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Exam (elaborations)

Florida Claims Adjuster Exam, 6-20 All Lines Adjuster- Florida- Review| 332 Questions| 41 Pages

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Florida Claims Adjuster Exam, 6-20 All Lines Adjuster- Florida- Review| 332 Questions| 41 Pages

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1. Peril: Something that causes a loss.
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2. Hazard: Something that increases the probability that a loss will o ccur.
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3. Warranty: A policy condition, either based on information in the in sureds appli-
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cation or inserted by the insurer. It is a guarantee of a fact.
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4. Misrepresentation: An untrue statement by the insured, made in an application gh gh gh gh gh gh gh gh gh gh




for insurance but which does not become a part of the policy.
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5. Concealment: The failure of the insured to reveal relevant facts known to the gh gh gh gh gh gh gh gh gh gh gh gh




insured in applying for insurance.
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6. Abandonment: Property insurance policies usually contain an abandonment gh gh gh gh gh gh gh




clause, stating the insured cannot dump damaged property on the in surer and
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demand its full value.
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7. Severability: The insurance applies separately to each insured as if other in- gh gh gh gh gh gh gh gh gh gh




sureds did not exist.
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8. Proximate Cause: The cause having the most significant impact in bringing about
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the loss under a first-party property insurance policy, when two or mor e independent
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perils operate at the same time (i.e., concurrently) to produce a loss. C a ourts employ
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set of rules to resolve causation disputes when a property policy st ates that it
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covers or excludes losses "caused by" a peril and there is more than one peril at
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work in a fact pattern. Under common law, whether the policy provides coverage
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depends on which peril is chosen as the proximate cause.
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9. Direct Loss: Physical harm to tangible property.
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,10. Indirect Loss: Economic loss which flows as a result of direct l oss.
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11. Actual Cash Value(ACV): Replacement Cost minus Depreciat ion
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12. Coinsurance: The amount, generally expressed as a fixed percentage, an gh gh gh gh gh gh gh gh gh




insured must pay against a claim after the deductible is satisfied. It's ultimately a
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way for the insured and insurer to share responsibility for the risk. It c an also help
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reduce the cost of the insurance policy premium. Coinsurance can be written on an
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80/20, 90/100, or 100% rule.
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13. Personal Contract: Policies cover people who own and operate t hings, such as
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automobiles.
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14. Conditional Contract: Also called a hypothetical contract, is a contract agree- gh gh gh gh gh gh gh gh gh gh




ment that only requires performance once the delineated conditions are met. This
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legal agreement requires prior performance of another agreement or clause in
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order to be enforceable. If the other agreement or condition is perform ed, then
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conditional contract is enforceable and the parties are bound to carry the
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of the contract.
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15. Contract of Indemnity: Principle of insurance that provides that w hen a loss
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occurs, the insured should be restored to the approximate financial condition he/she
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occupied before the loss occurred, no better or no worse.
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16. Insurable Interest: the reasonable concern of a person to obtain ins urance for gh gh gh gh gh gh gh gh gh gh gh




any individual or property against unforeseen events such as death, los ses, etc.
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17. Waiver: 1.) Implied voluntary relinquishment, abandoning a legal advantage,
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need, claim or right.
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2.) Agreement or added clause of a policy that excludes some losses or limits the
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sum of a claim, or extends coverage to add items not in a normal policy.
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18. ExpressWaiver: Occurs when the insurer or its representative knowingly gives
g
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up a known right under the insurance contract.
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,19. Implied Waiver: A waiver that is assumed to be in effect from a person's gh gh gh gh gh gh gh gh gh gh gh gh gh




behavior and shows he is waiving a right.
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20. Damages: Monetary compensation that is awarded by a court in a civil action to gh gh gh gh gh gh gh gh gh gh gh gh




an individual who has been injured through the wrongful conduct of a nother party.
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21. Subrogation: When an insured has a right to collect damages from another gh gh gh gh gh gh gh gh gh gh gh




party, but instead elects to claim the damages under his insurance policy, his rights
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against the other party are transferred to the insurer.
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22. Changes: All policies provide that any changes to the policy be made by the gh gh gh gh gh gh gh gh gh gh gh gh gh




