Florida Claims Adjuster Exam Questions and Answers, Exams of Nursing

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Florida Claims Adjuster Exam Questions

And Answers

Severability - ANSWER>>Insurance applies separately to each insured as if other insureds did not exist.

Abandonment - ANSWER>>Property insurance policies usually contain a(n) __________ clause, stating the insured cannot dump damaged property on the insurer and demand its full value.

Insurable Interest - ANSWER>>One wherein economic loss would be suffered from an adverse happening to the subject.

Liberalization - ANSWER>>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..

Doctrine of Proximate Cause - ANSWER>>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.

Actual Cash Value - ANSWER>>The Loss Settlement Valuation that subtracts an allowance for depreciation

Warranty - ANSWER>>A policy condition, either based on information in the insured's application or inserted by the insurer

Conditional Contract - ANSWER>>The Insurer's responsibility to pay for a property loss may be conditioned on the insured having used reasonable means

to avoid the loss, to protect the property against further loss, and to give the insurer proof of the loss is defined as?

Under Mechanical Breakdown Coverage, new cars are eligible for service up to: - ANSWER>>36 Months/36,000 Miles

Used vehicles: 12 Months/12,000 Miles

If financial responsibility doesn't exist at the time of an accident, what happens?

• ANSWER>>The legally valid claims of others must be satisfied (10/20/10)

The owner and operator must provide certification of future responsibility for future accidents

As to required proof for future accidents by purchase of auto liability insurance, the insurer must make a filing (Form SR-22) certifying that coverage is in effect, and this certification must remain on file for __________ years - ANSWER>>

The Business Automobile Policy includes all of the following coverage forms except: - ANSWER>>The Trailer Interchange Coverage Form

Personal Injury Protection, or PIP, has a __________ per person, per accident limit. - ANSWER>>10,

Used to insure businesses engaged in selling, servicing, repairing, parking or storing automobiles: - ANSWER>>Garage Coverage Form

The following examples are referred to as __________ liability limits: 25/50/ or 10/20/10. - ANSWER>>Split

10/20/10 = 10,000 per person injured 20,000 all injuries combined

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 - ANSWER>>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

• ANSWER>>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 - ANSWER>>D. A business condo owned by a local insurance company

Commercial property is not eligible for a Homeowner's policy.

Which of the following are characteristics of Homeowner's Insurance?

A. Protects against economic loss to residences and household property and legal liabilities B. Owner-occupants of 1-4 family dwellings C. Renters who maintain residential occupancy in any type of building D. All of the Above - ANSWER>>D. All of the Above

Also included: personal, non-business risk, no more than 2 roomers/boarders, condominium unit owners and cooperative apartment occupants

Jeremy owns a home that is recently damaged due to a hurricane. The repair estimate is averaged at $25,000 and Jeremy decides to stay in a hotel because most of the damage is to his bedroom and kitchen. Under a Homeowner's Policy, what coverage will pay for the hotel room bill? A. Fair Rental Value B. Value Obligation C. Loss of Use D. Insurers Duties - ANSWER>>C. Loss of Use The insurer will pay any necessary and reasonable expenses associated with a daily living routine.

An insured who wishes to purchase flood insurance, but is located in a moderate or low risk flood zone may do so by purchasing a: - ANSWER>>Preferred Risk Flood Policy

Although Flood Insurance is provided by the Federal Government, those who are not in a "flood zone" may purchase a preferred risk policy to cover them for a flood claim.

Used only for Commercial Condominiums, it covers the unit-owners business personal property and the personal property of others in the insured's care, custody or control: - ANSWER>>Condominium Unit Owners Form

The Commercial Property Contract includes all of the following, except:

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." - ANSWER>>45 days

Used to cover buildings in the course of construction - ANSWER>>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. - ANSWER>>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. (BIIC) - ANSWER>>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? - ANSWER>>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? - ANSWER>>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 - ANSWER>>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. - ANSWER>>0%

Under a Commercial General Liability Policy, a basic limit of __________ per person applies to Medical Payments: - ANSWER>>$5,

The Commercial General Liability __________ identifies the named insured and address, states the policy period and premium and miscellaneous information

B. Reimbursement for Medical Expenses incurred C. Reimbursement for lost wages on percentage basis D. Funeral costs up to $7,500 - ANSWER>>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: - ANSWER>>Temporary Full

Also included: Temporary Partial

The measure to determine disability benefits is the __________ of the employee at the time of injury: - ANSWER>>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: - ANSWER>>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. - ANSWER>>$

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 - ANSWER>>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 - ANSWER>>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 - ANSWER>>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: - ANSWER>>Retrospective Rating Plan

benefit plans) is covered regardless of when it occurred. This is defined as: - ANSWER>>Discovery

If XYZ restaurant discovers stolen goods taken over a year ago, this is within 2 years of inception date and found within policy period so it's covered.

