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A comprehensive set of questions and answers related to the sc claims adjuster exam. It covers various topics including insurance contracts, risk management, claims investigation, and legal aspects of insurance. Designed to help individuals preparing for the sc claims adjuster licensing exam by providing insights into key concepts and practical applications.
Typology: Exams
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What is ACV equation? CORRECT ANSWER Replacement cost-depreciation What is the coinsurance formula? CORRECT ANSWER Cov you did have / cov should've had x loss = claim payment - deductible To serve in The Director's position they must? CORRECT ANSWER Appointed by governor, member of governors cabinet, serve at governors pleasure, bonded by 50000 surety bond Powers and duties of the director CORRECT ANSWER Supervise and regulate rates and service of every insurer in state. Enforce insurance related laws in state.. Reports to Atty General. Acts as circuit judge for insurance matters. License individuals, agencies and companies Qualifications to be licensed adjuster CORRECT ANSWER At least 18; apply either on prescribed form or website, pass license exam, pay $80 license fee; not committed any immoral act grounds for license denial, suspension, or revocation Are nonresident applicants for nonresident license required to provide a SLED Background check? CORRECT ANSWER No What is a resident adjuster CORRECT ANSWER Authorized by SC Dept of insurance to represent insurance companies and write insurance policies to citizens of SC; resident of SC and consider it their home of record companies What is a non resident adjuster CORRECT ANSWER When director enters reciprocal agreement with director of another state and each state accepts the
other's process and accepts the requirements of that state. Adjuster's license must meet min requirement for SC Duty of adjuster CORRECT ANSWER Dispose of claims Staff Adjuster CORRECT ANSWER Salaried employee of insurance company to handle the company's claims Independent Adjuster CORRECT ANSWER Licensed adjuster not directly employed by company but may be contracted to represent a company or organization Public Adjuster CORRECT ANSWER represent the policyholder in the negotiation and settlement of a claim with the staff or independent adjuster Claim investigation process CORRECT ANSWER DENS - Document claim file, Evaluate to determine if insured is liable, Negotiate to come to agreement , Settle Dwelling policy form structure CORRECT ANSWER Agreement; definitions, deductible, Coverages, Perils insured against, General exclusions, conditions Dwelling Policy Eligibility CORRECT ANSWER Up to 5 roomers or boarders; no more than 4 residential units, properties under construction; owner or tenant occupied, mobile homes on basic of its no more than 1 apartment, seasonal dwellings unoccupied for 3 or more months in a 12 month period, Can't be designed as a farm policy When would a nonresident adjuster be able to adjust claims in SC without beinh licensed in SC? CORRECT ANSWER In a catastrophe when there arent enough licensed adjusters in SC to handle claims
How long does the adjuster have to notify the Dept of insurance of change of address? CORRECT ANSWER 30 days What are the rules regarding hearing and notice of hearing? CORRECT ANSWER Director can hold hearing for anything necessary, or can be requested by effected party. Notice must be given 30 days before the hearing and must state the subject of the inquiry and specific charges What are applicable penalties for noncompliance with the SC insurance code? CORRECT ANSWER License suspension, denial, revocation, monetary fines, imprisonment Describe fraud in insurance CORRECT ANSWER A willful oral or written statement intending to deceive or omit material facts EX : applicant misstated their age or occupation applying for property insurance Can a person who has been found guilty of fraud work in insurance? CORRECT ANSWER Yes with a 1033 waiver What are the four elements of an insurance contract CORRECT ANSWER Agreement(offer and acceptance) consideration, competent parties, legal purpose What is a contract of adhesion? CORRECT ANSWER Contract where insured must accept the entire contract with all of its terms and conditions; insurer sets terms and conditions and insured can only "take it or leave it" Definition of indemnify CORRECT ANSWER Restore to same financial status before the loss and prevent financial gain
Definition of representation CORRECT ANSWER Statements believed to be true but not guaranteed to be true Definition of warranties CORRECT ANSWER Absolutely true statement; if breached could make the policy invalid What are the 3 types of hazards? CORRECT ANSWER Physical, Moral, Morale What is risk? CORRECT ANSWER The uncertainty or chance of a loss occurring. What type of behavior constitutes negligence? CORRECT ANSWER failure to use reasonable care resulting in damage or injury to another proximate cause CORRECT ANSWER the act or cause that sets in motion a train of events which brings about a result, without the intervention (direct reason it all happened) Contributory Negligence CORRECT ANSWER A theory in tort law under which a complaining party's own negligence contributed to or caused his or her injuries. Contributory negligence is an absolute bar to recovery in a minority of jurisdictions. Comparative Negligence CORRECT ANSWER A theory in tort law under which the liability for injuries resulting from negligent acts is shared by all parties who were negligent (including the injured party), on the basis of each person's proportionate negligence What is property damage? CORRECT ANSWER means physical damage to tangible property including loss of use.
