Understanding Insurance Policies: Coverage, Exclusions, and Claims, Exams of Nursing

Download Understanding Insurance Policies: Coverage, Exclusions, and Claims and more Exams Nursing in PDF only on Docsity! 1 | P a g e SUPER-DUPER TEXAS ADJUSTER LICENSE EXAM 2024 WITH ACTUAL CORRECT QUESTIONS AND VERIFIED DETAILED ANSWERS |FREQUENTLY TESTED QUESTIONS AND SOLUTIONS |ALREADY GRADED A+|NEWEST |GUARANTEED PASS |LATEST UPDATE insurance Policy: What is an insurance binder? Proof of insurance given to the insured by the insurer until the actual policy can be created and delivered. Insurance Policy: An insurance binder provides evidence of coverage for up to _________ 30 days Insurance Policy: list the 6 basic contents of an insurance policy DDICEE Declarations Page, Definitions, Insuring Agreement, Conditions, Exclusions, Endorsements Insurance Policy: What is a unilateral contract? a contract where only one of the participating parties makes a promise to perform Insurance Policy: What 9 items are found on the declarations page of most insurance policies 1) Name of insured 2) Address of insured 3) Limits of Coverage 4) Description 5) Valuation and Location of Property 6) Cost of the Policy 7) Premium amounts 8) Deductibles 9) Policy number and dates of coverage 2 | P a g e Insurance Policy: Who receives any premium refund, cancellation and/or non-renewal notices of the insurance policy? 1st Named Insured -- they are responsible for upholding the duties and obligations of the policy agreement too Insurance Policy: List 3 other people who are covered under an insurance policy as "insured" 1) spouse who resides in insured's home 2) resident relatives 3) any person under the age of 21 who is in the care, or custody of any insured or named insured Insurance Policy: What is meant by "policy territory"? this is the geographic area in which the property must be damaged ( in inland marine policies) or where injury or damage must occur (liability policies) for coverage to apply. Insurance Policy: What is the significance of the "definitions" section in an insurance policy? This section outlines the specific meaning of certain terms that are contained in the policy and are there to provided clarification of the intent of the contract. Insurance Policy: What is meant by "conditions" in an insurance policy? This is the section of the insurance policy that details the responsibilities, limitations and obligations of the insurer and the insured. Insurance Policy: List two people who would have an insurable interest in the insured property 1) the insured 2) the mortgage or loan company if the property is being financed Insurance Policy: What does "insurable interest" refer to ? The financial loss a person will suffer when an event occurs Insurance Policy: How may the insurance company indemnify the insured if there is a loss to a pair or set? 1) Repair or replace any part OR 2) Pay the difference between the Actual Cash Value (ACV) or the property before and after the loss Insurance Policy: If there is a disagreement between the insured and the insurer on the amount of the loss, then either of them may make a written demand for what ? An Appraisal of the loss. Insurance Policy: Catastrophe claims have an extended deadline of ____ additional days 15 Insurance Policy: If a policyholder has a second policy providing property coverage, how does the settlement pay out if there is a claim? 5 | P a g e A person who is moving, holding or storing insured property for a fee such as a dry cleaners or an auto repair shop. if an insured's property is damaged at a bailee's location, then the bailee's insurance would pay for the dam age and not the insured's insurance policy. Loss Settlement Valuation: How is ACV (Actual Cash Value) calculated? ACV = RCV - depreciation Loss Settlement Valuation: Depreciation is always deducted from... the current value or replacement cost (not the original cost of the property) of the loss Loss Settlement Valuation: Replacement Cost Value (RCV) is when a loss is settled based on the current cost to replace the property with like kind and quality Loss Settlement Valuation: In an "agreed value" loss settlement, what does the insurer pay? The whole amount of the loss less any deductible Loss Settlement Valuation: In an "agreed value" loss settlement, when is the value agreed upon? ahead of time, and it cannot be adjusted later Loss Settlement Valuation: In an "agreed value" loss settlement, what happens with the co-insurance requirement? it is suspended Loss Settlement Valuation: In a "stated value" policy, the insurer agrees to pay the lessor of either: (1) the stated amount (2) the cost to repair or replace (3) the actual cash value Loss Settlement Valuation: In ___________________, the insurer agrees to pay