Tx Claim Adjuster Pre- License

The insurance industry can accurately trace its formation to the great fire of London on:

September 2, 1666

PAP

The Personal Auto Policy is a package policy that combines property damage and liability insurance for motor vehicles.

After finishing high school , Tom decided to enlist in the military and was stationed in another state. He is concerned as to whether or not his Texas policy will still cover him?

The Texas policy will automatically meet any other states liability insurance requirement. However he maybe require to buy a policy in the state he is stationed at his renewal date.

The insured tells you that their family car was damaged in Mexico while they were on the a little vacation. They want you to pay for it and do not understand " the laws" of Mexico. What would you tell them about the laws and insurance coverage?

The insurance company may not be able to provide protection in Mexico as this is a criminal and civil law Mexico does not recognize U.S. auto liability policy

An adjuster tells the claimant that he has to got to ABC auto repair to have the work done on the damaged vehicle. He reasons that an agreement has been made with his insures and ABC to keep the costs at a reasonable amount and save money (this is the best interest of the insured ). What should the adjuster really have told the insured?

The insured can take the damaged vehicle to any car repair shop.

Your insured , the claimant has had her CD's stolen from her vehicle . She claims it was locked; however they were worth $700.00 and would like you to pay for them. She has "full coverage ." (Do not consider a deductible). What do you say to her?

The insurer will not pay for the loss.

Supplementary Death payments under the Personal Injury Protection will pay up to a maximum of $______

The insurer will pay supplementary death benefits equal to the limits shown for the appliable coverage (but not more than $10,0000 per person because of death if it is a result of an accident and the person was wearing a seat belt if had an airbag.

One of the persons who works with you in your office has had an adjuster license that has been expired for a period of more than 90 days but less than 12 months . He wants to know if he needs to take another class and examination again. What is the amount of time that would exempt him from re-examination.

The license has expired for a period of more than 90 days, but less than one year.

**When adjusting a first party claim the adjuster must keep in must in mind at all times that the claimant and the insured are____.

The same and have a contractual relationship with the company.

You are looking in your desk to get your license and wondered when it expires because you have to renew it. You ask someone " How often do I have to renew my license ?" What is the correct answer?

The second anniversary of the date

** Property insurance has been designed to protect persons or entities desiring to have protection for:

Their personal or commercial buildings and contents and other areas associated with owning renting or leasing a building and contents.

A tornado has hit Waco and a bunch of "storm troopers" come to Waco to begin to settle claim there. There are several hundred of them are trying to settle the claims quickly as possible. You find out that some of them don't even have a valid license to do this and get upset . They tell you this it is no big deal and continue to handle the claims. Why do you think they say this (for a correct answer)?

They have received an emergency license from the commissioner and include persons who are residents of nonresidents of this state and who may or may not be other wise licensed adjusters.

You are working for a fairly good sized adjusting firm and note the there a number of "new adjuster" who are coming to work each month. Some of the people are adjuster losses, but you know that they don't have a license and you had to "get your license" before you could adjust claims . you asked your supervisor why this is happening ? What is the correct answer if done correctly?

This person is being trained by a license adjuster and may for a period not exceed 12 months act as an adjuster without having an adjuster license if at the beginning of such a trainee has been registered as such with the commissioner.

According to the TDI , an insurer must have__ telephone lines available for policy holders so that they may try to solve complaints fairly.

Toll- Free Number

Policy language include under "Your covered auto" includes which i the following?

Truck with a gross vehicle weight less than 10000 pounds not used for the purpose of delivering goods, materials of supplies.

** How long must a person's auto policy be in effect before the insurer can refuse to renew it ?

Twelve months

A person applies through an agent to obtain auto insurance and is denied because of the prospective client to TAIPA is to write his/her insurance?

Two or more

A vehicle has hit your insured, however the other party left the scene (a hit and run) and there is no proof regarding insurance. What should apply in this case?

UM/UIM

Liability imposed upon one as a result of the negligence of another would be the definition of;

Vicarious liability

You want to issue a Reservation of right letter to an insured for lack of cooperation. How long do you wait to do this according to the Texas Insurance Code?

Whatever is reasonable.

Your insured Tom, gets an estimate for damaged from you. They are shown as $13,500. You feel that is fair, however Tom wants to keep his car since it is " totaled" as you have indicated . Can he do this or what happens now?

Yes he can do this, however you will subtract the "salvage value" from the amount offered to him.

