Florida Claims Adjuster Exam – 3 Accurately Answered., Exams of Nursing

Download Florida Claims Adjuster Exam – 3 Accurately Answered. and more Exams Nursing in PDF only on Docsity! Florida Claims Adjuster Exam – 3 Accurately Answered. This optional provision states that if the insured becomes totally disabled, premiums are waived but the coverage remains in force: B. Waiver of Premium - Answer B. Waiver of Premium "premiums are waived" Frank owned a home that was destroyed by a hurricane. Both ABC and XYZ Banks were listed as additional interests on his homeowner policy. The insurance company will make a payment to: D. All listed interests - Answer D. All listed interests Remember that the insurer is not responsible to know the degrees of interest. In the event of a loss, one payment is made by the insurer and it is up to the additional interests on working out their share. Florida Claims Adjuster Exam – 3 Accurately Answered. Insurance applies *separately* to each insured as if other insureds did not exist. This is defined as: A. Severability - Answer A. Severability Property insurance policies usually contain a(n) __________ clause, stating the insured cannot *dump damaged property* on the insurer and demand its full value: B. Abandonment - Answer B. Abandonment A(n) __________ is one wherein economic loss would be suffered from an adverse happening to the subject: Florida Claims Adjuster Exam – 3 Accurately Answered. C. Loss of Settlement Contract - Answer C. Loss of Settlement Contract The Insurer's responsibility to pay for a property loss *may be conditioned* on the insured having used reasonable means to avoid the loss, to protect the property against further loss, and to give the insurer proof of the loss is defined as? A. Conditional Contract - Answer A. Conditional Contract "may be conditioned" Which of the following is not one of the "Thresholds" in the "No-Fault" law? B. Temporary Injury of the Insured - Answer B. Temporary Injury of the Insured Also included: permanent injury other than scarring and disfigurement Florida Claims Adjuster Exam – 3 Accurately Answered. Under Mechanical Breakdown Coverage, new cars are eligible for service up to: A. 36 Months/36,000 Miles - Answer A. 36 Months/36,000 Miles Used vehicles: 12 Months/12,000 Miles If financial responsibility doesn't exist at the time of an accident, which of the following things must happen to avoid penalties? A. The legally valid claims of others must be satisfied (up to 10/20/10) B. The owner and operator must provide certification of future responsibility for future accidents C. Both A & B - Answer C. Both A & B As to required proof for future accidents by purchase of auto liability insurance, the insurer must make a filing Form SR-22 certifying that Florida Claims Adjuster Exam – 3 Accurately Answered. coverage is in effect, and this certification must remain on file for __________ years: B. 3 - Answer B. 3 The Business *Automobile* Policy includes all of the following coverage forms except: B. The Trailer Interchange Coverage Form - Answer B. The Trailer Interchange Coverage Form Personal Injury Protection, or PIP, has a __________ per person, per accident limit. A. 10,000 - Answer A. 10,000 Used to insure businesses engaged in selling, servicing, repairing, *parking or storing automobiles:* Florida Claims Adjuster Exam – 3 Accurately Answered. Which of the following is not one of the rating factors for a Homeowner's Policy? C. Age & Gender of Insured - Answer C. Age & Gender of Insured On a Homeowner's Policy, covers items that are *not permanently attached to the dwelling.* This is defined as: A. Other Structures - Answer A. Other Structures Examples include sheds, fences, pool houses, detached car ports, etc. A lender has an insurable interest in a home and finds protection in the: B. Mortgagee Clause - Answer B. Mortgagee Clause Florida Claims Adjuster Exam – 3 Accurately Answered. Mortgagee - Homeowner's policy Loss Payee - Automobile policy Which of the following forms is "all-risk" on the dwelling policy? A. DP-3 C. DP-3, or the Special Form Dp3 - Answer C. DP-3, or the Special Form When the basic liability limits provided by the policy are insufficient for an insureds needs, two coverage forms are used to provide the *additional amounts* of coverage: C. Both a & b A. Excess Liability B. Umbrella Florida Claims Adjuster Exam – 3 Accurately Answered. C. Both A & B - Answer C. Both A excess liability & B umbrella Which of the following is not covered under Coverage C, Personal Property? B. A fish dies because he has been left alone for a week without food - Answer B. A fish dies because he has been left alone for a week without food Animals are listed as an "exclusion" under a Homeowner's policy. All of the following are eligible for a *Homeowner's Policy,* except? D. A business condo owned by a local insurance company - Answer D. A business condo owned by a local insurance company Florida Claims Adjuster Exam – 3 Accurately