Insurance and Adjustment: Florida Public Adjuster State Test Solutions, Exams of Advanced Education

Download Insurance and Adjustment: Florida Public Adjuster State Test Solutions and more Exams Advanced Education in PDF only on Docsity! Florida Public Adjuster State Test (2023 – 2024) Complete Solutions Florida No-Fault Tort Exemption - Those who comply with the law are granted limited immunity from suits of others through PIP coverage. 4 Exceptions to Tort Exemption(Threshold of No-Fault) - 1. Significant and Permanent loss of bodily function. 2.Permanent injury other than scarring and disfigurement. 3.Significant and Permanent scarring or disfigurement. 4.Death What does NFIP stand for? - National Flood Insurance Program Form SR-22 - Drivers Convicted of DUI or a traffic felony over the prior 3 years are required to have 100/300/50 coverage or a certificate of self insurance of $350,000. Contents of a CGL Contract - 1.Declarations Form 2.Common Policy Conditions Form 3. One of: A.Occurrence Form B.Claims Made Form 4.Nuclear Energy Liability Exclusion Endorsement. Declarations of a CGL Contract(4) - 1.Named Insured(including address) 2.Policy Period 3.Premium 4.Limits of Coverage 7 Common CGL Conditions - 1.Cancellation(30 Days by insurer option, 10 Days By no payment). 2.Changes 3.Examination of Books 4.Inspections and Surveys 5.Premiums 6.Transfer 7.Nuclear Endorsement CGL Coverage A - Bodily Injury and Property Damage Insuring Agreement The 3 Conditions that define work as "completed" - 1.When all work called for in the contract is completed. 2.When all work to be done at the site has been completed if one contract calls for work at more than one site. 3.When that part of the work done at a job site has been put to its intended use by any person or organization other than another contractor or subcontractor. Occurance - An accident, including continuous or repeated exposure to substantially the same general harmful conditions. accident - Sudden, unexpected event The Difference between "Occurance" and "Claims Made" CGL Coverages - The Coverage Trigger: The Occurance Form applies to BI and PD regardless of any later time at which the claim is made. The Claims-Made Form applies only to BI and PD that occurs on or after the "Retro-Active date" What is the most important Condition that has direct impact on Homeowners Coverage? - Loss Settlement When might "Loss Settlement" cover buildings under Coverages A & B to Full Replacement Cost? - If the limit of Insurance at the time of Loss is equal to 80% or more of the replacement value of the building. Statute that requires that when Property is Insured for replacement cost is deemed a total loss, the full replacement cost without reservation or holdback of depreciation must be paid. - 627.7011 627.7011 - Statute that requires that when Property Insured for replacement cost is deemed a total loss, the full replacement cost without reservation or holdback of depreciation must be paid. Four Additional Homeowners Coverages - 1. Claims Expense 2. First Aid Expenses 3. Damage to Property of Others 4. Loss Assessment Does Hurricane Coverage Occur on a Per Occurrence or an Annual Basis - An annual basis What if there is more than one applicable deductible? - Only the highest deductible applies. What must the Insured do if they wish to completely reject Windstorm Coverage? - Hand write "I DO NOT WANT THE INSURANCE ON MY (HOME/MOBILE HOME/CONDOMINIUM UNIT) TO PAY FOR DAMAGE FROM WINDSTORMS OR HURRICANES. I WILL PAY THOSE COSTS. MY INSURANCE WILL NOT." How much notice must the insurer give the insured of non-renewal of a homeowner's Policy? - 120 Days 4 Elements of a Valid Contract? - 1.A manifestation of assent to its terms by parties who make the contract. 2.A sufficient consideration (value or payment) for each promise. 3.Legal Capacity of the parties to contract. 4.Legal Subject matter. Insurance - A contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit upon determinable contingencies. 4 Elements of an Insurance Contract - D.I.C.E. 1.Declarations 2.the Insuring Agreement 3.Exclusions 4.Conditions Example of Subrogation - Insurance Company pays the victim and collects for the DUIer or liable party of any sort. Example of Severability - Tom and Eva are insured for liability of injury. Tom intentionally injured someone(intention voiding coverage for Tom), Eva is still covered. Valued Policy Law - The value of the property is agreed to as part of the policy. Coinsurance - A policy for less than the entire value of the insured property and cover pro-rata whether or not other insurance exists. 