the face value of the policy limit if there is a total loss regardless of the actual cash value (ACV) a "valued" policy Loss Settlement Valuation: What are the 2 purposes of a deductible? (1) to encourage loss control (2) To avoid small claims Loss Settlement Valuation: The ____________ is the self-insured portion of an insured loss and is taken off the final settlement amount before the settlement check is written. Deductible Adjusting losses: The insurance company's initial contact with the insured should be within ____ hours of receiving the claim 24 Adjusting losses: During a catastrophic situation, the insurance company must acknowledge receipt of a claim within _________ 6 | P a g e 30 Days Adjusting losses: Someone who is acting in the best interest of the principle, acting without self-interest and avoiding self-advancement at the expense of the represented party is said to be a _________________ fiduciary agent Adjusting losses: What is utmost good faith? working with all parties with honesty and integrity Adjusting losses: Can an adjuster be personally sued by an insured for unfair claims practices? yes. Adjusting losses: What is one thing that is noted in the course that you should never state in the claim file documentation of an insured and why? As an adjuster you should never state your opinion about the client or the claim in your records since these notes are discoverable in court. Adjusting losses: are the 4 ways to gather evidence that are noted in the course? (1) Document everything in writing (2) Take Photos (3) Take Samples (4) Witness statements Adjusting losses: All recorded statements that are gathered as evidence to help an adjuster settle a claim, must be _____________________ by the subjects in order to be valid as evidence expressly permitted Adjusting losses: Whose responsibility is it to prove a loss? the burden of proof for a loss lies with the insured Adjusting losses: What form is required by most insurance companies when submitting a claim for a loss? Proof of loss form Adjusting losses: what is initiated if the adjuster cannot get the insured to agree on the settlement range? A dispute resolution is initiated Adjusting losses: What two things are required of the insurance company if they deny a claim? (1) Written notification to be insured (2) Reason for the denial must be in the written notification. Settling Losses: Who is considered the 1st, 2nd, and 3rd Party in a claim? (1) Then Insured (2) The insurance company (insurer) (3) the party who is damaged by a covered event by the insured Settling Losses: How soon after a claim settlement amount is reached is the insurer to pay the claim? 7 | P a g e The insurer is required by law to pay the claim within 5 days after a claim settlement amount is reached. Settling Losses: ___________________________ method of claims settlement is used usually for paying LARGE amounts of money installment or structured settlement Settling Losses: Damage discovered during repairs must be covered by a ________________ Supplemental Claim. If additional damage is discovered during repairs of a covered claim, then the insurer should file a supplemental claim Settling Losses: If the insured and the insurance company cannot agree on the value of a covered loss, then either of them may ______________________________ request an appraisal Settling Losses: How many arbitrators are appointed to settle any disputes between the insured and the insurer and who pays the cost of the arbitrator(s)? 2 are appointed, 1 by the insured and the other by the insurer, to resolve the dispute and usually the cost is split between both parties Settling Losses: _____________ is when an insurance company seeks repayment of the damages cause d by a 3rd party Subrogation Settling Losses: What is "draft authority"? when an insurance company gives the adjuster the authority to use bank drafts on their behalf to settle a claim. Most insurance companies will give an adjuster draft authority to handle small claims. Settling Losses: The insurer has ___ days to either deny or settle a claim 15 Dwelling Policy: If an insured wants to have personal liability coverage for their dwelling, how would this be covered? Since personal liability coverage is not automatically included in a dwelling policy, it can be added by endorsement. Dwelling Policy: __________________ provide protection for a property that the insured owns but does not occupy Dwelling policies Dwelling Policy: Name the 5 eligible properties for a dwelling policy (1) 1,2,3,4 Family homes and apartments (2) Dwellings with up to 5 roomers or boarders (3) Permanently installed mobile homes or trailers 10 | P a g e WCSHAVVER perils 1) Windstorm 2) Civil Disorder 3) Smoke 4) Hail 5) Aircraft 6) Vehicles 7) Volcano 8) Explosion 9) Riot Dwelling Policy: Vandalism/Malicious Mischief (V/MM) only covers willful or intentional acts Dwelling Policy: What is specifically not covered under V/MM? related glass breakage and theft Dwelling Policy: What are the BIG AFFECT covered perils? 