Answered. Used only for *Commercial Condominiums,* it covers the *unit- owners* business personal property and the personal property of others in the insured's care, custody or control: C. Condominium Unit Owners Form - Answer C. Condominium Unit Owners Form Does not cover buildings since coverage would typically be provided under the Condo Association coverage form issued. The Commercial Property Contract includes all of the following, except: D. Commercial Loss Schedule - Answer D. Commercial Loss Schedule Also included: Declarations, Causes of Loss Form, Endorsements Florida Claims Adjuster Exam – 3 Accurately Answered. Insures a *condominium association* against direct physical loss or damage to buildings, business personal property and personal property of others in the care, custody or control of the association and located at the premises: A. Condominium Association Form - Answer A. Condominium Association Form This, along with Condo Unit Owners Form, is located under Condo Coverage. Sometimes referred to as *commercial* fire and allied lines, this is the form of insurance that covers direct and indirect losses related to properties other than one-to-four family dwellings and farm properties: Florida Claims Adjuster Exam – 3 Accurately Answered. C. Commercial Property Insurance - Answer C. Commercial Property Insurance (the question is the definition for this term) Under Commercial Property Policies, Florida law requires an insurer to give the insured at least __________days advance written notice of non-renewal. C. 45 - Answer C. 45 Also, notice must state reasons the policy is not to be renewed. When a business's personal property values fluctuate, a single, fixed amount of insurance could produce either over - or under - insurance at any given time. With this option, the limit of coverage is set at an amount somewhat higher than expected peak *values.* Florida Claims Adjuster Exam – 3 Accurately Answered. A. Business Income Insurance Coverage. Period of restoration begins 72 hours after date of direct damage. In effect, coverage has a 72 hour deductible. Coverage ends on either - Answer A. Business Income Insurance Coverage 1. date when damaged property could be repaired, rebuilt, or replaced 2. date business resumes operations at new, permanent location (whichever comes first) What payment covers several areas of costs related to claims, and are payable *in addition* to the policy limits? A. Supplementary - Answer A. Supplementary Generally, all costs of litigation are covered (court costs, prejudgment interest, judgement interest, cost of bonds to release attachments) Florida Claims Adjuster Exam – 3 Accurately Answered. Three full-time employees from a local furniture company are horsing around and one is pushed into a machine that cut his foot. How will the company's General Liability respond? A. The GL policy will not pay C. The GL policy will not pay D.The GL policy will not pay - Answer C. The GL policy will not pay Coverage excludes liabilities under Workers Comp or similar law or arising from injuries to employees of the insured. The employees would have to file through Workers Comp. Which of the following can be found in a Commercial General Liability Contract? D. All of the Above A. Declarations B. Common Policy Conditions C. Occurrence and Claims-Made Forms D. All of the Above - Answer D. All of the Above Florida Claims Adjuster Exam – 3 Accurately Answered. Also included: Nuclear Energy Liability Exclusion endorsement other endorsements may be attached There is __________ coverage for injury, damage or clean-up costs caused by pollutants, subject to minor exceptions: A. 0% B. 0% C. 0% D. 0 Percentage Ratio - Answer C. 0% Under a Commercial General Liability Policy, a basic limit of __________ per person applies to Medical Payments: A. $5,000 B. $5,000 Florida Claims Adjuster Exam – 3 Accurately Answered. Insurer should have been notified and further investigation of the spill and effective clean-up would have been observed. Applies to *Bodily Injury or Property Damage* which occurs during the policy period, regardless of any later time at which a claim is made: A. Occurrence Form - Answer A. Occurrence Form vs. Claims-Made: applies only to BI or PD occurring on or after retroactive date for which claim is received/recorded during policy period Applies only to a or Property Damage* 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: B. Claims-Made - Answer B. Claims-Made Florida Claims Adjuster Exam – 3 Accurately Answered. Retroactive date is stated in Declarations and will normally be same date as issuing company's first claims-made effective date for insured. All of the following are components of Workers Compensation, *except:* *A. Up to $750,000 in Death Benefits B. Reimbursement for Medical Expenses incurred C. Reimbursement for lost wages on percentage basis* D. Funeral costs up to $7,500 - Answer A. Up to $750,000 in Death Benefits Compensation for death is payable if death results