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FloridaClaimsAdjusterExam,6-20AllLinesAdjusterFlorida-ReviewQuestionswithAnswers Peril - Correct AnswersSomething that causes a loss. Hazard - Correct AnswersSomething that increases the probability that a loss will occur. Warranty - Correct AnswersA policy condition, either based on information in the insureds application or inserted by the insurer. It is a guarantee of a fact. Misrepresentation - Correct AnswersAn untrue statement by the insured, made in an application for insurance but which does not become a part of the policy. Concealment - Correct AnswersThe failure of the insured to reveal relevant facts known to the insured in applying for insurance. Abandonment - Correct AnswersProperty insurance policies usually contain an abandonment clause, stating the insured cannot dump damaged property on the insurer and demand its full value.
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Peril - Correct AnswersSomething that causes a loss. Hazard - Correct AnswersSomething that increases the probability that a loss will occur. Warranty - Correct AnswersA policy condition, either based on information in the insureds application or inserted by the insurer. It is a guarantee of a fact. Misrepresentation - Correct AnswersAn untrue statement by the insured, made in an application for insurance but which does not become a part of the policy. Concealment - Correct AnswersThe failure of the insured to reveal relevant facts known to the insured in applying for insurance. Abandonment - Correct AnswersProperty insurance policies usually contain an abandonment clause, stating the insured cannot dump damaged property on the insurer and demand its full value. Severability - Correct AnswersThe insurance applies separately to each insured as if other insureds did not exist. Proximate Cause - Correct AnswersThe cause having the most significant impact in bringing about the loss under a first-party property insurance policy, when two or more independent perils operate at the same time (i.e., concurrently) to produce a loss. Courts employ a set of rules to resolve causation disputes when a property policy states that it covers or excludes losses "caused by" a peril and there is more than one peril at work in a fact pattern. Under common law, whether the policy provides coverage depends on which peril is chosen as the proximate cause.
Direct Loss - Correct AnswersPhysical harm to tangible property. Indirect Loss - Correct AnswersEconomic loss which flows as a result of direct loss. Actual Cash Value(ACV) - Correct AnswersReplacement Cost minus Depreciation Coinsurance - Correct AnswersThe amount, generally expressed as a fixed percentage, an insured must pay against a claim after the deductible is satisfied. It's ultimately a way for the insured and insurer to share responsibility for the risk. It can also help reduce the cost of the insurance policy premium. Coinsurance can be written on an 80/20, 90/100, or 100% rule. Personal Contract - Correct AnswersPolicies cover people who own and operate things, such as automobiles. Conditional Contract - Correct AnswersAlso called a hypothetical contract, is a contract agreement that only requires performance once the delineated conditions are met. This legal agreement requires prior performance of another agreement or clause in order to be enforceable. If the other agreement or condition is performed, then the conditional contract is enforceable and the parties are bound to carry out the terms of the contract. Contract of Indemnity - Correct AnswersPrinciple of insurance that provides that when a loss occurs, the insured should be restored to the approximate financial condition he/she occupied before the loss occurred, no better or no worse. Insurable Interest - Correct Answersthe reasonable concern of a person to obtain insurance for any individual or property against unforeseen events such as death, losses, etc. Waiver - Correct Answers1.) Implied voluntary relinquishment, abandoning a legal advantage, need, claim or right. 2.) Agreement or added clause of a policy that excludes some losses or limits the sum of a claim, or extends coverage to add items not in a normal policy.
