Insurance Claims Adjuster Test Questions & Answers for Florida 2024, Exams of Nursing

Download Insurance Claims Adjuster Test Questions & Answers for Florida 2024 and more Exams Nursing in PDF only on Docsity! Claims Adjuster (Florida) Test Questions & Answers Latest 2024 For purposes of insurance, a "loss" is best defined as: - Answer an unwelcomed, unplanned reduction in economic value An automatic sprinkler system in a hotel building is a risk reduction measure because it: - Answer reduces the amount of damage that a fire is likely to do Insuring a new restaurant against business failure is not possible because business success or failure is: - Answer a speculative risk Which of the following is an example of pure risk? - Answer the possibility of a business being flooded Zenith Insurance Company issues a policy to Best Manufacturing Company. A dispute arises between Zenith and Best on the meaning of an ambiguous clause in their contract. The matter goes to court, which can be expected to interpret the clause in a manner that: - Answer favors Best Manufacturing The fact that insurance policy language is written by an insurance company and is nonnegotiable makes insurance policies: - Answer contracts of adhesion Claims Adjuster (Florida) Test Questions & Answers Latest 2024 Which of the following correctly identifies three elements that must be present to create an enforceable contract? - Answer acceptance, consideration, and offer Rhonda's parents bought her a car for her sixteenth birthday and made her responsible for maintaining and insuring it. However, when Rhonda applied for auto insurance after getting her driver's license, she was told that she could not enter into a binding insurance contract because, according to the law in her state, a 16-year-old does not qualify as a(n): - Answer competent party A fire severely damages Carl's home, making it uninhabitable. He moves his family to a hotel while the house is repaired. The additional expenses incurs in housing the family are considered what type of loss? - Answer indirect Butch's Meat Market loses electrical power during a flood. The business closes for several days, during which time there is no refrigeration and a large quantity of meat spoils. The loss of the meat is what type of loss? - Answer consequential "Replacement cost minus physical depreciation" describes which type of loss valuation method? - Answer actual cash value Claims Adjuster (Florida) Test Questions & Answers Latest 2024 Which one of the following incidents is an example of vicarious liability? Rudy is held responsible for an accident caused by his employee. Dominic is held responsible for food poisoning due to a pizza he delivered. Edie is held responsible for striking a pedestrian with her bicycle. Lilly is held responsible for her cat's injury to Lilly's guest. - Answer Rudy is held responsible for an accident caused by his employee. Bill's children have grown up and moved away, but the tree house that he built for them now draws other neighborhood children despite his handmade "No Trespassing" sign. If a neighbor's child is injured by falling from the tree house, Bill might be held liable for the child's injuries under what legal doctrine or principle? - Answer attractive nuisance Lorraine was parking her car when her brakes failed, and she struck the car next to her, which was owned by Marty. In this case, all the following statements are correct EXCEPT: The rolling of Lorraine's car into Marty's car was the proximate cause of the damage. The costs to repair Marty's car represent compensable damages. The accident was a breach of duty on Lorraine's part. Claims Adjuster (Florida) Test Questions & Answers Latest 2024 Lorraine had a duty to keep her car from striking Marty's car. - Answer The rolling of Lorraine's car into Marty's car was the proximate cause of the damage. The gradually expanding brown spot on the ceiling of his barbershop suggests that Edmond might have a plumbing leak, but he ignores it because any drips from the ceiling fall into a sink. When the ceiling collapses because of water damage, Edmond finally submits an insurance claim that the insurer denies because his policy has an exclusion for: - Answer water leakage or seepage Many endorsements are attached to Bettie's policy. If she examines them closely, she will probably find one or more endorsements that do all the following EXCEPT: expand coverage to cover a specific exposure add exclusions eliminate an exclusion cancel the policy - Answer cancel the policy Why do insurance policies use quotation marks with certain words and phrases? - Answer to identify words and phrases that are defined in the policy Claims Adjuster (Florida) Test Questions & Answers Latest 2024 Which one of the following is NOT a type of provision found in property and casualty insurance policies? declarations insertions definitions conditions - Answer insertions The standard mortgage (mortgagee) clause in a property insurance policy covering real property does which of the following? -It requires the lender to purchase property insurance on the mortgaged property. -It ensures that the mortgage lender is paid if mortgaged property suffers a loss. -It makes the lender the owner of the property if the borrower does not maintain insurance on the mortgaged property. -It requires the lender to pay off the mortgage should a loss occur on the mortgaged property. - Answer It ensures that the mortgage lender is paid if mortgaged property suffers a loss. With respect to property and casualty insurance policies, "subrogation" refers to: - Answer the insurer's right to recover its claim payment from the party that was responsible for the loss Claims Adjuster (Florida) Test Questions & Answers Latest 2024 Which of the following is a requirement to operate as an insurance agency in Florida? having transacted insurance in Florida for at least two years before applying for a license submitting an application and appointing the Office as its agent for service of process obtaining a license or registration from the state appointment of at least two agents to manage the agency - Answer obtaining a license or registration from the state BBX Insurers terminated Henry's appointment as its adjuster on December 1. How long will Henry remain eligible to be appointed as an adjuster by another insurer? - Answer 48 months Sasha, Kendall, Adam, and Julio are licensed agents in Florida. The Department of Financial Services would NOT be able to suspend or revoke which agent's license for engaging in the following acts? Julio, who used insurance premiums he collected to renovate his business office Sasha, who sold insurance policies to family members and friends this year