Insurance Contracts: Characteristics and Exceptions, Exams of Nursing

Download Insurance Contracts: Characteristics and Exceptions and more Exams Nursing in PDF only on Docsity! Claims Adjuster (Florida) Exam Frank owned a home that was destroyed by a hurricane. Both TD Bank and Bank of America were listed as additional interests on his homeowner policy. The insurance company will make a payment to: A. The first mortgagee, TD Bank B. The Insured C. Jointly to TD Bank and Bank of America D. All listed interests - ✔D. All listed interests Insurance applies separately to each insured as if other insureds did not exist. This is defined as: A. Severability B. Conditional C. Warranty D. None of the above - ✔A. Severability Property insurance policies usually contain a(n) __________ clause, stating the insured cannot dump damaged property on the insurer and demand its full value: A. Pro Rata B. Abandonment C. Liberalization D. All of the above - ✔B. Abandonment A(n) __________ is one wherein economic loss would be suffered from an adverse happening to the subject: A. Conditional Contract B. Personal Contract C. Economic Contract D. Insurable Interest - ✔D. Insurable Interest States that if the insurer adopts a revision which would broaden coverage without additional premium within some period of time prior to the policy period or during the policy period, the insured receives the benefit of such broadened coverage. A. Cancellation Clause B. Policy Period C. Pro Rata D. Liberalization - ✔D. Liberalization Time frame is typically 60 days The __________ states that when there is an unbroken connection between an occurrence and damage that grows out of the occurrence, then the resultant damage is all a part of the occurrence. A. Doctrine of Proximate Cause B. Doctrine of Perils & Hazards C. Insurance Policy Handbook D. Doctrine of Property Insurance - ✔D. Doctrine of Property Insurance The Loss Settlement Valuation that subtracts an allowance for depreciation is defined as? A. Actual Cash Value B. Replacement Cost C. "Old for New" D. None of the Above - ✔A. Actual Cash Value A policy condition, either based on information in the insured's application or inserted by the insurer, is defined as: A. Warranty B. Misrepresentation C. Concealment D. None of the Above - ✔A. Warranty The following are basic characteristics of a property or liability insurance contract, except: A. Personal Contract B. Conditional Contract C. Loss of Settlement Contract D. Contract of Adhesion - ✔C. Loss of Settlement Contract The Insurer's responsibility to pay for a property loss may be conditioned on the insured having used reasonable means to avoid the loss, to protect the property against further loss, and to give the insurer proof of the loss is defined as? A. Conditional Contract B. Adhesion Contract C. Indemnity Contract D. All of the Above - ✔A. Conditional Contract Which of the following is not one of the "Thresholds" in the "No-Fault" law? A. Death of the Insured B. Temporary Injury of the Insured C. A permanent loss of a bodily function D. Permanent scarring on the face of the insured - ✔B. Temporary Injury of the Insured Under Mechanical Breakdown Coverage, new cars are eligible for service up to: A. 36 Months/36,000 Miles B. 24 Months/36,000 Miles C. 12,000 Months/12,000 Miles D. 12 Months/36,000 Miles - ✔A. 36 Months/36,000 Miles Used Vehicles: 12 Months/12,000 Miles D. None of the Above - ✔C. Both A & B Which of the following is not covered under Coverage C, Personal Property? A. A fire breaks out in the residence and an overnight guest loses his clothes in the fire B. A fish dies because he has been left alone for a week without food C. The insureds daughters tennis racket is stolen from her locker D. The insureds suitcase and clothing, valued at $1,500, are stolen from his hotel - ✔B. A fish dies because he has been left alone for a week without food Animals are listed as an "exclusion" under a Homeowner's policy. All of the following are eligible for a Homeowner's Policy, except? A. An apartment tenant B. A condominium owner C. Four-family dwelling owner-occupant D. A business condo owned by a local insurance company - ✔D. A business condo owned by a local insurance company Commercial property is not eligible for a Homeowner's policy. Which of the following are characteristics of Homeowner's Insurance? A. Protects against economic loss to residences and household property and legal liabilities B. Owner-occupants of 1-4 family dwellings C. Renters who maintain residential occupancy in any type of building D. All of the Above - ✔D. All of the Above