Adjuster License 6

Which of the following would be covered under the Jones Act? A. Crew members of a ship B. Tourists on a cruise ship C. Repairs of ships D. Loaders of ships

A. Crew members of a ship The Jones Act applies to crew members of a vessel operating on the waters. It allows injured employees (or their survivors) to sue the vessel owner for negligence that results in injury or death.

Information a/b the premium & policy limits, the identity & address of the named insured, & the policy period is found in which part of an insurance policy? A. Declarations B. Conditions C. Insuring Agreement D. Exclusions

A. Declarations

Which of the following is covered under the Federal Employees Compensation Act (FECA)? I. Fed EE exempt under state w/c laws II. Active duty military members III. Memebers of the Merchant Marine under the Jones Act IV. Longshoremen & Harbor Workers A. I only B. I, II & III only C. I & III only D. I & IV only

A. I only The Federal Employers Compensation Act covers federal EE, excluding active-duty military, the Coast Guard & The Merchant Marine. The Jones Act covers civilian sailors at sea while Longshoremen & Harbor workers can be covered by private employers under their own endorsement.

Which of the following best describes a competitive state when it comes to w/c coverage? A. Private insurance company writes w/c coverage, but the state also writes coverage that competes with the coverage offered by private carriers. B. All w/c coverage offered in the state is provided by private insurance carriers that compete against one another C. All w/c coverage offered in the state is provided by state programs D. All w/c coverage offered in the state must be provided by the state's residual market program.

A. Private insurance company writes w/c coverage, but the state also writes coverage that competes with the coverage offered by private carriers.

What kind of risk is this? Ex. would be medical expenses, liability lawsuit, damage to property by fire or lighting. A. Pure Risks B. Speculative Risks C. Static Risks D. Particular Risks

A. Pure Risks

Which of the following statements a/b risk is the most accurate? A. Risk can be retained, shared, transferred, avoided, or reduced. B. Risk is most properly assumed when loss potential is catastrophic. C. Risk is any characteristic or condition that increases the chance of loss. D. Total risk is reduced by the use of deductibles & insurance.

A. Risk can be retained, shared, transferred, avoided, or reduced.

These risks are historical factors that do not frequently fluctuate. These risks may or may not occur and are therefore insurable. A. Static Risks B. Dynamic Risks C. Fundamental Risks D. Particular Risks

A. Static Risks

What is the purpose of the "Other States" coverage of a standard workers' comp policy? A. To provide coverage for exposures that develop in other states during the policy period. B. To provide coverage in any other state the EE selects. C. To provide blanket coverage in any other state in which the insured may operate. D. To provide coverage in one or more of the "monopollistic" states.

A. To provide coverage for exposures that develop in other states during the policy period. The "Other States" coverage applies to both w/c & Employers Liability coverage under a w/c policy. The purpose is to provide coverage against loss exposures which develop during the policy period (but were not present at policy inception), in any state designated on the information page of the policy.

Which of the following best describes the purpose of the "insuring agreement" contained in an ins. policy? A. To the insurer's promise to pay in case of a loss. B. To identify the named insured who is bound by the contract C. To explain the duties of the named insured in case of a loss. D. To set forth the conditions & exclusions.

A. To the insurer's promise to pay in case of a loss. The insuring agreement section of the policy contains the insurers promise to pay. This is the section where the "contractual agreement" is located.

Tort law applies to all of the following EXCEPT: A. Liability arising from the commission of an unintentional tort B. Liability arising from negligence C. Liability arising from a breach of duty D. Liability arising from breach of contract

B. Liability arising from negligence A tort is a civil wrong, not arising from a contract. Contract law is a completely different branch of law

Which of the following would be info an IME physician would require from the w/c adjuster in order to complete the IME reports? A. A detailed list of the injured worker's dependents & their ages B. The injured worker's detailed job description provided by the employer that is now part of the claims file C. An itemized lists of how the injured worker is being compensated while he/she is recovering from injury D. A statement from the employer as to whether or not the worker has a "light duty" job waiting on him or her if the IME shows that the employer can return to work.