within one year of an accident or if it follows disability within five years of accident. The following are classes of disability, *except:* Florida Claims Adjuster Exam – 3 Accurately Answered. *D. Temporary Full - Answer D. Temporary Full Also included: Temporary Partial. The following are examples of classes of disabilities. A. Permanent Total B. Temporary Total C. Permanent Impairment The measure to determine disability benefits is the __________ of the employee at the time of injury: A. Average Weekly Wage B. Average Weekly Wage - Answer B. Average Weekly Wage Disability - incapacity due to injury to earn same or any other employment wages that employee was receiving at time of injury. Florida Claims Adjuster Exam – 3 Accurately Answered. C. Claims made by employees that are not subject to Workers Comp Laws D. All of the Above - Answer D. All of the Above Samantha eats uncooked chicken at a local barbecue joint and becomes violently ill. Which of the following workers compensation benefits would pay for this occurrence? D. None of the Above - Answer D. None of the Above Samantha is not an employee of the barbecue joint; Workers Comp does not apply. An optional alternative providing for adjustment of premium after expiration, based on a guaranteed basic premium to the insurer to which is added the actual losses incurred by the insured. This is defined as: Florida Claims Adjuster Exam – 3 Accurately Answered. C. Retrospective Rating Plan - Answer C. Retrospective Rating Plan Often referred to as Cost-Plus Programs Under Employer's Liability, the minimum limits of liability are: A. 100/100/500 - Answer A. 100/100/500 $100,000 for all claims in each accident $100,000 per employee for disease $500,000 for all disease claims Under Inside The Premises - Robbery or Safe Burglary of Personal Property, a special limit of __________ : Florida Claims Adjuster Exam – 3 Accurately Answered. D. $5,000 - Answer D. $5,000 per occurrence applies to articles whose principal value is precious metals, precious or semiprecious stones, pearls or furs, and to the physical or intrinsic value of manuscripts, drawings or records Under Crime Insurance, losses must be *discovered* within 1 year. This is defined as: A. The Discovery Period - Answer A. The Discovery Period Crime Insurance is _________ Excess over any other Insurance coverage. C. Excess - Answer C. Excess Florida Claims Adjuster Exam – 3 Accurately Answered. Provides for loss of money and securities *outside the premises* in the care, custody and control of a messenger or armored car service resulting from theft, disappearance or destruction. This is defined as: B. Outside the Premises - Answer B. Outside the Premises Also covers robbery of other property under the circumstances. Taking or attempted taking of property from within a *locked safe* or vault, by unlawful entry, with visible marks of forcible entry, or taking of the safe or vault from inside the premises. This is defined as: A. Safe Burglary - Answer A. Safe Burglary Exclusions: accounting errors, giving/surrendering property, voluntarily parting, fire (except damage to safe/vault), vandalism, transferring Florida Claims Adjuster Exam – 3 Accurately Answered. property to someone based on unauthorized instructions or from threat to harm Covers for all types of property, when surrendered away from the premises as a result of a threat to do bodily harm to the insured or an employee, or to a relative or invitee of either, who is (or allegedly is) being *held captive.* This is defined as: A. Extortion - Answer A. Extortion Also triggered by threats to damage the premises or property within the premises. Employee Theft Coverage may be written in the following ways: D. All May Apply A. Scheduled Persons Coverage B. Scheduled Position Coverage C. Blanket Coverage Florida Claims Adjuster Exam – 3 Accurately Answered. D. All May Apply - Answer D. All May Apply Employee Theft may be written in three ways. Which of the following are NOT a type of bond? D. Apprentice A. Contract B. Fiduciary C. Court D. Apprentice - Answer D. Apprentice A.Contract - fulfill obligation B.Fiduciary - make good to court for any deficiencies found in performance C.Court - protect opposing party from loss Florida Claims Adjuster Exam – 3 Accurately Answered. A. Bid - Answer A. Bid May act as part of the bonding party and agrees to reimburse the surety for any loss it may suffer from having bonded the principal: A. Indemnitor - Answer A. Indemnitor Known as "fourth party", may put up collateral Which of the following are parties to a Bond? D. All of the Above A. Principal B. Obligee C. Surety D. All of the Above - Answer D. All of the Above Principal - undertakes to perform/fulfill Florida Claims Adjuster Exam – 3 Accurately Answered. Obligee - guaranteed principal will perform Surety - guarantees performance *Indemnitor - may act as additional party; agrees to reimburse surety for any loss This type of bond covers streets, sidewalks, sewers, etc.: B. Subdivision / maintenance bond - Answer B. Subdivision Falls under Maintenance Bond When a person has lost stock certificates, bonds or similar *instruments*, a bond is generally required by the issuing company to reissue the document. This is known as a: Florida Claims Adjuster Exam – 3 Accurately Answered. B. Lost Instrument Bond - Answer B. Lost Instrument Bond Also guarantees to save issuer from any loss growing out of lost instrument A __________ ppo is a selected group of hospitals and medical *practitioners* in a given area who have joined together in an effort to reduce medical costs. D. PPO - Answer D. PPO Most plans provide that emergency treatment will be paid even if treated party does not go to service provider on approved list. Define the coverage that pays a flat amount per day for hospitalization, regardless of expenses or other insurance: B. Hospital Indemnity - Answer B. Hospital Indemnity Florida Claims Adjuster Exam – 3 Accurately Answered. This helps keep premiums reasonable by eliminating chance of persons buying coverage only when they are sick Characteristics of an HMO plan usually include: A. Small of non-existent Deductibles B. Fewer Exclusions C. Insurance services to members through employed physicians D. All of the Above - Answer D. All of the Above Also included: broad coverage, coinsurance provisions Provides indemnification to the insured for basic hospitalization of room and board in the hospital, nursing care, laboratory fees, operating room, medical supplies, etc. This is defined as? Florida Claims Adjuster Exam – 3 Accurately Answered. A. Hospitalization Expense - Answer A. Hospitalization Expense Associated with a daily limit, not to exceed specified maximum A(n) __________ provides comprehensive health services to its members for a prepaid fixed fee, equivalent to an insurance premium. A. HMO - Answer A. HMO Referred to as an emerging and increasingly important non-insurance alternative to dealing with risk of health care costs Established in 1973, this association was created for applicants who are unable to obtain insurance in the private market: E. FAJUA - Answer E. FAJUA Florida Claims Adjuster Exam – 3 Accurately Answered. In 2002, the Florida Residential Property and Casualty Joint Underwriting Association (FRPCJUA) and the Florida Windstorm Joint Underwriting Association (FWUA), were combined to create: C. Citizens - Answer C. Citizens Passed during a legislative session in 1993, this association was created for employers who cannot obtain workers compensation insurance in the private market: A. FWCJUA - Answer A. FWCJUA A General Lines Agent instructs a licensed Customer Representative 4- 40 to thoroughly cover the details of a new life insurance product with every Homeowner customer who calls or visits the office. The agent provides training on the new product. - Answer Although the Customer Florida Claims Adjuster Exam – 3 Accurately Answered. C. 30 D. 30 - Answer C. 30 Must be licensed, appointed by a General Lines Agent and can transact AUTO insurance only in the Office Only. B. Limited Customer Representative 4-42 - Answer B. Limited Customer Representative 4-42 Defaming a competitor company or agent is not only unprofessional, it can also result in a license suspension. A. True B. True - Answer A. True Florida Claims Adjuster Exam – 3 Accurately Answered. A General Lines Claim Adjuster is required to obtain the same number of Continuing Education hours as a licensed Customer Service Representative. A. False B. False - Answer B. False An Insurance Company which is formed under the laws of the State of Illinois, and has its Home Office there, is considered a: A. US Domestic Company B. Foreign Company C. Alien Company D. Unadmitted Company - Answer B. Foreign Company A.Domestic: this state (FL) B. Foreign: other state (still in US) Florida Claims Adjuster Exam – 3 Accurately Answered. C.Alien: elsewhere One who is involved in the investigation, adjustment, negotiation and/or trial preparations of claims arising under insurance policies is defined as: C. Claims Adjuster - Answer C. Claims Adjuster Commonly referred to as claims auditor Establishing a dollar value on a claim is defined as: B. Evaluation - Answer B. Evaluation Florida Claims Adjuster Exam – 3 Accurately Answered. Investigation - establish coverage, determine liability, verify damages qualify Evaluation - determine fair payment in accordance with contract and law Negotiation - settlement based on facts discovered during evaluation Under the Florida Unfair Insurance Trade Practices Act, penalties are provided for misrepresentation of business practices, which include all of the following except: C. Denying claims with reasonable investigation - Answer C. Denying claims with reasonable investigation An adjuster who represents the financial interests of the insured named in the policy is defined as a(n): A. Public Adjuster - Answer A. Public Adjuster Florida Claims Adjuster Exam – 3 Accurately