Florida Claims Adjuster Exam - 3: Questions and Answers, Exams of Insurance law

Download Florida Claims Adjuster Exam - 3: Questions and Answers and more Exams Insurance law in PDF only on Docsity! Florida Claims Adjuster Exam – 3 (206 Questions and Answers). This optional provision states that if the insured becomes totally disabled, premiums are waived but the coverage remains in force: A. Waiver of Subrogation B. Waiver of Premium C. Waiver of Value D. None of the Above - Correct Answers B. Waiver of Premium "premiums are waived" Frank owned a home that was destroyed by a hurricane. Both ABC and XYZ Banks were listed as additional interests on his homeowner policy. The insurance company will make a payment to: A. The first mortgagee, ABC B. The Insured C. Jointly to ABC and XYZ D. All listed interests - Correct Answers D. All listed interests Remember that the insurer is not responsible to know the degrees of interest. In the event of a loss, one payment is made by the insurer and it is up to the additional interests on working out their share. Insurance applies *separately* to each insured as if other insureds did not exist. This is defined as: A. Severability B. Conditional C. Warranty D. None of the above - Correct Answers A. Severability Property insurance policies usually contain a(n) __________ clause, stating the insured cannot *dump damaged property* on the insurer and demand its full value: A. Pro Rata B. Abandonment C. Liberalization D. All of the above - Correct Answers B. Abandonment A(n) __________ is one wherein economic loss would be suffered from an adverse happening to the subject: A. Conditional Contract B. Personal Contract C. Economic Contract D. Insurable Interest - Correct Answers D. Insurable Interest States that if the insurer adopts a revision which would *broaden* coverage without additional premium within some period of time prior to the policy period or during the policy period, the insured receives the benefit of such *broadened* coverage. A. Cancellation Clause B. Policy Period C. Pro Rata D. Liberalization - Correct Answers D. Liberalization The time frame is typically 60 days. The __________ states that when there is an unbroken connection between an occurrence and damage that *grows* out of the occurrence, then the resultant damage is all a part of the occurrence. A. Doctrine of Proximate Cause B. Doctrine of Perils & Hazards C. Insurance Policy Handbook D. Doctrine of Property Insurance - Correct Answers A. Doctrine of Proximate Cause For example, if a property insurance policy covers the peril of fire but further damage is caused by smoke, water used to extinguish, and the process of moving property away - fire is considered to be the *proximate cause* of all of the damage. Personal Injury Protection, or PIP, has a __________ per person, per accident limit. A. 10,000 B. 20,000 C. 1,000 D. Depends on the damaged property - Correct Answers A. 10,000 Used to insure businesses engaged in selling, servicing, repairing, *parking or storing automobiles:* A. Servicing Coverage Form B. Garage Coverage Form C. Truckers Coverage Form D. None of the Above - Correct Answers B. Garage Coverage Form The following examples are referred to as __________ liability limits: 25/50/25 or 10/20/10. A. Split B. Single C. Straight D. None of the Above - Correct Answers A. Split 10/20/10 = 10,000 per person injured 20,000 all injuries combined 10,000 property damage Example of straight liability limit = $30,000 Jeremy has a not at fault accident. If he has PIP with a $1,000 deductible, how much can he expect his PIP coverage to pay toward his medical bills that total $3,000? A. $1,600 B. $1,000 C. $2,400 D. $3,000 - Correct Answers A. $1,600 3000 (bills) - 1000 (deductible) = 2000 x .80 (eighty percent) Frank has a not-at-fault accident, he has basic PIP, no deductible and Med pay of $5,000. How much will his Med Pay contribute to medical bills of $15,000? A. $15,000 B. $5,000 C. $3,000 D. $0, Frank is not-at-fault - Correct Answers B. $5,000 Medical Payment limits apply per person; Frank will receive full amount towards medical bills. Which of the following is not one of the rating factors for a Homeowner's Policy? A. Type of Construction B. Location of Risk C. Age & Gender of Insured D. Proximity to Fire Department - Correct Answers C. Age & Gender of Insured On a Homeowner's Policy, covers items that are *not permanently attached to the dwelling.