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Florida Claims Adjuster Exam, 6-20 All
Lines Adjuster- Florida- Review exam
with solutions
Peril - correct answer ✔ Something that causes a loss. Hazard - correct answer ✔ Something that increases the probability that a loss will occur. Warranty - correct answer ✔ A policy condition, either based on information in the insureds application or inserted by the insurer. It is a guarantee of a fact. Misrepresentation - correct answer ✔ An untrue statement by the insured, made in an application for insurance but which does not become a part of the policy. Concealment - correct answer ✔ The failure of the insured to reveal relevant facts known to the insured in applying for insurance. Abandonment - correct answer ✔ Property insurance policies usually contain an abandonment clause, stating the insured cannot dump damaged property on the insurer and demand its full value.
Severability - correct answer ✔ The insurance applies separately to each insured as if other insureds did not exist. Proximate Cause - correct answer ✔ The cause having the most significant impact in bringing about the loss under a first-party property insurance policy, when two or more independent perils operate at the same time (i.e., concurrently) to produce a loss. Courts employ a set of rules to resolve causation disputes when a property policy states that it covers or excludes losses "caused by" a peril and there is more than one peril at work in a fact pattern. Under common law, whether the policy provides coverage depends on which peril is chosen as the proximate cause. Direct Loss - correct answer ✔ Physical harm to tangible property. Indirect Loss - correct answer ✔ Economic loss which flows as a result of direct loss. Actual Cash Value(ACV) - correct answer ✔ Replacement Cost minus Depreciation Coinsurance - correct answer ✔ The amount, generally expressed as a fixed percentage, an insured must pay against a claim after the deductible is satisfied. It's ultimately a way for the insured and insurer to share responsibility for the risk. It can also help reduce the cost of the insurance policy premium. Coinsurance can be written on an 80/20, 90/100, or 100% rule. Personal Contract - correct answer ✔ Policies cover people who own and operate things, such as automobiles.
Damages - correct answer ✔ Monetary compensation that is awarded by a court in a civil action to an individual who has been injured through the wrongful conduct of another party. Subrogation - correct answer ✔ When an insured has a right to collect damages from another party, but instead elects to claim the damages under his insurance policy, his rights against the other party are transferred to the insurer. Changes - correct answer ✔ All policies provide that any changes to the policy be made by the insurer, in writing. Policy Period - correct answer ✔ The condition states that coverage applies only to losses or occurrences that take place during the policy period. (Prior to the stated date and time of termination). Policy Territory - correct answer ✔ Condition limiting coverage to occurrences or losses that take place only within a stated geographical region. Other Insurance - correct answer ✔ The principle of indemnity dictates against duplicate recovery for the same loss. Cancellation - correct answer ✔ The insured may cancel at any time, for any reason, without advance notice. If the conpany wishes to cancel, it must provide some degree of advance notice so the insured will have time to replace the coverage.
Appraisal - correct answer ✔ A written contract of or written agreement for or effecting insurance, or the certificate thereof, by whatever name called, and includes all clauses, riders, endorsements and papers which are a part thereof. Insurance - correct answer ✔ Is a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit upon determinable contingencies. Binder - correct answer ✔ Acts as a temporary contract until the policy is issued. How many days should an insurer give for prior notice of cancellation of a binder? - correct answer ✔ 5 days. Property Insurance - correct answer ✔ Any insurance wherein payment by the insurer will be paid directly to the insured or other specifically named interests. Liability Insurance - correct answer ✔ Payment will be on behalf of the insured to another, based upon the insureds liability to the recipient. Simply stated, Liability is "Negligence of the Insured". Loss Payee Clause - correct answer ✔ A Clause in a contract of insurance that provides, in the event of payment being made under the policy in relation to the insured risk, that payment will be made to a 3rd party rather than to the insured beneficiary of the policy. Mortgage Clause - correct answer ✔ A property insurance provision granting special protection for the interest of a mortgagee named in the policy, in effect setting up a separate content between the insurer and the mortgagee.
Employee Theft - correct answer ✔ Provides coverage for loss of or damage to money, securities, and other property resulting from theft committed by an employee. Theft is defined as the unlawful taking of money, securities or other property to the deprivation of the insured. Bid - correct answer ✔ Aggreement to fulfill a contractual obligation used frequently in construction and supplying goods. Health Maintenance Organization (HMO) - correct answer ✔ Provides comprehensive health services to its members for a prepaid fixed fee, equivalent to an insurance premium. Preferred Provider Organization (PPO) - correct answer ✔ A selected group of hospital's and medical practitioners in a given area who have joined together in an effort to reduce medical costs. Estoppel - correct answer ✔ Is an equitable principle to the effect that if one intentionally or unintentionally creates the impression that a certain fact exists, and an innocent party relies on that impression and is damaged as a result, the guilty party may be legally prohibited(estopped) from asserting that the fact does not exist. Salvage - correct answer ✔ Motor vehicle or mobile home is a total loss. Junk - correct answer ✔ Any material which is or may have been a motor vehicle or mobile home, with or without all component parts, which is inoperable and which material is in such condition that its highest or primary value is either in its sale or transfer as scrap metal.
