Melinda's Claims Adjuster Study Guide
What is the definition of "bodily injury?"
"Bodily Injury" refers to bodily harm, sickness, disease, or death resulting from an accident.
What does "occupying" mean in regard to an auto?
"Occupying" means in, upon, getting in, on, out or off of a vehicle.
What does "product" mean in regards to General Liability?
"Product" means an article or substance, other than real property, manufactured, sold, handled, distributed or disposed of by the named insured or others trading under the named insured's name.
Builder's Risk Coverage covers a building in the course of construction. The proper amount of coverage for a building that has an expected completed value of $1 million is ___:
$1 million
A request for mediation of a personal injury claim applies to a claim with a value of ___ or less.
$10,000
If the policy limit is $80,000; 80% coinsurance requirement; loss of $20,000 and the value of property is $200,000, what loss amount will the insurer pay? What is the formula?
$10,000 COINSURANCE x PROPERTY VALUE = A POLICY LIMIT / A = B B x LOSS = loss amount insurer will pay
An insured rear-ended an auto at 80 mph. The insured was injured and had Additional PIP-$90,000 and Extended PIP. The insured has medicals of $150,000. What will PIP pay? What if the insured had a deductible of $5000?
$100,000
The insured has a homeowner's policy with a 5% Hurricane deductible. If a hurricane loss of $6,000 occurs to the home that is valued and insured for $100,000, how much will the policy pay? What type of deductible is this?
$1000 Percentage Deductible
The insured was in a 2012 automobile accident and had medical bills that totaled $12,000. One month after the accident, and as a result of his injuries, he died. How much will PIP pay for death?
$12,000 X 80% = $9,600 $10,000 - $9,600 = $400
In order to receive replacement cost under a Flood policy, an insured must live in the home at least 80% of the time and a $200,000 home must be insured for at least:
$160,000
An insured had basic PIP coverage with no deductible. He had an accident that occurred January 2, 2015 and sought medical treatment within 14 days, but was not diagnosed as having an emergency medical condition. Medical bills totaled $5000. What will PIP pay?
$2,500
An insured has basic PIP with a $1000 deductible. If the insured is injured in an accident and has $20,000 in covered medicals, how much will PIP pay?
$20,000 x 80% = $16,000 $16,000 - $1,000 = $15,000 $10,000 max
What is the maximum recovery amount of a tort action against the state?
$200,000
A covered loss is $6,000. Policy A has a limit of $25,000. Policy B has a limit of $50,000. Both policies are pro-rata policies. How much will policy B pay for this loss?
$25,000 + $50,000 = $75,000 $50,000 / $75,000 = 66.66% $6,000 X 66.66% = $4,000
An insured has an auto policy with a single limit of $30,000. What claims are covered?
$30,000 is available for third party property damage and bodily injury claims
A covered loss is $5,000. The insured has a straight deductible of $1,000. How much will the insurance company pay?
$4,000
I am a FL resident insured for PIP. I drove my car to Miami where I rear-ended a van causing medicals of $5,000 to a FL driver insured for PIP. What is the amount of my tort exemption?
$4,000.
An insured had basic PIP. He had an auto accident in 2015. Medicals were $9,000. Lost wages were $1000. What is left from basic PIP for death?
$5,000
A speeder's vehicle hit the insured's vehicle from the rear. The speeder was insured for PIP and liability. The insured was an owner but not insured for PIP. The insured has $5,000 in medical bills and $1000 in lost wages as a result of the accident. If the insured files a lawsuit against the speeder, how much of the medicals and lost wages can the insured sue for?
$5,000 X 80% = $4,000 $1,000 X 60% = $600 $4,000 + $6,000 = $4,600 $6,000 - $4,600 = $1,400
A public adjuster is required to post a ___bond.
$50,000
What is the bonding requirement for a public adjuster?
$50,000
A covered loss is $60,000. Policy A has a limit of $50,000. Policy B has a limit of $150,000. Both policies are pro-rata policies. How much will policy A pay for this loss?
