Insurance Terms and Concepts, Exams of Nursing

Download Insurance Terms and Concepts and more Exams Nursing in PDF only on Docsity! Florida 3-20 Public Adjusters State Exam Set 1 Questions with Verified Answers The insurer and insured agree to a specific value of insured item - Correct answer Agreed Value Policies Someone who has care, custody or control of another's property - Correct answer Bailed Claim filed by policy holder against his _ - Correct answer First Party Claim When a person who entrusts another with an object and it results in injury to someone can be held liable for the injury to someone. Can be held liable for the injury i.e. Firearm or DWI - Correct answer Negligent Entrustment Hazard those results from a conscious decision made by an insured to participate in a manner or behavior more likely to result in a loss because they have insurance - Correct answer Moral Hazard Used to provide temporary insurance coverage until an insurance policy can be written - Correct answer Binder Required by lenders to guarantee that outstanding loans against a job are paid upon completion - Correct answer Completion Bonds The section of an insurance policy identifying the insured, endorsements, coverage’s, limits, and premiums - Correct answer Declarations Policyholder cannot transfer the policy to someone else without written permission from their insurance company - Correct answer Assignment An instance, behavior or environment that increases the likelihood of a loss on an insured item - Correct answer Hazard Actual cause or source of an incidence of destruction, injury, or loss - Correct answer Peril An insurance company organized and domiciled outside the US - Correct answer Alien When there is an unbroken chain of events between an occurrence and a loss, then the loss is part of the original occurrence - Correct answer Proximate Cause Is proximate cause of all subsequent damages - Correct answer Original Occurrence? An individual who contracts with an adjusting firm as an independent contractor and handles claims for the insurance companies - Correct answer Independent Adjuster Action or practice of the insured party is permitted to continue because any defense against a continuation of said action or practice has been waived by the insurer - Correct answer Estoppel Operate for profit, collect premiums, and reserve a portion of premiums to pay claims - Correct answer Commercial Insurers Any person who investigates or adjusts losses on behalf of either an insurer or a self- insured - Correct answer Independent Adjuster The result of an insured's tort or wrongdoing. Consequences of a loss or amount or type of losses suffered - Correct answer Damages Requires the insured to insure the named property for a specific amount of insurance as required by the insurance company - Correct answer Agreed Value Physical harm to tangible property caused by peril (loss to property or person in which a covered peril is the proximate cause of damage or destruction) - Correct answer Direct loss The entity that is the "recipient" to the principal - Correct answer Oblige Insurance contracts are written on a take it or leave it basis to the policy owner. - Correct answer Adhesion Event or circumstance that causes damage - Correct answer Occurrence Coverage provides for payment of losses if civil authority denies access to the insured premises due to a covered peril - Correct answer Civil Authority Voluntary relinquishment of a known legal right - Correct answer Waiver An insurer domiciled outside the state where it writes insurance - Correct answer Foreign A state officer who administers the state's insurance laws and regulations - Correct answer Commissioner Insurance company assesses, mitigates, and monitors the items of risk that potential customers want to insure - Correct answer Risk management Granting the privileges and licensing in a state based on having a license in another state that is deemed equivalent by the granting state - Correct answer Reciprocity Specific protection in an insurance policy - Correct answer Coverage An individual holding a license under the authority of the State - Correct answer Licensee Means any solid, liquid, gaseous or thermal irritant or contaminant including smoke, vapor, soot, fumes, acids, alkalis and chemicals - Correct answer Pollutants A package insurance policy that combines both property and casualty coverage’s into a single policy - Correct answer Homeowners policy Legal term applying the third party claims meaning “to pay back or to make whole" - Correct answer Indemnification An agreement by one party, the guarantor to answer to a 3rd person for the debt of default of a responsible party called the principal - Correct answer Surety bonds The necessary increase in living expense resulting from a loss by a covered peril, and incurred by the insured - Correct answer Additional Living Expense (ALE) The replacement cost of like kind and quality at the time of loss, less a reasonable amount of depreciation - Correct answer Actual cash value Physical condition that increases the change of loss - Correct answer Physical Hazard Openness to loss or damage - Correct answer Exposure Any changes that broaden coverage on the edition of the policy that the insured holds will automatically apply without premiums - Correct answer liberalization clues Bonds that protect an employer form losses by an employee - Correct answer fidelity bonds A