Claim Adjusting Flashcards


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1

What is the minimum age to obtain an insurance license in the State of Florida?

18

2

"Upon successful completion of this class, what should you do next to obtain your Insurance license?"

Retain your original Certificate of Completion with your important records.

Schedule your fingerprint reservation

Apply online at https://aalf.fldfs.com

3

How can you determine how many continuing education hours you need to complete to keep your license active?

Call the Florida Department of Financial Services (FLDFS); they can obtain that information for you.

Visit the Florida Department of Financial Services website to view your compliance requirement and transcripts.

4

How long is this course valid for licensure purposes after their course completion date?

Forever

5

Which statement is FALSE?

Change

Upon successful completion of this course you are guaranteed to pass the state examination.

6

Sometimes referred to as commercial fire and allied lines, this is the form of insurance that covers direct and indirect losses related to properties other than one- to four-family dwellings and farm properties:

Commercial Property Insurance

7

Under Commercial Property Policies, Florida law requires an insurer to give the insured at least __________days advance written notice of non-renewal.

45

8

When a business s personal property values fluctuate, a single, fixed amount of insurance could produce either over- or under-insurance at any given time. With this option, the limit of coverage is set at an amount somewhat higher than expected peak values.

Group of answer choices

Value Reporting

9

First developed as an extension of Ocean Marine coverage, to provide coverage for cargo traveling over land, instead of by sea.

Commercial Inland Marine Coverage

10

Used to cover buildings in the course of construction:

Builders Risk Policy

11

Protects against loss of business income that results from damage to covered property from a covered cause of loss.

Business Income Insurance Coverage

12

Used only for Commercial Condominiums, it covers the unit-owners business personal property and the personal property of others in the insured s care, custody or control:

Condominium Unit Owners Form

13

Liberalization states, "The insured gets the benefit of any broadened coverage if the company, within __________ days of inception, adopts a form revision that is broader and without increase in premium."

45 days

14

Insures a condominium association against direct physical loss or damage to buildings, business personal property and personal property of others in the care, custody or control of the association and located at the premises:

Condominium Association Form

15

The Commercial Property Contract includes all of the following, except:

change

Commercial Property Conditions....

Common Policy Conditions

Coverage Form

Commercial Loss Schedule

16

Under Crime Insurance, the insured is covered for loss by:

Theft

Burglary

Robbery

17

Employee Theft Coverage may be written in the following ways:

Scheduled Persons Coverage

Scheduled Position Coverage

Blanket Coverage

18

Taking, or attempted taking of property from within a locked safe or vault, by unlawful entry, with visible marks of forcible entry, or taking of the safe or vault from inside the premises. This is defined as:

Safe Burglary

19

Under Inside The Premises - Robbery or Safe Burglary of Personal Property, a special limit of __________ per occurrence applies to articles whose principal value is precious metals, precious or semiprecious stones, pearls or furs, and to the physical or intrinsic value of manuscripts, drawings or records:

$5000

20

Provides for loss of money and securities outside the premises in the care, custody and control of a messenger or armored car service resulting from theft, disappearance or destruction. This is defined as:

Outside the Premises

21

Covers for all types of property, when surrendered away from the premises as a result of a threat to do bodily harm to the insured or an employee, or to a relative or invitee of either, who is (or allegedly is) being held captive.

Extortion

22

Any loss discovered during the policy period or within 60 days after its expiration (one year after expiration for losses connected with employee benefit plans) is covered regardless of when it occurred if the policy is written using

The Discovery Form

23

This form only provides coverage for losses that both occurred and were discovered during the policy period, or within one year of its expiration:

The Loss Sustained Form

24

Under Crime Insurance, coverage does not apply to:

The named insured

25

Crime Insurance is ______ over any other Insurance coverage

Excess

26

Which of the following can be found in a Commercial General Liability Contract?

Declarations

Common Policy Conditions

Two Forms: Occurence & Claims-Made

27

The Commercial General Liability __________ 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.

