Claims Adjuster Exam 1 with 100% Correct Answers 2023

Actual Cash Value (ACV) - Correct answer-Cost to replace property with new property of like kind and quality less depreciation. Combined Single Limit - Correct answer-One limit per occurrence is what we pay up to Split limit - Correct answer-What we pay up to per person and per occurrence Deductible - Correct answer-What the customer will have to pay; we cover everything else Declarations Page (Dec Page) - Correct answer-The basic information about a policy: Who - names of insurer and insured What - description of insured property Where - address and legal description of insured property When - effective and expiration dates. How Much - limits of coverage, deductible, premium Depreciation - Correct answer-Amount taken off for wear and tear Earned Premium - Correct answer-The amount of the premium for which the policy protection has been given. Risk - Correct answer-A chance or uncertainty of loss endorsement - Correct answer-Something you can add/change on policy; car, kid, etc lapse - Correct answer-The insured did not pay so is not covered; will effect renewal Named driver exclusion - Correct answer-Excluded from coverage and covered cars; cannot drive as they would be considered 1st party coverage Coverage A - Correct answer-Building and structures Coverage B - Correct answer-Other structures (such as a detached garage, workshop, swimming pools, fences and gazebos) Coverage C - Correct answer-personal property Coverage D - Correct answer-Loss of use Coverage E - Correct answer-personal liability Coverage F - Correct answer-Medical Payments Personal Umbrella Policy - Correct answer-provides protection against a catastrophic lawsuit or judgment What is covered through PUP? - Correct answer-Liability (property damage and bodily injury [excess]) Other- Personal Injury (libel & slander) Dwelling Components - Correct answer-Construction of dwelling inflation protection - Correct answer-A rider in some insurance policies that automatically raises the benefit amount or the maximum daily or annual payments, based on the rate of inflation, in order to ensure that the amount of coverage remains adequate over time. Market Value - Correct answer-the price at which property would sell named peril basis - Correct answer-Covered for everything named on policy open peril basis - Correct answer-It's covered for any loss unless it is specifically excluded Replacement Cost - Correct answer-The cost to repair or replace property using new materials of like kind and quality with no deduction for depreciation. Scheduled Personal Property - Correct answer-endorsement - provides broader coverage for personal jewelry, furs, cameras, musical instruments, silverware, fine arts, golf equipment, and stamp/coin collections. must be insured on full value basis. Special Limit - Correct answer-Covered up to a certain amount unscheduled personal property - Correct answer-Property not specifically listed in the policy bodily injury liability - Correct answer-insurance that covers physical injuries caused by a vehicle accident for which you are responsible property damage liability - Correct answer-insurance that protects a driver against claims if the insured's car damages someone else's property and the insured is at fault comprehensive - Correct answer-Covers theft, hitting an animal, weather, fire, etc. Collision - Correct answer-Hitting something; colliding with another object or people medical payments coverage - Correct answer-pays medical expenses for the driver and any passengers riding in the car at the time of the accident Personal Injury Protection (PIP) - Correct answer-coverage for medical, hospital, and funeral costs of the insured and passengers in the event of an auto accident uninsured/underinsured - Correct answer-protection against damages caused by a motorist with no or insufficient insurance Other Common Coverages - Correct answer-Rental Car Towing and labor New car added protection Loan/lease protection Ride sharing coverage Individual Rating Factors - Correct answer-Driving record Credit Usage Coverages you choose Group Rating Factors - Correct answer-Gender Location Age Type of vehicle Rating - Correct answer-Standard categories that insurance companies use to decide level of risk that an insured represents. Determines premium cost based on exposure. First Notice of Loss - Correct answer-initial report made to an insurance provider following a loss, theft, or damage of an insured asset. Mitigation - Correct answer-the action of reducing the severity, seriousness, or painfulness of something What does CSAA IG stand for? - Correct answer-California State Automobile Association Insurance Group What does AAA stand for? - Correct answer-American Automobile Association What are our values? - Correct answer-We are caring We have humility We are inclusive We are curious We are accountable We do the right thing Vision statement - Correct answer-To