Insurance Terms and Concepts, Exams of Animal Anatomy and Physiology

Download Insurance Terms and Concepts and more Exams Animal Anatomy and Physiology in PDF only on Docsity! Florida Claims Adjuster Exam (150 Question with Verified Answers) Graded A+ 1. Peril - Correct answer something that causes a loss. 2. Hazard - Correct answer something that increases the probability that a loss will occur. 3. Warranty - Correct answer a policy condition, either based on information in the insured’s application or inserted by the insurer. It is a guarantee of a fact. 4. Misrepresentation - Correct answer an untrue statement by the insured, made in an application for insurance but which does not become a part of the policy. 5. Concealment - Correct answer the failure of the insured to reveal relevant facts known to the insured in applying for insurance. 6. Abandonment - Correct answer Property insurance policies usually contain an abandonment clause, stating the insured cannot dump damaged property on the insurer and demand its full value. 7. Severability - Correct answer the insurance applies separately to each insured as if other insured’s did not exist. 8. Proximate Cause - Correct answer a fundamental doctrine in property insurance holds 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. 9. Direct Loss - Correct answer Physical harm to tangible property. 10. Indirect Loss - Correct answer Economic loss which flows as a result of direct loss. 11.Actual Cash Value (ACV) - Correct answer Replacement Cost minus Depreciation 12.Coinsurance - Correct answer Is a method of providing equity in premiums by granting lower rates to those insured’s who accept the responsibility of insuring for amounts which reflect a high percentage of the value of the subject property. 13.Personal Contract - Correct answer Policies cover people who own and operate things, such as automobiles. Page 1 of 14 14.Conditional Contract - Correct answer the parties are of unequal bargaining power, and the insured cannot negotiate the terms, having to take the offer of the insurer as made. 15.Contract of Indemnity - Correct answer one should return to their same position as they were before the loss occurred. This limits the number of people intentionally causing losses because it was to their economic advantage. 16. Insurable Interest - Correct answer any actual, lawful and substantial economic interest in the safety or preservation of the subject of the insurance free from loss, destruction, or pecuniary damage or impairment. 17.Waiver - Correct answer generally defined as the voluntary relinquishment or surrender of some righter privilege. 18.Express Waiver - Correct answer Occurs when the insurer or its representative knowingly gives up a known right under the insurance contract. 19. Implied Waiver - Correct answer May result from some act of neglect on the part of the adjuster. 20.Damages - Correct answer Money Amounts. 21.Subrogation - Correct answer when an insured has a right to collect damages from another party, but instead elects to claim the damages under his insurance policy, his rights against the other party are transferred to the insurer. 22.Changes - Correct answer all policies provide that any changes to the policy be made by the insurer, in writing. 23.Policy Period - Correct answer the condition states that coverage applies only to losses or occurrences that take place during the policy period. (Prior to the stated date and time of termination). 24.Policy Territory - Correct answer Condition limiting coverage to occurrences or losses that take place only within a stated geographical region. 25.Other Insurance - Correct answer the principle of indemnity dictates against duplicate recovery for the same loss. 26.Cancellation - Correct answer the insured may cancel at any time, for any reason, without advance notice. If the company wishes to cancel, it must provide some degree of advance notice so the insured will have time to replace the coverage. Page 2 of 14 52.Foreign Insurer - Correct answer Insurer is one formed under the laws of any state, district territory, or commonwealth of the United States other than this State. 53.Alien Insurer - Correct answer Insurer is an insurer other than a domestic or foreign insurer. 54.Appointment - Correct answer the authority given by an insurer or employer to a licensee to transact insurance or adjust claims on behalf an insurer or employer. 55.Derelict - Correct answer Material which is or may have been a motor vehicle or mobile home, with or without all component parts, which is inoperable and which material is in such condition that its highest or primary value is either in its sale or transfer as scrap metal or component parts or both. 56.Mechanical Breakdown Coverage - Correct answer covers repairs to mechanical parts of your vehicle that break. Even covers break in events not related to an accident. 57.Sliding - Correct answer selling an item and stating that it is required by law. 58.What is the Death Benefit amount for PIP? - Correct answer $5,000 59.What is the amount for medical and disability benefits afforded by PIP? - Correct answer $10,000 60.Who is the Financial Responsibility Law administered by? - Correct answer The Department of Highway Safety and Motor Vehicles. 61.What are the Basic PIP Benefits? - Correct answer -Medical-80% of responsible expenses are paid for necessary medical, surgical, X-Ray and dental. 