Insurance Claims Adjuster Roles and Practices in Florida, Exams of Insurance law

Download Insurance Claims Adjuster Roles and Practices in Florida and more Exams Insurance law in PDF only on Docsity! Florida Adjuster Exam Questions and verified Answers 2024 Update. Which of the following is NOT one of the duties of the Department of Financial Services? b. Dept. does NOT set rates nor write policies - Correct Answer Set rates and write policies for various company products The adjuster has a particular relationship to his principal, the insurer. Which of the following best describes this relationship? - Correct Answer It is a fiduciary relationship. The Claims Adjuster's role in the insurance industry includes all the following EXCEPT: - Correct Answer Gives appropriate legal advice and writes binding contracts All of the following activities are illegal for an adjuster, EXCEPT: - Correct Answer Use only company forms to prepare releases All of the following are part of the conditions imposed upon the insured in the event of a loss, EXCEPT: - Correct Answer Insured should negotiate on behalf of the company for 3rd party claimants. A claimant was given a settlement, which stipulated, that if the claimant did not contact the company within a certain period of time, the claim would automatically close. No release was signed. Which of the following best describes this method of settlement? - Correct Answer No release or walk-away The Continuing Education requirement to maintain an Adjuster license in Florida is: - Correct Answer Twenty-four hours every two years. An adjuster received written notice from the Department of Financial Services regarding a claim. What length of time does he have to respond to the inquiry? - Correct answer 21 calendar days Comparative negligence is determined through - Correct Answer Investigation & Analysis Agreement between parties or by mediation or arbitration Judge and/or jury During what period of time must an adjuster reply to communication from a policyholder on a claim? - Correct answer 14 days Which of the following is NOT a goal in the adjusting process? - Correct answer always pay the maximum limit of the policy An adjuster offered a claimant a settlement where the full payment would be presented and a release was signed. This is called a: - Correct Answer a Full Release settlement Adjuster Jane moved from one city in Florida to another. What length of time does she have to notify the Insurance Department of the address change? - Correct answer 30 Days Which of the following is TRUE? - Correct Answer If an appointment is terminated; an adjuster has 48 months to secure another appointment Bad Faith & Adjusting Practices - Under the Florida Unfair Trade Practices Act & the Unfair Methods of Competition and Unfair or Deceptive Acts, all of the following are prohibited, EXCEPT: - Correct Answer Adjuster keeps accurate records on a claim Florida's Administrative Code contains a Code of Ethics for Adjuster - which of the following is FALSE? - Correct Answer an Adjuster owes fair and prompt treatment to their own company's policyholders only Which of the following is a duty owed to an invitee? - Correct answer land owner must make reasonable efforts to maintain property in safe condition What is the difference between liability and coverage? - Correct answer liability is a legal doctrine and coverage is a contractual obligation Which of the following is NOT one of the fiduciary responsibilities of an adjuster? - Correct Answer Withhold pertinent information from the company to please a client Which of the following is NOT one of the duties of the Florida Department of Financial Services? - Correct Answer the Department writes policies for the non-standard insurance companies. Continuing education requirements to maintain a Customer representative license are: - Correct answer 24 hours every two years. When an insurance licensee ends his appointment with an authorized company in Florida, he has how long to secure another appointment? - Correct answer 48 months When an insurance licensee moves, he has how long to notify the Florida Dept. of Financial Services of his change of address? - Correct answer 30 Days Activities that may result in license suspension or revocation include: - Correct Answer Using discriminatory practices Making false entries on an insurance application Defaming another agent or company Activities that may result in license suspension or revocation include: - Correct Answer Lacking reasonable knowledge & technical competence Misappropriation of funds Failure to notify the Dept. of Insurance in writing within 30 days after pleading guilty to a felony An insured had an accident in another state that required liability limits of 25/50/25. Our insured had 10/20/10 limits. What happens if the liability he incurs exceeds 10/20/10? - Correct Answer Our insured's policy will respond to the higher limit of the other state Joe has 10/20/10 liability limits, and he borrows Sue's car. Sue has 15/30/15 limits of liability. Joe injures a pedestrian while driving Sue's car and the pedestrian's medical bills due from liability total $22,000 (PIP & Med Pay are paid out in full). How much is paid from Liability? - Correct answer Sue's policy pays $15,000 & Joe's policy pays $7,000 Your insured has purchased the minimum split limit policy that meets Financial Responsibility Law in Florida. He causes the following bodily injuries to passengers: Carl $12,000 Jeanne $10,000 Charlie $10,000 How much will his policy pay? - Correct answer $20,000 for the total BI portion of accident An insured has 25/50/25 limits and injured another person. The injured person won a tort claim for $30,000 against the insured and the insured's attorney charged $7,500 to defend the insured. How much is paid by the insured's insurance company? - Correct answer $32,500, the policy limit and the attorney's fees for defense. Which of the following is NOT one of the "thresholds" in the "No-Fault" law? - Correct Answer The temporary injury of the insured Which of the following is a "defined motor vehicle" under Florida No-Fault law? - Correct