Ch. 19 - NY State Law Chapter

The insured's auto policy issued in New York has bodily injury limits of $500,000 per person and $1 million per accident. What are the highest limits the insured may purchase for uninsured/underinsured motorist coverage? a. $250,000/$500,000 b. $500,000/$1 million c. $1 million/$2 million d. 100,000/$300,000

a. $250,000/$500,000 Uninsured/underinsured motorists coverage is subject to maximum limits established by statute, which are determined to be the lesser of either the insured's bodily injury liability limits or $250,000/$500,000 (or a combined single limit of $500,000). This is provided by supplemental uninsured/underinsured motorists (SUM) coverage.

In New York, vocational rehabilitation benefits payable to disabled employees eligible for Workers' Compensation benefits may not exceed: a. $30 per week b. $20 per week c. The worker's base wage, when combined with disability compensation benefits d. $2,000 per injury

a. $30 per week Compensation for disability includes vocational rehabilitation benefits of up to $30 per week. Vocational rehabilitation benefits are paid from a fund specifically designed to provide these benefits.

In New York, how many days' written notice must the Superintendent provide to the licensee before holding a hearing? a. 10 days b. 15 days c. 20 days d. 30 days

a. 10 days Before a resident license can be revoked or suspended, the Superintendent must give the licensee and all sublicensees a hearing with 10 days' advance notice.

An auto insurer in New York may defer an inspection required to issue auto physical damage coverage for up to: a. 14 calendar days after the coverage effective date b. 5 calendar days after the coverage effective date c. 30 calendar days after the coverage effective date d. 10 calendar days after the coverage effective date

a. 14 calendar days after the coverage effective date Auto insurers may defer the inspection for up to 14 calendar days after the effective date of auto physical damage coverage. The insurer must send notice to the named insured that an inspection is required, and the notice must include at least 1 location where the inspection may take place during the deferral period.

An insurer cancels a Personal Auto policy issued in New York after discovering the insured submitted a fraudulent claim. Under the Amendment of Policy Provisions Endorsement, termination notice must be sent to the insured at least how many days in advance? a. 20 days b. 5 days c. 10 days d. 15 days

a. 20 days The Amendment of Policy Provisions - New York Endorsement specifies that written cancellation notice must be provided at least 20 days in advance. An exception applies to cancellations due to premium nonpayment, in which case the notice must be provided at least 15 days in advance. Fraud is a permitted grounds for cancellation at any time during the policy period.

An individual health insurance policy issued in New York requires an annual premium. The policy must include a grace period of at least: a. 31 days b. 7 days c. 20 days d. 10 days

a. 31 days Individual health insurance policies are required to provide a grace period provision allowing for the payment of premium after the due date to avoid policy lapse. The grace period must be at least 7 days for weekly premium policies, 10 days for monthly premium policies, and 31 days for all other policies, like those requiring quarterly, semi-annual, or annual premiums.

How many years must insurers typically maintain books and records, producer licensing records, complaints and claims, financial, or any other or licensee doing business in New York? a. 6 years b. 3 years c. 5 years d. 2 years

a. 6 years The Superintendent may examine the books and records, including policy, claim, complaint, financial, and producer licensing records, of any insurer or licensee doing business in New York. Typically, insurers must maintain records for 6 calendar years, or until after the filing of an examination report or the conclusion of an investigation in which the record was subject to review.

When the Flood Coverage Endorsement is attached to a commercial property policy, flood coverage is subject to a waiting period of: a. 72 hours b. 7 days c. 10 days d. 48 hours

a. 72 hours The Flood Coverage Endorsement does not provide coverage for loss resulting from a flood that begins within 72 hours after the inception date of the endorsement.

A driver working for a transportation network company is logged on to the company's digital network, but is not engaged in a prearranged trip. Which of the following minimum liability limits does New York require? a. 75/150/25 b. A combined single limit of $1.25 million c. 25/50/10 d. A combined single limit of $175,000

a. 75/150/25 When a TNC driver is logged into the digital network, the driver must at least be covered up to $75,000 per person for bodily injury or death, $150,000 per accident for bodily injury or death, and $25,000 per accident for damage to the property of others. This can be provided by the driver's policy, the company's group policy, or a combination. If the driver were engaged in a prearranged trip, a combined single limit of at least $1.25 million per accident must apply.

A Homeowners policy issued with the Water Back-Up and Sump Discharge or Overflow Endorsement would cover a loss to the dwelling caused by the back-up of water through sewers, subject to: a. A $250 special deductible b. The policy deductible stated on the Declarations page c. A 30-day Vacancy provision d. A 50% coinsurance requirement

a. A $250 special deductible The Water Back-Up and Sump Discharge or Overflow Endorsement applies a special $250 deductible to losses covered by the endorsement.

J is an employee in New York who is disabled as a result of an occupational disease. Under Workers' Compensation laws, this occupational disease is treated as a(n): a. Accident b. Injury not covered c. Willful personal injury d. Occurrence

a. Accident Workers' Compensation treats occupational diseases resulting in disablement as accidents.

In New York, compensation to disabled employees following a workplace injury is paid based on: a. Average weekly wages b. Average monthly wages c. Average yearly wages d. Average quarterly wages

a. Average weekly wages Compensation and benefits are based on the worker's average weekly wages. This is calculated by determining their average daily wage, multiplying that wage by a certain amount (such as 260 for 5-day workers and 300 for 6-day workers) to determine average annual wage, then dividing that amount by 52.