$50,000 + $150,000 = $200,000 $50,000 / $200,000 = 25% $60,000 X 25% = $15,000
The Citizens Insurance standard deductible for mobile home homeowners is:
$500/2% hurricane
An insured negligently struck another vehicle, causing the other driver to incur $5000 in covered medicals. The other driver owned a car insured for PIP. How much is the insured's tort exemption? What if the other driver was riding a motorcycle?
$5000 -0-
A covered loss is $100,000. Policy A has a limit of $75,000. Policy B has a limit of $150,000. Both policies are pro-rata policies. How much will policy A pay for this loss?
$75,000 + $150,000 = $225,000 $75,000 / $225,000 = 33.33% $100,000 X 33.33% = $33,330
An insured has PIP with a $1000 deductible. If the insured has an accident and incurs covered medical bills in the amount of $1100, what will PIP pay?
$80
An insured rear-ended an auto at 80 mph in 2012. The insured was injured and had Additional PIP-$90,000 and Extended PIP. The insured has medicals of $150,000 What will PIP pay?
$90,000 + $10,000 = $100,000 $1000,000 max
I have Additional PIP-$90,000 and Extended PIP. I was in an accident in 2012 and have $100,000 in medicals and $1,000 in lost wages. What will PIP pay?
$90,000 + $10,000 = $100,000 $1,000 X 80% = $800 $100,000 + $800 = $100,800 $1000,000 max
How many total hours of continuing education is required for a new adjuster?
- 5 hour update course every 2 years specific to the license held. - 19 hours of any elective continued education every 2 years. 24 hours total.
How much can an insured recover from their own 10/20/10 policy?
-0-
The deductible under a Personal Articles Floater is:
-0-
What is the deductible in a Personal Articles Floater?
-0-
An insured negligently struck a motorcycle rider with his vehicle, causing the rider to incur $5000 in covered medicals. The motorcyclist also owned a car insured for PIP. How much is the insured's tort exemption?
-0- Motorcycles are not eligible.
What are the differences between the Annual Transit Policy, the Trip Transit Policy, and Motor Truck Cargo Policy?
-Annual Trip Transit policy protects the shipper or receiver of goods against loss to goods in transit. An example of an insured that may need this coverage might be the Home Shopping Network that ships thousands of packages per month. -Trip Transit Policy is used to insure single shipments of goods for companies that have only occasional shipments to ensure. An example of an insured that may need this coverage might be a florist. -Motor Truck Cargo policy is designed to protect the carrier, instead of the shipper, for losses to domestic shipments in transit. Only an act of God, or the shipper's own neglect excuses the carrier from liability. An example of an insured that may need this coverage might be UPS or FedEx.
What is a complaint in a lawsuit? What is an answer?
-Any written communication primarily expressing a grievance. -The defendant's response to a complaint.
What is required to win a claim for negligence?
-DUTY: the plaintiff must prove that the defendant had a duty to act or not act -BREACH: that the defendant breached that duty - CAUSE: the defendant's breach of duty was the cause of the plaintiff's injury -INJURY: there was actual injury to the plaintiff
What are the elements an adjuster investigates in a liability claim?
-NEGLIGENCE: whether or not the insured was guilty of a negligent act -COMPARATIVE: whether the claimant was guilty of comparative negligence -INJURY: whether risk of injury was assumed -RELATIONSHIP: whether the claim is actionable because of the relationship of the parties
What are the elements of a proof of loss?
-ORIGIN: origin of loss -PROXIMATE: the proximate cause of loss -INTEREST: the interest of the insured and all other persons in the property -CONTRACTS: all contracts of insurance that applied to the property -CHANGES: any changes in title use, location or possession of the property
Construction employers must have at least ___ employee(s) before being required to carry Workers' Compensation.
1
The insured has a franchise deductible of $5,000. A covered loss is $4,999. How much will the insurance company pay? What if the loss was $5100?
1. -0- 2. $5100
In regards to insurance that does "transact" mean?