* This is defined as: A. Other Structures B. Excess Structures C. Personal Property D. Dwelling - Correct Answers A. Other Structures Examples include sheds, fences, pool houses, detached car ports, etc. A lender has an insurable interest in a home and finds protection in the: A. Loss Payee Clause B. Mortgagee Clause C. Lender Clause D. Additional Insured Clause - Correct Answers B. Mortgagee Clause Mortgagee - Homeowner's policy Loss Payee - Automobile policy Which of the following forms is "all-risk" on the dwelling policy? A. DP-1, or the Basic Form B. DP-2, or the Broad C. DP-3, or the Special Form D. None of the Above - Correct Answers C. DP-3, or the Special Form When the basic liability limits provided by the policy are insufficient for an insureds needs, two coverage forms are used to provide the *additional amounts* of coverage: A. Excess Liability B. Umbrella C. Both A & B D. None of the Above - Correct Answers C. Both A & B Which of the following is not covered under Coverage C, Personal Property? A. A fire breaks out in the residence and an overnight guest loses his clothes in the fire B. A fish dies because he has been left alone for a week without food C. The insureds daughters tennis racket is stolen from her locker D. The insureds suitcase and clothing, valued at $1,500, are stolen from his hotel - Correct Answers B. A fish dies because he has been left alone for a week without food Animals are listed as an "exclusion" under a Homeowner's policy. All of the following are eligible for a *Homeowner's Policy,* except? A. An apartment tenant B. A condominium owner C. Four-family dwelling owner-occupant D. A business condo owned by a local insurance company - Correct Answers D. A business condo owned by a local insurance company A. Business Property Insurance B. Building Property Insurance C. Commercial Property Insurance D. None of the Above - Correct Answers C. Commercial Property Insurance (the question is the definition for this term) Under Commercial Property Policies, Florida law requires an insurer to give the insured at least __________days advance written notice of non- renewal. A. 25 B. 90 C. 45 D. None of the Above - Correct Answers C. 45 Also, notice must state reasons the policy is not to be renewed. When a business's personal property values fluctuate, a single, fixed amount of insurance could produce either over - or under - insurance at any given time. With this option, the limit of coverage is set at an amount somewhat higher than expected peak *values.* A. Value Reporting B. Replacement Cost C. Agreed Value D. None of the Above - Correct Answers A. Value Reporting Replacement Cost is incorrect b/c it calculates monetary value of one's personal property Liberalization states, "The insured gets the benefit of any broadened coverage if the company, within __________ days of inception, adopts a form revision that is broader and without increase in premium." A. 10 days B. 55 days C. 65 days D. 45 days - Correct Answers D. 45 days Used to cover buildings in the course of *construction:* A. Builders Risk Policy B. Builders Replacement Policy C. Construction Replacement Policy D. None of the Above - Correct Answers A. Builders Risk Policy Includes: structure being built (including foundations), fixtures and machinery, equipment to service building, owned materials and supplies used for construction. Temporary structures built or assembled on site are also included if not covered by insurance. First developed as an extension of Ocean *Marine* coverage, to provide coverage for *cargo traveling over land,* instead of by sea. A. Commercial Inland Marine Coverage B. Personal Inland Marine Coverage C. Ocean Commercial Coverage D. None of the Above - Correct Answers A. Commercial Inland Marine Coverage Definition: to help identify kinds of risks which are eligible for either Ocean or Inland Marine insurance. Protects against loss of *business income* that results from damage to covered property from a covered cause of loss. A. Business Income Insurance Coverage B. Business Income Replacement Coverage C. Business Income Actual Value Coverage D. None of the Above - Correct Answers A. Business Income Insurance Coverage Period of restoration begins 72 hours after date of direct damage. In effect, coverage has a 72 hour deductible. Coverage ends on either 1. date when damaged property could be repaired, rebuilt, or replaced 2. date business resumes operations at new, permanent location (whichever comes first) What payment covers several areas of costs related to claims, and are payable *in addition* to the policy limits? A. Supplementary B. Liability C. Personal Injury D. All of the Above - Correct Answers A. Supplementary Generally, all costs of litigation are covered (court costs, prejudgment interest, judgement interest, cost of bonds to release