1) Burglar damage 2) Ice and Snow Weight 3) Glass Breakage 4) Accidental Discharge 5) Falling Objects 6) Freezing of Pipes 7) Electrical Damage 8) Collapse 9) Tearing Apart Dwelling Policy: In regard to insurance perils, what is the definition of collapse? Collapse is an abrupt falling down or caving in of a building Dwelling Policy: What is not covered as a part of the Ice and Snow Weight peril? most outside and below ground structures such as awnings, fences, patios, pavement, swimming pools, foundations, retaining walls, bulkheads, wharves, docks, and piers Dwelling Policy: What are the 9 generally excluded perils in a Dwelling policy? 1) Ordinance or law 2) Earth movement -- earthquakes 3) Water damage -- floods 4) Power Failure 5) Neglect 6) War 7) Nuclear Hazard 11 | P a g e 8) Intentional loss 9) Theft Dwelling Policy: What can happen to the insurance policy if the insured has intentionally concealed or misrepresented any material fact or engaged in fraudulent conduct in regards to the insurance policy The policy can be voided Dwelling Policy: If a mortgagee is named on an insurance policy, how will the settlement check be made out? The settlement check will include the named insured and the name of the mortgagee Dwelling Policy: What is the liberalization clause? The liberalization clause states that if the insurer makes a change to a coverage of an existing policy that broadens the coverage, then this change will automatically apply to the insured's policy as of the date of implementation of the change. Dwelling Policy: DP-1 Basic Form loss Settlement ACV on Dwelling, Appurtenant Structures, & Personal Property (Contents) Dwelling Policy: DP-2 Broad Form loss settlement RCV on Dwelling & Appurtenant Structures, ACV on Personal Property (Contents) Dwelling Policy: DP-3 Special Form loss settlement RCV on Dwelling & Appurtenant Structures, ACV on Personal Property (Contents) Dwelling Policy: What is the method of requiring the insured to insure at least 80% (or another stated amount set by the insurance company) of the value of the covered property? This is the co-insurance clause Dwelling Policy: What happens if the insured co-insures for less than 80% and there is a loss? Then the insurance company only insures for the amount that is proportionate to the RCV -- the insured would be responsible for part of the loss Dwelling Policy: What is the payout calculation that is used to determine the payout of a loss that is co- insured? (Had / should have had) * amount of loss - deductible = payout Dwelling Policy: Insured has property valued at $125,000 and has insured it at $90,000 and has a loss of $10,000 by a covered peril with a $1,000 deductible what's the payout? (90,000/100,000)*10,000 - 1,000 = $8,000 Dwelling Policy: What would the insured have to insure a property valued at $200,000 to satisfy the coinsurance requirement? 12 | P a g e $160,000 Dwelling Policy: What property is TWIA referring to when it references Tier I? the counties that border the Gulf of Mexico Dwelling Policy: What 3 things are excluded from TWIA coverage and eligibility? Atennas, radio towers, and masts Homeowners Policy: Does a standard fire policy only cover the peril of fire? No. It can cover the basic perils of a homeowners policy such as lightning, explosion, etc. Homeowners Policy: In a homeowner policy, what is the maximum number of roomers or boarders allowed for a home to be eligible for a homeowners policy? The maximum number is 2 as opposed to a dwelling policy, where the maximum number is 5 Homeowners Policy: What are the 3 factors in determining eligibility for a homeowners policy? (1) Dwelling Type (2) Intended use of the dwelling (3) Occupancy of the dwelling Homeowners Policy: What are the 7 listed eligible dwellings for a homeowners policy? (1) Townhome that is owner occupied (2) Home under construction that the owner intends to occupy (3) Duplex that is owner occupied (4) On Co-owner occupant of a two-family dwelling (5) A person occupying and purchasing a home under a sales contract (6) Structures with no more than 2 roomers or boarders per family (7) Seasonal or secondary residences -- lake house, cabin, beach house, etc. Homeowners Policy: Coverage types for HO-A > Coverage A: Dwelling and Appurtenant Structures: Named Peril > Coverage B: Personal Property (Contents): Named Peril Homeowners Policy: Coverage types for HO-B > Coverage A: Dwelling and Appurtenant Structures: Open Peril / All Risk > Coverage B: Personal Property (Contents): Named Peril