Kendall, who intentionally violated an order issued by the Office of Insurance Regulation Claims Adjuster (Florida) Test Questions & Answers Latest 2024 Adam, who offered season football tickets to prospects who purchased policies - Answer Sasha, who sold insurance policies to family members and friends this year The Dwelling Property 3-Special Form provides more coverage than the Dwelling Property 2-Broad Form because the DP 3 automatically provides: - Answer open perils coverage rather than named perils coverage on the building David's job requires him to move from his suburban home to a distant city. He rents it to a couple in his absence. How can he maintain property insurance on the home now that he is leasing it to others? - Answer He should replace the homeowners policy with a dwelling policy. Dalton rents an unfurnished house. Dalton's dwelling policy is most likely to have Coverage C-Personal Property and: - Answer Coverage E- Additional Living Expense After buying a DP 1 basic policy, Clement realizes that he has no personal liability coverage. How can he get this coverage? - Answer add the personal liability supplement Claims Adjuster (Florida) Test Questions & Answers Latest 2024 Which ISO homeowners insurance form provides open perils coverage on the dwelling and named perils coverage on personal property? - Answer HO 3 A truck crashes into an insured's house. Before repairs can begin, the truck and damaged portions of the house must be removed. The additional coverage for debris removal in the homeowners insurance policy will: - Answer cover only the expense of removing damaged portions of the house Gertrude's will specifies that, upon her death, her son Dirk will be the executor of her estate. Coverage for Dirk's actions as the executor are described under what policy condition of the homeowners policy? - Answer death The collapse additional coverage in a homeowners policy applies only when: - Answer all or part of the building falls or caves in More than half of Darryl's home suffers tornado damage. Because the home did not comply with current building codes, Darryl must tear down the undamaged portion and rebuild it with more expensive components. The ordinance or law additional coverage in his HO 3 policy will NOT cover: - Answer replacement cost of repairing the damaged portion of the home Claims Adjuster (Florida) Test Questions & Answers Latest 2024 *Motor carriers subject to the Motor Carrier Act of 1980 must have insurance coverage of $750,000 to $5 million, depending on the cargo they transport. The errors and omissions coverage in an equipment breakdown policy is most likely to apply in which of the following situations? - Answer The insured made a mistake in describing the property location on the application. *Errors and omissions coverage insures a loss when the form would not otherwise provide coverage due to an unintentional error by the applicant/insured such as incorrectly describing the property owner or the location where coverage was intended to apply. The declarations page of Julius's equipment breakdown policy lists a number of coverages, such as property damage, expediting expenses, business income and extra expense, and utility interruption. The word "INCLUDED" is shown next to "property damage," but it does not appear elsewhere in the declarations, nor are there any dollar limits listed on the page. Julius's policy provides coverage for: - Answer property damage only *For any coverage option to apply, a dollar limit or the word "INCLUDED" must be shown on the policy for that coverage. Since the word is shown only for property damage, Julius has coverage for property damage only. Claims Adjuster (Florida) Test Questions & Answers Latest 2024 An equipment breakdown policy typically would NOT cover which of these incidents? - Answer Failure of a conveyer belt due to extended use. *An equipment breakdown policy defines breakdown to include pressure or vacuum equipment failure, mechanical failure, and electrical failure. It excludes coverage for equipment parts that are normally subject to periodic replacement or routine maintenance. Which of the following is a coverage option that is available in a standard equipment breakdown policy? - Answer spoilage damage *As long as the insured is legally responsible for the damaged property, spoilage damage is a covered peril. Dry rot, corrosion, and smoke damage are not coverage options. Which forms are attached to a commercial property policy to broaden or narrow coverage? - Answer endorsements *Endorsements broaden or narrow the coverage of a property or casualty policy. They may also modify it to comply with state requirements. Haley's new law office is in a commercial condominium unit she purchased. Which form is suitable for insuring her property? - Answer condominium commercial unit owners coverage form Claims Adjuster (Florida) Test Questions & Answers Latest 2024 *The condominium commercial unit owners form is designed for businesses that own and occupy commercial condominium units. Dixie's business personal property coverage of her building and personal property commercial property form covers almost everything in her barbershop, but NOT: - Answer cash in the cash register *Money is on the list of property not covered. Darnell manufactures building components at a constant rate. When sales are slow, the finished-goods inventory increases, and vice versa. Sales depend on the current construction market. Therefore, the policy covering Darnell's fluctuating inventory should include: - Answer a value reporting form *The reporting form coverage available with the value reporting form can be useful to a business with unpredictable, fluctuating property values at risk. What type of business is ineligible for a BOP regardless of its size? - Answer parking garage Parking lots or garages are ineligible for a BOP regardless of their size. Claims Adjuster (Florida) Test Questions & Answers Latest 2024 *Business income from dependent properties coverage applies to loss of business income resulting from damage from a covered cause to property of another business on which the insured depends. Which loss would the businessowners policy NOT cover? - Answer Manufacturing error causing defective product *The BOP does not cover manufacturing errors that result in worthless or defective products. This kind of loss arises from a business risk, not a peril that property insurance covers. Ida's boutique at a shopping mall escapes damage when a portion of the atrium roof caves in. However, her business came to a sudden halt when the debris blocks access to her store. Does Ida's businessowners policy cover the resulting loss of income? - Answer Yes, because the