1. Solicitation or inducement; 2. Preliminary negotiations; 3. Effectuation of a contract of insurance; 4. Transaction of matters subsequent to effectuation of a contract of insurance and arising out of it.
The insured owns a garage and sells cars. The garage policy liability limit is 100/300/50. A customer was test-driving a car and caused an accident. At the time, the customer was not an owner and did not carry insurance. The garage policy will provide liability coverage in the amount of:
10/20/10
The Florida Financial Responsibility Law requires:
10/20/10 Liability
A driver convicted of driving under the influence must carry liability limits of at least:
100/300/50
An insured has stacked 50/100 UM coverage for 3 cars. The maximum the policy will pay for the insured's injuries in one accident caused by an uninsured motorist is:
150
How long does an adjuster have to answer a written or oral inquiry from the department concerning a claim?
21 calendar days
The Department contacts an adjuster about a claim. The adjuster must respond within:
21 calendar days
What is the statute of limitations on Med Pay Coverage?
3 years from the date of the accident
If an adjuster has a change in name, telephone, or address, in what time frame must an adjuster notify the department?
30 days.
Length of notice required to cancel an auto binder
5 days
The insured has a Homeowner's insurance policy with a 5% Hurricane deductible. If a hurricane loss of $6,000 occurs to the home that is valued and insured for $100,000, how much will the policy pay?
5% X $100,000 = $5,000 $6,000 - $5,000 = $1,000
What is the waiting period for worker's compensation disability?
7 days. If the disability last more than 21 days, the employee is paid from the first day of injury.
In Florida property claims must be paid within __ days of notice of claims.
90
An adjuster must pay or deny a property damage claim within___, unless there are factors beyond his control.
90 days
An Excess Liability policy that has the same terms and conditions as the underlying policy is an example of:
A Follow Form policy
What is a derivative claim?
A claim regarding Proximate Cause.
An adjuster shall make truthful and unbiased reports of the facts after making ___.
A complete investigation
Define a "contract of adhesion"
A contract in which one party may not negotiate the terms. Any ambiguity is resolved in favor of that party.
What are the 'specified causes of loss'?
A limited alternative to comprehensive insuring only for fire, lightning, explosion, theft, windstorm, hail, earthquake, flood, vandalism, or the sinking, burning, collision or derailment of a conveying transport.
Define "Loss Payable Clause"
A loss payable clause protects personal property lenders (like an auto loan) as insured. (applies to personal property)
Define "mortgagee clause"
A mortgagee clause or mortgage clause protects mortgage lenders (real property lenders) as insured. (applies to real property)
What is a bailor?
A person who gives over possession of personal property to a bailee.
What is a bailee?
A person who takes possession of personal property from a bailor.
When is a public adjuster allowed to acquire an interest in Salvaged Property?
A public adjuster shall not acquire any interest in salvaged property, except with the written consent and permission of the insured.
What are the requirements for filing a request for mediation?
A request for mediation shall be filed with the department on a form approved by the department and the insurance policy must specify the terms and conditions for mediation of a first party claim.
Define "tort"
A tort is a civil wrong that infringes upon another person's rights.
What is the definition of Actual Cash Value?
ACV is generally understood to mean replacement cost less depreciation.
Regarding a Business Auto Policy, what do the terms "accident" and "bodily injury" mean?
Accident- continuous or repeated exposure to the same conditions resulting in bodily injury or property damage that is neither expected nor intended by the insured. Bodily Injury- physical harm and include sickness, disease or death resulting from that harm.
Define "additional PIP"
Additional PIP is an amount you can buy, in addition to the $10,000 base amount.
An insurer formed under the laws of the Canada would be:
An alien insurer
What is an eligible building for flood insurance?
An eligible building must have two or more rigid walls, a fully secured roof, and be 50% above ground, built on a permanent site and be located within an eligible community.
Define "peril"
An event that may cause loss such as fire, windstorm, earthquakes and flood.
