Chapter 15

Certificate of Insurance

Any document or record, including an electronic record, that is provided by an insurer or producer to a third person as evidence of property and casualty insurance coverage

Licensee

Any licensed insurer, HMO, producer, or other person licensed or required to be licensed

It is not considered an unfair claim practice to settle a claim by __________

Arbitration

Member Insurers

Are those that are admitted to transact insurance in Louisiana

Amendment of Policy Provisions-Louisiana (PP 01 95)

-This selected endorsement must be attached to the Change endorsement if issued after the policy is written -This endorsement modifies the personal auto policy

Benefit Payments- Waiting Period

-For temporary total/ permanent total disability or death -For permanent Partial Disability -Medical Benefits

Louisiana Automobile Insurance Plan

This plan provides auto insurance or individuals who have been unable to obtain auto insurance through normal markets

The Deputy Commissioner

-Has the authority to perform all of the Commissioner's duties if the commissioner is absent or unable to act

The Louisiana Insurance Commissioner

-Is elected for a 4-year term -Administers and enforce Louisiana's insurance code and related laws

Unfair Discrimination (Life/Health)

Allowing individuals of the same class, life expectance: -To be charged different rates for the same coverage -To receive different benefits -To have differing terms and conditions

An "Act of God"

An incident due directly to natural causes and exclusively without human intervention

A licensee establishes a _____________ when the licensee and customer enter into a continuing relationship

Customer Relationship

Unfair Discrimination (All Lines)

Refusing to insure or renew or limiting coverage on an individual solely because of: -His sex, marital status, race, religion or national origin -Another has cancelled a policy or refused to write or renew a policy in which the applicant was a named insured

Unfair Discrimination (Property/ Casualty)

Refusing to insure or renew, cancelling or limiting coverage on a property or casualty risk solely because of: -The property's location or age -The insured's being mentally/ Physically impaired -The insured's filing for bankruptcy -A lapse in coverage due to military deployment

Permanent Partial Disability

This benefit amount will be 66-2/3% of the employee's wages but the benefit period will depend on the specific injury

Transfer of Rights of Recovery Against Others to the Insurer

This condition is modified so that the insured may waive the right to recover against another party: A. Before a loss to covered property or income B. After a loss to covered property or income

Under Part D- Coverage for Damage to Your Auto

This coverage applies only when the vehicle is loaned by a person in the business of selling, repairing, or servicing autos

Misrepresentation

-Misleadingly representing or fraudulently comparing policies -Presenting policies as shares of stock

Louisiana Insurance Underwriting Plan (Costal Plan)

-This plan provides coverage for properties in Louisiana's costal areas -The plan provides coverage against direct physical damage to property caused by: 1. Fire, with/without extended coverage and vandalism and malicious mischief 2. Windstorm and hail, but only with respect to dwellings and commercial properties on a monoline basis

The Department of Insurance

-Under the Commissioner's direction -Carries out the regulations pertaining to producer qualification and licensing as well as the certification of insurers

UM

-Will cover bodily injury when an accident is caused by an automobile having no physical contact with the injured person or the vehicle the injured party was occupying -Unidentified vehicle, or an uninsured/underinsured vehicle

Louisiana Workers' Compensation Corporation

It offers a preferred risk policy program and an accepted risk program

False Information and Advertising

Presenting ant information or advertisement that is false or misleading about any person in the conduct of his/her insurance business

Misrepresentation in order to induce a person to lapse, cease, or forfeit an existing policy is known as ______

Twisting

The primary purpose of licensing is to protect the ______

General Public

Personal Injury-Louisiana (HO 24 81)

This endorsement adds liability coverage for personal injury

Defrauding

Knowingly, and with intent to defraud, making or presenting a written statement supporting, opposing, or attached to an application that does either of the following: -Contains materially false information -Applies to a claim that contains materially false information or conceals material facts

False Financial Statements/ False Entries

-Knowingly filing, delivering, or placing before the public any false material statement about an insurer's financial condition -Knowingly making a false entry or omitting a true entry of any material fact pertaining to the insurer's business

Covered Injuries

Injury and Personal Injuries include only injuries by violence to the body's physical structure and such disease or infection as many naturally result form it

Rebating

Offering any rebate, premium discount, advantage, or valuable consideration not specified in the policy

Death Benefits

Payment to dependents will be computed and divided equally among them

Under the Contents Broad From, HO 03 41

Provides coverage for the accidental discharge or overflow, for more than one week, of water or steam only if the damage is hidden and every insured is ignorant of the discharge or overflow