insurer, in writing.
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23. Policy Period: The condition states that coverage applies only to losses or
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occurrences that take place during the policy period. (Prior to the stated date and
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time of termination).
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24. PolicyTerritory: Condition limiting coverage to occurrences or losses that take
g
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place only within a stated geographical region.
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25. Other Insurance: The principle of indemnity dictates against duplicate recovery
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for the same loss.
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26. Cancellation: The insured may cancel at any time, for any reason, without gh gh gh gh gh gh gh gh gh gh gh




advance notice. If the conpany wishes to cancel, it must provide some degree of
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advance notice so the insured will have time to replace the coverage.
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27. Appraisal: A written contract of or written agreement for or effecting insurance, gh gh gh gh gh gh gh gh gh gh gh




or the certificate thereof, by whatever name called, and includes all clauses, riders,
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endorsements and papers which are a part thereof.
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28. Insurance: Is a contract whereby one undertakes to indemnify another or pay gh gh gh gh gh gh gh gh gh gh gh




or allow a specified amount or a determinable benefit upon determinable contingen-
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cies.
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Binder: Acts as a temporary contract until the policy is issued. gh gh gh gh gh gh gh gh gh gh g h


29.
30. How many days should an insurer give for prior notice of cancellation of a
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binder?: 5 days.
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31. Property Insurance: Any insurance wherein payment by the insurer will be paid gh gh gh gh gh gh gh gh gh gh gh




directly to the insured or other specifically named interests.
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32. Liability Insurance: Payment will be on behalf of the insured to another, based
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upon the insureds liability to the recipient. Simply stated, Liability is "Negligence of
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the Insured".
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33. Loss Payee Clause: A Clause in a contract of insurance that provides, in the
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event of payment being made under the policy in relation to the insured risk, that
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, payment will be made to a 3rd party rather than to the insured beneficiary of the
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policy.
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34. Mortgage Clause: A property insurance provision granting special protection gh gh gh gh gh gh gh gh




for the interest of a mortgagee named in the policy, in effect setting up a separate
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content between the insurer and the mortgagee.
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35. Other Structures: Covers items that are not permanently attached to the main
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dwelling, such as a shed, fence, etc.
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36. Commercial Inland Marine: Helps identify the kinds of risk which are eligible gh gh gh gh gh gh gh gh gh gh gh




for either ocean or inland Marine insurance.
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37. Building Ordinance Coverage: This endorsement covers the insured for en- gh gh gh gh gh gh gh gh gh




forcement of laws which require demolition of undamaged portions of buildings.
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38. Umbrella Policy: Covers a much higher limit and goes above and beyond claims gh gh gh gh gh gh gh gh gh gh gh gh




directly relating to your home and auto, it provides your assets from an unforeseen
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event, such as a tragic accident in which you are held responsible for damages or
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bodily injuries.
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39. Known Loss: Prevents an insured from coverage if the insured knew the loss
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was probable at the time of the insurance contract.
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40. Value Reporting: The limit of coverage is set at an amount somewhat higher
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than expected peak values.
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41. Commercial Property Insurance: Covers direct and indirect losses related to gh gh gh gh gh gh gh gh gh




properties other than one to four family dwellings and farm properties.
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42. Employee Theft: Provides coverage for loss of or damage to money, securities, gh gh gh gh gh gh gh gh gh gh gh




and other property resulting from theft committed by an employee. Theft is defined
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as the unlawful taking of money, securities or other property to the deprivation of the
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insured.
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43. Bid: Aggreement to fulfill a contractual obligation used frequently in construction
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and supplying goods.
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44. Health Maintenance Organization (HMO): Provides comprehensive healthgh gh gh gh gh gh




services to its members for a prepaid fixed fee, equivalent to an insurance premium.
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45. Preferred Provider Organization gh gh




(PPO): A selected group of hospital's and medical practitioners in a given area who
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have joined together in an effort to reduce medical costs.
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46. Estoppel: Is an equitable principle to the effect that if one intentionally or gh gh gh gh gh gh gh gh gh gh gh gh




unintentionally creates the impression that a certain fact exists, and an innocent
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party relies on that impression and is damaged as a result, the guilty party may be
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legally prohibited(estopped) from asserting that the fact does not exist.
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47. Salvage: Motor vehicle or mobile home is a total loss. gh gh gh gh gh gh gh gh gh




48. Junk: Any material which is or may have been a motor vehicle or mobile home,
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with or without all component parts, which is inoperable and which material is in
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