attachments) Three full-time employees from a local furniture company are horsing around and one is pushed into a machine that cut his foot. How will the company's General Liability respond? A. The Med Pay Section must pay Primary B. The General Liability Policy will pay up to $20,000 in medical payments C. The GL policy will not pay D. Only property damage is covered under GL policy - Correct Answers C. The GL policy will not pay Coverage excludes liabilities under Workers Comp or similar law or arising from injuries to employees of the insured. The employees would have to file through Workers Comp. Which of the following can be found in a Commercial General Liability Contract? A. Declarations B. Common Policy Conditions C. Occurrence and Claims-Made Forms D. All of the Above - Correct Answers D. All of the Above Also included: Nuclear Energy Liability Exclusion endorsement (other endorsements may be attached) There is __________ coverage for injury, damage or clean-up costs caused by pollutants, subject to minor exceptions: A. 50% C. Reimbursement for lost wages on percentage basis D. Funeral costs up to $7,500 - Correct Answers A. Up to $750,000 in Death Benefits Compensation for death is payable if death results within one year of an accident or if it follows disability within five years of accident. The following are classes of disability, except: A. Permanent Total B. Temporary Total C. Permanent Impairment D. Temporary Full - Correct Answers D. Temporary Full Also included: Temporary Partial The measure to determine disability benefits is the __________ of the employee at the time of injury: A. Average Monthly Wage B. Average Weekly Wage C. Average Daily Wage D. Income Estimate - Correct Answers B. Average Weekly Wage Disability - incapacity due to injury to earn same or any other employment wages that employee was receiving at time of injury. Mandatory for risks exceeding certain annual premiums, recognizes the prior loss *experience* of the risk and applies either a debit for unfavorable *experience* or a credit for better-than-expected loss results. This is defined as: A. The Experience Rating Plan B. The Retrospective Rating Plan C. The Risk Plan D. None of the Above - Correct Answers A. The Experience Rating Plan This, along with Retrospective Rating Plan, is a manual rating process until premiums reach a certain level. Under workers compensations, a rate is charged for every __________ of payroll to employees. A. $100 B. $1,000 C. $10 D. $500 - Correct Answers A. $100 The National Council on Compensation Insurance enforces this rating. Under Workers Compensation, Part Four Your Duties if Injuries Occur, an employer is required to: A. Provide the names/addresses of injured persons and witnesses B. Promptly provide any legal papers C. Cooperate and assist as insurer requests D. All of the Above - Correct Answers D. All of the Above Also included: immediate contact with insurer, providing immediate medical or other services, do nothing to interfere with insured's right of recovery, make no voluntary payments or assume any obligation except at employer's own cost. Under Workers Compensation, Employers Liability includes: A. Claims by others for the liabilities to insureds employees B. Claims by relatives of injured employees for consequential damages C. Claims made by employees that are not subject to Workers Comp Laws D. All of the Above - Correct Answers D. All of the Above Samantha eats uncooked chicken at a local barbecue joint and becomes violently ill. Which of the following workers compensation benefits would pay for this occurrence? A. A products and completed operations form B. A premises and operations form C. An owners and contractors protective liability form D. None of the Above - Correct Answers D. None of the Above Samantha is not an employee of the barbecue joint; Workers Comp does not apply. An optional alternative providing for adjustment of premium after expiration, based on a guaranteed basic premium to the insurer to which is added the actual losses incurred by the insured. This is defined as: A. Cost-Plus Rating Plan B. Experience Rating Plan C. Retrospective Rating Plan D. None of the Above - Correct Answers C. Retrospective Rating Plan Often referred to as Cost-Plus Programs Under Employer's Liability, the minimum limits of liability are: A. 100/100/500 B. 100/500/1000 C. 500/100/500 D. 100/500 - Correct Answers A. 100/100/500 $100,000 for all claims in each accident $100,000 per employee for disease $500,000 for all disease claims Under Inside The Premises - Robbery or Safe Burglary of Personal Property, a special limit