combination of property and liability coverage’s of two or more separate policies in one premium - Correct answer Package policy Fire that is not contained in the vessel in which it was set. Example: - Correct answer Hostile Fire Written agreement attached to a policy to add or subtract insurance coverage - Correct answer Endorsement Covers a variety of issues including lease of premiums, easements, sidetrack agreements and elevator maintenance agreements. - Correct answer Insured contract The act of taking responsibility through agreement for something that person may not be legally liable - Correct answer Assumption of liability Only applies to business income coverage and not to the extra expense coverage - Correct answer Actual cash value (bi) The value of the property is decreased or reduced due to damage but the property still remains some value and can be used - Correct answer Diminution of value Depreciation that is initially held back, then disbursed after proof of repairs being performed to bring property back to whole - Correct answer Recoverable depreciation Economic loss that arises as a consequence of the direct or physical loss - Correct answer indirect loss A statement made regarding the extent of the claim, it may be requested in accordance with the conditions of the policy - Correct answer Proof of loss Tangible property other than the products or work produced - Correct answer impaired property Works upon the principal that the more times an event is repeated, the more predictable the outcome of a specific event - Correct answer Law of Large Numbers To access the eligibility of a customer to receive their products, decide how much coverage the client should receive, and how much they should pay for it. - Correct answer Underwriting Actual cost of replacing property due to a covered peril with property of like kind and quality without depreciation - Correct answer replacement cost Exaggerating an otherwise legitimate claim for profit - Correct answer Soft Fraud Unincorporated association of members in which each member insures the other members - Correct answer Reciprocal insurance exchange An Agreement and - Correct answer Policy An ongoing assurance made by one party to another that certain facts: - Correct answer Warranty Method whereby the insurer pays the amount of each claim for each risk up to a limit determined in advance, and the re-insurer pays the amount of the claim above that specified limit - Correct answer Excess of loss A person who voluntarily gives up possession of the property - Correct answer bailer One of the earliest forms of insurance - Correct answer Ocean Marine An insurance adjuster who works primarily outside of an office and often meets personally with the public - Correct answer Field Adjuster Purposefully setting fire to property. Not covered under the policy if the act is committed by the insured - Correct answer Arson The attempt, by an applicant to deceive an insurance company - Correct answer Misrepresentation Personal property that is not part of the dwelling or structure - Correct answer Contents An individual that is used when a claim has been questioned by either the insured or the insurer; an unbiased part is required to resolve the dispute - Correct answer Umpire Amount an insurer will have to pay an insured to meet the promises outlined in the insurance contract, reduction in value of insured item - Correct answer loss An addition, deletion or change to a legal document or policy - Correct answer Amendment The section of an insurance policy identifying the insured, endorsements, coverage’s, limits and premiums - Correct answer The Declarations page Reinsurance agreement where the insurers involved will pay claims in direct relationship with the % of the risk they are insuring - Correct answer Co-insurance Financial investment or financial dependency that an individual or business has in a person or property - Correct answer Insurable interest Failure to use the care that a reasonable and prudent person would have used under that same or similar circumstance - Correct answer Negligence "Insurer" has an obligation to pay covered loss, "insured" has no obligation - Correct answer unilateral insurance contract Uninsurable because of the possibility of either loss or gain in the risk - Correct answer Speculative Risk 626.854 (10) (d) - Correct answer Any maneuver, shift, or device through which the limits on compensation set forth in this subsection are exceeded is a violation of this chapter punishable as provided under s. 626.8698. 626.854 (11) - Correct answer Each public adjuster must provide to the claimant or insured a written estimate of the loss to assist in the submission of a proof of loss or any other claim for payment of insurance proceeds. The public adjuster shall retain such written estimate for at least 5 years and shall make the estimate available to the claimant or insured, the insurer, and the department upon request. 626.854(12) - Correct answer A public adjuster, public adjuster apprentice, or any person acting on behalf of a public adjuster or apprentice may not accept referrals of business from any person with whom the public adjuster conducts business if there is any form or manner of agreement to compensate the person, directly or indirectly, for referring business to the public adjuster. A public adjuster may not compensate any person, except for another public adjuster, directly or indirectly, for the principal purpose of referring business to the public adjuster. 