Texas Insurance Exam Content Outlines for Property, Casualty, and Workers' Comp Adjusting, Lecture notes of Business

Download Texas Insurance Exam Content Outlines for Property, Casualty, and Workers' Comp Adjusting and more Lecture notes Business in PDF only on Docsity! TEXAS Insurance Supplement - Examination Content Outlines Effective: September 1, 2021 S1 TEXAS Insurance Supplement Examination Content Outlines Effective: September 1, 2021 LIFE-GENERAL KNOWLEDGE CONTENT OUTLINE Product Knowledge, Terms and Concepts (50 scoreable questions plus 10 pretest questions) I. TYPES OF POLICIES ......................................................... 12 A. Traditional whole life products 1. Ordinary whole life 2. Limited-pay and single-premium life B. Interest/market-sensitive/adjustable life products 1. Universal life 2. Variable whole life 3. Variable universal life 4. Interest-sensitive whole life 5. Indexed life C. Term life 1. Types a. Level b. Decreasing c. Return of premium d. Annually renewable 2. Special features a. Renewable b. Convertible D. Annuities 1. Single and flexible premium 2. Immediate and deferred 3. Fixed and variable 4. Indexed E. Combination plans and variations 1. Joint life 2. Survivorship life (second to die) II. POLICY RIDERS, PROVISIONS, OPTIONS, AND EXCLUSIONS………………………………………..18 A. Policy riders 1. Waiver of premium and waiver of monthly deduction 2. Guaranteed insurability 3. Payor benefit 4. Accidental death and/or accidental death and dismemberment 5. Term riders 6. Other insureds 7. Long term care 8. Return of premium B. Policy provisions and options 1. Entire contract 2. Insuring clause 3. Free look 4. Consideration 5. Owner’s rights 6. Beneficiary designations a. Primary and contingent b. Revocable and irrevocable a. Common disaster b. Minor beneficiaries 2. Premium Payment a. Modes b. Grace period c. Automatic premium loan d. Level or flexible 8. Reinstatement 9. Policy loans, withdrawals, partial surrenders 10. Non-forfeiture options 11. Dividends and dividend options (eg. participating, non-participating) 12. Incontestability 13. Assignments 14. Suicide 15. Misstatement of age and gender 16. Settlement options 17. Accelerated death benefits C. Policy exclusions III. COMPLETING THE APPLICATION, UNDERWRITING, AND DELIVERING THE POLICES…. ........................... 12 A. Completing the application 1. Required signatures 2. Changes in the application 3. Consequences of incomplete applications 4. Warranties and representations 5. Collecting the initial premium and issuing the receipt 6. Replacement 7. Disclosures at point of sale (e.g., HIPAA, HIV consent) 8. USA PATRIOT Act/anti-money laundering B. Underwriting 1. Insurable interest 2. Medical information and consumer reports 3. Fair Credit Reporting Act 4. Risk classification 5. Stranger/Investor-owned life insurance (STOLI/IOLI) C. Delivering the policy 1. When coverage begins 2. Explaining the policy and its provisions, riders, exclusions, and ratings to the client D. Contract law 1. Elements of a contract 2. Unique aspects of the insurance contract TEXAS Insurance Supplement - Examination Content Outlines Effective: September 1, 2021 S2 a. Conditional b. Unilateral c. Adhesion d. Aleatory IV. TAXES, RETIREMENT, AND OTHER INSURANCE CONCEPTS ....................................................................... 8 A. Third-party ownership B. Viatical Settlements C. Life Settlements D. Group life insurance 1. Conversion privilege 2. Contributory vs. noncontributory E. Retirement plans 1. Qualified plans 2. Nonqualified plans F. Life insurance needs analysis/suitability 1. Personal insurance needs 2. Business insurance needs a. Key person b. Buy sell G. Social Security benefits H. Tax treatment of insurance premiums, proceeds, and dividends 1. Individual life 2. Group life 3. Modified Endowment Contracts (MECs) LIFE AGENT STATE SPECIFIC CONTENT OUTLINE (30 scoreable questions plus 5 pretest questions) All references are to the Texas Insurance Code (Ins.) or the Texas Administrative Code (TAC), Title 28, unless otherwise noted I. TEXAS STATUTES AND RULES COMMON TO LIFE AND HEALTH INSURANCE .......................................... 