Florida Test Study Guide - Public Adjusting 3-20 (Set 1), Florida 3-20 Public Adjuster Exam Outlines, Florida 3-20 Public Adjusters State Exam (Set 1) All three in one

Those who are eligible for coverage under the Florida Automobile Joint Underwriting Association are? – Military Personnel A non-resident owning an automobile in Florida A non-resident subject to Florida no-fault law A forcible entry into locked premises and the carrying away of the property of others is a definition of: - Burglary The inland marine coverage form that covers clothing, cameras and other portable property worn and carried by tourists and travelers is a: - Personal effects floater A residual market to alleviate the temporary unavailability of property insurance coverage in significant portions of Florida (e.g. homeowners face non-renewal or cancellations) - Residential Property & Casualty Joint Underwriting Association for property owners. What does the property insurance term "improvements and betterment" apply to? - Real Property The penalty imposed upon a Florida licensee who violates a cease and desists order issued by the CFO: - $50,000 Fine What is amount is personal property used for business purposes, under a Homeowners policy covered up to - up to $2500 on premises up to $1500 off premises If a replacement costs exists, but the insured has a policy for only 50% of the replacement cost, what percentage will the insured received for the loss? - 50% of the settlement amount A statement that is believed to be true when made, which my prove to be false. - Representation A statement that is guaranteed to be correct: - Warranty When can an insured cancel his/her policy? - At any time. In Florida, how many days in advance of a premium due date must an auto insurer provide notice of renewal to an insured? - 30 days written notice What deductibles are subject to any aircraft physical damages that differ according to circumstances surrounding a given loss? - In-flight Ded (greatest amount) Not-in-Motion (least amount) They apply independently based on the actual loss Uninsured Motorist's Coverage form, the insured can request: - Non-stacked Coverage Stacked Coverage UM coverage at the limits lower than those that apply for liability coverage If a mortgage is acknowledged in the policy and the insured concealed the fact that a hazard exists to the insurance company, would the mortgage have a right to recover its full loan value? - Yes Under Florida Comparative Negligence law how much would one be able to recover if they were found 25% at fault? - 75% (the difference) If a claimant is under the influence of drugs and/or alcohol and is found to be 50% or more at fault, how much can they recover? - $0.00 A commercial property coverage part includes: - Common policy conditions Commercial property declarations One or more causes of loss forms When an insurance adjuster advises an insured to misrepresent the claim by suggesting how to report a claim, the adjuster should be charged with: - Unfair Claims Act The "outside premises" policy insuring agreement covers: - Loss of money and securities and other property outside the premises. The insurer cannot prevent a public adjuster from meeting with their client after: - the insurer has been notified of the existence of a contract DP-1 is basic Dwelling Coverage. What is the only water damaged covered under this form? - Damage caused by water used to extinguish a fire In Florida, any policy that contains a separate hurricane deductible must include: - the actual dollar value, bold print and notice of high-out-of pocket expense to you Coverages included under a commercial packaged policy (CPP): - Farm Coverage Commercial Crime Coverage Commercial GL Commercial Property Commercial Auto Commercial Inland Marine Boiler and Machinery Professional Liability Employment Practices If an insured fails to comply with the immediate notice of claim requirements, what could happen? - The coverage could be denied What coverage of the garage policy will pay for physical damage to a garage customer's auto regardless of legal liability? - Garage Keepers Direct Coverage Endorsement The purpose of the Florida Citizens Property Insurance Corporation is: - to provide coverage on dwelling and homeowner risks that are unable to obtain coverage in the standard markets using standard property insurance forms. If a property is eligible, what endorsement can Flood coverage be purchased under the Commercial Property Policy? - CP 10 65 If flood coverage CP 10 65 exists along with NFIP, which coverage is considered excess? - CP 10 65 The promise by one party that is conditioned on an uncertain event and where the value given by each party is unequal is called: - Aleatory When does coinsurance not apply? - When the insured suffers a total loss to the property. In Florida, grounds for compulsory refusal, suspension, or revocation of an agent's or adjuster's license or appointment includes: - Material misstatement, misreprepresentation, or fraud in obtaining a license Using the license to willfully circumvent any of the requirements or prohibitions of Florida insurance laws Demonstration of a lack of fitness or trustworthiness to engage in business of insurance What forms the basic eligibility requirements for all of the residual markets in Florida? - The risk is unable to find a market for the required coverages. When a business owner declaration page contains more than one named insured, in