In New York, applicants for insurance producer licenses must: a. Be at least 18 years old b. Have earned a GED c. Be at least 21 years old d. Graduate high school

a. Be at least 18 years old Applicants for insurance producer licenses must be at least 18 years old. There is not a general education requirement for applicants.

When issued in New York on a Claims-Made basis, which of the following policies must be offered unlimited tail coverage? a. Medical malpractice policies b. Commercial General Liability policies c. Employment Practices Liability policies d. Errors and Omissions policies

a. Medical malpractice policies Medical malpractice policies issued in New York are the only types of policies that must be offered an unlimited tail, which may be provided free of charge after certain qualifying events, such as death, disability, or retirement. CGL policies and E&O policies must be offered a 3-year tail. EPLI policies must be offered a 1-year tail.

Under New York insurance law, what unfair and prohibited practice involves the offer of a special premium or favor as an incentive to purchase insurance? a. Rebating b. Negotiation c. False advertising d. Misrepresentation

a. Rebating Rebating includes the offering of a rebate, special favor, or advantage not contained in the policy, or a valuable consideration, as an incentive or inducement to buy insurance.

In New York, a temporary insurance license authorizes the licensee to do which of the following? a. Renew existing insurance on behalf of the original licensee b. Sell new insurance on behalf of the original licensee c. Solicit new insurance on behalf of the original licensee d. Negotiate new insurance on behalf of the original licensee

a. Renew existing insurance on behalf of the original licensee Temporary licensees are not permitted to sell, solicit, or negotiate new insurance.

In New York, certain commercial liability coverages may be written on a Claims-Made basis if they have any of the following characteristics, except: a. The risk is obtaining coverage through an excess line broker b. The risk tends to have claims submitted long after the expiration of the policy period c. The risk has experienced substantial problems obtaining coverage d. The risk is large and sophisticated

a. The risk is obtaining coverage through an excess line broker New York's regulations for Claims-Made policies apply to commercial liability policies issued in the state, so seeking coverage through the excess line market would not be relevant to a risk's eligibility for Claims-Made coverage.

A dwelling insured on a Broad Form Dwelling policy issued in New York has been vacant for 40 consecutive days. The policy would exclude coverage for a loss resulting from which of the following perils? a. Vandalism and malicious mischief b. Windstorm or hail c. Damage by burglars d. Weight of ice, snow, or sleet

a. Vandalism and malicious mischief The Special Provisions - New York Endorsement changes the Dwelling policy so that VMM coverage is subject to a 30-day Vacancy provision, meaning VMM coverage is not provided if the dwelling has been vacant for more than 30 consecutive days immediately before the loss. Damage by burglars is subject to the policy's original 60-day Vacancy provision, and the coverage against the other perils is not subject to any Vacancy provision.

What is the maximum penalty that can be imposed under the Insurance Frauds Prevention Act for a single violation? a. 1 year in prison b. $5,000 c. $500 d. $50,000

b. $5,000 The Superintendent is authorized to impose a civil penalty up to $5,000, plus the amount of the claim, for each violation of the Insurance Frauds Prevention Act.

To qualify for coverage through New York's Coastal Market Assistance Program, single-family homes located in Long Island's north shore or the Bronx must be within: a. 3 mile of the shore b. 2,500 feet of the shore c. 1 mile of the shore d. 1,000 feet of the shore

b. 2,500 feet of the shore Property located in Long Island's north shore, the Bronx, or Westchester must be located within 2,500 feet of the shore to be eligible for Homeowners insurance through C-MAP. Property in Long Island's south shore or forks, Brooklyn, Queens, or Staten Island must be located within 1 mile of the shore to be eligible. C-MAP coverage only applies to 1- to 4-family homes.

In New York, the excess line tax applicable to insurance transactions with unauthorized insurers is equal to what percentage of the total policy premium? a. 4.5% b. 3.6% c. 1% d. 6 2/3%

b. 3.6% An excess line tax equal to 3.6% of the premium must be charged and disclosed to the consumer. The disclosure is accomplished by providing the consumer with a total cost form.

When a Workers' Compensation claim in New York has been through the alternative dispute resolution system, an employer is required to file a completed ADR-2 form with the Workers' Compensation Board within: a. 1 year of the final disposition or settlement of the claim b. 30 days of the final disposition or settlement of the claim c. 10 days from the date an employee is injured on the job d. 30 days from the date an employee is injured on the job

b. 30 days of the final disposition or settlement of the claim As part of New York's claims reporting requirements, the ADR-2 form must be submitted to the Board by the employer within 30 days after the final disposition or settlement of the claim. This applies when the claim has been through the alternative dispute resolution system.

To nonrenew a personal lines insurance policy issued in New York, an insurer must provide written notice at least: a. 30-40 days in advance b. 45-60 days in advance c. 15-20 days in advance d. 10-15 days in advance

b. 45-60 days in advance To nonrenew a personal lines policy, such as a Homeowners policy, an insurer must provide 45 to 60 days' advance written notice to a policyholder. This same nonrenewal notice requirement applies to Personal Auto policies.

After providing the initial treatment to an employee in New York who sustained a workplace injury, the authorized physician must provide a preliminary notice of injury and treatment within: a. 5 days b. 48 hours c. 15 days d. 3 weeks

b. 48 hours A preliminary notice must be provided to the employer and Workers' Compensation Board within 48 hours of providing the initial treatment. A more complete report must be provided within 15 days after the preliminary notice, and progress reports must be submitted at least every 3 weeks as necessary.