of __________ per occurrence applies to articles whose principal value is precious metals, precious or semiprecious stones, pearls or furs, and to the physical or intrinsic value of manuscripts, drawings or records: A. $1,000 B. $2,000 C. $4,000 D. $5,000 - Correct Answers D. $5,000 Under Crime Insurance, losses must be *discovered* within 1 year. This is defined as: A. The Discovery Period D. None of the Above - Correct Answers A. Extortion Also triggered by threats to damage the premises or property within the premises. Employee Theft Coverage may be written in the following ways: A. Scheduled Persons Coverage B. Scheduled Position Coverage C. Blanket Coverage D. All May Apply - Correct Answers D. All May Apply Employee Theft may be written in three ways. Which of the following are NOT a type of bond? A. Contract B. Fiduciary C. Court D. Apprentice - Correct Answers D. Apprentice Contract - fulfill obligation Fiduciary - make good to court for any deficiencies found in performance Court - protect opposing party from loss Which of the following are characteristics of a License Bond? A. To guarantee the licensee will act according to laws B. Protect public from unfair business practice C. Proper collection and payment of taxes D. All of the Above - Correct Answers D. All of the Above Guarantees the performance between the principle and the obligee: A. Principal B. Obligee C. Surety D. All of the Above - Correct Answers C. Surety aka Bonding Company; Surety is a "guarantee" This bond guarantees indemnification to the obligee for any losses resulting from the principal's failure to complete the contract work in accord with specifications: A. Performance B. Bid C. Court D. Maintenance - Correct Answers A. Performance Considered a contract bond One who undertakes to perform, to fulfill a contract or to meet an obligation is known as: A. Principal B. Obligee C. Surety D. All of the Above - Correct Answers A. Principal Obligee - needs guarantee principal will perform Surety - guarantees performance between principal and obligee This form of bond is required to accompany a *bid* for a contract which will require that the successful bidder furnish further bond if awarded the job: A. Bid B. Performance C. Court D. Maintenance - Correct Answers A. Bid May act as part of the bonding party and agrees to reimburse the surety for any loss it may suffer from having bonded the principal: A. Indemnitor B. Surety C. Obligee D. None of the Above - Correct Answers A. Indemnitor Known as "fourth party", may put up collateral Which of the following are parties to a Bond? A. Principal B. Obligee C. Surety D. All of the Above - Correct Answers D. All of the Above Principal - undertakes to perform/fulfill Obligee - guaranteed principal will perform Surety - guarantees performance *Indemnitor - may act as additional party; agrees to reimburse surety for any loss This type of bond covers streets, sidewalks, sewers, etc.: A. Sidewalk B. Subdivision C. Supply D. None of the Above - Correct Answers B. Subdivision Falls under Maintenance Bond When a person has lost stock certificates, bonds or similar *instruments*, a bond is generally required by the issuing company to reissue the document. This is known as a: A. Public Official Bond B. Lost Instrument Bond C. Public Instrument Bond D. None of the Above - Correct Answers B. Lost Instrument Bond Also guarantees to save issuer from any loss growing out of lost instrument A __________ is a selected group of hospitals and medical *practitioners* in a given area who have joined together in an effort to reduce medical costs. A. HMO B. Major Medical Insurance C. Coinsurance D. PPO - Correct Answers D. PPO A(n) __________ provides comprehensive health services to its members for a prepaid fixed fee, equivalent to an insurance premium. A. HMO B. PPO C. Major Medical Plan D. All of the Above - Correct Answers A. HMO Referred to as an emerging and increasingly important non-insurance alternative to dealing with risk of health care costs Established in 1973, this association was created for applicants who are unable to obtain insurance in the private market: A. FWCJUA B. FWUA C. Citizens D. FRPCJUA E. FAJUA - Correct Answers E. FAJUA In 2002, the Florida Residential Property and Casualty Joint Underwriting Association (FRPCJUA) and the Florida Windstorm Joint Underwriting Association (FWUA), were combined to create: A. FWCJUA B. FWUA C. Citizens D. FRPCJUA E. FAJUA - Correct Answers C. Citizens Passed during a legislative session in 1993, this association was created for employers who cannot obtain workers compensation insurance in the private market: A. FWCJUA B. FWUA C. Citizens D. FRPCJUA E. FAJUA - Correct Answers A. FWCJUA A General Lines Agent instructs a licensed Customer Representative 4-40 to thoroughly cover the details of a new life insurance product with every Homeowner customer who calls or visits the office. The agent provides training on the new product. Although the Customer Representative does not have a Life License, he or she feels comfortable with the training and does as requested. Which of the following is true? A. This practice is acceptable if done in the office under supervision of General Lines Agent B. This practice is acceptable because adequate training and product knowledge was provided C. This practice is unacceptable and may result in the suspension or revocation of the Customer Representative's license D. This practice is only acceptable if the product training was certified by the Life Insurance Company - Correct Answers C. This practice is unacceptable and may result in the suspension or revocation of the Customer Representative's license Unlike a Customer Representative, a General Lines Claim Adjuster need not be appointed with the Department of Financial Services. A. True B. False - Correct Answers B. False While selling an Automobile policy to a customer, an agent tells them that they are also required to purchase an Emergency Road Service Plan, even though that is not true. This is an example of: A. Misrepresentation B. Lack of Fitness C. Deception D. Sliding - Correct Answers D. Sliding A licensed General Lines Claim Adjuster is required to complete how many hours of continuing education every two years? A. 6 B. 12 C. 18 D. 24 - Correct Answers D. 24 Once a Customer Representative 4-40 has been licensed and appointed for at least 3 years, he or she may transact insurance in the home of an existing customer. A. True B. False - Correct Answers B. False After pleading guilty or no contest to a felony, a licensed individual has _________ days to inform the Department? A. 10 B. 20 C. 30 D. 40 - Correct Answers C. 30 Must be licensed, appointed by a General Lines Agent and can transact AUTO insurance only in the Office Only. A. Customer Representative 4-40 B. Limited Customer Representative 4-42 C. General Lines Claim Adjuster 6-20 D. General Lines Agent 2-20 - Correct Answers B. Limited Customer Representative 4-42 Defaming a competitor company or agent is not only unprofessional, it can also result in a license suspension. A. True B. False - Correct Answers A. True A General Lines Claim Adjuster is required to obtain the same number of Continuing Education hours as a licensed Customer Service Representative. A. True B. False - Correct Answers B. False An Insurance Company which is formed under the laws of the State of Illinois, and has its Home Office there, is considered a: An adjuster who represents the financial interests of the insured named in the policy is defined as a(n): A. Public Adjuster B. Bureau Adjuster C. Fee Adjuster D. Independent Adjuster - Correct Answers A. Public Adjuster When investigating liability insurance claims, which of the following three major elements are determined: A. Coverage B. Liability C. Damages D. All of the Above - Correct Answers D. All of the Above A relationship that requires maintenance of a high degree of *fidelity* and loyalty to the interests of the principal, whether or not the adjuster is a direct employee is defined as: A. Fiduciary B. Estoppel C. Public D. None of the Above - Correct Answers A. Fiduciary Should always be maintained whether or not the adjuster is a direct employee An adjuster who is *self-employed* and not affiliated with either insurers or bureaus is defined as a(n): A. Fee Adjuster B. Public Adjuster C. Bureau Adjuster D. Independent Adjuster - Correct Answers D. Independent Adjuster The adjuster's investigation may include all of the following except: A. Verification of Bills and Estimates B. Photographs C. Witness Canvasses D. Policy Cancellation - Correct Answers D. Policy Cancellation The assertion of an alleged legal right against an insurer, which carries with it a demand for appropriate relief, is defined as: A. Adjustment B. Summons C. Claim D. None of the Above - Correct Answers C. Claim Relieving the financial burden on the claimant by making certain payments to the claimant even *before* the claim can be negotiated is defined as: A. Advanced Payment B. Full Release Settlement C. Non-Advanced Payment D. Scheduled Payment - Correct Answers A. Advanced Payment The process of disposing of an insurance claim is defined as: A. Adjusting B. Claims Management C. Adjustment D. None of the Above - Correct Answers A. Adjusting Also "the negotiation period that results in an agreement" All of the following are requirements for the "Code of Ethics," except: A. Adjusters should not give legal advice B. Adjusters may negotiate with a claimant who is represented by an attorney C. A witness who requests a copy of a statement given must be provided with one D. Adjusters will keep an unprejudiced and open mind - Correct Answers B. Adjusters may negotiate with a claimant who is represented by an attorney Adjusters MAY NOT. Bad, adjuster, bad! A written statement given by the insured to the insurer acknowledging that money received in the settlement of damages is received, not as a final payment, but as an advance pending an outcome of a claim against the person responsible for the damage. This is defined as a(n): A. Loan Receipt B. Subrogation Loan C. Full Release Statement D. Partial Release Statement - Correct Answers A. Loan Receipt Enables insurer to bring an action for recovery against a third party Duties and functions of the Department of Financial Services include all of the following except: A. Approve the issuance of licenses B. Rating and underwriting rules C. Claims Supervision D. Investigate charges of unethical behavoir - Correct Answers B. Rating and underwriting rules An adjuster who is a salaried employee under the supervision of the *home, branch, or regional claims department of insurers* is defined as a(n): A. Company or Staff Adjuster B. Fee Adjuster C. Public Adjuster D. Bureau Adjuster - Correct Answers A. Company or Staff Adjuster Which of the following are not considered to be an adjuster: A. Employee or Staff Adjuster B. Independent Adjuster C. Public Adjuster D. General Lines Adjuster - Correct Answers D. General Lines Adjuster Bureau Adjusters are also considered adjusters. How many continuing education hours must an insurance adjuster complete every 2 years? A. 12 B. 20 C. 24 D. 14 - Correct Answers C. 24 Which of the following are considered unfair methods of competition and unfair or deceptive acts or practices: A. False Statements B. Unfair Discrimination C. Unlawful Rebates D. All of the Above - Correct Answers D. All of the Above A customer representative appointed by a general lines agent or agency in transacting only the business of private passenger motor vehicle insurance from the office of that agent or agency is defined as: A. Automobile Agent B. Automobile Representative C. Limited Customer Service Representative D. Limited Customer Service Agent - Correct Answers C. Limited Customer Service Representative An individual representing an insurer as to *life insurance* and annuity contracts, including agents appointed to transact life insurance, fixed-dollar annuities, or variable contracts by the same insurer is defined as: A. Life Agent B. Life Representative C. General Lines Agent D. None of the Above - Correct Answers A. Life Agent Charging an applicant for a specific ancillary coverage or product, in addition to the cost of the insurance coverage provided for, *without the informed consent of the applicant* is a practice of: A. Churning B. Sliding C. Soliciting D. None of the Above - Correct Answers B. Sliding Which of the following are reasons for refusal, suspension or revocation of a license or appointment? A. Lack of Qualifications B. Failure to Pass State Examinations C. Fraudulent or Dishonest Practices D. All of the Above - Correct Answers D. All of the Above Every licensee shall notify the department, in writing, after a change of name, residence address, principal business street address and/or mailing address within how many days? A. 60 B. 30 C. 15 D. 90 - Correct Answers B. 30 An agent who transacts any one or more of the following types of insurance: Property, Casualty, Surety, Marine, and Health is defined as a(n): A. Customer Service Representative B. Adjuster C. Health Agent D. General Lines Agent - Correct Answers D. General Lines Agent An agent representing a *health* maintenance organization, or as to health insurance only, an insurer transacting health insurance is defined as a(n): A. Health Agent B. Health Representative C. HMO Agent D. None of the Above - Correct Answers A. Health Agent An applicant for a temporary license must be: A. A natural person at least 18 years of age B. A US citizen or legal alien who possesses work authorization C. Both A & B D. None of the Above - Correct Answers C. Both A & B One who is duly *authorized* by a subsisting certificate of authority issued by the department to transact insurance in this state. This is defined as a(n): A. Unauthorized B. Certified C. Domiciled