20 A. Commissioner of Insurance Ref.: Ins. 31.001-.002, 31.021-.022, 38.001, 82.001-.056, 86.001-.002, 401.051-.056, 404.003, 051-.053, 521.003- .004, 541.107-108, 546.151, 4001.005, 4005.102, 83.051-.054; TAC § 1.88 1. General powers and duties 2. Examination of records 3. Investigation/Notice of hearing 4. Penalties 5. Cease and desist orders B. Insurance definitions Ref.: Ins. 101.051; 547.001; 801.051-.053, .057, 885.001-706; TAC § 3.9704; General insurance text 1. Certificate of authority 2. Transacting insurance 3. Foreign, domestic, alien 4. Stock, mutual 5. Fraternals C. Licensing requirements Ref.: Ins. 4001.003, .006; 4001.104-.106, 4001.151-.156, 4001.201 - .206, 4001.252, 4001.254-255, 4002.003, 4003.001, 4003.004, 4003.006-.007, 4004.051-.054, 4005.101-.102, 4005.105, 4052.001, 4054.301-.303, 1115.056; TAC § 1.502, 19.1001-.1030 1. Types a. Agent/Agency b. Temporary 2. Exemptions/exceptions 3. Appointment 4. Continuing education 5. Records maintenance 6. License denial, renewal, expiration 7. License termination, revocation, suspension 8. Notification to Department of certain information a. Change of address b. Felony convictions c. Administrative action taken against a license holder D. Marketing practices Ref.: Ins. 541.051-.61, .101-.111; 542.001-.014, .054- .058; 544.002; 701.001-.005, .051-.052, .101-.109, .151- .154; 1104.024; 4005.053, 4005.101; TAC § 21.4, 21.115, 21.201-.205 1. Unfair/Prohibited trade practices a. Claims methods and practices b. False advertising c. Misrepresentation d. Defamation e. Rebating f. Fraud g. Boycott, coercion, intimidation h. Commingling i. Unfair discrimination E. Agent duties/responsibilities Ref.: Ins.4001.157, 4005.053-.054; TAC § 3.120 1. Commission sharing F. Texas Life and Health Guaranty Association Ref.: Ins. 443.004, 463.205 II. TEXAS STATUTES AND RULES PERTINENT TO LIFE INSURANCE ONLY ............................................... 10 A. Marketing and Solicitation Ref.: TAC § 3.303, 21.104-.105, 21.107, 21.111, 21.114, 21.122, 21.2201-.2214 1. Advertising/Illustrations B. Policy provisions Ref: Ins. 1101.003-.009, .053, .055, .156; 1101.011, 1103.055; 1108.101; 1111.052; 1551.254; TAC § 3.101- .106, 3.111-.112, 3.119, 3.121, 3.123, 3.4301-.4317, 3.804 (5)(A) C. Individual life and annuity Ref: Ins. 1101.001, .105, .009, .051; 1116.002; TAC § 3.9711 1. Free look 2. Grace period 3. Policy loans TEXAS Insurance Supplement - Examination Content Outlines Effective: September 1, 2021 S5 A. Total, partial, recurrent and residual disability B. Owner’s rights C. Dependent children benefits D. Primary and contingent beneficiaries E. Modes of premium payments F. Nonduplication and coordination of benefits (e.g., primary vs. excess) G. Occupational vs. non-occupational H. Tax treatment of premiums and proceeds of insurance contracts (e.g., disability income and medical expenses, etc.) I. Managed care J. Workers Compensation K. Subrogation IX. FIELD UNDERWRITING PROCEDURES ........................ 9 A. Completing the application B. Explaining sources of insurability and HIPAA privacy information (e.g., MIB Report, Fair Credit Reporting Act, etc.) C. Initial premium payment and receipt and consequences of the receipt (e.g., medical examination, etc.) D. Submitting application (and initial premium if collected) to company for underwriting E. Policy delivery F. Explaining policy and its provisions, riders, exclusions, and ratings to clients G. Replacement H. Contract law 1. Elements of a contract 2. Insurable interest 3. Warranties and representations 4. Unique aspects of the insurance contract a. Conditional b. Unilateral c. Adhesion d. Aleatory LIFE and HEALTH AGENT STATE SPECIFIC CONTENT OUTLINE (30 scoreable questions plus 5 pretest questions) All references are to the Texas Insurance Code (Ins.) or the Texas Administrative Code (TAC), Title 28, unless otherwise noted I. TEXAS STATUTES AND RULES COMMON TO LIFE AND HEALTH INSURANCE .......................................... 14 A. Commissioner of Insurance Ref.: Ins. 31.001-.002, 31.021-.022, 38.001, 82.001-.056, 86.001-.002, 401.051-.056, 404.003, 051-.053, 521.003- .004, 541.107-108, 546.151, 4001.005, 4005.102, 83.051-.054; TAC § 1.88 1. General powers and duties 2. Examination of records 3. Investigation/Notice of hearing 4. Penalties 5. Cease and desist orders B. Insurance definitions Ref.: Ins. 101.051; 547.001; 801.051-.053, .057, 885.001-706; TAC § 3.9704; General insurance text 1. Certificate of authority 2. Transacting insurance 3. Foreign, domestic, alien 4. Stock, mutual 5. Fraternals C. Licensing requirements Ref.: Ins. 4001.003, .006; 4001.104-.106, 4001.151-.156, 4001.201 - .206, 4001.252, 4001.254-255, 4002.003, 4003.001, 4003.004, 4003.006-.007, 4004.051-.054, 4005.101-.102, 4005.105, 4052.001, 4054.301-.303, 1115.056; TAC § 1.502, 19.1001-.1030 1. Types a. Agent/Agency b. Temporary 2. Exemptions/exceptions 3. Appointment 4. Continuing education 5. Records maintenance 6. License denial, renewal, expiration 7. License termination, revocation, suspension 8. Notification to Department of certain information a. Change of address b. Felony convictions c. Administrative action taken against a license holder D. Marketing practices Ref.: Ins. 541.051-.61, .101-.111; 542.001-.014, .054- .058; 544.002; 701.001-.005, .051-.052, .101-.109, .151- .154; 1104.024; 4005.053, 4005.101; TAC § 21.4, 21.115, 21.201-.205 1. Unfair/Prohibited trade practices a. Claims methods and practices b. False advertising c. Misrepresentation d. Defamation e. Rebating f. Fraud g. Boycott, coercion, intimidation h. Commingling i. Unfair discrimination E. Agent duties/responsibilities Ref.: Ins.4001.157, 4005.053-.054; TAC § 3.120 1. Commission sharing F. Texas Life and Health Guaranty Association Ref.: Ins. 443.004, 463.205 II. TEXAS STATUTES AND RULES PERTINENT TO LIFE INSURANCE ONLY ............................................... 