Adjuster School Test Part 2

YES

. Donyalle disagrees with the coverage determination of her Worker's Compensation claim, can she hire an attorney and take the matter to court to get resolved?

Reserves

A company's best estimate of what it will pay for claims. The amount that represents actual potential liabilities kept by an insurer to cover debts to the policyholders.

Non-Renewal

A decision by an insurance company not to renew a policy

Public Adjuster

A person hired by the insured to settle the claim with the insurance company on their behalf is?

Adjuster

A person who investigates and settles insurance claims is the ______________________?

HO-B

A type of Homeowner's policy that provides coverage to Coverage A Structure for All Risks of Physical Loss, unless specifically excluded from Coverage B personal Property on a Named Peril basis.

HO-A

A type of Homeowner's policy that provides coverage to both Coverage A structure and Coverage B Personal Property on a Named Peril basis.

8 days

An employer must report the injuries within ______________ of the injury.

If Homeowner has 3 or more non-weather related claims w/in a 3 year period.

An insurance company can refuse to renew a policyholder under what circumstances?

Umpire

An_________________ is a person hired by the property owner to settle the claim with insurance company on their behalf.

Age, Condition and Life Expectancy

As an adjuster, you should base depreciation on these three factors?

Loss is $7850 is the total loss. 1% of COV A =$750.00 Amount to be paid is $7100.00

COV A limit is $75,000 COV B limit is $36,000 Your policyholder lives in Houston, Texas. While on vacation in Detroit, Michigan someone steals the following items from his house in Houston. How much will you pay for this loss? Electronics $1,600, Clothing $850, Business Laptop $3000 ONLY PAYS $2500, Music CD's $500, Golf Clubs $1,500, Shoes $900

Total Loss is $4950.00 less 1% deductible OF $85,000 = $850.00 = $4100.00

COV A limit is $85,000 COV B limit is $ 46,000 Your policyholder lives in Houston, Texas. While on vacation in Detroit, Michigan someone steals the following items from his house in Houston. How much will you pay for this loss? Electronics $1,600, Clothing $850, Golf Clubs $1,500, Shoes $600, Luggage $400,

Customer Service

Claim adjusting is what type of profession:

NO

Do you have to be a resident of Texas to obtain a Texas Adjuster's License?

$0 not covered Found in SECTION 1 Exclusions C1

During a recent windstorm, your policyholder's cloth awning sustains damage. The damage to the cloth awning is $400. How much can you pay for the cloth awning?

You need type of specialist to assist with the investigation. ie structural engineer

During the 15 Business Day period of your investigation, you may request an additional 45 calendar days to complete your investigation under what circumstances?

Floods are not covered

During the storm, your policyholder's dwelling sustained 12ft of flood water. He provides you with receipts for his Additional Living Expenses. The expenses are all reasonable. What do you tell the policyholder?

Staff Adjuster

Employee of the insurance company's claim department is__________________

Incurred Expenses

Expenses that have already sustained and that have not yet been paid are known as ____________________________________.

done in Writing

Full or partial denial of claims must be __________________________.

Issue a full denial of the claim within 5 days. Promptly!

If you deny a claim you must?

Coverage A

If your policyholder has a 1% deductible, this percentage would be taken from what coverage?

80% of the Replacement Cost

In order for a building to apply for Replacement Cost, it must be at least be insured for_______________________?

$50.00, $500

In the event you do not complete the adjuster CE requirements, you will be fined __________________ per hour, not to exceed ___________?

NO

Jacob was participating in the company softball tournament. During the game, he twists his ankle trying to run to 3rd base. Is this covered under Texas Worker's Compensation?

1)Fire and Lightening, 2) Sudden and Accidental Damage from Smoke, 3) Windstorm , Hurricanes and Hail, 4)Explosion 5) Aircraft 6) Vandalism and Malicious Mischief 7) Riot and Civil Commotion 8) Collapse of a building, or part of a building 9) accidental discharge overflow of water or Steam form plumbing, heating, air conditioning, system or household appliance 10) Falling objects, 11) Freezing, 12) theft or attempted theft

List the 12 named perils that contents are covered for under the HO-B?

$5000.00

Mary Johnson has an HO-B policy. Her coverage A limit of liability is $250,000 and her coverage B limit is $125,000. Her policy has a 2% deductible. What is her deductible?

Go online and renew. Make sure he has completed CE.

