Florida Claims Adjuster Exam | 206 Questions with 100%
Correct Answers | 35 Pages
Peril - ANSWERSSomething that causes a loss.
Hazard - ANSWERSSomething that increases the probability that a loss will occur.
Warranty - ANSWERSA policy condition, either based on information in the insureds
application or inserted by the insurer. It is a guarantee of a fact.
Misrepresentation - ANSWERSAn untrue statement by the insured, made in an
application for insurance but which does not become a part of the policy.
Concealment - ANSWERSThe failure of the insured to reveal relevant facts known to
the insured in applying for insurance.
Abandonment - ANSWERSProperty insurance policies usually contain an abandonment
clause, stating the insured cannot dump damaged property on the insurer and demand
its full value.
Severability - ANSWERSThe insurance applies separately to each insured as if other
insureds did not exist.
Proximate Cause - ANSWERSThe cause having the most significant impact in bringing
about the loss under a first-party property insurance policy, when two or more
independent perils operate at the same time (i.e., concurrently) to produce a loss.
Courts employ a set of rules to resolve causation disputes when a property policy states
that it covers or excludes losses "caused by" a peril and there is more than one peril at
work in a fact pattern. Under common law, whether the policy provides coverage
depends on which peril is chosen as the proximate cause.
Direct Loss - ANSWERSPhysical harm to tangible property.
Indirect Loss - ANSWERSEconomic loss which flows as a result of direct loss.
Actual Cash Value(ACV) - ANSWERSReplacement Cost minus Depreciation
Coinsurance - ANSWERSThe 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.
Personal Contract - ANSWERSPolicies cover people who own and operate things, such
as automobiles.
Conditional Contract - ANSWERSAlso called a hypothetical contract, is a contract
agreement 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 conditional
contract is enforceable and the parties are bound to carry out the terms of the contract.
Contract of Indemnity - ANSWERSPrinciple of insurance that provides that when a loss
occurs, the insured should be restored to the approximate financial condition he/she
occupied before the loss occurred, no better or no worse.
Insurable Interest - ANSWERSthe reasonable concern of a person to obtain insurance
for any individual or property against unforeseen events such as death, losses, etc.
Waiver - ANSWERS1.) Implied voluntary relinquishment, abandoning a legal
advantage, need, claim or right.
,2.) Agreement or added clause of a policy that excludes some losses or limits the sum
of a claim, or extends coverage to add items not in a normal policy.
Express Waiver - ANSWERSOccurs when the insurer or its representative knowingly
gives up a known right under the insurance contract.
Implied Waiver - ANSWERSA waiver that is assumed to be in effect from a person's
behavior and shows he is waiving a right.
Damages - ANSWERSMonetary compensation that is awarded by a court in a civil
action to an individual who has been injured through the wrongful conduct of another
party.
Subrogation - ANSWERSWhen an insured has a right to collect damages from another
party, but instead elects to claim the damages under his insurance policy, his rights
against the other party are transferred to the insurer.
Changes - ANSWERSAll policies provide that any changes to the policy be made by the
insurer, in writing.
Policy Period - ANSWERSThe condition states that coverage applies only to losses or
occurrences that take place during the policy period. (Prior to the stated date and time
of termination).
Policy Territory - ANSWERSCondition limiting coverage to occurrences or losses that
take place only within a stated geographical region.
Other Insurance - ANSWERSThe principle of indemnity dictates against duplicate
recovery for the same loss.
Cancellation - ANSWERSThe insured may cancel at any time, for any reason, without
advance notice. If the conpany wishes to cancel, it must provide some degree of
advance notice so the insured will have time to replace the coverage.
Appraisal - ANSWERSA written contract of or written agreement for or effecting
insurance, or the certificate thereof, by whatever name called, and includes all clauses,
riders, endorsements and papers which are a part thereof.
Insurance - ANSWERSIs a contract whereby one undertakes to indemnify another or
pay or allow a specified amount or a determinable benefit upon determinable
contingencies.
Binder - ANSWERSActs as a temporary contract until the policy is issued.
How many days should an insurer give for prior notice of cancellation of a binder? -
ANSWERS5 days.
Property Insurance - ANSWERSAny insurance wherein payment by the insurer will be
paid directly to the insured or other specifically named interests.
Liability Insurance - ANSWERSPayment will be on behalf of the insured to another,
based upon the insureds liability to the recipient. Simply stated, Liability is "Negligence
of the Insured".
Loss Payee Clause - ANSWERSA Clause in a contract of insurance that provides, in
the event of payment being made under the policy in relation to the insured risk, that
payment will be made to a 3rd party rather than to the insured beneficiary of the policy.
Mortgage Clause - ANSWERSA property insurance provision granting special
protection for the interest of a mortgagee named in the policy, in effect setting up a
separate content between the insurer and the mortgagee.