Insurer D. Authorized - Correct Answers D. Authorized Actual Cash Value - Correct Answers Replacement cost minus depreciation Subrogation - Correct Answers When an insured has a right to collect damages from another party but elects to claim damages under his/her insurance policy; rights transfer to the insurer Loss Payee Clause - Correct Answers Provides, in event of payment being made under the policy in relation to insured risk, that payment will be made to a third party rather than the beneficiary Mortgagee Clause - Correct Answers Protects a lender who has an insurable interest in a home Grants special protection for the interest of a mortgage named in the policy; setting up a separate content between insurer and mortgagee Liability - Correct Answers Negligence of the insured Other Structures - Correct Answers Homeowner's Policy, covers items not permanently attached to main dwelling (shed, fence, etc.) Commercial Inland Marine - Correct Answers Identifies risks which are eligible for either ocean or inland marine insurance Developed as extension to Ocean Marine coverage to provide coverage for cargo traveling over land instead of by sea Umbrella Policy - Correct Answers - Covers much higher limit Implied Waiver - Correct Answers May result from some act of neglect on part of the adjuster Express Waiver - Correct Answers Occurs when insurer or its representative knowingly gives up a known right under insurance contract Mechanical Breakdown Coverage - Correct Answers Covers repairs to mechanical parts of your vehicle that break; even covers in events not related to an accident Identify examples of peril. - Correct Answers Fire, windstorm, flood after hurricane, etc. (something that causes a loss) How long does one have to notify the Department of Financial Services for a name and/or address change? - Correct Answers 30 days What is the coinsurance clause and how might it apply to a given scenario? - Correct Answers A coinsurance clause on a property policy requires the policyholder to carry, at minimum, a specified percent of the dwelling's replacement cost. Failure results in monetary penalty. Almost without exception, the percentage is 80% in coinsurance clauses of homeowner policies - this means the insured should carry 80% of replacement cost if they don't want to be penalized at the time of loss. What are the minimum requirements for the Financial Responsibility Law? (there are two) - Correct Answers 1. legal valid claims of others must be satisfied up to the 10/20/10 requirements 2. owner/operator must provide certification of financial responsibility for future accidents What is PIP and how may it apply to a given scenario? - Correct Answers Personal Injury Protection with limit of $10,000 per person, per accident If Jeremy has a not-at-fault accident and he has PIP with a $1000 deductible, he can expect PIP to pay $1,600 of his $3,000 medical bill. (3,000 - 1,000 = 2,000 x .80 = 1,600) What is the difference between PIP and Workers Compensation? Which one is excess? - Correct Answers PIP is primary against all other forms of medical and disability insurance coverage. Florida courts have held PIP is excess over Workers Comp. To eliminate duplicate recoveries, the law prohibits persons who have received PIP from recovering same amounts from others in legal liability actions. What are the basic PIP benefits? - Correct Answers 1. Medical; 80% of reasonable expenses are paid for necessary medical, surgical, x-ray, dental, and rehab services 2. Work Loss; 60% of any loss of gross income and loss of earning capacity is reimbursed 3. Replacement Services; 100% for cost of having household services performed by others which the injured person would have normally performed 4. Death; $5,000 IN ADDITION to the $10,000 in medical/disability benefits afforded by PIP How does PIP apply to pedestrians (in and out of state)? - Correct Answers PIP applies to Florida residents if struck by insured's motor vehicle while not occupying a self-propelled vehicle (a pedestrian). In situations wherein PIP does not apply, named insured and relatives occupying or struck by others vehicles out-of-state; nonresident passengers out-of-state; and nonresidents as pedestrians in Florida - The No-Fault Law has no applicability and usual legal remedies and other insurance coverage's are to be relied upon. When can Other-Than-Collision (Comprehensive Coverage) be used? - Correct Answers When there is damage to your vehicle not caused by a collision (hail storm damages hood, animal runs into car, windshield replacement) What are the penalties for not complying with the No-Fault