6 A. Marketing and Solicitation Ref.: TAC § 3.303, 21.104-.105, 21.107, 21.111, 21.114, 21.122, 21.2201-.2214 1. Advertising/Illustrations B. Policy provisions TEXAS Insurance Supplement - Examination Content Outlines Effective: September 1, 2021 S6 Ref: Ins. 1101.003-.009, .053 .055, .156; 1101.011, 1103.055; 1108.101; 1111.052; 1551.254; TAC § 3.101- .106, 3.111-.112, 3.119, 3.121, 3.123, 3.4301-.4317, 3.804 (5)(A) C. Individual life and annuity Ref: Ins. 1101.001, .105, .009, .051; 1116.002; TAC § 3.9711 1. Free look 2. Grace period 3. Policy loans 4. Prohibited provisions D. Group life Ref: Ins. 1101.053; 1131.001-.806 1. Group eligibility and underwriting requirements 2. Conversion to individual policy 3. Dependent coverage 4. Assignment E. Credit life Ref.: Ins. 1153.003, .004,.151, .153, .155, .157, .201- .204, TAC § 3.5001 – 3.5206 F. Replacement Ref.: Ins. 1114.001 - .102 1. Purpose 2. Definitions 3. Duties of agent 4. Duties of replacing insurance company G. Nonforfeiture law Ref.: Ins. 1105.001 - .153, TAC § 3.3844 III. Texas statutes and rules pertinent to accident and health insurance only ................................................... 7 A. Required policy provisions 1. Coverage for newborns Ref.: Ins. 1551.004; 1367.003; TAC § 3.3403 2. Coverage for chemical dependency Ref.: Ins.1368.005 B. Medicare supplement Ref.: TAC § 3.3301- 3310, 3.3312-.3313, 3.3315-.3325 1. Minimum standards 2. Cancellation C. AIDS testing requirements Ref: TAC § 21.704 - .705 D. Long Term Care Ref: TAC § 3.3804, 3.3822, 3.3832 E. Small group health insurance Ref: TAC § 26.8; Ins 1501 1. Eligibility 2. Coverage and Benefits F. Affordable Care Act 1. Exchanges/Marketplace (Section 1321) 2. Taxes and subsidies (Section 1401, 1402) 3. Essential health benefits (Section 1302, 18022) a. Mental health and substance use disorder services b. Pediatric services c. Preventive services 4. Employer notification responsibilities (Section 1511-1515) IV. TEXAS STATUTES AND RULES PERTINENT TO HEALTH MAINTENANCE ORGANIZATIONS (HMOS)… ........................................................................ 3 Ref.: TAC Chapter 11; 11.501, 11.1611; Ins. 843, 1271 A. Definitions B. Evidence of coverage C. Nonrenewal/cancellation D. Enrollment PROPERTY AND CASUALTY - GENERAL KNOWLEDGE CONTENT OUTLINE Product Knowledge, Terms and Concepts (100 scoreable questions plus 15 pretest questions) I. TYPES OF POLICIES .......................................................... 25 A. Homeowners 1. HO-2 2. HO-3 3. HO-4 4. HO-5 5. HO-6 6. HO-8 B. Dwelling policies 1. DP-1 2. DP-2 3. DP-3 C. Commercial lines 1. Commercial Package Policy (CPP) 2. Commercial property a. Commercial building and business personal property form b. Causes of loss forms c. Business income d. Extra expense e. Equipment breakdown 3. Business Owners Policy (BOP) 4. Builders Risk D. Inland marine 1. Personal Articles floaters 2. Commercial Property floaters E. National Flood Insurance Program F. Others 1. Earthquake 2. Mobile Homes 3. Watercraft 4. Farm Owners 5. Windstorm II. INSURANCE TERMS AND RELATED CONCEPTS .......... 14 A. Insurance 1. Law of Large Numbers B. Insurable interest C. Risk 1. Pure vs. Speculative Risk D. Hazard 1. Moral 2. Morale TEXAS Insurance Supplement - Examination Content Outlines Effective: September 1, 2021 S7 3. Physical E. Peril F. Loss 1. Direct 2. Indirect G. Loss Valuation 1. Actual cash value 2. Replacement cost 3. Market value 4. Stated/agreed value 5. Salvage value H. Proximate cause I. Deductible J. Indemnity K. Limits of liability L. Coinsurance/Insurance to value M. Occurrence N. Cancellation O. Nonrenewal P. Vacancy and unoccupancy Q. Liability 1. Absolute 2. Strict 3. Vicarious R. Negligence S. Binder T. Endorsements U. Blanket vs. Specific III. POLICY PROVISIONS AND CONTRACT LAW ............... 11 A. Declarations B. Insuring agreement C. Conditions D. Exclusions E. Definition of the insured F. Duties of the insured G. Obligations of the insurance company H. Mortgagee rights I. Proof of loss J. Notice of claim K. Appraisal L. Other Insurance Provision M. Subrogation N. Elements of a contract O. Warranties, representations, and concealment P. Sources of underwriting information Q. Fair Credit Reporting Act R. Privacy Protection (Gramm Leach Bliley) S. Policy Application T. Terrorism Risk Insurance Act (TRIA) IV. TYPES OF POLICIES, BONDS, AND RELATED TERMS ............................................................. 