Mike's license expires in two weeks. What should he do to renew his license?

1. Money or Bank Cards 2. Valuable Papers, deeds, stamps BULLIONS etc. 3. Jewelry Watches or furs

Name 3 things that are subject to "Special Limits of Liability" under the HO-B

Notice of Loss

Notice required by insurance companies immediately after an accident or other loss. Part of the standard provisions defining a policyholder's responsibilities after a loss

5 Days

Once you have accepted or rejected an insurance claim, you have_____________ to issue the payment or issue the written denial letter.

Loss History Companies view "loss history" as an indication of an insured's propensity for a claim in the future.

Refers to an insured's history of losses (claims) with other companies, or the company they are currently with. A company will consider "loss history" when underwriting a new policy or considering a renewal of an existing policy.

Continuing Education Requirement

State-level requirement that insurance licensees periodically complete a minimum number of hours of insurance-related education in order to be eligible for license renewal

No

Stevens Jones has excess continuing education hours in a reporting period. Can he carry the hours over?

10% of COV B Limit of Liability or $1000, whichever is greater

The Homeowner's policy provides coverage's for Personal Property that is away from the residence premises. The total limit of liability for off premises losses is ______________________________?

a. Consumer Protection b. Adjuster Ethics

The Texas Department of Insurance specifically requires the adjuster applicants complete at least two hours of continuing education in:

Depreciation

The act of lowering an item's value due to use or wear and tear. Depreciation is based on Age, Condition and Life Expectancy

Premium

The amount paid by an insured to an insurance company to obtain or maintain an insurance policy.

Deductible

The amount the insured must pay in a loss before any payment is due from the company

Deductible

The amount the insured must pay in a loss before any payment is due is known as the ____________________________________.

Insurer

The insurance company

Insured

The party to an insurance arrangement whom the insurer agrees to indemnify for losses, provide benefits for, or render services to.

Loss Payee

The party to whom money or insurance proceeds is to be paid in the event of loss, such as the lien holder on an automobile or the mortgagee on real property

Material Misrepresentation

The party to whom money or insurance proceeds is to be paid in the event of loss, such as the lien holder on an automobile or the mortgagee on real property

Policy Period

The period of a policy is in force, from the beginning or effective date to the expiration date is the ________________________________?

Underwriting

The process an insurance company uses to decide whether to accept or reject an application for a policy.

Perils Insured Against

These are the specific causes of loss that are covered under the policy.

First Party Loss

This loss involves only the insurer and the insured?

HO-A

This type of policy provides coverage only for those perils that are listed in the policy?

18 years

To qualify to become an adjuster in Texas, you must be at least _____________________ of age.

False

True OR False? As an adjuster, you should advise a claimant against seeking legal advice.

False

True OR False? As an adjuster, you should advise a claimant as to their legal rights.

True

True OR False? As an adjuster, you should not contact a claimant represented by an attorney.

False

True OR False? Failing to settle claims when liability is reasonably clear is an accepted claim handling practice?

False

True OR False? Is it a violation of the Unfair Claim Settlement Practices Act to provide the policyholder with the pertinent information regarding their claim

False 30 Hours

True OR False?Licensees must obtain 40 hours of Continuing Education every 3 years?

False 24 hours

True or False: As an adjuster, you have up to 48 hours to make reasonable contact with your insured?

personal property contained in a building unless direct force of wind or hail makes an opening in a roof or wall and rain, snow, sand or dust enters through this opening and causes the damage.

Under Section I Exclusions, what does Exclusions c. (3). Say?

Physical loss to the property described in Section I Property Coverage, Coverage B unless the loss is excluded in Section I Exclusions

Under a HO-B policy, the contents are covered under what Coverage?

All risks of physical loss to the property described in Section I Property Coverage. Coverage A unless the loss is excluded in Section I exclusions

Under a HO-B policy, the dwelling/structure is covered for what types of losses?

Dwelling, Contents, Debris Removal and ICC (Increased Cost of Compliance)

What are the 4 sections of the Flood Policy?

1. 70 question pass. 2. 18+ years of age. 3. Not committed inappropriate acts. 4. Fingerprints. 5. Application, fee, and documentation.

What are the 5 requirements to obtain the Texas All-Lines License?

a. All Lines b. Property c. Property and Casualty d. Surety e. Workers Compensation

What are the types of adjusters licenses approved for insurance in Texas?

