FLORIDA CLAIMS ADJUSTER EXAM QUESTIONS WITH CORRECT ANSWERS, Exams of Nursing

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FLORIDA CLAIMS ADJUSTER EXAM QUESTIONS WITH

CORRECT ANSWERS

1. Frank owned a home that was destroyed by a hurricane. Both ABC and XYZ Banks were listed as additional interests on his homeowner policy. The insurance company will make a payment to: A. The first mortgagee, ABC B. The Insured C. Jointly to ABC and XYZ D. All listed interests: D. All listed interests Remember that the insurer is not responsible to know the degrees of interest. In the event of a loss, one payment is made by the insurer and it is up to the additional interests on working out their share.
2. Insurance applies separately to each insured as if other insureds did not exist. This is defined as: A. Severability B. Conditional C. Warranty D. None of the above: A. Severability
3. Property insurance policies usually contain a(n) clause, stating the insured cannot dump damaged property on the insurer and demandits full value: A. Pro Rata B. Abandonment C. Liberalization D. All of the above: B. Abandonment
4. A(n) is one wherein economic loss would be suffered from an adverse happening to the subject: A. Conditional Contract B. Personal Contract C. Economic Contract D. Insurable Interest: D. Insurable Interest
5. States that if the insurer adopts a revision which would broaden coverage without additional premium within some period of time prior to the policy period or during the policy period, the insured receives the benefit of such broadened coverage. A. Cancellation Clause B. Policy Period C. Pro Rata D. Liberalization: D. Liberalization The time frame is typically 60 days.

6. The states that when there is an unbroken connection be- tween an occurrence and damage that grows out of the occurrence, then the resultant damage is all a part of the occurrence.

A. Doctrine of Proximate Cause

B. Doctrine of Perils & Hazards

C. Insurance Policy Handbook

D. Doctrine of Property Insurance: A. Doctrine of Proximate Cause For example, if a property insurance policy covers the peril of fire but further damage is caused by smoke, water used to extinguish, and the process of moving property away - fire is considered to be the proximate cause of all of the damage.

7. The Loss Settlement Valuation that subtracts an allowance for deprecia- tion is defined as?

A. Actual Cash Value

B. Replacement Cost

C. "Old for New"

D. None of the Above: A. Actual Cash Value

8. A policy condition, either based on information in the insured's application or inserted by the insurer, is defined as:

A. Warranty

B. Misrepresentation

C. Concealment

D. None of the Above: A. Warranty

9. The following are basic characteristics of a property or liability insurance contract, except:

A. Personal Contract

B. Conditional Contract

C. Loss of Settlement Contract

D. Contract of Adhesion: C. Loss of Settlement Contract

10. 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?

A. Conditional Contract

B. Adhesion Contract

C. Indemnity Contract D. All of the Above: A. Conditional Contract "may be conditioned"

11. Which of the following is not one of the "Thresholds" in the "No-Fault" law?

A. Death of the Insured

B. Temporary Injury of the Insured

C. A permanent loss of a bodily function D. Permanent scarring on the face of the insured: B. Temporary Injury of the Insured

Also included: permanent injury other than scarring and disfigurement

12. Under Mechanical Breakdown Coverage, new cars are eligible for service up to:

A. 36 Months/36,000 Miles

B. 24 Months/36,000 Miles

C. 12,000 Months/12,000 Miles

D. 12 Months/36,000 Miles: A. 36 Months/36,000 Miles Used vehicles: 12 Months/12,000 Miles

13. If financial responsibility doesn't exist at the time of an accident, which of the following things must happen to avoid penalties?