Law? - Correct Answers 1. Owner is denied immunities from legal liabilities that are granted to those who comply 2. Owner is personally liable for payment of PIP benefits to those entitled 3. Owner's driver's license and vehicle registration are subject to suspension What is the PIP Death Benefit amount? - Correct Answers Effective 1/1/13, the death benefit will be $5,000 IN ADDITION to the $10,000 in medical and disability benefits afforded by PIP. Example: Joe is seriously injured in an accident and incurs $50,000 in medical bills. He passes away a few days later. PIP would pay its maximum amount of $10,000 and, in addition, pay an extra $5,000 for death benefit. Who administers the Financial Responsibility Law? - Correct Answers The Department of Highway Safety and Motor Vehicles What are the characteristics of a Homeowner's policy? - Correct Answers -protects against economic loss to residence and household property and legal liabilities -owner/occupants of 1-4 family dwellings -renters who maintain residential occupancy in any type of building -other structures (not permanently attached) What are the benefits under the Workers Compensation Law? - Correct Answers -Medical Expenses: needed medical treatment with no dollar limit -Disability Benefits: compensation for wage loss -Death Benefits: if death results within one year of accident or, if it follow continuous disability, within five years after the accident What are the requirements for continuing education for a 6-20 license? - Correct Answers A licensed General Lines Claims Adjuster is required to complete 24 hours of education every 2 years. Who might have an insurable interest in a property? - Correct Answers Anyone who would suffer an economic loss from an adverse happening to the property What do the Declarations of a policy outline? - Correct Answers The declarations identifies: - the named insured and address - states the policy period and premium and misc info - specifies the limits of coverage that apply Which parties are associated with a bond? - Correct Answers -Principal: one who undertakes to perform, fulfill a contract, or meet an obligation -Obligee: one who is guaranteed that the principal will perform -Surety (Bonding Company): guarantees performance 5. Demonstration of unworthiness or lack of fitness. 6. Misappropriation of funds. 7. Failure to inform Department of Financial Services, within 30 days, after pleading guilty or no contest to a felony. Compare/contrast different types of adjusters. - Correct Answers 1. Independent Adjuster - self-employed and not affiliated with either insurers or bureaus 2. Company/Staff Adjuster - salaried employee under supervision of home, branch, regional claims department of insurers 3. Public Adjuster - represents the financial interests of the insured named in the policy 4. Claims Adjuster - one who is involved in the investigation, adjustment, negotiation and/or trial preparations of claims arising under insurance policies 5. Bureau Adjuster - agent of adjustment bureau which serves multiple company clients *Independent and Bureau are both "Fee Adjusters" What is an Insurance Contract? - Correct Answers Insurance is a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit upon determinable contingencies What are the components that make up the investigation process? - Correct Answers Inquiry, verification, comparison What are the Code of Ethics for adjusters? - Correct Answers Formal rules which impact on adjuster practices 1. Adjusters may not directly negotiate with a claimant who is represented by an attorney. 2. In interviewing witnesses, adjusters must avoid any actions tending to induce a suppression or deviation from the truth. A witness who requests a copy of a statement given must be provided with a copy. 3. Adjusters shall not give legal advice. 4. Adjusters shall not draft special releases; they are permitted only to fill in blanks of forms provided by the insurer. 5. Adjusters will not take advantage of an incapacitated claimant which would be to the detriment of the claimant. 6. Adjusters will not knowingly fail to advise claimants of their rights under contracts and laws of the state. 7. Adjusters will approach all aspects of the process with an unprejudiced and open mind, make truthful and unbiased reports, handle all processes with integrity and accept no remuneration other than that to which there is legal entitlement, and act with diligence and due dispatch in achieving proper disposition of claims. 8. The adjuster must put the duty for fair and honest treatment of the claimant above the adjuster's own interests, in every instance.