The amount of disability income insurance benefits paid in New York is determined as: a. 75% of the insured's monthly earnings b. 66 2/3% of the insured's monthly earnings c. 80% of the insured's monthly earnings d. 50% of the insured's monthly earnings

b. 66 2/3% of the insured's monthly earnings In New York, the amount of disability income benefits is determined as 66 2/3% of the insured's monthly income. Though this applies to a health insurance product, this is the same percentage used to determine compensation benefits for disabilities covered by Workers' Compensation.

Auto policies issued in New York may be nonrenewed if the named insured is convicted of certain major vehicle offenses, but only if the conviction took place during what period? a. A 24-month period, ending on the last day of the fourth month before the effective date of the nonrenewal b. A 36-month period, ending on the last day of the fourth month before the effective date of the nonrenewal c. The 12-month period immediately before the policy effective date d. The 48-month period immediately before the policy effective date

b. A 36-month period, ending on the last day of the fourth month before the effective date of the nonrenewal In addition to other permitted grounds, auto policies may be nonrenewed or conditionally renewed after certain traffic conviction, such as being convicted of driving under the influence or being convicted of homicide resulting from the use or operation of a motor vehicle. These additional grounds are only permissible grounds when they occur within a specified period of time, which is calculated as the 36-month period that ends on the last day of the fourth month before the effective date of nonrenewal.

In New York, which of the following cannot be used to show proof of financial responsibility for auto liability exposures? a. A certificate of self-insurance b. A bank account with an adequate balance c. A certificate of insurance d. A bond

b. A bank account with an adequate balance A bank account cannot be used to show proof of financial responsibility. Liability insurance meeting the state's minimum requirements, evidence of self-insurance meeting minimum requirements, and financial security bonds all serve as adequate proof. A financial security deposit in the amount of $150,000 is also adequate proof.

Negotiation includes the following, except: a. A licensee offering advice directly to a purchaser or prospective purchaser of a particular contract of insurance b. A licensee conferring indirectly with a prospective purchaser of a particular contract of insurance c. A licensee conferring directly with a purchaser or prospective purchaser of a particular contract of insurance d. A licensee directly advises a prospective purchaser of the benefits of a particular contract of insurance

b. A licensee conferring indirectly with a prospective purchaser of a particular contract of insurance Negotiate means conferring directly, but not indirectly, with or offering advice directly to a purchaser or prospective purchaser of a particular contract of insurance.

Under New York Workers' Compensation laws, amounts payable for necessary medical treatment and care for injured employees are determined by: a. A percentage of the injured employee's average weekly wage b. A schedule of fees and charges c. A single limit applicable per person injured in any one accident d. The actual amount incurred for any services rendered

b. A schedule of fees and charges Amounts payable for necessary treatment and services to injured employees are determined by a schedule of fees and charges, which may be established for the entire state or for defined geographical areas. The schedule is based on fair and adequate charges determined by state medical societies. Different amounts may be paid voluntarily. Pharmaceutical fees are also subject to a schedule.

All of the following are considered compensation in New York, except: a. A trip to a beach destination b. A travel mug with an insurer's logo c. Interest on premiums d. Principal forgiveness

b. A travel mug with an insurer's logo Compensation is anything of value. This can include forgiveness of principal, interest on premiums, and trips. Compensation does not include tangible goods bearing the insurer's name, logo, or advertisement if the goods have an aggregate value of less than $100 per year.

Which of the following licensees helps with the investigation and settlement of insurance claims? a. Agent b. Adjuster c. Broker d. Consultant

b. Adjuster An adjuster acts on behalf of an insurer or an insured to investigate and adjust insurance claims.

An employer that provides Workers' Compensation benefits through self-insurance must provide at least one of the following to prove its financial ability, except: a. A deposit of securities b. An insurance policy c. Filing irrevocable letters of credit d. A deposit of cash

b. An insurance policy Because the employer is self-insuring, filing an insurance policy with the Workers' Compensation Board would not be necessary. Instead, security can be provide through a deposit of cash, a deposit of securities, the filing of irrevocable letters of credit, or the filing of a surety bond in the appropriate amount. Security may be provided by one of these, or by a combination.

By consumer privacy regulation, a licensee must provide a clear and conspicuous notice to customers that accurately reflects its privacy policies and practices at least: a. Every 12 months after a policy is in force b. At the time of application and annually thereafter c. Once at the time of application d. Biannually after policy is in force

b. At the time of application and annually thereafter A licensee must provide clear and conspicuous notice that accurately reflects its privacy policies and practices at the time a customer relationship is established. A licensee must provide these policies to customers annually if a customer relationship is maintained. Compliance with consumer privacy disclosure is ongoing, and must account for changes in policy, if any.

The Superintendent has the authority to take all of the following actions, except: a. Foster growth in the financial industry b. Create insurance laws c. Mediate consumer complaints d. Create rules to implement and enforce insurance laws

b. Create insurance laws The New York Assembly creates laws in this state. The Superintendent may create rules and regulations to carry out those laws.