BOP's business income and extra expense coverage applies when a business interruption is caused by damage to any area used to gain access to the insured's premises. *overage applies to cessation of the insured's business activities due to uninhabitability of described premises. This includes any area used to gain access to the insured's premises. A benefit of the extra expense additional coverage in a businessowners policy is that it - Answer is not subject to the limits of insurance Claims Adjuster (Florida) Test Questions & Answers Latest 2024 *Extra expense coverage is not subject to the limits of insurance but is provided in addition to those limits. Bert faced two personal liability claims during the past year. His homeowners insurance policy has a $100,000 personal liability limit. The first claim was $125,000 for bodily injury and $50,000 for property damage. The second claim was $2,000 for bodily injury. How much did Bert's insurer pay in damages? - Answer $102,000 *The insurer will pay the $100,000 limit for the first occurrence and $2,000 for the second. Which incident that resulted in a liability claim against Aida did NOT involve "bodily injury" as defined in her homeowners insurance policy? - Answer A neighbor's reputation was harmed by rumors Aida spread. *Homeowners forms define "bodily injury" as bodily harm, sickness, or disease, including death. Damage to reputation is not considered bodily injury. While backing out of her garage, Louise accidentally lowers her garage door. The door strikes her car and is damaged. She learns that her homeowners insurance policy excludes liability coverage for damage to the insured's own property. Where might she find coverage? - Answer Section I of the policy Claims Adjuster (Florida) Test Questions & Answers Latest 2024 *The homeowners insurance policy provides no liability coverage for property damage to property owned by an insured because first-party property coverage is covered by Section I of the policy. The chlorinated water that splashes out of Amber's backyard swimming pool eventually kills expensive trees that her neighbor Jeffrey planted at the edge of his property. He wants Amber to pay for the damage. Her homeowners policy may cover this liability claim if it involves an occurrence. Is it an occurrence? - Answer Yes, because the damage can arise from continuous or repeated exposure to the same harmful conditions. *An occurrence can include not only sudden accidents but also losses arising from continuous or repeated exposure to the same harmful conditions. In an attempt to reduce her expenses, Mattie sells her car. What must she do to cancel her auto insurance policy? - Answer notify the insurer in writing of her intent to cancel the policy *The named insured can cancel by giving the insurer advance written notice of the intent to cancel the policy. How much advance notice must an insurance company give its policyholder before it cancels a personal auto policy? - Answer At least 10 days Claims Adjuster (Florida) Test Questions & Answers Latest 2024 commercial automobile policy if they are principally used to carry or deliver goods as part of a commercial operation. The complete personal auto policy combines coverage for - Answer property and liability insurance *The ISO personal auto policy combines property and liability insurance in a single policy to protect families and individuals. Property insurance protects the vehicle from loss due to fire or collision. Liability insurance protects the owner or operator if the vehicle is involved in an accident that results in injury or death. Who usually determines which party is legally responsible for an auto accident? - Answer insurers *A court with a judge, jury, or both sometimes determines legal liability, but usually the insurer makes this determination based on its investigation of the accident. Trisha is driving Angelo's car with his permission when she causes an accident in which she sustains minor injuries. Trisha and Angelo have personal auto policies (PAP) with medical payments coverage. From what source(s), if any, will Trisha recover her medical expenses? - Answer Angelo's insurer provides primary coverage. *Primary insurance follows the car, so the owner's insurance provides primary coverage for the borrowing driver's injuries. Claims Adjuster (Florida) Test Questions & Answers Latest 2024 Phoebe rents her home. She loses control of her car on the icy driveway and crashes into the garage door. It will cost $1,000 to repair or replace the door. The property damage liability coverage of Phoebe's personal auto policy will: - Answer pay for the damage *Although the PAP does not cover liability for damage to others' property that the insured possesses, it does cover such property when the insured rents a residence or private garage. An insured would be prudent to rely upon health insurance to cover injuries sustained in an auto accident because medical payments coverage under a personal auto policy (PAP): - Answer has relatively low limits *Medical payments coverage pays for relatively small amounts of medical expenses. Melinda buys specified causes of loss coverage with the business auto policy (BAP) insuring the trucks in her fleet. She will NOT be covered for losses to the trucks caused by: - Answer glass breakage *Glass breakage is not among the list of perils covered by specified causes of loss coverage under the BAP. Nelson is the president of his company and has a company car. He does not have a personal auto policy because he does not own another Claims Adjuster (Florida) Test Questions & Answers Latest 2024 vehicle. Which endorsement to his company's business auto policy (BAP) will protect him when he uses another vehicle? - Answer Drive Other Car-Broadened Coverage for Named Individuals Which expense is NOT covered as property damage by a business auto policy (BAP)? - Answer damage to property transported in a covered auto *The BAP excludes damage to property owned or transported by the insured or in the insured's care, custody, or control. Sandy requires her employees to use their personal autos when calling on customers. If she adds the Employees as Insureds endorsement to her company's business auto policy (BAP), employees who use their personal cars for business calls will have: - Answer excess coverage under the BAP for losses that exceed their personal auto liability limits *The endorsed BAP will provide excess coverage over the employee's personal auto policy if an employee is liable for a loss involving the business use of his or her personal vehicle Minestra Company produces a defective quantity of mushroom soup which results in the hospitalization of consumers who become ill from