25 A. Commercial general liability 1. Exposures a. Premises and Operations b. Products and Completed Operations 2. Coverage a. Coverage A: Bodily Injury and Property Damage Liability (1) Occurrence (2) Claims made (a) Retroactive Date b. Coverage B: Personal Injury and Advertising Injury c. Coverage C: Medical Payments d. Supplemental Payments e. Who is an insured f. Limits (1) Per occurrence (2) Annual Aggregate g. Damage to Property of Others B. Automobile: personal auto and business auto 1. Liability a. Bodily Injury b. Property Damage c. Split Limits d. Combined Single Limit 2. Medical Payments 3. Physical Damage (collision; other than collision; specified perils) 4. Uninsured motorists 5. Underinsured motorists 6. Who is an insured 7. Types of Auto a. Owned b. Non-owned c. Hired d. Temporary Substitute e. Newly Acquired Autos f. Transportation Expense and Rental Reimbursement Expense 8. Garage Coverage Form, including Garagekeepers Insurance 9. Exclusions 10. Individual Insured and Drive Other Car (DOC) C. Workers Compensation Insurance, Employers Liability Insurance, and Related Issues (This section does not deal with specifics of state law, which are addressed elsewhere in this outline.) 1. Standard policy concepts a. Who is an employee/employer b. Compensation 2. Work-related vs. non-work-related 3. Other states’ insurance 4. Employers Liability 5. Exclusive remedy 6. Premium Determination D. Crime 1. Employee Dishonesty 2. Theft 3. Robbery 4. Burglary 5. Forgery and Alteration 6. Mysterious disappearance TEXAS Insurance Supplement - Examination Content Outlines Effective: September 1, 2021 S10 f. Transportation Expense and Rental Reimbursement Expense 8. Exclusions B. Umbrella/Excess liability III. PROPERTY AND CASUALTY INSURANCE TERMS AND RELATED CONCEPTS ............................................ 28 A. Insurance 1. Law of Large Numbers B. Insurable interest C. Risk 1. Pure vs. Speculative Risk D. Hazard 1. Moral 2. Morale 3. Physical E. Peril F. Loss 1. Direct 2. Indirect G. Loss Valuation 1. Actual cash value 2. Replacement cost 3. Market value 4. Stated value 5. Salvage value H. Proximate cause I. Deductible J. Indemnity K. Limits of liability L. Coinsurance/Insurance to value M. Occurrence N. Cancellation O. Nonrenewal P. Vacancy and unoccupancy Q. Liability 1. Absolute 2. Strict 3. Vicarious R. Negligence S. Binder T. Endorsements U. Blanket vs. Specific V. Burglary, Robbery, Theft, and Mysterious Disappearance W. Warranties X. Representations Y. Concealment Z. Deposit Premium/Audit AA. Certificate of Insurance BB. Damages 1. Compensatory a. General b. Special 2. Punitive CC. Compliance with Provisions of Fair Credit Reporting Act IV. PROPERTY AND CASUALTY POLICY PROVISIONS AND CONTRACT LAW ..................................................... 24 A. Declarations B. Insuring agreement C. Conditions D. Exclusions E. Definition of the insured F. Duties of the insured after a loss G. Obligations of the insurance company H. Mortgagee rights I. Proof of loss J. Notice of claim K. Appraisal L. Other Insurance Provision M. Subrogation N. Elements of a contract O. Sources of underwriting information P. Fair Credit Reporting Act Q. Privacy Protection (Gramm Leach Bliley) R. Policy Application S. Terrorism Risk Insurance Act (TRIA) T. Cancellation and nonrenewal provisions U. Supplementary payments V. Arbitration W. Loss settlement provisions including consent to settle a loss PERSONAL LINES AGENT STATE SPECIFIC CONTENT OUTLINE (25 scoreable questions plus 5 pretest questions) All references are to the Texas Insurance Code (Ins.) or the Texas Administrative Code (TAC), Title 28, unless otherwise noted I. TEXAS STATUTES AND RULES COMMON TO ALL LINES OF INSURANCE ................................................. 15 A. Commissioner of Insurance Ref.: Ins. 31.001, 31.002, 31.021, 201.004, 404.051-.053, 481.001-.009, 491.051, 491.052, 521.003-.004, 541.107- 108, 546.151, 4001.005, 38.001, 86.001-.002, 401.051- .062, 82.001-.056, 4005.102, 83.051-.054; TAC § 1.88 1. General powers and duties 2. Examination of records 3. Investigation/Notice of hearing 4. Penalties 5. Cease and desist orders B. Insurance definitions Ref.: Ins. 801.051-.053; General insurance text; TAC § 15.2 1. Certificate of authority 2. Transacting insurance 3. Foreign, domestic, alien 4. Stock, mutual 5. Admitted/nonadmitted C. Licensing requirements Ref.: Ins. 981.202, 1115.056, 4001.003, 4001.105, 4001.151-.156, 4001.201, 4001.205, 4001.252, 4001. TEXAS Insurance Supplement - Examination Content Outlines Effective: September 1, 2021 S11 255, 4003.001, 4003.004, 4003.006-.007, 4004.051-055, 4005.101-.102, 4005.105, 4051.051, 4053.051, 4056.001.