Oklahoma Insurance Adjuster's License
Collin suffered a work-related injury on the morning of June 2nd and was off work completely until he returned to work on full duty on June 20th. Collin had worked for his employer for four years and was paid $55,650 per year. Collin's state sets the TTD rate at 70% percent of the average weekly wage. The state sets the maximum compensation rate at $580 per week and the waiting period at 5 days retroactive after 7 days. Collin was not paid for working on February 5th. Collin's average weekly wage is approximately ____ and the amount of compensation benefits he will receive per week while off work is approximately ____.
$1,070 / $580.
Other than for Workers Compensation claims, the maximum obligation of the Oklahoma Property & Casualty Guaranty Association for any covered claim is:
$150,000
What is the lump sum benefit payable under workers compensation benefits to a dependent CHILD when an employee has died in a work related accident?
$25,000.
Any person acting as a licensee in OK after having insurance license revoked will be guilty of a felony and may be subject to a monetary fine up to:
$5,000
If a licensee has a change of legal name or change of address the Commissioner must be notified within 30 days. This must include an administrative fee of ____.
$50
A compensable injury means damage or harm to: I. the physical structure of the body II. Prosthetic appliances III. Eyeglasses IV. Hearing aids
*all of the above.
In regards to WC insurance, which of the following experience in modification factors would indicate that an insured has sustained a relatively high frequency and severity of losses in the recent year?
1.25
When then Oklahoma Insurance Commissioner calls a hearing regarding an alleged unfair trade practice, _____ days notice must be sent in advance to all parties involved.
10
An OK insurer needs more than the usual 60 days to investigate a claim that does not involve fraud or arson. What is the max amount of time the insurer has to complete the investigation of this claim?
120 days
In OK, if an insurer does not make an offer to settle a claim after rcv'ing a satisfactory proof of loss within 90 days when liability is clear, what is the penalty, if any, that applies?
15% interest on the judgment until payment is made.
Every licensee must keep at the licensee's place of business the usual and customary records pertaining to transactions authorized by the license for at least __ immediately following the date of completion of the transaction:
3 years.
Every agent or adjuster, upon receipt of any inquiry from the Oklahoma Insurance Commissioner concerning a claim or a problem involving premium monies must, within _____ after receipt of such inquiry, furnish the Commissioner with an adequate response to the inquiry.
30 days
Oklahoma licensees must inform the commissioner if a change of address within ___ of the change
30 days
In OK an applicant who has failed to pass the state licensing exam two times, will not be permitted to take a subsequent examination for:
30 days following the 2nd failed exam
How many days does an Oklahoma Property and Casualty insurer have to either accept or reject a first-party claim?
45 days
Every foreign an alien insurer licensed in OK must be examined at least once every __ years:
5.
Under OK WC, vocational rehabilitation services or training will not extend for a period more than:
52 weeks
one who is undergoing training as an apprentice adjuster in OK, under the direction and supervision of a licensed adjuster, may act as an adjuster w/o having an adjuster's license for a period of:
6 months
In OK how long does an insured have to submit a required proof of loss statement?
60 days
If an employee has sustained a permanent total disability in a work related incident, what percentage of his average weekly wage is paid?
70%.
An adjuster, who is licensed in his home state, is moving too OK. The adjuster is not required to take the licensing exam to become a resident adjuster if he applies for the license within ___ after establishing legal residence in OK
90 days
Anna is walking through the park one day while unwrapping an ice cream sandwich. It was a windy day, and the ice cream wrapper was covered with partially melted ice cream. Anna doesn't want to look for a trash can to throw away the wrapper so she simply throws it down. The wind takes the wrapper across the park and drops it to the ground just in time for Ulysses to ride onto it with his unicycle. The melted ice cream on the wrapper causes Ulysses' unicycle to slip out from under him and he falls backward, striking his head on the pavement. Several witnesses saw Anna throw the ice cream wrapper into the wind, so Ulysses sues her for his medical bills. Ultimately, Anna was not proven to be negligent and her insurance company did not have to pay damages to Ulysses. What is the most likely reason for the court's finding?