eating it. In anticipation of their claims, Minestra instructs retailers to remove its mushroom soup from their stores. Minestra asks its commercial general liability insurer to cover its expenses in removing Claims Adjuster (Florida) Test Questions & Answers Latest 2024 under Coverage C-medical payments? - Answer The injury occurred off the insured premises. *Medical payments coverage is no-fault coverage that protects members of the public while on the insured's premises or exposed to the insured's operations. It applies without regard to the insured's legal liability. Which activity would fall outside the definition of "farming" in the standard farm liability coverage form? -Field irrigation -Selling tee shirts at a farmer's market in the city -Crop dusting -Selling farm produce from a roadside stand - Answer Selling tee shirts at a farmer's market in the city *The farm liability coverage form defines "farming" as the operation of an agricultural or aquacultural enterprise, including the operation of roadside stands, on the farm premises, maintained for the sale of farm products produced primarily by the named insured. Farming usually does not include mechanized processing operations or retail activity other than that described. Which coverages does the standard farm liability coverage form provide? - Answer Bodily injury and prop Claims Adjuster (Florida) Test Questions & Answers Latest 2024 *The standard farm liability form provides coverage for bodily injury and property damage (Coverage H), personal injury and advertising injury (Coverage I), and medical payments (Coverage J), all on an occurrence basis. As defined in the farm liability coverage form, farming does NOT include: - Answer mechanized processing operations *Unless otherwise indicated on the declarations, farming does not include mechanized processing operations. The farm insurance bodily injury and property damage liability form (Coverage H) contains exclusions for all the following losses EXCEPT: - Answer loss of use *Coverage H includes the other party's loss of use of tangible property that is not physically damaged. Colin hires Sal, a retired farmer, to help him with the harvest. Sal is seriously injured when he falls off the tractor he was operating in Colin's field. Colin's farm liability coverage form: - Answer covers Sal's injuries as long as the loss is not subject to the state's workers compensation laws *The workers compensation exclusion precludes coverage if state law requires Colin to provide Sal with workers compensation benefits, which is usually done by purchasing workers compensation insurance. Claims Adjuster (Florida) Test Questions & Answers Latest 2024 Which of the following activities, if located on the farm premises, would NOT be considered a farming operation covered by the farm liability coverage form? harvesting of shellfish cultivation of aquatic plants roadside produce stand gift shop - Answer gift shop *The form defines "farming" as an agricultural or aquacultural enterprise, including the operation of roadside stands, on the farm premises. It typically does not include retail activity. Which of the following activities is covered under the basic farm liability coverage form (FL 00 20)? - Answer Farmer operates a mower mounted on his tractor in his own hay field. *Although the farm liability coverage form contains an exclusion for mobile equipment, that applies only to the transportation of mobile equipment by a motor vehicle. No coverage is provided for losses due to custom farming, aircraft discharge (crop dusting), or use of livestock to provide rides for a fee or in connection with a charitable function. Al's farm does not produce enough income to support his family, so he supplements his farming income by working as a carpenter. Which Claims Adjuster (Florida) Test Questions & Answers Latest 2024 not considered an employee. Therefore, a crime policy does not cover theft of property by an independent contractor. When an insurance policy provides crime coverage on a discovery basis, coverage is triggered by a loss that: - Answer is discovered during the policy period or within 60 days after the policy period ends *Discovery-based coverage applies to loss discovered during the policy period or within 60 days after the policy period ends. Loss sustained coverage applies to loss that occurs during the policy period and is discovered within one year after the policy period ends. When an insurance policy provides crime coverage on a loss sustained basis, coverage is triggered by a loss that occurs: - Answer after the retroactive date and is discovered during the policy period * Unlike an insurance policy, a surety bond: - Answer is a three-party contract *Three parties-the principal, the obligee, and the surety-are involved in a bonding relationship. Claims Adjuster (Florida) Test Questions & Answers Latest 2024 Linwood requires each of its public officials to furnish a public officials bond. These bonds will normally terminate: - Answer when the bonded public official leaves office *Public officials bonds usually terminate only when successors have been elected or appointed or the current official leaves office for any reason . An insurance policy is different from a surety bond in that an insurance policy: - Answer is issued with the expectation that some insureds will have losses *Although they do not know which insureds will suffer a loss, insurance underwriters anticipate that a certain number of losses will occur; insurance is a mechanism for spreading the financial impact of those losses. License and permit bonds, often required by a municipality or other public body, guarantee that the party seeking the license or permit will: - Answer comply with applicable laws or regulations *Public bodies require license and permit bonds as a condition to granting a license or permit to engage in a certain activity. The bond guarantees that the bonded party will comply with applicable laws or regulations. Claims Adjuster (Florida) Test Questions & Answers Latest 2024 Which of the following employees of the Seaside Marina is subject to the Longshore and Harbor Workers' Compensation Act? - Answer Sydney, an employee of a company that repairs ships *Unlike the others, Sydney's job involves repairing ships, which is within the scope of the LHWCA. Before workers compensation statutes were enacted, employers could defend themselves against negligence claims by injured workers by employing certain common-law defenses. Which is NOT one of those defenses? act of God assumption of risk contributory negligence negligence of a fellow employee - Answer act of God *The common-law defenses available to employers were assumption of risk, contributory