What is bodily injury? CORRECT ANSWER Includes bodily harm, sickness, disease, pain and suffering, lost wages *hardest to determine monetary value for Special Damages CORRECT ANSWER Can be quantified (out of pocket expenses for medical, loss of wages etc) General Damages CORRECT ANSWER Can't be quantified (pain and suffering, mental anguish, disfigurement) Absolute Liability CORRECT ANSWER a criminal offence in which intent is assumed to be present and need not be proven (hazardous - harboring wild animals that may get loose) Strict Liability CORRECT ANSWER For businesses that make and sell products with implied warranties that the product is safe Vicarious Liability CORRECT ANSWER Legal responsibility placed on one person for the acts of another who would have greater ability to pay such as employers liable for employees or a parent held liable for their minor child Named Peril CORRECT ANSWER A specific cause of loss listed and described in an insurance policy. Also used to describe policies containing named perils. Open Peril CORRECT ANSWER all perils or risks except those specifically excluded. Direct Loss CORRECT ANSWER Direct, physical damage to buildings and/or personal property.
Indirect Loss/Consequential Loss CORRECT ANSWER occurs as a consequence of the direct loss; fire would be a direct loss; loss of rental dollars due to fire would be the indirect loss Blanket Insurance CORRECT ANSWER A single property policy that provides coverage for multiple classes of property at one location, or provides coverage for one or more classes of property at multiple locations. Specific Insurance CORRECT ANSWER A property insurance policy that covers a specific kind or unit of property for a specific amount of insurance. Coverage is specific to one party Describe the ACV method of valuation CORRECT ANSWER Reinforces the principle of indemnity recognizing the depreciation of the value of property as it ages 3 elements of insurable risk CORRECT ANSWER 1. Financial (a monetary interest)
with new property of like kind & quality and for like occupancy without deduction for depreciation. *contrary to ACV as settlement can provide excess Functional Replacement Cost CORRECT ANSWER The cost to replace damaged property with less expensive and more modern construction or equipment. Market Value CORRECT ANSWER the amount for which something can be sold on a given market taking into account land and location rather than JUST the cost of rebuilding Agreed value method CORRECT ANSWER A method of valuing property in which the insurer and the insured agree, at the time the policy is written, on the maximum amount that will be paid in the event of a total loss. Stated Amount CORRECT ANSWER An amount of insurance scheduled in a property policy which is not subject to any coinsurance requirements in the event of a covered loss. Scheduled amt is the MAX insurer will pay in event of a loss Components of a policy structure CORRECT ANSWER Declarations, Definitions, insuring agreement, additional coverage, conditions, endorsements, exclusions/policy limits What is included in declarations page of a policy? CORRECT ANSWER Basic underwriting information (Name, address, amount of coverage and premiums) *summary of all coverages w/o all the details Definitions of a dec page? CORRECT ANSWER Clarifies terms in the policy Insuring Agreement or Clause CORRECT ANSWER The portion of an insurance policy in which the insurer promises to make payment to or on behalf of the
insured. Insuring agreements often outline a broad scope of coverage, which is then narrowed by exclusions and definitions. Additional/Supplementary Coverage on a policy CORRECT ANSWER A provision in an insurance policy that provides an additional amount of coverage for specific loss expense, at no additional premium. Conditions of the Policy CORRECT ANSWER The rights and responsibilities of all parties of the contract. exclusions of the policy CORRECT ANSWER states what the insurer will not do. This includes the risks that the insurer will not cover and persons that are not insured. Endorsements of a policy CORRECT ANSWER Changes to the policy's original terms, conditions, or coverages Cancellation CORRECT ANSWER The termination of an in-force insurance policy by either the insured or the insurer prior to the expiration date shown in the policy. Nonrenewal CORRECT ANSWER A termination of a policy by an insurer on the anniversary or renewal date. Per Occurrence CORRECT ANSWER the maximum amount that can or will be paid by an insurer in the event of a single claim per person CORRECT ANSWER The maximum amount available for payment of bodily injury to a single person in an accident, regardless of the policy limit stated in the policy for bodily injury claims.
