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Oklahoma Insurance Adjuster's License
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Which of the following statements about WC is correct? - ANSWER-WC is an exclusive remedy. According to the Jones Act, if a seaman is negligent in a claim against the employer, which of the following is correct: - ANSWER-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? - ANSWER-within 15 days of the written request. 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: - ANSWER-the employee does not have the right to select their own physician at any time. All of the following describe one of the four elements of a negligent act, EXCEPT: - ANSWER-the defendant entered into a legal contract w the plaintiff. Which of the following is the correct description of the "AMA guide to evaluation of permanent impairment"? - ANSWER-the guide lists a set of medical criteria used by physicians to form the basis for established medical ratings of permanent impairment.. All of the following are true statements regarding apprentice adjusters license in OK, EXCEPT: - ANSWER-an apprentice license is good for one year. 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: - ANSWER-two consecutive burglary claims A compensable injury means damage or harm to: I. the physical structure of the body II. Prosthetic appliances III. Eyeglasses IV. Hearing aids - ANSWER-*all of the above.
The estimated annual premium for WC policy will be based on all of the following, EXCEPT: - ANSWER-the average premium of insureds in the same area working in the same industry. Every foreign an alien insurer licensed in OK must be examined at least once every __ years: - ANSWER-5. 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: - ANSWER-3 years. Who administers the WC laws in OK? - ANSWER-the OK WC court. When a state is "monopolistic" w WC coverage, employers in that state are: - ANSWER-required to purchase their WC coverage from the state-funded plan. Insurance binders in OK can be issued for a 90-day period. What if coverage needs to be bound beyond 90 days? - ANSWER-the binder can be extended w the written permission of the OK commissioner. An insurer's certificate of authority in OK must be renewed each year by: - ANSWER- March 1. An adjuster in OK who does not comply w the mandated continuing education requirements may be subject to all of the following, EXCEPT: - ANSWER-a fine of not more than $5,000. 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?
- ANSWER-the insurer must place in bold type on the proof of loss that the 60-day proof od loss provision applies. 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? - ANSWER-15% interest on the judgment until payment is made. How often is the OK insurance commissioner required to examine domestic insurers? - ANSWER-as often as the commissioner deems appropriate but at least once every 5 years. If an employee has sustained a permanent total disability in a work related incident, what percentage of his average weekly wage is paid? - ANSWER-70%. Which of the following is not true regarding the OK continuing education program? - ANSWER-Excess CE hours may not be carried over to the next reporting period.
Under OK WC, vocational rehabilitation services or training will not extend for a period more than: - ANSWER-52 weeks With WC insurance the insurer is considered to have received notice of the claim: - ANSWER-when the employer has notice of the claim Which of the following is NOT true regarding the licensing of adjusters in OK: - ANSWER-is a high school graduate or equivalent 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: - ANSWER-both I and II Part one of the NCCI standard WC policy specifies the: - ANSWER-statutory provisions the policy will pay When an insurer takes no action upon realizing material changes in a contract, this is called: - ANSWER-an implied waiver Which of the following is generally not considered to be a legal defense against claims of negligence? - ANSWER-the loss to the plaintiff was caused intentionally by the defendant Which of the following is NOT a factor in reserving of a WC claim? - ANSWER-The amount of life insurance the worker carries 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: - ANSWER-$5, OK adjuster's are required to complete continuing education every 24 months to renew their licenses. This includes ___ hours in the subject of ethics: - ANSWER- Which of the following is a general summary of a policy?: - ANSWER-Certificate of Insurance In OK how long does an insured have to submit a required proof of loss statement? - ANSWER-60 days "Experience rating" provides employers with the incentive to: - ANSWER-Prioritize safety and control hazards in the workplace.
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: - ANSWER-30 days following the 2nd failed exam 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: - ANSWER-6 months Part three of the standard WC policy is: - ANSWER-Other States Insurance 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? - ANSWER-1. 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: - ANSWER-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. 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 - ANSWER-six 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? - ANSWER-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. 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? - ANSWER- Provide a written notice that the statue will expire in 30 days Which of the following best demonstrates morale hazard? - ANSWER-a recent purchaser of auto insurance drives less carefully, knowing that the insurer will cover the loss. 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? -
to collect a claim? - ANSWER-Must prove that the employer's negligence caused the injury All of the following injuries occurring on the job may be deemed compensable, EXCEPT: - ANSWER-a cerebral hemorrhage caused by years of high blood pressure All of the following are types of rehabilitative services provided under WC policy, EXCEPT: - ANSWER-Substance abuse When determining if an injury or illness is compensable under a workers' compensation policy, which of the following is the criteria used? - ANSWER-That the injury or illness arose out of and in the course of the employment All of the following statements are true regarding the Federal Employers Liability Act (FELA), EXCEPT: - ANSWER-It provides workers' compensation coverage for employees working in federal government buildings 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? - ANSWER- $25,000. With a work-related injury, the loss of a finger would be characterized as what type of disability? - ANSWER-Permanent partial Which of the following is NOT covered by the Federal Employee's Compensation Act (FECA)? - ANSWER-Damages awarded by a court 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. - ANSWER-I, II, and III. How long are benefits paid to a worker, covered by workers compensation that has suffered a permanent total disability in a work related accident? - ANSWER-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. Which of the following classifications of disability would be most likely be provided vocational rehabilitation under workers' compensation? - ANSWER-PPD How many days does an Oklahoma Property and Casualty insurer have to either accept or reject a first-party claim? - ANSWER-45 days 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? - ANSWER-Not until the Commissioner determines that the cause for suspension no longer exists 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. - ANSWER-30 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? - ANSWER-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. 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.
