Florida Claims Adjuster Exam: Questions and Answers, Exams of Nursing

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Florida Claims Adjuster Exam

Severability - Question and answersInsurance applies separately to each insured as if other insureds did not exist. Abandonment - Question and answersProperty insurance policies usually contain a(n) __________ clause, stating the insured cannot dump damaged property on the insurer and demand its full value. Insurable Interest - Question and answersOne wherein economic loss would be suffered from an adverse happening to the subject. Liberalization - Question and answersStates 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 - Question and answersStates 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 - Question and answersThe Loss Settlement Valuation that subtracts an allowance for depreciation Warranty - Question and answersA policy condition, either based on information in the insured's application or inserted by the insurer Conditional Contract - Question and answersThe 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: - Question and answers36 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? - Question and answersThe 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 - Question and answers The Business Automobile Policy includes all of the following coverage forms except: - Question and answersThe Trailer Interchange Coverage Form Personal Injury Protection, or PIP, has a __________ per person, per accident limit. - Question and answers10, Used to insure businesses engaged in selling, servicing, repairing, parking or storing automobiles: - Question and answersGarage Coverage Form The following examples are referred to as __________ liability limits: 25/50/25 or 10/20/10. - Question and answersSplit 10/20/10 = 10,000 per person injured 20,000 all injuries combined 10,000 property damage Example of straight liability limit = $30, 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? - Question and answers$1, 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? - Question and answers$5, 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? - Question and answersAge & Gender of Insured On a Homeowner's Policy, covers items that are not permanently attached to the dwelling. This is defined as: - Question and answersOther 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: - Question and answersMortgagee Clause

Mortgagee - Homeowner's policy Loss Payee - Automobile policy Which of the following forms is "all-risk" on the dwelling policy? - Question and answersDP-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 - Question and answersBoth 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 - Question and answersB. 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 - Question and answersD. 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 - Question and answersD. 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 - Question and answersC. 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: - Question and answersPreferred 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: - Question and answersCondominium Unit Owners Form The Commercial Property Contract includes all of the following, except: A. Common Policy Conditions B. Commercial Property Conditions C. Coverage Form D. Commercial Loss Schedule - Question and answersCommercial Loss Schedule Also included: Declarations, Causes of Loss Form, Endorsements Insures a condominium association against direct physical loss or damage to buildings, business personal property and personal property of others in the care, custody or control of the association and located at the premises: - Question and answersCondominium Association Form This, along with Condo Unit Owners Form, is located under Condo Coverage. Sometimes referred to as commercial fire and allied lines, this is the form of insurance that covers direct and indirect losses related to properties other than one-to-four family dwellings and farm properties: - Question and answersCommercial 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 - Question and answersC. 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. - Question and answersValue 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." - Question and answers45 days Used to cover buildings in the course of construction - Question and answersBuilders 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. - Question and answersCommercial 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) - Question and answersBusiness 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? - Question and answersSupplementary

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? - Question and answersThe 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 - Question and answersD. 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. - Question and answers0% Under a Commercial General Liability Policy, a basic limit of __________ per person applies to Medical Payments: - Question and answers$5, The Commercial General Liability __________ identifies the named insured and address, states the policy period and premium and miscellaneous information about the insured, and specifies the limits of coverage that apply. - Question and answersDeclarations The Nuclear Energy Liability Exclusion endorsement, in general, __________ all hazards related to nuclear energy. - Question and answersExcludes Firms involved in Nuclear activities receive protection from special insurer pools organized for that purpose. Toxic wastes escaped from a gas station disposal tank. The insured operator discovers the leak and cleans up the spill. Unfortunately, the waste quickly seeped into the ground and has caused illness among the residents of a neighboring community This is an example of? - Question and answersKnown Loss Insurer should have been notified and further investigation of the spill and effective clean-up would have been observed. Applies to BI or PD which occurs during the policy period, regardless of any later time at which a claim is made: - Question and answersOccurrence Form

vs. Claims-Made: applies only to BI or PD occurring on or after retroactive date for which claim is received/recorded during policy period Applies 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:

• Question and answersClaims-Made Retroactive date is stated in Declarations and will normally be same date as issuing company's first claims-made effective date for insured. All of the following are components of Workers Compensation, except: A. Up to $750,000 in Death Benefits B. Reimbursement for Medical Expenses incurred C. Reimbursement for lost wages on percentage basis D. Funeral costs up to $7,500 - Question and answersUp to $750,000 in Death Benefits Compensation for death is payable if death results within one year of an accident or if it follows disability within five years of accident. The following are classes of disability, except: - Question and answersTemporary Full Also included: Temporary Partial The measure to determine disability benefits is the __________ of the employee at the time of injury: - Question and answersAverage Weekly Wage Disability - incapacity due to injury to earn same or any other employment wages that employee was receiving at time of injury. Mandatory for risks exceeding certain annual premiums, recognizes the prior loss experience of the risk and applies either a debit for unfavorable experience or a credit for better-than-expected loss results. This is defined as: - Question and answersThe Experience Rating Plan This, along with Retrospective Rating Plan, is a manual rating process until premiums reach a certain level. Under workers compensations, a rate is charged for every __________ of payroll to employees. - Question and answers$ 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 - Question and answersAll 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 - Question and answersAll 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 - Question and answersNone 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: - Question and answersRetrospective Rating Plan Under Employer's Liability, the minimum limits of liability are: - Question and answersA. 100/100/ $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: - Question and answers$5, Under Crime Insurance, losses must be discovered within 1 year. This is defined as: - Question and answersThe Discovery Period

Crime Insurance is _________ over any other Insurance coverage. - Question and answersExcess A situation may arise where another form of insurance will pay claim - that insurance would be primary. Cover only losses that both occurred and were discovered during the policy period, or within one year of its expiration. This is defined as: - Question and answersLoss Sustained One exception to the rule is that Loss Sustained forms will also cover losses that occurred under previous (expired) crime policies and that were discovered during current policy year, as long as crime coverage had continued w/o interruption Any loss discovered during the policy period or within 60 days after its expiration (one year after expiration for losses connected with employee benefit plans) is covered regardless of when it occurred. This is defined as: - Question and answersDiscovery 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 - Question and answersD. 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: - Question and answersOutside 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: - Question and answersSafe 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: - Question and answersExtortion 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 - Question and answersD. All May Apply Employee Theft may be written in three ways. Which of the following are NOT a type of bond? - Question and answersApprentice 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 - Question and answersD. All of the Above Guarantees the performance between the principle and the obligee: - Question and answersSurety 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: - Question and answersPerformance Considered a contract bond One who undertakes to perform, to fulfill a contract or to meet an obligation is known as:

• Question and answersPrincipal 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: - Question and answersBid 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: - Question and answersIndemnitor Which of the following are parties to a Bond? A. Principal B. Obligee C. Surety D. All of the Above - Question and answersD. 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, sidealks, sewers, etc.: - Question and answersSubdivision 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:

• Question and answersLost 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. - Question and answersPPO 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: - Question and answersHospital Indemnity This optional provision states that if the insured becomes totally disabled, premiums are waived but the coverage remains in force - Question and answersWaiver of Premium Provides coverage for expenses, including loss of income, arising from an accident. This is defined as? - Question and answersAccident 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? - Question and answersConditionally 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? - Question and answersMajor 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 - Question and answersC. 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) - Question and answersS - Small of non-existent Deductibles F- Fewer Exclusions P - Insurance services to members through employed physicians B - Broad coverage C - Coinsurance provisions Provides indemnification to the insured for basic hospitalization of room and board in the hospital, nursing care, laboratory fees, operating room, medical supplies, etc. This is defined as? - Question and answersHospitalization Expense Associated with a daily limit, not to exceed specified maximum A(n) __________ provides comprehensive health services to its members for a prepaid fixed fee, equivalent to an insurance premium. - Question and answersHMO

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: - Question and answersFAJUA In 2002, the Florida Residential Property and Casualty Joint Underwriting Association (FRPCJUA) and the Florida Windstorm Joint Underwriting Association (FWUA), were combined to create: - Question and answersCitizens Passed during a legislative session in 1993, this association was created for employers who cannot obtain workers compensation insurance in the private market: - Question and answersFWCJUA 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 - Question and answersC. 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 - Question and answersB. 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: - Question and answersSliding A licensed General Lines Claim Adjuster is required to complete how many hours of continuing education every two years? - Question and answers