A. The legally valid claims of others must be satisfied (up to 10/20/10)

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

C. Both A & B

D. None of the Above: C. Both A & B

14. As to required proof for future accidents by purchase of auto liability in- surance, the insurer must make a filing (Form SR-22) certifying that coverage is in effect, and this certification must remain on file for years: A. 1

B. 3

C. 4

D. 2: B. 3

15. The Business Automobile Policy includes all of the following coverage forms except:

A. The Garage Coverage Form

B. The Trailer Interchange Coverage Form

C. The Truckers Coverage Form D. The Business Auto Coverage Form: B. The Trailer Interchange Coverage Form

16. Personal Injury Protection, or PIP, has a per person, per accident limit.

A. 10,

B. 20,

C. 1,

D. Depends on the damaged property: A. 10,

17. Used to insure businesses engaged in selling, servicing, repairing, park- ing or storing automobiles:

A. Servicing Coverage Form

B. Garage Coverage Form

C. Truckers Coverage Form

D. None of the Above: B. Garage Coverage Form

18. The following examples are referred to as liability limits: 25/50/25 or 10/20/10.

A. Split

B. Single

C. Straight D. None of the Above: A. Split 10/20/10 = 10,000 per person injured 20,000 all injuries combined 10,000 property damage

Example of straight liability limit = $30,

19. Jeremy has a not at fault accident. If he has PIP with a $1,000 deductible, how much can he expect his PIP coverage to pay toward his medical bills that total $3,000?

A. $1,

B. $1,

C. $2,

D. $3,000: A. $1,

3000 (bills) - 1000 (deductible) =

2000 x .80 (eighty percent)

20. Frank has a not-at-fault accident, he has basic PIP, no deductible and Med pay of $5,000. How much will his Med Pay contribute to medical bills of

$15,000?

A. $15,

B. $5,

C. $3,

D. $0, Frank is not-at-fault: B. $5,

Medical Payment limits apply per person; Frank will receive full amount towards medical bills.

21. Which of the following is not one of the rating factors for a Homeowner's Policy?

A. Type of Construction

B. Location of Risk

C. Age & Gender of Insured

D. Proximity to Fire Department: C. Age & Gender of Insured

22. On a Homeowner's Policy, covers items that are not permanently attached to the dwelling. This is defined as:

A. Other Structures

B. Excess Structures

C. Personal Property

D. Dwelling: A. Other Structures

Examples include sheds, fences, pool houses, detached car ports, etc.

23. A lender has an insurable interest in a home and finds protection in the:

A. Loss Payee Clause

B. Mortgagee Clause

C. Lender Clause

D. Additional Insured Clause: B. Mortgagee Clause Mortgagee - Homeowner's policy

Loss Payee - Automobile policy

24. Which of the following forms is "all-risk" on the dwelling policy?

A. DP-1, or the Basic Form

B. DP-2, or the Broad

C. DP-3, or the Special Form

D. None of the Above: C. DP-3, or the Special Form

25. 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: C. Both A & B

26. Which of the following is not covered under Coverage C, Personal Prop- erty?

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: 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.

27. 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: D. A business condo owned by a local insurance company

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

28. 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: D. All of the Above

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

29. 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: C. Loss of Use

The insurer will pay any necessary and reasonable expenses associated with a daily living routine.

30. 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:

A. Preferred Risk Flood Policy

B. Standard Flood Policy

C. Universal Flood Insurance

D. None of the Above: A. 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.

31. Used only for Commercial Condominiums, it covers the unit-owners busi- ness personal property and the personal property of others in the insured's care, custody or control:

A. Condominium Dwelling Form

B. Personal Condominium Unit Owners Form

C. Condominium Unit Owners Form

D. None of the Above: C. Condominium Unit Owners Form Does not cover buildings since coverage would typically be provided under the Condo Association coverage form issued.

32. 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: D. Commercial Loss Schedule Also included: Declarations, Causes of Loss Form, Endorsements

33. Insures a condominium association against direct physical loss or dam- age to buildings, business personal property and personal property of others in the care, custody or control of the association and located at the premises:

A. Condominium Association Form

B. Condominium Unit Owners Form

C. Condominium Insured Owner Form

D. None of the Above: A. Condominium Association Form

This, along with Condo Unit Owners Form, is located under Condo Coverage.

