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Progressive Florida Claims Adjuster Exam
with solutions
Claim - correct answer ✔ An assertion of an alleged legal right against a person, entity, company or insurer that carries with it a demand for money as compensation for injuries or damage What are you really buying when you purchase insurance? - correct answer ✔ Peace of mind Why is insurance such a unique product? - correct answer ✔ It is a financial product. The purchase of a promise base totally on trust that is absolutely essential in today's world. First foremost and always what is an adjuster's most important objective in today's world of insurance? - correct answer ✔ To help those who have been injured, or who have suffered a loss that is covered by the insurance contract or for which an insured policy holder is responsible while at the same time minimizing loss for the insured party and or carrier In today's society, the most important factor in the purchase of insurance is - correct answer ✔ Trust What would Joe do as an adjuster? - correct answer ✔ INVESTIGATE, EVALUATE, AND SETTLE INSURANCE CLAIMS ON BEHALF OF AN INSURER OR INSURED.
Joe saw an ad in the paper..... difference between an adjuster who works in the healthcare industry versus an adjuster in the property/casualty, insurance industry. What would you say? - correct answer ✔ Healthcare adjusters are processors, who reimburse medical bills if they fall within a list of approved conditions or treatment. A property/casualty adjuster evaluates a legal responsibilities, determines what or how much is owed and pays or settles claims. If Joe, where to go to work for an insurance company, what kind of adjuster with Joe be? - correct answer ✔ A company/staff adjuster Joe is really intrigued by his neighbors work and ask him who he works for. His neighbor told him that he owns his own adjusting company and adjust claims are several different companies. In other words he takes claim assignments from whoever calls. What kind of adjuster is he? - correct answer ✔ An independent adjuster Joe's neighbor tells him that field adjusting is "the best job in the insurance industry". Joe doesn't envision himself sitting behind a desk, so he is intrigued by this as well and white lines of business business with Joe need to experience to have the greatest chance of getting a good field adjusting job - correct answer ✔ Multi-line adjusting Joe sister is a nurse who works in a nearby hospital. As he talks to her about his interest, she asked him what type of adjusting she would be most qualified for if she were interested, which kind of adjusting would present her with the greatest opportunity? What would you tell her? - correct answer ✔ Worker's compensation
for slander in the embarrassment caused the insured what responsibility did that adjuster fail to fulfill? - correct answer ✔ Agency: the power to bind Which of the following is NOT one of the basic adjusting functions? - correct answer ✔ Inspection Which of the following best describes the functions of claims evaluation? - correct answer ✔ Establishing a dollar value for a claim In which of the following settlement types, would you pay what is owed and invite the claimant to contact you with any further expenses or questions? - correct answer ✔ No release "walk away" True or false; an adjuster's claim file is considered "work product" and therefore confidential - correct answer ✔ False The main components of the investigative process are: - correct answer ✔ Inquiry verification and comparison The adjusters code of ethics starts with a basic premise, which states: - correct answer ✔ The work of adjusting engages the public trust Which of the following would not be a preferred claims practice or behavior under Florida's unfair insurance, trade practices act? - correct answer ✔ Not responding to an insured's calls because you haven't made up your mind yet
Upon conclusion of a claims, investigation and adjuster determines if there was no coverage in effect for the loss and denies the claim. The adjuster later received notification that he in the carrier being sued due to a violation of Florida's unfair insurance trade practices act. Which of the following actions in the adjusters claim handling process would be considered a violation of the act?