The insured used her SUV to haul skids to soccer practices and games five days a week and has decided to use her van and get $7.50 per child per week and make a little money to pay for the gas. She is injured in an auto accident and wants to collect Medical Payments. Can she do this?

Yes she can so this as long as she is not attending to collect money for profit. Collecting money to maintain the vehicle is allowed.

On Billy 's 17th birthday a full year after getting his license, he is involved in an accident where he was at fault. Billy's parent never added him to their auto policy. Once a claim was filed against their auto policy, the insurance company of additional premium. Can they do this?

Yes, because the insurance company is required to change the correct rate based on the classification s of drivers in the family the company can and will bill the insured(parents) for the extra premium that should have been paid

Your claimant indicate that he was painting the eves on his house and was standing on the hood of his car and accidently slipped off and hurt his back. Now he wants to receive coverage from the PAP. Is this possible? If so, why?

Yes, its allowed because of the " definitions" in the policy.

**A person wants to know "do you pay for a loss to my mobile home under the Personal Auto Policy" What is the answer?

Yes, this can be done.

The insured has been involved in a hit and ruin accident . You indicate to them that they should file this with the police. Are you correct? If, so why or why not?

Yes, this is correct, as it is a procedure that is required in the policy for UM/UIM coverage.

Your insured was involved in an accident where someone else was liable. The policy holder wants you to " get her a rental car even though she doesn't have rental car coverage. What should you tell her ?

You are going to have to get this coverage from the other person.

You have been swamped with work and have forgotten to get back in touch with one of the claimants regarding an auto accidents and have not done the follow-up that is expected to you. You hope that you are not going to be terminated, but then you worry about your license . You have done a good job thus for however the claimant " turns you into the TDI" and your receive a letter from them indicating that you were not acting according to your duty. What would be the response from the TDI regarding the issue?

You are subject to the Unfair Claims and Settlement Practice Act.

You tell our insurance that their car has been damaged during a collision and that you are willing to pay them $23,150 for damages. They believed that is not enough as their car loan is more than $28,500 and want more. What is the reasoning you are offering lower than the loan amount?

You are using Actual Cash Value and that is all you have to do.

**Coinsurance Clause

at least 80% of required value used for partial losses. insurance carried / insurance required x the loss the payment by the insurer. $50,000/ $80,000=62.5% x $30,000= 18,750

Allied Lines

coverages which are generally written with property insurance, e.g., glass, tornado, windstorm and hail; sprinkler and water damage; explosion, riot, and civil commotion; growing crops; flood; rain; and damage from aircraft and vehicle, etc.

** The standard fire policy insures against losses associated with:

fire, lighting , and removal

**Under uninsurance/underinsurance motorist protection what is the deductible if any that is required under the PAP?

$250 for property damage

You see a person that graduated from high school with your daughter come into your company's office and indicate she wants to work as an adjuster. The is given an application to complete and writes her age down as 18 years old. You hope she is "old enough to required minimum age of a person who desires to have an adjuster's license?

18 years old

how many hours must an insured vehicle be withdrawn from service in order for rental reimbursement to provide coverage?

24 hours

** An insured may sue insurance companies for unfair discrimination, including denial of insurance and collect up to $______ in civil penalties if he/she wins the case

25,000

**What is the minimum amount of Personal Injury Protection ?

2500 - min amount of coverage afforded under PIP

If you the adjuster believes that the auto claim has been for arson how many days does this give you to determine whether or not you will pay the claim?

30 days

** If an adjuster notifies the insured that a claim will be paid under the PAP within how much time must the claim be paid?

5 business days

How many days does an insurance company have to notify the insurance commission of its application to have claims adjusted by "Emergency Adjuster?"

5 days

Referring to "Emergency Adjuster" who is responsible for their actions when they adjust claims?

A Texas licensed adjuster or/and a company licensed to do business in Texas and has an office here.

"Family member " means a person who is a resident of your household and related to you by blood marriage or adoption. Who else would be considered as a family member?

A spouse who is considering a divorce or doesn't live with you. Family spouse, in law, blood relatives, adopted and foster child and relatives living away.

** Collision coverage includes the collision and upset of the insured's vehicle. Which of the following is not covered under collision? (Damaged caused by which of the following types of perils).

All these ere correct ; theft , fire, damage by bird

** Your insured know that his car is going to be "totaled" and asks you " what does this mean?" what should be your answer?

An insurer totals a car if repairs would cost mare than its worth.