answer 9,500-pound SUV If an insured is injured by an at-fault driver, and has injuries of $5,000, what amount will PIP pay if he has Florida No-Fault Basic PIP with a $1,000 deductible? - Correct answer $3,200 Which of the following could NOT be considered an "owner" of a motor vehicle? - Correct Answer A long term lease of 3 months Which of the following is true concerning the extended PIP endorsement? - Correct Answer Medical expense reimbursement is raised from 80% to 100% When an Additional PIP Endorsement is added to the Personal Auto Policy, we know that the policy already has - Correct Answer Extended PIP Endorsement Nonresidents must comply with the Florida No Fault law: - Correct Answer If their auto is in Florida over 90 of the last 365 days When is the named insured NOT entitled to PIP benefits? - Correct Answer Injured outside of Florida while a pedestrian struck by a defined motor vehicle Which of the following statements is false concerning No-Fault Auto Insurance? - Correct Answer Negligence must be established. An insured has Basic PIP with no deductible, in an accident he incurs medical bills of $8,000, $1,000 in lost wages, and $500 in replacement services - how much will PIP portion of policy pay? - Correct answer $7,500 Jane is a Florida resident with an auto. She has PIP coverage of $10,000 with no deductible. If she is in an auto accident and has medical bills of $10,000, how much will her PIP pay? - Correct answer $8,000 If Jane also has work loss of $1000 due to the auto accident, how much will her PIP pay for work loss? - Correct answer $600 What if Jane's accident happened during the work day while she was driving a GEICO owned auto and Jane was out adjusting auto claims. How much would Jane's PIP pay for her medical injuries? - Correct answer zero If Jane had an accident while she was driving to Orlando to go to Disney and had borrowed her neighbor's minivan so she could take 5 friends ... how much would Jane's PIP insurance pay for her medical bills of $10,000 and her work loss due to the accident of $1000? - Correct answer $8600 If all 5 of Jane's friends are Florida residents who own automobiles, how much of Jane's PIP coverage is available for each of the 5 friends riding with her in the borrowed minivan? - Correct answer 0 What if Jane has 5 children and she is taking them all to Disney for the day ... how much total PIP coverage is available from Jane's PIP to Jane and her 5 children in the friend's minivan? - Correct answer $60,000 How much would Jane's PIP pay if the auto accident caused injuries to Jane that created $12,000 in medical bills and Jane had a $1000 PIP Deductible? - Correct answer $8800 A health insurance policy was issued containing the provision that the insurance company must renew the policy to a particular age, but could adjust premiums. What is this policy called? - Correct Answer A guaranteed renewable policy A health insurance policy was issued containing the provision that the insurance company must renew the policy to a particular age and could not adjust the premiums. What is this policy called? - Correct Answer A non-cancelable policy A health policy often has a provision which states a period of time between issuance and acceptance before sickness benefits begin. This eliminates people only buying health insurance when they find out that they are ill. This is called a/an: - Correct Answer Elimination Period All of the following are true for Medicare Supplement Insurance EXCEPT: - Correct Answer Policy must contain a 180 day "free look" What type of health insurance plan usually offers the broadest coverage at the lowest cost with the most freedom of choice? - Correct Answer Group Insurance PPO Insurance is considered a two-party contract; Surety Bonds are considered - Correct answer a three-party contract A builder contracted for framing on a new section of a hospital. There is a surety bond purchased to guarantee completion of the project. Which of the following best describes the hospital position in the surety bond? - Correct Answer The hospital is the oblige The Surety attempts to avoid default by investigating the principal with regard to: - Correct answer CharacterCapabilityCollateral The Surety bond that guarantees that companies will not misrepresent securities is - Correct answer Blue Sky Bond A Surety Bond that guarantees the performance of a person appointed by a court, or named in a will or trust to take possession of property, collect assets, make investments, pay debts, sell assets, carry on a business, distribute property to heirs, or any related tasks is what type? - Correct Answer Fiduciary Bond If an insured's administrative assistant fraudulently forged the insured's name on a check, and cashed it, which of the following would cover this event? - Correct Answer Employee theft Under one form of crime insurance, losses must occur during the policy period and be discovered within 1 year of policy expiration. This is: - Correct Answer the Loss Sustained Form Which of the following type of employee theft best fits a business with a large turnover in its personnel? - Correct Answer the Blanket coverage A loss discovered during the policy period that occurred before the inception of the current policy may be covered by? - Correct answer Discovery Form Which of the following could be covered by crime insurance? - Correct Answer A burglar breaks into a locked safe and steals a ruby necklace. An employee is robbed while A shipper contemplates 10 or 11 loads of produce to be shipped to Pennsylvania over the course of the next 12 months. What inland marine coverage best fits this exposure? - Correct Answer an annual transit policy Commercial leases have special coverages in the Leasehold Coverage Form due to the fact that - Correct answer they are long-term often with investment in the real estate. A home oxygen service must continue to supply its customers even if the facility is destroyed by a fire. Consequently, the service may make purchases from one of its competitors to keep their own customers supplied with medically necessary equipment in order to have the opportunity