TX ADJUSTER TEST QUESTIONS AND ANSWERS 2023

Subrogate Subrogation is the right for an insurer to legally pursue a third party that caused an insurance loss to the insured. This is done as a means of recovering the amount of the claim paid by the insurance carrier to the insured for the loss. - Answer- While investigating a claim, you determine that the loss was caused by a defective mechanism in the dishwasher. You would attempt to_________________________? Appraisal - Answer- What is the process when an insurer and an insured have a dispute regarding the amount of damage? Material Misrepresentation - Answer- __________________________________________________is a significant misstatement in an application form. If a company had access to the correct information at the time of application, the company might not have agreed to accept the application. Age, Condition and Life Expectancy - Answer- As an adjuster, you should base depreciation on these three factors? Umpire - Answer- An_________________ is a person hired by the property owner to settle the claim with insurance company on their behalf. HO-A - Answer- This type of policy provides coverage only for those perils that are listed in the policy? Additional Living Expenses - Answer- _________________________ are extra charges covered by homeowner's policies over and above the policyholder's customary living expenses. Occurrence - Answer- _______________________is an event that results in an insured loss/damages? Actual Cash Value - Answer- What is value of your property, based on the current cost to replace it, minus depreciation? Incurred Expenses - Answer- Expenses that have already sustained and that have not yet been paid are known as ____________________________________. Declarations Page - Answer- ________________________________is the part of the written insurance policy that states all the policy's specific's, including the name of the policyholder, the type of property insured, the premiums, and the term limits for the coverage. Negligence - Answer- What is the failure to use that degree of care which an ordinary person of reasonable prudence would use under similar circumstances? Overhead and Profit - Answer- ______________________________is the amount of money dedicated to a general contractor's cost of doing a business and earning a profit. Third Party Loss - Answer- ____________________________is a situation involving a person other than an insurer and the insured. Reserves - Answer- What is the amount representing actual or potential liabilities kept by and insurer to cover debts to policyholder? First Party Loss - Answer- This loss involves only the insurer and the insured? Liability - Answer- What is the responsibility to another for one's negligence? Severity - Answer- _____________________ is the size of a loss, the extent of damages. Premium - Answer- ___________________________ is the amount paid by an insured to an insurance company to obtain or maintain an insurance policy Replacement Cost - Answer- __________________________________is the cost associated with replacing property at the current market price. Policy Period - Answer- The period of a policy is in force, from the beginning or effective date to the expiration date is the ________________________________? deductible - Answer- The amount the insured must pay in a loss before any payment is due is known as the ____________________________________. Adjuster - Answer- A person who investigates and settles insurance claims is the ______________________? $5000.00 - Answer- Mary Johnson has an HO-B policy. Her coverage A limit of liability is $250,000 and her coverage B limit is $125,000. Her policy has a 2% deductible. What is her deductible? Coverage A - Answer- If your policyholder has a 1% deductible, this percentage would be taken from what coverage? 10% of COV B - Answer- The Homeowner's policy provides coverage's for Personal Property that is away from the residence premises. The total limit of liability for off premises losses is ______________________________? at the residence or elsewhere - Answer- When handing a homeowner's content claim, you should establish if the loss happened __________________________________________ to help determine the total limit of liability that will apply to the claim. $14,220 - Answer- Your policyholder has a Homeowner's Policy with the following limits on it COV A limit is $158,000 COV B limit is $90,000 His home has a detached garage. His home and detached garage were completely destroyed in a fire loss. What is the maximum that he can receive for his detached garage? $15,800 MINUS A 1% DEDUCTIBLE= Total Loss is $4950.00 less 