626.854 (13) - Correct answer A company employee adjuster, independent adjuster, attorney, investigator, or other persons acting on behalf of an insurer that needs access to an insured or claimant or to the insured property that is the subject of a claim must provide at least 48 hours' notice to the insured or claimant, public adjuster, or legal representative before scheduling a meeting with the claimant or an onsite inspection of the insured property. The insured or claimant may deny access to the property if the notice has not been provided. The insured or claimant may waive the 48-hour notice. 626.854 (14) - Correct answer The public adjuster must ensure that prompt notice is given of the claim to the insurer, the public adjuster's contract is provided to the insurer, the property is available for inspection of the loss or damage by the insurer, and the insurer is given an opportunity to interview the insured directly about the loss and claim. The insurer must be allowed to obtain necessary information to investigate and respond to the claim. 626.854 (14) (a) - Correct answer the insurer may not exclude the public adjuster from its in-person meetings with the insured. The insurer shall meet or communicate with the public adjuster in an effort to reach agreement as to the scope of the covered loss under the insurance policy. The public adjuster shall meet or communicate with the insurer in an effort to reach agreement as to the scope of the covered loss under the insurance policy. This section does not impair the terms and conditions of the insurance policy in effect at the time the claim is filed. 626.854 (14) (b) - Correct answer A public adjuster may not restrict or prevent an insurer, company employee adjuster, independent adjuster, attorney, investigator, or other person acting on behalf of the insurer from having reasonable access at reasonable times to any insured or claimant or to the insured property that is the subject of a claim. 626.854 (14) (c) - Correct answer A public adjuster may not act or fail to reasonably act in any manner that obstructs or prevents an insurer or insurer's adjuster from timely conducting an inspection of any part of the insured property for which there is a claim for loss or damage. The public adjuster representing the insured’s may be present for the insurer's inspection, but if the unavailability of the public adjuster otherwise delays the insurer's timely inspection of the property, the public adjuster or the insured’s must allow the insurer to have access to the property without the participation or presence of the public adjuster or insured’s in order to facilitate the insurer's prompt inspection of the loss or damage. 626.854 (15) - Correct answer A licensed contractor under part I of chapter 489, or a subcontractor, may not adjust a claim on behalf of an insured unless licensed and compliant as a public adjuster under this chapter. However, the contractor may discuss or explain a bid for construction or repair of covered property with the residential property owner who has suffered loss or damage covered by a property insurance policy, or the insurer of such property, if the contractor is doing so for the usual and customary fees applicable to the work to be performed as stated in the contract between the contractor and the insured. 626.854 (16) - Correct answer A public adjuster shall not acquire any interest in salvaged property, except with the written consent and permission of the insured through a signed affidavit. 626.854 (17) - Correct answer A public adjuster, a public adjuster apprentice, or a person acting on behalf of an adjuster or apprentice may not enter into a contract or accept a power of attorney that vests in the public adjuster, the public adjuster apprentice, or the person acting on behalf of the adjuster or apprentice the effective authority to choose the persons or entities that will perform repair work in a property insurance claim or provide goods or services that will require the insured or third-party claimant to expend funds in excess of those payable to the public adjuster under the terms of the contract for adjusting services. 626.854 (18) - Correct answer Subsections (5)-(17) apply only to residential property insurance policies and condominium unit owner policies as described in s. 718.111(11). 626.854 (19) - Correct answer Except as otherwise provided in this chapter, no person, except an attorney at law or a public adjuster, may for money, commission, or any other thing of value, directly or indirectly: 626.854 (19) (a) - Correct answer Prepare, complete, or file an insurance claim for an insured or a third-party claimant; 626.854 (19) (b) - Correct answer Act on behalf of or aid an insured or a third-party claimant in negotiating for or effecting the settlement of a claim for loss or damage covered by an insurance contract; 626.854 (19) (c) - Correct answer Advertise for employment as a public adjuster; or 626.854 (19) (d) - Correct answer Solicit, investigate, or adjust a claim on behalf of a public adjuster, an insured, or a third-party claimant. Under a dwelling broad or special form, what is the maximum that would be paid for "loss of use"? - Correct answer 20% of the Dwelling Coverage Under a dwelling (DP-2 or DP-3) policy, what is the maximum % that would be paid for ALE? - Correct answer 20%