Express Waiver - Correct AnswersOccurs when the insurer or its representative knowingly gives up a known right under the insurance contract. Implied Waiver - Correct AnswersA waiver that is assumed to be in effect from a person's behavior and shows he is waiving a right. Damages - Correct AnswersMonetary compensation that is awarded by a court in a civil action to an individual who has been injured through the wrongful conduct of another party. Subrogation - Correct AnswersWhen an insured has a right to collect damages from another party, but instead elects to claim the damages under his insurance policy, his rights against the other party are transferred to the insurer. Changes - Correct AnswersAll policies provide that any changes to the policy be made by the insurer, in writing. Policy Period - Correct AnswersThe condition states that coverage applies only to losses or occurrences that take place during the policy period. (Prior to the stated date and time of termination). Policy Territory - Correct AnswersCondition limiting coverage to occurrences or losses that take place only within a stated geographical region. Other Insurance - Correct AnswersThe principle of indemnity dictates against duplicate recovery for the same loss. Cancellation - Correct AnswersThe insured may cancel at any time, for any reason, without advance notice. If the conpany wishes to cancel, it must provide some degree of advance notice so the insured will have time to replace the coverage. Appraisal - Correct AnswersA written contract of or written agreement for or effecting insurance, or the certificate thereof, by whatever name called, and includes all clauses, riders, endorsements and papers which are a part thereof.
Insurance - Correct AnswersIs a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit upon determinable contingencies. Binder - Correct AnswersActs as a temporary contract until the policy is issued. How many days should an insurer give for prior notice of cancellation of a binder? - Correct Answers5 days. Property Insurance - Correct AnswersAny insurance wherein payment by the insurer will be paid directly to the insured or other specifically named interests. Liability Insurance - Correct AnswersPayment will be on behalf of the insured to another, based upon the insureds liability to the recipient. Simply stated, Liability is "Negligence of the Insured". Loss Payee Clause - Correct AnswersA Clause in a contract of insurance that provides, in the event of payment being made under the policy in relation to the insured risk, that payment will be made to a 3rd party rather than to the insured beneficiary of the policy. Mortgage Clause - Correct AnswersA property insurance provision granting special protection for the interest of a mortgagee named in the policy, in effect setting up a separate content between the insurer and the mortgagee. Other Structures - Correct AnswersCovers items that are not permanently attached to the main dwelling, such as a shed, fence, etc. Commercial Inland Marine - Correct AnswersHelps identify the kinds of risk which are eligible for either ocean or inland Marine insurance. Building Ordinance Coverage - Correct AnswersThis endorsement covers the insured for enforcement of laws which require demolition of undamaged portions of buildings. Umbrella Policy - Correct AnswersCovers a much higher limit and goes above and beyond claims directly relating to your home and auto, it provides your assets from an unforeseen
event, such as a tragic accident in which you are held responsible for damages or bodily injuries. Known Loss - Correct AnswersPrevents an insured from coverage if the insured knew the loss was probable at the time of the insurance contract. Value Reporting - Correct AnswersThe limit of coverage is set at an amount somewhat higher than expected peak values. Commercial Property Insurance - Correct AnswersCovers direct and indirect losses related to properties other than one to four family dwellings and farm properties. Employee Theft - Correct AnswersProvides coverage for loss of or damage to money, securities, and other property resulting from theft committed by an employee. Theft is defined as the unlawful taking of money, securities or other property to the deprivation of the insured. Bid - Correct AnswersAggreement to fulfill a contractual obligation used frequently in construction and supplying goods. Health Maintenance Organization (HMO) - Correct AnswersProvides comprehensive health services to its members for a prepaid fixed fee, equivalent to an insurance premium. Preferred Provider Organization (PPO) - Correct AnswersA selected group of hospital's and medical practitioners in a given area who have joined together in an effort to reduce medical costs. Estoppel - Correct AnswersIs an equitable principle to the effect that if one intentionally or unintentionally creates the impression that a certain fact exists, and an innocent party relies on that impression and is damaged as a result, the guilty party may be legally prohibited(estopped) from asserting that the fact does not exist. Salvage - Correct AnswersMotor vehicle or mobile home is a total loss.
