Insurance Claims and Coverage: A Comprehensive Guide, Exams of Nursing

Download Insurance Claims and Coverage: A Comprehensive Guide and more Exams Nursing in PDF only on Docsity! Florida Claims Adjuster Exam, 6-20 All Lines Adjuster- Florida- Review complete material Peril Something that causes a loss. Hazard Something that increases the probability that a loss will occur. 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 Waiver 1.) Implied voluntary relinquishment, abandoning a legal advantage, need, claim or right. 2.) Agreement or added clause of a policy that excludes some losses or limits the sum of a claim, or extends coverage to add items not in a normal policy. Express Waiver Occurs when the insurer or its representative knowingly gives up a known right under the insurance contract. Implied Waiver A waiver that is assumed to be in effect from a person's behavior and shows he is waiving a right. Damages Monetary compensation that is awarded by a court in a civil action to an individual who has been injured through the wrongful conduct of another party. Subrogation 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. Changes All policies provide that any changes to the policy be made by the insurer, in writing. Policy Period 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). Policy Territory Condition limiting coverage to occurrences or losses that take place only within a stated geographical region. Other Insurance The principle of indemnity dictates against duplicate recovery for the same loss. Cancellation The insured may cancel at any time, for any reason, without advance notice. If the conpany wishes to cancel, it must provide some degree of advance notice so the insured will have time to replace the coverage. Appraisal 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 -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 -Uninsured Motorist -Medical Payments -Personal Injury Protection -Collision Deductible -Comprehensive Deductible -Towing Coverage -Rental Coverage What are examples of Transacting Insurance? -Solictitation of Insurance -Negotiation of Insurance -Effecting Coverage (Binding insurance coverage) -Transacting Insurance Matters(during and after insurance is bound). What are thresholds of the No-Fault Law ? -Significant and permanent loss of a bodily function or -Permanent injury other than scarring and disfigurement or -Significant and permanent scarring or disfigurement or -Death What is the adjusters investigation limited too ? A simple verification of bills and estimates or it may be expanded to include photographs, witness canvasses, or recorded statements as the circumstances require. What are the componets of a investigation process ? -Inquiry -Verification -Comparison What are some reasons for suspension, revocation or termination of a license ? -Transacting Insurance outside of scope of one's license -Misrepresentation or fraud -Sliding -Demonstration of unworthiness or lack of fitness -Misappropriation of funds -Failure to inform Department of financial services, within 30 days, after pleading guilty or no contest to a felony. Florida Unfair Insurance Trade Practices Act Describes certain practices, penalties are provided for misrepresentation to insureds and claimants and business practices such as -Failing to act promptly -Failure to affirm or deny a claim when an insured is entitled there to -Failure to explain claim denials in writing -Failure to maintain complaint-handling procedures such as keeping accurate records of complaints. Comprehensive Coverage Covers all loss except collision or overturn. Standard deductible is $100 per car, $500 per occurrence applies to losses from theft, mischief, and vandalism. What is the minimum requirements for the Financial Responsibility Law ? -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. If not satisfied operator's driver's license and the registrations of all owned vehicle's are suspended. What are the basic activities in claims handling ? -Investigation to establish coverage, determine legal liability, and verify if the alleged damages qualify the loss for payment. -Evaluation to determine the fair payment in accordance with the contract and applicable law. -Negotiation of a quality settlement based on facts discovered during the evaluation process. Claim Is the assertion of an alleged legal right against an insurer, which carries with it a demand for appropriate relief. Claims Adjuster One who is involved in the investigation, adjustment, negotiation and/or trial preparations of claims arising under insurance policies. Adjusting Process of disposing of an insurance claim. Loan Receipt A written statement given by the insured to the insurer acknowledging that money received in the settlement of damages is received, not as a final payment, but as an advanced pending the outcome of a claim against the person responsible for the damage. Apportionment Is a provision for computing and assigning to each of two or more contracts covering a claim its proportion of the amount of the loss. How to settle a claim for an Injured Minor ? Under Fl Law, the adjuster should settle a third-party liability claim of an injured minor child with both parents of the injured child, presuming the settlement is for an amount not in excess of $15,000. If it is more than that it must be consummated through the Circuit or County Courts. What are the violations of the Unfair Trade Practices Act ? -Failing to act promptly. -Failure to affirm or deny a claim when an insured is entitled thereto. -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. The policy states that if a company wishes to cancel, How many days must it give prior notice ? 