- correct answer ✔ The adjuster inform the policyholders attorney of the denial over the phone, closed the file and moved onto his next case Which of the following is not one of the four critical elements of a contract - correct answer ✔ Written evidence of the agreement and its terms. An insurance policy is often referred to as a contract of adhesion. This means: - correct answer ✔ If any of the wording or language in the policy is vague or ambiguous, if the meaning of the wording is difficult to understand or interpret, or if what is written can be interpreted to have different meanings, the law is well settled that the interpretation shall be in favor of the party who did not control its terms...in this case, the policyholder. Breach of contract to buy a carrier or it's adjusters, through non-payment, or noncompliance with policy requirements, could have which of the following consequences for a carrier: - correct answer ✔ If found guilty of a breach of contract, the carrier could be punished with a bad faith verdict that would cost it millions of dollars Which of the following is not a fundamental part of an insurance policy: - correct answer ✔ endorsement Which of the following is one of the duties of an insured following a loss? - correct answer ✔ giving prompt notice of loss to the insurer
Assume that five years ago a couple ensure their home for it so that appraise value of $60,000. Two weeks ago a pipe burst in the home resulting in an estimated loss of $15,000 in water damage. The adjuster find the value of their home is now $100,000 for the home is still only insured for $60,000 and there's a deductible of $500. A policy has an 80% coinsurance clause how much the adjuster pay the couple? - correct answer ✔ $10, Describe the coverage s provided in a split limit policy of 10/20/10 - correct answer ✔ 10,000 max bodily injury individual, 20,000 max bodily injuries regardless of how many individuals, 10,000 max for property damage Negligence is described as: - correct answer ✔ fault that arises from doing something you shouldn't have done, or not doing something you should have done Which of the following is not a defense to a claim of negligence? - correct answer ✔ breach of warranty Which of the following is not an example of "compensatory damages": - correct answer ✔ A jury verdict of $1 million against the defendant to punish them for the reprehensible actions in causing the loss Which of the following is not a law that affects one's legal liability? - correct answer ✔ Valued policy law Which of the following statements is not true? - correct answer ✔ If a question of coverage arises, and cannot be swiftly resolved in favor of the insured, the carrier should immediately tender the claim to its defense attorney, and deny the claim
Which of the following is not a defense to a claim of negligence? - correct answer ✔ breach of warranty What is the difference between a peril and a hazard? - correct answer ✔ Peril is the cause of loss. Hazard is a condition that creates or increases the chance of loss. A couple has coverage a limit of $250,000 on their home located in Miami Florida. They suffer a wind loss to the roof from a tornado Spond by hurricane Irma that results in an estimate of $12,700 for repairs. The adjuster to docs the Florida hurricane deductible of $5000 from the estimate and pays them $7700 in settlement of their property claim this is known as the application of: - correct answer ✔ Percentage deductible Floridas code of Ethics under 69B-220.201(3) begins with an important statement that provides a basis for the very sensitive nature of what an adjuster does. Select that statement from below: - correct answer ✔ The work of adjusting engage is the public trust The most important factor to consider, when purchasing an insurance policy is: - correct answer ✔ Trust Assume that five years ago a couple ensure their home for that appraised value of $60,000. Two weeks ago they had a stove fire resulting in an estimated lost of $15,000 for repairs. The adjuster find the value of the home is now $100,000 but the home is still only insured for $60,000 and has a deductible of $500. The policy has an 80% coinsurance clause. How much should the adjuster pay the couple? - correct answer ✔ $10,
Define the doctrine of proximate cause: - correct answer ✔ When an initial loss caused by an insured peril, that triggers, one or more subsequent losses, the payroll, causing the initial loss is the proximate cause of both initial and subsequent losses And insured policy is often referred to a contract of adhesion. This means: - correct answer ✔ If any wording or language in the policy is vague or ambiguous, if the meaning of the wording is difficult to understand, or interpret, or if what is written, can be interpreted to have different meanings the law as well settled that the interpretation shall be in favor of the party, he did not control it's terms in this case, the policyholder In the property/casualty industry, a claim is defined as: - correct answer ✔ And assertion of alleged legal right against a person, entity, company, or insure that carries without a demand for money as compensation for injuries or damage Which of the following is not one of the four critical elements of a contract? - correct answer ✔ Written evidence of the agreement and its terms. Negligence can best be described as: - correct answer ✔ Fault that arises from doing something you shouldn't have done or not doing some thing you should've done Which of the following is not an example of compensatory damages? - correct answer ✔ A jury verdict of $1,000,000 against the defendant to punish them for their reprehensible actions in causing the loss.