1% deductible OF $85,000 = $850.00 = $4100.00 - Answer- COV A limit is $85,000 COV B limit is $ 46,000Your policyholder lives in Houston, Texas. While on vacation in Detroit, Michigan someone steals the following items from his house in Houston. How much will you pay for this loss? Electronics $1,600, Clothing $850, Golf Clubs $1,500, Shoes $600, Luggage $400, Loss is $7850 is the total loss. 1% of COV A =$750.00 Amount to be paid is $7100.00 - Answer- COV A limit is $75,000 COV B limit is $36,000 Your policyholder lives in Houston, Texas. While on vacation in Detroit, Michigan someone steals the following items from his house in Houston. How much will you pay for this loss? Electronics $1,600, Clothing $850, Business Laptop $3000 ONLY PAYS $2500, Music CD's $500, Golf Clubs $1,500, Shoes $900 1. Money or Bank Cards 2. Valuable Papers, deeds, stamps BULLIONS etc. 3. Jewelry Watches or furs - Answer- Name 3 things that are subject to "Special Limits of Liability" under the HO-B Coverage A - Answer- Under a HO-B policy, the dwelling/structure is covered for what types of losses? Coverage B - Answer- Under a HO-B policy, the contents are covered under what Coverage? 1)Fire and Lightening, 2) Sudden and Accidental Damage from Smoke, 3) Windstorm , Hurricanes and Hail, 4)Explosion 5) Aircraft 6) Vandalism and Malicious Mischief 7) Riot and Civil Commotion 8) Collapse of a building, or part of a building 9) accidental discharge overflow of water or Steam form plumbing, heating, air conditioning, system or household appliance 10) Falling objects, 11) Freezing, 12) theft or attempted theft - Answer- List the 12 named perils that contents are covered for under the HO-B? $250 - Answer- What is the maximum amount for coverage for a covered loss to a tree? Not Covered Found on HO-B PG 2 Under Property - Answer- Your policyholder sustained a theft loss. His roommate's personal laptop, plasma television and Sony stereo were all stolen. What are you going to tell him regarding his roommate's property? (Explain your answer and cite where you found it in the policy) personal property contained in a building unless direct force of wind or hail makes an opening in a roof or wall and rain, snow, sand or dust enters through this opening and causes the damage. - Answer- Under Section I Exclusions, what does Exclusions c. (3). Say? NO. She is OVER 21. - Answer- Your aunt is caring for a 22 year old female. Is this 22 year old female an Insured under the HO-B policy? $0 not covered - Answer- Your policyholder misplaced his watch somewhere in his house. The watch costs $800. How much are you going to pay him? Floods are not covered - Answer- During the storm, your policyholder's dwelling sustained 12ft of flood water. He provides you with receipts for his Additional Living Expenses. The expenses are all reasonable. What do you tell the policyholder? $0 not covered Found in SECTION 1 Exclusions C1 - Answer- During a recent windstorm, your policyholder's cloth awning sustains damage. The damage to the cloth awning is $400. How much can you pay for the cloth awning? Not GO!! - Answer- While working on a claim with an approved vendor, he invites you to the Cowboys game. What should you do? Professionally - Answer- When dealing with a customer, you should always behave_________________? Timely Follow Up - Answer- ________________________is critical to keep your Policy holder informed during the claims process. Show them where it is in the policy. - Answer- While handling an auto claim, your policyholder seems confused about your coverage determination. At this time, what should you do? To organize the claims so you know dates, times and facts for each claim. - Answer- Why should you keep a chronological detailed log of all the activity on a claim? done in Writing - Answer- Full or partial denial of claims must be __________________________. Customer Service - Answer- Claim adjusting is what type of profession: Adjuster Me and Insured - Answer- When setting appointments, getting an agreed time should be a balance between what? own Merits - Answer- You should always handle claims based on their _____________________________? Perceived! - Answer- Your actions do matter, you should always be aware of how you are Safe, Secure and Sanitary - Answer- To what standard will FEMA repair a home to? Dwelling, Contents, Debris Removal and ICC (Increased Cost of Compliance) - Answer- What are the 4 sections of the Flood Policy? 