Fiduciary Agent - correct answer ✔ Agent for a principal/Client. The legal or special relationship of trust, confidence, or responsibility between 2 or more parties. Domestic Insurer - correct answer ✔ Insurer is one formed under the laws of its this state. Foreign Insurer - correct answer ✔ Insurer is one formed under the laws of any state, district territory, or commonwealth of the United States other than this State. Alien Insurer - correct answer ✔ Insurer is an insurer other than a domestic or foreign insurer. Appointment - correct answer ✔ The authority given by an insurer or employer to a licensee to transact insurance or adjust claims on behalf an insurer or employer. Derelict - correct answer ✔ Material which is or may have been a motor vehicle or mobile home, with or without all component parts, which is inoperable and which material is in such condition that its highest or primary value is either in its sale or transfer as scrap metal or component parts or both. Mechanical Breakdown Coverage - correct answer ✔ Covers repairs to mechanical parts of your vehicle that break. Even covers break in events not related to an accident.
Bureau Adjuster - correct answer ✔ Employee or agent of an adjustment bureau which serves multiple company clients such as the GAB Business Services, Inc and Underwriters Adjusting Company both national firms. Independent Adjuster - correct answer ✔ Are Self-Employed and are not affiliated with either insurers or bureaus. They serve as adjuster representatives of insurers, and their services are compensated on a fee-plus-expenses basis for each loss handled. Public Adjuster - correct answer ✔ Is a claims adjuster who is an advocate for the policyholder in appraising and negotiating an insurance claim. What are the Characteristics of a Personal Auto Policy Declaration Page? - correct answer ✔ -Liability(Bodily Injury) -Property Damage -Uninsured Motorist -Medical Payments -Personal Injury Protection -Collision Deductible -Comprehensive Deductible -Towing Coverage -Rental Coverage What are examples of Transacting Insurance? - correct answer ✔ -Solictitation of Insurance -Negotiation of Insurance
-Effecting Coverage (Binding insurance coverage) -Transacting Insurance Matters(during and after insurance is bound). What are thresholds of the No-Fault Law? - correct answer ✔ -Significant and permanent loss of a bodily function or -Permanent injury other than scarring and disfigurement or -Significant and permanent scarring or disfigurement or -Death What is the adjusters investigation limited too? - correct answer ✔ A simple verification of bills and estimates or it may be expanded to include photographs, witness canvasses, or recorded statements as the circumstances require. What are the componets of a investigation process? - correct answer ✔ -Inquiry -Verification -Comparison What are some reasons for suspension, revocation or termination of a license? - correct answer ✔ -Transacting Insurance outside of scope of one's license -Misrepresentation or fraud -Sliding -Demonstration of unworthiness or lack of fitness -Misappropriation of funds -Failure to inform Department of financial services, within 30 days, after pleading guilty or no contest to a felony.
Claim - correct answer ✔ Is the assertion of an alleged legal right against an insurer, which carries with it a demand for appropriate relief. Claims Adjuster - correct answer ✔ One who is involved in the investigation, adjustment, negotiation and/or trial preparations of claims arising under insurance policies. Adjusting - correct answer ✔ Process of disposing of an insurance claim. Loan Receipt - correct answer ✔ A written statement given by the insured to the insurer acknowledging that money received in the settlement of damages is received, not as a final payment, but as an advanced pending the outcome of a claim against the person responsible for the damage. Apportionment - correct answer ✔ Is a provision for computing and assigning to each of two or more contracts covering a claim its proportion of the amount of the loss. How to settle a claim for an Injured Minor? - correct answer ✔ Under Fl Law, the adjuster should settle a third-party liability claim of an injured minor child with both parents of the injured child, presuming the settlement is for an amount not in excess of $15,000. If it is more than that it must be consummated through the Circuit or County Courts. What are the violations of the Unfair Trade Practices Act? - correct answer ✔ - Failing to act promptly. -Failure to affirm or deny a claim when an insured is entitled thereto. -Failure to explain claim denials in writing.