Which of the following statements is not true? - correct answer ✔ If a question of coverage arises, and cannot be swiftly resolved in favor of the insured, the carrier should immediately tender the claim to its defense attorney, and deny the claim Insurance company has many goals and standards for claim handling. One of the most important goals of an insurance company is: - correct answer ✔ Help those who have suffered a loss for which the insured is legally responsible The basic and primary functions of an adjuster are: - correct answer ✔ investigating, evaluating, reporting, negotiating and disposing of claims An adjuster has many responsibilities. The adjuster's responsibility as a fiduciary means: - correct answer ✔ The adjuster represents and controls the property and financial interest of the client to whom he/she owes a high degree of loyalty in good faith When you purchase insurance you are buying: - correct answer ✔ peace of mind that if an insured event does occur, that the insurance company will keep its promise and provide the financial protection that you purchased Under Florida's unfair insurance trade practices act, which of the following would not be considered a preferred claims practice? - correct answer ✔ Not responding to an insurance calls because you haven't made up your mind yet After a loss, and insured has certain responsibilities, laid out within the insurance contract. Which of the following is one of the responsibilities of an insured after a loss? - correct answer ✔ Giving prompt notice of loss to the insurer
Which of the following symbols is used to provide coverage for specifically describes autos under a business auto policy? - correct answer ✔ 7 Jack's auto has a garage policy with $100,000 in liability symbol 21 garage keepers with a $40,000 limit a $100 comprehensive deductible and a $ collision deductible. One day a customer brings his car in for repair. It is left parked outside the shop until it can be worked on. An unknown driver loses control of his car hits the customers car and leave the scene. Damage to the customers car is $1500. The customer has no insurance what would be payable by the garage policy for this claim? - correct answer ✔ $1000 paid under the garage keepers coverage Sunshine auto sales and service has a standard garage policy with symbol 21 for liability coverage. All of the following claims would be covered under sunshine's policy, except: - correct answer ✔ John is test, driving a new car when he sideswipes another car. The other driver, who is injured Sue's Jon. Jon tenders the claim to sunshine's insurance carrier to provide his defense. He does not want to use his own carrier for fear of premium increase. Harold's auto repair has a garage keepers policy to cover the businesses commercial auto exposures. After reviewing his policy notice is the symbol 22 next to a liability, physical damage comprehensive and physical damage collision coverage. What does the symbol mean? - correct answer ✔ Owned autos only What was one of the initial intentions behind the development of no-fault/PIP benefit laws? - correct answer ✔ To help reduce litigation by preventing lawsuits for less serious automobile related bodily injury claims
In Florida what is the minimum PIP limit of the owner of a motor vehicle must carry? - correct answer ✔ $10, Basic PIP provides for what benefits, in addition to a death benefit? - correct answer ✔ 80% medical 60% loss wages 100% replacement services What benefits does the basic PIP policy provide in the event of death? - correct answer ✔ $5000 in addition to medical and disability benefits Jon has a PAP with liability limits of 10 - 20-10 basic PIP with no deductible and med. Pay with a $1000 limit. He is driving his car during a thunderstorm loses control on a wet street and runs off the road into a tree. He is injured and incurs $13,232 in medical bills. How much will Jon's policy pay under what coverage? - correct answer ✔ $11, Mary Jo has an PAP With basic PIP coverage a deductible of $500 in property damage limits of $10,000. She has a bicyclist who is riding on the right side of the road and veerers into the lane in front of her. Are any of the bicyclist medical expenses and lost wages, covered under any part of Mary Jo's policy? - correct answer ✔ Yes If an insured has the basic $10,000 in PIP coverage, and no deductible and after an automobile accident incurs $2300 in medical expenses $1300 and lost wages and $300 and expense for general housekeeping services. How much would you pay in response to claim filed for PIP? - correct answer ✔ $ If an insured has $10,000 in PIP coverage with a deductible of $500 and after an auto accident incurs $5000 in medical expenses and $3000 in lost wages before dying from complications directly related to the accident. How much PIP