- ANSWER- Which of the following is NOT a factor in the reserving of a workers' compensation claim? - ANSWER-The amount of Life insurance the injured worker carries. Which of the following workers' compensation reserves will be used to pay the expenses associated with IMEs? - ANSWER-Expense reserves 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 ____. - ANSWER- $ Which of the following is true regarding Independent Medical Examinations (IMEs) requested by an insurer while adjusting a workers compensation claim? - ANSWER-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. 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: - ANSWER-MMI- Maximum Medical Improvement
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 ____. - ANSWER-$1,070 / $580. 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? - ANSWER-Excess coverage. In Oklahoma, spouses of deceased employees are entitled to what percentage of the employee's average weekly wages? - ANSWER-70% The process of bringing a contract dispute before an objective third party for resolution is known as: - ANSWER-Arbitration Any licensed agent/producer who ceases to maintain residency in Oklahoma must deliver the licensee's insurance license to the Commissioner within ______ after terminating residency. - ANSWER-10 days A couple has volunteered to cook at special events for their church. The church is concerned that one of these volunteers might be injured in the kitchen and wants to protect them in case of an accident. The church maintains workers compensation coverage for its maintenance personnel. What should the church do to provide coverage? - ANSWER-Add the Voluntary Compensation Endorsement to the workers compensation policy.. Which of the following would be covered under Part Two - Employer's Liability of a standard workers' compensation policy? - ANSWER-The spouse of an injured employee sues the employer for loss of consortium Which of the following best describes the reason for using various work classifications in the calculation of workers' compensation premiums? - ANSWER-To accurately reflect the risks of each employer Would a claim for an employee who is temporarily on business in France, be covered under Part Two - Employer's Liability of the standard workers compensation policy? - ANSWER-Yes, because the employee was only outside of the United States and Canada temporarily. What must the insurer do, regarding a proof of loss that is required on a property loss that contains a provision that proof of loss must be tendered within 60 days of the loss?
- ANSWER-The insurer must place in bold type on the proof of loss that the 60-day proof of loss provision applies.. Which of the following would be considered "general damages" that could be awarded to a plaintiff in a negligence case? - ANSWER-pain and suffering
If the employer fails or neglects to provide medical treatment within ____ after actual knowledge is received of an injury, the injured employee may select a physician to provide medical treatment at the expense of the employer. - ANSWER-5 days If an employer fails to report a workers compensation claim, what is the fine by the Oklahoma Workers Compensation Court Administrator? - ANSWER-$1, Which of the following factors is the most crucial in distinguishing between an employee-employer relationship and an independent contractor relationship? - ANSWER-Whether the employer controls the manner in which the work is performed. Which one of the following is not covered under the Oklahoma Workers' Compensation Act? - ANSWER-Sole proprietors Which of the following terms is used to describe a contract where the insurance company is the only party to the contract that is legally bound to perform its part of the agreement? - ANSWER-Unilateral. When can an insured assign his or her insurance policy over to another party? - ANSWER-Only with written consent of the insurer For a liability policy to pay a claim, the person who is legally liable: - ANSWER-Must be an "insured" under the policy.. Employers are responsible to make payments to the injured worker, in excess of the benefits regularly provided by workers' compensation law for all of the following, EXCEPT: - ANSWER-If the employer contributed to the injury in any way.. Which of the following circumstances would NOT be an injury considered to "arise out of and in the course of" the employment? - ANSWER-An employee was injured during a lunch break in the factory parking lot. Oklahoma licensees must inform the Commissioner of a change of address within _____ days of the change. - ANSWER-30 days Mark is injured at work in a state that provides a TTD benefit at 66 2/3%, the state minimum is $40 and the state maximum is $540. The waiting period is 3 days and the retroactive period is 15 days. Which of the following is Mark's TTD benefit if he earns $20 per hour and usually works a 40-hour week. Mark is injured on July 14th and does not return to work until September 3rd. Which of the following is the amount of TTD benefit he would have received? - ANSWER-$3,809.50. $20 X 40 - $800 (This is the average weekly wage). 66 2/3% X $800 = $533.33 (Still lower than the maximum). July 15th to September 2nd = 50 days, which is 7 weeks and one day (7 1/7th) weeks. The waiting period does not apply because the disability exceeded 15 days. 7 1/7 X $533.33 = $3,809.
When is an employer required by law to report job-related injuries that resulted in loss of time beyond the shift when the injury occurred, OR required medical attention away from the work site, to the Oklahoma Workers Compensation Court? - ANSWER-Within 10 days Which of the following is a statement that is guaranteed to be the truth throughout the duration of the policy? - ANSWER-A warranty; A warranty is something that becomes part of the contract and is a statement that is considered to be a guarantee of truth for the entire term of the policy. In the insurance industry, which of the following terms refers to continuous or repeated exposure to conditions that may result in bodily injury or property damage neither expected nor intended? - ANSWER-an occurrence The Vocational Rehabilitation Director will issue an order for a vocational rehabilitation evaluation for any injured employee unable to work for at least: - ANSWER-90 days Which of the following is the BEST explanation as to the reason insurance policies are called "unilateral contracts"? - ANSWER-Because the insurance company is the only party to the contract that can be sued if they do not meet the terms