Declarations

28

The Nuclear Energy Liability Exclusion endorsement, in general, __________ all hazards related to nuclear energy.

Excludes

29

Applies to BI or PD which occurs during the policy period, regardless of any later time at which a claim is made:

Occurrence Form

30

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:

Claims-Made

31

Toxic wastes escaped from a gas station disposal tank. The insured operator discovers the leak and cleans up the spill. Unfortunately, the waste quickly seeped into the ground and has caused illness among the residents of a neighboring community This is an example of?

Known Loss

32

What payment covers several areas of costs related to claims, and are payable in addition to the policy limits?

Supplementary

33

There is __________ coverage for injury, damage or clean-up costs caused by pollutants, subject to minor exceptions:

0%

34

Under a Commercial General Liability Policy, a basic limit of __________ per person applies to Medical Payments:

$5000

35

Three full-time employees from a local furniture company are horsing around and one is pushed into a machine that cut his foot. How will the company's General Liability respond?

The GL policy will not pay

36

A(n) __________ provides comprehensive health services to its members for a prepaid fixed fee, equivalent to an insurance premium.

HMO

PPO

Major Medical Plan

37

Characteristics of an HMO plan usually include:

Small or Non-existent Deductibles

Fewer Exclusions

Insurance services to members through employed physicians

38

A __________ is a selected group of hospitals and medical practitioners in a given area who have joined together in an effort to reduce medical costs.

PPO

39

The coverage that is intended to afford protection against catastrophic losses is defined as?

Major Medical

40

Define the coverage that pays a flat amount per day for hospitalization, regardless of expenses or other insurance:

Hospital Indemnity

41

Provides coverage for expenses, including loss of income, arising from an accident. This is defined as?

Accident Insurance

42

Provides indemnification to the insured for basic hospitalization of room and board in the hospital, nursing care, laboratory fees, operating room, medical supplies, etc. This is defined as?

Hospitalization Expense

43

This optional provision states that if the insured becomes totally disabled, premiums are waived but the coverage remains in force:

Group of answer choices

Waiver of Premium

44

A policy may contain a provision which states a period of time between issuance and acceptance before sickness benefits begin. This is defined as:

Waiting Period

Elimination Period

45

This type of provision states the insurer can refuse to renew the policy only under certain conditions. The policy must state the conditions under which the policy will not be renewed. This is defined as?

Conditionally Renewable

46

The following are basic characteristics of a property or liability insurance contract, EXCEPT:

Loss Settlement Contract......

Personal Contract

Conditional Contract

Contract of Adhesion

47

The Insurer s responsibility to pay for a property loss may be conditioned on the insured having used reasonable means to avoid the loss, to protect the property against further loss, and to give the insurer proof of the loss is defined as?

Conditional Contract

48

A(n) __________ is one wherein economic loss would be suffered from an adverse happening to the subject:

Group of answer choices

Insurable Interest

49

The __________ states that when there is an unbroken connection between an occurrence and damage that grows out of the occurrence, then the resultant damage is all a part of the occurrence. Group of answer choices

Doctrine of Proximate Cause

50

Frank owned a home that was destroyed by a hurricane. Both ABC and XYZ Banks were listed as additional interests on his homeowner policy. The insurance company will make a payment to:

The first mortgagee ABC

The Insured

Jointly to ABC and XYZ

51

The Loss Settlement Valuation that subtracts an allowance for depreciation is defined as?

Actual Cash Value

52

States that if the insurer adopts a revision which would broaden coverage without additional premium within some period of time prior to the policy period or during the policy period, the insured receives the benefit of such broadened coverage

Liberalization

53

A policy condition, either based on information in the insured s application or inserted by the insurer, is defined as:

Group of answer choices

Warranty

54

Property insurance policies usually contain a(n) __________ clause, stating the insured cannot dump damaged property on the insurer and demand its full value:

Abandonment

55

Insurance applies separately to each insured as if other insureds did not exist. This is defined as:

Severability

56

All the following are eligible for full coverage (Liability, PIP, Med Pay, and Physical Damage) in the Florida Automobile (FAJUA) EXCEPT:Group of answer choices

Members of the Armed Forces stationed in Florida who own a Private Passenger Vehicle.