80% of the Replacement Cost - Answer- In order for a building to apply for Replacement Cost, it must be at least be insured for_______________________? $250,000 - Answer- What is the maximum amount of coverage you can get on a building under the Flood policy? $0 - Answer- What is the maximum amount a person can receive for Additional Living Expenses (ALE) under the Flood Policy? No - Answer- Stevens Jones has excess continuing education hours in a reporting period. Can he carry the hours over? False 30 Hours - Answer- True OR False?Licensees must obtain 40 hours of Continuing Education every 3 years? a. Consumer Protection b. Adjuster Ethics - Answer- The Texas Department of Insurance specifically requires the adjuster applicants complete at least two hours of continuing education in: Go online and renew. - Answer- Mike's license expires in two weeks. What should he do to renew his license? a. All Lines b. Property c. Property and Casualty d. Surety e. Workers Compensation - Answer- What are the types of adjusters licenses approved for insurance in Texas? NO - Answer- Do you have to be a resident of Texas to obtain a Texas Adjuster's License? Complete and comply audited by TDI - Answer- The Texas Department of Insurance does not track completion of continuing educations hours, but you must ---------------------------- in the event you are _______________________________. 18 years - Answer- To qualify to become an adjuster in Texas, you must be at least _____________________ of age. $50.00 - Answer- In the event you do not complete the adjuster CE requirements, you will be fined __________________ per hour. False 24hours - Answer- True or False: As an adjuster, you have up to 48 hours to make reasonable contact with your insured? If Homeowner has 3 or more non-weather related claims w/in a 3 year period. - Answer- An insurance company can refuse to renew a policyholder under what circumstances? False - Answer- True OR False? Is it a violation of the Unfair Claim Settlement Practices Act to provide the policyholder with the pertinent information regarding their claim Issue a full denial of the claim within 5 days. Promptly! - Answer- If you deny a claim you must? a. Acknowledge the Claim b. Begin the Investigation c. Request all items needed to evaluate the claim. - Answer- Within 15 days after we receive written notice of your claim we must: 5 Days - Answer- Once you have accepted or rejected an insurance claim, you have_____________ to issue the payment or issue the written denial letter. ?You need type of specialist to assist with the investigation. ie structural engineer - Answer- During the course of your investigation, you may request an additional 45 calendar days to complete your investigation under what circumstances? False - Answer- True OR False? Failing to settle claims when liability is reasonably clear is an accepted claim handling practice? False - Answer- True OR False? As an adjuster, you should advise a claimant as to their legal rights. True - Answer- True OR False? As an adjuster, you should not contact a claimant represented by an attorney. False - Answer- True OR False? As an adjuster, you should advise a claimant against seeking legal advice. NO - Answer- Jacob was participating in the company softball tournament. During the game, he twists his ankle trying to run to 3rd base. Is this covered under Texas Worker's Compensation? YES - Answer- . Donyalle disagrees with the coverage determination of her Worker's Compensation claim; can she hire an attorney and take the matter to court to get resolved? a. if they 'are injured on the job b. have a work related injury or illness. - Answer- Worker's Compensation benefits will pay under what circumstances? a. You were intoxicated at-the time of the injury b. You injured yourself on purpose at while trying to injure- someone else c. You were injured by another person for personal reasons; d. You were injured by an act of God e. Your injury occurred during horseplay; or Your injury occurred while voluntarily participating in an off-work activity. - Answer- You cannot receive Worker's Compensation benefits if: Be on the approved DRs. List kept by the Division of Worker's Comp - Answer- You have the right to an initial choice of Doctor. The Doctor you choose must? 30 Days - Answer- You must tell your employer within _________________of the date you were injured. 8 days - Answer- An employer must report the injuries within ______________ of the injury. Underwriting - Answer- The process an insurance company uses to decide whether to accept or reject an application for a policy. Staff Adjuster - Answer- Employee of the insurance company's claim department is__________________ Reserves - Answer- A company's best estimate of what it will pay for claims. The amount that represents actual potential liabilities kept by an insurer to cover debts to the policyholders.