Limited Fungi, Wet or Dry Rot, or Bacteria Coverage-Louisiana (HO 03 41, HO 03 42)

This endorsement adds coverage for damages caused by fungi, wet/dry rot or bacteria

Louisiana Citizens Property Insurance Corporation

-This corporation is to provide essential property insurance for residential and commercial property for applicants who are in good faith entitles, but are unable, to produce insurance through the voluntary market -Is nonprofit and shall operate residual market insurance programs, designated as the Costal plan and the FAIR plan -Determines rates to be charged

Lessor- Additional Insured and Loss Payee

-This endorsement changes a leased auto to be considered an auto the insured owns, rather than hired or borrowed -This endorsement includes the lessor named in the schedule as an insured -The coverage provided under this endorsement apply to any leased auto described in the Schedule until the earlier of the expiration date shown in the Schedule

Louisiana Insurance Guaranty Association

-Used to pay claims of insolvent insurers -Is used to protect policy owners and beneficiaries from the failure of insurers

Unfair Claim Settlement

Attempting to settle a claim for less than the amount that a reasonable person would believe he/she is entitled by reference to written or printed advertising material

The Inspection Bureau

Determines the insurability of the properties for which insurance is sought (property must be insurable)

Boycott, Coercion, or Intimidation

Entering into action resulting in an unreasonable restraint of, or monopoly in, the insurance business

Supplemental Earnings

For any injury resulting in an employee's inability to earn 90% of what he/she was earning when injured

Extraterritorial Coverage

If an employee is injured while working outside the territorial limits of Louisiana, he/she or the dependents shall receive benefits if: 1. The benefits would have been payable had the accident/ injury/ death occurred in Louisianan 2. The employment is principally located in Louisiana 3. He/ she is working under a contract of hire made in Louisiana

Defamation

Making any false statement maliciously critical of, or derogatory to, any insurer's financial condition with the intent to injure someone in the insurance business

Builders or Other Temporary Insurance

May be made, orally or in writing, and shall be deemed to include all the policy terms and endorsements

Sharing a commission with another licensed producer in the same line of insurance is_________

Permitted

Cancellation Clause

Specifying the hour of the day at which the insurance shall begin, may be superseded by the express terms of the binder or other temporary insurance

Fair Access to Insurance Requirements (FAIR) Plan

The FAIR plan allows the purchase of basic insurance on property that otherwise meets underwriting standards when it cannot be obtained through standard markets because of geographic location

Administration

The Workers' Compensation program is administered by the Office of Workers' comp Administration under the supervision of the Department of Labor

Drive Other Car Coverage- Broadened Coverage for Named Individuals

This endorsement is used to add a Named individual to an auto policy for a vehicle that the named individual does not own

Special Provisions- Louisiana (01 17)

This endorsement makes changes to the standard homeowners policy form

Lessor- Additional Insured and Loss Payee (CA 04 13)

This endorsement modifies insurance provided under the following: -Business Auto Coverage Form -Business Auto Physical Damage Form -Garage Coverage Form -Motor Carrier Coverage From -Truckers Coverage Form

Additional Coverage

This endorsement provides additional coverage of up to $1,000 for a loss assessment that a property owner's association that is not a government body charges against the insured in connection with any covered personal injury liability

Property Coverage

This endorsement specifies an additional limit for property coverage, regardless of the number of occurrences, claims made, or locations insured

Binder

This is used to temporarily bind insurance and is only valid until the policy is issued

Privacy of Customer Financial Information

This rule applies to nonpublic financial information about individuals who are claimants or beneficiaries or who obtain products or services primarily for personal, family, or household purposes from the Department's licensees

Cancellation and Nonrenewal of Auto Insurance

This section applies to personal auto insurance that has not been assigned to an assigned risk plan

Rehabilitation/ Retraining Services

When an injured employee cannot earn wages equal to those earned prior to the injury, he/she is entitled to rehabilitative and retraining services A. Retraining programs shall not exceed 26 weeks but may be extended for up to 26 additional weeks. Insurers may extend for longer periods it they wish B. The injured employee must request and begin retraining within 2 years after temporary total disability is terminated Compensable retraining costs include board, lodging, or travel

Benefits Payable

Workers' Comp benefits include medical/vocational rehabilitation expenses, as well as all necessary drugs, supplies, hospital care/services, medical/surgical treatment and any nonmedical treatment recognized by the State of Louisiana