30 days. Nuclear Endorsement Excludes all hazards related to nuclear energy. What is Coverage A ? Bodily Injury and Property Damage Insuring Agreement. Bodily Injury(BI) Physical harm and includes sickness or disease or death resulting there from. Property Damage(PD) Physical injury to tangible property, including loss of use of that property. Occurrence An accident, including. continues or repeated exposure to substantially the same general harmful conditions. Accident A sudden, unexpected event. Coverage Territory Is the U.S. and its territories or possessions , Puerto Rico and Canada, including international waters and airspace between these places. The Coverage Trigger Determines how policy will respond. The Occurrence form Applies to BI or PD which occurs during the policy period, regardless of any later time at which a claim is made. The Claims-Made form 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. Retroactive Date Establishes the original policy date for a serious of claims made policies. Intentionally Injury Coverage excludes injury or damage which is expected or intended by the insured. liquor Liability 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. Employee Injuries Coverage excludes liabilities under a workers compensation or similar law or arising from injuries to employees of the insured. Pollution There a basically no coverage for injury, damage or clean up costs caused by pullutants, subject to minor exceptions. What is Coverage B ? Personal and Advertising Injury. What is Coverage C ? Medical Payments. What are the General Liability Insurance Forms ? -Owners and Contractors Protective Liability(OCP)Form. -Liquor Liability Coverage Form. -Products/Completed Operations Liability Coverage Form -Pollution Liability Coverage and Pollution Limited Form. Professional Liability Insurance Coverage Covers liability arising from rendering of or failure to render professional services. Farm Liability Coverage Form Provides coverage for BI or PD arising out of farming operations of personal activities. The Custom Farming Endorsement Provides coverage for liability arising from the insureds performance of farming operations for another, for a charge under any contract or agreement. The Farm Employers Liability/Medical Payments Endorsement Applies the basic Liability and Medical Payments coverages to injuries to farm employees, but not to employees eligible to receive workers compensation benefits. Employment Related Practices Liability This Form provides employers witg claims- made coverage for liability arising out of claims for injury to an employee because of an employment-related offense. Unauthorized Entity 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. To be Authorized and transact business in FL what must you have ? Certificate of Authority. General Lines Agent 2-20 Licensed to write property/casualty, surety, or health insurance. Customer Representative 4-40 Must be licensed, appointed by a General Lines Agent and may assist in transactions in the OFFICE ONLY. Limited Customer Representative 4-42 Must be licensed, appointed by a General Lines Agent and transact AUTO insurance in the OFFICE ONLY. All Lines Claims Adjuster 6-20 Investigates, Evaluates, and Negotiates Claims. A General Lines Adjuster is required to do what ? following are examples of a peril Lighting, Explosion and Fire The abandonment clause The clause that prohibits the insured from dumping damaged property on the insurance company and demanding to be paid in full is? Liberalization When a policy change results in broadened coverage with no additional premium, the insured automatically receives the benefit under the principle of? Risk The chance of financial loss is known as? Percentage Hurricane insurance in coastal areas in Florida is written subject to which of the following deductibles? The principle of proximate cause When there is an unbroken connection between an occurrence and the damage that arises from the occurrence, and all the resulting damage happened on account of that occurrence, this is known as? characteristics of a contract Consideration must be given to at least one party Primary When two or more policies apply to the same loss, the one that pays first is