-.004, 4153.051; TAC § 1.502, 19.1001-.1030, 19.1201-.1206, 19.1301-.1320, 19.1501-.1503, 19.805 1. Types a. Agent/agency b. Nonresident agent c. Temporary d. Limited license e. Managing general agent f. Surplus lines g. Adjuster h. Risk manager i. Emergency 2. Exemptions/exceptions 3. Appointment 4. Continuing education 5. Records maintenance 6. License application, denial, renewal, expiration 7. License termination, revocation, suspension 8. Notification to Department of certain information a. Change of address b. Felony convictions c. Administrative action taken against a license holder D. Marketing practices Ref.: Ins. 541.051-.054, 541.056, 541.060, 542.001-.014, 701.001-.154, 4001.104, 4005.101; TAC § 21.4, 21.201- .205, 21.111, 21.115 1. Unfair/Prohibited trade practices a. Claims methods and practices b. False advertising c. Misrepresentation d. Defamation e. Controlled business f. Rebating g. Discrimination h. Fraud i. Unfair comparison j. Boycott, coercion, intimidation 2. Rating and underwriting practices E. Agent duties/responsibilities Ref.: General insurance text 1. Fiduciary capacity II. TEXAS STATUTES AND RULES PERTINENT TO PERSONAL LINES INSURANCE .................................. 10 A. Property and casualty definitions Ref.: TAC § 5.5002 B. Approval of Rates and Forms Ref: Texas Insurance Code Sec. 5.35 C. Homeowner's Insurance 1. Declination, cancellation, nonrenewal Ref: General insurance text 2. Texas FAIR Plan Association 3. Texas Windstorm Insurance Association (TWIA) 4. Loss settlement provisions Ref: Texas Insurance Code § 542.051 through § 542.061; § 542.151 through § 542.154 5. Liquidated demand Ref: Texas Insurance Code § 862.053 D. Automobile insurance 1. Provisions Ref: Transportation Code: Chapter 601; Ins. 1952.101–.110, Ins. 1952.151–.161; TAC § 5.204 a. Coverage b. Uninsured Motorists/Underinsured Motorists c. Personal Injury Protection (PIP) 2. Financial responsibility and required minimum liability limits Ref: Transportation Code: § 601.051, 601.053, 601.056-.057, 601.071-.072 3. Renewal, nonrenewal, and cancellation Ref: Ins. 551.101–.113, 551.151-.152; TAC § 5.7002 4. Texas Automobile Insurance Plan Association Ref: Ins. 2151.051–.154 E. Texas Property and Casualty Insurance Guaranty Association Ref: Ins. 462.001–.351; TAC § 29.1 SURPLUS LINES CONTENT OUTLINE (60 scoreable questions) This examination will test topics listed on the following content outline and is composed of sixty (60) four-option, multiple choice questions. All references are to General insurance texts and forms, unless otherwise noted I. INSURANCE TERMS AND RELATED CONCEPTS A. Insurance B. Elements of a contract C. Indemnity D. Risk (pure vs. speculative) E. Hazard F. Peril G. Loss (direct vs. indirect) H. Proximate cause I. Liability J. Actual Cash Value K. Replacement cost L. Subrogation M. Salvage N. Negligence O. Warranties, representation/misrepresentation P. Lloyd’s Q. Reinsurance II. TEXAS STATUTES AND RULES PERTINENT TO SURPLUS LINES INSURANCE All references are to the Texas Insurance Code (Ins.) or the Texas Administrative Code (TAC), Title 28, unless otherwise noted A. Commissioner of Insurance Ref.: Ins. 31.001-.002, 31.021, 981.009 TEXAS Insurance Supplement - Examination Content Outlines Effective: September 1, 2021 S12 1. General powers and duties 2. Examination of records 3. Investigation/hearing 4. Penalties/sanctions B. Definitions 1. Surplus lines insurance Ref.: Ins. 981.002 2. Managing General Agent Ref.: Ins. 4053.001, 4053.051; TAC § 19.1202 3. Insurance transaction Ref.: General insurance text 4. Authorized/unauthorized, admitted/non-admitted Ref.: Ins. 101.301; TAC § 15.8 5. Purchasing groups Ref.: Ins. 2201.001-.259 6. Risk retention Ref.: Ins. 2201.001-.209 7. Domestic, foreign, and alien companies Ref.: General insurance text 8. Stock, mutual companies Ref.: General insurance text C. Licensing requirements Ref.: Ins. 4001.252, 981.202-.204; TAC § 15.101 1. Surplus lines agent 2. License renewal 3. License suspension, revocation, termination 4. Notification to Department of certain information a. Change of address b. Felony convictions c. Administrative action taken against a license- holder D. Marketing practices Ref.: Ins. 541.051-.054, 541.057, 541.061, 542.001-.014, -.051- .061; 4001.104, 4005.053, 4005.101; TAC § 21.4, 21.201-.205, 21.111, 21.115 1. Unfair/Prohibited trade practices a. Claims methods and practices b. False advertising c. Misrepresentation d. Defamation e. Controlled business f. Rebating g. Unfair discrimination h. Fraud i. Unfair comparison j. Boycott, coercion, intimidation E. Surplus lines insurance 1. Purpose/definitions Ref.: Ins. 981.001-002; TAC § 15.2 2. Premium payments and unearned premiums Ref.: Ins. 981.007 3. Evidence of insurance Ref.: Ins. 981.103; TAC § 15.15.105 4. Premium taxes Ref.: Ins. 225.004, 225.006; Pub. Fin. TAC § 3.822 5. Reports and notices Ref.: Ins. 981.216-217 6. Eligible unauthorized insurers Ref.: Ins. 981.002 7. Commissions Ref.: 981.212; 225.001 8. Stamping Office Ref.: Ins. 981.105, 981.151-.160; TAC § 15.106, 15.201 9. Recordkeeping Ref.: Ins. 981.215-.216; TAC § 15.4, 15.9, 15.108, 15.108-.110, 15.113 10. Minimum capital and surplus Ref.: Ins. 981.057 11. Contract requirements