Homeowners Policy: Coverage types for HO- C > Coverage A: Dwelling and Appurtenant Structures: Open Peril / All Risk > Coverage B: Personal Property (Contents): Open Peril / All Risk 15 | P a g e It provides coverage proportional to the value of the property at each location to the total value covered under Coverage B Homeowners Policy: What are the covered perils in a HO-A policy WCSHAVVER, V/MM, Fire & Lightning and Theft Homeowners Policy: What additional 4 perils are covered in an HO-B policy (1) Collapse of Building (2) Accidental discharge, leakage or overflow of water or stream (3) Falling objects (4) Freezing of household appliances Homeowners Policy: Be familiar with the HO-A, HO-B, and HO-C perils exclusions -name 16 1. Electrical devices or wiring caused by electricity other than lighting 2. Flood/water damage 3. Earth Movement 4. Governmental action 5. Ordinance or law 6. War 7. Nuclear damage 8. Mold 9. Neglect 10. Windstorm, hurricane or hail loss to awnings, greenhouses, antennas, radio towers 11. Mechanical Breakdown 12. Wear and Tear, Rust or rot 13. rats, mice, termites, moths, or other insects 14.Freezing while building is unoccupied 15. Loss caused by settling, cracking, bulging, shrinkage or expansion of swimming pools, curbs, etc. 16. Loss cause by breakage, marring or scratching of fragile articles such as statuary, marble, glassware, etc. Homeowners Policy: What is Scheduled Personal Property (Personal Article Floater) replaces coverage of all items listed in the endorsement. Also note that it is not additional coverage. Homeowners Policy: Coverage C - liability Coverage and Coverage D - Medical Payments to Others of a homeowners policy provides coverage to whom? to third parties, not the insured himself Homeowners Policy: Property Damage to Others additional coverage of a homeowners policy does not apply to property damage intentionally caused by an insured who is _________ or older 13 years Homeowners Policy: What happens to the obligation of the insurer when the insured has filed for bankruptcy? 16 | P a g e The insurer is still liable to fulfill their responsibilities even if the insured or the insured's estate files for bankruptcy. Homeowners Policy: The insurance company can cancel a policy for what 3 reasons? (1) Late premium payment (2) Insured commits fraud in regard to insurance coverage (3) Increase in hazard covered that is within the insured's control Homeowners Policy: What must the insurer provide to the insured if they are cancelling the insured's insurance policy? A written notice explaining the reasons for the cancellation Homeowners Policy: List 5 common HO endorsements Personal Articles Floater, Earthquake, Sinkhole, Sewer Backup and Tree & Shrub Homeowners Policy: When settling losses in a personal articles floater, the insurer settles the lesser of what 3 amounts? ACV, Cost to repair or replace the item, or coverage limit Flood Policy: The NFIP definition of flood is a general and temporary condition of partial or complete inundation of two or more acres of normally dry land area or of two or more properties from: (1) Overflow of inland or tidal waters (2) Unusual and rapid accumulation or runoff of surface waters from any source (3) Mudflow or mudslides Flood Policy: a flood is not a) Subsidence b) Landslide c) Sewer overflow Farm Policy: What type of farm animal is specifically not covered under the farm definition of "livestock"? Birds -- they are covered under the definition of "poultry" Crop Insurance: Crop Insurance only covers _________ crops. ___________ crops are covered by a Farm and Ranch policy growing, Harvested Crop Insurance: In crop insurance, there are two different coverages provided These coverages are: (1) Crop-yield insurance (2) Crop-revenue insurance Personal Auto Policy: What are the 5 eligible vehicles that can be covered under a Personal Auto Policy? 17 | P a g e (1) Personal Vehicles (2) Four-Wheel vehicles weighing 10,000 or less and not used for business purposes (3) Leased vehicles for at least 6 consecutive months (4) Temporary substitute vehicle, i.e. rental car when covered auto is being repaired (5) Three-wheeled vehicle used in a medical emergency only Personal Auto Policy: Most standard PAP cover which three common territories? US, its territories and possessions Puerto Rico, and Canada --Mexico not covered-- Personal Auto Policy: Be familiar with types of vehicles that are considered a "covered auto" in a PAP policy a) Any vehicle shown on Declarations pages b) A newly acquired auto c) Any trailer designed to be pulled by a private passenger auto or pickup of van or a farm wagon or farm implement while towed by the above listed vehicle d) Any auto or trailer you do not own while used as a temporary substitute for any other vehicle described in the definition which is out of normal use because of its: breakdown, repair, servicing, loss or destruction Personal Auto Policy: What are the Texas minimum limits of liability as of 2012 ? 