case of cancellation, who receives the notice? - The first named insured What is insured under the valuable papers and records coverage form? - Books, maps and film Property of Others Mortgage & Manuscripts Someone, other than the insured, to whom the insured property is entrusted "temporarily" is known as a: - Bailee Name three claim settlement options: - Repair Replace with LKQ Replace with New When are non-residents subject to florida's insurance laws if a motor vehicle has been physically present in florida? - 90 days during the preceding year When can an insured assign a policy to another policy? - Only with written consent from the insurer Name the exclusions under the DP-2 Dwelling form: - Flood, Earthquake, Mudslides. What is considered to be the most important implied warranty under a Ocean Marine Policy? - Seaworthiness of the Vessel Taking property by force or the threat of force is defined as: - Robbery Requirements that truckers be financially responsible for cargo they carry are imposed by: - State and Federal Government What is the standard deductible for each coverage under the "emergency flood program"? - $2,000.00 Under a HO-3 Policy, there is no coverage for loss resulting from "earth movement" except when endorsed using: - Earthquake Endorsement An earthquake endorsement defines a single earthquake as all earthquake shocks within what period? - 72 Hour Period Earthquake peril is defined to include: - land shock waves or tremors accompanied by volcanic eruption Name the endorsement used on the dwelling policy to keep values current with the replacement cost of the buildings (inflation of construction costs) - The Automatic Increase Endorsement What coverage should be added to the Business Owners Coverage Form if the named insured's employees use their own vehicles to run errands when the insured does not have commercial auto coverage? - Non-Owned and Hired What is coverage based on under the commercial property condominium association form? - Association agreement and bylaws Name the excluded types of property under the Commercial Building and Personal Property Form. - Animals (unless for sale) Autos Money The BOP 2010 has extended the time for loss of income under an act of civil authority. Was is the length of the time? - Four Weeks How long must all claim files be maintained and available for open and closed files for the current and the preceding year? - 3 Years DP-3 only provides damage to covered property caused by: - Burglars The HO-3 policy limits the theft of money to what amount? - $200.00 In addition to the max coverage under an equipment breakdown protection policy, what other expenses in addition to the limits of coverage will the insurer pay? - Legal Fees What is the prime coverage under flood insurance? - Overflow of inland or tidal water Under the DP-1 basic form what is excluded? - war earthquake landslide Volcanic eruption can be found on which type of policy? - The basic dwelling policy A Scheduled Personal Property endorsement under a Personal Inland Marine Policy is usually settled on - ACV or Agreed Mutual Basis A Scheduled Personal Property endorsement under a Personal Inland Marine Policy is usually issued on: - An Open Peril Which section explains the important terms used throughout the contract? - Definitions Under a dwelling broad or special form, what is the maximum that would be paid for "loss of use"? - 20% of the Dwelling Coverage Though multiple parties may be involved in a lawsuit, the opposing sides are referred to as: - Plaintiff and Defendant Exclusions under the theft, disappearance and destruction coverage form. - Fire Vandalism Accounting Errors The theft disappearance and destruction coverage form is designed to cover - Criminal Activities of customer and others What is covered by a SP-23 protection and indemnity policy? - Loss of life, Injury and illness Collision liabilities including defence costs Damage to docks, buoys and other structures When a motor vehicle is sold, transported, or delivered to a salvage motor vehicle dealer, it must be accompanied by: - Properly endorsed certificate of title Salvage certificate of title Vehicle certificate of destruction What does the HO Policy Loss of Use cover? - ALE An equipment dealers coverage form is designed to provide insurance on - Equipment owned by the insured Equipment in the insured's custody for servicing or storage Equipment entrusted to the insured dealer for sale What is not included in the calculations for replacement cost coverage? - (Hidden Items) Underground pipes Flues Wiring Drains When is a public adjuster in Florida not Permitted to Solicit an insured or claimant? - Sunday What are the allowed hours for a public adjuster to solicit services? - 8am - 8pm M-Sat When can coverage under the National Flood Insurance Program be written? - Only with participating communities In order to be a participating community with NFIP, which guidelines must be accepted? - FEMA Under a dwelling (DP-2 or DP-3) policy, what is the maximum % that would be paid for ALE? - 20% What is the limit of insurance that applies to property in transit in the BOP? - $10,000 With admitted aircraft liability, what is not considered a factor? - Negligence An inland marine coverage which covers the insured's merchandise held for sale, such property that is sold but not delivered, customers property in the care and custody of the insured, and property being transported to or from the insured