34. 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:

A. Business Property Insurance

B. Building Property Insurance

C. Commercial Property Insurance

D. None of the Above: C. Commercial Property Insurance (the question is the definition for this term)

35. Under Commercial Property Policies, Florida law requires an insurer to give the insured at least days advance written notice of non-re- newal.

A. 25

B. 90

C. 45

D. None of the Above: C. 45

Also, notice must state reasons the policy is not to be renewed.

36. 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 some- what higher than expected peak values.

A. Value Reporting

B. Replacement Cost

C. Agreed Value

D. None of the Above: A. Value Reporting Replacement Cost is incorrect b/c it calculates monetary value of one's personal property

37. Liberalization states, "The insured gets the benefit of any broadened coverage if the company, within days of inception, adopts a form revision that is broader and without increase in premium."

A. 10 days

B. 55 days

C. 65 days

D. 45 days: D. 45 days

38. Used to cover buildings in the course of construction:

A. Builders Risk Policy

B. Builders Replacement Policy

C. Construction Replacement Policy

D. None of the Above: A. Builders Risk Policy

Includes: structure being built (including foundations), fixtures and machinery, equipment to service building, owned materials and supplies used for construction. Temporary structures built or assembled on site are also included if not covered by insurance.

39. First developed as an extension of Ocean Marine coverage, to provide coverage for cargo traveling over land, instead of by sea.

A. Commercial Inland Marine Coverage

B. Personal Inland Marine Coverage

C. Ocean Commercial Coverage

D. None of the Above: A. Commercial Inland Marine Coverage

Definition: to help identify kinds of risks which are eligible for either Ocean or Inland Marine insurance.

40. Protects against loss of business income that results from damage to covered property from a covered cause of loss.

A. Business Income Insurance Coverage

B. Business Income Replacement Coverage

C. Business Income Actual Value Coverage

D. None of the Above: A. Business Income Insurance Coverage Period of restoration begins 72 hours after date of direct damage. In effect, coverage has a 72 hour deductible. Coverage ends on either 1. date when damaged property could be repaired, rebuilt, or replaced 2. date business resumes operations at new, permanent location (whichever comes first)

41. What payment covers several areas of costs related to claims, and are payable in addition to the policy limits?

A. Supplementary

B. Liability

C. Personal Injury

D. All of the Above: A. Supplementary

Generally, all costs of litigation are covered (court costs, prejudgment interest, judgement interest, cost of bonds to release attachments)

42. Three full-time employees from a local furniture company are horsing around and one is pushed into a machine that cut his foot. How will the company's General Liability respond?

A. The Med Pay Section must pay Primary

B. The General Liability Policy will pay up to $20,000 in medical payments

C. The GL policy will not pay

D. Only property damage is covered under GL policy: C. The GL policy will not pay Coverage excludes liabilities under Workers Comp or similar law or arising from injuries to employees of the insured. The employees would have to file through Workers Comp.

43. 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: D. All of the Above

Also included: Nuclear Energy Liability Exclusion endorsement (other endorse- ments may be attached)

44. There is coverage for injury, damage or clean-up costs caused by pollutants, subject to minor exceptions:

A. 50%

B. 10%

C. 0%

D. A Percentage Ratio: C. 0%

45. Under a Commercial General Liability Policy, a basic limit of per person applies to Medical Payments:

A. $1,

B. $10,

C. $2,

D. $5,000: D. $5,

Payment is for medical, dental, hospital, and funeral services incurred within one year of date of accident to persons who suffer bodily injury by accident 1. on or next to insured's owned or rented premises, or 2. due to insured's operations.

46. The Commercial General Liability identifies the named in- sured and address, states the policy period and premium and miscellaneous information about the insured, and specifies the limits of coverage that apply.

A. Declarations

B. Contract

C. Policy

D. None of the Above: A. Declarations States the pertinent information of the policy

47. The Nuclear Energy Liability Exclusion endorsement, in general,

all hazards related to nuclear energy.