Anna could not have foreseen that the act of throwing her ice cream wrapper into the wind would have resulted in the bodily injuries to Ulysses.
How long are benefits paid to a worker, covered by workers compensation that has suffered a permanent total disability in a work related accident?
Benefits are paid until the employee reaches the age of maximum Social Security retirement benefits or for a period of 15 years, whichever is longer.
Under OK WC laws, employees does not include: I. any person who is employed in agriculture or horticulture by an employer who had a gross annual payroll in preceding calendar year of less than $100,000 wages for agriculture or horticulture workers II. Any person who is employed in agriculture or horticulture who is not engaged in operation of motorized machines
Both I and II
Which of the following is a general summary of a policy?:
Certificate of Insurance
Which of the following methods is specified by the standard NCCI's WC policy to handle claims payment when other insurance, including self insurance, covers the WC risk?
Contribution by equal shares
OK requires that the acceptance or denial of a claim must be within 45 days of the claim after receipt of a properly executed proof of loss by a proper and casualty insurer. When might there be an exception to this rule?
In the event of a weather-related catastrophe or major natural disaster as declared by the governor, the insurance commissioner may extend the deadline by an additional 20 days imposed under this section.
All of the following statements are true regarding the Federal Employers Liability Act (FELA), EXCEPT:
It provides workers' compensation coverage for employees working in federal government buildings
A workers' compensation adjuster works with the treating physician to develop an appropriate treatment plan to restore the injured worker to the best possible outcome, which is know as:
MMI- Maximum Medical Improvement
Manfred's Masonry is covered by a standard workers' compensation policy. One day Manfred is looking through his policy and he sees policy limits listed. He begins to worry that his employee's indemnity benefits will not be paid because of these limits. Which of the following statements is TRUE about Manfred's worries?
Manfred's worries are unfounded because the only liability limits shown in a workers' compensation policy are for Part Two - Employers' Liability.
An insurer's certificate of authority in OK must be renewed each year by:
March 1.
What is the term used to describe the circumstance when a state requires its employers to buy coverage from a state-designated Workers Compensation program?
Monopolistic
Overinsurance can create a:
Moral hazard for the insured because it may motivate them to intentionally cause a loss to make a profit
A licensee in Oklahoma has been convicted of a felony and sentenced to a 10-year prison term. The Commissioner revoked the license because of the felony. When can the licensee have his license returned?
Not until the Commissioner determines that the cause for suspension no longer exists
Ollie lives in OK and gold a property & casualty w/ motor vehicle adjuster license. His license must be renewed in Feb of 2019. Ollie understands that he must have taken 24 hours of continuing education to be eligible to renew his license, but he is confused as to the number of hours in each of the required topics, he must take to be in compliance. Which of the following statements correctly states Ollie's continuing education requirements to renew his license:
Ollie's courses must include 3 hours of ethics, 2 hours of state or federal legislative updates, 1 hour of earthquake insurance, 1 hour of flood insurance and 17 hours of general courses to meet the renewal of requirements.
Part three of the standard WC policy is:
Other States Insurance
All of the following are methods of controlling the medical costs of WC claims, EXCEPT:
Over estimating the initial reserve for the claim
an "other insurance" clause is included in insurance policies to deal with the problem of:
Overinsurance
Which of the following classifications of disability would be most likely be provided vocational rehabilitation under workers' compensation?
PPD
With a work-related injury, the loss of a finger would be characterized as what type of disability?
Permanent partial
"Experience rating" provides employers with the incentive to:
Prioritize safety and control hazards in the workplace.
Which of the following best describes a competitive state when it comes to WC coverage?
Private insurance companies write WC coverage, but the state also writes coverage that competes w/ the coverage offered by private carriers.
If a claimant in OK is not an attorney or represented by one, what must the insurer do in the case where the statue of limitation is factor in a first party claim?
Provide a written notice that the statue will expire in 30 days
Which of the following is NOT a factor in the reserving of a workers' compensation claim?
The amount of Life insurance the injured worker carries.
Which of the following is NOT a factor in reserving of a WC claim?
The amount of life insurance the worker carries
Part one of the standard WC policy describes:
The insurer's duty to pay promptly, when due, the benefits required of the employer by the WC statue.