Junk - Correct AnswersAny material which is or may have been a motor vehicle or mobile home, with or without all component parts, which is inoperable and which material is in such condition that its highest or primary value is either in its sale or transfer as scrap metal. Fiduciary Agent - Correct AnswersAgent for a principal/Client. The legal or special relationship of trust, confidence, or responsibility between 2 or more parties. Domestic Insurer - Correct AnswersInsurer is one formed under the laws of its this state. Foreign Insurer - Correct AnswersInsurer is one formed under the laws of any state, district territory, or commonwealth of the United States other than this State. Alien Insurer - Correct AnswersInsurer is an insurer other than a domestic or foreign insurer. Appointment - Correct AnswersThe authority given by an insurer or employer to a licensee to transact insurance or adjust claims on behalf an insurer or employer. Derelict - Correct AnswersMaterial which is or may have been a motor vehicle or mobile home, with or without all component parts, which is inoperable and which material is in such condition that its highest or primary value is either in its sale or transfer as scrap metal or component parts or both. Mechanical Breakdown Coverage - Correct AnswersCovers repairs to mechanical parts of your vehicle that break. Even covers break in events not related to an accident. Sliding - Correct AnswersSelling an item and stating that it is required by law. What is the Death Benefit amount for PIP? - Correct Answers$5, What is the amount for medical and disability benefits afforded by PIP? - Correct Answers$10,
Who is the Financial Responsibility Law administered by? - Correct AnswersThe Department of Highway Safety and Motor Vehicles. What are the Basic PIP Benefits? - Correct Answers-Medical-80% of responsible expenses are paid for necessary medical, surgical, X-Ray and dental.
Claim - Correct AnswersIs the assertion of an alleged legal right against an insurer, which carries with it a demand for appropriate relief. Claims Adjuster - Correct AnswersOne who is involved in the investigation, adjustment, negotiation and/or trial preparations of claims arising under insurance policies. Adjusting - Correct AnswersProcess of disposing of an insurance claim. Loan Receipt - Correct AnswersA 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 advanced pending the outcome of a claim against the person responsible for the damage. Apportionment - Correct AnswersIs a provision for computing and assigning to each of two or more contracts covering a claim its proportion of the amount of the loss. How to settle a claim for an Injured Minor? - Correct AnswersUnder Fl Law, the adjuster should settle a third-party liability claim of an injured minor child with both parents of the injured child, presuming the settlement is for an amount not in excess of $15,000. If it is more than that it must be consummated through the Circuit or County Courts. What are the violations of the Unfair Trade Practices Act? - Correct Answers-Failing to act promptly.
What does 10 /20/10 mean? - Correct Answers10=10,000 Livability per person injured- amount that will be paid out for injuries to one person. 20=20,000 Combined Total Liability for all injuries-this is the most paid out for injuries for an accident. 10=10,000 Property Damage-the most paid out for damage caused to property of others. What is SR- 22? - Correct AnswersA form of coverage known as a NAMED NOOWNER policy is required, this form offers insurance coverage only while the insured is operating automobiles owned by others. What are the two things that need to happen for financial responsibility that did not exist at the time of the accident? - Correct Answers-The legally valid claims of others must be satisfied(up to the 10/20/10 requirements).
What does Extended PIP do? - Correct Answers-Increases medical benefits from 80% to 100%.
What does Commercial General Liability contract includes? - Correct Answers- Declarations
The Coverage Trigger - Correct AnswersDetermines how policy will respond. The Occurrence form - Correct AnswersApplies to BI or PD which occurs during the policy period, regardless of any later time at which a claim is made. The Claims-Made form - Correct AnswersApplies only to a BI or PD which occurs on or after the retroactive date, and for which the claim is received or recorded by an insured or the company during the policy period. Retroactive Date - Correct AnswersEstablishes the original policy date for a serious of claims made policies. Intentionally Injury - Correct AnswersCoverage excludes injury or damage which is expected or intended by the insured. liquor Liability - Correct AnswersIf the insured is in the business of manufacturing, distributing, selling, serving or furnishing alcoholic beverages, liability associated with serving liquor to intoxicated or underage persons or in violation of a law is excluded. Employee Injuries - Correct AnswersCoverage excludes liabilities under a workers compensation or similar law or arising from injuries to employees of the insured. Pollution - Correct AnswersThere a basically no coverage for injury, damage or clean up costs caused by pullutants, subject to minor exceptions. What is Coverage B? - Correct AnswersPersonal and Advertising Injury. What is Coverage C? - Correct AnswersMedical Payments. What are the General Liability Insurance Forms? - Correct Answers-Owners and Contractors Protective Liability(OCP)Form.