-Failure to maintain complaint-handling procedures, such as keeping accurate records of complaints. Section 624.155 of the Florida Statues provides? - correct answer ✔ That any person who is damaged by certain insurer practices is granted a right to sue the insurer for damages. The Principle Of Utmost Good Faith - correct answer ✔ An insurance contract is based, places serious responsibilities on the claim adjuster with regard to conduct, work habits, and specific claims handling activities. What does 10/20/10 mean? - correct answer ✔ 10=10,000 Livability per person injured-amount that will be paid out for injuries to one person. 20=20,000 Combined Total Liability for all injuries-this is the most paid out for injuries for an accident. 10=10,000 Property Damage-the most paid out for damage caused to property of others. What is SR-22? - correct answer ✔ A form of coverage known as a NAMED NOOWNER policy is required, this form offers insurance coverage only while the insured is operating automobiles owned by others. What are the two things that need to happen for financial responsibility that did not exist at the time of the accident? - correct answer ✔ -The legally valid claims of others must be satisfied(up to the 10/20/10 requirements).
-Increases do not impact $5,000 death benefit. -Applies only to insured and family members. Personal Auto Policy - correct answer ✔ Used to insure the automobile exposures of individuals and families. Business Auto Policy - correct answer ✔ Insurers the automobile exposures of Business. What are the kinds of autos owned by businesses and covered under a Business Auto Policy? - correct answer ✔ -Private Passenge Type Auto-Station Wagons, jeeps, pickups, panel trucks, vans, and utility trailers. -Public Auto- Buses and Taxicabs -Commercial Auto- truck tractors, semi-trailers, commercial trailers, and Service trailers. -Special types of vehicles like cherry pickers, air compressors. Garage Coverage Form - correct answer ✔ Used to insure businesses engaged in selling, servicing, repairing, parking or storing autos. Truckers Coverage Form - correct answer ✔ Used to insure businesses that are hired to transport goods for someone else. Business Auto Coverage Form - correct answer ✔ Used to insure the automobile exposures of all businesses other than garage or trucking businesses.
What does Commercial General Liability contract includes? - correct answer ✔ - Declarations -Common policy conditions -One of the two coverage forms, Occurrence, or Claims-Made -A Nuclear Energy Liability Exclusion endorsement -Various other endorsements may be attached to broaden or restrict the coverage provided by these basic forms. Declarations - correct answer ✔ Identifies the named insured and address, states the policy period and premium and miscellaneous information about the insured, and specifies the limits of coverage that apply. The policy states that if a company wishes to cancel, How many days must it give prior notice? - correct answer ✔ 30 days. Nuclear Endorsement - correct answer ✔ Excludes all hazards related to nuclear energy. What is Coverage A? - correct answer ✔ Bodily Injury and Property Damage Insuring Agreement. Bodily Injury(BI) - correct answer ✔ Physical harm and includes sickness or disease or death resulting there from. Property Damage(PD) - correct answer ✔ Physical injury to tangible property, including loss of use of that property.
liability associated with serving liquor to intoxicated or underage persons or in violation of a law is excluded. Employee Injuries - correct answer ✔ Coverage excludes liabilities under a workers compensation or similar law or arising from injuries to employees of the insured. Pollution - correct answer ✔ There a basically no coverage for injury, damage or clean up costs caused by pullutants, subject to minor exceptions. What is Coverage B? - correct answer ✔ Personal and Advertising Injury. What is Coverage C? - correct answer ✔ Medical Payments. What are the General Liability Insurance Forms? - correct answer ✔ -Owners and Contractors Protective Liability(OCP)Form. -Liquor Liability Coverage Form. -Products/Completed Operations Liability Coverage Form -Pollution Liability Coverage and Pollution Limited Form. Professional Liability Insurance Coverage - correct answer ✔ Covers liability arising from rendering of or failure to render professional services. Farm Liability Coverage Form - correct answer ✔ Provides coverage for BI or PD arising out of farming operations of personal activities.
The Custom Farming Endorsement - correct answer ✔ Provides coverage for liability arising from the insureds performance of farming operations for another, for a charge under any contract or agreement. The Farm Employers Liability/Medical Payments Endorsement - correct answer ✔ Applies the basic Liability and Medical Payments coverages to injuries to farm employees, but not to employees eligible to receive workers compensation benefits. Employment Related Practices Liability - correct answer ✔ This Form provides employers witg claims- made coverage for liability arising out of claims for injury to an employee because of an employment-related offense. Unauthorized Entity - correct answer ✔ An entity that is required to be licensed or registered with the Florida Office of Insurance Regulation but is operating without the proper authorization is identified as an unauthorized insurer. To be Authorized and transact business in FL what must you have? - correct answer ✔ Certificate of Authority. General Lines Agent 2-20 - correct answer ✔ Licensed to write property/casualty, surety, or health insurance. Customer Representative 4-40 - correct answer ✔ Must be licensed, appointed by a General Lines Agent and may assist in transactions in the OFFICE ONLY.