negligence, and negligence of a fellow employee. In most states, what workers compensation coverage is available for sole proprietors and partners? - Answer They are not covered as employees under the state workers compensation act but may voluntarily choose to purchase coverage. Claims Adjuster (Florida) Test Questions & Answers Latest 2024 When an independent contractor discovered he had asbestosis, he submitted a workers compensation claim to Iva Builders, the contractor that employed him. Iva's risk manager submitted the claim to its insurer, but asserted that the contractor got the disease elsewhere and told the insurer to refuse the claim. Which of the following statements is true? -The insurer can settle this claim only with Iva's consent, so it must refuse to investigate or pay the claim. -The insurer has no right to consider a defense and is obligated to pay the claim. -The insurer has a right to investigate and settle the claim regardless of Iva's consent. -The insurer has a contractual obligation to investigate the case, but must refuse to settle the claim. - Answer The insurer has the right to investigate and settle workers compensation claims or suits without the insured employer's consent. What unfair trade practice has a person committed if he knowingly and with intent to defraud files an insurance claim that is false? - Answer fraud Delta Insurers typically affirms or denies claims within 120 days after it receives proof of loss statements. Which statement is correct? Delta is engaged in lawful claims settlement practices. Claims Adjuster (Florida) Test Questions & Answers Latest 2024 Delta is engaged in unfair claims settlement practices. Delta is legally required to pay its claims within 90 days. Delta has committed insurance fraud. - Answer Delta is engaged in unfair claims settlement practices. *It is an unfair claims settlement practice for insurers to fail to affirm or deny coverage of claims within 30 days after receiving proof of loss statements. In which of the following cases would the applicant be eligible for coverage through an insurer in the residual insurance market? The applicant is a business entity. The applicant is entitled to insurance but cannot buy it through the voluntary market. The applicant wants the most affordable premium available. The applicant has been rejected by an insurer. - Answer The applicant is entitled to insurance but cannot buy it through the voluntary market. *The residual market is a source of coverage of last resort for individuals and businesses that have been rejected by insurers in the voluntary market. These individuals and businesses are otherwise in good faith entitled to buy insurance from these insurers but are prevented from doing so. Claims Adjuster (Florida) Test Questions & Answers Latest 2024 Residual markets systems provide a source of insurance coverage for individuals and businesses that - Answer are entitled to it but cannot buy it through the voluntary market. An insured's health insurance policy pays a flat rate of $200 a month if she becomes disabled, regardless of her actual income. What kind of policy does she have? - Answer valued policy *Valued policies pay a fixed sum that is stipulated in the contract. A policy that pays a flat rate of $200 a month in case of disability is a valued contract. How does health insurance differ from life insurance? - Answer Health insurance protects against risks that may arise more than once in a lifetime. *Unlike the risk of death, a person may face health risks many times during his or her life. Which statement about group health insurance is true? Requirements for individual and group plans are the same. Insurers may impose restrictions and exclusions on individual and group policies. The federal government cannot impose requirements on group plans. Claims Adjuster (Florida) Test Questions & Answers Latest 2024 Which statement about disability income insurance (DI) policies is correct? A flat benefit is paid in group DI policies, while a percentage of earnings is paid in individual DI policies. DI policy benefits usually match the insured's wages. Most DI policies cover both occupational and nonoccupational disabilities. DI benefits are paid if the insured is under the regular care of a physician and gives periodic proof of loss, unless the disability is total and permanent. - Answer DI benefits are paid if the insured is under the regular care of a physician and gives periodic proof of loss, unless the disability is total and permanent. *Because all states require employers to maintain workers' compensation coverage or equivalent protection for employees, most DI policies cover only nonoccupational disabilities. Which definition of total disability lets the insured qualify for benefits most easily? - Answer own occupation *From an insured's point of view, an own occupation disability income policy is more favorable because it only requires the insured to be unable to work at his or her own occupation to qualify for benefits. Claims Adjuster (Florida) Test Questions & Answers Latest 2024 Which of the following statements about individual disability income policies is correct? Benefits never exceed the insured's income. A flat benefit amount is rare in individual disability income policies. Benefits equal the insured's pre-disability income. Benefits are not related to a flat amount or percentage of the insured's earnings. - Answer Benefits never exceed the insured's income. *Benefits rarely approach the insured's pre-disability income. They never exceed that income. To do so might encourage the insured to prolong the disability. Which statement is NOT correct about utilization reviews? They determine whether treatment is appropriate. The review can only take place after a medical service is provided. They determine coverage for medical issues arising in the future. They determine whether a managed care provider will cover services or treatment. - Answer The review can only take place after a medical service is provided. *The review can take place before (prospective review), during (concurrent review), or after (retrospective review) a medical service is provided. Claims Adjuster (Florida) Test Questions & Answers Latest 2024 Which statement is correct about managed care plans? An insured who is unhappy with the services of a health care provider may choose another. Insureds may choose any health care provider. They coordinate the financing and the delivery of health care. They are indemnity plans. - Answer They coordinate the financing and the delivery of health care. *It is with a medical expense policy, not a managed care policy, that an insured unhappy with the services of a health care provider