Claims Adjuster Exam
15/15/5 rule
15 calendar days to send notice you received claim 15 business days to resolve case 5 days to pay claim (if applicable)
Article 542.003 (acknowledge)
15 days to acknowledge receipt of new claim
Inland Marine (build milk policy) would cover e.g.
3k gallons of milk in tanker truck
ISO
A policy sold in Texas, but is not a Texas Policy form
Personal Injury Protection would require this
A written letter of rejection if coverage in policy were rejected
Replacement cost less depreciation
Actual Cost Value can also be defined as the current
Call supervisor & find out companies rules regarding salvaged items
Adjuster pays for total loss of most contents in home following nasty fire confined in kitchen--smoke & water damages were extensive but some items salvageable. What should adjuster's next move be in regard to salvageable items?
15 business days to...
Affirm or deny payment once insured has complied with all claim department's requests
Immediately be paid
After all investigation is complete & you're aware that liability for insured's claim is clear, when should claim get paid?
Contractual Liability
Agreement which one party voluntarily accepts cost of someone else's potential risk of loss
Withheld (recoverable) depreciation
Although "holdback" is not a term used in property, commonly used by adjuster... what does it refer to in terms of claim payment
Multi peril or package
Any policy that provides both property and liability coverage
Multi Peril-Package
Any policy which provides property & liability coverage (not homeowner)
2 hours...
At least how many hours must be on the subject of ethics or consumer protection?
Liability will respond to demands of... E.g.
Auto insured has lost control of auto & caused damage to parked car. which covered in policy will respond to demands of parked car? E.g.
In scenarios where things may look, feel & actually would be inappropriate:
Better to appear inappropriate than to behave innapropriate lay E.g. Insured offers adjuster gift card for doing great job & working hard--be polite and decline with appreciation
E.g. Owner of a taxi who needs collision damage for his own taxi
Business auto e.g.
If a claim cannot be resolved, what is usually the final venue for resolution?
Court
Ocean Marine Hull Coverage
Cover potential collision damage to insured's ship
Commercial General Liability coverage
Covers basically any risk imaginable that would "cause" bodily injury or property damage E.g. Customer slip-fall; hit by debris; escalator lurching;poison get well card
Firefighters during a fire e.g.
Direct loss from water would be covered if caused by...? E.g.
Combustion or Rapid Oxidation
Fire is defied as this and this accompanied by heat and flame or visible glow
Friendly fire--classified as
Fire that is intentionally set & remains within its intended boundaries is classified as
Types of claims I am unable to do without attaining other licenses? (Name at least 2)
Flood Workers comp Crop Coastal wind Etc....
Garage Liability e.g.
For valet parking service to have appropriate liability coverage it needs what kind of policy?
Garage Liability
For valet parking service to have appropriate liability coverage... Need what policy?
Transfer, reduce, retain or avoid are the 4 ways to...
Four methods of handling a pure risk
Hostile Fire
Friendly fire that escapes its intended boundaries & does damage
Texas Standard Fire Policy
Granddaddy of all Texas property policies
Adjuster has to total home due to tornado & insured has replacement cost policy--what is upper payment threshold? E.g.
Highest threshold is the limit, next is replacement cost/cost of rebuilding e.g.
Any Homeowner policy e.g.
If owner-occupant wants liability and property coverage, they must purchase... E.g.
ACV & broad named peril
In TDP-3, dwelling is covered for all risk and replacement cost, but PP is covered for...
Fingerprinting
In addition to application for license, certificate of completion and payment of license fee, Texas residents are required to also get...
At least 80% of replacement e.g.
In all risk TDP what % of actual replacement cost must be insured to actually have replacement cost coverage? E.g.
You have 91 days
In an umbrella policy there is a provision that
Known as Gap Coverage
In an umbrella policy there is a provision that allows for payment in case underlying policies exclude coverage for even which is....
E.g. 3,000 gallons of milk in tanker truck
Inland Marine (Bulk Milk) e.g.
None of them respond to this damage
Insured has "full coverage" under auto, accidentally backs over his own motorcycle--what part of policy respond to his claim for motorcycle damage?
None will pay, even policy described as it is not "full coverage"--no such thing
Insured has full coverage on home, auto, & boat--falls down stairs at home, seriously injures knee, which policy might pay medical bills?
Insured has no liability over that property e.g.
Insured's care, custody & control of other people's property is given unusual treatment in any liability policy e.g.
Exclusions--clarify policy as well as...
Insuring agreement--clarifies the policy as well as...
Paying premiums
Is the first thing insured must to have coverage prior to any loss
Covered (if it's not written)
It's safe to assume that if something is not excluded in writing it's appropriate to assume that the loss is?
Personal Injury examples
Libel slander & wrongful detention (among others) are examples of what?
Companies do not deal with this risk
List all the ways Insurance deals with this risk
Only Texas DP 1
Mainly the only TDP sold, now with plethora of endorsements
Insured and covered persons
Medical payments coverage on auto policy provide medical benefits for injury to...