Other Structures - ANSWERSCovers items that are not permanently attached to the
main dwelling, such as a shed, fence, etc.
,Commercial Inland Marine - ANSWERSHelps identify the kinds of risk which are eligible
for either ocean or inland Marine insurance.
Building Ordinance Coverage - ANSWERSThis endorsement covers the insured for
enforcement of laws which require demolition of undamaged portions of buildings.
Umbrella Policy - ANSWERSCovers a much higher limit and goes above and beyond
claims directly relating to your home and auto, it provides your assets from an
unforeseen event, such as a tragic accident in which you are held responsible for
damages or bodily injuries.
Known Loss - ANSWERSPrevents an insured from coverage if the insured knew the
loss was probable at the time of the insurance contract.
Value Reporting - ANSWERSThe limit of coverage is set at an amount somewhat
higher than expected peak values.
Commercial Property Insurance - ANSWERSCovers direct and indirect losses related to
properties other than one to four family dwellings and farm properties.
Employee Theft - ANSWERSProvides coverage for loss of or damage to money,
securities, and other property resulting from theft committed by an employee. Theft is
defined as the unlawful taking of money, securities or other property to the deprivation
of the insured.
Bid - ANSWERSAggreement to fulfill a contractual obligation used frequently in
construction and supplying goods.
Health Maintenance Organization (HMO) - ANSWERSProvides comprehensive health
services to its members for a prepaid fixed fee, equivalent to an insurance premium.
Preferred Provider Organization
(PPO) - ANSWERSA selected group of hospital's and medical practitioners in a given
area who have joined together in an effort to reduce medical costs.
Estoppel - ANSWERSIs an equitable principle to the effect that if one intentionally or
unintentionally creates the impression that a certain fact exists, and an innocent party
relies on that impression and is damaged as a result, the guilty party may be legally
prohibited(estopped) from asserting that the fact does not exist.
Salvage - ANSWERSMotor vehicle or mobile home is a total loss.
Junk - ANSWERSAny material which is or may have been a motor vehicle or mobile
home, with or without all component parts, which is inoperable and which material is in
such condition that its highest or primary value is either in its sale or transfer as scrap
metal.
Fiduciary Agent - ANSWERSAgent for a principal/Client. The legal or special
relationship of trust, confidence, or responsibility between 2 or more parties.
Domestic Insurer - ANSWERSInsurer is one formed under the laws of its this state.
Foreign Insurer - ANSWERSInsurer is one formed under the laws of any state, district
territory, or commonwealth of the United States other than this State.
Alien Insurer - ANSWERSInsurer is an insurer other than a domestic or foreign insurer.
Appointment - ANSWERSThe authority given by an insurer or employer to a licensee to
transact insurance or adjust claims on behalf an insurer or employer.
Derelict - ANSWERSMaterial which is or may have been a motor vehicle or mobile
home, with or without all component parts, which is inoperable and which material is in
such condition that its highest or primary value is either in its sale or transfer as scrap
metal or component parts or both.
, Mechanical Breakdown Coverage - ANSWERSCovers repairs to mechanical parts of
your vehicle that break. Even covers break in events not related to an accident.
Sliding - ANSWERSSelling an item and stating that it is required by law.
What is the Death Benefit amount for PIP ? - ANSWERS$5,000
What is the amount for medical and disability benefits afforded by PIP ? -
ANSWERS$10,000
Who is the Financial Responsibility Law administered by ? - ANSWERSThe Department
of Highway Safety and Motor Vehicles.
What are the Basic PIP Benefits ? - ANSWERS-Medical-80% of responsible expenses
are paid for necessary medical, surgical, X-Ray and dental.
-Work Loss-60% of any loss of gross income and loss of earning capacity reimbursed.
-Replacement Services-100% for the cost of having household services performed by
others.
-Death-Effective 01/01/2013 the death benefit will be $5,000 in addition to the $10,000
in medical and disability benefits afforded by PIP.
Company or Staff Adjuster - ANSWERSAre salaried employees under the supervision
of the home, branch or regional claims department of insurers.
Fee Adjusters - ANSWERSOffer their services on a fee-for-service basis. They
represent many insurers.
Bureau Adjuster - ANSWERSEmployee or agent of an adjustment bureau which serves
multiple company clients such as the GAB Business Services, Inc and Underwriters
Adjusting Company both national firms.
Independent Adjuster - ANSWERSAre Self-Employed and are not affiliated with either
insurers or bureaus. They serve as adjuster representatives of insurers, and their
services are compensated on a fee-plus-expenses basis for each loss handled.
Public Adjuster - ANSWERSIs a claims adjuster who is an advocate for the policyholder
in appraising and negotiating an insurance claim.
