CLAIMS ADJUSTER EXAM 1 WITH 100% CORRECT ANSWERS 2024, Exams of Finance

Download CLAIMS ADJUSTER EXAM 1 WITH 100% CORRECT ANSWERS 2024 and more Exams Finance in PDF only on Docsity! HOSMERIT CLAIMS ADJUSTER EXAM 1 WITH 100% CORRECT ANSWERS 2024 Actual Cash Value (ACV) - Correct answer-Cost to replace property with new property of like kind and quality less depreciation. Combined Single Limit - Correct answer-One limit per occurrence is what we pay up to Split limit - Correct answer-What we pay up to per person and per occurrence Deductible - Correct answer-What the customer will have to pay; we cover everything else Declarations Page (Dec Page) - Correct answer-The basic information about a policy: Who - names of insurer and insured What - description of insured property Where - address and legal description of insured property When - effective and expiration dates. How Much - limits of coverage, deductible, premium Depreciation - Correct answer-Amount taken off for wear and tear Earned Premium - Correct answer-The amount of the premium for which the policy protection has been given. Risk - Correct answer-A chance or uncertainty of loss endorsement - Correct answer-Something you can add/change on policy; car, kid, etc lapse - Correct answer-The insured did not pay so is not covered; will effect renewal Named driver exclusion - Correct answer-Excluded from coverage and covered cars; cannot drive as they would be considered 1st party coverage Coverage A - Correct answer-Building and structures Coverage B - Correct answer-Other structures (such as a detached garage, workshop, swimming pools, fences and gazebos) Coverage C - Correct answer-personal property Coverage D - Correct answer-Loss of use Coverage E - Correct answer-personal liability Coverage F - Correct answer-Medical Payments Personal Umbrella Policy - Correct answer-provides protection against a catastrophic lawsuit or judgment What is covered through PUP? - Correct answer-Liability (property damage and bodily injury [excess]) Other- Personal Injury (libel & slander) Dwelling Components - Correct answer-Construction of dwelling inflation protection - Correct answer-A rider in some insurance policies that automatically raises the benefit amount or the maximum daily or annual payments, based on the rate of inflation, in order to ensure that the amount of coverage remains adequate over time. Market Value - Correct answer-the price at which property would sell named peril basis - Correct answer-Covered for everything named on policy open peril basis - Correct answer-It's covered for any loss unless it is specifically excluded Replacement Cost - Correct answer-The cost to repair or replace property using new materials of like kind and quality with no deduction for depreciation. Scheduled Personal Property - Correct answer-endorsement - provides broader coverage for personal jewelry, furs, cameras, musical instruments, silverware, fine arts, golf equipment, and stamp/coin collections. must be insured on full value basis. Special Limit - Correct answer-Covered up to a certain amount unscheduled personal property - Correct answer-Property not specifically listed in the policy bodily injury liability - Correct answer-insurance that covers physical injuries caused by a vehicle accident for which you are responsible property damage liability - Correct answer-insurance that protects a driver against claims if the insured's car damages someone else's property and the insured is at fault While backing into the garage where the insured resides, he hits the interior wall causing damage to the garage. Is the damage to the garage covered under the insured's Property Damage? Explain. - Correct answer-Yes- However, send to homeowner's first. If denied, then go through auto insurance. The driver has hit his residence/garage. (See Page 12 of policy jacket.) If our insured is involved in a motor vehicle accident and the car seat was damaged, do we owe for the replacement of their car seat? - Correct answer-Per CSAA IG's business practices, CSAA will reimburse a claimant or insured for the cost of an equivalent replacement child safety seat in the circumstances outlined below, provided the insured or claimant submits required proof. First Party Coverage Only - Correct answer-Comprehensive, Rental, and Collision Non-Owned Auto/ NOA - Correct answer-Any auto or trailer not owned by or furnished or available for the regular use of you or any family member while: 1. In the custody of 2. Being operated by You or any family member with the express or implied permission of the owner. (Page 8) Coverage Check (Step 2) - Correct answer-Any CCQ's that are able to be cleared prior to transfer, should be cleared if they have been cleared by OA prior to transfer. Exposure Assessment (Step 3) - Correct