The three groups of coverage generally available on both and commercial polices would be called

Basic , broad, and special

**At what coverage levels is collapse first seen as a covered peril?

Broad

**During your investigations of this 3rd party liability claim have determine that the claim was filed fraudulently and your insured was not liable for the damages. As the adjuster your primary duty toward your insured in a liability claim is to;

Defend the insured against all claims whether fraudulent, frivolous, or false.

**The name given to the associated SFP risks of smoke, hail, windstorm, hurricane, vandalism and civil commotion are also commonly called.

Extended Coverage

**You tell your insured that you have delayed continuation of payment on the auto collision claim until you are able to have him release the insurer from further payment on medical injury portion of the claim paying for the Personal Injury Protection coverage. You feel this is justified Can you do this?

It is not justified - you cant do this

The PAP applies to accidents in all of the following areas except?

Mexico

Your insured is involved in an auto accident and wants to know (after you haven't paid the claim according to the insured's desires) if he can hire an attorney to get it paid more quickly. How would you respond?

No legal action may be brought against us until there has been full compliance with all of the terms of the policy.

The level off duty owed to a trespasser would be

Not purposefully set out to harm by setting injurious traps

The insured calls you and finds that his trailer been wrecked. You need to know how t was being used. What is the purpose or design of a "trailer" in the PAP?

One that is to be pulled by a pickup or van.

the insured has a PAP with full coverage. He owns three cars and makes a claim indicating that one of the cars, an uninsured vehicle he owns and now he wants to make a claim under the UM/UIM portion of the PAP policy. How should an adjuster respond to this claim?

Pay for the insured vehicle to get fixed under the collision coverage and subject insurer to a deductible.

PIP

Personal Injury Policy - plus 80% loss income

Under "General Provisions" for a loss, how much time should the insurance company receive whenever a loss has to be reported by the claimant?

Promptly notified

**In the news this week a local doctor and his staff was found guilty of negligence in a malpractice lawsuit by the county judge. The judge decided due to the fact that during re-examination of the patient. It was determination that during the patient recent appendectomy the doctor had accidently left serval surgical tool inside of the patients chest cavity. The judge ruled in favor of the patient primarily due to

Res Ipsa loquitur

Every year XYZ Insurance has their Annual Holiday Sales event at the company's headquarter. The event draws large crowds of potential customers to the building in the hopes that they will eventually become customers of XYZ. Those individuals who attend the event would be considered

invitees

What other peril is always present when fire is covered under the home owners policy?

lightening

A person applies to TAPI for an auto policy. Which of the following is not required by TAIPA to underwrite for an individual?

limits of liability of 100/ 100/100 is not required by TAIPA to underwrite of an individuals

TAIPA coverage

more expensive , 2 insurance companies reject insurer , covers for 3 yrs.

High Risk Drivers

multiple Tickets or accidents , at - fault accidents within 3 yr. to 5yr , fast car, and DUI. after no accident for 3 yrs. chose own insurance.

Which endorsement can be added to the PAP so that a young driver can be removed from coverage?

named driver exclusion

Liability

pay for other people damages only

The PAP requires the insured person to perform the following whenever he/she is involved in an auto accident. (Choose the answer that is NOT correct).

provide insured obtained photographs evidence as proof of any accidents being claimed.

**If a loss occurs with first party claim _____ and in the case of bodily injury ____, is broken.

something, someone

medical payment pay for losses up to ___ year

three

Failure of any insurer to maintain a complete record of all the complaints, which it has received during the preceding ____year(s) or since the date of its last examination by the commissioner whichever time is shorter is considered to be a part of the Unfair Claims Settlement Act.

three years

The insured's car has been towed and the total cost includes $40 for towing $75 for service performed at the service station. How much will you pay for this claim if the insurer has maximum protection?

$40.00

Alicia, a 23 year old recent college graduate has PIP $10,0000 coverage is working at her new job making $1,000 per week. She is involved in an auto accident and is disabled due to the injury, however she is able to return to work would you pay her for loss of income?

$560- 80% of her lost of income of $100 per week

**your insured hit a deer while traveling through the hill country around Austin and wants to know what the company will pay as $2,700 in damages he been done. He has collision with a $500 deductible and comprehensive at $250 deductible.

(Comprehensive) Subject to the $250 deductible

** You received notice of a claim by the insured. How many days do you have ( according to the policy ) to respond to the claim?

15 days

Created in 1941, the standard fire policy was so well known that it would be referred to as the _____ line policy.

165

What are the minimum limits of liability coverage affordable in Texas for liability insurance ?

30/60/25- thousand

What is the most that would be paid for bodily injury under a combined single limit policy if the limits were 300 for in person?