Jeremy owns a home that is recently damaged due to a hurricane. The repair estimate is averaged at $25,000 and Jeremy decides to stay in a hotel because most of the damage is to his bedroom and kitchen. Under a Homeowner's Policy, what coverage will pay for the hotel room bill? A. Fair Rental Value B. Value Obligation C. Loss of Use D. Insurers Duties - ✔C. Loss of Use The insurer will pay any necessary and reasonable expenses associated with a daily living routine. An insured who wishes to purchase flood insurance, but is located in a moderate or low risk flood zone may do so by purchasing a: A. Preferred Risk Flood Policy B. Standard Flood Policy C. Universal Flood Insurance D. None of the Above - ✔A. Preferred Risk Flood Policy Although Flood Insurance is provided by the Federal Government, those who are not in a "flood zone" may purchase a preferred risk policy to cover them for a flood claim. Used only for Commercial Condominiums, it covers the unit-owners business personal property and the personal property of others in the insured's care, custody or control: A. Condominium Dwelling Form B. Personal Condominium Unit Owners Form C. Condominium Unit Owners Form D. None of the Above - ✔C. Condominium Unit Owners Form Does not cover buildings since coverage would typically be provided under the Condo Association coverage form issued The Commercial Property Contract includes all of the following, except: A. Common Policy Conditions B. Commercial Property Conditions C. Coverage Form D. Commercial Loss Schedule - ✔D. Commercial Loss Schedule Also included: Declarations, Causes of Loss Form, Endorsements Insures a condominium association against direct physical loss or damage to buildings, business personal property and personal property of others in the care, custody or control of the association and located at the premises: A. Condominium Association Form B. Condominium Unit Owners Form C. Condominium Insured Owner Form D. None of the Above - ✔A. Condominium Association Form This, along with Condo Unit Owners Form, is located under Condo Coverage. Sometimes referred to as commercial fire and allied lines, this is the form of insurance that covers direct and indirect losses related to properties other than one-to-four family dwellings and farm properties: A. Business Property Insurance B. Building Property Insurance C. Commercial Property Insurance D. None of the Above - ✔C. Commercial Property Insurance (the question is the definition for this term) Under Commercial Property Policies, Florida law requires an insurer to give the insured at least __________days advance written notice of non-renewal. A. 25 B. 90 C. 45 D. None of the Above - ✔C. 45 Also, notice must state reasons the policy is not to be renewed. When a business's personal property values fluctuate, a single, fixed amount of insurance could produce either over- or under-insurance at any given time. With this option, the limit of coverage is set at an amount somewhat higher than expected peak values. A. Value Reporting B. Replacement Cost C. Agreed Value D. None of the Above - ✔A. Value Reporting Liberalization states, "The insured gets the benefit of any broadened coverage if the company, within __________ days of inception, adopts a form revision that is broader and without increase in premium." A. 10 days B. 55 days C. 65 days D. 45 days - ✔D. 45 days Used to cover buildings in the course of construction: A. Builders Risk Policy B. Builders Replacement Policy C. Construction Replacement Policy D. None of the Above - ✔A. Builders Risk Policy Includes: structure being built (including foundations), fixtures and machinery, equipment to service building, owned materials and supplies used for construction. Temporary structures built or assembled on site are also included if not covered by insurance. First developed as an extension of Ocean Marine coverage, to provide coverage for cargo traveling over land, instead of by sea. A. Commercial Inland Marine Coverage B. Personal Inland Marine Coverage C. Ocean Commercial Coverage D. None of the Above - ✔A. Commercial Inland Marine Coverage Definition: to help identify kinds of risks which are eligible for either Ocean or Inland Marine insurance. Protects against loss of business income that results from damage to covered property from a covered cause of loss. A. Business Income Insurance Coverage B. Business Income Replacement Coverage C. Business Income Actual Value Coverage D. None of the Above - ✔A. Business Income Insurance Coverage Period of restoration begins 72 hours after date of direct damage. In effect, coverage