Ref.: Ins. 981.102; TAC §15.5 12. Service of process Ref.: Ins. 804.106 13. Advertising Ref.: Ins. Ch. 981.219 RISK MANAGER CONTENT OUTLINE (100 scoreable questions) This examination will test topics listed on the following content outline and is composed of one hundred (100) four-option, multiple choice questions. All references are General insurance text and forms, unless otherwise noted I. INSURANCE TERMS AND RELATED CONCEPTS A. Risk (pure vs. speculative) B. Hazard C. Peril D. Loss/Causes of loss E. Exposure F. Indemnity G. Liability H. Deductible I. Contractual ambiguities J. Negligence K. Torts L. Personal property M. Actual cash value N. Occurrences O. Warranty P. Insurable interest Q. Insurance II. POLICY PROVISIONS AND CONTRACT LAW A. Declarations B. Insuring Agreement C. Conditions D. Exclusions E. Duties of the insured after a loss 1. Proof of loss F. Loss settlement G. Appraisal TEXAS Insurance Supplement - Examination Content Outlines Effective: September 1, 2021 S15 c. Defamation d. Rebating e. False advertising f. Controlled business g. Unfair discrimination h. Fraud i. Unfair comparison j. Boycott, coercion, intimidation 2. Rating and underwriting practices E. Duties/responsibilities Ref.: TAC § 19.1201-1204 1. Fiduciary capacity 2. Processes 3. Reinsurance 4. Reports/records 5. Commission sharing F. Premium financing/premium taxes Ref.: Ins. 221.002 G. Rates and ratemaking Ref: Texas Insurance Code Sec. 5.35 H. County Mutual Companies Ref.: Ins. 911.303, 912.002; TAC § 5.9361 I. Lloyd’s plan Ref.: General insurance text J. Surplus Lines Ref. Ins. 981.202 K. Automobile insurance 1. Under/Uninsured Motorists Ref: Transportation Code: Chapter 601; Ins. 1952.101–.110, Ins. 1952.151–.161, TAC § 5.204 2. Financial responsibility and required minimum liability limits Ref: Transportation Code: § 601.051, 601.053, 601.056-.057, 601.071-.072 3. Renewal, nonrenewal, and cancellation Ref: Ins. 551.101–.113, 551.151-.152; TAC § 5.7002 4. Texas Automobile Insurance Plan Association Ref: Ins. 2151.051–.154 5. Personal Injury Protection (PIP) 6. Medical payments 7. Liability 8. Collision/Other than collision L. Workers’ Compensation Ref.: Texas Labor Code-Title 5: Secs. 401.012; 406.002, 406.034; 407.061-.065, 409.003 1. Coverage 2. Employment covered 3. Employer election 4. Employee election 5. Self-insured employers M. Homeowners 1. HO-2 2. HO-3 3. HO-4 4. HO-5 5. HO-6 6. HO-8 N. Commercial lines 1. Commercial Package Policy (CPP) 2. Commercial property a. Commercial building and business personal property form b. Causes of loss forms c. Business income d. Extra expense e. Equipment breakdown 3. Businessowners Policy (BOP) 4. Directors and Officers liability/Professional O. Medical Liability Insurance Underwriting Association (JUA) Ref.: TAC § 5.2001-.2002; Ins. Chapter 2203 P. Texas Windstorm Insurance Association Ref: TAC § 5.4016, 5.4700, 5.4800, 5.4903 Q. Texas Property and Casualty Guaranty Insurance Association Ref: Ins. 462.001–.351; TAC § 29.1 R. Texas FAIR Plan Association S. Property and Casualty definitions Ref.: TAC Chapter 5 T. National Flood Insurance Program (NFIP) U. Umbrella WORKERS’ COMPENSATION ADJUSTER CONTENT OUTLINE (60 scoreable questions) This examination will test topics listed on the following content outline and is composed of sixty (60) four-option, multiple choice questions. All references are to General insurance texts and forms, unless otherwise noted I. INSURANCE TERMS AND RELATED CONCEPTS A. Risk B. Hazard C. Loss D. Deductible E. Indemnity F. Subrogation G. Binder H. Liability II. POLICY PROVISIONS A. Declarations B. Insuring Agreement C. Conditions D. Exclusions E. Appraisal III. TEXAS STATUTES AND RULES PERTINENT TO WORKERS’ COMPENSATION ADJUSTING All references are to the Texas Insurance Code (Ins.) or the Texas Administrative Code (TAC), Title 28, unless otherwise noted A. Commissioner of Insurance TEXAS Insurance Supplement - Examination Content Outlines Effective: September 1, 2021 S16 Ref.: Ins. 31.001, 31.002, 31.021, 201.004, 404.051-.053, 481.001-.009, 491.051, 491.052, 521.003-.004, 4001.005, 38.001, 86.001-.002, 401.051-.062, 82.001- .056, 4005.102 1. General powers and duties 2. Examination of records 3. Investigation/Notice of hearing 4. Penalties B. Licensing requirements Ref.: Ins. 4001.252, 4101-.001, .002, .051-.054, 4101.057, 4101.059, 4101.061, 4101.101, 4101.202-203; TAC § 19.601-.602, 19.1001-.1018 1. Adjuster 2. Exemptions/exceptions 3. Continuing education 4. License denial, renewal, expiration 5. License termination, revocation, suspension 6. Notification to Department of certain information a. Change of address b. Felony convictions c. Administrative action taken against a license holder C. Marketing practices Ref.: Ins. 542.001-.014, 542.051-061, 542.151-.154; TAC § 21.4, 21.201-.205 1. Unfair/Prohibited trade practices a. Claims methods and practices