is a: - Dealers Form What contains the basic policy conditions that apply to many controlled inland marine coverage? - Commercial Inland Marine Condition Form Under HO-3, materials and supplies to be used in the construction, alteration or repair of the structure and kept next to the residence premises are covered only: - If they are lost due to an insured peril. What percentage is a HO-3, the limit for Coverage C - Personal Property for a one or two family dwelling set at? - 50% of Coverage A unless higher limit is requested Personal Property - Coverage C is set at 50% for which Policy types? - HO-2 HO-3 HO-5 Marine cargo coverage refers to loose cargo, (e.g. cartoons, boxes) that are stowed directly (or placed on pallets) in the ship's hold, is commonly referred to as: - Break Bulk What coverage is required to cover a loss if a guest leaves valuables in the hotel safe and it is missing upon return to retrieve? - Guest Property Crime Form Another word for a stand-alone policy? - Monoline Policy What does improvements and betterment apply to? - Real Property HO-4 is designed for - Renters/Tenants and covers direct damage to personal property owned or used by an insured while it anywhere in the world. When a vehicle is stolen, transportation expenses are not paid until after how long of a waiting period? - 48 Hours When someone is acting on behalf of another for an extended period of time but without the express authority to do so, the concept of agency is called - Ratification What are true benefits of insurance? - Ins. allows individuals and companies to undertake activities they might attempt otherwise Total risk is potentially reduced because of the insurer's attention to loss control Tens of thousands of people can achieve gainful employment in the industry How much does Debris Removal Additional Coverage extend to cleanup debris if there is no damage? - $5,000 626.854 (3) - A public adjuster may not give legal advice or act on behalf of or aid any person in negotiating or settling a claim relating to bodily injury, death, or noneconomic damages. 626.854 (5) - A public adjuster may not directly or indirectly through any other person or entity solicit an insured or claimant by any means except on Monday through Saturday of each week and only between the hours of 8 a.m. and 8 p.m. on those days. 626.854 (6) - An insured or claimant may cancel a public adjuster's contract to adjust a claim without penalty or obligation within 3 business days after the date on which the contract is executed or within 3 business days after the date on which the insured or claimant has notified the insurer of the claim, whichever is later. The public adjuster's contract must disclose to the insured or claimant his or her right to cancel the contract and advise the insured or claimant that notice of cancellation must be submitted in writing and sent by certified mail, return receipt requested, or other form of mailing that provides proof thereof, to the public adjuster at the address specified in the contract; provided, during any state of emergency as declared by the Governor and for 1 year after the date of loss, the insured or claimant has 5 business days after the date on which the contract is executed to cancel a public adjuster's contract. 626.854 (7) - It is an unfair and deceptive insurance trade practice pursuant to s. 626.9541 for a public adjuster or any other person to circulate or disseminate any advertisement, announcement, or statement containing any assertion, representation, or statement with respect to the business of insurance which is untrue, deceptive, or misleading. 626.854 (7) (a) - The following statements, made in any public adjuster's advertisement or solicitation, are considered deceptive or misleading: 1. A statement or representation that invites an insured policyholder to submit a claim when the policyholder does not have covered damage to insured property. 2. A statement or representation that invites an insured policyholder to submit a claim by offering monetary or other valuable inducement. 3. A statement or representation that invites an insured policyholder to submit a claim by stating that there is "no risk" to the policyholder by submitting such claim. 4. A statement or representation, or use of a logo or shield, that implies or could mistakenly be construed to imply that the solicitation was issued or distributed by a governmental agency or is sanctioned or endorsed by a governmental agency. 626.854 (7) (b) - For purposes of this paragraph, the term "written advertisement" includes only newspapers, magazines, flyers, and bulk mailers. The following disclaimer, which is not required to be printed on standard size business cards, must be added in bold print and capital letters in typeface no smaller than the typeface of the body of the text to all written advertisements by a public adjuster: "THIS IS A SOLICITATION FOR BUSINESS. IF YOU HAVE HAD A CLAIM FOR AN INSURED PROPERTY LOSS OR DAMAGE AND YOU ARE SATISFIED WITH THE PAYMENT BY YOUR INSURER, YOU MAY DISREGARD THIS ADVERTISEMENT." 626.854 (8) - A public adjuster, a public adjuster apprentice, or any person or entity acting on behalf of a public adjuster or public adjuster apprentice may not give or offer to give a monetary loan or advance to a client or prospective client. 