62. -Work Loss-60% of any loss of gross income and loss of earning capacity reimbursed. 63. -Replacement Services-100% for the cost of having household services performed by others. 64. -Death-Effective 01/01/2013 the death benefit will be $5,000 in addition to the $10,000 in medical and disability benefits afforded by PIP. 65.Company or Staff Adjuster - Correct answer Are salaried employees under the supervision of the home, branch or regional claims department of insurers. 66.Fee Adjusters - Correct answer Offer their services on a fee-for-service basis. They represent many insurers. Page 5 of 14 67.Bureau Adjuster - Correct answer Employee or agent of an adjustment bureau which serves multiple company clients such as the GAB Business Services, Inc. and Underwriters Adjusting Company both national firms. 68. Independent Adjuster - Correct answer Are Self-Employed and are not affiliated with either insurers or bureaus. They serve as adjuster representatives of insurers, and their services are compensated on a fee-plus-expenses basis for each loss handled. 69.Public Adjuster - Correct answer is a claims adjuster who is an advocate for the policyholder in appraising and negotiating an insurance claim. 70.What are the Characteristics of a Personal Auto Policy Declaration Page? - Correct answer -Liability (Bodily Injury) 71. -Property Damage 72. -Uninsured Motorist 73. -Medical Payments 74. -Personal Injury Protection 75. -Collision Deductible 76. -Comprehensive Deductible 77. -Towing Coverage 78. -Rental Coverage 79.What are examples of Transacting Insurance? - Correct answer -Solicitation of Insurance 80. -Negotiation of Insurance 81. -Effecting Coverage (Binding insurance coverage) 82. -Transacting Insurance Matters (during and after insurance is bound). 83.What are thresholds of the No-Fault Law? - Correct answer -Significant and permanent loss of a bodily function or 84. -Permanent injury other than scarring and disfigurement or 85. -Significant and permanent scarring or disfigurement or 86. -Death 87.What is the adjusters investigation limited too? - Correct answer a simple verification of bills and estimates or it may be expanded to include photographs, witness canvasses, or recorded statements as the circumstances require. 88.What are the components of an investigation process? - Correct answer -Inquiry 89. -Verification 90. -Comparison 91.What are some reasons for suspension, revocation or termination of a license? - Correct answer -Transacting Insurance outside of scope of one's license 92. -Misrepresentation or fraud Page 6 of 14 93. -Sliding 94. -Demonstration of unworthiness or lack of fitness 95. -Misappropriation of funds 96. -Failure to inform Department of financial services, within 30 days, after pleading guilty or no contest to a felony. 97.Florida Unfair Insurance Trade Practices Act - Correct answer describes certain practices, penalties are provided for misrepresentation to insured’s and claimants and business practices such as 98. -Failing to act promptly 99. -Failure to affirm or deny a claim when an insured is entitled there to 100. -Failure to explain claim denials in writing 101. -Failure to maintain complaint-handling procedures such as keeping accurate records of complaints. 102. Comprehensive Coverage - Correct answer Covers all loss except collision or overturn. Standard deductible is $100 per car, $500 per occurrence applies to losses from theft, mischief, and vandalism. 103. What is the minimum requirements for the Financial Responsibility Law? - Correct answer -The legally valid claims of others must be satisfied (up to the 10/20/10 requirements) 104. -The owner and operator must provide certification of financial responsibility for future accidents. If not satisfied operator's driver's license and the registrations of all owned vehicles are suspended. 105. What are the basic activities in claims handling? - Correct answer - Investigation to establish coverage, determine legal liability, and verify if the alleged damages qualify the loss for payment. 106. -Evaluation to determine the fair payment in accordance with the contract and applicable law. 107. -Negotiation of a quality settlement based on facts discovered during the evaluation process. 108. Claim - Correct answer is the assertion of an alleged legal right against an insurer, which carries with it a demand for appropriate relief. 109. Claims Adjuster - Correct answer one who is involved in the investigation, adjustment, negotiation and/or trial preparations of claims arising under insurance policies. 110. Adjusting - Correct answer Process of disposing of an insurance claim. 111. Loan Receipt - Correct answer A written statement given by the insured to the insurer acknowledging that money received in the settlement of damages Page 7 of 14 145. Truckers Coverage Form - Correct answer Used to insure businesses that are hired to transport goods for someone else. 146. Business Auto Coverage Form - Correct answer Used to insure the automobile exposures of all businesses other than garage or trucking businesses. 147. What does Commercial General Liability contract includes? - Correct answer -Declarations 148. -Common policy conditions 149. -One of the two coverage forms, Occurrence, or Claims-Made 150. -A Nuclear Energy Liability Exclusion endorsement 151. -Various other endorsements may be attached to broaden or restrict the coverage provided by these basic forms. 