The owner of a light (6000lb.) commercial vehicle....

Non-residents who are subject to Florida's No-Fault law

Legal residents of Florida who lease a vehicle for 1 year or more.

57

Once a risk is assigned to a Servicing Carrier in the FAJUA, the carrier owns the premium and the losses for that risk.

Group of answer choices

False

58

To make needed Homeowner Insurance available, Citizens must insure all risks that cannot find insurance in the voluntary market.

False

59

To be eligible for coverage under the Florida Workers Compensation JUA (FWCJUA), the applicant must have been turned down by at least two voluntary carriers and not be indebted for any previous unpaid WC premiums.

True

60

If financial responsibility doesnt exist at the time of an accident, which of the following things must happen to avoid penalties?

he legally valid claims of others must be satisfied (up to 10/20/10)

The owner and operator must provide certification of future responsibility for future accidents

61

Personal Injury Protection, or PIP, has a __________ per person, per accident limit.

10,000

62

Jeremy has a not at fault accident. If he has PIP with a $1,000 deductible, how much can he expect his PIP coverage to pay toward his medical bills that total $3,000?

$1,600

63

Frank has a not-at-fault accident, he has basic PIP, no deductible and Med pay of $5,000. How much will his Med Pay contribute to medical bills of $15,000?

$5,000

64

As to required proof for future accidents by purchase of auto liability insurance, the insurer must make a filing (Form SR-22) certifying that coverage is in effect, and this certification must remain on file for __________ years:

3

65

Which of the following is not one of the "Thresholds" in the "No-Fault" law?

Group of answer choices

Temporary Injury of the Insured....

Death of the Insured

A permanent loss of a bodily function

Permanent scarring on the face of an insured

66

Used to insure businesses engaged in selling, servicing, repairing, parking or storing automobiles:

Garage Coverage Form

67

Under Mechanical Breakdown Coverage, new cars are eligible for service up to:

36 Months/36,000 Miles

68

The Business Automobile Policy includes all of the following coverage forms except:

The Trailer Interchange Coverage Form...

The Garage Coverage

The Truckers Coverage Form

The Business Auto Coverage Form

69

The following examples are referred to as __________ liability limits: 25/50/25 or 10/20/10

Split

70

Jane and Sue are riding with Jim in Jim’s car. All 3 are Florida Residents who own cars and carry Basic PIP with no deductible. There is an accident and Jane has $5,000 in Medical Bills. Whose PIP will pay and how much will it pay?

Jane’s PIP will pay $4,000

71

Jane and Sue are riding with Jim in Jim’s car. All 3 are Florida Residents who own cars and carry Basic PIP with no deductible. Sue has $12,000 in Medical Bills. Whose coverage will pay and how much will it pay?

Sue’s PIP will pay $9600

72

Robert is driving his car in Florida when he is hit by an at-fault driver. Robert has $10,000 in medical bills, carries Basic PIP with a $1000 deductible and has no Med Pay. How much will the at-fault driver have to pay for Robert’s injuries?Group of answer choices

$2800

73

While driving his own car, Bill is involved in an accident that is the fault of the other driver, Mike. He looks to collect for his injuries in the following order:

His PIP, his Med Pay, Mike’s Liability, his UM.

74

Jim has had an auto policy with the Wonderful Insurance Group for 3 years. 30 days before his renewal date he receives notice of the company’s intention to non-renew because of 3 negligent losses and 1 speeding ticket in the past 3 years. His driving record and claim history make this a valid non-renewal.

False

75

Which of the following are characteristics of Homeowner's Insurance?