to stay in business. Where is this type of insurance coverage found? - Correct Answer Extra Expense Coverage form A community applied to be part of the National Flood Insurance Program. Until they are approved, what is the status of the community? - Correct Answer They are in the emergency program Which of the following would be excluded (NOT covered) under a personal articles floater on an "all risks" basis? - Correct Answer Insects destroy a valuable postage stamp worth $500 Which of the following is false concerning flood insurance? - Correct Answer to be insured for flood, a new building only must have the walls up. All of the following are EXCLUSIONS under a personal articles floater (Personal Inland Marine Policy) EXCEPT: - Correct Answer Theft An Umbrella Policy may be broader than the underlying policies and respond as primary coverage. When the Umbrella is PRIMARY, there is an amount to be paid by the insured before the Umbrella will pay. What is this amount called? - Correct Answer The self-insured retention All of the following may qualify for a dwelling policy EXCEPT: - Correct Answer A 6 - family dwelling All of the following are eligible for a Homeowners Policy EXCEPT: - Correct Answer A beach house owned by Acme Corporation The principle of "insurable interest" is important in the dwelling policy as well as other kinds of insurance. Which of the following does not have " insurable interest" in the described property? - Correct Answer One who attends a Mary Kay party at a friend's property Aunt Mary lives with the insured Homeowner. A thief steals her hearing aid. The HO-3 will: - Correct Answer Cover within the limits of the H/O policy Which of the following is eligible for a Homeowners policy? I. Susie, who has purchased a condo unit for her residence. II. John, who buys a duplex and lives in one side. III. Sam, who rents an apartment for his residence. - Correct answer I, II, and III Which of the following is NOT covered under the HO - Coverage C, Personal Property? - Correct Answer The dead fish when the insured accidentally overturns his tropical fish tank and all the fish die from lack of oxygen. Under both the Dwelling and Homeowners, Coverage B - unattached structures coverage - usually is: - Correct answer 10% of Coverage A - Structure Which of the following forms is "all risks" on the dwelling policy? - Correct answer DP-3, or the special form Which of the following is NOT one of the rating factors used in determining a H/O (Homeowners) premium? - Correct Answer Gender of owner Jane has a dwelling policy with the house insured for $40,000. If her detached shed, which is valued at $4500, is destroyed by a covered peril, what can she expect? - Correct Answer She can expect $4,000 to be paid, because unattached structures are covered up to 10% of the dwelling amount. Homeowners Policies usually insure property for which of the following? - Correct Answer Fire, lightning, theft If the policy holder has a HO-3 policy with no endorsements and there is a fire - jewelry worth $20,000 in the house might be covered: - Correct Answer Could be covered for $20,000 if the Coverage C limit is high enough Liability limits may be expressed as a: - Correct Answer Aggregate Limit Split Limit Single Limit An insured has A SPLIT limit liability policy with 10/20/10 limits. He owes the following people liability bodily injuries claims of: Passenger 1 = $12,000, Passenger 2 = $10,000, Passenger 3 = $18,000. How much liability insurance will his policy pay for these claims? - Correct answer $ 20,000 Loss payee - Correct Answer If a lender has an insurable interest in an auto, because of the money loaned to finance the auto, the lender would appear on the policy as the: To turn partially damaged property over to the insurance company and ask them to pay for a total loss is called - Correct Answer Abandonment Firemen caused water damage to a property by spraying water to put out a fire. If the property insurance policy listed "fire" as the only named peril: - Correct Answer The water damage is covered due to the concept of proximate cause. XYZ Insurance Corp. filed its corporate charter in Tallahassee and has its home office in Tampa: - Correct Answer in Florida, XYZ is a domestic insurer. An insured has a home with a replacement cost / value of $100,000, on which he carries an insurance policy for $80,000 with an 80% Coinsurance clause. The insured has a $20,000 partial loss; the insurance company will pay how much for this partial loss of $20,000? (Remember $80,000 is 80% of $100,000) - Correct answer 20,000 "Actual Cash Value" ACV means: - Correct Answer Current cost to replace minus depreciation Which of the following is TRUE concerning Subrogation? - Correct Answer Allows the insurer to sue a negligent third party to recover a loss paid. An insurer may sever the interests of 2 insureds so that the insurer can protect an innocent party - this is the Doctrine of: - Correct Answer Severability All of the following describe insurable interest EXCEPT: - Correct Answer Show a similarity between insurance and wagering. An Insurance Policy is a contract with all of the following characteristics, EXCEPT - Correct Answer Indemnity is not part of an insurance contract An insurance contract may contain a "gray area" or an ambiguity, that is generally resolved in favor of the insured because insurance policies are contracts of: - Correct Answer Adhesion If an insured sells his car to another person, the buyer may be prohibited from also receiving the insured's policy. This is because the insurance contract is a contract of: - Correct Answer Personal nature Strict or absolute liability: - Correct answer is assigned by law or statute. Jack and Connie - both 50 years old and of sound mind - agree to have Jack burn down Connie's house for $10,000. What element of a valid contract is missing? - Correct Answer Legal purpose Risks that are insurable are: - Correct Answer Pure risk Insurance that covers the responsibility for loss arising out of policy holder's negligence - that results in payment to a party other than the insured is: - Correct Answer Liability