152. Declarations - Correct answer identifies the named insured and address, states the policy period and premium and miscellaneous information about the insured, and specifies the limits of coverage that apply. 153. The policy states that if a company wishes to cancel, how many days must it give prior notice? - Correct answer 30 days. 154. Nuclear Endorsement - Correct answer Excludes all hazards related to nuclear energy. 155. What is Coverage A? - Correct answer Bodily Injury and Property Damage Insuring Agreement. 156. Bodily Injury (BI) - Correct answer Physical harm and includes sickness or disease or death resulting there from. 157. Property Damage (PD) - Correct answer Physical injury to tangible property, including loss of use of that property. 158. Occurrence - Correct answer an accident, including. Continues or repeated exposure to substantially the same general harmful conditions. 159. Accident - Correct answer a sudden, unexpected event. 160. Coverage Territory - Correct answer is the U.S. and its territories or possessions, Puerto Rico and Canada, including international waters and airspace between these places. 161. The Coverage Trigger - Correct answer determines how policy will respond. Page 10 of 14 162. The Occurrence form - Correct answer Applies to BI or PD which occurs during the policy period, regardless of any later time at which a claim is made. 163. The Claims-Made form - Correct answer Applies only to a BI or PD which occurs on or after the retroactive date, and for which the claim is received or recorded by an insured or the company during the policy period. 164. Retroactive Date - Correct answer Establishes the original policy date for a serious of claims made policies. 165. Intentionally Injury - Correct answer Coverage excludes injury or damage which is expected or intended by the insured. 166. liquor Liability - Correct answer If the insured is in the business of manufacturing, distributing, selling, serving or furnishing alcoholic beverages, liability associated with serving liquor to intoxicated or underage persons or in violation of a law is excluded. 167. Employee Injuries - Correct answer Coverage excludes liabilities under a workers compensation or similar law or arising from injuries to employees of the insured. 168. Pollution - Correct answer There a basically no coverage for injury, damage or cleanup costs caused by pollutants, subject to minor exceptions. 169. What is Coverage B? - Correct answer Personal and Advertising Injury. 170. What is Coverage C? - Correct answer Medical Payments. 171. What are the General Liability Insurance Forms? - Correct answer - Owners and Contractors Protective Liability (OCP) Form. 172. -Liquor Liability Coverage Form. 173. -Products/Completed Operations Liability Coverage Form 174. -Pollution Liability Coverage and Pollution Limited Form. 175. Professional Liability Insurance Coverage - Correct answer Covers liability arising from rendering of or failure to render professional services. 176. Farm Liability Coverage Form - Correct answer Provides coverage for BI or PD arising out of farming operations of personal activities. 177. The Custom Farming Endorsement - Correct answer Provides coverage for liability arising from the insured’s performance of farming operations for another, for a charge under any contract or agreement. Page 11 of 14 178. The Farm Employers Liability/Medical Payments Endorsement - Correct answer applies the basic Liability and Medical Payments coverage’s to injuries to farm employees, but not to employees eligible to receive workers compensation benefits. 179. Employment Related Practices Liability - Correct answer This Form provides employers with claims- made coverage for liability arising out of claims for injury to an employee because of an employment-related offense. 180. Unauthorized Entity - Correct answer An entity that is required to be licensed or registered with the Florida Office of Insurance Regulation but is operating without the proper authorization is identified as an unauthorized insurer. 181. To be authorized and transact business in FL what must you have? - Correct answer Certificate of Authority. 182. General Lines Agent 2-20 - Correct answer Licensed to write property/casualty, surety, or health insurance. 183. Customer Representative 4-40 - Correct answer must be licensed, appointed by a General Lines Agent and may assist in transactions in the OFFICE ONLY. 184. Limited Customer Representative 4-42 - Correct answer must be licensed, appointed by a General Lines Agent and transact AUTO insurance in the OFFICE ONLY. 185. All Lines Claims Adjuster 6-20 - Correct answer Investigates, Evaluates, and Negotiates Claims. 186. A General Lines Adjuster is required to do what? - Correct answer Participate in 24 hrs. of continuing education every 2 years. 187. A licensee must notify the Department in writing in how many days for change of name, address, phone number or email? - Correct answer 30 days. 188. Loss Sustained - Correct answer Cover only losses that both occurred and were discovered during the policy period, or within one year of its expiration. 189. Discovery - Correct answer any loss discovered during the policy period or within 60 days after its expiration is called regardless of when it occurred. 190. Property Covered - Correct answer The policy covers only property the named insured owns or holds or for which the insured is legally liable, and for the benefit of the insured. Page 12 of 14