Insurance Terminology and Concepts, Exams of Nursing

Download Insurance Terminology and Concepts and more Exams Nursing in PDF only on Docsity! Florida Claims Adjuster Exam, 6-20 All Lines Adjuster- Florida- Review Peril Something that causes a loss. Hazard Something that increases the probability that a loss will occur. Skip Ad Warranty A policy condition, either based on information in the insureds application or inserted by the insurer. It is a guarantee of a fact. Misrepresentation An untrue statement by the insured, made in an application for insurance but which does not become a part of the policy. Concealment The failure of the insured to reveal relevant facts known to the insured in applying for insurance. Abandonment Property insurance policies usually contain an abandonment clause, stating the insured cannot dump damaged property on the insurer and demand its full value. Severability The insurance applies separately to each insured as if other insureds did not exist. Proximate Cause The cause having the most significant impact in bringing about the loss under a first- party property insurance policy, when two or more independent perils operate at the same time (i.e., concurrently) to produce a loss. Courts employ a set of rules to resolve causation disputes when a property policy states that it covers or excludes losses "caused by" a peril and there is more than one peril at work in a fact pattern. Under common law, whether the policy provides coverage depends on which peril is chosen as the proximate cause. Direct Loss Physical harm to tangible property. Indirect Loss Economic loss which flows as a result of direct loss. Actual Cash Value(ACV) Replacement Cost minus Depreciation A written contract of or written agreement for or effecting insurance, or the certificate thereof, by whatever name called, and includes all clauses, riders, endorsements and papers which are a part thereof. Insurance Is a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit upon determinable contingencies. Binder Acts as a temporary contract until the policy is issued. How many days should an insurer give for prior notice of cancellation of a binder? 5 days. Property Insurance Any insurance wherein payment by the insurer will be paid directly to the insured or other specifically named interests. Liability Insurance Payment will be on behalf of the insured to another, based upon the insureds liability to the recipient. Simply stated, Liability is "Negligence of the Insured". Loss Payee Clause A Clause in a contract of insurance that provides, in the event of payment being made under the policy in relation to the insured risk, that payment will be made to a 3rd party rather than to the insured beneficiary of the policy. Mortgage Clause A property insurance provision granting special protection for the interest of a mortgagee named in the policy, in effect setting up a separate content between the insurer and the mortgagee. Other Structures Covers items that are not permanently attached to the main dwelling, such as a shed, fence, etc. Commercial Inland Marine Helps identify the kinds of risk which are eligible for either ocean or inland Marine insurance. Building Ordinance Coverage This endorsement covers the insured for enforcement of laws which require demolition of undamaged portions of buildings. Umbrella Policy Covers a much higher limit and goes above and beyond claims directly relating to your home and auto, it provides your assets from an unforeseen event, such as a tragic accident in which you are held responsible for damages or bodily injuries. Known Loss Prevents an insured from coverage if the insured knew the loss was probable at the time of the insurance contract. Value Reporting The limit of coverage is set at an amount somewhat higher than expected peak values. Commercial Property Insurance Covers direct and indirect losses related to properties other than one to four family dwellings and farm properties. Employee Theft Provides coverage for loss of or damage to money, securities, and other property resulting from theft committed by an employee. Theft is defined as the unlawful taking of money, securities or other property to the deprivation of the insured. Bid Aggreement to fulfill a contractual obligation used frequently in construction and supplying goods. Health Maintenance Organization (HMO) Provides comprehensive health services to its members for a prepaid fixed fee, equivalent to an insurance premium. Preferred Provider Organization (PPO) A selected group of hospital's and medical practitioners in a given area who have joined together in an effort to reduce medical costs. Estoppel Is an equitable principle to the effect that if one intentionally or unintentionally creates the impression that a certain fact exists, and an innocent party relies on that impression and is damaged as a result, the guilty party may be legally prohibited(estopped) from asserting that the fact does not exist. Salvage Motor vehicle or mobile home is a total loss. Junk Any 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. Fiduciary Agent Agent for a principal/Client. The legal or special relationship of