of an Insured after a loss? a.)Giving prompt notice of loss to the insurer b.)Reporting the loss to the police

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c.)Making a record of all damaged property d.)Stopping payment of the most recent premium payment - - - correct answer ✅a.)Giving prompt notice of loss to the insurer Florida's Code of Ethics under 69B-220.201(3) begins with an important statement that provides a basis for the very sensitive nature of what an adjuster does. Select that statement from below: a.)It is important for an adjuster to avoid violations of the Unfair Trade Practices Act. The insurer, on whose behalf the adjuster performs, may be subjected to administrative penalties if the adjuster commits an infraction. b.)Any person who is damaged by certain adjuster practices is granted a right to sue the adjuster. c..)Not attempting in good faith to settle claims when it could and should have done so may subject an adjuster to direct liability for bad faith claims practices. d.)The work of adjusting engages the public trust. - - - correct answer ✅