30/60/25 Personal Auto Policy: What does 30/50/15 mean 30k max bodily injury per person/ 50k total bodily injury coverage per accident/ 15K max property damage per accident for a vehicle other than the insured's Personal Auto Policy: are vehicle contents covered under a PAP? No -- Any vehicle contents such as clothing, laptop, etc, would be covered under a homeowners or renters policy Personal Auto Policy: Supplementary Payments in a PAP cover what 5 things? Up to $250 for bail bonds Defense costs Accrued interest Up to $200/day for loss of earnings Other reasonable expenses incurred Personal Auto Policy: Are vehicles used for the purpose of competing in or practicing or preparing for a racing or speed contest covered under a PAP? No -- these vehicles are specifically excluded from coverage Personal Auto Policy: Part B -- Medical Payments in a PAP covers the following people 20 | P a g e Business Owners' Policy: Who are the 9 people listed as an "insured" in a BOP? (1) Sole owner of business and their spouse (2) Members, partners, and their spouses if the business is a partnership or joint venture (3) Members and managers if the business is a limited liability company (4) Executive officers, directors and stockholders if the business is an organization that is a partnership, joint venture, or limited liability company (5) Volunteer workers while performing duties related to the conduct of the business (6) Employees of the business (7) any person or organization while acting as the insured's real estate manager (8) Any Person who is driving any motor vehicle registered with the business along a public highway with your permission (9) Any person or organization responsible for the conduct of the person listed in #8 above Business Owners' Policy: Materials and supplies that are within __________ of the insured premises used to repair or construct the building on the premises are covered in a BOP 100 feet Business Owners' Policy: List some personal property that is used to maintain the building that is covered under Coverage A - Buildings and structures of a BOP Fire Extinguisher, cooling system, floor coverings, dishwasher, refrigerator, et cetera Business Owners' Policy: In order for it to be covered in a BOP , machinery and equipment must be permanently installed Business Owners' Policy: Are additions to the original building covered in a BOP? Yes - all additions that are either complete or under construction are covered. Business Owners' Policy: Are outdoor signs covered in a BOP? Yes, only if they are attached to the insured building although signs not attached can be covered by an endorsement Business Owners' Policy: List some business personal property that is covered in Coverage B of a BOP Desk, filing, cabinets, inventory, office supplies, et cetera Business Owners' Policy: Does a BOP provide coverage for a business auto? No, it would be covered under a commercial auto policy Business Owners' Policy: Preservation of Property is covered for ____ days after it is first moved 30 days Business Owners' Policy: The Debris Removal additional coverage in a BOP can cover up to an additional ________ for debris removal expense of each location if the insured exceeds their building or business personal property limit 21 | P a g e $10,000 Business Owners' Policy: The Fire Department Service Charge covers up to ________ for charges $1,000 Business Owners' Policy: The business income additional coverage in a BOP covers actual loss of... business income (net income) Business Owners' Policy: The business income additional coverage in a BOP covers extra expense to the extent they ... reduce the business interruption loss Business Owners' Policy: The business income additional coverage in a BOP have a waiting period of 72 hours Business Owners' Policy: The business income additional coverage in a BOP covers a loss up to _______________________ after the date of the direct physical loss or damage 12 consecutive months Business Owners' Policy: The business income additional coverage in a BOP covers ordinary payroll expenses for _________ following the date of the direct loss or damage 60 days Business Owners' Policy: What three costs does the "extra expense" additional coverage cover in a BOP? (1) Any necessary extra expense insured might incur to continue doing business during the period of restoration (2) Cost to relocate temporarily or permanently (3) Research costs to replace lost information Business Owners' Policy: In regards to the "civil authority" additional coverage in a BOP, how long does coverage