Aggregate Limit CORRECT ANSWER The maximum amount an insurer will pay for all covered losses during the covered policy period. Split Limits CORRECT ANSWER the amounts of insurance for bodily injury liability and property damage liability are stated separately; provides separate limits for BI and PD Duties after a loss CORRECT ANSWER 1. Protect the property form further damage
SC property and Casualty Insurance Guaranty Association CORRECT ANSWER In case of insurer insolvencies (unable to meet financial obligations) it will pay covered claims
Clear liability CORRECT ANSWER Responsibility of the insured is clearly established with no defense available ( either 0% your fault or 100% your fault) Doubtful liability CORRECT ANSWER When the Defense has a fair chance of winning, case should be compromised No liability CORRECT ANSWER The insured party has 0% or no liability in the damages to a third party and claim is rejected Reservations of Rights Letter CORRECT ANSWER An insurer's letter that specifies coverage issues and informs the insured that the insurer is handling a claim with the understanding that the insurer may later deny coverage should the facts warrant it. Nonwaiver agreement CORRECT ANSWER A signed agreement indicating that during the course of investigation, neither the insurer nor the insured waives rights under the policy. Declaratory judgement action CORRECT ANSWER A legal action in which the insurer (or insured) presents a coverage question to the court and asks the court to declare the rights of the parties under applicable insurance policy. Declaratory Judgment CORRECT ANSWER A course of action declaring rights claimed under a contract or statute intended to prevent loss or to guide performance by the party or parties affected. Subrogation Clause CORRECT ANSWER Any rights the insured had to sue the person who caused the damage are assigned to the insurance company that has
already paid the insured for the damages. relinquishment of rights of recovery by an insured is limited to extent of amount paid by the insurance company Advance payments CORRECT ANSWER Under clear liability adjuster issues periodic checks to claimant to meet expenses accrued due to the loss Draft Authority CORRECT ANSWER The authority expressly given to an agent by an insurer allowing the agent to settle and pay certain types of claims up to a specified limit Full Release Settlement CORRECT ANSWER Results in immediate payment when the claimant signs a release relinquishing his or her right to sue Scheduled payment release CORRECT ANSWER Sometimes called "open-ended release" or "rehabilitation settlement." The insurer agrees to pay all of the special damages and general damages that have accumulated so far, and agrees to pay special damages in the future. Hey Payment of property damage release CORRECT ANSWER Used in claims with bodily injury and property damage wheee insurer agrees to pay property damage portion of claim while leaving bodily injury open until it can be negotiated No Release or Walk-Away CORRECT ANSWER The bills presented are paid with no attempt to obtain a separate release, although the wording on the draft or check may also serve as a form of release. After a certain amount of time has passed with no further contact with the claimant, the file is considered closed. appraisal CORRECT ANSWER An estimate of the current value of the property.
Appraiser CORRECT ANSWER An independent person trained to provide an unbiased estimate of value umpire CORRECT ANSWER Third appraiser hired to settle disputes between the two appraisers hired by the insured and insurance company Competitive Estimates CORRECT ANSWER Estimate from 2 independent companies for their unbiased assessment of cost to make repairs Mediator CORRECT ANSWER A neutral impartial third party who facilitates a negotiated solution by using reasoning, persuasion, and suggestions for alternatives. (Less formal, but can have their attorneys with them) negotiation CORRECT ANSWER Process where parties resolve disputes, agree on courses of action, bargain for advantage DP1 CORRECT ANSWER Named peril; Most limited; Basic form/ basic coverage Includes fire, lightning, internal explosion Extended coverage perils CORRECT ANSWER Can be added to basic form at no additional premium. Windstorm Hail Aircraft/vehicles Riot/civil commotion Volcanic eruption
Explosion Smoke Vandalism and Malicious Mischief CORRECT ANSWER V&MM is covered basic peril insured can add if they have Extended coverage perils. It covers losses due to vandalism but not theft; excludes glass breakage, actual property stolen from theft, and if premises vacant for more than 60 consecutive days before the loss DP2 CORRECT ANSWER Named peril Covered at RC if insured maintains coverage min to 80% of RC Broad form Covers basic perils + extended coverage perils + VMM Broad form extended coverage perils CORRECT ANSWER Bursting of heating systems Burglary damage Breaking of water heaters Ice/snow/sleet weight Collapse of building or part of building Electrical damage Glass breakage Objects falling from outside Leakage of water , steam damage Freezing of plumbing