300,000

You ask your instructor how many hours the licensing class is designed to last. Also how many minutes/hours are allowed to take the final examination . What are the correct answers?

40 hours - 180 minutes

Additional Living Expenses

A coverage in homeowners policies that indemnifies the insured for the additional expenses that are incurred following a covered property loss so that the household can maintain its normal standard of living while the dwelling is being restored.

A business day is defend as in the PAP as___

A day other than a Saturday, Sunday of holiday recognized by the state of Texas.

A friend of yours move to Tx and wants to become an insurance adjuster and asks you " What are the qualifications to be an adjuster ?" This person has completed her insurance designation the CLU (certified life insurance underwriter) after passing several rigorous examination while living in Oklahoma. Which would NOT be the correct answer?

A person with college degree in Risk Management and Insurance is not required. -must be 18 years of age -resident of state -have a drivers license

** Actual cash value = replacement cost

ACV=RC - minus depreciation (%or$)

An insurance adjuster may NOT include which of the following types?

An attorney who does this part of this jobs

You are new on the job and trying to learn your duties . A some what complicated claim is given to you to handle as all of the other adjusters are busy doing their regular work each day. Rather than conducting a thorough investigating you simply tell the claimant ; " Here is what we are willing to offer not knowing if ; you are right of wrong . You just hope that this will be acceptable to everyone. You soon discover that you are in violation of what portion of the law ?

Article 21.21

**A tort is a ____ .

Civil wrong

C.L.U.E.

Comprehensive Loss Underwriting Exchange

**If both parties do not agree on the amount of loss, either may demand an appraisal of the loss. In this event, each party will select a competent appraiser. The two appraisers will select an umpire. The appraiser will state separately the actual cash value and the amount loss. If they fail to agree, they will submit their differences to the umpire. Who would be responsible for payment of the appraisal?

Each party is responsible for their own appraisers and bear the expense of the appraisal and split umpire equally.

What type of fire is covered by home owners policy

Hostile fires

**The failure to exercise the degree of care required by law or custom is

Negligence

Can an insurance company refuse to renew a policy because of the insured age of because a family member reaches a driving age?

No

The primary basis for which property is insured is:

Standard Fire Policy

All property covered issued in Texas is in some manner based on the ____.

Standard Fire policy

A TAIPA insured has been receive insurance for the 3yrs and want to know if he can get a less expensive policy compared to that he has been paying. He has had no accidents or tickets in that period of time. What would you tell him?

That's fine this is a requirement by the TDI (at fault insurer pays for medical, loss wages ,(due to injury) and car rental).

**An insurance company cannot have auto policy cancelled that has been in effect for more than sixty days unless (choose the answer that is NOT correct).

The insured got a felony

** The named insured is involved in an auto accident and you have determined his vehicle is a total loss and he was at fault for the loss. You offer him a settlement of $10,000 and he wants $12,500 or won't accept your offer. What now?

The insurer can demand an appraisal and allow other parties including an appraisal and umpire to make the decision.

**During a recent wind storm one of the trees in your insured's back yard has fallen into the dwelling. Breaking a window and allowing water to enter the home. An excessive amount of water proceeded to fill up the couch cushions causing the weight of the couch to become to great for the floor supports of the living room. The couch fell through the floor and landed on top of the water heater located in the basement bellow. The basement then became flooded due to the burst pipes supplying the water heater. What was the proximate cause; of the loss in the scenario ?

Wind

** Can a pickup be used for farming or ranching and have a PAP?

YES

Business Interruption Insurance

an insurance that protects companies during the period necessary to restore property damaged by an insured peril. Coverage pays for lost income and other expenses related to recovery.

Ben Wlson, currently unemployed from a large technology company just had an auto accident when he realized that he had PIP and was anxious to obtain the part on that would allow him to have some income (that was the reason he bought this coverage). What percentage of his income will he be able to receive under PIP?

none

Liability insurance

only covers other people medical bills and auto damages

Your client grandfather has come to live with the insured family and borrows the family's car to go to the grocery store. He doesn't see well and is involved in an accident and deemed to be at fault for having rear ended someone in the parking lot. He has fractured his wrist (cost $2500 for medical payments). You have been asked to make payments under PIP coverage will the PIP respond?

yes

The insured has presented to you a situation what struck ere he indicates that the car that struck his car was an uninsured vehicle and wants to collect for damages under the UM/UIM portion of the PAP. You don't think you owe this. Whose responsibility is this to verify if the other driver had insurance or not?

you - the adjuster of his own insurance company