may choose another. Which does NOT restrict the health care coverage that an HMO provides? In an emergency, it may be impossible for a member to get prior approval for treatment. requirement to contact the HMO within one hour of treatment outside the HMO's service area limitations on when, where, and how members receive treatment prior approval of hospital stays and surgeries - Answer requirement to contact the HMO within one hour of treatment outside the HMO's service area *Hospital stays and surgeries must have prior approval from the HMO if it is to cover the cost of the stay or surgery. Claims Adjuster (Florida) Test Questions & Answers Latest 2024 She must meet the minimum health standards required of Medicare beneficiaries. - Answer She must meet the minimum health standards required of Medicare beneficiaries. *She must be at least 65 years old and apply for a Medicare supplement policy within six months of enrolling in Medicare Part B. Insurers cannot deny or condition the issue of the policy because of her medical history, health status, or claims experience. Which statement does NOT describe the standard Medicare supplement plans? Insurers selling Medicare supplement policies must offer Plan A. Plan A provides the basic core benefits. A plan may be cancelled if the insured's health significantly deteriorates. Plans B through N include Plan A's core benefits. - Answer A plan may be cancelled if the insured's health significantly deteriorates. *A policy cannot be canceled because of the insured's health. Even though they offer the same benefits as Medicare supplement policies, why do Medicare SELECT plan's charge a lower premium? - Answer Medicare SELECT plans deliver health care through a network of providers. Claims Adjuster (Florida) Test Questions & Answers Latest 2024 *Medicare SELECT plans deliver health care through a network of providers, which reduces the cost of care. Medicare supplement insurance policies supplement coverage of which Medicare Part? - Answer Medicare Parts A and B only *Medicare supplement policies supplement Original Medicare (Parts A and B), but not Part C, which covers many of the gaps that Medigap policies cover. The insurance company (principal) grants authority to its agent, the producer. Which of the following types of authority is usually granted via the agent/company contract? - Answer expressed The expressed authority granted to an agent is usually contained in an agent-company contract. Understanding practices that are considered unethical is the first step in - Answer identifying, preventing, and resolving ethical dilemmas *The first step in identifying, preventing, and resolving ethical dilemmas is to fully understand practices that are considered unethical. In the insurance workplace, ethical dilemmas occur because differences of opinion and perception exist between clients and producers (and Claims Adjuster (Florida) Test Questions & Answers Latest 2024 among insurance professionals) with respect to which of the following? - Answer matters of significant value *Ethical dilemmas occur because of differences of opinion concerning matters of significant value (i.e., what's important and what isn't important); the existence, or viability, of available options; and the possible consequences or results of particular actions and behaviors. A society, community, or business industry determines the collective standards of acceptable ethical conduct. An individual, however, approaches ethical decisions from a personal perspective of life experiences along with other factors. Which of the following is not one of the factors from which an individual makes an ethical decision? - Answer state insurance regulations *State insurance regulations are not personal perspectives or life experiences. Producers owe duties to their insurers per industry accepted concepts and practices. If a producer provides a compensation disclosure to an insured, which of the following practices is the producer observing? - Answer fair sales practice A mode or standard of personal behavior based on moral or ethical principles defines which of the following? - Answer Conduct is a mode or standard of personal behavior based on moral or ethical principles. Claims Adjuster (Florida) Test Questions & Answers Latest 2024 *Trust accounts are bank accounts that are obtained, maintained, and held separate and apart from other funds for a specific purpose. Producers who do not meet the standards of which of the following are a threat to the well-being of not only the consumer, but professionals within the insurance industry? - Answer competency *Producers who do not meet the standards of competency are a threat to the well-being of not only the consumer, but the professionals within the insurance industry, as well. A fiduciary responsibility requires the utmost in care and the highest standards of conduct with respect to the law or ethics. All of the following are qualities required by a fiduciary EXCEPT: honesty good faith good communication skills loyalty - Answer good communication skills *A fiduciary is not required to have good communications skills. In the insurance industry, placing an insured's funds into any type of bank account other than a trust account is considered - Answer commingling Claims Adjuster (Florida) Test Questions & Answers Latest 2024 *Producers who do not meet the standards of competency are a threat to the well-being of not only the consumer, but the professionals within the insurance industry, as well. Who has the authority to determine insurance coverage or to settle insurance claims? - Answer insurance companies *Only insurance companies and its claims representatives have the authority to determine coverage and settle claims. Producers should understand and explain to consumers that producers do not have such authority. If a producer does not properly and thoroughly represent an insurance contract or product, his or her failure to do so may be construed as - Answer misrepresentation *Failure of a producer to properly and thoroughly represent an insurance contract or product may be construed as misrepresentation. Making misrepresentations about an insurance policy or contract is both illegal and unethical. Protected health information includes all of the following EXCEPT: information about financial status information that is submitted or recorded in any form information that might help identify an individual Claims Adjuster (Florida) Test Questions & Answers Latest 2024 information about mental or physical health - Answer information about financial status Senior clients are more at risk than any other sector of the population in this country. Which of the following is not a practice to