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Adjuster Pro
State Insurance Claims Adjuster-Pro Certification
Insurance Claims Adjuste-Pro Exam
Course Title and Number: Insurance Claims Adjuste-Pro Exam Exam Title: Board Exam Exam Date: Exam 2024- 2025 Instructor: [Insert Instructor’s Name] Student Name: [Insert Student’s Name] Student ID: [Insert Student ID]
Examination
180 minutes
Instructions:
- Read each question carefully.
- Answer all questions.
- Use the provided answer sheet to mark your responses.
- Ensure all answers are final before submitting the exam.
- Please answer each question below and click Submit when you have completed the Exam.
- This test has a time limit, The test will save and submit automatically when the time expires
- This is Exam which will assess your knowledge on the course Learning Resources.
Good Luck!
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State Insurance Claims Adjuster-Pro Certification 2024- Adjuster-Pro Exam Section 6 Comprehensive Review Study Guide | 100% Pass Guaranteed | Graded A+ | Read All Instructions Carefully and Answer All the Questions Correctly Good Luck: - Adjuster's Ethical SItuation - =Answer>> -Adjuster make frequent decisions involving larger amounts of money -Adjusters should always determine a fair and equitable settlement that abides by the insurance contract Inducement - =Answer>> An action, item, or promise made to someone to motivate them toward certain desired actions Consequences for Accepting Inducements - =Answer>> - Losing license -Reputation Loss -Lawsuits -Jail time Kickbacks - =Answer>> Money or favors offered to the adjuster in exchange for referring business to specific repair shops or contractors Settlement Padding - =Answer>> Increasing the settlement amount dishonestly in order to increase commissions Need Writing 🤔Help? We've Got You Covered! ✍️ 100% NO A I or Plagiarism Guaranteed🤔
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Adjuster Code Rule #3 Avoid Prejudice - =Answer>> Adjusters must never be prejudiced in their investigations, adjustments, or settlements Adjuster Code Rule #4 Truthfulness - =Answer>> An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation Adjuster Code Rule #5 Honesty and Integrity - =Answer>> An adjuster shall handle every adjustment and settlement with honest and integrity Adjuster Code Rule #6 Diligence and Dispatch - =Answer>> An adjuster should act with speed and care in completing the adjusting process Adjuster Code Rule #7 Reporting Violations - =Answer>> An adjuster shall promptly report licensed insurance representatives whose conduct violates any insurance law, rule, or order Adjuster Code Rule #8 Elderly Claimants - =Answer>> An adjuster shall exercise extraordinary care when dealing with elderly clients Adjuster Code Rule #9 Dealing with Attorneys - =Answer>> -A claimant has the right to representation by an attorney -Adjusters are strictly prohibited from dealing directly with a claimant who has hired an attorney Need Writing 🤔Help? We've Got You Covered! ✍️ 100% NO A I or Plagiarism Guaranteed🤔
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Adjuster Code Rule #10 Witnesses - =Answer>> An adjuster is permitted to interview any witness, prospective witness, without the consent of opposing counsel or party Adjuster Code Rule #11 Right to Attorney - =Answer>> An adjuster shall not advise a claimant to refrain from seeking legal advice, nor advise against the retention of counsel to protect the claimant's interest Adjuster Code Rule #12 Traumatized Claimants - =Answer>> Adjusters shall not attempt to negotiate with, or obtain any statements from, claimants or witnesses who appear to be in shock or under severe emotional distress Adjuster Code Rule #13 Advising of Rights - =Answer>> An adjuster must advice claimants of all their claim rights in accordance with the terms and conditions of the contract and of applicable laws Adjuster Code Rule #14 Release Forms - =Answer>> An adjuster shall not draft any form of release, unless approved in writing in advance by the insurer, this ensures that the adjuster is properly representing the insurer's intentions Adjuster Code Rule #15 Competence - =Answer>> An adjuster should not deal with a claim that he is not trained to take on Unlawful Sales Practices - =Answer>> - Misrepresentation
- Lying on Applications Need Writing 🤔Help? We've Got You Covered! ✍️ 100% NO A I or Plagiarism Guaranteed🤔
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- Delaying the settlement process by demanding a preliminary claim report as well as formal proof of loss forms
- Refusing to settle claims promptly under one part of the policy in order to influence settlement under another
- Failing to explaining promptly and thoroughly why a claim was denied or a compromise settlement was offered Standards for Prompt Settlement of Claims in NC - =Answer>> -Acknowledge the claim within 30 days after receiving sufficient information to identify the coverage involved -Accept or deny the claim without unreasonable delay after receiving all necessary items and documents from the claimant -Deliver the claim payment within 10 business days after settling it In NC Acknowledgment of a Claim may include any of the following methods - =Answer>> 1. Statement to the claimant that the claim is being investigated
- Payment of the claim
- Written offer of settlement
- Written denial of the claim Cancellations Reasons for Insurer in NC - =Answer>> - Nonpayment of premium -Material misrepresentation or concealment in a policy application, renewal, or claim -Substantial change in the risk -Substantial breach of contract that materially affects the insurability of the risk Need Writing 🤔Help? We've Got You Covered! ✍️ 100% NO A I or Plagiarism Guaranteed🤔