answer-If the only injury is to the insured driver- does not qualify for triage to casualty. Injuries only to 3rd party- triaged to casualty (EX: If claimant says my neck is sore and made arrangements to see my primary care doctor. Obtain provider (Name of Primary care facility or doctor) and triage to casualty. EX: If claimant says my neck is sore and I plan on seeking treatment but have not made any arrangements at this time. Then the file does NOT need to be transferred at this time. Advise claimant to contact OA if they do not seek treatment with the name of their provider.) Newly Acquired Automobile/NAA - Correct answer-Any auto you become the owner of during the policy period for which no other insurance policy provides coverage. Collision/Comprehensive coverage begins on the date you become the owner if: • the NAA replaces a vehicle shown in the dec • We provide coverage on the vehicle you replaced for at least 12 months prior to the date of replacement. In this case, the NAA will have the same coverage as the vehicle you replaced. However, you must ask us to insure it within 3 days after you become the owner. Three things required to Waive our insureds Deductible on our NJSS policy. - Correct answer- Driver must be insured Damages must exceed deductible The other driver must be at the scene of accident and completely at fault. Leaving work, our insured backs into a fence. His vehicle and the fence have sustained damage. What is the fault rating? - Correct answer-If the fence is not his, yes. The driver would get collision for his vehicle and PD for the fence. If the fence is his, no. This accident is 100% driver's fault. PD - Correct answer-Property Damage Tangible - Correct answer-If it is attached to the car; connected to the car, building, structure, lawn, fence, etc Temporary Substitute Auto (TSA) - Correct answer-Renting a vehicle while yours is in the shop/out of commission First Party Claimant - Correct answer-Asserting their right to recovery; The insured is the first party claimant. Subrogation - Correct answer-Situation where an insurer, on behalf of the insured, has a legal right to bring a liability suit against a third party who caused losses to the insured. Insurer maintains the right to seek reimbursement for losses incurred by the insurer at fault of a third party. Third Party Claimant - Correct answer-Asserting their right to recovery; Our insured hit them. Claimant - Correct answer-A person who asserts the right to recovery by making a claim. Claims Agent - Correct answer-Employed/Authorized by an insurer. Does not include an attorney or anyone hired by an insurer (Doctor) solely to provide valuation as to the subject matter of the claim. Extraordinary Circumstances - Correct answer-Catastrophic loss Insurer - Correct answer-A person licensed to issue or that issues an insurance policy or surely bond in this state. (CSAA IG) Licensee - Correct answer-Any person that holds a license or Cert. of Authority from the Insurance Commissioner or any other entity for whom the Insurance Commissioner's consent is required before transacting business in the State of CA. Proof of Claim - Correct answer-any evidence or documentation that provides any evidence of the claim and that reasonably supports the claimed loss. (Objective evidence) • Repair estimates • Receipts • Rental bills • Medical bills • Pictures Monetary items/amounts Notice of Claim - Correct answer-Any written or oral notification the claimant wishes to make against a policy. Triaging - Correct answer-The process of determining the ownership of claims based on the severity or complex nature of the claims condition Comparative Negligence - Correct answer-A rule in tort law that reduces the plaintiff's recovery in proportion to the plaintiff's degree of fault, rather than barring recovery completely; used in the majority of states. Liability Assessment (Step 1) - Correct answer-If we are not at fault- it does not go to casualty. What is the definition of "NI" in our NJSS Policy? Could a spouse get covered under our NI policy if they have their own? - Correct answer-"You" & "Your" Yes What is "required proof" for reimbursement of a car seat? - Correct answer-Original Manufacturer receipt from purchase or photos of car seat in car. Homeowners Assist - Correct answer-At fault party; You're still the owning adjuster Investigation - Correct answer-All activities of an insurer or its claims agent related to the determination of coverage liabilities or nature and extent of loss or damage for which benefits are afforded by an insurance policy, obligations, or duties under a bond. Files - Correct answer-Shall contain all documents, notes, work papers (including correspondence) related in detail to claim that pertinent events and the dates of the events can be