A. Includes

B. Excludes

C. Prohibits

D. Summarizes: B. Excludes Firms involved in Nuclear activities receive protection from special insurer pools organized for that purpose.

48. 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?

A. Loss Known

B. Known Loss

C. Claims-Made

D. None of the Above: B. Known Loss

Insurer should have been notified and further investigation of the spill and effective clean-up would have been observed.

49. Applies to BI or PD which occurs during the policy period, regardless of any later time at which a claim is made:

A. Occurrence Form

B. Claims-Made Form

C. Premises and Operations Exposure

D. None of the Above: A. Occurrence 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

50. 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:

A. Occurrence

B. Claims-Made

C. Operations Completed

D. None of the Above: B. Claims-Made Retroactive date is stated in Declarations and will normally be same date as issuing company's first claims-made effective date for insured.

51. 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: A. Up to $750,000 in Death Benefits Compensation for death is payable if death results within one year of an accident or if it follows disability within five years of accident.

52. The following are classes of disability, except:

A. Permanent Total

B. Temporary Total

C. Permanent Impairment D. Temporary Full: D. Temporary Full Also included: Temporary Partial

53. The measure to determine disability benefits is the of the employee at the time of injury:

A. Average Monthly Wage

B. Average Weekly Wage

C. Average Daily Wage

D. Income Estimate: B. Average Weekly Wage

Disability - incapacity due to injury to earn same or any other employment wages that employee was receiving at time of injury.

54. Mandatory for risks exceeding certain annual premiums, recognizes the prior loss experience of the risk and applies either a debit for unfavorable experience or a credit for better-than-expected loss results. This is defined as:

A. The Experience Rating Plan

B. The Retrospective Rating Plan

C. The Risk Plan

D. None of the Above: A. The Experience Rating Plan

This, along with Retrospective Rating Plan, is a manual rating process until premiums reach a certain level.

55. Under workers compensations, a rate is charged for every of payroll to employees.

A. $

B. $1,

C. $

D. $500: A. $

The National Council on Compensation Insurance enforces this rating.

56. 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: D. All of the Above Also included: immediate contact with insurer, providing immediate medical or other services, do nothing to interfere with insured's right of recovery, make no voluntary payments or assume any obligation except at employer's own cost.

57. 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: D. All of the Above

58. 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: D. None of the Above

Samantha is not an employee of the barbecue joint; Workers Comp does not apply.

59. An optional alternative providing for adjustment of premium after expira- tion, based on a guaranteed basic premium to the insurer to which is added the actual losses incurred by the insured. This is defined as:

A. Cost-Plus Rating Plan

B. Experience Rating Plan

C. Retrospective Rating Plan

D. None of the Above: C. Retrospective Rating Plan Often referred to as Cost-Plus Programs

60. Under Employer's Liability, the minimum limits of liability are:

A. 100/100/

B. 100/500/

C. 500/100/

D. 100/500: A. 100/100/

$100,000 for all claims in each accident

$100,000 per employee for disease

$500,000 for all disease claims

61. Under Inside The Premises - Robbery or Safe Burglary of Personal Prop- erty, a special limit of per occurrence applies to articles whose principal value is precious metals, precious or semiprecious stones, pearls or furs, and to the physical or intrinsic value of manuscripts, drawings or records:

A. $1,

B. $2,

C. $4,

D. $5,000: D. $5,

62. Under Crime Insurance, losses must be discovered within 1 year. This is defined as:

A. The Discovery Period

B. The Loss Sustained Period

C. The Open Period

D. All of the Above: A. The Discovery Period

63. Crime Insurance is over any other Insurance coverage.

A. Primary

B. Secondary

C. Excess

D. Recess: C. Excess

A situation may arise where another form of insurance will pay claim - that insurance would be primary.