A 'medical incident' covered by Physician's Professional Liability Insurance would not include:
Assault of a patient
Define "Principle of Utmost Good Faith"
Assumes that parties to an insurance policy have disclosed all relevant facts and intend to carry out their obligations.
A defense to a claim made by a person who knowingly competes in an extreme sport and is injured would be considered what?
Assumption of Risk
A dry cleaner damages a customers clothes. Damages would be covered by what policy?
Bailee's customer policy
What is builder's risk coverage?
Builder's risk coverage protects the owner of a construction project from normal perils. The building must be insured for the expected finished cost.
A claim _______ be settled with a legal document prepared by the adjuster, only if the adjuster has filled in the blanks on a contract of __________.
CANNOT RELEASE
An insurer is required to have a _______ for a collection of new premiums.
Certificate of Authority
Define "Coinsurance"
Coinsurance states that an insured must carry a specific amount of insurance coverage in order to recover 100% of a loss within policy limits.
My car was damaged when I lost control and it overturned. What coverage am I looking for on my policy to repair my car?
Collision
Florida is a ____Negligence state.
Comparative
Define "comparative negligence"
Comparative negligence allows a verdict in favor of the defendant to be reduced by the percentage that the plaintiff contributed to the occurrence.
Define "Compensatory Damages"
Compensatory damages are damages paid to settle a lawsuit.
Giving prompt notice of loss is best described as a policy _______.
Condition.
Define "contributory negligence"
Contributory negligence states that a plaintiff who is found to be even 1% at fault will recover nothing.
What do Coverages A, B, C, and D provide in a Homeowners Policy?
Coverage A- provides coverage for the dwelling and structures attached. Coverage B- provides coverage for other structures. This covers detached structures, such as a detached garage, fence, or storage building. Coverage C- provides coverage for personal property. This covers personal property belonging to the insured and family members, and the homeowners' policy provides the option for the insured to give the benefit of coverage to property owned by others while such property is located at any residence occupied by the insured. Note: Coverage C of the homeowner's policy covers the insured's personal property, wherever it is located. Coverage D- Additional Living Expenses provides coverage for expenses required to maintain the insured's normal living standards when the property becomes uninhabitable through damage by a covered peril.
Damage to a fence under a homeowners' policy would be paid under:
Coverage B
If coverage A in a Homeowner's policy is $200,000, then how much is Coverage B and Coverage C?
Coverage B = $20,000 (10% of A) Coverage C = $100,000 (50% of A)
Define "Ocean Marine Coverage"
Coverage for perils associated with water transport.
If a merchant accepts counterfeit money, what is true regarding coverage under Money Orders and Counterfeit Paper Currency?
Currency from any country is covered.
In a motor vehicle accident, auto liability coverage does not cover:
Damage to the insured's vehicle caused by the collision.
Define "proximate cause"
Damages that result from a covered event and the unbroken connection to damage that grows out of that event are covered.
Name the parts of an insurance contract
Declarations, Insuring Agreement, Exclusions and Conditions. (DIEC...like dice)
What ways can a UM Claim be settled?
Determining UM damages is accomplished by an AGREEMENT between the insured and UM insurer, ARBITRATION between the insured and UM insurer, or LITIGATION against the at-fault driver and the UM insurer.
What is the difference between a Domestic, Foreign and Alien insurance company?
Domestic- formed under the laws of the state of Florida. Foreign- formed under the laws of any state, district, territory, or commonwealth of the United States other than Florida. Alien- an insurer other than a domestic or foreign insurer.
What does the Florida Financial Responsibility Law Require?
Each owner of a vehicle must carry a minimum of 10/20/10 liability coverage.
The cost of mediation is paid ___.
Equally by both parties
Adjusters must take 24 hours of continuing education ___.
Every two years
What are the two kinds of waivers?
Express and Implied
Define "extended PIP"
Extended PIP raises medicals to 100% (from 80%) and lost wages to 80% (from 60%). Replacement costs remain at 100%.