called? Mortgagee Clause The clause that protects the lender in a real property policy is the? Indemnity The concept that one should not profit from the payment provided by an insurance policy is known as? Property or first-party insurance Payment the insurance company makes directly to the insured is? Written To be considered an insurance contract, a policy must be? Subrogation When the insured transfers his/her rights to collect for damages to the insurer, it is known as? The insured If an insurance policy is unclear or ambiguous, in whose favor does the policy respond? Insurable interest A partial owner of a building cannot receive full value for the building in the event of a loss because of? Comparative negligence Reduces the insured's damages by the degree of negligence the following are part of an insurance policy Exclusions, Declarations and Endorsementd ACV replacement cost minus depreciation The insured's house is totally destroyed in a fire. The house is insured for $200,000. The adjuster who investigates the claims determines the ACV of the home is $185,000. The Florida Valued Policy Law requires the insurer to pay $200,000 describe a franchise deductible No payment is made until the loss equals or exceeds the amount of the deductible and then the loss is paid in full All of the following are characteristics of an insurance contract EXCEPT? Personal, Private, Conditional, Adhesion? Private If a claimant is represented by an attorney, the adjuster should? Only meet with the client when the attorney is present Adjusters should advise claimants on? claims information An adjuster is required to notify a claimant when a claim is denied. The notification must be? Written The term ethics refers to? service to others, personal respect and proper mode of conduct When an adjuster deals with a claimant who is not a policyholder, this claim is known as an? third party claim The successful adjuster/negotiator should understand that communication includes all of the following EXCEPT? Select one: A. Verbal and non-verbal messages B. Questioning C. Listening D. Decision-making Decision-making Which of the following is not a duty of the claims adjuster? Select one: A. Investigating B. Evaluating C. Negotiating D. Counseling Counseling The adjuster's duty to the insurer is best described as? Select one: A. Friendly B. Factual C. Fun D. Fiduciary Fiduciary Errors and Omissions claims are a result of? Select one: A. unethical behavior B. lack of knowledge or information Dan has a Personal Auto Policy with Liability of 10/20/10 and basic PIP with a $1,000 deductible. He is running one day when a car strikes him. A week later he dies. Medical bills are $7,500 and lost wages are $1,000. How much, if any, will PIP pay in this claim? 10,800.00 Joe is an owner insured for PIP. In which of the following situations does Joe have his PIP benefits available to him? Select one: A. In a slip and fall accident in the mall in Florida B. In an accident while riding his motorcycle C. Struck as a pedestrian in Georgia D. In an accident while riding as a passenger in a friend's car in Florida In an accident while riding as a passenger in a friend's car in Florida The insured bought a new car with a Mechanical Breakdown Policy. When the odometer reaches 40,000 the car has a serious breakdown involving the transmission. How does the Mechanical Breakdown Policy respond? Select one: A. No coverage because the policy expired B. No coverage because a transmission is not covered C. ACV coverage will apply D. Replacement cost coverage will apply No coverage because the policy expired An insured borrows his neighbor's trailer to pick up his new furniture. Which of the following best describes the insured if he has an accident? Select one: A. His PAP will extend coverage if the proper endorsement is added B. Only the liability of the PAP extends to the trailer C. His auto is insured, but not the borrowed trailer D. His PAP extends liability to the trailer and Part D-Physical Damage extends $1,500 coverage to the borrowed trailer His PAP extends liability to the trailer and Part D-Physical Damage extends $1,500 coverage to the borrowed trailer Jane is driving Mary's car. Jane has an at-fault accident with Bob. Mary has liability limits of 10/20/10. Jane has liability limits of 100/300/100. If Bob has $40,000 in bodily injury, how much will be collected from Jane's policy? (IGNORE PIP) Select one: A. $30,000 B. $10,000 C. $50,000 D. $20,000 $30,000 Jim owns an auto and he is involved in an auto accident. He suffered $4,000 in medical expenses and $4,000 of lost income. How much does his insurance pay if he has Extended PIP? Select one: A. $7,200 B. $8,200 C. $4,200 D. $5,200 $7,200 If an insured has $100,000 of unstacked UM coverage with three cars on the policy, how much is available under a UM claim? Select one: A. $0- B. $300,000 C. $100,000 D. $200,000 $100,000 The insured has a PAP with single liability of $50,000. The following loss occurs: $37,000-BI pedestrian; $3,000-Display window; $10,000-Sports car; $1,500-Legal defense. How much would his policy pay for the loss? Select one: A. $51,500 B. $37,000 C. $40,000 D. $50,000 $51,500 The insured is driving down the road when a low hanging branch strikes and cracks his windshield. The cost to replace the windshield is $650. The insured has a $500 collision deductible and a $250 other than collision deductible. The insurance company will pay...? Select one: A. $250 B. No coverage C. $500 D. $650 $650 Which of the following is covered under PAP liability? Select one: A. Intentional damage B. Permissive use of insured's automobile C. Damage to property owned by the insured D. Injury to an employee in the course of employment Permissive use of insured's automobile Joe is injured when the jack slips as he is changing a tire in his driveway. The bill for his treatment in the emergency room is $450. Where will Joe go first to collect for his medical expenses? Select one: A. Worker's Compensation B. His PIP insurance C. His homeowner insurance D. His health insurance His PIP insurance All of the following UM options are available to an insured, EXCEPT? Select one: A. May purchase UM coverage less than liability limits B. May purchase UM coverage more than liability limits C. May reject UM coverage in writing D. May elect non-stacked UM coverage in writing May purchase UM coverage more than liability limits The Truckers form that provides liability coverage for damage to non-owned trailers is called? Select one: A. Interchange coverage B. Commercial Trailer coverage C. Trailer Interchange coverage D. Trailer coverage Trailer Interchange coverage Hail damage to an auto is an example of? Select one: A. An exclusion to Part A\-Liability B. An exclusion to Part D-Physical Damage C. Other than collision D. Collision When a community applies for flood coverage, until they are approved they are under: Select one: A. The Regular Program B. The Special Program C. The Emergency Program D. The Flood Program The Emergency Program If an insured sells his house to another person, the buyer is prohibited from receiving the seller's insurance policy because insurance is a contract of: Select one: A. Conditions B. Adhesion C. Indemnity D. A personal nature A personal nature All of the following are eligible for a Homeowner Policy, EXCEPT: Select one: A. Renters who maintain resident in any type of building B. Dwellings owned by a corporation C. Owner-occupants of 1-4 family dwellings D. Condominium unit owners Dwellings owned by a corporation Outdoor equipment used to service the premises is covered under: Select one: A. Coverage C B. Coverage A C. Coverage B D. Coverage D Coverage C A contract condition of the Homeowners policy which provides that the insured gets the benefit of broadened coverage if the company adopts a broader form without an increase in premium is: Select one: A. Subrogation B. Liberalization C. Assignment D. Coinsurance Liberalization The coverage territory for Personal Inland Marine Insurance (PAF) is: Select one: A. Whatever is specified in the policy B. Worldwide C. United States D. U.S., Canada, and U.S. territories Worldwide What condition must be met in a HO Policy for replacement cost to settle the loss? Select one: A. The insured must replace the item lost or damaged B. All of these answers are correct C. The insured must file the claim within 10 days D. The insured must carry insurance of at least 80% of the cost to replace the dwelling The insured must carry insurance of at least 80% of the cost to replace the dwelling Which HO form covers a condo owner? Select one: A. HO-3 B. HO-2 C. HO-6 D. HO-4 HO-6 Joe had a Dwelling Policy with $40,000 Coverage A limit. A covered loss occurred that totaled the dwelling and the detached garage. The loss to the detached garage was $6,000. How much will be paid to Joe to cover this loss? Select one: A. $44,000 B. $40,000 C. $46,000 D. There is no coverage $44,000 Tommy and Chris leave their golf clubs in the trunk of Tommy's car when they stop to eat lunch. Both sets of clubs are stolen. Which policy covers Chris' clubs? Select one: A. Tommy's HO B. Tommy's auto C. Chris' auto D. Chris' HO Chris' HO Which of the following is not covered under Coverage C of a HO Policy? Select one: A. An aquarium is knocked over and the fish die B. A student away at school has his golf clubs stolen C. An insured's luggage is stolen from his hotel room D. A weekend guest loses his hearing aid during a fire An aquarium is knocked over and the fish die The clause that protects the lender in a real property policy is the: Select one: A. Coinsurance Clause B. Loss Payee Clause C. Appraiser Clause D. Mortgagee Clause Mortgagee Clause Under an HO3 policy, if Coverage A is $250,000, Coverage B is: Select one: A. $10,000 B. None of the above C. $20,000 D. $25,000 $25,000 An HO-4 Policy is designed for a: Select one: A. Condo owner B. Home owner C. All of the above D. Renter Renter What is the deductible for a Personal Articles Floater (PAF)? Select one: A. $250 B. $100 C. Peak Season D. Inflation Guard Peak Season The Builders Risk coverage form covers: Select one: A. Contractors B. Buildings under construction C. Investors D. Builders Buildings under construction The Builders Risk Coverage Form assumes which coinsurance provision: Select one: A. 90% B. 100% C. 80% D. 70% . 