Answered. When investigating liability insurance claims, which of the following three major elements are determined: D. All of the Above A. Coverage B. Liability C. Damages D. All of the Above - Answer D. All of the Above A relationship that requires maintenance of a high degree of *fidelity* and loyalty to the interests of the principal, whether or not the adjuster is a direct employee is defined as: A. Fiduciary - Answer A. Fiduciary Should always be maintained whether or not the adjuster is a direct employee Florida Claims Adjuster Exam – 3 Accurately Answered. An adjuster who is *self-employed* and not affiliated with either insurers or bureaus is defined as a(n): D. Independent Adjuster - Answer D. Independent Adjuster The adjuster's investigation may include all of the following D. Policy Cancellation - Answer D. Policy Cancellation The assertion of an alleged legal right against an insurer, which carries with it a demand for appropriate relief, is defined as: C. Claim - Answer C. Claim Florida Claims Adjuster Exam – 3 Accurately Answered. An adjuster who is a salaried employee under the supervision of the *home, branch, or regional claims department of insurers* is defined as a(n): A. Company or Staff Adjuster - Answer A. Company or Staff Adjuster Which of the following are not considered to be an adjuster: D. General Lines Adjuster - Answer D. General Lines Adjuster Bureau Adjusters are also considered adjusters. An applicant for a license as an adjuster may qualify as an adjuster in the following fields (but not limited to):D. All of the Above Florida Claims Adjuster Exam – 3 Accurately Answered. A. All lines of insurance except life and annuities B. Property and Casualty C. Workers Compensation Insurance D. All of the Above - Answer D. All of the Above Also: motor vehicle physical damage and health insurance A motor vehicle or mobile home which is a total loss is defined as: B. Salvage - Answer B. Salvage It cannot be restored to prior condition When making any payment for damage to an automobile for a partial loss, the insurer shall have printed on the loss settlement, Florida Claims Adjuster Exam – 3 Accurately Answered. A. Third Party Claim - Answer A. Third Party Claim Failure to use the insurance proceeds in accordance with the security agreement, if any, could be a violation of. s.812.014, Florida Statutes. This is payment for a(n): Third Party Claim The District of Columbia and any state or territory of the United States in which an insurance agent maintains his or her principal C. Home State - Answer C. Home State *place of residence* or principal place of business and is licensed to act as an insurance agent. This is defined as: home state Any material which is or may have been a motor vehicle or mobile home, which is inoperable and which material is in such condition that its highest or B. Derelict - Answer B. Derelict. primary value is either in its sale or transfer as scrap metal or for its component parts, or a combination of the two. This is defined as: Florida Claims Adjuster Exam – 3 Accurately Answered. A customer representative appointed by a general lines agent or agency in transacting only the business of private passenger C. Limited Customer Service Representative - Answer C. Limited Customer Service Representative motor vehicle insurance from the office of that agent or agency is defined as: An individual representing an insurer as to *life insurance* and annuity contracts, including agents appointed to transact life insurance, fixed- dollar annuities, or variable contracts by the same insurer is defined as: A. Life Agent - Answer A. Life Agent Charging an applicant for a specific ancillary coverage or product, in addition to the cost of the insurance coverage provided for, *without the informed consent of the applicant* is a practice of: Florida Claims Adjuster Exam – 3 Accurately Answered. B. Sliding - Answer B. Sliding Which of the following are reasons for refusal, suspension or revocation of a license or appointment?D. All of the Above A. Lack of Qualifications B. Failure to Pass State Examinations C. Fraudulent or Dishonest Practices D. All of the Above - Answer D. All of the Above Every licensee shall notify the department, in writing, after a change of name, residence address, principal business street address and/or mailing address within how many days? A. 30 B. 30 - Answer B. 30 Florida Claims Adjuster Exam – 3 Accurately Answered. An agent who transacts any one or more of the following types of insurance: Property, Casualty, Surety, Marine, and Health is defined as a(n): D. General Lines Agent - Answer D. General Lines Agent An agent representing a *health* maintenance organization, or as to health insurance only, an insurer transacting health insurance is defined as a(n): A. Health Agent - Answer A. Health Agent An applicant for a temporary license must be:C. Both A & B A. A natural person at least 18 years of age B. A US citizen or legal alien who possesses work authorization