All Lines Claims Adjuster 6 - 20 - Correct AnswersInvestigates, Evaluates, and Negotiates Claims. A General Lines Adjuster is required to do what? - Correct AnswersParticipate in 24 hrs of continuing education every 2 years. A licensee must notify the Department in writing in how many days for change of name, address, phone number or email? - Correct Answers30 days. Loss Sustained - Correct AnswersCover only losses that both occurred and were discovered during the policy period, or within one year of it's expiration. Discovery - Correct AnswersAny loss discovered during the policy period or within 60 days after it's expiration is called regardless of when it occurred. Property Covered - Correct AnswersThe policy covers only property the named insured owns or holds or for which the insured is legally liable, and for the benefit of the insured. Safe Depository - Correct AnswersCovers the named insureds legal liability if it is the safe depository for customers property. Perils covered include burglary, robbery, destruction on damage. Valuation - Correct AnswersMoney is valued at its face value; securities at their value on the day loss is discovered; and other property at actual replacement cost or, if less, cost to repair. Government Crime - Correct AnswersA slightly different set of basic Crime Coverage Forms is tailored for insuring governmental entities. Guests' Property - Correct AnswersCovers the named insureds legal liability for guest's property while in a safe deposit box or while the property is inside the premises or in the named insureds possession.
Commercial Crime Forms - Correct AnswersCrime Insurance may be written as a separate policy, with it's own Declaration and Conditions, or as a package policy, bundled together with Employee Dishonesty. Forgery Or Alteration - Correct AnswersProvides coverage for loss by forgery or alteration of negotiable instruments, such as checks, drafts, promissory notes or similar instruments calling for payment of a sum certain in money. Computer Fraud - Correct AnswersWill pay for the loss of or damage to money, securities and other property resulting from using a computer to fraudulently transport from inside the insureds promises to a person or place outside the premises, which encompasses anywhere in the world. Extortion - Correct AnswersCovers for all types of property, when surrendered away from the premises as a result of a threat to do bodily harm to the insured or an employee, or to a relative or invitee of either, who is being held captive. Clients Property - Correct AnswersOffers coverage for non-owned property for which the insured is legally liable while the property is on the premises of the insureds client. Lesses of Safe Deposit Boxes - Correct AnswersCovers theft, disappearance, or destruction of securities; and burglary or robbery of property other than money or securities, all from within designated places of safe depository. Funds Transfer Fraud - Correct AnswersIs designed to cover loss due to the fraudulent transfer of funds through the use of a telephone or fax machine. Securities Deposited with Others - Correct AnswersCovers theft, disappearance, or destruction of securities, which have been deposited with a custodian, such as a bank or stockbroker. The deductible - Correct AnswersThe dollar amount that the insured pays before the insurer is required to pay the remainder of the loss is known as? Replacement cost - Correct AnswersWhich loss settlement provides new for old?