b. Misrepresentation c. Defamation D. Workers’ Compensation 1. Definitions Ref.: Texas Labor Code Secs. 401.011-..013 a. Workers’ Compensation insurance b. Employer c. Employee d. Disability definitions 2. Who is covered Ref.: Texas Labor Code Sec. 406.091 3. Obtaining coverage (Employer) Ref.: Texas Labor Code Secs. 401.022, 406.003, 406.033 4. Employer election Ref.: Texas Labor Code Sec. 406.002 5. Average weekly wage Ref.: Texas Labor Code Secs. 408.041- .047 6. Waiting period Ref.: Texas Labor Code Secs. 408.082 7. Compensable injuries Ref: Texas Labor Code Secs. 401.011, 406.032, 408.181 8. Benefits Ref.: Texas Labor Code Secs. 401.011, 408.021-.030, 408.041, 408.081-.086, 408.101-.105, 408.150, 408.181-.187; 409.021-.024 a. medical b. income c. temporary income d. rehabilitation e. death and burial 9. Other insurance coverage Ref.: Texas Labor Code Sec. 406.052 10. Claims procedures/Reports Ref.: Texas Labor Code Secs. 401.110, 409.001-.013, 409.021-.024, 410.021 11. Informal Hearing/Awards Ref.: Texas Labor Code Secs. 410.006, 410.119, 410.121 12. Subsequent Injury Fund Ref.: Texas Labor Code Sec. 403.007 13. Workers’ compensation and employers liability Ref.: Texas Approved Workers’ Compensation Policy a. Employers Liability insurance b. Other States insurance 14. Federal Workers’ Compensation (US Code) Ref.: Texas Workers’ Compensation Manual a. Federal Employers Liability Act (FELA) Ref.: 45 USC 51-60 b. U.S. Longshore and Harbor Workers Compensation Act Ref: 33 USC 901-950 ALL LINES ADJUSTER CONTENT OUTLINE (150 scoreable questions) This examination will test topics listed on the following content outline and is composed of one hundred fifty (150) four-option, multiple choice questions. All references are to General insurance texts and forms, unless otherwise noted I. GENERAL PROPERTY AND CASUALTY INSURANCE PRODUCT KNOWLEDGE PERTINENT TO ADJUSTERS A. Standard Fire Policy 1. Basic coverages, provisions, and clauses 2. Limitations and restrictions 3. Proof of loss 4. Loss requirements and inventories 5. Appraisal 6. Replacement costs B. Auto liability 1. Personal 2. Coverage C. Personal lines Homeowner coverage 1. Dwelling and contents 2. Homeowners forms/coverages a. Policy provisions b. Replacement costs c. Appraisal d. Special limits of liability e. Proof of loss 3. General property forms TEXAS Insurance Supplement - Examination Content Outlines Effective: September 1, 2021 S17 a. ISO, HO-2, HO-3, HO-4, HO-5, HO-6 D. Commercial lines coverage 1. Commercial property forms a. Commercial property and buildings b. Causes of loss 2. Commercial Package Policy (CPP) 3. Boiler and Machinery (includes small Boiler and Machinery) 4. Businessowners policy 5. Cargo E. Inland Marine 1. Definitions 2. Policies a. Personal floaters b. Commercial floaters c. Commercial inland marine F. Ocean Marine G. Additional coverages, exclusions, and extensions 1. Business Interruption 2. Time Element 3. Law and Ordinance exclusion 4. Law and Ordinance coverage 5. Valuable Papers and records 6. Garagekeepers liability 7. Aviation 8. Umbrella 9. Protection and Indemnity 10. Yacht H. Bonds II. INSURANCE TERMS AND RELATED CONCEPTS A. Peril B. Waiver/non-waiver agreement C. Insurance, insurance contracts, and insurable interest D. Estoppel E. Proof of loss F. Depreciation G. Deductible H. Liability/ limits of liability I. Valued policy J. Appraisal K. Actual cash value, fair market value L. Robbery M. Burglary and theft N. Agreed value O. Replacement cost P. Indemnity Q. Damages R. Subrogation S. Other insurance T. Arbitration U. Constructive total loss V. Loss W. Warranties X. Salvage Y. Risk Z. Hazard AA. Liberalization BB. Binder CC. Policy Provisions 1. Declarations 2. Insuring Agreement 3. Conditions 4. Exclusions 5. Appraisal III. TEXAS STATUTES AND RULES PERTINENT TO PROPERTY AND CASUALTY ADJUSTING All references are to the Texas Insurance Code (Ins.) or the Texas Administrative Code (TAC), Title 28, unless otherwise noted A. Licensing requirements Ref.: Ins. 4001.252, 4101-.001, .002, .051-.054, 4101.057, 4101.059, 4101.061, 4101.101, 4101.202-203; TAC § 19.601-.602, 19.1001-.1018 1. Adjuster 2. Exemptions/exceptions 3. Continuing education 4. License denial, renewal, expiration 5. License termination, revocation, suspension 6. Notification to Department of certain information a. Change of address b. Felony convictions c. Administrative action taken against a license holder 7. Commissioner of Insurance Ref.: Ins. 31.001, 31.002, 31.021, 201.004, 404.051-.053, 481.001-.009, 491.051, 491.052, 521.003-.004, 4001.005, 38.001, 86.001-.002, 401.051-.062, 82.001- .056, 4005.102 a. General powers and duties b. Examination of records c. Investigation/hearing d. Penalties B. Marketing practices Ref.: Ins. 541.053, 542.001-.014, 542.051-061, 542.151- .154; TAC § 21.4, 21.201-.205 1. Unfair/Prohibited trade practices a. Claims methods and practices