80% actually means (pro-rata share)/80% Beginning statement of a liability insurance policy - Insurer agrees "to pay on behalf of the insured all sums the insured becomes legally obligated to pay as damages" or equivalent wording. Three Ways in which the limits to a liability insurance policy Insuring Agreement can be expressed? - 1.single limit 2.split limit 3.Aggregate limit 2 Types of Tort Liability - 1.Negligent Liability(Unintentional) 2.Strict Liability(Intentional) What is the difference between Common Law and Statute Law? - Common Law is based on stare decisis, whereas statutory law is explicit with a statute number. What are the two broad classifications of damages that a plaintiff can seek in an action for money damages? - 1.Compensatory 2.Punitive Two main defenses against Negligence - 1. Assumption of Risk 2.Comparative Negligence Why is it common to have the attorney's name on the settlement draft? - Because should the insurer pay over the money solely to the claimant, the attorney may sue the company for the fee. Contracts wherein the parties are of unequal bargaining power are called? - Contracts of Adhesion What is the rule of law's attempt to counter balance a contract of Adhesion? - To have any ambiguities resolved in favor of the insured. How long must the Public Adjuster keep his written estimate of the claimant's Loss. - 5 years If a time consuming process to resolution is more lucrative, may the Public Adjuster loan the client an advance on the claim? - No. (626.854(8)). Can the Public Adjuster acquire an interest in Salvaged Property, for example as payment for Services? - Not without written consent and a signed affidavit. (626.854(11)) Insurer's 3 Goals when handling a claim - 1. Comply with the Contract 2. Control Costs 3. Cultivate Good Customer Relations 3 Basic Claims Handling activities? - 1. Investigate 2.Evaluate 3.Negotiate 5 Technical Expertise for a successful negotiation - 1.The Insurance Contract 2.Reparable from replacement requiring damages. 3.Law 4.Insurer's goals 5.Computer Estimating Systems being utilized by the insurance industry. Duration of the statute of limitations to claim windstorm damage. - 3 years (627.70132) 5 Questions to establish the contract coverage - 1.Did a covered Peril Occur? 2.When? 3.Were there more than one? 4.Which one was the proximate cause? 5.Was there a mix of covered and uncovered losses? 5 Ways to appraise damages - 1.Survey and Estimate of Determination 2.Acceptance of Cost or Quality shown by records. 3.Actual repair or replacement 4.Sale of Salvage 5.Appraisal(after 2 parties have failed to agree). 7 Settlement and Release Options - 1.Full release Settlement 2.Open Ended Release 3.Payment of PD, BI pending 4.No Release 5.Advanced Payment 6.Structured Settlement 7.Rehabilitation, including provisions for rehabilitative treatment of the claimant. What is called when 2 or more contracts cover the same claim and have to pay proportionate amounts? - Apportionment What are the principles that guide apportionment to avoid controversy that could delay adjustment called? - Guiding Principles What is the maximum injury to a minor that can be settled out of court, preferably with both parents. - $15,000 (statute 744.387) A contract by whereby the person executing the instrument gives up a right, claim or privilege to the person against whom it might have been demanded or enforced is called a: - Release What must a release be supported by to be a binding contract? - Valuable Consideration 5 Practices that the Insured are protected from under the "Florida Unfair Insurance Trade Practices Act." - 1.failing to act promptly 2.denying claims without reasonable investigation 3.failure to affirm or deny a claim when an insured is entitled thereto 4.failure to explain claim denials in writing 5.failure to maintain complaint-handling procedures, such as keeping accurate records of complaints. The Department requires each adjusting form and each of it's branches to designate an Adjuster to be responsible for the supervision of all individuals within an adjusting firm. This individual is called the: - Primary Adjuster(626.8695) How long do Insurance Companies have to acknowledge Claims? - 14 Days(627.70131) How long do Insurance Companies have to pay or deny property claims? - 90 Days 7 Ethics to the code of Ethics - 1. No negotiating with an attorney's client. 2. No misleading in any way. 3.No legal advice 4.No special releases, fill in the blanks only 5.No exploiting incapacitated clients 6.Advise the client of rights under the contract and by the state. 7.Act with no bias.