The coverage needed by a business to cover the loss of property surrendered as a result of a kidnapping threat of the insured is:
Extortion
An auto dealer allowed a customer to test drive a vehicle believing that the person was interested in buying the car. The customer tricked the dealer and stole the car. Which coverage would provide physical damage coverage if the car was damaged or wrecked by the thief?
False Pretense
An adjuster is a ___ agent.
Fiduciary
Self-interest or self-dealing is a violation of an adjuster's:
Fiduciary duty
A home destroyed by a mud-slide would be covered under a:
Flood Policy
A catastrophe or emergency adjuster license may be issued for what period of time?
For the period of the emergency determined by the Department
What is FAJUA
For those persons who are unable to purchase auto insurance in the voluntary insurance market, insurance coverage is available through the FAJUA.
What does worker's compensation provide for funeral coverage?
Funeral expenses are covered for the actual amount but not exceeding $7500.
What coverages does Garage Insurance provide?
Garage Insurance is specifically designed for those in the business of selling, servicing, repairing or parking automobiles. Liability coverage is structured in a way that dealers are covered for liability for any auto. "Garage operations" means the ownership, maintenance or use of locations for a garage business and all operations incidental to the business.
Rule 69B-220.201 prohibits adjusters from ____?
Giving legal advice
Speeding while driving is best described as what?
Hazard
Define "hazard"
Hazards increase the risk of loss by a peril, such as an intoxicated driver or broken smoke alarm.
What is Hull Insurance?
Hull coverage provides coverage for loss of or damage to a vessel for perils of fire, lightning, earthquake, assailing thieves (pirates), perils of the seas, jettison, barratry of the master and all other like perils.
Define "Valued Policy Law"
If there is a total covered loss to a building (real property), the insurance company must pay the policy limits—meaning, insured amount rather than ACV. (in Florida)
Emergency adjusters may be appointed for what period of time?
In the event of a catastrophe or emergency the department may issue a license, for the purposes and under the conditions for which it shall fix and for the period of emergency as it shall determine, to persons who are residents or nonresidents of the state.
Define "Property Insurance"
Insurance in which the payment by the insurance company is made to the insured or others with an interest similar to the insured (like home owners and mortgage lenders).
Define "Liability Insurance". Who does this protect?
Insurance where the payment by the insurance company will be made to a third-party who is injured or damaged by the insured. This protects the insured from the third party.
How much notice must an insurance company give before cancelling an auto policy?
Insurers may cancel for any reason within the first 60 days of a policy.
Auto liability insurance will pay damages to others except for injuries caused by _______ hitting someone.
Intentionally
Denying claims without ____ is a violation of Ethical Requirements.
Investigation
I sold my home yesterday, signed a deed and transferred the title. Last night the house caught fire. The homeowners policy has not yet been cancelled. Under which policy is this claim covered?
It is not covered because there is no longer an Insurable Interest.
When both an attorney and the surety are required to sign checks to disburse an estate's funds, this is an example of:
Joint Control
Another word for charge or encumbrance on a claim is ___________.
LOSS
What is casual labor in worker's compensation?
Labor that is intermittent, irregular, temporary. It is not covered under worker's comp.
I have Collision, Liability, PIP and Medical Payment coverages on my car. I was injured while driving. Which of my coverages will never pay me any damages?
Liability
A homeowner's dog bites a postman. What homeowners policy would pay damages?
Liability Policy
Form SR-22 certifies that:
Liability coverage is in effect
What is excluded from auto liability?
Liability coverage is not available to pay for intentional incidences, property owned or being transported by the insured, injuries to an employee while on the job, and for using a vehicle without reasonable belief of permission.
Commercial vehicles under the FAJUA residual market may purchase which of the following coverages?
Liability, PIP and UM
What is a 'permanent impairment' under workers' compensation?
Loss of limb
Regarding an Ocean Marie policy, what does the term "average" mean?
Loss or damage.
A total loss vehicle has two liens on the title. The adjuster is required to:
Make payment to the owner and first lien holder
When is med pay available?