B. The injured worker's detailed job description provided by the employer that is now part of the claims file The adjuster should provide the employee's detailed job description as this would assist the IME physician in determining if the injury was work-related or non-work-related

Widgets Warehouse has submitted a FROI to their w/c ins. co. for an injury sustained by one of their EE. After an investigation, the insurer has decided to deny the claim. Which of the following is true in this situation? A. Widgets Warehouse will be required to pay all expenses involved with the claim B. The ins. co. must forward to the injured EE an official written notice of denial. C. The ins co is prohibited from denying the claim b/c w/c is a no-fault coverage. D. The ins. co. must refer the claim to the WCC for payment of the medical expenses of the EE.

B. The ins. co. must forward to the injured EE an official written notice of denial.

Which of the following is true regarding pure & speculative risks? A. With speculative risk the end result is always known B. With pure risk there is only the possibility of loss C. Speculative risks always result in a financial loss D. Pure risks always result in financial gain.

B. With pure risk there is only the possibility of loss Remember that pure risk is insurable b/c there is only the possibility of loss.

An insurance contract that means it is contingent upon an uncertain (random) event that provides for an unequal transfer of value between the parties. A. Contract of Adhesion B. Personal Contract C. Aleatory Contract D. Conditional Contract

C. Aleatory Contract

All of the following are exceptions to the w/c exclusive remedy EXCEPT: A. Failure of the employer to provide benefits B. Third-party-over actions C. An on-the-job injury caused by worker fatigue from working on excessive number of over-time hours D. The fellow worker doctrine

C. An on-the-job injury caused by worker fatigue from working on excessive number of over-time hours An on the job injury would be covered, whether or not it was caused by worker fatigue. All of the other answer choices are exceptions to the exclusive remedy provided by w/c.

The Jones Act allows the crew of the ship to sue their employer for negligence that results in injury or death using the: A Modified Comparative Negligence Standard B. Contributory Negligence Standard C. Comparative Negligence Standard D. Modified Contributory Negligence Standard

C. Comparative Negligence Standard

In order for a contract to be binding, all parties must have the necessary competence, to enter into the contract. Ex. minors, mentally incompetent, signing a contract while under the influence of drugs or alcohol. An exception is a 15 yr old who is a minor is deemed to have the capacity to contract for Life Ins. A. Consideration B. Legal Purposes C. Competent Parties D. Offer & Acceptance

C. Competent Parties

Which of the following are covered by the Federal Employers' Liability Act (FELA)? A. Longshoremen & Harbor workers B. Coal Miners C. Employees of Interstate Railroads D. Crew members of federal waters & high seas

C. Employees of Interstate Railroads The Federal Employers' Liability Act (FELA) applies to employees of interstate railroads. Like the Jones Act, it allows workers or the survivors of deceased workers to sue their employers for occupational injuries resulting form the employers negligence.

Part One of the NCCI standard workers' compensation policy specifies the: A. The schedule showing the dollar limit of the policy coverage. B. Amount of coverage that federal programs will pay. C. Statutory provisions of the policy. D. The schedule showing the dollar amount paid for exemplary damages.

C. Statutory provisions of the policy.

Wyatt is a blasting contractor who set off a blasting charge, demanding several buildings in the area and causing severe bodily injury to several people which of the following types of liability apply in this scenario? A. Comparative Liability B. Contingent Liability C. Strict Liability D. Vicarious

C. Strict Liability Strict (Absolute) liability would be applied here without any need to prove negligence. Strict liability is imposed by law on those who participate in especially hazardous activities.