the claims adjuster's role in the insurance industry includes - Correct AnswersGive appropriate legal advice and write binding contracts following are examples of a peril - Correct AnswersLighting, Explosion and Fire The abandonment clause - Correct AnswersThe clause that prohibits the insured from dumping damaged property on the insurance company and demanding to be paid in full is? Liberalization - Correct AnswersWhen a policy change results in broadened coverage with no additional premium, the insured automatically receives the benefit under the principle of? Risk - Correct AnswersThe chance of financial loss is known as? Percentage - Correct AnswersHurricane insurance in coastal areas in Florida is written subject to which of the following deductibles? The principle of proximate cause - Correct AnswersWhen there is an unbroken connection between an occurrence and the damage that arises from the occurrence, and all the resulting damage happened on account of that occurrence, this is known as? characteristics of a contract - Correct AnswersConsideration must be given to at least one party Primary - Correct AnswersWhen two or more policies apply to the same loss, the one that pays first is called? Mortgagee Clause - Correct AnswersThe clause that protects the lender in a real property policy is the? Indemnity - Correct AnswersThe concept that one should not profit from the payment provided by an insurance policy is known as?
Property or first-party insurance - Correct AnswersPayment the insurance company makes directly to the insured is? Written - Correct AnswersTo be considered an insurance contract, a policy must be? Subrogation - Correct AnswersWhen the insured transfers his/her rights to collect for damages to the insurer, it is known as? The insured - Correct AnswersIf an insurance policy is unclear or ambiguous, in whose favor does the policy respond? Insurable interest - Correct AnswersA partial owner of a building cannot receive full value for the building in the event of a loss because of? Comparative negligence - Correct AnswersReduces the insured's damages by the degree of negligence the following are part of an insurance policy - Correct AnswersExclusions, Declarations and Endorsementd ACV - Correct Answersreplacement cost minus depreciation The insured's house is totally destroyed in a fire. The house is insured for $200,000. The adjuster who investigates the claims determines the ACV of the home is $185,000. - Correct AnswersThe Florida Valued Policy Law requires the insurer to pay $200, describe a franchise deductible - Correct AnswersNo payment is made until the loss equals or exceeds the amount of the deductible and then the loss is paid in full All of the following are characteristics of an insurance contract EXCEPT? Personal, Private, Conditional, Adhesion? - Correct AnswersPrivate If a claimant is represented by an attorney, the adjuster should? - Correct AnswersOnly meet with the client when the attorney is present
Adjusters should advise claimants on? - Correct Answersclaims information An adjuster is required to notify a claimant when a claim is denied. The notification must be? - Correct AnswersWritten The term ethics refers to? - Correct Answersservice to others, personal respect and proper mode of conduct When an adjuster deals with a claimant who is not a policyholder, this claim is known as an? - Correct Answersthird party claim The successful adjuster/negotiator should understand that communication includes all of the following EXCEPT? Select one: A. Verbal and non-verbal messages B. Questioning C. Listening D. Decision-making - Correct AnswersDecision-making Which of the following is not a duty of the claims adjuster? Select one: A. Investigating B. Evaluating C. Negotiating D. Counseling - Correct AnswersCounseling The adjuster's duty to the insurer is best described as? Select one: A. Friendly
B. Factual C. Fun D. Fiduciary - Correct AnswersFiduciary Errors and Omissions claims are a result of? Select one: A. unethical behavior B. lack of knowledge or information C. Both unethical behavior and lack of knowledge or information are correct D. Neither unethical behavior and lack of knowledge or information are correct - Correct AnswersBoth unethical behavior and lack of knowledge or information are correct Unethical behavior affects? Select one: A. The claimant B. The adjuster C. All of the above D. The entire company - Correct AnswersAll of the above All of the following are components of negotiating EXCEPT? Select one: A. The issue should be negotiable B. There must be an exchange of value for value C. The parties should trust each other D. The claimant must be satisfied - Correct AnswersThe claimant must be satisfied The Civil Remedies Provision of the Insurance Code states that adjusters should not?