All of the following statements about the Health Insurance Portability and Accountability Act are correct, except: a. HIPAA guarantees policy issuance to eligible persons b. HIPAA mandates that policies are not renewable c. HIPAA limits the use of pre-existing condition limitations d. HIPAA requires healthcare providers to preserve patient confidentiality

b. HIPAA mandates that policies are not renewable HIPAA guarantees policy issuance and renewability to eligible persons, with some exceptions, like in the event of fraud. HIPAA also helps people with pre-existing conditions have and maintain coverage, and its Privacy Rule protects the confidentiality of patients' information.

Major medical insurance is a type of indemnity plan, meaning: a. Benefits are based on a prepaid capitation fee to the provider b. Insureds pay for services and submit reimbursement claims to the insurer c. Benefits depend entirely on the average fee charged by providers in a geographical area d. The insurer pays healthcare providers directly for any services rendered to insureds

b. Insureds pay for services and submit reimbursement claims to the insurer Indemnity plans, also known as reimbursement plans, will reimburse insureds for medical services, based on the policy's payment and benefit structure, meaning insureds must pay up front for any services. Major medical insurance is an indemnity plan. Service plans, like HMOs and PPOs, pay providers directly and can either be prepaid, meaning a designated capitation fee is paid to the provider, or negotiated fee-for-service plans, meaning payments are provided to providers for each service the insured receives.

After an auto accident, an insured is eligible for first-party benefits under New York's no-fault law. If the insured permanently loses the use of a bodily organ, or sustains other serious injury, the insured may recover against the at-fault driver for: a. The insured is never able to recover from the at-fault driver b. Noneconomic losses c. Loss of earnings from work d. Medical expenses

b. Noneconomic losses Any serious injury sustained by a covered person meets the requirements of the verbal threshold and allows the person the right to recover against the at-fault driver for noneconomic losses, like pain and suffering. Otherwise, the insured does not have the right of recovery against the driver because personal injury protection benefits are provided without regard to fault. Serious injuries include death, dismemberment, significant disfigurement, fracture, and permanent loss of use of bodily organs or systems, among other injuries.

Under the Affordable Care Act, which of the following is NOT considered an essential health benefit? a. Mental health services b. Personal care c. Newborn care d. Emergency services

b. Personal care Personal care is not an essential health benefit. Essential health benefits include mental health and behavioral health treatment, emergency services, hospitalization, maternity and newborn care, and rehabilitative services, among others.

In New York, a vehicle inspection is required before coverage can be provided for: a. Liability for death b. Physical damage to the insured auto c. Bodily injury liability d. Injuries resulting from an uninsured motorist

b. Physical damage to the insured auto A newly issued policy insuring a private passenger vehicle in New York may not provide physical damage coverage until the insurer has inspected the vehicle. In certain circumstances, the inspection may be waived.

In New York, which of the following is not an unfair claim settlement practice? a. Requiring an insured to sue by offering less than the amount due b. Promptly acknowledging communications pertinent to a claim c. Misrepresenting pertinent policy facts or provisions to claimants d. Failing to attempt, in good faith, to promptly and equitably settle a claim in which the insurer's liability has become reasonably clear

b. Promptly acknowledging communications pertinent to a claim Promptly acknowledging communications pertinent to a claim is required with respect to claim practices. Misrepresenting policy facts or provisions, requiring an insured to sue for fair claim settlement, and failing to settle a claim in good faith, promptly, fairly, and equitably are unfair claims practices.

When a group health policy is underwritten using experience rating, the rate charged for group coverage each year is determined by utilizing: a. The average credit rating of all participants b. The actual loss experience of the group c. The actual loss experience of everyone in that zip code d. The plan sponsor's credit rating

b. The actual loss experience of the group Experience rating uses claims history of the group to determine cost. This is different from community rating, which determines cost based on the geographic region of insureds.

What is the purpose of a Medicare Supplement policy? a. To replace Medicare benefits b. To supplement Medicare benefits c. To cancel Medicare benefits d. To duplicate Medicare benefits

b. To supplement Medicare benefits Medicare Supplement insurance is designed to supplement benefits under Medicare Part A and Medicare Part B, and is subject to Medicare guidelines.

Under the Home Business Endorsement available to Homeowners policies, the special limit of liability applicable to loss to money and bullion is equal to: a. $200 b. $1,500 c. $1,000 d/ $500

c. $1,000 The special limit under Coverage C that applies to money, bank notes, bullion, coins, medals, and similar items is increased to $1,000 by the Home Business Endorsement. An unendorsed Homeowners policy would provide a $200 limit.

An employer group self-insuring Workers' Compensation coverage in New York fails to file evidence of a blanket fidelity bond that meets the requirements of the Workers' Compensation Board. As an alternative to revoking the group's authorization for self-insurance, the Board may assess a penalty of up to: a. $1,000 per violation b. $5,000 per violation c. $2,500 per violation d. $10,000 per violation

c. $2,500 per violation Employer groups that violate group self-insurance regulations may have their authorization revoked or be subject to a penalty. For most violations, the penalty is an amount of up to $2,500 per violation. An exception is made for failing to submit a required periodic report, like a financial statement or payroll report, which is subject to a penalty of up to $500 per day.

In New York, what are the minimum required limits of auto liability insurance for liability for death? a. $25,000 per person/$50,000 per accident b. $10,000 per person/$25,000 per accident c. $50,000 per person/$100,000 per accident d. $100,000 per accident/$300,000 per accident

c. $50,000 per person/$100,000 per accident New York has separate limit requirements applicable to liability for death and liability for bodily injuries other than death. The limits for liability for death are $50,000/$100,000. The limits for liability for bodily injury other than death are $25,000/$50,000.