reconstructed. Benefits - Correct answer-Must be disclosed to a first part claimant (or beneficiary) all benefits, coverage, time limits or other provisions of any insurance policy that may apply to the claim presented by claimant. The insurer shall immediately communicate this fact to the insured. Denying - Correct answer-No insurer shall deny a claim on the basis of the claimant's failure to exhibit property unless there is documentation in the file. § Of reasonable demand by the insurer and unfounded refusal by the claimant to exhibit property § Of the breach of any policy provision providing for the exhibition of property. No insurer shall require a first party claimant under a policy to give notice of a claim or proof of claim within a specified time- If it is UMPD- 10 business days. No insurer shall: ○ Third day- email ○ Diary it out five days (business days) ○ (repeat two more times) If the IV strikes a tree branch in the road while traveling, what type of coverage will apply? If a tree branch falls on the IV while traveling, what type of coverage will apply? Explai - Correct answer-Collision- We collided with the tree when it could have been avoided. Comprehensive- It was a falling object that we could not prevent from falling. Can a deductible waiver be applied to a comprehensive loss? Explain - Correct answer- No, only in a collision loss. If a shopping cart collides with an Insured Vehicle (IV) while parked and unoccupied, would this be considered Comprehensive or Collision for coverage? Explain - Correct answer-Comprehensive The vehicle was not in motion. Is there a deductible with our Named Insured (NI) Uninsured Motorist Property Damage (UMPD) coverage on our NJSS policy? Explain - Correct answer-Yes- $500 No rental in this case scenario Collision pays first BEFORE UMPD What is the definition of "occupying" and where can it be found in the NJSS policy? - Correct answer-In Upon; or Getting in, on, out, or off Page number 8, section M Under the liability portion of the NJSS Auto Policy, exclusion Number 2 dictates that an insured cannot make a property damage claim against his/her own policy? T/F & why? - Correct answer- True- the only time this is applicable is if this concerns your home (residence) or garage. If homeowner's blocks it (mistake in the policy) Who is considered a claimant in the DOI California Fair Claims Settlement Practices? - Correct answer-First and Third party In Part IV Coverage for Damage to your auto, what type of deductible waiver can apply under the NJSS Auto Policy? - Correct answer-No Fault Waiver What is the difference between PIP and BI? - Correct answer-PIP- first party claimant; fault is not a factor; Pays dollar for dollar medical bills BI- third party claimant; fault is a factor; Pain and suffering UMPD/ Uninsured Motor Property Damage - Correct answer-We will pay for compensatory damages an insured is legally entitled to recover from the owner or operator of an "uninsured motor vehicle" or "underinsured motor vehicle" because of: -Property damage caused by an accident except under Paragraph 2 of the definition of uninsured motor vehicle. -Fault is a factor -1st Party Coverage We (CSAA IG) will cover up to $100 for tapes or CDs stolen from the insured vehicle? T/F & why? - Correct answer-False- it is a non-tangible item (not a permanent fixture in the car). Can be done under homeowners In Part IV Coverage for Damage to your What are punitive damages? And do we (CSAA IG) cover them? Provide an example of a loss where punitive damages may be awarded? - Correct answer-Punitive Damages are when a Judge awards you for something (ex. DUI) and sentences you to pay additional fines from your accident. CSAA IG does not cover punitive damages. Collision/Comprehensive cover NI's car PD covers any other damage BI covers any injuries to other drives Punitive Damage is awarded by judge (fine from a judge awarded to set an example). What are the State Minimums for Limits in NJ? - Correct answer-15K per person/ 30K per group 5k for PD What is the Statute of Limitation in NJ for PD, BI, COL, and Comp? Explain - Correct answer-BI- 2 years PD- 6 Years Collision/Comp- Reasonable notice Phantom Vehicle - Correct answer-No contact with the vehicle but caused you to swerve off of the road. Difference between TSA and NOA - Correct answer-If you have an accident: NOA- Coverage is under owner's insurance TSA- Coverage is under your insurance Permissive Use - Correct answer-Auto owner consents to the use of his auto by another is vicariously liable to the damage resulting from driver's negligence. Is there a deductible with our NI Uninsured Motorist Property Damage (UMPD) coverage on our NJSS policy? Explain - Correct answer-There is; $500 However, your insurance would kick in first and then you would be reimbursed.