What is covered in burglary damage on the broad DP2 form CORRECT ANSWER Damage to any covered property not just the building DP3 CORRECT ANSWER Open peril (all risks covered unless specially excluded) No exclusions for antennas, outdoor equipment, fences from falling objects Identical coverages between broad and special forms : (DP) CORRECT ANSWER Lawn, trees, shrubs, and plants -max $500 per OR 5% of dwelling Breakage of glass Collapse Ordinance of law (addtl coverage for special form) Property Coverage A-Dwelling CORRECT ANSWER 1.Resident dwelling located on the residence premises including any attached structures. 2.Materials/supplies on or next to premise used to construct, alter, or repair dwelling
Structure rented to anyone other than tenant of dwelling when not used as private garage Grave marker Property coverage C dwelling CORRECT ANSWER Personal property 1.Personal property usual to a residence on premises for insured and resident family
2.Coverage continues until repairs are completed for shortest time required 3.Expiration of policy won't end payment of existing covered claim 4.Civil authority prohibits use of property due to damage to neighboring prop payment for loss issued for up to 2 weeks
General Exclusions CORRECT ANSWER Earth movement, water damage (flood), Power Failure, War, Neglect, Nuclear hazard, Govt action, intentional loss Conditions of the Policy CORRECT ANSWER 1. Assignment
DP Coverage L CORRECT ANSWER Supplementary coverage Personal liability Basic limit of $100, Bodily injury or property damage to 3rd parties DP Coverage M CORRECT ANSWER Supplementary coverage Medical payments to others not insured/residents Covers med expenses within 3 years of covered accident $1000 per person What are 3 other coverages in personal liability supplement coverage? DP CORRECT ANSWER Claims expense , first aid to others, damage to property of others Eligibility of HO policy CORRECT ANSWER 1-4 family owner occupied residence 2 families 2 roomers or boarders per unit Life estates, dwellings under construction, townhomes, duplexes Tenants of no owned dwelling (renter) Residential condominium Seasonal dwellings and secondary residences Section 1 of the homeowners insurance policy covers CORRECT ANSWER Property coverage Section 2 of the homeowners insurance policy covers CORRECT ANSWER Liability coverage
Types of HO policies CORRECT ANSWER HO-2, HO3, HO4 HO5 HO6 HO HO2 CORRECT ANSWER Broad Form; Named perils; 1-4 unit owner occupied; What is not covered in HO2 policy CORRECT ANSWER Inside of building by rain snow sleet sand or dust unless wind/hail created opening; Inside loss by falling object unless falling object damaged roof/outside first Fences driveways walks from vehicle owned/operated by resident; Damage from water or steam if vacant more than 60 days HO3 CORRECT ANSWER Special Form, open peril on Coverage A & B, Named peril on Coverage C 1-4 unit occupied Difference between dwelling and homeowners insurance CORRECT ANSWER Dwelling insurance is used in instances for "secondary home insurance" or investment property insurance and covers only the building; homeowners insurance the owner must occupy the dwelling and is referred to as the primary residence the insured lives in for most of the year. What homeowners form provides protection for losses from named perils? CORRECT ANSWER HO-2 broad form
What type of coverage is expanded upon from HO-2 to HO-3? CORRECT ANSWER Vehicle damage to fences, driveways, walks is covered even if caused by an insured or resident What type of coverage does the HO-4 provide? CORRECT ANSWER The HO-4 tenant broad form ensures personal property for the same perils as found in the broad form (HO-2) What is covered under the HO-5? CORRECT ANSWER Comprehensive form that covers open perils on both the dwelling and structures also covers personal property on open peril basis Under HO-6, where may business property be stored? CORRECT ANSWER HO-6 will cover a structure that contains business property solely owned by an insured or a tenant of the dwelling, provided that the business property does not include gaseous or liquid fuel, other than fuel in a permanently installed fuel tank of a vehicle or craft parked or stored in the structure. When replacement coverage is not reasonable what type of HO coverage is applicable? CORRECT ANSWER The HO-8 modified homeowners form is intended for use when replacement cost coverage is not practical. Define Insured in a HO policy CORRECT ANSWER Insured : named insured, residents of premises who are relatives or under 21 in care of insured, full time students under 24 relatives of insured and any person legally responsible for insured animals watercraft or certain motorized vehicles Define insured location in HO policy CORRECT ANSWER Residence premises, premises not owned by insured but where insured is temporarily living, vacant land owned or rented by insured excluding farmland, part of premises rented to insured