64. Cover only losses that both occurred and were discovered during the policy period, or within one year of its expiration. This is defined as:

A. Discovery

B. Loss Sustained

C. Sustained Loss

D. None of the Above: B. Loss 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

65. 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:

A. Loss Sustained

B. Valuation

C. Discovery

D. None of the Above: C. 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.

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

A. Theft

B. Burglary

C. Robbery

D. All of the Above: D. All of the Above

Unless the loss is specifically excluded or limited

67. 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:

A. Inside the Premises

B. Outside the Premises

C. Care, Custody, & Control

D. None of the Above: B. Outside the Premises

Also covers robbery of other property under the circumstances.

68. 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:

A. Safe Burglary

B. Inside the Premises

C. Custodial Burglary

D. None of the Above: A. 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

69. Covers for all types of property, when surrendered away from the premis- es 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:

A. Extortion

B. Surrendered Property

C. Client's Property

D. None of the Above: A. Extortion

Also triggered by threats to damage the premises or property within the premises.

70. 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: D. All May Apply Employee Theft may be written in three ways.

71. Which of the following are NOT a type of bond?

A. Contract

B. Fiduciary

C. Court

D. Apprentice: D. Apprentice Contract - fulfill obligation Fiduciary - make good to court for any deficiencies found in performance Court - protect opposing party from loss

72. 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: D. All of the Above

73. Guarantees the performance between the principle and the obligee:

A. Principal

B. Obligee

C. Surety

D. All of the Above: C. Surety

aka Bonding Company; Surety is a "guarantee"

74. This bond guarantees indemnification to the obligee for any losses re- sulting from the principal's failure to complete the contract work in accord with specifications:

A. Performance

B. Bid

C. Court

D. Maintenance: A. Performance Considered a contract bond

75. One who undertakes to perform, to fulfill a contract or to meet an obliga- tion is known as:

A. Principal

B. Obligee

C. Surety

D. All of the Above: A. Principal

Obligee - needs guarantee principal will perform

Surety - guarantees performance between principal and obligee

76. This form of bond is required to accompany a bid for a contract which will require that the successful bidder furnish further bond if awarded the job:

A. Bid

B. Performance

C. Court

D. Maintenance: A. Bid

77. May act as part of the bonding party and agrees to reimburse the surety for any loss it may suffer from having bonded the principal:

A. Indemnitor

B. Surety

C. Obligee

D. None of the Above: A. Indemnitor

Known as "fourth party", may put up collateral

78. Which of the following are parties to a Bond?

A. Principal

B. Obligee

C. Surety

D. All of the Above: D. All of the Above

Principal - undertakes to perform/fulfill Obligee - guaranteed principal will perform Surety - guarantees performance

*Indemnitor - may act as additional party; agrees to reimburse surety for any loss

79. This type of bond covers streets, sidealks, sewers, etc.:

A. Sidewalk

B. Subdivision

C. Supply

D. None of the Above: B. Subdivision Falls under Maintenance Bond

80. When a person has lost stock certificates, bonds or similar instruments, a bond is generally required by the issuing company to reissue the document. This is known as a:

A. Public Official Bond

B. Lost Instrument Bond

C. Public Instrument Bond

D. None of the Above: B. Lost Instrument Bond

Also guarantees to save issuer from any loss growing out of lost instrument

81. A is a selected group of hospitals and medical practitioners in a given area who have joined together in an effort to reduce medical costs.

A. HMO

B. Major Medical Insurance

C. Coinsurance

D. PPO: D. PPO

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

82. Define the coverage that pays a flat amount per day for hospitalization, regardless of expenses or other insurance:

A. Hospitilization

B. Hospital Indemnity

C. Hospital Services

D. All of the Above: B. Hospital Indemnity

83. This optional provision states that if the insured becomes totally dis- abled, premiums are waived but the coverage remains in force:

A. Waiver of Subrogation

B. Waiver of Premium

C. Waiver of Value

D. None of the Above: B. Waiver of Premium "premiums are waived"

84. Provides coverage for expenses, including loss of income, arising from an accident. This is defined as?

A. Accident Insurance

B. Hospitilization

C. Hospital Pay

D. None of the Above: A. 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

85. 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?