Group of answer choices

Protects against economic loss to residences and household property, and legal liabilities

Owner-occupants of 1-4 family dwellings

Renters who maintain residential occupancy in any type of building

76

On a Homeowner's Policy, covers items that are not permanately attached to the dwelling. This is defined as:

Other Structures

77

Jeremy owns a home that is recently damaged due to a hurricane. The repair estimate is averaged at $25,000 and Jeremy decides to stay in a hotel becuase most of the damage is to his bedroom and kitchen. Under a Homeowner's Policy, what coverage will pay for the hotel room bill?

Group of answer choices

Loss of Use

78

All of the following are eligible for a Homeowner's Policy, except?

A business condo owned by a local insurance company.....

An apartment tenant

A condominium owner

Four-Family dwelling owner-occupant

79

Which of the following is not covered under Coverage C, Personal Property?

A fire breaks out in the residence and an overnight guest loses his clothes in a fire

A fish dies because he has been left alone for a week without food .......

The insureds daughters tennis racket is stolen from her locker

The insureds suitcase and clothing, valued at $1,500, are stolen from his hotel room

80

Which of the following forms is "all-risk" on the dwelling policy?

DP-3, or the For Special Form

81

An insured who wishes to purchase flood insurance, but is located in a moderate or low risk flood zone may do so by purchasing a:Group of answer choices

Preferred Risk Flood Policy

82

Which of the following is not one of the rating factors for a Homeowner's Policy?

Age & Gender of Insured

83

A lender has an insurable interest in a home and finds protection in the:

Mortgagee Clause

84

When the basic liability limits provided by the policy are insufficient for an insureds needs, two coverage forms are used to provide the additional amounts of coverage:

Excess Liability

Umbrella

85

The authority given by an insurer or employer to a licensee to transact insurance or adjust claims on behalf of an insurer or employer is defined as:

Group of answer choices

Appointment

86

Any material which is or may have been a motor vehicle or mobile home, which is not a major part or major component part, which is inoperable and which material is in such condition that its highest or primary value is either in its sale or transfer as scrap metal or for its component parts, or a combination of the two.

This is defined as:

Derelict

87

A motor vehicle or mobile home which is a total loss is defined as:

Salvage

88

One who is duly authorized by a subsisting certificate of authority issued by the department to transact insurance in this state.

Authorized

89

An individual appointed by a general lines or agency to assist that agent or agency in transacting the business of insurance from the office of that agent or agency is defined as:

Customer Representative

90

An agent who transacts any one or more of the following types of insurance: Property, Casualty, Surety, Marine, and Health is defined as a(n)

General Lines Agent

91

An agent representing a health maintenance organization , or as to health insurance only, an insurer transacting health insurance is defined as a(n):

Health Agent

92

The District of Columbia and any state or territory of the United States in which an insurance agent maintains his or her principal place of residence or principal place of business and is licensed to act as an insurance agent. This is defined as:

Group of answer choices

Home State

93

An individual representing an insurer as to life insurance and annuity contracts, including agents appointed to transact life insurance, fixed-dollar annuities, or variable contracts by the same insurer is defined as:

Life Agent

94

A customer representative appointed by a general lines agent or agency in transacting only the business of private passenger motor vehicle insurance from the office of that agent or agency is defined as:

Limited Customer Service Representative

95

The Department may issue a nonrenewable temporary license authorizing the appointment of a general lines insurance agent, life agent, or an industrial fire or burglary agent, for a period not to exceed:

6 Months

96

An applicant for a temporary license must be:

A natural person at least 18 years of age

A US citizen or legal alien who possesses work authorization

97

How many continuing education hours must an insurance adjuster complete every 2 years?

24

98

Every licensee shall notify the department, in writing, after a change of name, residence address, principal business street address and/or mailing address within how many days?

30

99

Which of the following are reasons for refusal, suspension or revocation of a license or appointment?