Florida Claims Adjuster Exam – 3 Accurately Answered. - Protects assets from unforeseen events Known Loss - Answer Prevents insured from coverage if insured knew the loss was probable at time of contract Commercial Property Insurance - Answer Sometimes referred to as Commercial Fire and Allied Lines; Covers direct and indirect losses related to properties other than 1-4 family dwelling and farm properties Value Reporting - Answer Limit of coverage set at an amount higher than expected peak values Employee Theft - Answer Provides coverage for loss or damage to money, securities, and other property resulting from theft committed by an employee Florida Claims Adjuster Exam – 3 Accurately Answered. Bid - Answer Form of bond required to accompany a bid for a contract which will require that successful bidder furnish further bond if awarded job. Agreement to fulfill a contractual obligation used frequently in construction and supplying goods PPO - Answer (Preferred Provider Organization) Selected group of hospitals and medical practitioners in given area who have joined together in an effort to reduce medical costs HMO (pre-paid fixed fee) - Answer (Health Maintenance Organization) Provides comprehensive health services to its members for a prepaid fixed fee equivalent to an insurance premium Domestic - Answer Insurer formed under laws of this state Foreign - Answer Insurer formed under laws of another state, district territory, or commonwealth of U.S. Florida Claims Adjuster Exam – 3 Accurately Answered. Alien - Answer Insurer other than domestic or foreign (outside U.S.) Sliding - Answer Selling an item and stating that it is required by law Waiver - Answer Voluntary relinquishment or surrender of some right or privilege Fiduciary - Answer A relationship that requires maintenance of a high degree of fidelity and loyalty to the interests of the principal, whether or not the adjuster is a direct employee Evaluation - Answer Establishing a dollar value on a claim. Determines the fair payment in accordance with the contract and applicable law Negotiation - Answer A quality settlement based on facts discovered during the evaluation process Florida Claims Adjuster Exam – 3 Accurately Answered. Identify examples of peril. - Answer Fire, windstorm, flood after hurricane, etc. (something that causes a loss) How long does one have to notify the Department of Financial Services for a name and/or address change? - Answer 30 days What is the coinsurance clause and how might it apply to a given scenario? - Answer A coinsurance clause on a property policy requires the policyholder to carry, at minimum, a specified percent of the dwelling's replacement cost. Failure results in monetary penalty. Almost without exception, the percentage is 80% in coinsurance clauses of homeowner policies - this means the insured should carry 80% of replacement cost if they don't want to be penalized at the time of loss. What are the minimum requirements for the Financial Responsibility Law? (there are two) - Answer 1. legal valid claims of others must be satisfied up to the 10/20/10 requirements Florida Claims Adjuster Exam – 3 Accurately Answered. 2. owner/operator must provide certification of financial responsibility for future accidents What is PIP and how may it apply to a given scenario? - Answer Personal Injury Protection with limit of $10,000 per person, per accident If Jeremy has a not-at-fault accident and he has PIP with a $1000 deductible, he can expect PIP to pay $1,600 of his $3,000 medical bill. (3,000 - 1,000 = 2,000 x .80 = 1,600) What is the difference between PIP and Workers Compensation? Which one is excess? - Answer PIP is primary against all other forms of medical and disability insurance coverage. Florida courts have held PIP is excess over Workers Comp. To eliminate duplicate recoveries, the law prohibits persons who have received PIP from recovering same amounts from others in legal liability actions. Florida Claims Adjuster Exam – 3 Accurately Answered. What are the basic PIP benefits? - Answer 1. Medical; 80% of reasonable expenses are paid for necessary medical, surgical, x-ray, dental, and rehab services 2. Work Loss; 60% of any loss of gross income and loss of earning capacity is reimbursed 3. Replacement Services; 100% for cost of having household services performed by others which the injured person would have normally performed 4. Death; $5,000 IN ADDITION to the $10,000 in medical/disability benefits afforded by PIP How does PIP apply to pedestrians (in and out of state)? - Answer PIP applies to Florida residents if struck by insured's motor vehicle while not occupying a self-propelled vehicle (a pedestrian). In situations wherein PIP does not apply, named insured and relatives occupying or struck by others vehicles out-of-state; nonresident passengers out-of-state; and nonresidents as pedestrians in Florida - The No-Fault Law has no applicability and usual legal remedies and other insurance coverage's are to be