be our member's first choice for solutions in life's uncertainties. What does it mean when we say we insure risk? - Correct answer-We cover the chance of loss and probability of a loss. How many Claims offices do we have with CSAA IG and where are they located? - Correct answer-Four Mount Laurel, NJ Oklahoma City, OK Colorado Springs, CO Las Vegas, NV When do you need to submit your timecard by? - Correct answer-At the end of your work week. (Friday at the end of the day) Safelite - Correct answer-FNOL/ Glass Network Vendor Where is our headquarters located? - Correct answer-Walnut Creek, CA What are we responsible for enhancing, individually and collectively, on a day to day basis? - Correct answer-Enhancing our brand Standard Claim Outcome - Correct answer-Paying the right amount + at the right time + with excellent proactive service + while being internally and externally compliant Leakage - Correct answer-When we pay out too much on a claim. Direct Repair Network - Correct answer-Shops that we approve and guarantee their work; In our network. Out of Network - Correct answer-Shop that does not have a contract with us. We cannot guarantee their work. Simple, Proactive, and Personal - Correct answer-Our approach to claim process Mission Statement - Correct answer-"We serve AAA members and clubs by making insurance simple, proactive, and personal" Combined Ratio - Correct answer-How we determine what we will charge people based on a profitability ratio that indicates whether an insurer has made an underwriting loss or gain from the previous year. First Party Coverage Only - Correct answer-Comprehensive, Rental, and Collision Non-Owned Auto/ NOA - Correct answer-Any auto or trailer not owned by or furnished or available for the regular use of you or any family member while: 1. In the custody of 2. Being operated by You or any family member with the express or implied permission of the owner. (Page 8) Newly Acquired Automobile/NAA - Correct answer-Any auto you become the owner of during the policy period for which no other insurance policy provides coverage. Collision/Comprehensive coverage begins on the date you become the owner if: 1. the NAA replaces a vehicle shown in the dec 2. We provide coverage on the vehicle you replaced for at least 12 months prior to the date of replacement. In this case, the NAA will have the same coverage as the vehicle you replaced. However, you must ask us to insure it within 3 days after you become the owner. PD - Correct answer-Property Damage Tangible - Correct answer-If it is attached to the car; connected to the car, building, structure, lawn, fence, etc Temporary Substitute Auto (TSA) - Correct answer-Renting a vehicle while yours is in the shop/out of commission First Party Claimant - Correct answer-Asserting their right to recovery; The insured is the first party claimant. Subrogation - Correct answer-Situation where an insurer, on behalf of the insured, has a legal right to bring a liability suit against a third party who caused losses to the insured. Insurer maintains the right to seek reimbursement for losses incurred by the insurer at fault of a third party. Third Party Claimant - Correct answer-Asserting their right to recovery; Our insured hit them. Claimant - Correct answer-A person who asserts the right to recovery by making a claim. Claims Agent - Correct answer-Employed/Authorized by an insurer. Does not include an attorney or anyone hired by an insurer (Doctor) solely to provide valuation as to the subject matter of the claim. Extraordinary Circumstances - Correct answer-Catastrophic loss Insurer - Correct answer-A person licensed to issue or that issues an insurance policy or surely bond in this state. (CSAA IG) Licensee - Correct answer-Any person that holds a license or Cert. of Authority from the Insurance Commissioner or any other entity for whom the Insurance Commissioner's consent is required before transacting business in the State of CA. Proof of Claim - Correct answer-any evidence or documentation that provides any evidence of the claim and that reasonably supports the claimed loss. (Objective evidence) • Repair estimates • Receipts • Rental bills • Medical bills • Pictures Monetary items/amounts Notice of Claim - Correct answer-Any written or oral notification the claimant wishes to make against a policy. Investigation - Correct answer-All activities of an insurer or its claims agent related to the determination of coverage liabilities or nature and extent of loss or damage for which benefits are afforded by an insurance policy, obligations, or duties under a bond. Files - Correct answer-Shall contain all documents, notes, work papers (including correspondence) related in detail to claim that pertinent events and the dates of the events can be reconstructed. Benefits - Correct answer-Must be disclosed to a first part claimant (or beneficiary) all benefits, coverage, time limits or other provisions of any insurance policy