b. Misrepresentation c. Defamation C. Adjuster practices, responsibilities, and duties Ref.: Ins. 4101.251; TAC Ins § 19.602; General insurance text D. Workers’ Compensation 1. Definitions Ref.: Texas Labor Code Secs. 401.011-.013 a. Workers’ Compensation insurance b. Employer c. Employee d. Disability definitions 2. Who is covered Ref.: Texas Labor Code Sec. 406.091 TEXAS Insurance Supplement - Examination Content Outlines Effective: September 1, 2021 S20 d. Limited license (lines of authority) 2. Exemptions/exceptions 3. Appointment/contract 4. Continuing education 5. License denial, renewal, expiration 6. License termination, revocation, suspension 7. Notification to Department of certain information a. Change of address b. Felony convictions c. Administrative action taken against a license holder D. Marketing practices Ref.: Ins. 541.051-.061, 542.001-.014, .054-.058; 701.001-.154, 4001.104, 4005.053(c), 4005.101; TAC § 21.4, 21.201-.205, 21.115 1. Unfair/Prohibited trade practices a. Claims methods and practices b. False advertising c. Misrepresentation d. Defamation e. Controlled business f. Rebating g. Discrimination h. Fraud i. Boycott, coercion, intimidation 2. Ethics Ref.: General insurance text E. Agent duties/responsibilities Ref.: Ins. 4001.157, 4005.053-.054 1. Fiduciary capacity 2. Commission sharing PUBLIC INSURANCE ADJUSTER CONTENT OUTLINE (100 scoreable questions) This examination will test topics listed on the following content outline and is composed of one hundred (100) four-option, multiple choice questions. All references are to General insurance texts and forms, unless otherwise noted I. GENERAL PROPERTY INSURANCE PRODUCT KNOWLEDGE PERTINENT TO PUBLIC INSURANCE ADJUSTERS A. Standard fire policy Ref.: Standard Fire policy 1. Basic coverages, provisions, and clauses 2. Limitations and restrictions 3. Proof of loss 4. Loss requirements and inventories 5. Appraisal 6. Replacement costs B. Auto liability 1. Personal 2. Coverage C. Personal lines coverage 1. Dwelling and contents 2. Homeowners forms/coverages a. Policy provisions b. Replacement costs c. Appraisal d. Special limits of liability e. Proof of loss 3. General property forms a. ISO, HO-2, HO-3, HO-4, HO-5, HO-6 D. Commercial lines coverage 1. Commercial property forms a. Commercial property and buildings b. Causes of loss 2. Commercial Package Policy (CPP) 3. Boiler and Machinery (includes small Boiler and Machinery) 4. Businessowners policy 5. Cargo E. Inland Marine 1. Definitions 2. Policies a. Personal floaters b. Commercial floaters c. Commercial inland marine F. Ocean Marine G. Additional coverages, exclusions, and extensions 1. Business Interruption 2. Time Element 3. Law and Ordinance exclusion 4. Law and Ordinance coverage 5. Valuable Papers and records 6. Garagekeepers liability 7. Aviation 8. Umbrella 9. Yacht 10. Coinsurance H. Bonds II. INSURANCE TERMS AND RELATED CONCEPTS A. Peril B. Waiver/non-waiver agreement C. Insurance, insurance contracts, and insurable interest D. Estoppel E. Proof of loss F. Depreciation G. Deductible H. Liability/Limits of liability I. Valued policy J. Appraisal K. Actual cash value, fair market value L. Robbery M. Burglary and theft N. Agreed value O. Replacement cost P. Indemnity Q. Damages TEXAS Insurance Supplement - Examination Content Outlines Effective: September 1, 2021 S21 R. Subrogation S. Other insurance T. Arbitration U. Constructive total loss V. Loss W. Salvage X. Risk Y. Hazard Z. Liberalization III. POLICY PROVISIONS A. Declarations B. Insuring Agreement C. Conditions D. Exclusions E. Appraisal IV. TEXAS STATUTES AND RULES PERTINENT TO PUBLIC INSURANCE ADJUSTING All references are to the Texas Insurance Code (Ins.) or the Texas Administrative Code (TAC), Title 28, unless otherwise noted A. Commissioner of Insurance Ref.: Ins. 4101.052-.055, 4101.057, 4101.203-.204, 4102.001, 4102.110; TAC § 19.601 1. General powers and duties 2. Examination of records 3. Investigation/hearing 4. Penalties B. Licensing requirements Ref.: Ins. 4001.252, 4102-.001, .002, 4102.051, 4102.064, 4102.101-.103, 4102.109, 4102.152, 4102.201, 4103.156; TAC § 19.1001-.016; TAC §19.701- 713 1. Public Insurance Adjuster 2. Exemptions/exceptions 3. Continuing education 4. License denial, renewal, expiration 5. License termination, revocation, suspension, cease and desist 6. Notification to Department of certain information a. Change of address b. Felony convictions c. Administrative action taken against a license holder C. Marketing practices Ref.: Ins. 541.051, 541.062, 542.001-.014; TAC § 21.201-.205, 21.4 1. Unfair/Prohibited trade practices a. Claims methods and practices b. Misrepresentation D. Public Insurance Adjuster practices, responsibilities, and duties Ref. Ins. 4102.005, .151, .163; TAC § 19.708, 19.713; General insurance text 1. Unauthorized practice of law 2. Disclosures 3. Consumer rights 4. Ethics