apply after the 72-hour waiting period has elapsed? Coverage applies for up to three consecutive weeks Business Owners' Policy: What are the 7 BOP exclusions listed in the course? Ordinance or law, earth movement, governmental action, nuclear hazard, power failure, war, flood/water damage. Business Owners' Policy: What are the 3 losses that are not covered in a BOP regarding Accounts Receivable? (1) Loss or damages that is caused by or resulting from falsifying, concealing or destroying accounts receivable records to cover up the wrongful giving, taking or withholding of money, securities or other property 22 | P a g e (2) Loss caused by bookkeeping or accounting errors or omissions (3) Loss recognized by an audit of records or inventory Business Owners' Policy: Which clause in an insurance policy, strictly prohibits property from being abandoned? The abandonment clause Business Owners' Policy: In a BOP, what are the 4 listed Section I - Property: Optional Coverages? (1) Outdoor signs (2) Money and securities (3) employee dishonesty (4) mechanical breakdown (boiler & machinery) Business Owners' Policy: Personal and advertising injury liability arises out of certain offenses such as: invasion of privacy, slander, libel, et cetera Business Owners' Policy: In Section II - Liability: Supplementary Payments of a BOP, what is the maximum per day that the insurer will pay for an insured's loss of earnings? $250/day Business Owners' Policy: How does a BOP handle expected or intended injury? This liability coverage is specifically excluded in a BOP Business Owners' Policy: How is a "volunteer worker" defined by a BOP (a) Someone who donates their work and time under the insured's direction (b) Is not one of the insured's business employees (c) Is not compensated for their time in any form or fashion Business Owners' Policy: What is required to transfer the rights and duties of the insured in a policy to someone else? Written consent of the insurer Commercial General Liability: Commercial General Liability covers claims of bodily injury or other physical injury or property damage to whom? To other - it does not cover damage or injury to the insured or the insured's property Commercial General Liability: Does a CGL policy cover assault and battery if committed by an insured No Commercial General Liability: Coverages A & B of a CGL provide coverage for what? Coverage A - Bodily Injury and Property Damage Liability and Coverage B - Personal and Advertising Injury 25 | P a g e Bonds/Surety: who is considered the surety in a surety bond? The one who guarantees the performance of the principal to the obligee -- usually a bonding agency. The surety is also the one who will pay the obligee if the principal does not perform Bonds/Surety: If the principal does not fulfill the contractual agreement, who will be paid for the loss or damage? The obligee -- the person receiving the work performed. Bonds/Surety: A contract bond is sometimes referred to as a ___________________ and they are provided to guarantee the _________________________________________ construction bond, fulfillment of a contractual agreement Bonds/Surety: A _____ bond assures the obligee that the bidder will perform the job if chosen bid Bonds/Surety: A _____________ bond guarantees that the work done by a contractor (principal) is without defects for a specified amount of time after completion. maintenance Bonds/Surety: A _____________ bond guarantees no financial loss to the obligee if the contractor (principal) does not satisfactorily complete the project performance Bonds/Surety: A ____________ bond guarantees the surety that the work will be completed free and clear of any liens. completion Ocean Marine Insurance: What are the 4 ocean marine coverages and what do they each cover? (1) Hull insurance -- covers the ship itself (2) Cargo insurance -- covers a vessel's cargo while in transit over water (3) Freight insurance -- covers the cost of the shipping (4) Protection and Indemnity (P&I) -- provides marine liability insurance for injuries to passengers, crew members or persons on other ships; job-related injures to sailors; injuries to stevedores, etc; and damage to cargo, docks, ships, or other property. Ocean Marine Insurance: What is barratry in Ocean Marine insurance? illegal acts (including hijacking, abandonment & embezzlement) committed willfully by a ship's master or crew for the purpose of damaging the ship or cargo Ocean Marine Insurance: What is jettison? a voluntary action to rid the ship of cargo in order to prevent further damage or peril 26 | P a g e Ocean Marine Insurance: What coverage does the "running down" clause provide in an Ocean Marine policy? Covers collision damage to another vessel or its cargo, but does not cover bodily injury