Axel Jamison contacts an insurance agent to purchase a Homeowners policy. The agent advises Axel that he will stop by later that day to inspect the home & take the policy application. The Homeowners policy, with personal liability coverage is issued later that week, and the next day a snake escapes and bites a neighbor. How will the adjuster handle this claim? A. The claim will be paid because the policy provides personal liability coverage. B. The claim will be denied based upon soft fraud. C. The claim will be denied because Axel is guilty of concealment. D. A reservations of rights letter will be issued to the insured while the adjuster continues the claims investigation.

C. The claim will be denied because Axel is guilty of concealment.

With w/c ins. the insurer is considered to have received notice of a claim: A. When the employee informs the insurer B. On the day the insurer receives notice of the claim by certified mail C. When the employer has notice of the claim D. When the employer informs the insurer

C. When the employer has notice of the claim

All of following are criteria for an accident to have occurred "in the course of" the employment under a w/c policy EXCEPT: A. the accident occurred on the employee's premises B. The accident occurred during the injured employees regular working hours C. While performing a task that a fellow worker requested, that was unusual to the employees job description, but occurred on the employer premises during working hours

C. While performing a task that a fellow worker requested, that was unusual to the employees job description, but occurred on the employer premises during working hours

The Commissioner of Insurance will not issue a license to any nonresident applicant until the applicant has filed the forms to designate the LA Commissioner of Insurance as the true & lawful agent of the applicant in the case that any interested person initiates an action or lawsuit against the non-resident licensee in LA. The designation will allow the notice of the action or lawsuit to be served upon the Commissioner who will provide notice to the nonresident licensee within: A. 30 days of the date of service B. 20 days of the date the lawsuit or "action" was filed C. 5 days of the date the lawsuit or "action" was filed D. 10 days of the date of service

D. 10 days of the date of service

Melinda's insurance policy is cancelled because she has not paid the premium. In this scenario, which of the elements of a valid contract is missing? A. Competent parties B. A legal purpose C. An offer & an acceptance D. A valuable consideration

D. A valuable consideration

Maggie is a cleaning professional who works for Maid My Day household cleaning services. Maggie Mae is traveling in her own vehicle, to a client's home when she strikes an hits a pedestrian. Maggie is liable as the owner & operator of the vehicle, but Maid My Day could be held ______________ liable, because Maggie was acting on their behalf. A. Vicariously B. Contingently C. Contributorily D. Absolutely

D. Absolutely

Which of the following is the best explanation as to the reason ins. policies are called "unilateral contracts"? A. B/c the ins. contract will only restore one party to the contract to his previously held financial position B. B/c the ins. contract is based on the insured's personal insurable interest. C. B/c the insured is the only party to the contract that is required to pay a premium. D. B/c the ins. co. is the only party to the contract that can be sued if they do not meet the terms.

D. B/c the ins. co. is the only party to the contract that can be sued if they do not meet the terms. An insurance policy is unilateral b/c only one party is legally bound to perform its part of the agreement.

Which insurance contract means that the contract is drafted by one party with stronger bargaining power (the ins co.) & accepted by another party with weaker bargaining power (the insured). In case of ambiguous language in the ins. contract the courts will usually find in favor of the insured. A. Executory Contract B. Unilateral Contract C. Contract of Indemnification D. Contract of Adhesion

D. Contract of Adhesion

The part of a standard workers' compensation policy that contains the cancellation procedure is: A. Part One- Worker's Compensation B. Part Two- Employers Liability C. Part Five- Premium D. Part Six- Conditions

D. Part Six- Conditions Part Six- Conditions spells out the cancellation procedures

Which of the following factors is the most crucial in distinguishing between an employee-employer relationship & an independent contractor relationship? A. The number of hours a worker spends doing the job for the employer B. The place at which the work is performed C. Whether the worker used his or her D. Whether the employer controls the manner in which the work is performed

D. Whether the employer controls the manner in which the work is performed When an employer controls the manner in which an employee or an independent contractor performs the work, the employer could be responsible for work-related injuries