Part One of the standard workers' compensation policy describes:
The insurer's duty to pay promptly, when due, the benefits required of the employer by the workers compensation statute..
Which of the following statements about WC is correct?
WC is an exclusive remedy.
All adjusters in OK who adjudicate WC claims must complete __ hours of continuing education relating to the WC act as part of the required 24 clock hours of continuing insurance education
six
Regulation of insurance industry in the US is primarily left to:
state governments
Part one of the NCCI standard WC policy specifies the:
statutory provisions the policy will pay
Who administers the WC laws in OK?
the OK WC court.
The estimated annual premium for WC policy will be based on all of the following, EXCEPT:
the average premium of insureds in the same area working in the same industry.
Insurance binders in OK can be issued for a 90-day period. What if coverage needs to be bound beyond 90 days?
the binder can be extended w the written permission of the OK commissioner.
With WC insurance the insurer is considered to have received notice of the claim:
when the employer has notice of the claim
OK adjuster's are required to complete continuing education every 24 months to renew their licenses. This includes ___ hours in the subject of ethics:
3
When is a mental injury or illness NOT compensable for workers compensation benefits in Oklahoma?
A result of domestic violence.
Which of the following is true regarding Independent Medical Examinations (IMEs) requested by an insurer while adjusting a workers compensation claim?
An IME does not create a doctor-patient relationship, therefore the findings of the IME are not confidential and can be shared with the adjuster and insurance company.
Estoppel is best exemplified by which of the following?
An insurance is prohibited from denying a claim bc its appointed producer advised the insured the claim covered.
Which of the following is NOT covered by the Federal Employee's Compensation Act (FECA)?
Damages awarded by a court
Which of the following is not true regarding the OK continuing education program?
Excess CE hours may not be carried over to the next reporting period.
When an employer self-insures their workers' compensation risks, but would like to purchase insurance to cover claims that may exhaust their self-insured limits, what coverage should be purchased?
Excess coverage.
Which of the following workers' compensation reserves will be used to pay the expenses associated with IMEs?
Expense reserves
The Oklahoma Insurance Commissioner may hold hearings for any purpose deemed necessary. The Commissioner has the power: I. To take depositions. II. Subpoena witnesses or evidence. III. Administer oaths.
I, II, and III.
Fernando is a railroad worker under the FELA(Federal Employers Liability Act). He has sustained an injury on the job, which of the following must be true in order for Fernando to collect a claim?
Must prove that the employer's negligence caused the injury
Wyatt is a blasting contractor who set off a blasting charge, damaging several buildings in the area and causing severe bodily injury to several people. Which of the following types of liability apply in this scenario?
Strict liability
What type of liability is imposed by law w/o regard to fault on those participating in certain activities or owning certain things the are considered especially hazardous?
Strict/Absolute (absolute or strict liability is w/o fault)
All of the following are types of rehabilitative services provided under WC policy, EXCEPT:
Substance abuse
When determining if an injury or illness is compensable under a workers' compensation policy, which of the following is the criteria used?
That the injury or illness arose out of and in the course of the employment
If the insurance policy is issued by a surplus lines company in OK, what statement must be contained on the Declarations page of the policy?
The fact that the coverage is not subject to the protection of any guaranty association.
All of the following are advantages of purchasing workers' compensation insurance from a private carrier, EXCEPT:
The high deductibles
What benefit is paid to the surviving spouse of an employee who has died in a work related accident and then remarries?
The spouse will receive two years of indemnity benefits
A document that temporarily obligates an insurance company to provide coverage while the issuance of a policy is pending is known as:
a binder
All of the following injuries occurring on the job may be deemed compensable, EXCEPT:
a cerebral hemorrhage caused by years of high blood pressure
An adjuster in OK who does not comply w the mandated continuing education requirements may be subject to all of the following, EXCEPT:
a fine of not more than $5,000.
Which of the following best demonstrates morale hazard?
a recent purchaser of auto insurance drives less carefully, knowing that the insurer will cover the loss.
All of the following are true statements regarding apprentice adjusters license in OK, EXCEPT:
an apprentice license is good for one year.