or damage to property such as harbors , piers, et cetera Inland Marine Insurance: Any property that has an "element of _____________ is eligible for inland marine coverage. portability Inland Marine Insurance: what perils are insured against in an "annual transit" policy? Fire, windstorm, collision, theft Inland Marine Insurance: Give some examples of some items that can be covered with a Personal Articles Floaters (PAF) Jewelry, furs, cameras, musical instruments, golf equipment, stamps et cetera Inland Marine Insurance: What Inland Marine coverage form provides for open peril/all risk coverage for specific items of personal property that are "scheduled" Personal Articles Floater Inland Marine Insurance: What Inland Marine coverage form provides for open peril/all risk coverage with a blanket maximum limit for categories of property? Personal Property Floater. the property in this coverage form would be "unscheduled" Inland Marine Insurance: What does the business floater "Valuable Papers and Records Coverage Form" provide coverage for ? Damage or loss to any valuable papers such as books, deeds, maps, manuscripts, files, mortgages et cetera Inland Marine Insurance: What inland marine coverage form provides coverage for money that cannot be collected from customers because of damage that has been incurred to the insured's accounts receivable records? Accounts Receivable Coverage Form Aviation Insurance: What aviation coverage provides coverage for loss or damage to the aircraft itself? Hull coverage Aviation Insurance: What aviation coverage provides coverage for property damage to or loss of the aircraft of others in the insured's care, custody, or control or while the aircraft is being serviced, handles or repaired by the insured on the insured's premises? Hangarkeeper's Liability coverage Worker's Compensation Insurance: Why was Workers' Compensation insured created? 27 | P a g e To provide a way that work-related injuries or illnesses could be compensated for without the employer having a civil suit brought against him by the injured employee. (WC.1) Worker's Compensation Insurance: What does WC insurance cover? All work-related injuries or illnesses regardless of fault. (WC.1) Worker's Compensation Insurance: What are the 5 listed "injuries covered" under WC insurance? (WC.6) (1) Bodily injury that arises out of employment or in the course of employment (2) Occupational disease that is unique to the occupation (3) Bodily injury or illness that occurs on the premises of the business or away from the business while performing work duties (4) Repetitive stress injuries (5) May sometimes apply if a pre-existing physical condition is made worse through the course of work duties Worker's Compensation Insurance: What are the 6 listed "injuries not covered" under WC insurance? (1)Intentional injuries (2) off-duty work-related or work-sponsored social, athletic or recreational events unless participation is required by the employer (3) Mental or nervous injury due to fright or excitement only (4) Injury arising from voluntary intoxication (5) Injury caused by horseplay (6) Diseases due to habitual drug and alcohol use Worker's Compensation Insurance: What are the 4 types of WC benefits? (1) Income (2) Medical (3) Death (4) Burial Worker's Compensation Insurance: No workers' comp benefits are paid if within ________ of an injury an employee is able to return to work 7 days Worker's Compensation Insurance: If a disability continues for _________________, then the workers' comp benefits are retroactive to the date of the disability 4 or more weeks Worker's Compensation Insurance: Income benefits are usually _____ of the employee's salary at the time of injury 75% Worker's Compensation Insurance: List and define the 4 classifications of disability in a workers' comp insurance policy 30 | P a g e 6. vehicle damage 7. aircraft damage 8. vandalism/malicious mischief (V/MM) 9. falling objects 10. weight of snow, ice or sleet 11. sudden and accidental water damage from plumbing, heating, or A/C overflow 12. freezing damage to plumbing 13. riots 14. civil disobedience Insurance: What is a hazard? situations or behaviors that increase the risk of loss of property Insurance: Name the three kinds of hazards and give an example of each 1) Physical -- large hole in the front yard where someone could step in and hurt themselves 2) Morale -- leaving a home with the doors unlocked and the windows opened 3) Moral -- embezzlement Insurance: List and define the 2 types of losses 1) Direct loss -- damage that is a direct result of a covered peril such as a fire destroying a home 2) Indirect loss -- consequential loss resulting indirectly from a direct loss due to a covered peril such as loss of business income or loss of use