Lack of Qualifications

Failure to Pass State Examinations

Fraudulent or Dishonest Practices

100

An applicant for a license as an adjuster may qualify as an adjuster in the following fields (but not limited to):

All lines of insurance except life and annuities

Property and Casualty

Workers Compensation Insurance

101

Which of the following are considered unfair methods of competition and unfair or deceptive acts or practices:

False Statements

Unfair Discrimination

Unlawful Rebates

102

Charging an applicant for a specific ancillary coverage or product, in addition to the cost of the insurance coverage provided for, without the informed consent of the applicant is a practice of:

Sliding

103

When making any payment for damage to an automobile for a partial loss, the insurer shall have printed on the loss settlement, "Failure to use the insurance proceeds in accordance with the security agreement, if any, could be a violation of s.812.014, Florida Statutes." This is payment for a(n):

Third Party Claim

104

A licensed and appointed All-lines Adjuster may solicit business on behalf of a licensed Public Adjuster only if under the supervision of that licensed Public Adjuster.

Group of answer choices

False

105

Which of the following are parties to a Bond?

Principal

Obligee

Surety

106

One who undertakes to perform, to fulfill a contract or to meet an obligation is known as:

Principal

107

Guarantees the performance between the principle and the obligee:

May act as part of the bonding party and agrees to reimburse the surety for any loss it may suffer from having bonded the principal:

Group of answer choices

Surety

108

Which of the following are NOT a type of bond?

Apprentice

109

This form of bond is required to accompany a bid for a contract which will require that the successful bidder furnish further bond if awarded the job:

Bid

110

This bond guarantees indemnification to the obligee for any losses resulting from the principal s failure to complete the contract work in accord with specifications:

Group of answer choices

Performance

111

This type of bond covers streets, sidealks, sewers, etc.:

Subdivision

112

Which of the following are characteristics of a License Bond?

To guarantee the licensee will act according to the laws

Protect the public from unfair business practice

Proper collection and payment of taxes

113

May act as part of the bonding party and agrees to reimburse the surety for any loss it may suffer from having bonded the principal:

Indemnitor

114

When a person has lost stock certificates, bonds or similar instruments, a bond is generally required by the issuing company to reissue the document. This is known as a:

Lost Instrument Bond

115

Under Workers Compensation, Part Four Your Duties if Injuries Occur, an employer is required to:

Provide the names and addresses of injured persons and witnesses

. Promptly provide any legal papers

Cooperate and assist as the insurer requests

116

The measure to determine disability benefits is the __________ of the employee at the time of injury:

Average Weekly Wage

117

The following are classes of disability, except:

Temporary Full

118

Mandatory for risks exceeding certain annual premiums, recognizes the prior loss experience of the risk and applies either a debit for unfavorable experience or a credit for better-than-expected loss results. This is defined as:

Group of answer choices

The Experience Rating Plan

119

An optional alternative providing for adjustment of premium after expiration, based on a guaranteed basic premium to the insurer to which is added the actual losses incurred by the insured. This is defined as:

Group of answer choices

Retrospective Rating Plan

120

Under workers compensations, a rate is charged for every __________ of payroll to employees.

Group of answer choices

$100

121

All of the following are components of Workers Compensation, except:

Up to $750,000 in Death Benefits.....

Reimbursement for Medical Expenses incurred

Reimbursement for lost wages on a percentage basis

Funeral costs up to $7,500

122

Under Workers Compensation, Employers Liability includes:

Claims by others for the liabilities to insureds employees

Claims by relatives of injured employees for consequential damages

Claims made by employees that are not subject to Workers Compensation Laws

123

Under Employer's Liability, the minimum limits of liability are:

100/100/500

124

Samantha eats uncooked chicken at a local barbecue joint and becomes violently ill. Which of the following workers compensation benefits would pay for this occurrence?

Group of answer choices

A products and completed operations form

A premises and operations form

An owners and contractors protective liability form

None of the above ,,,,,,,.....

125

The voluntary or intentional relinquishment of a known right is defined as a(n):

Waiver

126

The principle of utmost good faith on which an insurance contract is based places serious responsibilities on the claims adjuster in regards to:

Conduct

Work Habits

Claim Handling Activities

127

Duties and functions of the Department of Financial Services include all of the following except:

Rating and underwriting rules....