Named insured, spouse if living in same household e.g.
Most exclusions in policy take away something then give it back by saying "does not apply to you or any family member."..... Who is "you"?.... E.g.
surety bond is this type e.g.
Name a type of bond that one party guarantees with money the performance of another party to another 3rd party? E.g.
Personal injury Protection e.g.
Name of coverage offer in auto policy that would pay medical bills incurred by insured as result of at fault accident e.g.
How many Texas Dwelling policies are sold now?
ONE
When can you get TAIPA
Once you've been rejected by 2 or more insurance companies
You will find this phrase in insuring agreement e.g.
Other than declaration, where in broad form policy will you find phrase "collapse of building"? E.g.
Business auto coverage e.g.
Owner of a taxi to cover collision damage
Tx Personal Auto Policy e.g.
Owner of family far, for potential injury to other people
3rd party or claimant
Person who is not party to contract but has interest in coverage is...
Open peril, special, or all risk policies are...
Policies that do not name/list covered perils
Dwelling Form 3 or equivalent e.g.
Policy a landlord purchase would provide best coverage on a rental property e.g.
Fire, vandalism & malicious mischief, are suspended
Policy condition that causes us to be concerned about building being vacant beyond a period of (usually) 60 days
Scoping
Property claims equivalent of investigating a loss
Insurance for Insurance companies
Reassurance in very simple terms...
Actual Cash Value (ACV)
Replacement cost less depreciation
Reserve
Required to establish approximate value of claim & establish figure known as "what" to make funds available for payment
Excluding real property, any property "totaled" becomes:
Salvage
Legal duty to someone
Settling a liability claim on behalf of insured takes care of the insured's:
Texas Standard Fire Policy, Standard Fire Policy e.g.
Small Texas retail store would have to buy one of these 2 if they did not want liability policy...? e.g.
ISO policy
Sold in Texas, but not Texas form
Inland marine Cargo e.g.
Someone who bought and is importing furniture from Thailand would want what kind of policy to cover potential damage? E.g.
Subrogation definition:
Standing in the shoes of he insured and exercising the insured's common law rights to recover paid damages from legally responsible 3rd party defines what?
E.g.Fire damage to small greeting card shop (3 possible policies)
Texas Standard Fire, Standard Fire, Business owner e.g.
Options for High Risk Drivers?
Texas started TAIPA Risk pool
TX Dwelling Form 1
The dwelling policy sold in texas
Texas Standard Fire Policy is...
The granddaddy of all Texas property policies
Trucker's policy
Trucking company, for potential damage to other people's trailers which the trucking company may be pulling
This license approves you to handle both property & liability claims, true or false?
True
Flood, workers comp, crop, costal wind among others
Types of casualty claims I will be unable to handle under license I'm studying for
Must have 30 hours
Upon receipt of License you're required to have how many hours of continuing education before next renewal
Persons and property
Vacancy of commercial building or residential property is described as property with...
Article 542.003 (claim to be paid)
We have 5 business days to make payment once we have told insured claim or part of claim will be paid
Property and Liability
What 2 default lines of insurance are included in homeowner and business owner policy
Minus PIP ($2,500) Uninsured/underinsured motorist coverage
What does TAIPA provide?
Actual Cash Value (ACV)
What is replacement cost less depreciation?
Provides coverage that was excluded on an underlying policy
What is the function of Gap Coverage in an Umbrella Policy>
To protect assets
What is the purpose of insurance?
Falling objects, Water loss (flood is not the answer)
What would not be covered as direct loss in any of the least expensive policy forms (limited, standard, basic)? E.g.
Flood would result
What would result from rising water which has touched eart?
Negotiation
When 2 or more parties talk out a solution to a dispute; mutually agreeable compromise; "act of "talking it out"
Vacant
When a property is empty of all persons & property it is considered
Proof of loss
When insured files claim that is suspected of being potentially fraudulent--you should always have him file a motorized what?
When is it safe to assume something is covered?
When it is not excluded
Promptly or immediately e.g.
When must first party loss be reported to insurer? E.g.
Aviation is another place you find this policy
Where else other than ocean marine policies will you find "hull coverage...?
Declarations Page e.g.
Where will you find where the damaged property is located? E.g.
Notify the insured
Within 10 days after receiving an offer of settlement in investigation & handling of liability claim against our insured
Texas Standard, Standard Fire & Business Owner
Would all cover damage to something like a gift card shop fire
Ocean Marine Hull coverage
Would have to be written for an insured to cover potential collision damage to insured's ship
Knowingly (21.21)
______________ misrepresenting to claimants pertinent facts or policy provisions relating to coverages at issue is on of provisions of Article 21.21 of Texas Insurance Code
Delay or refuse (21.21)
it's a violation of article 21.21 to ______ or ______ settlement of claim solely because there is other insurance of different type available
show Insurable interest in order...
to buy insurance policy on property or on life of another person must...
Denial of claim
what resolution of claim is considered least desirable, though sometimes inevitable?