Med Pay is available as optional coverage that may be part of either a Personal or Business Auto Policy that is available to help pay medical expenses that are not paid by PIP when the insured is injured in any accident.
The claimant was injured in a one-car auto accident while working when he lost control and ran off the road. The claimant is insured for Collision, PIP, Medical Payments and Workers Compensation. Which could not pay damages to him?
Medical Payments
What are typical health insurance exclusions?
Mental illness, war, childbirth
What does the Miscellaneous Type Vehicle endorsement cover?
Miscellaneous Type Vehicle endorsement covers equipment such as motor-homes, motorcycles, golf carts and all-terrain vehicles.
Hackers damaged broke into a bank's system, transferred money, client's information and inserted a virus that damaged the computers. A claim for damages under Computer Fraud coverage has been presented. What may be covered?
Money
How does a crime policy value money and securities?
Money is valued at face value. Securities are valued on the day the loss is discovered.
What is the requirement for dealing with elderly clients?
Must exercise extraordinary care.
What are the requirements for a principal residence in Flood?
Must live in the home 80% of the time.
What is the definition of "Business Income"?
Net profit or loss
An insured owns two cars. One is insured for non-stacked UM. The other is not insured for UM. If the insured is injured by an uninsured motorist while riding in the auto not insured for UM, what is true?
No UM is available.
Do all Homeowner's policies contain Coverage A?
No, HO-4--contents broad form (renter's personal property) does not.
What does jettison mean in regards to an Ocean Marine Policy?
Objects thrown or dropped overboard.
A drunk driver was arrested and purchased a surety bond (bail bond) to get out of jail. The parties to the bond are the drunk driver, the Court, the Bonding Company and the driver's relative who posted collateral and agreed to reimburse the bonding company if there was a loss. The Court would be the:
Obligee
A provision in a homeowners' policy that pays additional costs required to rebuild a damaged structure so that it conforms to the latest building codes is known as:
Ordinance or Law
Property and Liability insurance policies cover ________, not the ____________ or ____________ of a business.
PERSONS PROPERTY OPERATIONS
The No Fault Law requires:
PIP
A speeding driver struck a FL pedestrian crossing the street. The driver was insured for PIP, Liability insurance and Uninsured Motorist Coverage. The pedestrian did not own a vehicle and had no PIP. The pedestrian may be entitled to recover damages from which of the insured's coverages?
PIP and Liability
When is PIP Available to the insured?
PIP is available to an insured while occupying a motor vehicle or while injured as a pedestrian in the state of Florida.
What coverage is primary to PIP?
PIP is primary against all other insurance coverage except worker's compensation.
Which health insurance policy provides for payment of emergency treatment even if the treated party does not go to a service provider on the approved list.
PPO
What is Part D of a Personal Auto Policy?
Part D pays for the direct and accidental loss to a covered or any non-owned auto. Part D- Collision means upset or impact with another object. Covers other than collision as well.
Collision is 'first party' insurance which means:
Payment is to the insured.
A business has been accused of detaining a customer resulting in a false arrest for shoplifting. This claim would be covered by:
Personal and Advertising Injury
Property and Liability policies cover _______.
Persons
Define "direct loss"
Physical harm or damage to a tangible property.
How much is paid for a total loss by an insured peril to a FL building?
Policy Limits.
What are the parties to a surety bond?
Principal - party expected to perform (criminal must show up in court) Surety - party guaranteeing the performance (bail bondsperson) Obligee - party guaranteed the performance (the court) Indemnitor - party who agrees to reimburse the surety for any possible loss (a relative of the criminal who pays the bondsperson)
What is "all risk" in a home owner's policy?
Property insurance covering loss arising from any cause except those that are specifically excluded.
Passengers on a cruise ship contracted a serious illness due to the ship's cleanliness and they are now presenting claims for medicals and damages. This type of claim would be covered by the ship's _______coverage.
Protection and Indemnity
define "punitive damages"
Punitive damages are awarded when the acts of the defendant are so outrageous it is necessary to punish them and deter others.