that may apply to the claim presented by claimant. The insurer shall immediately communicate this fact to the insured. Denying - Correct answer-No insurer shall deny a claim on the basis of the claimant's failure to exhibit property unless there is documentation in the file. § Of reasonable demand by the insurer and unfounded refusal by the claimant to exhibit property § Of the breach of any policy provision providing for the exhibition of property. No insurer shall require a first party claimant under a policy to give notice of a claim or proof of claim within a specified time- If it is UMPD- 10 business days. No insurer shall: § Request that a claimant sign a release that extends beyond the subject matter. § Require the claimant to waive the provisions of California Civil Code Section 1542. It is important that we explain to any claimant what they are signing in laymen terms as to what a "full and final" release means. Protects from going to court/being sued. Receipt of Communication - Correct answer-Every licensee shall immediately, no longer than 21 days, furnish the DOI with a complete written response. ○ Occurs in a DOI complaint which may or may not be a justified complaint. ○ A third party claimant can file a DOI complaint. (most states) In NJ, they can file an appeal. Acknowledgement Letter - Correct answer-Acknowledges the receipt of claim, date of loss, their rights, our rights, coverages; Requests contact with the insured or claimant. PAF Letter - Correct answer-Required when an insured is 51% or more at fault. Notice of Claim - Correct answer-Any written or oral notification to an insurer or it's agent that reasonably apprises the insurer that the claimant wishes to make a claim against a policy. Fines and Possibility of losing license. - Correct answer-The partial penalties for failing to comply with DOI regulations. Exposure - Correct answer-The state of being subject to loss because of some hazard or contingency. Also used as a measure of the rating units or the premium base of a risk. Claimant Carrier - Correct answer-Adverse carrier; Insurance company of other driver Claimant - Correct answer-First or Third Party Litigation - Correct answer-The process of taking legal action; lawsuit Cross Insured - Correct answer-Both parties are through the same insurer. Metropolitan Report - Correct answer-Need to order police report Officials Report - Correct answer-Police report and did not have to order Contributing Factors - Correct answer-DUI, Given a ticket/citation for reckless driving, careless driving, speeding The basic loss description field should not contain abbreviations such as SIU, Fraud, CCQ, or DUI in it? True or False? Should the basic loss description field be updated by the OA after a review? - Correct answer-True- the customers, other insurance companies, and the agents all have access to seeing these notes. Yes- if it's not in the notes, it didn't happen. An acknowledgment letter should be sent out to our NI on every claim open on their policy? T/F? What is the timeline for sending an acknowledgment letter out in the state of NJ? - Correct answer-True Fifteen Days- CAS will auto send. The owning Adjuster (OA) should follow up with the insured or claimant every day after they have set them up for services with a DRN? - Correct answer-False, DRN is a 5 day follow up OR the day after they have scheduled for the photo and estimate. Our job is just to get it to the shop for photos and estimates. Enterprise (ERAC) is CSAA IG's prefer vender when it comes to rental cars? T/F? - Correct answer-False- Hertz is the preferred vendor. Hertz has lower rates to fit our $20/$60(0) What are the guidelines for meaningful contact when an adjuster receives a new claim? - Correct answer-○ Aggressive Pursuit ○ Call twice a day ○ One email ○ Third day- email ○ Diary it out five days (business days) ○ (repeat two more times) If the IV strikes a tree branch in the road while traveling, what type of coverage will apply? If a tree branch falls on the IV while traveling, what type of coverage will apply? Explai - Correct answer-Collision- We collided with the tree when it could have been avoided. Comprehensive- It was a falling object that we could not prevent from falling. Can a deductible waiver be applied to a comprehensive loss? Explain - Correct answerNo, only in a collision loss. If a shopping cart collides with an Insured Vehicle (IV) while parked and unoccupied, would this be considered Comprehensive or Collision for coverage? Explain - Correct answer-Comprehensive The vehicle was not in motion. Is there a deductible with our Named Insured (NI) Uninsured Motorist Property Damage (UMPD) coverage on our NJSS policy? Explain - Correct answer-Yes- $500 No rental in this case scenario Collision pays first BEFORE UMPD What is the definition of "occupying" and where can it be found in the NJSS policy? - Correct answer-In Upon; or Getting in, on, out, or off Page number 8, section M