which seniors are vulnerable? - Answer honesty, no matter how unpleasant the truth *Senior clients may be vulnerable to scams, high-pressure tactics, and fears about a medical condition or longevity. Honesty is a behavior and not something that creates vulnerability. When does a false statement constitute fraud in the insurance industry? - Answer when the false statement was about a material fact by a person intending to deceive *A false statement is not necessarily fraudulent. Fraud exists only when the intent of the person making the false statement is to deceive and secure unfair or illegal advantage and it is a false statement of material fact. According to the Securities and Exchange Commission, which of the following allows one to invest in another person's life insurance policy? - Answer a viatical settlement Which of the following is not among the recognized approaches to handling risk? Claims Adjuster (Florida) Test Questions & Answers Latest 2024 Who of the following would be able to buy insurance to cover their potential losses from the activity described? Judith, who has just purchased an automobile Suzanne, who trades stocks online Darryl, who buys land as a speculative investment Jimmy, who places bets on horse races - Answer Judith, who has just purchased an automobile *In general, only pure risks are insurable. Pure risk involves only the chance of a loss. Insuring an automobile against the risk of damage or theft is an example of an insurable pure risk. When referring to the subject that is being insured under an insurance policy, the term that is used is: - Answer risk *The term "risk" is sometimes used to refer to the person, property, or activity that is insured under a policy. Which of the following best explains why war is generally excluded from coverage in most insurance policies? - Answer War involves the potential for catastrophic loss that simultaneously affects many policyholders. *An insurable risk must not be catastrophic. Insurance companies do not generally cover losses resulting from a war or a nuclear reaction Claims Adjuster (Florida) Test Questions & Answers Latest 2024 because a single event might affect many policyholders at the same time. Stephanie keeps valuable hobby supplies in a self-storage warehouse. The policy was just renewed, and the new policy imposed new limits for property in a self-storage facility, which Stephanie's agent did not point out to her. If a fire destroys the warehouse, Stephanie might be able to collect in full under what doctrine? - Answer reasonable expectations *Courts sometimes agree to apply the reasonable expectations doctrine to provide protection an insured might reasonably expect in a case where the insured was uninformed that coverage had changed when a policy was renewed. If the courts find an ambiguity in an insurance policy, they will interpret it in the policyholder's favor because insurance policies are: - Answer contracts of adhesion *Insurance contracts are contracts of adhesion, and if the courts find that a contract of adhesion is ambiguous, they will interpret it in favor of the party that did not write the contract. Olen buys insurance on the inventory in his warehouse, which includes a sizable quantity of watches bearing the "Rolex" label, and Olen pays the insurance premium. After Olen reports a theft, the insurer's investigation reveals that the watches it had agreed to insure were Claims Adjuster (Florida) Test Questions & Answers Latest 2024 illegal counterfeits. Olen's contract with the insurer is: - Answer unenforceable because it was for an illegal purpose *For a contracting party to be able to enforce the terms of the contract, the contract must be for a legal purpose, and counterfeit merchandise is illegal. The property insurance policy with a $500,000 limit that covers Logan's store is a contract of indemnity. If Logan's store is partially damaged by a covered peril, what is Logan's insurer obligated to pay? - Answer an amount that is related to the value of the loss, not to exceed $500,000 *When a covered loss occurs under a contract of indemnity, the benefit payable is related to the amount of the loss. From an insurance perspective, the items inside a house, in a yard, and in a suitcase when the insured travels is considered to be: - Answer personal property *Every kind of property that is not real property is personal property. This includes, but is not limited to, the contents of the insured's house and car. In the context of a property or casualty insurance policy, which of the following is personal property? a house Claims Adjuster (Florida) Test Questions & Answers Latest 2024 Which of the following is commonly listed as an excluded cause of loss in an open perils property insurance policy? vandalism explosion flood windstorm - Answer flood *An open (special) perils policy typically lists flood as an excluded peril, necessitating the need for flood insurance or a difference-in-conditions (D-I-C) policy to cover that risk. Liability insurance basically involves: - Answer tort law *Liability insurance involves tort law, which protects the rights of individuals from civil wrongs. Which one of the following legally qualifies as an attractive nuisance? a swimming pool in a homeowner's backyard that neighborhood children use, without the owner's permission, while the owner is at work an artfully painted garbage can behind a neighbor's garage that attracts flies Claims Adjuster (Florida) Test Questions & Answers Latest 2024 an ornate Christmas display in a neighbor's front yard that attracts spectators a billboard with a pretty picture on the side of the highway - Answer a swimming pool in a homeowner's backyard that neighborhood children use, without the owner's permission, while the owner is at work *An attractive nuisance is attractive to curious children who could be injured by it, even if the children are technically trespassers. Harding Paint Store mixed a gallon of paint with the custom color Meghan requested. However, the store clerk failed to tighten the lid on the paint can, which came open while Megan was driving home with the can in her car. Under which type of law was Harding required to pay for the expensive damage to Megan's car that resulted from the paint spill? - Answer tort law *Meghan had a right to freedom from damage to her property. Tort law protects the rights of individuals like Meghan from civil wrongs and provides for the payment of money damages as a remedy. John let his 17-year-old daughter Ashley use his motorboat, knowing she was normally a responsible operator. On this evening, while fooling around, she collided with another boat causing injuries and property damage. Though John was not in the