Florida Claims Exam, 6-20 All Lines Adjuster Review 47 Pages
1. Florida Unfair Insurance Trade Practices Act: Describes certain practices, penalties are provided for
misrepresentation to insureds and claimants and busi- ness practices such as
-Failing to act promptly
-Failure to affirm or deny a claim when an insured is entitled there to
-Failure to explain claim denials in writing
-Failure to maintain complaint-handling procedures such as keeping accurate records of complaints.
2. Comprehensive Coverage: Covers all loss except collision or overturn. Stan- dard deductible is $100 per
car, $500 per occurrence applies to losses from theft, mischief, and vandalism.
3. What is the minimum requirements for the Financial Responsibility Law
?: -The legally valid claims of others must be satisfied(up to the 10/20/10 require- ments)
-The owner and operator must provide certification of financial responsibility for future accidents. If not satisfied
operator's driver's license and the registrations of all owned vehicle's are suspended.
1. Peril: Something that causes a loss.
4. What are the basic activities in claims handling ?: -Investigation to establish coverage, determine legal
liability, and verify if the alleged damages qualify the loss for payment.
-Evaluation to determine the fair payment in accordance with the contract and applicable law.
-Negotiation of a quality settlement based on facts discovered during the evaluation process.
5. Claim: Is the assertion of an alleged legal right against an insurer, which carries with it a demand for
appropriate relief.
6. Claims Adjuster: One who is involved in the investigation, adjustment, nego- tiation and/or trial
preparations of claims arising under insurance policies.
7. Adjusting: Process of disposing of an insurance claim.
8. Loan Receipt: A written statement given by the insured to the insurer acknowl- edging that money received in
the settlement of damages is received, not as a final
payment, but as an advanced pending the outcome of a claim against the person responsible for the damage.
9. Apportionment: Is a provision for computing and assigning to each of two or more contracts covering a
claim its proportion of the amount of the loss.
,10. How to settle a claim for an Injured Minor ?: Under Fl Law, the adjuster should settle a third-party
liability claim of an injured minor child with both parents of the injured child, presuming the settlement is for an
amount not in excess of
$15,000. If it is more than that it must be consummated through the Circuit or County Courts.
11. What are the violations of the Unfair Trade Practices Act ?: -Failing to act promptly.
-Failure to affirm or deny a claim when an insured is entitled thereto.
-Failure to explain claim denials in writing.
-Failure to maintain complaint-handling procedures, such as keeping accurate records of complaints.
12. Section 624.155 of the Florida Statues provides ?: That any person who is damaged by certain insurer
practices is granted a right to sue the insurer for damages.
13. The Principle Of Utmost Good Faith: An insurance contract is based, places serious responsibilities on the
claim adjuster with regard to conduct, work habits, and specific claims handling activities.
14. What does 10/20/10 mean ?: 10=10,000 Livability per person injured-amount that will be paid out for
injuries to one person.
20=20,000 Combined Total Liability for all injuries-this is the most paid out for injuries for an accident.
10=10,000 Property Damage-the most paid out for damage caused to property of others.
15. What is SR-22 ?: A form of coverage known as a NAMED NOOWNER policy is required, this form offers
insurance coverage only while the insured is operating automobiles owned by others.
16. Hazard: Something that increases the probability that a loss will occur.
17. Warranty: A policy condition, either based on information in the insureds appli- cation or inserted by the
insurer. It is a guarantee of a fact.
18. Misrepresentation: An untrue statement by the insured, made in an application for insurance but which does
not become a part of the policy.
19. Concealment: The failure of the insured to reveal relevant facts known to the insured in applying for
,insurance.
20. Abandonment: Property insurance policies usually contain an abandonment clause, stating the insured
cannot dump damaged property on the insurer and demand its full value.
21. Severability: The insurance applies separately to each insured as if other insureds did not exist.
, 22. Proximate Cause: The cause having the most significant impact in bringing about the loss under a first-
party property insurance policy, when tw independent perils operate at the same time (i.e., concurrently)
o or more to
pr oduce a loss.
Courts employ a set of rules to resolve causation disputes when a pr states that it covers or operty policy
excludes losses "caused by" a peril and there one peril at work in a fact pattern. Under common law,
is more than
whether the po coverage depends on which peril is chosen as the proximate cause. licy provides
23. Direct Loss: Physical harm to tangible property.
24. Indirect Loss: Economic loss which flows as a result of direct loss.
25. Actual Cash Value(ACV): Replacement Cost minus Depreciation
26. Coinsurance: The amount, generally expressed as a fixed percentage, an insured must pay against a claim
after the deductible is satisfied. It's ultimately a way for the insured and insurer to share responsibility for the
risk. It can also help reduce the cost of the insurance policy premium. Coinsurance can be written on an 80/20,
90/100, or 100% rule.