Select one: A. Handle claims in a prompt manner B. Accompany claims payments with statements explaining coverage C. Settle claims in good faith D. Try to influence settlements - Correct AnswersTry to influence settlements The insured, a resident of Florida, was in an accident in Georgia. The Florida car was insured with liability limits of 10/20/10. Georgia's minimum liability limits are 20/40/10. How will the Florida policy respond? Select one: A. 10/20/10 B. 20/40/10 C. No coverage D. 20/40/20 - Correct Answers20/40/10 Under a PAP, when does the insurance company cease to defend the insured? Select one: A. The insurance company is not obligated to defend the insured B. After the case has been resolved C. When the policy limit is exhausted D. At the policy's expiration - Correct AnswersWhen the policy limit is exhausted The Florida Financial Responsibility Law is triggered by? Select one: A. Registration of the vehicle B. Purchase of the vehicle C. An accident involving bodily injury or property damage
D. Purchase of an auto policy - Correct AnswersAn accident involving bodily injury or property damage The insured is an owner and is insured for PIP. She is injured in an accident and has the following damages? medicals-$12,000, lost wages-$6,000. How much will PIP pay if there is a $1,000 deductible? Select one: A. $11,20 0 B. $12,400 C. $9,600 D. $10,000 - Correct Answers$10,000 Trucker insurance premiums are based on all EXCEPT? Select one: A. Radius B. Age of the driver C. Type of business D. Territory garaged - Correct AnswersAge of the driver Joe works for Sinks-R-Us, Inc. As part of his compensation package, he is supplied with a company car, which he gets to take home every night. Joe wants to make sure the Liability coverage under his PAP covers him while driving his company car. What coverage would you add to Joe's PAP? Select one: A. Named Non-owned coverage B. Extended Non-owned Liability coverage C. Drive Away Liability coverage D. False Pretense coverage - Correct AnswersExtended Non-owned Liability coverage
Dan has a Personal Auto Policy with Liability of 10/20/10 and basic PIP with a $1,000 deductible. He is running one day when a car strikes him. A week later he dies. Medical bills are $7,500 and lost wages are $1,000. How much, if any, will PIP pay in this claim? - Correct Answers10,800.00 Joe is an owner insured for PIP. In which of the following situations does Joe have his PIP benefits available to him? Select one: A. In a slip and fall accident in the mall in Florida B. In an accident while riding his motorcycle C. Struck as a pedestrian in Georgia D. In an accident while riding as a passenger in a friend's car in Florida - Correct AnswersIn an accident while riding as a passenger in a friend's car in Florida The insured bought a new car with a Mechanical Breakdown Policy. When the odometer reaches 40,000 the car has a serious breakdown involving the transmission. How does the Mechanical Breakdown Policy respond? Select one: A. No coverage because the policy expired B. No coverage because a transmission is not covered C. ACV coverage will apply D. Replacement cost coverage will apply - Correct AnswersNo coverage because the policy expired An insured borrows his neighbor's trailer to pick up his new furniture. Which of the following best describes the insured if he has an accident? Select one: A. His PAP will extend coverage if the proper endorsement is added B. Only the liability of the PAP extends to the trailer C. His auto is insured, but not the borrowed trailer
D. His PAP extends liability to the trailer and Part D-Physical Damage extends $1,500 coverage to the borrowed trailer - Correct AnswersHis PAP extends liability to the trailer and Part D-Physical Damage extends $1,500 coverage to the borrowed trailer Jane is driving Mary's car. Jane has an at-fault accident with Bob. Mary has liability limits of 10/20/10. Jane has liability limits of 100/300/100. If Bob has $40,000 in bodily injury, how much will be collected from Jane's policy? (IGNORE PIP) Select one: A. $30,000 B. $10,000 C. $50,000 D. $20,000 - Correct Answers$30,000 Jim owns an auto and he is involved in an auto accident. He suffered $4,000 in medical expenses and $4,000 of lost income. How much does his insurance pay if he has Extended PIP? Select one: A. $7,200 B. $8,200 C. $4,2 00 D. $5,200 - Correct Answers$7,200 If an insured has $100,000 of unstacked UM coverage with three cars on the policy, how much is available under a UM claim? Select one: A. $0- B. $300,000 C. $100,000 D. $200,000 - Correct Answers$100,000