100% In the event that the Condominium Association Coverage form and the Condominium Unit Owners Coverage form both cover a loss, which of the following is true? Select one: A. Both forms pay equally B. The Unit Owner form is primary and the Association form is excess. C. The two forms are prorated D. The Association form is primary and the Unit Owner form is excess The Association form is primary and the Unit Owner form is excess Both commercial property and liability were combined into one policy, thus saving money on underwriting expense. What is this combination called? Select one: A. A monocline policy B. A valid policy C. A combination policy D. A package policy A package policy Under the Business and Personal Property Coverage Form the provision for suspension for certain perils applies after: Select one: A. 60 days vacancy B. 30 days vacancy C. 90 days vacancy D. 120 days vacancy 60 days vacancy Under Business Income Coverage, the period of restoration begins: Select one: A. 72 hours after reporting the loss B. 72 hours after the date of direct damage C. 48 hours after the date of direct damage D. 48 hours after reporting the loss 72 hours after the date of direct damage All of the following are included in the definition of a building, EXCEPT: Select one: A. Floor coverings B. Wall treatments (wallpaper) C. Temporary structures on or within 100 feet of the premises D. Copy machines Copy machines Three types of property are covered under the Building and Personal Property coverage form. They are: Select one: A. Building; Business Personal Property; Personal Property of Others B. Building; Your Personal Property; Detached structures C. Building; Personal Property; Personal Property of Others D. Building; Your Business Personal Property; Your Personal Property Building; Business Personal Property; Personal Property of Others When covered property is damaged, the cost for temporary repairs and the cost to expedite permanent repairs or replacement is covered under: Select one: A. Defense Costs B. Supplementary Payments C. Automatic Coverage D. Expediting Expenses Expediting Expenses A florist wanted coverage on business contents, which vary in amount over the course of a year. Which form best fits this situation? Select one: A. Peak Season Endorsement B. None of the above C. Value Reporting Endorsement D. An automatic increase in insurance Value Reporting Endorsement Under the Business and Personal Property Coverage Form, all of the following are additional coverages EXCEPT: Select one: A. Cost to hire a night watchman B. Cost to preserve property C. Debris Removal D. Fire Department Service Charge Cost to hire a night watchman Which exposures are covered by the Leaseholder Interest Coverage Form? Select one: A. All of the above B. A loss of any unused prepaid rent C. An unused part of tenant improvements D. A tenant's loss of a favorable lease/sub-lease All of the above A claim is made under a CGL for a slip and fall injury. Two years later the injured person comes back saying the injury has flared-up. Is the reoccurrence covered under CGL Medical Payments? Select one: A. Yes, expenses are covered because of proximate cause. B. No, slip and falls are not covered under Medical Payment coverage C. Yes, expenses are covered within three years of the injury. D. No, expenses are covered within one year of the injury. No, expenses are covered within one year of the injury. Acme Toys has a CGL policy. They hold a party and one of the guests has a little too much to drink. If the guest injures someone and the injured party sues the Acme Toys, the CGL policy: Select one: A. Will cover if the insure has Liquor Liability Coverage B. Will not cover C. 1-1-04 is primary and 1-1-05 policy is excess D. Neither policy covers Neither policy covers What is unique about lawyer's professional liability insurance? Select one: A. It covers claims that existed before the policy was effective. B. It deducts claims expenses first and the balance is payable for the claim. C. It covers lawyers for fraudulent activities. D. It covers only lawyers in group practice. It deducts claims expenses first and the balance is payable for the claim. The three parties to a bond are: Select one: A. Surety, principal and cosigner B. Surety, insured and insurer C. Surety, obligee and indemnitor D. Surety, obligee and principal Surety, obligee and principal Safe Burglary is defined as: Select one: A. The taking of property by someone who has caused bodily harm B. The taking of property by someone who has entered the premises unlawfully