has a 72 hour deductible. Coverage ends on either 1. date when damaged property could be repaired, rebuilt, or replaced 2. date business resumes operations at new, permanent location (whichever comes first) What payment covers several areas of costs related to claims, and are payable in addition to the policy limits? A. Supplementary D. None of the Above - ✔A. The Experience Rating Plan Under workers compensations, a rate is charged for every __________ of payroll to employees. A. $100 B. $1,000 C. $10 D. $500 - ✔A. $100 Under Workers Compensation, Part Four Your Duties if Injuries Occur, an employer is required to: A. Provide the names/addresses of injured persons and witnesses B. Promptly provide any legal papers C. Cooperate and assist as insurer requests D. All of the Above - ✔D. All of the Above Under Workers Compensation, Employers Liability includes: A. Claims by others for the liabilities to insureds employees B. Claims by relatives of injured employees for consequential damages C. Claims made by employees that are not subject to Workers Comp Laws D. All of the Above - ✔D. All of the Above Samantha eats uncooked chicken at a local barbecue joint and becomes violently ill. Which of the following workers compensation benefits would pay for this occurrence? A. A products and completed operations form B. A premises and operations form C. An owners and contractors protective liability form D. None of the Above - ✔D. None of the Above Samantha is not an employee of the barbecue joint; Workers Comp does not apply. Under Employer's Liability, the minimum limits of liability are: A. 100/100/500 B. 100/500/1000 C. 500/100/500 D. 100/500 - ✔A. 100/100/500 $100,000 for all claims in each accident $100,000 per employee for disease $500,000 for all disease claims Under Crime Insurance, losses must be discovered within 1 year. This is defined as: A. The Discovery Period B. The Loss Sustained Period C. The Open Period D. All of the Above - ✔A. The Discovery Period Crime Insurance is _________ over any other Insurance coverage. A. Primary B. Secondary C. Excess D. Recess - ✔C. Excess Cover only losses that both occurred and were discovered during the policy period, or within one year of its expiration. This is defined as: A. Discovery B. Loss Sustained C. Sustained Loss D. None of the Above - ✔B. Loss Sustained Any loss discovered during the policy period or within 60 days after its expiration (one year after expiration for losses connected with employee benefit plans) is covered regardless of when it occurred. This is defined as: A. Loss Sustained B. Valuation C. Discovery D. None of the Above - ✔C. Discovery Under Crime Insurance, the insured is covered for loss by: A. Theft B. Burglary C. Robbery D. All of the Above - ✔D. All of the Above Taking or attempted taking of property from within a locked safe or vault, by unlawful entry, with visible marks of forcible entry, or taking of the safe or vault from inside the premises. This is defined as: A. Safe Burglary B. Inside the Premises C. Custodial Burglary D. None of the Above - ✔A. Safe Burglary Exclusions: accounting errors, giving/surrendering property, voluntarily parting, fire (except damage to safe/vault), vandalism, transferring property to someone based on unauthorized instructions or from threat to harm Covers for all types of property, when surrendered away from the premises as a result of a threat to do bodily harm to the insured or an employee, or to a relative or invitee of either, who is (or allegedly is) being held captive. This is defined as: A. Extortion B. Surrendered Property C. Client's Property D. None of the Above - ✔A. Extortion Also triggered by threats to damage the premises or property within the premises. Which of the following are NOT a type of bond? A. Contract B. Fiduciary C. Court D. Apprentice - ✔D. Apprentice Which of the following are characteristics of a License Bond? A. To guarantee the licensee will act according to laws B. Protect public from unfair business practice C. Proper collection and payment of taxes D. All of the Above - ✔D. All of the Above Guarantees the performance between the principle and the obligee: A. Principal B. Obligee C. Surety D. All of the Above - ✔C. Surety One who undertakes to perform, to fulfill a contract or to meet an obligation is known as: A. Principal B. Obligee C. Surety D. All of the Above - ✔A. Principal Which of the following are parties to a Bond? A. Principal B. Obligee C. Surety D. All of the Above - ✔D. All of the Above This type of bond covers streets, sidewalks, sewers, etc.: A. Sidewalk B. Subdivision