Approve the issuance of licenses

Claims Supervision

Investigate Charges of Unethical Behavior

128

The assertion of an alleged legal right against an insurer, which carries with it a demand for appropriate relief, is defined as:

Claim

129

One who is involved in the investigation, adjustment, negotiation and/or trial preparations of claims arising under insurance policies is defined as:

Claims Adjuster

130

The process of disposing of an insurance claim is defined as:

Adjusting

131

Which of the following are not considered to be an adjuster:

Group of answer choices

General Lines Adjuster...

Employee or Staff Adjuster

Independent Adjuster

Public Adjuster

132

An adjuster who represents the financial interests of the insured named in the policy is defined as a(n):

Public Adjuster

133

An adjuster who is a salaried employee under the supervision of the home, branch, or regional claims department of insurers is defined as a(n):

Company or Staff Adjusters

134

An adjuster who is self employed and not affiliated with either insurers or bureaus is defined as a(n):

Independent Adjuster

135

A relationship that requires maintenance of a high degree of fidelity and loyalty to the interests of the principal, whether or not the adjuster is a direct employee is defined as:

Fiduciary

136

The adjusters basic activities in claims handling are:

Investigation

Evaluation

Negotiation

137

The adjuster's investigation may include all of the following except:

Policy Cancellation.....

Verification of Bills and Estimates

Photographs

Witness Canvasses

138

Establishing a dollar value on a claim is defined as:

Evaluation

139

Relieving the financial burden on the claimant by making certain payments to the claimant even before the claim can be negotiated is defined as:

Group of answer choices

Advanced Payment

140

Damaged property that may be retrieved, reconditioned and sold to reduce an insured loss is defined as:

Salvage

141

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 advance pending an outcome of a claim against the person responsible for the damage.

Loan Receipt

142

When investigating liability insurance claims, which of the following three major elements are determined:

Coverage

Liability

Damages

143

Under the Florida Unfair Insurance Trade Practices Act, penalties are provided for misrepresentation of business practices, which include all of the following except:

Denying claims with reasonable investigation.....

Failing to act promptly

Failure to explain claim denials in writing

Failure to maintain complaint handling procedures

144

All of the following are requirements for the "Code of Ethics," except:

Adjusters may negotiate with a claimant who is represented by an attorney...

Adjusters should not give legal advice

A witness who requests a copy of a statement given must be provided one

145

Must be licensed, appointed by a General Lines Agent and can transact AUTO insurance only in the Office Only.

Limited Customer Representative 4-42

146

Once a Customer Representative 4-40 has been licensed and appointed for at least 3 years, he or she may transact insurance in the home of an existing customer.

Group of answer choices

False

147

Unlike a Customer Representative, a General Lines Claim Adjuster need not be appointed with the Department of Financial Services.

False

148

While selling an Automobile policy to a customer, an agent tells them that they are also required to purchase an Emergency Road Service Plan, even though that is not true.

Sliding

149

After pleading guilty or no contest to a felony, a licensed individual has _________ days to inform the Department?

30

150

A General Lines Claim Adjuster is required to obtain the same number of Continuing Education hours as a licensed Customer Service Representative.

.Group of answer choices

False

151

A licensed General Lines Claim Adjuster is required to complete how many hours of continuing education every two years?

24

152

Defaming a competitor company or agent is not only unprofessional, it can also result in a license suspension.

True

153

An Insurance Company which is formed under the laws of the State of Illinois, and has its Home Office there, is considered a:

Group of answer choices

Foreign Company

154

A General Lines Agent instructs a licensed Customer Representative 4-40 to thoroughly cover the details of a new life insurance product with every Homeowner customer who calls or visits the office. The agent provides training on the new product. Although the Customer Representative does not have a Life License, he or she feels comfortable with the training and does as requested.

This practice is unacceptable and may result in the suspension or revocation of the Customer Representative's license.