626.854 (9) - A public adjuster, public adjuster apprentice, or any individual or entity acting on behalf of a public adjuster or public adjuster apprentice may not give or offer to give, directly or indirectly, any article of merchandise having a value in excess of $25 to any individual for the purpose of advertising or as an inducement to entering into a contract with a public adjuster. 626.854 (10) (a) - If a public adjuster enters into a contract with an insured or claimant to reopen a claim or file a supplemental claim that seeks additional payments for a claim that has been previously paid in part or in full or settled by the insurer, the public adjuster may not charge, agree to, or accept from any source compensation, payment, commission, fee, or any other thing of value based on a previous settlement or previous claim payments by the insurer for the same cause of loss. The charge, compensation, payment, commission, fee, or any other thing of value must be based only on the claim payments or settlement obtained through the work of the public adjuster after entering into the contract with the insured or claimant. Compensation for the reopened or supplemental claim may not exceed 20 percent of the reopened or supplemental claim payment. In no event shall the contracts described in this paragraph exceed the limitations in paragraph (b). 626.854 (10) (b) - A public adjuster may not charge, agree to, or accept from any source compensation, payment, commission, fee, or any other thing of value in excess of: 1. Ten percent of the amount of insurance claim payments made by the insurer for claims based on events that are the subject of a declaration of a state of emergency by the Governor. This provision applies to claims made during the year after the declaration of emergency. After that year, the limitations in subparagraph 2. apply. 2. Twenty percent of the amount of insurance claim payments made by the insurer for claims that are not based on events that are the subject of a declaration of a state of emergency by the Governor. 626.854 (10) (c) - Insurance claim payments made by the insurer do not include policy deductibles, and public adjuster compensation may not be based on the deductible portion of a claim. 626.854 (10) (d) - Any maneuver, shift, or device through which the limits on compensation set forth in this subsection are exceeded is a violation of this chapter punishable as provided under s. 626.8698. 626.854 (11) - Each public adjuster must provide to the claimant or insured a written estimate of the loss to assist in the submission of a proof of loss or any other claim for payment of insurance proceeds. The public adjuster shall retain such written estimate for at least 5 years and shall make the estimate available to the claimant or insured, the insurer, and the department upon request. 626.854 (12) - A public adjuster, public adjuster apprentice, or any person acting on behalf of a public adjuster or apprentice may not accept referrals of business from any person with whom the public adjuster conducts business if there is any form or manner of agreement to compensate the person, directly or indirectly, for referring business to the public adjuster. A public adjuster may not compensate any person, except for another public adjuster, directly or indirectly, for the principal purpose of referring business to the public adjuster. 626.854 (13) - A company employee adjuster, independent adjuster, attorney, investigator, or other persons acting on behalf of an insurer that needs access to an insured or claimant or to the insured property that is the subject of a claim must provide at least 48 hours' notice to the insured or claimant, public adjuster, or legal representative before scheduling a meeting with the claimant or an onsite inspection of the insured property. The insured or claimant may deny access to the property if the notice has not been provided. The insured or claimant may waive the 48-hour notice. 626.854 (14) - The public adjuster must ensure that prompt notice is given of the claim to the insurer, the public adjuster's contract is provided to the insurer, the property is available for inspection of the loss or damage by the insurer, and the insurer is given an opportunity to interview the insured directly about the loss and claim. The insurer must be allowed to obtain necessary information to investigate and respond to the claim. 626.854 (14) (a) - The insurer may not exclude the public adjuster from its inperson meetings with the insured. The insurer shall meet or communicate with the public adjuster in an effort to reach agreement as to the scope of the covered loss under the insurance policy. The public adjuster shall meet or communicate with the insurer in an effort to reach agreement as to the scope of the covered loss under the insurance policy. This section does not impair the terms and conditions of the insurance policy in effect at the time the claim is filed. 626.854 (14) (b) - The insurer may not exclude the public adjuster from its inperson meetings with the insured. The insurer shall meet or communicate with the public adjuster in an effort to reach agreement as to the scope of the covered loss under the insurance policy. The public adjuster shall meet or communicate with the insurer in an effort to reach agree 626.854 (14) (c) - A public adjuster may not act or fail to reasonably act in any manner that obstructs or prevents an insurer or insurer's adjuster from timely conducting an inspection of any part of the insured property for which there is a claim for loss or damage. The public adjuster representing the insureds may be present for the insurer's inspection, but if the unavailability of the public adjuster otherwise delays the insurer's timely inspection of the property, the public adjuster or the insureds must allow the insurer to have access to the property without the participation or presence of the public adjuster or insureds in order to facilitate the insurer's prompt inspection of the loss or damage. 