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CERTIFIED CLAIMS ADJUSTER FLORIDA STUDY EXAM Questions and Answers Latest Updates 2024 TOP RATED A+
Typology: Exams
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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, b.)$10, c.)$14, d.)$11,500 - CORRECT ANSWER-b.)$10, 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 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- In a Personal Auto Policy, liability coverage only protects: - CORRECT ANSWER-Those individuals meeting the definition of an "insured" under the policy WHEN COVERAGE SYMBOLS #1 OR #21 ARE USED TO DESCRIBE AUTOS FOR WHICH COVERAGE IS PROVIDED UNDER THE BUSINESS AUTO OR GARAGE POLICIES, TO WHICH TYPE OF AUTOS ARE THESE SYMBOLS REFERRING? - CORRECT ANSWER-Any Auto Which of the following symbols is used to provide coverage for "Specifically Described Autos" under a Business Auto Policy? - CORRECT ANSWER- 7 What does symbol "22" next to the Liability, Physical Damage: Comprehensive and Physical Damage: Collision coverage mean? - CORRECT ANSWER-Owned Autos Only 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
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 Carrier's Claim Handling Goal #3: - CORRECT ANSWER--To comply with the requirements of the law or terms of the insurance contract
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-
or a promise of performance. 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. 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. 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. 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 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": 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. 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 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 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. 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. 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.