What is rule 69b-220.201?
RULE 69b-220.201- Ethical Requirements Adjusters shall not interfere with legal operations, and most of all approach the process with an unprejudiced and open mind.
What is the General Average Clause?
Refers to a loss which is a voluntary sacrifice on the part of the ship or cargo, made by the master of the ship to avoid a common peril which might destroy the entire ship or cargo unless the voluntary sacrifice is made. Losses are born by each interest in the proportion that the value of its interest bears to the total value of all interests engaged in the common venture.
An insured signs a release to settle a claim. In the event the insured discovers injuries or damages that were unknown at the time of settlement, what is generally true?
Releases extinguish any cause of action, known or unknown, so the insured will not recover anything further.
Employee theft is written in what ways?
Scheduled Person coverage, Scheduled Position coverage, Blanket coverage
How is employee theft coverage written?
Scheduled Persons Coverage Scheduled Positions Coverage Blanket Coverage
Medicare Supplement insurance limits the application of a pre-existing condition to limit coverage to a period of ____.
Six months
What type of damages pay medical bills?
Special Damages
An adjuster is negotiating with a claimant. The claim will be barred by the statute of limitations in less than 30 days. After that date, the adjuster knows that no claim will be permitted. Ethical Requirements require the adjuster to:
Tell the claimant about the statute of limitations
An employee cannot work at all, but is expected to recover. The class of disability that applies under Workers' Compensation is:
Temporary Total Disability
Define "Burden of Proof"
The Burden of Proof is the greater weight of evidence in a civil case. The burden of proof rests on the plaintiff to prove damages.
The Declaration page contains what information?
The Declarations contain information regarding the insured, the premium, the period of coverage and the policy limits.
What does the Florida Unfair Insurance Trace Practices Act penalize?
The FL Unfair Insurance Trade Practices Act penalizes misrepresentation to an insured, claimants and for certain business practices including failing to act promptly, denying claims without investigation, failing to give a decision on a claim, failing to explain claim decisions in writing and failing to maintain complaint handling procedures.
What is the FWCJUA?
The FWCJUA provides coverage for those employers who are unable to either self- insure or secure coverage through normal marketing channels. To be eligible the employer must have been unable to obtain coverage from a lease to other insurance companies and must not be in debt for any previous unpaid workers compensation premiums.
A ship's captain throws a portion of cargo overboard to save the ship in a storm. Losses from this voluntary sacrifice are settled under a Marine policy using:
The General Average clause
Define "Principle of indemnity"
The Principle of Indemnity states that an insured shall not profit from payment made for a loss.
What does it mean to be a fiduciary?
The adjuster has a responsibility of loyalty to the interest of the principal, the insurance company and the insured.
A commercial building was vacant for 90 consecutive days prior to a fire loss. What is true?
The amount payable is reduced by 15%
Define "assumption of risk"
The assumption of risk is a defense that asserts that the plaintiff knowingly exposed themselves to the danger of injury.
What is required to settle a claim on a minor?
The claim of a minor may be settled with both parents if the amount does not exceed $15,000. If the amount is larger it must be court approved.
What are the Ethical Requirements in the FL Statutes?
The code of ethics provides that the work of adjusting insurance claims engages the public trust and adjuster must put the duty for fair and honest treatment of the claimant above the adjuster's own interests. (There are 17 points to this).
What parties pay the cost of mediation?
The cost of mediation shall be borne equally by both parties unless the mediator determines that one party has not mediated in good faith.
A crime policy values securities on:
The day the loss is discovered.
What is the deductible in an umbrella policy?
The deductible is subject to its own terms and not that of the underlying policy.
Define "indirect loss"
The economic loss that results from direct loss.
Define "negligence"
The failure to exercise the degree of care a reasonable person would use to protect others from harm.
An insured had basic PIP with a $1000 deductible. A friend was riding in the insured's car in Orlando at the time of an accident. The friend did not have PIP but she did own an automobile registered in FL. In the event of an accident, what is true?
