Claims Adjuster Exam Questions and Answers Already Passed

Claims Adjuster Exam Questions and Answers Already Passed Multi Peril-Package Any policy which provides property & liability coverage (not homeowner) ISO policy Sold in Texas, but not Texas form Only Texas DP 1 Mainly the only TDP sold, now with plethora of endorsements Texas Standard Fire Policy Granddaddy of all Texas property policies Business auto coverage e.g. Owner of a taxi to cover collision damage Inland Marine (build milk policy) would cover e.g. 3k gallons of milk in tanker truck Texas Standard, Standard Fire & Business Owner Would all cover damage to something like a gift card shop fire Tx Personal Auto Policy e.g. Owner of family far, for potential injury to other people Trucker's policy Trucking company, for potential damage to other people's trailers which the trucking company may be pulling Actual Cash Value (ACV) Replacement cost less depreciation Garage Liability e.g. For valet parking service to have appropriate liability coverage it needs what kind of policy? Flood, workers comp, crop, costal wind among others Types of casualty claims I will be unable to handle under license I'm studying for Ocean Marine Hull coverage Would have to be written for an insured to cover potential collision damage to insured's ship Covered (if it's not written) It's safe to assume that if something is not excluded in writing it's appropriate to assume that the loss is? 15/15/5 rule 15 calendar days to send notice you received claim 15 business days to resolve case 5 days to pay claim (if applicable) Options for High Risk Drivers? Texas started TAIPA Risk pool Minus PIP ($2,500) Uninsured/underinsured motorist coverage What does TAIPA provide? When can you get TAIPA Once you've been rejected by 2 or more insurance companies Commercial General Liability coverage Covers basically any risk imaginable that would "cause" bodily injury or property damage E.g. Customer slip-fall; hit by debris; escalator lurching;poison get well card Multi peril or package Any policy that provides both property and liability coverage ISO A policy sold in Texas, but is not a Texas Policy form How many Texas Dwelling policies are sold now? ONE TX Dwelling Form 1 The dwelling policy sold in texas Texas Standard Fire Policy is... The granddaddy of all Texas property policies E.g. Owner of a taxi who needs collision damage for his own taxi Business auto e.g. E.g. 3,000 gallons of milk in tanker truck Inland Marine (Bulk Milk) e.g. E.g.Fire damage to small greeting card shop (3 possible policies) Texas Standard Fire, Standard Fire, Business owner e.g. Actual Cash Value (ACV) What is replacement cost less depreciation? Garage Liability For valet parking service to have appropriate liability coverage... Need what policy? Types of claims I am unable to do without attaining other licenses? (Name at least 2) Flood Workers comp Crop Coastal wind Etc.... Ocean Marine Hull Coverage Cover potential collision damage to insured's ship When is it safe to assume something is covered? When it is not excluded Open peril, special, or all risk policies are... Policies that do not name/list covered perils ACV & broad named peril In TDP-3, dwelling is covered for all risk and replacement cost, but PP is covered for... Property and Liability What 2 default lines of insurance are included in homeowner and business owner policy Inland marine Cargo e.g. Someone who bought and is importing furniture from Thailand would want what kind of policy to cover potential damage? E.g. Dwelling Form 3 or equivalent e.g. Policy a landlord purchase would provide best coverage on a rental property e.g. Insured has no liability over that property e.g. Insured's care, custody & control of other people's property is given unusual treatment in any liability policy e.g. Any Homeowner policy e.g. If owner-occupant wants liability and property coverage, they must purchase... E.g. This license approves you to handle both property & liability claims, true or false? True At least 80% of replacement e.g. In all risk TDP what % of actual replacement cost must be insured to actually have replacement cost coverage? E.g. Exclusions--clarify policy as well as... Insuring agreement--clarifies the policy as well as... Declarations Page e.g. Where will you find where the damaged property is located? E.g. Promptly or immediately e.g. When must first party loss be reported to insurer? E.g. Falling objects, Water loss (flood is not the answer) What would not be covered as direct loss in any of the least expensive policy forms (limited, standard, basic)? E.g. Firefighters during a fire e.g. Direct loss from water would be covered if caused by...? E.g. Texas Standard Fire Policy, Standard Fire Policy e.g. Small Texas retail store would have to buy one of these 2 if they did not want liability policy...? e.g. Aviation is another place you find this policy Where else other than ocean marine policies will you find "hull coverage...? Named insured, spouse if living in same household e.g. Most exclusions in policy take away something then give it back by saying "does not apply to you or any family member."