trust, confidence, or responsibility between 2 or more parties. Domestic Insurer Insurer is one formed under the laws of its this state. Foreign Insurer Insurer is one formed under the laws of any state, district territory, or commonwealth of the United States other than this State. Alien Insurer Insurer is an insurer other than a domestic or foreign insurer. Appointment The authority given by an insurer or employer to a licensee to transact insurance or adjust claims on behalf an insurer or employer. Derelict 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. Mechanical Breakdown Coverage Covers repairs to mechanical parts of your vehicle that break. Even covers break in events not related to an accident. Sliding Selling an item and stating that it is required by law. What is the Death Benefit amount for PIP ? $5,000 What is the amount for medical and disability benefits afforded by PIP ? $10,000 Who is the Financial Responsibility Law administered by ? The Department of Highway Safety and Motor Vehicles. What are the Basic PIP Benefits ? -Medical-80% of responsible expenses are paid for necessary medical, surgical, X-Ray and dental. -Work Loss-60% of any loss of gross income and loss of earning capacity reimbursed. -Replacement Services-100% for the cost of having household services performed by others. -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. Company or Staff Adjuster Are salaried employees under the supervision of the home, branch or regional claims department of insurers. Fee Adjusters Offer their services on a fee-for-service basis. They represent many insurers. Bureau Adjuster 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. Independent Adjuster 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. Public Adjuster Is a claims adjuster who is an advocate for the policyholder in appraising and negotiating an insurance claim. What are the Characteristics of a Personal Auto Policy Declaration Page ? -Liability(Bodily Injury) -Property Damage 20=20,000 Combined Total Liability for all injuries-this is the most paid out for injuries for an accident. 10=10,000 Property Damage-the most paid out for damage caused to property of others. What is SR-22 ? A form of coverage known as a NAMED NOOWNER policy is required, this form offers insurance coverage only while the insured is operating automobiles owned by others. What are the two things that need to happen for financial responsibility that did not exist at the time of the accident ? -The legally valid claims of others must be satisfied(up to the 10/20/10 requirements). -The owner and operator must provide certification of financial responsibility for future accidents. What are the main elements of the FL Law ? -Those who comply with the law have limited immunity from tort suits. -As one may not be able to seek legal liability damages against another for bodily injuries, the law substitutes, under one's own insurance, the coverage defined as Personal Injury Protection(PIP) How many days does a Non-Resident's vehicle physically present in FL have subject to the No-fault law ? 90 days. What are the three penalties for non-compliance with the compulsory insurance requirements ? -The owner is denied the immunities from legal liabilities that are granted to those who comply. -The owner is personalltly liable for payment of PIP benefits to those entitled to such benefits. -The owner's driver's license and vehicle registration are subject to suspension, as under the Financial Responsibility Law. What does Extended PIP do ? -Increases medical benefits from 80% to 100%. -Increases income loss from 60% to 80%. -Applies only to named insured and family members. What does additional PIP do ? -Increases the $10,000 limit by amounts such as $10,000, $25,000, $40,000, and $90,000(again, for a premium increase). -Increases do not impact $5,000 death benefit. -Applies only to insured and family members. Personal Auto Policy Used to insure the automobile exposures of individuals and families. Business Auto Policy Insurers the automobile exposures of Business. What are the kinds of autos owned by businesses and covered under a Business Auto Policy ? -Private Passenge Type Auto-Station Wagons, jeeps, pickups, panel trucks, vans, and utility trailers. -Public Auto- Buses and Taxicabs -Commercial Auto- truck tractors, semi-trailers, commercial trailers, and Service trailers. -Special types of vehicles like cherry pickers, air compressors. Garage Coverage Form Used to insure businesses engaged in selling, servicing, repairing, parking or storing autos. Truckers Coverage Form Used to insure businesses that are hired to transport goods for someone else. Business Auto Coverage Form Used to insure the automobile exposures of all businesses other than garage or trucking businesses. What does Commercial General Liability contract includes ? -Declarations -Common policy conditions -One of the two coverage forms, Occurrence, or Claims-Made -A Nuclear Energy Liability Exclusion endorsement -Various other endorsements may be attached to broaden or restrict the coverage provided by these basic forms. Declarations 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.