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 - Question and answersB. False After pleading guilty or no contest to a felony, a licensed individual has _________ days to inform the Department? - Question and answers Must be licensed, appointed by a General Lines Agent and can transact AUTO insurance only in the Office Only. - Question and answersLimited 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 - Question and answersA. 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 - Question and answersB. False An Insurance Company which is formed under the laws of the State of Illinois, and has its Home Office there, is considered a: - Question and answersForeign 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: - Question and answersClaims Adjuster Establishing a dollar value on a claim is defined as: - Question and answersEvaluation For bodily injury and uninsured motorist claims, a settlement range will be set rather than a single dollar amount Damaged property that may be retrieved, reconditioned and sold to reduce an insured loss is defined as: - Question and answersSalvage Efficient disposal of salvage reduces amount of loss to either insured or insurer

The voluntary or intentional relinquishment of a known right is defined as a(n): - Question and answersWaiver The law recognizes two types: express and implied. The principle of utmost good faith on which an insurance contract is based places serious responsibilities on the claims adjuster in regards to: A. Conduct B. Work Habits C. Claim Handling Activites D. All of the Above - Question and answersD. All of the Above The adjusters basic activities in claims handling are: A. Investigation B. Evaluation C. Negotiation D. All of the Above - Question and answersD. All of the Above Investigation - establish coverage, determine liability, verify damages qualify Evaluation - determine fair payment in accordance with contract and law Negotiation - settlement based on facts discovered during evaluation Under the Florida Unfair Insurance Trade Practices Act, penalties are provided for misrepresentation of business practices, which include all of the following except: A. Failing to act promptly B. Failure to explain claim denials in writing C. Denying claims with reasonable investigation D. Failure to maintain complaint handling procedures - Question and answersC. Denying claims with reasonable investigation An adjuster who represents the financial interests of the insured named in the policy is defined as a(n): - Question and answersPublic Adjuster When investigating liability insurance claims, which of the following three major elements are determined: (CLD) - Question and answersCoverage Liability Damages 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: - Question and answersFiduciary

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): - Question and answersIndependent 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 - Question and answersPolicy Cancellation The assertion of an alleged legal right against an insurer, which carries with it a demand for appropriate relief, is defined as: - Question and answersClaim Relieving the financial burden on the claimant by making certain payments to the claimant even before the claim can be negotiated is defined as: - Question and answersAdvanced Payment The process of disposing of an insurance claim is defined as: - Question and answersAdjusting 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 - Question and answersB. 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): - Question and answersLoan 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 behavior - Question and answersRating 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): - Question and answersCompany 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 - Question and answersD. General Lines Adjuster Bureau Adjusters are also considered adjusters. An applicant for a license as an adjuster may qualify as an adjuster in the following fields (but not limited to): A. All lines of insurance except life and annuities B. Property and Casualty C. Workers Compensation Insurance D. All of the Above - Question and answersD. All of the Above Also: motor vehicle physical damage and health insurance A motor vehicle or mobile home which is a total loss is defined as: - Question and answersSalvage It cannot be restored to prior condition When making any payment for damage to an automobile for a partial loss, the insurer shall have printed on the loss settlement, "Failure to use the insurance proceeds in accordance with the security agreement, if any, could be a violation of s.812.014, Florida Statutes." This is payment for a(n): - Question and answersThird Party Claim The District of Columbia and any state or territory of the United States in which an insurance agent maintains his or her principal place of residence or principal place of business and is licensed to act as an insurance agent. This is defined as: - Question and answersHome State Any material which is or may have been a motor vehicle or mobile home, 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 for its component parts, or a combination of the two. This is defined as: - Question and answersDerelict