626.854 (15) - A licensed contractor under part I of chapter 489, or a subcontractor, may not adjust a claim on behalf of an insured unless licensed and compliant as a public adjuster under this chapter. However, the contractor may discuss or explain a bid for construction or repair of covered property with the residential property owner who has suffered loss or damage covered by a property insurance policy, or the insurer of such property, if the contractor is doing so for the usual and customary fees applicable to the work to be performed as stated in the contract between the contractor and the insured. 626.854 (16) - A public adjuster shall not acquire any interest in salvaged property, except with the written consent and permission of the insured through a signed affidavit. 626.854 (17) - A public adjuster, a public adjuster apprentice, or a person acting on behalf of an adjuster or apprentice may not enter into a contract or accept a power of attorney that vests in the public adjuster, the public adjuster apprentice, or the person acting on behalf of the adjuster or apprentice the effective authority to choose the persons or entities that will perform repair work in a property insurance claim or provide goods or services that will require the insured or third-party claimant to expend funds in excess of those payable to the public adjuster under the terms of the contract for adjusting services. 626.854 (18) - Subsections 5-17 only apply to homeowners and condominium policies 626.854 (19) - Except as otherwise provided in this chapter, no person, except an attorney at law or a public adjuster, may for money, commission, or any other thing of value, directly or indirectly: (a) Prepare, complete, or file an insurance claim for an insured or a third-party claimant; (b) Act on behalf of or aid an insured or a third-party claimant in negotiating for or effecting the settlement of a claim for loss or damage covered by an insurance contract; (c) Advertise for employment as a public adjuster; or (d) Solicit, investigate, or adjust a claim on behalf of a public adjuster, an insured, or a third-party claimant. There are several important statutory requirements pertaining to contracts made by public adjusters: - Must state the type of claim, including an emergency claim, non-emergency claim or supplemental claim. Requires the signatures of all named insureds. If the signatures of all named insureds are not available, the public adjuster must submit an affidavit signed by the available named insureds attesting that they have authority to enter into the contract and settle all claim issues on behalf of the named insureds. An unaltered copy of the contract must be remitted to the insurer within 30 days after execution. This means the contract provided to the insurer must also contain the agreed upon fee percentage. True or False: Both mediation and sinkhole neutral evaluation are non-binding. Neither the insured nor the insurance company is legally obligated to accept the outcome of the mediation conference. - True The ______________ is intended for use by parties who are beginning the process of filing suit against an insurer, when a party feels they have been damaged by specific acts of the insurer. The Notice is intended to meet a portion of legal requirements set forth in Section 624.155, Florida Statutes, which requires a party to file Notice with both the insurer and the Department of Financial Services (DFS) at least 60 days prior to bringing an action against the insurer. The DFS does not involve itself in the pre-suit negotiations or communications related to Notices as such actions are not within the scope of its statutory authority. - Civil Remedies Notice Mediation Statute 627.7015 - The department shall adopt by rule a property insurance mediation program to be administered by the department or its designee. The department may also adopt special rules which are applicable in cases of an emergency within the state. The rules shall be modeled after practices and procedures set forth in mediation rules of procedure adopted by the Supreme Court. The rules shall provide for:(a) Reasonable requirement for processing and scheduling of requests for mediation.(b) Qualifications, denial of application, suspension, revocation of approval, and other penalties for mediators as provided in s. 627.745 and the Florida Rules for Certified and Court-Appointed Mediators.(c) Provisions governing who may attend mediation conferences.(d) Selection of mediators.(e) Criteria for the conduct of mediation conferences.