When an insurer takes no action upon realizing material changes in a contract, this is called:
an implied waiver
All of the following are exceptions to the WC exclusive remedy, EXCEPT:
an on the job injury caused by worker fatigue from working excessive hours of over time
How often is the OK insurance commissioner required to examine domestic insurers?
as often as the commissioner deems appropriate but at least once every 5 years.
Alec goes to an amusement park and rides a roller coaster that was designed to flip the riders upside down. Alec is taller than the average person so when the roller coaster flips, he hits his head on the safety bar. After receiving medical care, Alec files a claim against the amusement park, seeking payment for his medical bills, pain and suffering. What defense against negligence would the amusement park most likely use to deny this claim?
assumption of risk
If an insurer in OK takes an adverse actions bases upon credit information, the insurer must: I. prove notification to the consumer that an adverse action has been taken in accordance w/ the requirements if the Federal Fair Trade Reporting Act II. provide notification to the consumer explaining the reason for the adverse action:
both I and II
An applicant fails to disclose known facts when completing an application for insurance. This act is known as:
concealment
Which of the following is required to calculate the estimated annual premium in a WC insurance policy?
estimated annual payroll and work classification(s)
Which of the following is NOT true regarding the licensing of adjusters in OK:
is a high school graduate or equivalent
In the event of a catastrophe, the OK insurance commissioner may declare an emergency to exist, and in the event of such a declaration, the commissioner may issue an emergency adjuster to any resident or non resident applicant. All of the following of the statements are correct regarding the emergency adjuster license, EXCEPT:
must be a licensed adjuster in OK or another state that reciprocates w/ the state
To receive WC benefits, an employee's occupations disease:
must be caused by the conditions of the employment.
An employee who injured his shoulder and could no longer perform his/her original job but was rehabilitated to perform another job would be classified under which type of disability?
permanent partial.
Adjuster should organize the medical information in the WC claim file using which of the following methods?
placed in chronological order by the dates of medical treatments and procedures.
Which of the following is NOT a way to provide WC coverage for employees in OK?
post a property bond equal to the value of $1M
When a state is "monopolistic" w WC coverage, employers in that state are:
required to purchase their WC coverage from the state-funded plan.
All of the following describe one of the four elements of a negligent act, EXCEPT:
the defendant entered into a legal contract w the plaintiff.
All of the following are true regarding how an injured employee in OK may select his or her medical treatment in the event if job-related accident, EXCEPT:
the employee does not have the right to select their own physician at any time.
Which of the following is the correct description of the "AMA guide to evaluation of permanent impairment"?
the guide lists a set of medical criteria used by physicians to form the basis for established medical ratings of permanent impairment..
What must the insurer do, regarding proof of loss that is required on a property loss that contains a provision that the proof of loss must be tendered within 60 days of the loss?
the insurer must place in bold type on the proof of loss that the 60 day proof of loss provision applies
What must the insurer do, regarding a proof of loss that is require on a property loss that contains a provision that proof of loss must be tendered within 60 days of the loss?
the insurer must place in bold type on the proof of loss that the 60-day proof od loss provision applies.
Which of the following is generally not considered to be a legal defense against claims of negligence?
the loss to the plaintiff was caused intentionally by the defendant
An insurer in OK may cancer or nonrenewal of a Homeowner's policy that has been in effect for more than 45 days for all of the following reasons, EXCEPT:
two consecutive burglary claims
According to the Jones Act, if a seaman is negligent in a claim against the employer, which of the following is correct:
violation of posted safety standards can affect the outcome of the claim.
The Sooners insurance company has written WC policies for several employers in OK. Tim's employer, Tiny Trinkets, has submitted a claim on Tim's behalf for a leg injury he sustained in the course of performing his job duties. Sooner's insurance procedures were medically unnecessary. Sooners had Tim submit to a medical examination by a licensed reviewing physician, Dr. Denny, who created a report outlining the exact procedures that he felt were medically unnecessary. Tim's treating physician requests a copy of Dr. Denny's report. How long does Sooners insurance company have to mail this report to Tim's treating physician?
within 15 days of the written request.