After an agent is appointed, when must the insurer file a certificate of appointment with the Superintendent of New York? a. 30 days after the agency contract is executed b. A certificate of appoinment is not required in New York c. 15 days after the agency contract is executed d. On the day the agency contract is executed

c. 15 days after the agency contract is executed An insurer that appoints an agent must file a certification of appointment with the Department within 15 days after the agency contract is executed. An insurer that terminates an agent appointment must notify the Department within 30 days.

In New York, insurance producers are required to complete how many hours of approved continuing education during each 2-year license period? a. 12 hours b. 40 hours c. 15 hours d. 20 hours

c. 15 hours Producers must complete 15 hours of approved continuing education during each 2-year license period.

After being injured in an accident involving an identified uninsured motorist, a qualified person may receive basic economic loss benefits from the Motor Vehicle Accident Indemnification Corporation by submitting a notice of claim within how many days after the accident? a. 60 days b. 90 days c. 180 days d. 30 days

c. 180 days To receive benefits, qualified persons must file a notice of claim against the owner of an uninsured motor vehicle within 180 days after the accident. If the motorist was unidentified, such as when a qualified person is injured by a hit-and-run driver, then the notice of claim must be filed within 90 days after the accident. Accidents should be reported to law enforcement within 24 hours after the accident.

Under the Comprehensive Motor Vehicle Insurance Reparations Act, injured persons eligible for PIP benefits must provide written notice of the accident within: a. 5 days after the accident b. 60 days after the accident c. 30 days after the accident d. 45 days after the accident

c. 30 days after the accident Under New York's no-fault law, notice must be provided as soon as possible, but no more than 30 days after the date of the accident. Notice can be provided by the injured person or by someone else on their behalf.

An agent licensed in New York places Homeowners insurance with an unauthorized insurer. The agent is subject to what penalty? a. A $2,000 penalty b. No penalty applies c. A $500 penalty d. A $1,000 penalty

c. A $500 penalty Aiding unauthorized insurers is a prohibited act, and the person or entity who does so is subject to a $500 penalty per violation. Certain exceptions are made for licensed brokers to place certain types of insurance with unauthorized insurers, such as Ocean Marine insurance and insurance on risks located outside of New York. Exceptions are also made for licensed excess line brokers, who have an additional license allowing them to place insurance with unauthorized insurers in the excess line marketplace.

If an individual health policy issued in New York contains a provision that terminates coverage for a dependent child upon the attainment of a certain age, coverage cannot be terminated for which of the following dependent children? a. A married child b. A child who is working c. A child incapable of working due to a disability d. A child with a covered pre-existing condition

c. A child incapable of working due to a disability Coverage cannot be terminated for an unmarried dependent child who is incapable of continuous, self-sustaining employment due to mental or physical disability.

Permanent total disability benefits payable under Workers' Compensation in New York are paid at: a. 75% of the employee's average weekly wages b. 50% of the employee's average weekly wages c. 50 2/3% of the employee's average weekly wages d. 66 2/3% of the employee's average weekly wages

d. 66 2/3% of the employee's average weekly wages Disability benefits are paid at 66 2/3% of the employee's average weekly wages, subject to certain minimums and maximums defined by law. For permanent total disabilities, this amount is payable for the duration of the disability. Permanent partial disabilities and temporary total disabilities are subject to the same compensation basis. Compensation for temporary partial disabilities will be 66 2/3% of the difference in wages before and after the accident.

Which of the following is NOT correct concerning the minimum standards for commercial liability insurance issued on a Claims-Made basis in New York? a. Endorsements that restrict coverage during extended reporting periods are typically prohibited b. A 60-day tail must be provided, and an additional tail must be offered c. A retroactive date may be changed during the term of the Claims-Made relationship or any extended reporting period d. A claim is first made when the insurer receives written notice of a claim or suit from the insured or a third party

c. A retroactive date may be changed during the term of the Claims-Made relationship or any extended reporting period New York's minimum standards for liability insurance issued on a Claims-Made basis state that a retroactive date may not be changed during the term of the Claims-Made relationship or any extended reporting period.

Under Workers' Compensation laws in New York, treatment and care benefits for medical and surgical services are based on: a. Minimum and maximum amounts established by legal statute b. The actual cost of services c. A schedule of fees and charges d. The national average cost of those treatments or services

c. A schedule of fees and charges New York uses a schedule of fees and charges to determine the treatment and care benefits payable to injured employees. The schedule is established either for the state or for more defined geographical areas within the state, based on the fair and adequate remuneration as determined by medical societies in New York. The schedule provides standardization, but employers may pay higher or lower amounts voluntarily, within reason. These benefits must be provided promptly to injured employees.

The New York Property Insurance Underwriting Association may insure against all of the following perils as additional perils coverages, except: a. Sprinkler leakage b. Business interruption c. Accidental discharge or overflow of water or steam from a system or appliance d. Vandalism and malicious mischief

c. Accidental discharge or overflow of water or steam from a system or appliance The NYPIUA offers fire insurance, extended coverage insurance, Broad Form coverage, and additional perils coverage. Additional perils coverage includes vandalism and malicious mischief coverage, sprinkler leakage coverage, business interruption coverage, and rent coverage. Accidental discharge or overflow of water or steam is a Broad Form coverage. Broad Form coverage also includes other perils seen on a Broad Form Dwelling policy, including falling objects and damage by burglars (not including theft).