as evidenced by visible signs of forced entry C. The taking of property by someone who has entered the premises unlawfully as evidenced by visible signs of forced entry and caused bodily harm D. Any act of stealing The taking of property by someone who has entered the premises unlawfully as evidenced by visible signs of forced entry All of the following are penalties for non-compliance with Workers Compensation laws, EXCEPT: Select one: A. The employer may be charged a $1000 fine, plus $100 for each day of non-compliance B. The employer may be charged with a second-degree misdemeanor C. The employer's business property may be seized D. The employer's business may be closed The employer's business property may be seized Under Workers Compensation, what is the waiting period for disability benefits to begin? Select one: A. 30 days B. 7 days C. 14 days D. 21 days 7 days A fourth party to a bond is called a: Select one: A. Surety B. Principal C. Indemnitor D. Obligee Indemnitor Bill sent a cashier's check through the mail, but it never arrived at the destination of the recipient. Under which bond can the cashier's check be replaced? Select one: A. Fiduciary bond B. Blue Sky bond C. Lost Instrument bond D. Payment bond Lost Instrument bond A Florida employee was sent Boston to work for one week. While in Boston, they were injured on the job. How is the injury covered under WC benefits? Select one: A. The injury is covered under Florida's WC law B. There is no coverage under either state law C. The injury is covered under Massachusetts WC law D. None of the above The injury is covered under Florida's WC law Contract bonds include all of the following, EXCEPT: Select one: A. Permit bond B. Performance bond C. Bid bond D. Maintenance bond Permit bond In the non-construction industry, all of the following employments are exempt from Workers Compensation EXCEPT: Select one: A. Pro athletes B. Casual labor completed in 30 days for $750 C. Labor under sentence of a court order D. Domestic servants in private homes Casual labor completed in 30 days for $750 Which bond protects the consumer against misrepresentation of a securities dealer? Select one: A. Blue Sky bond B. Permit bond C. Payment bond D. Lost Instrument bond Blue Sky bond Under Part One of the WC policy, what is the limit for recovery of medical bills incurred by an employee as a result of work related injuries? Select one: A. $100, 000 B. $150,000 C. No limit D. $250,000 No limit An employee is injured on the job and is out of work for 10 days. How many days' wages can this employee recover? Select one: A. No recovery B. 5 days C. 3 days D. 10 days 3 days Am employee of ABC Financing altered and cashed a check for $2000. The loss is payable under which insuring agreement? Select one: A. No coverage 27 days Workers Compensation in Florida is regulated by: Select one: A. The Department of Labor B. The Department of Labor Security C. The Department of Labor & Employment Security D. The Division of Workers' Compensation of the Department of Financial Services The Division of Workers' Compensation of the Department of Financial Services Securities were purchased for $150,000. They were stolen and sold for $175,000. On the day the theft was reported the securities were valued at $162,000. How much would be paid? Select one: A. $150,000 B. No coverage C. $175,000 D. Conditionally renewable E. $162,000 $162,000 How many people can a private employment hire before they are required to purchase WC? Select one: A. 1 B. 4 C. 12 D. 8 4 Jettison is defined as: Select one: A. Fraud by the ship's master or crew B. Throwing cargo overboard to save the ship C. Taking the insured property by force D. Winds, waves, collision or sinking Throwing cargo overboard to save the ship Which Commercial Inland Marine policy protects those who ship and receive goods on an annual basis? Select one: A. Trip Transit B. Motor Truck Cargo C. Annual Transit D. Trailer Interchange Annual Transit All of the following are among the broad classes of Ocean Marine Insurance, EXCEPT: Select one: A. Cargo B. Barratry C. Freight D. Hull Barratry An insured wants to fly to Canada and then down to Mexico. Will he have coverage available for this trip? Select one: A. He cannot go outside the U.S. B. There is coverage in Canada, but not in Mexico C. There is coverage in Canada, and 100 miles into Mexico D. There is coverage in Mexico, but not in Canada There is coverage in Canada, and 100 miles into Mexico Admitted Liability is: Select one: A. Requires a legal action for injuries B. None of the above C. Applicable to passengers carried for hire D. Not applicable to passengers carried for hire Not applicable to passengers carried for hire The minimum basic liability limit for a Boiler and Machinery policy is: Select one: A. $500,000 B. $1,000,000 C. $250,000 D. $100,000 $500,000 he Valuation Clause in Boiler and Machinery coverage provides for replacement cost if: Select one: A. Property is repaired