relied upon. Florida Claims Adjuster Exam – 3 Accurately Answered. -Death Benefits: if death results within one year of accident or, if it follow continuous disability, within five years after the accident What are the requirements for continuing education for a 6-20 license? - Answer A licensed General Lines Claims Adjuster is required to complete 24 hours of education every 2 years. Who might have an insurable interest in a property? - Answer Anyone who would suffer an economic loss from an adverse happening to the property What do the Declarations of a policy outline? - Answer The declarations identifies: - the named insured and address - states the policy period and premium and misc info - specifies the limits of coverage that apply Florida Claims Adjuster Exam – 3 Accurately Answered. Which parties are associated with a bond? - Answer -Principal: one who undertakes to perform, fulfill a contract, or meet an obligation -Obligee: one who is guaranteed that the principal will perform -Surety (Bonding Company): guarantees performance -Indemnitor: may act as additional party at times; agrees to reimburse the surety for any loss it may suffer from having bonded the principal What are the features of Major Medical Insurance? - Answer Major Medical Insurance is intended to afford protection against catastrophic losses. Some forms are designated to supplement basic hospital/surgical policies; others intend to provide both basic and catastrophic coverage These policies are characterized by a deductible, high maximum limit, and percentage participation or coinsurance. It may contain internal limits for hospital daily room charge and surgical services. Florida Claims Adjuster Exam – 3 Accurately Answered. What associations make up Citizens Property and Insurance? - Answer Florida Residential Property and Casualty Joint Underwriting Association (FRPCJUA) and Florida Windstorm Joint Underwriting Association (FWUA) What are the characteristics of a Personal Automobile Policy Declaration page? - Answer Liability (bodily injury), property damage, uninsured motorist, medical payments, PIP, collision deductible, comprehensive deductible, towing coverage, and rental coverage What are some examples of transacting insurance? - Answer 1. solicitation and inducement 2. preliminary negotiations 3. effectuation of a contract of insurance 4. transaction of matters subsequent to effectuation of contract of insurance Florida Claims Adjuster Exam – 3 Accurately Answered. 2. Customer Representative 4-40: must be licensed, appointed by a General Lines Agent and may assist in transactions in the OFFICE ONLY 3. Limited Customer Representative 4-42: must be licensed, appointed by a General Lines Agent and transact AUTO insurance in the OFFICE ONLY. 4. All Lines Claims Adjuster 6-20: investigates, Evaluates and Negotiates Claims What are some reasons for suspension, revocation, or termination of a license? - Answer 1. Transacting insurance outside of scope of one's license ►For example, an individual cannot sell life insurance if he or she has a Customer Service license but has not obtained a life license. 2. Misrepresentation or Fraud. 3. Participating in unfair methods of competition. ►Using discriminatory practices, making false entries on an insurance application or defaming others. Florida Claims Adjuster Exam – 3 Accurately Answered. 4. Sliding: Selling an item and stating that it is required by law (when it is not). 5. Demonstration of unworthiness or lack of fitness. 6. Misappropriation of funds. 7. Failure to inform Department of Financial Services, within 30 days, after pleading guilty or no contest to a felony. Compare/contrast different types of adjusters. - Answer 1. Independent Adjuster - self-employed and not affiliated with either insurers or bureaus 2. Company/Staff Adjuster - salaried employee under supervision of home, branch, regional claims department of insurers 3. Public Adjuster - represents the financial interests of the insured named in the policy 4. Claims Adjuster - one who is involved in the investigation, adjustment, negotiation and/or trial preparations of claims arising under insurance policies 5. Bureau Adjuster - agent of adjustment bureau which serves multiple Florida Claims Adjuster Exam – 3 Accurately Answered. company clients *Independent and Bureau are both "Fee Adjusters" What is an Insurance Contract? - Answer Insurance is a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit upon determinable contingencies What are the components that make up the investigation process? - Answer Inquiry, verification, comparison What are the Code of Ethics for adjusters? - Answer Formal rules which impact on adjuster practices 1. Adjusters may not directly negotiate with a claimant who is represented by an attorney. 2. In interviewing witnesses, adjusters must avoid any actions tending to induce a suppression or deviation from the truth. A witness who requests a copy of a statement given must be provided with a copy.