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=Fraudulent acts or omissions by the insured to obtain, continue, or file a claim against the policy -Willful failure to implement loss control measures after written notification from the insurer -Loss of reinsurance -Conviction of a crime that increases the hazard insured against -Commissioner determines that continuing the policy would violate state insurance laws -An insured's failure to meet the insurer's requirements as stated in the insurer's corporate charter, or bylaws NC Notice of Insurance Cancellation Requirements - =Answer>> -Insurer must notify the policyholder at least 15 days in advance -Must include the reason for cancellation -Must notify about non-renewal: at least 45 days in advance -Must notify changes to their policy: at least 30 days in advance NC Notice of Auto Insurance Cancellation Requirements - =Answer>> -For non-payment of premiums: at least 15 days in advance -For all other reasons: at least 60 days in advance -Insured who wishes to have the policy termination reviewed, must request the review in writing within 10 days of receiving cancellation notice 3 Main Consumer Privacy Protection Laws - =Answer>> 1. The Fair Credit Reporting Act
- The Insurance Information and Privacy Act Need Writing 🤔Help? We've Got You Covered! ✍️ 100% NO A I or Plagiarism Guaranteed🤔
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Adjuster Learner's Permit - =Answer>> -Allows an applicant to work without a license under the supervision of a licensed adjuster at a company where both are employed -Valid for 90 days Continuing Education for Resident Agents and Adjusters - =Answer>> 24 hours of CE every 2 years including 3 hours of ethics How often do agent and adjuster licenses need to be renewed - =Answer>> Each year, by April 1 Agents and adjusters that hold a property or personal lines license must complete what? - =Answer>> Three CE Credits in Flood Insurance Incomplete Continuing Education - =Answer>> -If for some reason a licensee has not been able to complete her continuing education requirements, they can request an extension. This request must be made in writing and be submitted no earlier than 30 days prior to the end of their compliance period. -If continuing education is not complete and no extension is requested, the license will lapse. At this point the person has 120 days to complete the CE requirements to be eligible for reinstatement In the event that the commissioner's office is vacant, who will fulfill the duties of the office until another commissioner is elected? - =Answer>> The Governor Need Writing 🤔Help? We've Got You Covered! ✍️ 100% NO A I or Plagiarism Guaranteed🤔
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Commissioner of Insurance Duties - =Answer>> 1. Writing and enforcing insurance rules and regulations, with a special focus on protecting the public
- Writing rules and regulations for the recording and reporting of insurance transactions
- Making rules for proxies of capital stock or other equity securities of domestic stock insurance companies
- Providing the necessary forms to companies that have to report to the commissioner
- Reporting any violations of insurance law to the attorney general
- Providing information to residents of the state in order to help them understand insurance contracts, upon request
- Administering oaths
- Compiling insurance rates and explanations of Homeowners, Dwelling, and Personal Auto Policy coverages Commissioner power on restraining orders, and license surrenders - =Answer>> -Can apply for a restraining order against someone who may be breaking state insurance laws -Can suspend the license of anyone convicted of a crime -Ask a licensee to surrender their license if they are accused of something with cause for license suspension/revocation -Fine a licensee between $100 and $1,000 for insurance code violations -Must inform commissioner if convicted of a crime within 10 business days Need Writing 🤔Help? We've Got You Covered! ✍️ 100% NO A I or Plagiarism Guaranteed🤔
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Notice of License Suspension or Revocation - =Answer>> - Upon suspending, revoking, or denying renewal of a license, the commissioner will notify every appointing insurer in the state. Insurers will be informed when a license holder surrenders their license for any reason -Commissioner will also inform the National Association of Insurance Commissioners -License holders who no longer live in NC, must deliver their license to the commissioner within 30 days after moving When does insurance fraud occur - =Answer>> -Consumers deceive an insurer for financial gain -Insurers deceive consumers for illegal profit Common Types of Insurance Fraud - =Answer>> -Staged Auto Accidents -Arson -Faked Death -Murder for Insurance -Corporate Health Insurance Fraud -Individual Health Insurance Fraud -Insurer Fraud -Property Insurance Fraud Arson - =Answer>> Deliberately setting fire to insured goods or property so that you can collect the insurance money Corporate Health Insurance Fraud - =Answer>> Corporate healthcare chains over-bill insurance companies Need Writing 🤔Help? We've Got You Covered! ✍️ 100% NO A I or Plagiarism Guaranteed🤔
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Individual Health Insurance Fraud - =Answer>> A doctor may prescribe procedures that are not necessary in order to get the insurance payments Insurer Fraud - =Answer>> -Employees, managers, or executives of an insurance company steal money from the company -Also called internal Fraud How are insurance companies responding to fraud? - =Answer>> -Starting fraud busting units -Educating customers -Training employees -Sponsoring the National Insurance Crime Bureau Model State Fraud Law - =Answer>> -Developed by the Coalition Against Insurance Fraud -Creates state fraud bureaus -Requires insurance companies to develop plans for preventing and detecting fraud -Requires insurance forms to warn that fraud is a serious crime -Nearly 20 states have adopted this model State Fraud Bureas - =Answer>> -Exist in 41 states and D.C. -Enforces closer scrutiny of insurers and their finances How is the Federal Government fighting Health Insurance Fraud - =Answer>> -Enacting tougher penalties -Expanding current fraud laws -Imposing stiff prison terms Need Writing 🤔Help? We've Got You Covered! ✍️ 100% NO A I or Plagiarism Guaranteed🤔
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Independent Organizations Rate Financial Health of Insurers based on what? - =Answer>> -Performance -Experience -Management A.M. Best - =Answer>> Insurance rater that rates insurers' financial strength by letter, A++ TO f Reasons for Insurance Regulation - =Answer>> 1. Increase the availability of insurance
- Prohibit price-fixing
- Promote reasonable insurance rates Need Writing 🤔Help? We've Got You Covered! ✍️ 100% NO A I or Plagiarism Guaranteed🤔
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