or replaced within 18 months B. Property is repaired or replaced within 24 months C. Property is repaired or replaced within 36 months D. Property is repaired or replaced within 48 months Property is repaired or replaced within 18 months Which Commercial Inland Marine policy would cover those who ship and receive goods on a single trip basis? Select one: A. Motor Truck Cargo B. Trip Transit C. Trailer Interchange D. Annual Transit Trip Transit One category of Commercial Inland Marine insurance is "Instrumentalities of Transportation and Communication. All of the following are covered under this form, EXCEPT: Select one: A. Tractor trailer trucks B. Pipelines C. Radio and TV towers D. Bridges and tunnels Tractor trailer trucks Covered losses in a Boiler and Machinery Policy include: Select one: A. Explosion, overheating, burning and cracking B. Leaking at the valve, fitting or shaft C. The functioning of a safety device D. Depletion, deterioration and wear and tear Explosion, overheating, burning and cracking The master of the ship voluntarily sacrifices the ship's cargo to save the ship. If the loss is settled with each interest paying a pro-rata share of the loss, it is known as: Select one: A. Sue and Labor B. Particular Average C. General Average D. Demurrage General Average Citizens Joe pays his health insurance premium on a monthly basis. If he forgets to pay this month's premium, how long will the policy remain in force after the premium date? Select one: A. 10 days B. It cancels immediately C. 31 days D. 7 days 10 days Under Medicare Supplement insurance, the maximum waiting period before coverage applies to pre- existing conditions is: Select one: A. 3 months B. 6 months C. 12 months D. 9 months 6 months An organization that provides comprehensive health services to its members for a prepaid fixed fee, equivalent to an insurance premium is: Select one: A. A Professional Practitioner Group B. A PPO C. A Health Managed Hospital D. An HMO An HMO Which is the largest limit available for commercial vehicles in the residual market? Select one: A. Any higher limits required by any law B. 100/300/50 C. 250/500/250 D. 250/500/100 Any higher limits required by any law Which of the following is not a requirement to qualify for the FWCJUA? Select one: A. Must have been unable to obtain coverage from at least three other carriers B. Must have been unable to obtain coverage from at least two other carriers C. Must not be indebted for any previous unpaid WC premiums D. Must be an employer Must have been unable to obtain coverage from at least three other carriers The Residual Market that is a source for persons who are unable to purchase auto insurance through normal channels is: Select one: A. FRPCJUA B. FWUA C. FWCJUA D. FAJUA FAJUA If a health insurance policy cannot be cancelled and can be renewed at the option of the insured to a stated age with no premium increases, this policy is: Select one: A. Guaranteed renewable B. Optionally renewable C. Noncancelable D. Conditionally renewable Noncancelable ane has a health insurance policy that prevents cancellation during the policy period, but reserves the right of the insurer to non-renew the policy once it expires. This is an example of: Select one: A. Conditionally renewable B. Noncancelable C. Optionally renewable D. Guaranteed renewable Optionally renewable Joe wrote a policy through the Florida Automobile Joint Underwriting Association, and the company issued the policy. What is the company issuing the policy called? Select one: A. A non-standard carrier B. A non-servicing carrier C. A servicing carrier D. A standard carrier A servicing carrier How is funding determined for Tier Three employers? Select one: A. It is based on an assessment of Tier Three participants B. None of the above C. It is based on an assessment of Tier One participants D. It is based on an assessment of Tier Two participants It is based on an assessment of Tier Three participants Bob has a basic health insurance policy. He has a covered accident in which he suffers an injury to his mouth that requires dental treatment. Which of the following is true? Select one: A. Dental expenses will be paid after the first $500 B. Dental expenses will not be paid C. Dental expenses will be paid after the first $100 D. Dental expenses will be paid Dental expenses will be paid Which is not a requirement for licensure as an adjuster? Select one: A. Be a bonafied resident of Florida B. Be appointed by a company C. Be appointed by an office manager D. Take an approved course and pass a state exam e appointed by a company If an adjuster terminates their insurance appointment, how long from the date of the termination do they have to reactivate their appointment? Select one: A. 5 years B. 4 years C. 3 years D. 1 year 4 years Which of the following is not one of the basic claims activities of the adjuster? Select one: A. Defining claims B. Negotiating claims C. Evaluating claims D. Investigating claims