(f) Right to legal counsel. (5) All statements made and documents produced at a mediation conference shall be deemed to be settlement negotiations in anticipation of litigation within the scope of s. 90.408. All parties to the mediation must negotiate in good faith and must have the authority to immediately settle the claim. Mediators are deemed to be agents of the department and shall have the immunity from suit provided in s. 44.107. (6)(a) Mediation is nonbinding; however, if a written settlement is reached, the policyholder has 3 business days within which the policyholder may rescind the settlement unless the policyholder has cashed or deposited any check or draft disbursed to the policyholder for the disputed matters as a result of the conference. If a settlement agreement is reached and is not rescinded, it is binding and acts as a release of all specific claims that were presented in that mediation conference. (b) At the conclusion of the mediation, the mediator shall provide a written report of the results of mediation, including any settlement amount, to the insurer, the policyholder, and the policyholder's representative if the policyholder is represented at the mediation. (7) If the insurer fails to comply with subsection (2) by failing to notify a policyholder of its right to participate in the mediation program under this section or if the insurer requests the mediation, and the mediation results are rejected by either party, the policyholder is not required to submit to or participate in any contractual loss appraisal process of the property loss damage as a precondition to legal action for breach of contract against the insurer for its failure to pay the policyholder's claims covered by the policy. (8) The department may designate an entity or person to serve as administrator to carry out any of the provisions of this section and may take this action by means of a written contract or agreement. (9) For purposes of this section, the term "claim" refers to any dispute between an insurer and a policyholder relating to a material issue of fact other than a dispute:(a) With respect to which the insurer has a reasonable basis to suspect fraud;(b) When, based on agreed-upon facts as to the cause of loss, there is no coverage under the policy;(c) With respect to which the insurer has a reasonable basis to believe that the policyholder has intentionally made a material misrepresentation of fact which is relevant to the claim, and the entire request for payment of a loss has been denied on the basis of the material misrepresentation;(d) With respect to which the amount in controversy is less than $500, unless the parties agree to mediate a dispute involving a lesser amount; or(e) With respect to a windstorm or hurricane loss that does not comply with s. 627.70132. Code of ethics (FAC 69B-220.201) - The work of adjusting insurance claims engages the public trust. An adjuster shall put the duty for fair and honest treatment of the claimant above the adjuster's own interests in every instance. ... (b) An adjuster shall treat all claimants equally. Florida Insurance Guaranty Association - establishes and maintains a serviceoriented operation for processing covered claims of insolvent members. FIGA is a nonprofit corporation created by the Florida Legislature in 1970. FIGA services pending claims by or against Florida policyholders of member insurance companies which become insolvent and are ordered liquidated. The Residential Property and Casualty Joint Underwriting Association originally created by this statute shall be known as the Citizens Property Insurance Corporation - The corporation shall provide insurance for residential and commercial property, for applicants who are entitled, but, in good faith, are unable to procure insurance through the voluntary market. Business auto coverage form Section 3 Physical Damage Coverage - We will pay for "loss" to a covered "auto" or its equipment under: a. Comprehensive Coverage From any cause except: (1) The covered "auto's" collision with another object; or (2) The covered "auto's" overturn. b. Specified Causes Of Loss Coverage Caused by: (1) Fire, lightning or explosion; (2) Theft; (3) Windstorm, hail or earthquake; (4) Flood; (5) Mischief or vandalism; or (6) The sinking, burning, collision or derailment of any conveyance transporting the covered "auto". c. Collision Coverage Caused by: (1) The covered "auto's" collision with another object; or (2) The covered "auto's" overturn. Part D - Coverage for damage to your auto - the insurance company agrees to pay an amount in excess of your deductible for direct and accidental loss to your covered car or any other car specified in the agreement. Thus, it pays for damage or theft to your car. 627.70131 Insurer's duty to acknowledge communications regarding claims; investigation. - (1) Upon an insurer's receiving a communication with respect to a claim, the insurer shall, within 14 calendar days, review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the insurer which reasonably prevent such acknowledgment. If the acknowledgment is not in writing, a notification indicating acknowledgment shall be made in the insurer's claim file and dated. A communication made to or by an agent of an insurer with respect to a claim shall constitute communication to or by the insurer. (2) Such acknowledgment shall be responsive to the communication. If the communication constitutes a notification of a claim, unless the acknowledgment reasonably advises the claimant that the claim appears not to be covered by the insurer, the acknowledgment shall provide necessary claim forms, and instructions, including an appropriate telephone number. (3) Unless otherwise provided by the policy of insurance or by law, within 10 working days after an insurer receives proof of loss statements, the insurer shall begin such investigation as is reasonably