An individual appointed by a general lines or agency to assist that agent or agency in transacting the business of insurance from the office of that agent or agency is defined as: - Question and answersCustomer Representative (4-40 license) The authority given by an insurer or employer to a licensee to transact insurance or adjust claims on behalf of an insurer or employer is defined as: - Question and answersAppointment Licensees are given authority through the appointment process The Department may issue a nonrenewable temporary license authorizing the appointment of a general lines insurance agent, life agent, or an industrial fire or burglary agent, for a period not to exceed: - Question and answers6 Months How many continuing education hours must an insurance adjuster complete every 2 years? - Question and answers 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 - Question and answersD. 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: - Question and answersLimited 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: - Question and answersLife 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: - Question and answersSliding 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 - Question and answersAll 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? - Question and answers 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): - Question and answersGeneral 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): - Question and answersHealth Agent An applicant for a temporary license must be: - Question and answers1. A natural person at least 18 years of age

2. A US citizen or legal alien 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): - Question and answersAuthorized Actual Cash Value - Question and answersReplacement cost minus depreciation Subrogation - Question and answersWhen 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 - Question and answersProvides, 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 - Question and answersProtects 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 - Question and answersNegligence of the insured Other Structures - Question and answersHomeowner's Policy, covers items not permanently attached to main dwelling (shed, fence, etc.) Commercial Inland Marine - Question and answersIdentifies 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 - Question and answersCovers much higher limit and goes above/beyond claims directly relating to home and auto; protects assets from unforeseen events Known Loss - Question and answersPrevents insured from coverage if insured knew the loss was probable at time of contract Commercial Property Insurance - Question and answersSometimes referred to as Commercial Fire and Allied Lines; Covers direct and indirect losses related to properties other than 1-4 family dwelling and farm properties Value Reporting - Question and answersLimit of coverage set at an amount higher than expected peak values Employee Theft - Question and answersProvides coverage for loss or damage to money, securities, and other property resulting from theft committed by an employee Bid - Question and answersForm of bond required to accompany a bid for a contract which will require that successful bidder furnish further bond if awarded job. Agreement to fulfill a contractual obligation used frequently in construction and supplying goods PPO - Question and answers(Preferred Provider Organization) Selected group of hospitals and medical practitioners in given area who have joined together in an effort to reduce medical costs HMO (pre-paid fixed fee) - Question and answers(Health Maintenance Organization) Provides comprehensive health services to its members for a prepaid fixed fee equivalent to an insurance premium Domestic - Question and answersInsurer formed under laws of this state Foreign - Question and answersInsurer formed under laws of another state, district territory, or commonwealth of U.S. Alien - Question and answersInsurer other than domestic or foreign (outside U.S.) Sliding - Question and answersSelling an item and stating that it is required by law Waiver - Question and answersVoluntary relinquishment or surrender of some right or privilege Fiduciary - Question and answersA 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

Evaluation - Question and answersEstablishing a dollar value on a claim. Determines the fair payment in accordance with the contract and applicable law Negotiation - Question and answersA quality settlement based on facts discovered during the evaluation process Estoppel - Question and answersAn equitable principle to the effect that if one intentionally or unintentionally creates the impression that a certain fact exists, 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. Junk - Question and 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 Salvage - Question and answersDamaged property that may be retrieved, reconditioned and sold to reduce an insured loss. Motor vehicle or mobile home is a total loss Appointment - Question and answersAuthority given by an insurer or employer to a licensee to transact insurance or adjust claims on their behalf Derelict - Question and 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 Implied Waiver - Question and answersMay result from some act of neglect on part of the adjuster Express Waiver - Question and answersOccurs when insurer or its representative knowingly gives up a known right under insurance contract Mechanical Breakdown Coverage - Question and answersCovers repairs to mechanical parts of your vehicle that break; even covers in events not related to an accident Identify examples of peril. - Question and answersFire, 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? - Question and answers30 days What is the coinsurance clause and how might it apply to a given scenario? - Question and answersA 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) - Question and answers1. 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? - Question and answersPersonal 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?