An elderly customer slips and falls on spilled salt that fell from the store shelf, injuring her hip. What kind of claim will be filed under the store CGL policy? - correct answer ✔ A premises liability claim A roofing contractor is installing a new roof on a building when one of the insured's employees accidentally types of bucket of tar off the side of the roof. It falls 30 feet onto a car that is parked on the side of the building below. What kind of claim is this and what kind of policy would respond? - correct answer ✔ And operations claim to be addressed by the insured's general liability policy Your company insures a heating and air conditioning contractor. Three days after the company, installs an air conditioner in the attic of the customers residence, the air conditioner falls through the laundry, room, ceiling and damages the ceiling washer, dryer cabinets and flooring. Damages are appraised at $26,500. When the claim for PD arrives what kind of claim is it and what kind of policy will respond? - correct answer ✔ A completed operations claim filed under the general liability policy The per occurrence limit of a commercial general liability policy is the maximum amount that a policy will pay for: - correct answer ✔ All bodily injury, and or property loss is that arise from each individual occurrence The aggregate limit of a commercial general liability policy is the maximum amount that a policy will pay for: - correct answer ✔ All bodily injury and/or property losses that occur within the policy period An insured's employee is injured when he falls off a ladder. A claim for his injuries is submitted to the insured's general liability carrier. How should they respond? - correct answer ✔ There is no coverage. Injuries to employees are
excluded under the GL and covered under the employer's Worker's Compensation policy Books-a-trillion bookstore held an annual holiday party for their employees. Attendance is voluntary. One of the employees became intoxicated at the party and was involved in an auto accident on their way home. The occupants of the other vehicles to the bookstore for allowing their employees become intoxicated and drive. The bookstore filed a claim under at CGL policy. Would this claim be covered or excluded? - correct answer ✔ Yes, it is covered. The CGL policy only excludes liquor liability if the insured is in the business of serving alcohol and the bookstore is not. Which of the following coverages would homeowner's personal liability not provide? - correct answer ✔ Coverage for the dwelling and all personal property within it? Which of the following would not be covered under a homeowners or personal liability policy? - correct answer ✔ A resident of your insurance household accidentally cut herself with a knife while preparing dinner Which of the following exposures would be covered under a homeowners policy? - correct answer ✔ OPERATING A MOTORIZED CART PURCHASED FOR A DISABLED SPOUSE. The best defense to a claim of defamation i.e., libel slander is: - correct answer ✔ That what was said or written was the truth Which of the following would be covered under personal injury liability coverage? - correct answer ✔ You write an editorial for newspaper, stating that
How would a business that has a high turnover of employees best handle? It's exposure for employees theft or dishonesty - correct answer ✔ Blanket coverage Burglary is different from robbery in that: - correct answer ✔ BURGLARY REQUIRES EVIDENCE OF FORCED ENTRY. Two of the three parties to a surety bond include: - correct answer ✔ A principal and obligee One who guarantees the performance or payment of one party, who is obligated by contract to another, is called a: - correct answer ✔ Surety When a public adjuster is required to provide a bond to guarantee performance, the public adjuster becomes which party to the bonding agreement? - correct answer ✔ Principal The state department requiring a public adjuster to secure a bond would be considered which party to the binding agreement? - correct answer ✔ Obligee A major difference between a surety bond in an insurance policy is: - correct answer ✔ The surety has recovery rights against the purchaser of the bond in the event of a loss Which of the following is required in order for an employee to be eligible for workers' compensation benefits? - correct answer ✔ As long as the injury resulted from an accident while at work the injury is covered by workers comp regardless of fault
In general, an employees who suffers an occupation injury and collects workers comp benefits during recuperation... - correct answer ✔ Gives up the right to sue the employer for personal injury and pain and suffering and can sue only for workers comp benefits Coverage of workers' compensation policy provides for: - correct answer ✔ Payment of all benefits required of the employer under the law of the state in which an employee is injured A lost time case is defined as: - correct answer ✔ An injury that results in more than seven (7) days off work, or for which indemnity benefits would otherwise be due, such as a medical only claim that results in a permanent impairment. Maximum Medical Improvement (MMI) means: - correct answer ✔ A date in time when an employee's recuperation from injury is as good as it is going to get. An "injury" is defined to mean: - correct answer ✔ Personal injury, or death by "accident", arising out of work performed in the course of employment Under Worker's Compensation law, the rule that applies when an injury aggravates a pre-existing condition is: - correct answer ✔ You take em as you find em... meaning you must pay for the aggravation until the injury returns to its pre-injury state