C. Supply D. None of the Above - ✔B. Subdivision A __________ is a selected group of hospitals and medical practitioners in a given area who have joined together in an effort to reduce medical costs. A. HMO B. Major Medical Insurance C. Coinsurance D. PPO - ✔D. PPO D. This practice is only acceptable if the product training was certified by the Life Insurance Company - ✔C. This practice is unacceptable and may result in the suspension or revocation of the Customer Representative's license Unlike a Customer Representative, a General Lines Claim Adjuster need not be appointed with the Department of Financial Services. A. True B. False - ✔B. False While selling an Automobile policy to a customer, an agent tells them that they are also required to purchase an Emergency Road Service Plan, even though that is not true. This is an example of: A. Misrepresentation B. Lack of Fitness C. Deception D. Sliding - ✔D. Sliding A licensed General Lines Claim Adjuster is required to complete how many hours of continuing education every two years? A. 6 B. 12 C. 18 D. 24 - ✔D. 24 Once a Customer Representative 4-40 has been licensed and appointed for at least 3 years, he or she may transact insurance in the home of an existing customer. A. True B. False - ✔B. False After pleading guilty or no contest to a felony, a licensed individual has _________ days to inform the Department? A. 10 B. 20 C. 30 D. 40 - ✔C. 30 Must be licensed, appointed by a General Lines Agent and can transact AUTO insurance only in the Office Only. A. Customer Representative 4-40 B. Limited Customer Representative 4-42 C. General Lines Claim Adjuster 6-20 D. General Lines Agent 2-20 - ✔B. Limited Customer Representative 4-42 Defaming a competitor company or agent is not only unprofessional, it can also result in a license suspension. A. True B. False - ✔A. True A General Lines Claim Adjuster is required to obtain the same number of Continuing Education hours as a licensed Customer Service Representative. A. True B. False - ✔B. False An Insurance Company which is formed under the laws of the State of Illinois, and has its Home Office there, is considered a: A. US Domestic Company B. Foreign Company C. Alien Company D. Unadmitted Company - ✔B. Foreign Company Domestic: this state (FL) Foreign: other state (still in US)Alien: elsewhere One who is involved in the investigation, adjustment, negotiation and/or trial preparations of claims arising under insurance policies is defined as: A. Insurance Agent B. General Lines Agent C. Claims Adjuster D. All of the Above - ✔C. Claims Adjuster Establishing a dollar value on a claim is defined as: A. Negotiation B. Evaluation C. Adjusting D. None of the Above - ✔B. Evaluation Damaged property that may be retrieved, reconditioned and sold to reduce an insured loss is defined as: A. Junk B. Salvage C. Covered Property D. Peril - ✔B. Salvage The voluntary or intentional relinquishment of a known right is defined as a(n): A. Waiver B. Estoppel C. Avoidance of Performance D. None of the Above - ✔A. Waiver The principle of utmost good faith on which an insurance contract is based places serious responsibilities on the claims adjuster in regards to: A. Conduct B. Work Habits C. Claim Handling Activites D. All of the Above - ✔D. All of the Above The adjusters basic activities in claims handling are: A. Investigation B. Evaluation C. Negotiation D. All of the Above - ✔D. All of the Above Under the Florida Unfair Insurance Trade Practices Act, penalties are provided for misrepresentation of business practices, which include all of the following except: A. Failing to act promptly B. Failure to explain claim denials in writing C. Denying claims with reasonable investigation D. Failure to maintain complaint handling procedures - ✔C. Denying claims with reasonable investigation An adjuster who represents the financial interests of the insured named in the policy is defined as a(n): A. Public Adjuster B. Bureau Adjuster C. Fee Adjuster D. Independent Adjuster - ✔A. Public Adjuster When investigating liability insurance claims, which of the following three major elements are determined: A. Coverage B. Liability C. Damages D. All of the Above - ✔D. All of the Above An adjuster who is self employed and not affiliated with either insurers or bureaus is defined as a(n): A. Fee Adjuster B. Public Adjuster C. Bureau Adjuster D. Independent Adjuster - ✔D. Independent Adjuster The adjuster's investigation may include all of the following except: A. Verification of Bills and Estimates B. Photographs C. Witness Canvasses D. Policy Cancellation - ✔D. Policy Cancellation