Reserves

What is the amount representing actual or potential liabilities kept by and insurer to cover debts to policyholder?

Negligence

What is the failure to use that degree of care which an ordinary person of reasonable prudence would use under similar circumstances?

$0

What is the maximum amount a person can receive for Additional Living Expenses (ALE) under the Flood Policy?

$250

What is the maximum amount for coverage for a covered loss to a tree?

$250,000

What is the maximum amount of coverage you can get on a building under the Flood policy?

Appraisal

What is the process when an insurer and an insured have a dispute regarding the amount of damage?

Liability

What is the responsibility to another for one's negligence?

Actual Cash Value

What is value of your property, based on the current cost to replace it, minus depreciation?

Professionally

When dealing with a customer, you should always behave_________________?

On or off premises

When handing a homeowner's content claim, you should establish if the loss happened __________________________________________ to help determine the total limit of liability that will apply to the claim.

Adjuster Me and Insured

When setting appointments, getting an agreed time should be a balance between what?

Pull out and Show them where it is in the policy.

While handling an auto claim, your policyholder seems confused about your coverage determination. At this time, what should you do?

Subrogation is the right for an insurer to legally pursue a third party that caused an insurance loss to the insured. This is done as a means of recovering the amount of the claim paid by the insurance carrier to the insured for the loss.

While investigating a claim, you determine that the loss was caused by a defective mechanism in the dishwasher. You would attempt to_________________________?

Not GO!!

While working on a claim with an approved vendor, he invites you to the Cowboys game. What should you do?

To organize the claims so you know dates, times and facts for each claim.

Why should you keep a chronological detailed log of all the activity on a claim?

a. Acknowledge the Claim b. Begin the Investigation c. Request all items needed to evaluate the claim.

Within 15 Calendar days after we receive written notice of your claim we must:

a. if they 'are injured on the job b. have a work related injury or illness.

Worker's Compensation benefits will pay under what circumstances?

a. You were intoxicated at-the time of the injury b. You injured yourself on purpose at while trying to injure- someone else c. You were injured by another person for personal reasons; d. You were injured by an act of God e. Your injury occurred during horseplay; or f. Your injury occurred while voluntarily participating in an off-work activity.

You cannot receive Worker's Compensation benefits if:

Be on the approved DRs. List kept by the Division of Worker's Comp

You have the right to an initial choice of Doctor. The Doctor you choose must?

30 Days

You must tell your employer within _________________of the date you were injured.

own Merits

You should always handle claims based on their _____________________________?

Perceived!

Your actions do matter, you should always be aware of how you are

NO. She is OVER 21.

Your aunt is caring for a 22 year old female. Is this 22 year old female an Insured under the HO-B policy?

$17,800

Your policyholder has a Homeowner's Policy with the following limits on it COV A limit is $178,000 COV B limit is $90,000 < 1% >. His home has a detached garage. His home and detached garage were completely destroyed in a fire loss. What is the maximum that he can receive for his detached garage?

$0 not covered

Your policyholder misplaced his watch somewhere in his house. The watch costs $800. How much are you going to pay him?

Not Covered Found on HO-B PG 2 Under Property

Your policyholder sustained a theft loss. His roommate's personal laptop, plasma television and Sony stereo were all stolen. What are you going to tell him regarding his roommate's property? (Explain your answer and cite where you found it in the policy)

Severity

_____________________ is the size of a loss, the extent of damages.

Additional Living Expenses

_________________________ are extra charges covered by homeowner's policies over and above the policyholder's customary living expenses.

Premium

___________________________ is the amount paid by an insured to an insurance company to obtain or maintain an insurance policy

Material Misrepresentation

__________________________________________________is a significant misstatement in an application form. If a company had access to the correct information at the time of application, the company might not have agreed to accept the application.

Replacement Cost

__________________________________is the cost associated with replacing property at the current market price.

Declarations Page

________________________________is the part of the written insurance policy that states all the policy's specific's, including the name of the policyholder, the type of property insured, the premiums, and the term limits for the coverage.

Overhead and Profit (O&P)

______________________________is the amount of money dedicated to a general contractor's cost of doing a business and earning a profit.

Third Party Loss

____________________________is a situation involving a person other than an insurer and the insured.

Timely Follow Up

________________________is critical to keep your Policy holder informed during the claims process.

Occurrence

_______________________is an event that results in an insured loss/damages?