Which of the following correctly describes the difference between a broker and an agent? a. An agent represents an insurer, whereas a broker acts on behalf of an HMO b. An agent represents an insurer, whereas a broker is a representative of the agent c. An agent represents an insurer, whereas a broker acts on behalf of an insured d. A broker represents an insurer, whereas an agent acts on behalf of an insured

c. An agent represents an insurer, whereas a broker acts on behalf of an insured An agent represents an insurer, whereas a broker acts on behalf of an insured. An agent may also represent a fraternal benefit society, or an HMO.

In New York, information regarding a producer's compensation connected to an insurance sale must be disclosed to the consumer at what time? a. At or before policy delivery b. Immediately upon establishing a customer relationship c. At or before the time of application d. Only upon the purchaser's request

c. At or before the time of application Compensation disclosures must be made at or before the time of application. Disclosures include a description of the producer's role in the sale, a statement regarding whether the producer will receive compensation, and a statement that compensation may vary based on the type of contract. Information about the compensation the producer anticipates receiving may also be disclosed upon the purchaser's request, to be delivered no later than policy issuance.

When Claims-Made commercial liability policies are issued in New York, the insurer must provide a prominent notice that discloses all of the following information about Claims-Made coverage, except: a. The length of any required tail and any additional tail coverage that must be offered to insureds b. Coverage under the policy ends when the policy is terminated, except for tail coverage c. Claims-Made rates are higher than rates applicable for Occurrence policies, but rates will decrease over time d. The policy does not cover incidents that took place before the retroactive date

c. Claims-Made rates are higher than rates applicable for Occurrence policies, but rates will decrease over time Insurers must disclose that Claims-Made rates are lower when compared to policies written on an Occurrence basis, and that rates increase substantially as the Claims-Made relationship reaches maturity. Other disclosures include how coverage applies with respect to retroactive dates and tail coverage. The insurer must also disclose the required tail automatically provided by the policy (typically 60 days) and offer the additional tail coverage to which the policy is subject (1 year, 3 years, or unlimited duration, depending on the type of policy).

In New York, failure to complete a mandatory auto inspection before the deferral period expires results in: a. A premium surcharge b. Voidance of coverage c. Coverage suspension, as of 12:01 a.m. on the following day d. Coverage suspension, as of 12:01 p.m. on the following day

c. Coverage suspension, as of 12:01 a.m. on the following day Failure to complete a mandatory inspection will result in the suspension of physical damage coverage, which will go into effect at 12:01 a.m. immediately after the deferral period expires. The insurer must mail notice of suspension to the insured, and coverage may be reinstated once the inspection is complete.

All of the following health plan benefits are required for contracts issued in New York by group or individual commercial insurers, except: a. Maternity care b. Post-mastectomy reconstruction c. Elective cosmetic surgery d. Infertility treatment

c. Elective cosmetic surgery Coverage for elective cosmetic surgery is not a required benefit, and many policies, like major medical plans, typically exclude that coverage.

How often do individual producer licenses expire in New York? a. Every year on the licensee's birthday b. Every 2 years on June 30th c. Every 2 years on the licensee's birthday d. Every year on December 31st

c. Every 2 years on the licensee's birthday Individual producer licenses expire every 2 years on the licensee's birthday. Licenses expire in even years for producers born in even years and in odd years for producers born in odd years.

The New York Property Insurance Underwriting Association may provide property insurance against which of the following? a. Liability b. Theft c. Fire d. Flood

c. Fire The NYPIUA provides essential property insurance when property owners are unable to obtain coverage in the standard market, meaning fire insurance must be provided. The NYPIUA does not insure against flood or theft losses, nor does it provide liability coverage.

A consumer in New York purchases a new auto that is replacing their current auto. If an insurer has provided auto physical damage coverage on the current auto for at least 12 months, the applicable physical damage coverage: a. May not be extended to the replacement auto b. May be extended without a request for coverage only after the auto is inspected c. May be extended for 5 calendar days without requiring a request for coverage d. May be automatically extended for the remainder of the policy period without requiring a request for coverage

c. May be extended for 5 calendar days without requiring a request for coverage If the current auto has had continuous physical damage coverage for at least 12 months, the same type and level of physical damage coverage may be extended to replacement autos for 5 calendar days, without requiring the insured to request coverage. Unless otherwise waived, the vehicle is still subject to inspection if the insured wants physical damage coverage after the extension period, but the time frames applicable to those requirements begin after the 5-day extension.

Continuing education requirements in New York apply to: a. Nonresident licensees, regardless of whether an examination was required b. Resident licensees, regardless of whether an examination was required c. Resident and nonresident licensees, if an examination was required d. Resident licensees only, if an examination was required

c. Resident and nonresident licensees, if an examination was required Continuing education requirements apply to resident and nonresident licensees, if an examination was required.

In New York, compensation for disability payable under Workers' Compensation is subject to a waiting period of: a. The first 60 days of disability b. The first 30 days of disability c. The first 7 days of disability d. The first 14 days of disability

c. The first 7 days of disability Benefits are not paid for the first 7 days of disability. If the disability lasts for more than 14 days, benefits are payable from the date of the injury.