except for business purposes, individual or family cemetery plots, land owned/rented by insured where residential dwelling is being constructed What are personal property special limitations for theft of firearms, furs, and letters of credit? CORRECT ANSWER 2500-firearms 1500-furs 1500-letters of credit Personal property coverage in HO policies automatically include a limit of insurance equal to ____% of the coverage A limit. CORRECT ANSWER 50% ; can be increased or decreased but not below 40% for 1-2 family residences What is the purpose of Coverage D Loss of use? CORRECT ANSWER In HO policies Will pay either additional living expenses to maintain normal standard of living or fair rental value if premises is uninhabitable due to covered loss What does debris removal cover on a homeowners policy? CORRECT ANSWER Reasonable expenses for removal of debris of covered property if a covered peril applied to damaged property causes the loss Is liability coverage provided with all HO forms? CORRECT ANSWER Liability coverage is included in all the homeowner's policy forms unlike dwelling What type of coverage is provided by Coverage E? CORRECT ANSWER Personal Liability Coverage for HO policy will respond if a claim is made or a suit is brought against an insured for damages because of bodily injury or property damage caused by an occurrence to which the coverage applies. Under coverage E, what is the basic limit of liability that is included? CORRECT ANSWER $100,000
Under Coverage F, payments for necessary medical expenses will be covered within ____ years of an accident causing bodily injury? CORRECT ANSWER 3 (36 months) What additional coverages are included with liability section of HO policy? CORRECT ANSWER Claims expense, first aid to others, damage to property of others, loss assessment coverage When does the insurer's duty to settle or defend suits end? CORRECT ANSWER When the limit of liability for the occurrence has been exhausted by payment of a judgement or settlement What endorsement should be used if the insured operates a home day care business out of the insured residence? CORRECT ANSWER Home Day Care Coverage endorsement What does the personal injury coverage endorsement provide? CORRECT ANSWER Personal Injury Coverage, including injuries that result from false arrest, libel, slander, defamation of character, and invasion of privacy may be added by endorsement. How does the mobile home endorsement affect the other coverage of law or ordinance in a homeowners policy? CORRECT ANSWER It removes the coverage How does the mobile home endorsement change the homeowners policy? CORRECT ANSWER Covers a mobile home and other structures on land owned or leased by the resident of the mobile home
What types of vehicles are covered under a personal auto policy? CORRECT ANSWER Any vehicle on the declarations page, newly acquired vehicles for 30 days, trailers owned by the insured, and temporary substitute vehicles Define a newly acquired auto CORRECT ANSWER Any vehicle acquired by the insured during the policy period. Difference between a newly acquired auto and a covered auto in a PAP CORRECT ANSWER Covered auto is any vehicle shown on the dec page and a newly acquired auto is a vehicle acquired by the insured during the policy period What supplementary payments are provided in the PAP? CORRECT ANSWER Bail bonds up to $250; Premiums on appeal bonds; Interest on a judgement; Other reasonable expenses by request of insurer including up to $200 a day for loss of earnings for assisting in legal proceedings What losses are excluded from coverage in the liability section of the Personal Auto Policy? CORRECT ANSWER Intentional injury or damage, damage to property owned or transported by the insured, use of a vehicle as a public conveyance, or use of a vehicle without permission, motorized vehicles with less than 4 wheels, What does liability section of the PAP protect the insured against? CORRECT ANSWER Loss arising from legal liability when an auto the insured owns operates or maintains is involved an accident
What is a combined single coverage? CORRECT ANSWER Uses 1 dollar amount to indicate the max coverage for all losses regardless of the number of people involved or amount of pd Under the other insurance clause for PAP for nonowned vehicles the insurance will be considered _____ over any other collectible insurance CORRECT ANSWER Excess 4 ways a motor vehicle can be classified as uninsured CORRECT ANSWER No liability bond or insurance on vehicle; Bond on insurance is less than that required by financial responsibility laws of the state where accident occurred; Accident was a hit and run & driver can't be identified; Bonding company/insurance company denies coverage or is insolvent What is an uninsured motorist? CORRECT ANSWER Person who owns or operates a vehicle but does not carry liability insurance What coverages are available in the physical damage section of the PAP? CORRECT ANSWER Collision and other than collision (comprehensive) How much will a physical damage policy pay for transportation expenses due to a theft of covered auto? CORRECT ANSWER Up to $20 a day max $600 ; begin after 24 hour waiting period for reasons other than theft; beginning 48 hours after the theft Describe the duties of an insured motorist that is involved in an accident CORRECT ANSWER Promptly notify insurer of loss; Cooperate with insurer;