27. Personal Contract: Policies cover people who own and operate as automobiles. things, such
28. Conditional Contract: Also called a hypothetical contract, is a contract agree- ment that only requires
performance once the delineated conditions are met. This legal agreement requires prior performance of another
agreement or clause in order to be enforceable. If the other agreement or condition is performed, then the
1. Florida Unfair Insurance Trade Practices Act: Describes certain practices, penalties are provided for
misrepresentation to insureds and claimants and busi- ness practices such as
-Failing to act promptly
-Failure to affirm or deny a claim when an insured is entitled there to
-Failure to explain claim denials in writing
-Failure to maintain complaint-handling procedures such as keeping accurate records of complaints.
2. Comprehensive Coverage: Covers all loss except collision or overturn. Stan- dard deductible is $100 per
car, $500 per occurrence applies to losses from theft, mischief, and vandalism.
3. What is the minimum requirements for the Financial Responsibility Law
?: -The legally valid claims of others must be satisfied(up to the 10/20/10 require- ments)
-The owner and operator must provide certification of financial responsibility for future accidents. If not satisfied
operator's driver's license and the registrations of all owned vehicle's are suspended.
1. Peril: Something that causes a loss.
4. What are the basic activities in claims handling ?: -Investigation to establish coverage, determine legal
liability, and verify if the alleged damages qualify the loss for payment.
-Evaluation to determine the fair payment in accordance with the contract and applicable law.
-Negotiation of a quality settlement based on facts discovered during the evaluation process.
5. Claim: Is the assertion of an alleged legal right against an insurer, which carries with it a demand for
appropriate relief.
6. Claims Adjuster: One who is involved in the investigation, adjustment, nego- tiation and/or trial
preparations of claims arising under insurance policies.
7. Adjusting: Process of disposing of an insurance claim.
8. Loan Receipt: A written statement given by the insured to the insurer acknowl- edging that money received in
the settlement of damages is received, not as a final
payment, but as an advanced pending the outcome of a claim against the person responsible for the damage.
9. Apportionment: Is a provision for computing and assigning to each of two or more contracts covering a
claim its proportion of the amount of the loss.
,10. How to settle a claim for an Injured Minor ?: Under Fl Law, the adjuster should settle a third-party
liability claim of an injured minor child with both parents of the injured child, presuming the settlement is for an
amount not in excess of
$15,000. If it is more than that it must be consummated through the Circuit or County Courts.
11. What are the violations of the Unfair Trade Practices Act ?: -Failing to act promptly.
-Failure to affirm or deny a claim when an insured is entitled thereto.
-Failure to explain claim denials in writing.
-Failure to maintain complaint-handling procedures, such as keeping accurate records of complaints.
12. Section 624.155 of the Florida Statues provides ?: That any person who is damaged by certain insurer
practices is granted a right to sue the insurer for damages.
13. The Principle Of Utmost Good Faith: An insurance contract is based, places serious responsibilities on the
claim adjuster with regard to conduct, work habits, and specific claims handling activities.
14. What does 10/20/10 mean ?: 10=10,000 Livability per person injured-amount that will be paid out for
injuries to one person.
20=20,000 Combined Total Liability for all injuries-this is the most paid out for injuries for an accident.
10=10,000 Property Damage-the most paid out for damage caused to property of others.
15. What is SR-22 ?: A form of coverage known as a NAMED NOOWNER policy is required, this form offers
insurance coverage only while the insured is operating automobiles owned by others.
16. Hazard: Something that increases the probability that a loss will occur.
17. Warranty: A policy condition, either based on information in the insureds appli- cation or inserted by the
insurer. It is a guarantee of a fact.
18. Misrepresentation: An untrue statement by the insured, made in an application for insurance but which does
not become a part of the policy.
19. Concealment: The failure of the insured to reveal relevant facts known to the insured in applying for
,insurance.
20. Abandonment: Property insurance policies usually contain an abandonment clause, stating the insured
cannot dump damaged property on the insurer and demand its full value.
21. Severability: The insurance applies separately to each insured as if other insureds did not exist.
, 22. Proximate Cause: The cause having the most significant impact in bringing about the loss under a first-
party property insurance policy, when tw independent perils operate at the same time (i.e., concurrently)
o or more to
pr oduce a loss.
Courts employ a set of rules to resolve causation disputes when a pr states that it covers or operty policy
excludes losses "caused by" a peril and there one peril at work in a fact pattern. Under common law,
is more than
whether the po coverage depends on which peril is chosen as the proximate cause. licy provides
23. Direct Loss: Physical harm to tangible property.
24. Indirect Loss: Economic loss which flows as a result of direct loss.
25. Actual Cash Value(ACV): Replacement Cost minus Depreciation
26. Coinsurance: The amount, generally expressed as a fixed percentage, an insured must pay against a claim
after the deductible is satisfied. It's ultimately a way for the insured and insurer to share responsibility for the
risk. It can also help reduce the cost of the insurance policy premium. Coinsurance can be written on an 80/20,
90/100, or 100% rule.
27. Personal Contract: Policies cover people who own and operate as automobiles. things, such
28. Conditional Contract: Also called a hypothetical contract, is a contract agree- ment that only requires
performance once the delineated conditions are met. This legal agreement requires prior performance of another
agreement or clause in order to be enforceable. If the other agreement or condition is performed, then the