Claims Adjuster: What is a Staff/Company Adjuster? work for the insurance company such as State Farm and handle claims on behalf of the insurer; they are paid a salary with benefits. Claims Adjuster: What is an Independent Adjuster? work for the insurance companies to handle and evaluate certain claims on an as-needed basis; they are paid a percentage of the claims they settle Claims Adjuster: What is a Public Adjuster? work for the insured to make an evaluation of loss to be presented to the insurer; they are paid on a fee basis (usually 10%) and are usually required to carry an adjuster bond Claims Adjuster: CAT ( catastrophic) Adjusters represent the insurance company that hired the catastrophic adjusting company that you are doing claims for Claims Adjuster: 11 things that a claims adjuster may do 1) Determine coverage 2) determine amount of damage 31 | P a g e 3) prepare report of findings 4) Try to work out a fair settlement 5) prepare a claim file 6) interview with insured and/or witnesses 7) inspect and estimate property damage or loss 8) consult police, fire dept. and medical reports 9) take pictures and draw diagrams 10) make advance settlement payments 11) attend court hearings if necessary Claims Adjuster: 4 educational requirements that are suggested for adjusters to have 1) a combination of related education and on-the-job experience 2) at least a high school diploma 3) some post high school education is an asset 4) a valid driver's license Claims Adjuster: Initial contact with the insured should be within __________ of receiving the claim. 24 hours Claims Adjuster: The insurer has _________ to respond to a claim during non-catastrophic situations. 15 days Claims Adjuster: During catastrophic situations, the insurer has _________ to respond to a claim. 30 days Claims Adjuster: Adjusters are __________________ for they act in the best interest of the principle and not in their own best interest. Fiduciary Agents Claims Adjuster: Can adjusters be sued by the client/insured ? Yes, adjusters can be sued personally for unfair claims practices. Claims Adjuster: Define Utmost Good Faith When the adjuster and the insured are working together with honesty and integrity Claims Adjuster: Is it considered ethical for an adjuster to adjust for family members and/or friends? No -- this would be considered a conflict of interest Licensing Requirements: Name the 6 licensing requirements according to the Texas Statutes for a Texas Adjuster License? 1) must be at least 18 years of age or older 2) must be trustworthy 3) must reside in the state practicing in or in one that has reciprocity 32 | P a g e 4) must submit appropriate application and fees to the state of Texas 5) must complete an approved pre-licensing course 6) must successfully pass a state approved examination Licensing Requirements: Persons holding which 2 designations are exempt from the requirements of an adjuster's license examination? chartered property casualty underwriter or associate in claims Licensing Requirements: list the 3 adjuster licenses available in Texas 1) all-lines adjuster 2) property & casualty adjuster 3) Worker's Compensation Adjuster Licensing Requirements: How many CE hours are required every two years? 24 hours (at least 12 of them must be from classroom equivalent approved courses) Licensing Requirements: How many of the 24 CE hours have to be Ethics or Consumer Protection? 2 hours Licensing Requirements: How often is the Texas Adjuster's License to be renewed? Every 2 years and the renewal date is the licensee's birthdate Licensing Requirements: If you have an expired license of less than _________ then you do not have to retake the exam or reapply for a new license. 90 Days Licensing Requirements: What is the fine per hour for deficient CE credits? $50/CE hour Licensing Requirements: What is the grace period for deficient CE hours? there is no grace period, you would just pay a fine of $50 per hour, but you are still required to complete all 24 of CE before your license can be renewed. Licensing Requirements: If extra CE credits are earned above and beyond the required number in a reporting period, can those be carried over to the next reporting period? no -- the required 24 hours must be earned within the 2 year reporting period Licensing Requirements: Name 6 reasons for an adjuster's license to be revoked 1) has communicated fraudulent information on his licensing application 2) has had his adjuster's license revoked in another state 3) has misrepresented the terms of a policy to an insured while working a claim 4) makes a false statement on a claim 5) has committed a felony 6) has committed a misdemeanor in connection with his duties as an adjuster Contracts: What 5 things does a legally enforceable contract include?