• Question and answersPIP 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? - Question and answers1. 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)? - Question and answersPIP 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? - Question and answersWhen 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? (3)

(Hint: I L S) - Question and answers1. 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? - Question and answersEffective 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? - Question and answersThe Department of Highway Safety and Motor Vehicles What are the characteristics of a Homeowner's policy? - Question and 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? - Question and 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? - Question and answersA 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? - Question and answersAnyone who would suffer an economic loss from an adverse happening to the property What do the Declarations of a policy outline? - Question and answersThe declarations identifies the named insured and address, states the policy period and premium and miscellaneous information about the insured, and specifies the limits of coverage that apply Which parties are associated with a bond? - Question and 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 -Indemnitor: may act as additional party at times; agrees to reimburse the surety for any loss it may suffer from having bonded the principal

What are the features of Major Medical Insurance? - Question and answersMajor Medical Insurance is intended to afford protection against catastrophic losses. Some forms are designated to supplement basic hospital/surgical policies; others intend to provide both basic and catastrophic coverage These policies are characterized by a deductible, high maximum limit, and percentage participation or coinsurance. It may contain internal limits for hospital daily room charge and surgical services. What associations make up Citizens Property and Insurance? - Question and answersFlorida Residential Property and Casualty Joint Underwriting Association (FRPCJUA) and Florida Windstorm Joint Underwriting Association (FWUA) What are the characteristics of a Personal Automobile Policy Declaration page? - Question and answersLiability (bodily injury), property damage, uninsured motorist, medical payments, PIP, collision deductible, comprehensive deductible, towing coverage, and rental coverage What are some examples of transacting insurance? - Question and answers1. solicitation and inducement

2. preliminary negotiations
3. effectuation of a contract of insurance
4. transaction of matters subsequent to effectuation of contract of insurance
5. mailing or otherwise delivering written solicitation to any person in this state by an insurer or any person acting on their behalf for fee or compensation What is the website for the Florida Department of Financial Services? - Question and answerswww.myfloridacfo.com What are the thresholds of the No-Fault Law? - Question and answers(1) Significant and permanent loss of a bodily function, or (2) Permanent injury other than scarring and disfigurement, or (3) Significant and permanent scarring or disfigurement, or (4) Death. What is the Florida Unfair Insurance Trade Practices Act? - Question and answersUnder this Act, penalties are provided for misrepresentation of business practices including: -Failing to act promptly -Failure to affirm or deny a claim when an insured is entitled thereto -Failure to explain claim denials in writing -Failure to maintain complaint-handling procedures, such as keeping accurate records of complaints

What perils are covered by Comprehensive Coverage? Does the deductible apply to them all? - Question and answersComprehensive Coverage applies to damage not caused by collision (an animal runs into your vehicle, hail damages your hood, glass claims, etc.) In Florida, windshields are replaced for free and you ARE NOT responsible for paying a deductible. What is the time frame for a Non-Renewable Temporary License? - Question and answersA period not to exceed 6 months What types of insurance licenses are offered by the Department and how do they differ?

• Question and answers1. General Lines Agent 2-20: licensed to write property/casualty, surety or health insurance.

2. Customer Representative 4-40: must be licensed, appointed by a General Lines Agent and may assist in transactions in the OFFICE ONLY
3. Limited Customer Representative 4-42: must be licensed, appointed by a General Lines Agent and transact AUTO insurance in the OFFICE ONLY.
4. All Lines Claims Adjuster 6-20: investigates, Evaluates and Negotiates Claims What are some reasons for suspension, revocation, or termination of a license? - Question and answers1. Transacting insurance outside of scope of one's license ►For example, an individual cannot sell life insurance if he or she has a Customer Service license but has not obtained a life license.
5. Misrepresentation or Fraud.
6. Participating in unfair methods of competition. ►Using discriminatory practices, making false entries on an insurance application or defaming others.
7. Sliding: Selling an item and stating that it is required by law (when it is not).
8. Demonstration of unworthiness or lack of fitness.
9. Misappropriation of funds.
10. 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. - Question and answers1. Independent Adjuster - self-employed and not affiliated with either insurers or bureaus
11. Company/Staff Adjuster - salaried employee under supervision of home, branch, regional claims department of insurers
12. Public Adjuster - represents the financial interests of the insured named in the policy
13. Claims Adjuster - one who is involved in the investigation, adjustment, negotiation and/or trial preparations of claims arising under insurance policies
14. Bureau Adjuster - agent of adjustment bureau which serves multiple company clients *Independent and Bureau are both "Fee Adjusters"