Prior to placing insurance with an unauthorized insurer, excess line brokers must make a diligent effort to place insurance in New York with at least how many authorized insurers? a. Five b. One c. Three d. Two

c. Three Excess line brokers are deemed to have made a diligent effort if 3 authorized insurers, licensed to write the requested insurance, have declined to write insurance on the risk. Certain exceptions exist for risks that are difficult to place in the admitted market, as listed on the export list published by the Excess Line Association of New York.

The required policy period for a Homeowners policy issued in New York is a period of: a. Two years b. Four years c. Three years d. One year

c. Three years According to New York's regulations regarding cancellation and renewal provisions, personal lines insurance has a required policy period of 3 years, and Personal Auto insurance has a required policy period of 1 year. In this case, personal lines insurance includes coverage for real property, personal property, or personal liability, such as a Dwelling policy, Homeowners policy, or types of personal excess coverage.

A Businessowners policy issued with the Named Perils Endorsement insures against all of the following perils, except: a. Sinkhole collapse b. Sprinkler leakage c. Water leakage or discharge from a system or appliance d. Collision or overturn of a vehicle

c. Water leakage or discharge from a system or appliance In addition to other standard exclusions, the Named Perils Endorsement excludes coverage for losses resulting from water leakage or discharge from a system or appliance, rupture or bursting of water pipes, and mechanical breakdown. Sprinkler leakage, sinkhole collapse, and transportation are all perils named on the endorsement. The transportation peril applies to covered property in transit.

Under New York Workers' Compensation laws, compensation for a disability is payable for the 7-day waiting period only if the disability lasts for longer than: a. 25 days b. 30 days c. 35 days d. 14 days

d. 14 days Benefits payable for disabilities are subject to a 7-day waiting period, during which no benefits are provided. However, if the disability lasts longer than 14 days, benefits are paid as of the first day of disability. This waiting period does not apply to treatment and care benefits.

Rather than cancelling a Personal Auto policy, the insurer may choose to condition continuation of the policy on the cancellation of coverages that are not required by New York law. To do so, the insurer must provide: a. 30 days' advance written notice b. 15 days' advance written notice c. 45 days' advance written notice d. 20 days' advance written notice

d. 20 days' advance written notice Conditioned continuations require 20 days' advance written notice to the insured. This is an alternative to cancellation, and may be elected when the insurer has the right to cancel the policy. Conditioned continuations may not include the elimination of any required coverages, like required auto liability insurance coverage.

In New York, an insurer must provide notice that it is not renewing a commercial lines policy how many days in advance? a. 30-90 days b. 45-60 days c. 90-150 days d. 60-120 days

d. 60-120 days If nonrenewing or conditionally renewing a commercial lines policy, New York insurers must provide 60-120 days' advance written notice, which must state the reason for doing so. To meet this requirement, late notices will cause the nonrenewal or conditional renewal to not be effective until 60 days after the notice is provided. Excess Liability policies and insurance covering jumbo risks are subject to advance written notice of 30-120 days. Personal lines nonrenewals are subject to a different rule requiring 45-60 days' advance written notice.

Which of the following extended reporting periods is mandatory on most Claims-Made commercial liability policies issued in New York? a. 3-year tail b. Unlimited tail c. 5-year tail d. 60-day tail

d. 60-day tail The 60-day tail must be provided, except that public entity liability policies are subject to a 90-day tail requirement. An additional extended reporting period must be offered to insureds, but not necessarily accepted.

A New York certificate of authority contains the following information regarding an authorized insurer, except: a. Lines of insurance authorized to transact within New York b. The state or country the insurer was organized c. The certificate's term d. A New York satellite office address

d. A New York satellite office address A New York certificate of authority includes the home office address, the insurer's name, the certificate's term, the state or country in which the insurer was organized, and the lines of insurance for which the insurer is authorized to transact in this state.

New York Workers' Compensation law considers all of the following to be a grave injury, except: a. Amputation of a hand b. Paraplegia c. Total and permanent blindness d. A concussion resulting in a temporary disability

d. A concussion resulting in a temporary disability For a brain injury to be considered a grave injury, it must result in a permanent total disability. Determining when an injury is a grave injury is necessary when determining an employer's liability under certain legal circumstances.

When the Workers' Compensation - Certain Residence Employees - New York Endorsement is attached to a Homeowners policy, all of the following residence employees are covered in the event they sustain a workplace injury, except: a. A regularly employed residence employee who works part-time for 15 hours per week b. A residence employee engaged in casual employment c. A regularly employed residence employee who works 30 hours per week d. A regularly employed residence employee who works 50 hours per week

d. A regularly employed residence employee who works 50 hours per week New York's Workers' Compensation endorsement available to Homeowners policies is only used to cover certain residence employees, including those engaged in casual employment or those engaged in regular employment of fewer than 40 hours per week.

An insured has a Personal Auto policy issued in New York and purchases Additional PIP coverage. Additional PIP coverage can provide which of the following coverages? a. Coverage for the named insured's family members if they are injured in a covered auto outside of New York b. An additional $25,000 used only for work loss and physical therapy c. Coverage for noneconomic losses, such as pain and suffering d. An additional $50,000 for PIP benefits

d. An additional $50,000 for PIP benefits Additional PIP coverage provides for higher PIP benefits, typically an additional $50,000. This is different from the Optional Basic Economic Loss (OBEL) benefit, which provides an additional $25,000 that applies specifically to loss of earnings from work and certain types of therapy or rehabilitation. Additional PIP can also provide coverage for guest occupants who are injured while occupying a covered auto outside of New York.