A. Conditionally Renewable

B. Guaranteed Renewable

C. Optionally Renewable

D. None of the Above: A. Conditionally Renewable

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

86. The coverage that is intended to afford protection against catastrophic losses is defined as?

A. Major Medical

B. HMO

C. PPO

D. None of the Above: A. Major Medical

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

87. 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: C. Both A & B This helps keep premiums reasonable by eliminating chance of persons buying coverage only when they are sick

88. Characteristics of an HMO plan usually include:

A. Small of non-existent Deductibles

B. Fewer Exclusions

C. Insurance services to members through employed physicians

D. All of the Above: D. All of the Above

Also included: broad coverage, coinsurance provisions

89. 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?

A. Hospitalization Expense

B. Hospital Indemnity

C. Accident Policy

D. All of the Above: A. Hospitalization Expense

Associated with a daily limit, not to exceed specified maximum

90. A(n) provides comprehensive health services to its members for a prepaid fixed fee, equivalent to an insurance premium.

A. HMO

B. PPO

C. Major Medical Plan

D. All of the Above: A. HMO

Referred to as an emerging and increasingly important non-insurance alternative to dealing with risk of health care costs

91. Established in 1973, this association was created for applicants who are unable to obtain insurance in the private market:

A. FWCJUA

B. FWUA

C. Citizens

D. FRPCJUA

E. FAJUA: E. FAJUA

92. In 2002, the Florida Residential Property and Casualty Joint Underwriting Association (FRPCJUA) and the Florida Windstorm Joint Underwriting Asso- ciation (FWUA), were combined to create:

A. FWCJUA

B. FWUA

C. Citizens

D. FRPCJUA

E. FAJUA: C. Citizens

93. Passed during a legislative session in 1993, this association was created for employers who cannot obtain workers compensation insurance in the private market:

A. FWCJUA

B. FWUA

C. Citizens

D. FRPCJUA

E. FAJUA: A. FWCJUA

94. 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 knowl- edge was provided

C. This practice is unacceptable and may result in the suspension or revoca- tion of the Customer

Representative's license

D. This practice is only acceptable if the product training was certified by the Life Insurance Company: C. This

practice is unacceptable and may result in the suspension or revocation of the Customer Representative's license

95. Unlike a Customer Representative, a General Lines Claim Adjuster need not be appointed with the Department of Financial Services.

A. True

B. False: B. False

96. While selling an Automobile policy to a customer, an agent tells them that they are also required to purchase an Emergency Road Service Plan, even though that is not true. This is an example of:

A. Misrepresentation

B. Lack of Fitness

C. Deception

D. Sliding: D. Sliding

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

A. 6

B. 12

C. 18

D. 24: D. 24

98. 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: B. False

99. After pleading guilty or no contest to a felony, a licensed individual has

days to inform the Department?

A. 10

B. 20

C. 30

D. 40: C. 30

100. Must be licensed, appointed by a General Lines Agent and can transact AUTO insurance only in the Office Only.

A. Customer Representative 4-40

B. Limited Customer Representative 4-42

C. General Lines Claim Adjuster 6-20

D. General Lines Agent 2-20: B. Limited Customer Representative 4-42

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

A. True

B. False: A. True

102. 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: B. False

103. An Insurance Company which is formed under the laws of the State of Illinois, and has its Home Office there, is considered a:

A. US Domestic Company

B. Foreign Company

C. Alien Company

D. Unadmitted Company: B. Foreign Company Domestic: this state (FL) Foreign: other state (still in US) Alien: elsewhere

104. One who is involved in the investigation, adjustment, negotiation and/or trial preparations of claims arising under insurance policies is defined as:

A. Insurance Agent

B. General Lines Agent

C. Claims Adjuster D. All of the Above: C. Claims Adjuster Commonly referred to as claims auditor

105. Establishing a dollar value on a claim is defined as:

A. Negotiation

B. Evaluation

C. Adjusting

D. None of the Above: B. Evaluation

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

106. Damaged property that may be retrieved, reconditioned and sold to reduce an insured loss is defined as:

A. Junk

B. Salvage

C. Covered Property

D. Peril: B. Salvage

Efficient disposal of salvage reduces amount of loss to either insured or insurer

107. The voluntary or intentional relinquishment of a known right is defined as a(n):

A. Waiver

B. Estoppel

C. Avoidance of Performance

D. None of the Above: A. Waiver

The law recognizes two types: express and implied.

108. 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: D. All of the Above

109. The adjusters basic activities in claims handling are:

A. Investigation

B. Evaluation

C. Negotiation

D. All of the Above: D. 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

110. 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: C. Denying claims with reasonable investigation

111. An adjuster who represents the financial interests of the insured named in the policy is defined as a(n):

A. Public Adjuster

B. Bureau Adjuster

C. Fee Adjuster

D. Independent Adjuster: A. Public Adjuster

112. When investigating liability insurance claims, which of the following three major elements are determined:

A. Coverage

B. Liability

C. Damages

D. All of the Above: D. All of the Above

113. A relationship that requires maintenance of a high degree of fidelity and loyalty to the interests of the principal, whether or not the adjuster is a direct employee is defined as:

A. Fiduciary

B. Estoppel

C. Public

D. None of the Above: A. Fiduciary

Should always be maintained whether or not the adjuster is a direct employee

114. An adjuster who is self employed and not affiliated with either insurers or bureaus is defined as a(n):

A. Fee Adjuster

B. Public Adjuster

C. Bureau Adjuster

D. Independent Adjuster: D. Independent Adjuster

115. 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: D. Policy Cancellation

116. The assertion of an alleged legal right against an insurer, which carries with it a demand for appropriate relief, is defined as:

A. Adjustment

B. Summons

C. Claim

D. None of the Above: C. Claim

117. Relieving the financial burden on the claimant by making certain pay- ments to the claimant even before the claim can be negotiated is defined as:

A. Advanced Payment

B. Full Release Settlement

C. Non-Advanced Payment

D. Scheduled Payment: A. Advanced Payment

118. The process of disposing of an insurance claim is defined as:

A. Adjusting

B. Claims Management

C. Adjustment

D. None of the Above: A. Adjusting

Also "the negotiation period that results in an agreement"

119. 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: B. Adjusters may negotiate with a claimant who is represented by an attorney

Adjusters MAY NOT. Bad, adjuster, bad!

120. A written statement given by the insured to the insurer acknowledging that money received in the settlement of damages is received, not as a final payment, but as an advance pending an outcome of a claim against the person responsible for the damage. This is defined as a(n):

A. Loan Receipt

B. Subrogation Loan

C. Full Release Statement

D. Partial Release Statement: A. Loan Receipt

Enables insurer to bring an action for recovery against a third party

121. Duties and functions of the Department of Financial Services include all of the following except:

A. Approve the issuance of licenses

B. Rating and underwriting rules

C. Claims Supervision

D. Investigate charges of unethical behavoir: B. Rating and underwriting rules

122. An adjuster who is a salaried employee under the supervision of the home, branch, or regional claims department of insurers is defined as a(n):

A. Company or Staff Adjuster

B. Fee Adjuster

C. Public Adjuster

D. Bureau Adjuster: A. Company or Staff Adjuster

123. 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: D. General Lines Adjuster Bureau Adjusters are also considered adjusters.

124. 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: D. All of the Above

Also: motor vehicle physical damage and health insurance

125. A motor vehicle or mobile home which is a total loss is defined as:

A. Lost Profit

B. Salvage

C. Salvageable

D. All of the Above: B. Salvage

It cannot be restored to prior condition

126. 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,