..... Who is "you"?.... E.g. surety bond is this type e.g. Name a type of bond that one party guarantees with money the performance of another party to another 3rd party? E.g. Personal Injury Protection would require this A written letter of rejection if coverage in policy were rejected Flood would result What would result from rising water which has touched eart? Paying premiums Is the first thing insured must to have coverage prior to any loss Liability will respond to demands of... E.g. Auto insured has lost control of auto & caused damage to parked car. which covered in policy will respond to demands of parked car? E.g. You will find this phrase in insuring agreement e.g. Other than declaration, where in broad form policy will you find phrase "collapse of building"? E.g. Personal injury Protection e.g. Name of coverage offer in auto policy that would pay medical bills incurred by insured as result of at fault accident e.g. None will pay, even policy described as it is not "full coverage"--no such thing Insured has full coverage on home, auto, & boat--falls down stairs at home, seriously injures knee, which policy might pay medical bills? show Insurable interest in order... to buy insurance policy on property or on life of another person must... Combustion or Rapid Oxidation Fire is defied as this and this accompanied by heat and flame or visible glow Known as Gap Coverage In an umbrella policy there is a provision that allows for payment in case underlying policies exclude coverage for even which is.... You have 91 days In an umbrella policy there is a provision that Personal Injury examples Libel slander & wrongful detention (among others) are examples of what? Insured and covered persons Medical payments coverage on auto policy provide medical benefits for injury to... Persons and property Vacancy of commercial building or residential property is described as property with... Replacement cost less depreciation Actual Cost Value can also be defined as the current Subrogation definition: Standing in the shoes of he insured and exercising the insured's common law rights to recover paid damages from legally responsible 3rd party defines what? Transfer, reduce, retain or avoid are the 4 ways to... Four methods of handling a pure risk Friendly fire--classified as Fire that is intentionally set & remains within its intended boundaries is classified as Companies do not deal with this risk List all the ways Insurance deals with this risk Provides coverage that was excluded on an underlying policy What is the function of Gap Coverage in an Umbrella Policy> Insurance for Insurance companies Reassurance in very simple terms... Fire, vandalism & malicious mischief, are suspended Policy condition that causes us to be concerned about building being vacant beyond a period of (usually) 60 days Withheld (recoverable) depreciation Although "holdback" is not a term used in property, commonly used by adjuster... what does it refer to in terms of claim payment 3rd party or claimant Person who is not party to contract but has interest in coverage is... Reserve Required to establish approximate value of claim & establish figure known as "what" to make funds available for payment Must have 30 hours Upon receipt of License you're required to have how many hours of continuing education before next renewal None of them respond to this damage Insured has "full coverage" under auto, accidentally backs over his own motorcycle--what part of policy respond to his claim for motorcycle damage? Immediately be paid After all investigation is complete & you're aware that liability for insured's claim is clear, when should claim get paid? Article 542.003 (acknowledge) 15 days to acknowledge receipt of new claim Article 542.003 (claim to be paid) We have 5 business days to make payment once we have told insured claim or part of claim will be paid 15 business days to... Affirm or deny payment once insured has complied with all claim department's requests Notify the insured Within 10 days after receiving an offer of settlement in investigation & handling of liability claim against our insured To protect assets What is the purpose of insurance? Vacant When a property is empty of all persons & property it is considered Contractual Liability Agreement which one party voluntarily accepts cost of someone else's potential risk of loss Hostile Fire Friendly fire that escapes its intended boundaries & does damage Scoping Property claims equivalent of investigating a loss Proof of loss When insured files claim that is suspected of being potentially fraudulent--you should always have him file a motorized what? Fingerprinting In addition to application for license, certificate of completion and payment of license fee, Texas residents are required to also get... 2 hours... At least how many hours must be on the subject of ethics or consumer protection? Knowingly (21.21) ______________ misrepresenting to claimants pertinent facts or policy provisions relating to coverages at issue is on of provisions of Article 21.21 of Texas Insurance Code Delay or refuse (21.21) it's a violation of article 21.21 to ______ or ______ settlement of claim solely because there is other insurance of different type available Negotiation When 2 or more parties talk out a solution to a dispute; mutually agreeable compromise; "act of "talking it out" Denial of claim what resolution of claim is considered least desirable, though sometimes inevitable? Legal duty to someone Settling a liability claim on behalf of insured takes care of the insured's: If a claim cannot be resolved, what is usually the final venue for resolution? Court Excluding real property, any property "totaled" becomes: Salvage Call supervisor & find out companies rules regarding salvaged items Adjuster pays for total loss of most contents in home following nasty fire confined in kitchen--smoke & water damages were extensive but some items salvageable. What should adjuster's next move be in regard to salvageable items? In scenarios where things may look, feel & actually would be inappropriate: Better to appear inappropriate than to behave innapropriate lay E.g. Insured offers adjuster gift card for doing great job & working hard--be polite and decline with appreciation Adjuster has to total home due to tornado & insured has replacement cost policy--what is upper payment threshold? E.g. Highest threshold is the limit, next is replacement cost/cost of rebuilding e.g.