necessary unless the failure to begin such investigation is caused by factors beyond the control of the insurer which reasonably prevent the commencement of such investigation. (4) For purposes of this section, the term "insurer" means any residential property insurer. (5)(a) Within 90 days after an insurer receives notice of an initial, reopened, or supplemental property insurance claim from a policyholder, the insurer shall pay or deny such claim or a portion of the claim unless the failure to pay is caused by factors beyond the control of the insurer which reasonably prevent such payment. Any payment of an initial or supplemental claim or portion of such claim made 90 days after the insurer receives notice of the claim, or made more than 15 days after there are no longer factors beyond the control of the insurer which reasonably prevented such payment, whichever is later, bears interest at the rate set forth in s. 55.03. Interest begins to accrue from the date the insurer receives notice of the claim. The provisions of this subsection may not be waived, voided, or nullified by the terms of the insurance policy. If there is a right to prejudgment interest, the insured shall select whether to receive prejudgment interest or interest under this subsection. Interest is payable when the claim or portion of the claim is paid. Failure to comply with this subsection constitutes a violation of this code. However, failure to comply with this subsection does not form the sole basis for a private cause of action. (b) Notwithstanding subsection (4), for purposes of this subsection, the term "claim" means any of the following:1. A claim under an insurance policy providing residential coverage as defined in s. 627.4025(1);2. A claim for structural or contents coverage under a commercial property insurance policy if the insured structure is 10,000 square feet or less; or3. A claim for contents coverage under a commercial tenant policy if the insured premises is 10,000 square feet or less. (c) This subsection shall not apply to claims under an insurance policy covering nonresidential commercial structures or contents in more than one state. Valuation of Mobile/Manufactured Homes - If the manufactured home's homeowners' policy has a value on it, and you're in a valued policy state, the insurance company will pay up to the limit listed on the policy if the home is deemed a total loss. Some manufactured home policies will have a provision that allows for homes less than a certain age (10 years for example) to be valued at replacement cost. This has been done in part because some companies recognize that construction methods have changed over the years and that the home is newer. It's kind of like getting new car replacement on your auto policy, but only for late models. DP-1 Basic Form - Perils insured against are fire, lightning, and internal explosion. DP-2 Broad Form - This dwelling coverage form covers perils included under the DP-1 with ECE and optional VMM endorsement attached, plus: burglars; falling objects; weight of snow, ice, sleet; accidental discharge or overflow of water or steam; sudden and accidental tearing apart, cracking, burning or bulging of a steam or hot water heating system, or an air conditioning or automatic fire protective sprinkler system, or an appliance for heating water; freezing of a plumbing, heating, air conditioning, or automatic fire protective sprinkler system, or of a household appliance; and sudden and accidental damage from artificially generated electrical current. DP-3 Special Form - covers the dwelling and other structures on an open perils basis, except for the perils specifically excluded. Basic Form - covers these 11 "perils" or causes of loss: Fire or Lightning, Smoke, Windstorm or Hail, Explosion, Riot or Civil Commotion, Aircraft (striking the property), Vehicles (striking the property), Glass Breakage, Vandalism & Malicious Mischief, Theft, and Volcanic Eruption. Broad Form - covers the same 11 perils, but adds 6 more: Falling objects, Weight of ice, snow or sleet, accidental discharge or overflow of water or stream from within plumbing or related systems; does not include discharge or overflow of water from a sump, sudden and accidental rupture of heating, air conditioning, fire protective sprinkler, or hot water heating system. Freezing of plumbing or related systems. And Sudden and accidental damage from artificially generated electrical current. Special Form - does not specifically list perils, rather it is "all risk" coverage unless otherwise specifically excluded. HO-2 Policy - home insurance policy covers only your home and personal property against threats specifically named on the policy's declarations page. named peril policy — the covered threats are specifically listed. Below are the 16 named perils covered:. Lightning or fire Hail or windstorm Damage caused by aircraft Explosions Riots or civil disturbances Smoke damage Damage caused by vehicles Theft Vandalism Falling objects Volcanic eruption Damage from the weight of snow, ice, or sleet Water damage from plumbing, heating, or air conditioning overflow Water heater cracking, tearing, and burning Damage from electrical current Frozen pipes These policies are uncommon. Most insurance companies only write an_____ if they deem the risk presented by you and your property to be too great for a higherlevel policy. An ____ policy can leave you and your belongings vulnerable to many unnamed