boat, he was found to be responsible for damages based on the doctrine of: - Answer vicarious liability Claims Adjuster (Florida) Test Questions & Answers Latest 2024 *Vicarious liability arises when one person is legally responsibility for the acts of another. For example, a parent who has not personally committed any negligent act may still be held responsible for a tort committed by his or her minor child. Which one of the following losses would most likely be excluded by one of the maintenance or wear-and-tear exclusions in a property insurance policy? Pieces of siding blow off in a windstorm. Heat from a fire in the building next door melts the siding. Bees build a nest under the siding. A hailstorm creates cracks in the siding. - Answer Bees build a nest under the siding. *Maintenance and wear-and-tear exclusions typically exclude coverage for damage by insects. In contrast, nearly all building policies cover the perils of fire, windstorm, and hail. Which are typically NOT among the provisions of a typical property and casualty insurance policy? Waivers Declarations Insuring Agreements Claims Adjuster (Florida) Test Questions & Answers Latest 2024 *An aggregate limit is the maximum amount the insurer will pay for all applicable claims during the policy period. In negotiating the settlement of claims, an adjuster would not normally deal with - Answer a beneficiary *The adjuster may negotiate with the policyholder/insured in first-party claims. The adjuster may negotiate with third-party claimants in liability claims. Alternatively, the adjuster may negotiate with an attorney who represents either a policyholder or a third-party claimant. When investigating a claim, and adjuster does each of the following tasks EXCEPT: Analyze information Interpret information Obtain information Verify information - Answer Interpret information *An adjuster would not interpret information as this might constitute the unauthorized practice of law. To avoid the appearance of practicing law, a claims adjuster's communications with an insured should always be - Answer limited to the wording of the policy Claims Adjuster (Florida) Test Questions & Answers Latest 2024 *To avoid practicing law, a claims adjuster's communications with an insured that deal with coverage issues should be limited to the wording of the policy and the insured's claim. When insured property is damaged, what must the insured do with it? - Answer Arrange for its repair or disposal. *Property insurance policies prohibit the insured from abandoning damaged property to the insurer for repair or disposal. Arranging for repair or disposal is the insured's responsibility, unless the insurer elects otherwise. During the first six months following the assignment of a claim, how often is an adjuster required to provide claim status reports? - Answer At the 30th, 90th, and 180th day after assignment When obtaining information about a claim, an adjuster is interested in - Answer collecting information about the claim that is needed to resolve it *The adjuster collects information, facts, documents, etc., that the adjuster believes are essential to bringing the claim to resolution. When insured property is damaged, what must the insured do with it? - Answer Arrange for its repair or disposal. Claims Adjuster (Florida) Test Questions & Answers Latest 2024 A claims adjuster is obligated to carry out each of the following functions EXCEPT: Determine the final settlement value Determine the grounds to deny a claim. Determine the cause of loss Determine the amount of loss - Answer Determine the grounds to deny a claim. *The adjuster works on the insurer's behalf to help the insured in proving a loss to the insurer. What is the difference between loss-of-use Coverage D-Fair Rental Value and Coverage E-Additional Living Expenses in a dwelling policy? - Answer Coverage D protects premises that the insured rents out, while Coverage E applies to premises the insured occupies. *Both coverages apply when a residence is uninhabitable due to damage by a covered peril. Coverage D covers a landlord's lost rents, while Coverage E covers the insured's additional living expenses. Which peril covered under the Dwelling Property 2-Broad Form cannot be covered by the Dwelling Property 1-Basic Form? - Answer falling objects Claims Adjuster (Florida) Test Questions & Answers Latest 2024 *"Motor vehicle" is defined as a self-propelled land or amphibious vehicle or any trailer connected with it. This definition is broad enough to include motorcycles, self-propelled lawn mowers, and even motorized wheelchairs. Two matching gas lampposts stand at the end of Hiram's driveway. A car damages one of the lampposts. The Loss to a Pair or Set condition in Hiram's HO 3 policy will not permit his insurer to: - Answer pay Hiram half the value of the pair of lampposts *The insurer can repair or replace any part of a pair or set to restore it to its value before the loss or pay the difference between the actual cash value of the entire pair or set before and after the loss. Sharron had a large saltwater aquarium in her living room. Vandals entered her house and broke the aquarium. This led to the death of her fish and the warping of the hardwood floor beneath the aquarium. Coverage C-Personal Property of her homeowners insurance policy will cover the loss or damage to the: - Answer aquarium *The aquarium is covered personal property. Water and fish are not covered property, and the floor is part of the dwelling rather than personal property. Eva bought a single-family home in an adult community that provides amenities that are supported by homeowners' association dues. The Claims Adjuster (Florida) Test Questions & Answers Latest 2024 association has inadequate property insurance and charges Eva $750 for her share of payment for uninsured windstorm damage to the clubhouse. Which statement is correct about her HO 3 policy coverage for this expense? - Answer Loss assessment additional coverage applies. *The loss assessment additional coverage applies when the association's insurance coverage is inadequate to cover a property loss, and the association assesses its members to pay for the damage. Jordan converts her home's attached garage into an apartment that students rent year-round for $300 each month. A tenant accidentally starts a fire in the apartment, making it uninhabitable for three months while the damage is repaired. Which coverage in Jordan's homeowners insurance policy covers her rental income loss? - Answer fair rental value *If a covered property loss makes it impossible to live in a portion of the residence premises that is rented out, the insurer covers the fair rental value of such residence premises.