Claims Adjuster Exam 1 with 100% Correct Answers, Exams of Insurance Economics

Download Claims Adjuster Exam 1 with 100% Correct Answers and more Exams Insurance Economics in PDF only on Docsity! Claims Adjuster Exam 1 with 100% Correct Answers 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 comprehensive - Correct answer-Covers theft, hitting an animal, weather, fire, etc. Collision - Correct answer-Hitting something; colliding with another object or Vision statement - Correct answer-To be our member's first choice for solutions in life's uncertainties. What does it mean when we say we insure risk? - Correct answer-We cover the chance of loss and probability of a loss. How many Claims offices do we have with CSAA IG and where are they located? - Correct answer-Four Mount Laurel, NJ Oklahoma City, OK Colorado Springs, CO Las Vegas, NV When do you need to submit your timecard by? - Correct answer-At the end of your work week. (Friday at the end of the day) Safelite - Correct answer-FNOL/ Glass Network Vendor Where is our headquarters located? - Correct answer-Walnut Creek, CA What are we responsible for enhancing, individually and collectively, on a day to day basis? - Correct answer-Enhancing our brand Standard Claim Outcome - Correct answer-Paying the right amount + at the right time + with excellent proactive service + while being internally and externally compliant Leakage - Correct answer-When we pay out too much on a claim. Direct Repair Network - Correct answer-Shops that we approve and guarantee their work; In our network. Out of Network - Correct answer-Shop that does not have a contract with us. We cannot guarantee their work. Simple, Proactive, and Personal - Correct answer-Our approach to claim process Mission Statement - Correct answer-"We serve AAA members and clubs by making insurance simple, proactive, and personal" Combined Ratio - Correct answer-How we determine what we will charge people based on a profitability ratio that indicates whether an insurer has made an underwriting loss or gain from the previous year. 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) 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: 1. the NAA replaces a vehicle shown in the dec 2.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. 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. 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: § Request that a claimant sign a release that extends beyond the subject matter. § Require the claimant to waive the provisions of California Civil Code Section 1542. It is important that we explain to any claimant what they are signing in laymen terms as to what a "full and final" release means. Protects from going to court/being sued. 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 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 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. 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. Insured backs out of his garage and hits his other vehicle. Can we repair one of the vehicles under Property Damage? - Correct answer-No. This would be the same as collision and would have to pay one deductible; We would waive the lower deductible. 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. If the CV R/E our IV while our IV was stopped at a traffic light and there was an injury in the CV to the driver of the CV, then you would Auto reassign this claim to Causality? - Correct answer-No- it should then go to the CV's carrier as they caused the collision and this is not our IV's fault. What letter should be sent out to an insured if we are unable to reach them? - Correct answer-Contact Request/Contact Attempted Letter Where can I go in CAS to obtain a copy of our insured's dec page? - Correct answer- Policy Endorsements & Forms Fastlane 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 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. 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.) Check for Unique Circumstances (Step 4) - Correct answer-Loss involves a pedestrian, motorcycle, bicycle, or a bus- triage to casualty. Arbitration - Correct answer-settling a dispute by agreeing to accept the decision of an impartial outsider PD Subro - Correct answer-PD Subro money is owed to the adverse party for their incurred losses. 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 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