The friend is not covered by insured's PIP, because she has her own PIP.
Is the information in an insurance application a warranty?
The information in an insurance application is not a warranty because applications are considered representations.
Who has the right to settle auto liability claims?
The insurance company has the right to settle claims in any manner it sees fit.
An insured had a 50/100/50 auto policy that was the subject of lawsuit. Judgment in the amount of $50,000 with interest was entered against the insured. What is true?
The insurer must pay $50,000 plus interest
An employee stole merchandise from a business on three separate occasions. The value of each theft was more than the Employee Theft policy limit. The business wants the limit to apply separately to each incident. What is true?
The limit applies once to all loss caused by the three thefts.
What are the coverages in Farm Property?
The main dwelling structure; fences, garages and unattached structures; mobile equipment; livestock; loss of use for living expenses; scheduled property; and unscheduled property.
'Liability' refers to:
The merits of a claim
What is the primary function of the FL Department of Financial Services?
The primary function of the department of financial services is fighting financial fraud, waste and abuse in the government, reducing government spending and providing transparency and accountability in spending.
What is the Loss Payable Clause?
The protection of a lender who has made a loan secured by personal property.
What does the Wrongful Death Act provide?
The recovery rights of survivors of a deceased person. No action is permitted for the pain and suffering of the person who died.
What is "preservation of property"?
The right of possession and use applies to those who rent property and therefore, a renter may have an insurable interest in the preservation of the property. Example: A renter who leases space for 10 years to operate a restaurant. The renter invests money in the remodeling and installation of equipment and furnishings.
What is a bailment?
The temporary placement of control over, or possession of personal property by one person. ex dry cleaner.
Define "Inland Marine Coverage"
The transport of cargo traveling overland
What is the limit of medical expenses in workers' compensation?
There is no dollar limitation.
What medical care is not covered?
Treatment by massage or acupuncture is excluded no matter who provides it.
A Temporary Total Disability is compensated under Workers' Compensation for a period not to exceed:
Two years
What are the underwriting requirements for an aviation policy?
Underwriting considerations in an aircraft Hull policy include the pilot's qualifications and experience, the size of the aircraft, the type of the aircraft and the age and condition of the aircraft.
The right to sue when damaged by the practices of an insurance company is based upon the:
Unfair Trade Practices Act
What is Uninsured Motorist coverage?
Uninsured Motorist coverage pays damages to an insured for BI caused by an at fault driver with no insurance or not enough. Also applies to hit and run drivers.
What type of tort arises from a negligent act?
Unintentional
A best-selling novelist had computer fraud coverage. His computer was vandalized and the manuscript of his latest novel was destroyed. What is the best description of coverage provided?
Up to $5000 for manuscript, vandalism excluded.
Appraisal determines the ______ of a loss.
Value
What vehicles are not covered under auto liability insurance?
Vehicles with less than 4 wheels or those designed mainly for use off road are not covered. A vehicle owned by or available for use of a family member that is not insured is excluded.
A public adjuster may be disciplined for what actions?
Violating Department rules, Entering into a split fee arrangement with a non-public adjuster, Soliciting a vulnerable person
What is not an Aviation policy named peril?
Weight of ice and snow
What is a Valued Policy?
Where the parties agree in advance on a coverage limit or value of an item.
An Auto Policy Physical Damage Coverage has a $500 deductible. The deductible does not apply to:
Windshield glass damage
What is the FL statute of limitations to file a lawsuit?
Within 4 years of the offense.
A public adjuster may NOT represent a claimant in which matter?
Workers' Compensation claim
PIP is primary except to what?
Workers' Compensation.
Define "salvage"
a motor vehicle or mobile home that is a total loss.
What is form SR-22?
form SR-22 certifies to the state that the insured has the minimum amount of required coverage and must remain on file for 3 years.
A bank discovered that one of its' tellers had served time for theft prior to employment. Employee Theft coverage for that employee would be cancelled:
immediately.
Define "damages"
money