perils. HO-3 Policy - Homeowners Policy Special Form — part of the Insurance Services Office, Inc. (ISO), homeowners forms portfolio, the _____ insures the described owner-occupied dwelling, private structures in connection with the dwelling, unscheduled personal property on and away from the premises, and loss of use. Personal liability coverage and medical payments coverage are also provided by this policy. Coverage of the dwelling, related structures, and scheduled personal property is on an all risks basis, while coverage of unscheduled personal property is on a broad named perils basis. Losses to the dwelling and other structures are paid on a replacement cost basis, with no deduction for depreciation if certain conditions apply. Losses to personal property are paid on an actual cash value (ACV) basis, unless amended by endorsement. HO-4 Policy - Renters policy. Personal property covered for broad perils. HO-5 Policy - policies are written on open-perils forms, which means it lists the perils that your insurance doesn't cover. Common Exclusions: Earth movement Ordinance or law Water damage from flood, sewer backup, or water seepage Power failure War Nuclear hazard Intentional loss Government action Collapse Theft to a dwelling under construction Vandalism or malicious mischief if vacant more than 60 days Mold, fungus, or wet rot Neglect, wear and tear, and deterioration Mechanical breakdown Smog, rust, and corrosion Smoke from agricultural smudging and industrial operations Discharge, dispersal, or seepage of pollutants Settling, shrinking, bulging, or expanding of your home's foundation Infestation of birds, vermin, rodents, or insects Animals owned by insured HO-6 Policy - is home insurance for owners of co-ops or condominiums. It provides personal property coverage, liability coverage and specific coverage of improvements to the owner's unit. ... An HO-6 policy will cover interior damage to your unit, improvements, additions and alterations you've made and your personal property. HO-8 Policy - form is a modified version that provides coverage for homeowners unable to attain an HO-3 policy for their older home — typically more than 40 years old. Under an HO-8 policy, the insured's dwelling, personal property, liability, and loss of use are covered. However, it should be noted this insurance policy will not go as far in covering your home and personal belongings as an HO-3 or HO-5 policy. An______ will at least provide certain key coverages against the most common perils (causes of loss) Florida No-Fault Tort Exemption - Those who comply with the law are granted limited immunity from suits of others through PIP coverage. 4 Exceptions to Tort Exemption(Threshold of No-Fault) - 1. Significant and Permanent loss of bodily function. 2.Permanent injury other than scarring and disfigurement. 3.Significant and Permanent scarring or disfigurement. 4.Death What does NFIP stand for? - National Flood Insurance Program Form SR-22 - Drivers Convicted of DUI or a traffic felony over the prior 3 years are required to have 100/300/50 coverage or a certificate of self insurance of $350,000. Contents of a CGL Contract - 1.Declarations Form 2.Common Policy Conditions Form 3. One of:A.Occurrence Form B.Claims Made Form 4.Nuclear Energy Liability Exclusion Endorsement. Declarations of a CGL Contract(4) - 1.Named Insured(including address) 2.Policy Period 3.Premium 4.Limits of Coverage 7 Common CGL Conditions - 1.Cancellation(30 Days by insurer option, 10 Days By no payment). 2.Changes 3.Examination of Books 4.Inspections and Surveys 5.Premiums 6.Transfer 7.Nuclear Endorsement CGL Coverage A - Bodily Injury and Property Damage Insuring Agreement The 3 Conditions that define work as "completed" - 1.When all work called for in the contract is completed. 2.When all work to be done at the site has been completed if one contract calls for work at more than one site. 3.When that part of the work done at a job site has been put to its intended use by any person or organization other than another contractor or subcontractor. Occurance - An accident, including continuous or repeated exposure to substantially the same general harmful conditions. accident - Sudden, unexpected event The Difference between "Occurance" and "Claims Made" CGL Coverages - The Coverage Trigger:The Occurance Form applies to BI and PD regardless of any later time at which the claim is made.The Claims-Made Form applies only to BI and PD that occurs on or after the "Retro-Active date" Retro-Active Date - The date on which the coverage legally began. Basic Extended Reporting Period for CGL - 60 Days after expiration Why is the term "Coverage Trigger" misleading? - Because it intends to refer to the time period during which the insurance contract is in effect. A Homeowners Policy consists of(3 components): - 1.Declarations 2.One of 6 Homeowners forms 3.Mandatory and optional endorsements What are the two main divisions of a Home Owners Form? - Section IProperty& Section II-Liability 4 Subsections of Section I of a Property Coverage Policy - 1. Coverage 2.Perils Insured Against 3.Exclusions 4.Conditions Who determines how much HO-6 coverages a Condominium Owner needs? - The Association Homeowners Coverage A - "Dwelling" covers the dwelling building and structures attached; also construction materials and supplies on or adjacent to the premises. Homeowners Coverage B - Other Structures or Appurtenant Structures (10% of Coverage A)