Under Crime Insurance, the insured is covered for loss by:

A. Theft B. Burglary C. Robbery D. All of the Above - ANSWER>>D. All of the Above

Unless the loss is specifically excluded or limited

Provides for loss of money and securities outside the premises in the care, custody and control of a messenger or armored car service resulting from theft, disappearance or destruction. This is defined as: - ANSWER>>Outside the Premises

Also covers robbery of other property under the circumstances.

Taking or attempted taking of property from within a locked safe or vault, by unlawful entry, with visible marks of forcible entry, or taking of the safe or vault from inside the premises. This is defined as: - ANSWER>>Safe Burglary

Exclusions: accounting errors, giving/surrendering property, voluntarily parting, fire (except damage to safe/vault), vandalism, transferring property to someone based on unauthorized instructions or from threat to harm

Covers 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 (or allegedly is) being held captive. This is defined as: - ANSWER>>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 - ANSWER>>D. All May Apply

Employee Theft may be written in three ways.

Which of the following are NOT a type of bond? - ANSWER>>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 - ANSWER>>D. All of the Above

Guarantees the performance between the principle and the obligee: - ANSWER>>Surety

aka Bonding Company; Surety is a "guarantee"

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: - ANSWER>>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. - ANSWER>>PPO

Most plans provide that emergency treatment will be paid even if treated party does not go to service provider on approved list.

Define the coverage that pays a flat amount per day for hospitalization, regardless of expenses or other insurance: - ANSWER>>Hospital Indemnity

This optional provision states that if the insured becomes totally disabled, premiums are waived but the coverage remains in force - ANSWER>>Waiver of Premium

Provides coverage for expenses, including loss of income, arising from an accident. This is defined as? - ANSWER>>Accident Insurance

Typical exclusions would be: hernia, war, disease and bacterial infections, suicide attempts, air travel injuries, accidents while committing felony, accidents while under the influence

This type of provision states the insurer can refuse to renew the policy only under certain conditions. The policy must state the conditions under which the

policy will not be renewed. This is defined as? - ANSWER>>Conditionally Renewable

vs. Optionally: company may not cancel during term but reserves right to non- renew upon expiration vs. Guaranteed: insurer required to renew policy at stated age (typically 65); company reserves right to increase premium

The coverage that is intended to afford protection against catastrophic losses is defined as? - ANSWER>>Major Medical

Some forms designed to supplement basic policies; others provide both basic and catastrophic coverage

A policy may contain a provision which states a period of time between issuance and acceptance before sickness benefits begin. This is defined as: A. Waiting Period B. Elimination Period C. Both A & B D. None of the Above - ANSWER>>C. Both A & B

This helps keep premiums reasonable by eliminating chance of persons buying coverage only when they are sick

Characteristics of an HMO plan usually include:

(HINT: S F P B C) - ANSWER>>S - Small of non-existent Deductibles F- Fewer Exclusions P - Insurance services to members through employed physicians B - Broad coverage C - Coinsurance provisions

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 - ANSWER>>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 - ANSWER>>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: - ANSWER>>Sliding

A licensed General Lines Claim Adjuster is required to complete how many hours of continuing education every two years? - ANSWER>>

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 - ANSWER>>B. False

After pleading guilty or no contest to a felony, a licensed individual has _________ days to inform the Department? - ANSWER>>

Must be licensed, appointed by a General Lines Agent and can transact AUTO insurance only in the Office Only. - ANSWER>>Limited Customer Representative 4-

Defaming a competitor company or agent is not only unprofessional, it can also result in a license suspension.

A. True B. False - ANSWER>>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 - ANSWER>>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: - ANSWER>>Foreign Company

Domestic: this state (FL) Foreign: other state (still in US) Alien: elsewhere

One who is involved in the investigation, adjustment, negotiation and/or trial preparations of claims arising under insurance policies is defined as: - ANSWER>>Claims Adjuster

Establishing a dollar value on a claim is defined as: - ANSWER>>Evaluation

For bodily injury and uninsured motorist claims, a settlement range will be set rather than a single dollar amount