Y has a Personal Auto policy issued in New York. If Y newly acquires an auto that replaces their currently insured auto, liability coverage under Part A is provided: a. Only if requested within 3 days of ownership b. Only if requested within 5 days of ownership c. Only if requested within 14 days of ownership d. Automatically

d. Automatically Liability coverage is automatically provided to newly acquired autos that are replacing an auto already covered by the policy, without needing to request coverage. Other coverages (other than physical damage coverage under Part D) can apply as of the date of ownership if those coverages are requested within 14 days of ownership. If the auto were being added to the policy, rather than replacing an insured auto, then the insured must request liability coverage within 14 days of ownership in order for it to apply from the date of ownership. These terms are provided by the Amendment of Policy Provisions - New York Endorsement.

Uninsured motorists coverage required in New York covers insureds for which of the following losses resulting from an at-fault uninsured motorist? a. Bodily injury, not including death b. Property damage c. Death, not including bodily injury d. Bodily injury or death

d. Bodily injury or death Uninsured motorists coverage only applies when an insured sustains bodily injury or death as a result of an uninsured motorist. Just like the required financial responsibility limits applicable to liability coverage, New York establishes minimum required UM limits for bodily injury and death separately.

Under a group health insurance contract issued in New York, individual employees receive a: a. ID card b. Master policy c. Binder d. Certificate of insurance

d. Certificate of insurance Group contracts are between the plan sponsor and the insurer, so the plan sponsor receives the master policy, and each individual employee receives a certificate of insurance that shows a summary of benefits.

A consumer in New York is obtaining a Personal Auto policy and receives notice that supplementary uninsured/underinsured motorists (SUM) coverage is available. Which of the following statements is NOT correct regarding SUM coverage? a. SUM limits may be issued up to 250/500, subject to the insured's bodily injury liability limits b. An underinsured motorist is an at-fault motorist with auto liability insurance at limits lower than the insured's own liability limits c. The insured's own policy will not pay until the liability limits of all other bodily injury liability policies and bonds have been exhausted d. Every motor vehicle policy must include supplementary uninsured/underinsured motorists coverage

d. Every motor vehicle policy must include supplementary uninsured/underinsured motorists coverage SUM coverage must be offered to consumers through a written notice delivered when the policy is first issued and at renewal, but the coverage is not required. SUM coverage makes underinsured motorists available, which covers injured insureds in the event the at-fault motorist has auto liability insurance at limits lower than the insured's own liability limits. If SUM coverage is obtained, coverage is subject to statutory maximum limits of $250,000 per person for bodily injury or death and $500,000 per accident, but limits may not exceed the insured's liability limits under Part A of their policy. All other applicable policies must be exhausted before the insurer will make payments under SUM coverage, and deductions will be made for the amounts already paid.

In accordance with the Protective Safeguards Endorsement added to a commercial property policy, failure to maintain a required safeguard will cause coverage to be excluded for which of the following perils? a. Theft b. Vandalism c. Water damage due to accidental discharge or leakage d. Fire

d. Fire If insureds fail to maintain scheduled safeguards before the loss, fire coverage would be excluded. The same applies if the insured knew of any suspension or impairment to the scheduled safeguards that were not appropriately reported or addressed.

Which of the following is a managed care system that is a prepaid health plan? a. POS b. PPO c. Major Medical insurance d. HMO

d. HMO Because HMO providers are paid a capitation fee for all services (rather than a fee based on the specific services provided), they are considered prepaid health plans. PPOs pay a negotiated fee for service. Major Medical plans are indemnity (reimbursement) plans, not service plans.

An individual health policy issued in New York has lapsed, and the insurer requires an application and premium payment to reinstate the policy. If the applicant provides these, the policy will be reinstated: a. On the 25th day after the conditional receipt is issued b. On the 65th day after the conditional receipt is issued c. Immediately d. On the 45th day after the conditional receipt is issued

d. On the 45th day after the conditional receipt is issued As provided by the Reinstatement provision required for individual health policies, the policy will be reinstated on the 45th day after the conditional receipt for the premium payment is issued. If the insurer does not require an application, the policy is reinstated automatically after accepting the premium payment. In either case, coverage for accidents begins immediately, and coverage for sickness begins after 10 days.

In New York, all of the following types of insurance may not be cancelled due solely to the geographic location of the risk, except: a. Fire insurance b. Personal Auto insurance c. Fire and extended coverage insurance d. Personal Umbrella Liability insurance

d. Personal Umbrella Liability insurance New York's protections against redlining prohibit insurers from denying, cancelling, or nonrenewing fire insurance, fire and extended coverage insurance, or auto insurance based solely on the risk's geographical location. This law helps protect essential coverages. Personal Umbrella Liability coverage is not subject to the same protections.

If a health insurer in New York misuses dual filing information regarding Workers' Compensation benefits paid to injured employees, the insurer would be: a. Guilty of a felony b. Guilty of a misdemeanor c. Subject to a penalty of no more than $200 d. Prohibited from using dual filing information for up to 3 years

d. Prohibited from using dual filing information for up to 3 years Misuse of dual filing information will cause the entity to be prohibited from obtaining dual filing information for up to 3 years. The entity may also be subject to a penalty of up to $10,000, after a hearing. Dual filing information may only be used to ensure that payments covered by Workers' Compensation are appropriately covered by the Workers' Compensation carrier and any health insurer paying for covered treatment is reimbursed.