What are the Characteristics of a Personal Auto Policy Declaration Page ? -
ANSWERS-Liability(Bodily Injury)
-Property Damage
-Uninsured Motorist
-Medical Payments
-Personal Injury Protection
-Collision Deductible
-Comprehensive Deductible
-Towing Coverage
-Rental Coverage
What are examples of Transacting Insurance? - ANSWERS-Solictitation of Insurance
-Negotiation of Insurance
-Effecting Coverage (Binding insurance coverage)
-Transacting Insurance Matters(during and after insurance is bound).
What are thresholds of the No-Fault Law ? - ANSWERS-Significant and permanent loss
of a bodily function or
-Permanent injury other than scarring and disfigurement or
-Significant and permanent scarring or disfigurement or
-Death
Correct Answers | 35 Pages
Peril - ANSWERSSomething that causes a loss.
Hazard - ANSWERSSomething that increases the probability that a loss will occur.
Warranty - ANSWERSA policy condition, either based on information in the insureds
application or inserted by the insurer. It is a guarantee of a fact.
Misrepresentation - ANSWERSAn untrue statement by the insured, made in an
application for insurance but which does not become a part of the policy.
Concealment - ANSWERSThe failure of the insured to reveal relevant facts known to
the insured in applying for insurance.
Abandonment - ANSWERSProperty insurance policies usually contain an abandonment
clause, stating the insured cannot dump damaged property on the insurer and demand
its full value.
Severability - ANSWERSThe insurance applies separately to each insured as if other
insureds did not exist.
Proximate Cause - ANSWERSThe cause having the most significant impact in bringing
about the loss under a first-party property insurance policy, when two or more
independent perils operate at the same time (i.e., concurrently) to produce a loss.
Courts employ a set of rules to resolve causation disputes when a property policy states
that it covers or excludes losses "caused by" a peril and there is more than one peril at
work in a fact pattern. Under common law, whether the policy provides coverage
depends on which peril is chosen as the proximate cause.
Direct Loss - ANSWERSPhysical harm to tangible property.
Indirect Loss - ANSWERSEconomic loss which flows as a result of direct loss.
Actual Cash Value(ACV) - ANSWERSReplacement Cost minus Depreciation
Coinsurance - ANSWERSThe 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.
Personal Contract - ANSWERSPolicies cover people who own and operate things, such
as automobiles.
Conditional Contract - ANSWERSAlso called a hypothetical contract, is a contract
agreement 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 conditional
contract is enforceable and the parties are bound to carry out the terms of the contract.
Contract of Indemnity - ANSWERSPrinciple of insurance that provides that when a loss
occurs, the insured should be restored to the approximate financial condition he/she
occupied before the loss occurred, no better or no worse.
Insurable Interest - ANSWERSthe reasonable concern of a person to obtain insurance
for any individual or property against unforeseen events such as death, losses, etc.
Waiver - ANSWERS1.) Implied voluntary relinquishment, abandoning a legal
advantage, need, claim or right.
,2.) Agreement or added clause of a policy that excludes some losses or limits the sum
of a claim, or extends coverage to add items not in a normal policy.
Express Waiver - ANSWERSOccurs when the insurer or its representative knowingly
gives up a known right under the insurance contract.
Implied Waiver - ANSWERSA waiver that is assumed to be in effect from a person's
behavior and shows he is waiving a right.
Damages - ANSWERSMonetary compensation that is awarded by a court in a civil
action to an individual who has been injured through the wrongful conduct of another
party.
Subrogation - ANSWERSWhen an insured has a right to collect damages from another
party, but instead elects to claim the damages under his insurance policy, his rights
against the other party are transferred to the insurer.
Changes - ANSWERSAll policies provide that any changes to the policy be made by the
insurer, in writing.
Policy Period - ANSWERSThe condition states that coverage applies only to losses or
occurrences that take place during the policy period. (Prior to the stated date and time
of termination).
Policy Territory - ANSWERSCondition limiting coverage to occurrences or losses that
take place only within a stated geographical region.
Other Insurance - ANSWERSThe principle of indemnity dictates against duplicate
recovery for the same loss.
Cancellation - ANSWERSThe insured may cancel at any time, for any reason, without
advance notice. If the conpany wishes to cancel, it must provide some degree of
advance notice so the insured will have time to replace the coverage.
Appraisal - ANSWERSA written contract of or written agreement for or effecting
insurance, or the certificate thereof, by whatever name called, and includes all clauses,
riders, endorsements and papers which are a part thereof.
Insurance - ANSWERSIs a contract whereby one undertakes to indemnify another or
pay or allow a specified amount or a determinable benefit upon determinable
contingencies.
Binder - ANSWERSActs as a temporary contract until the policy is issued.
How many days should an insurer give for prior notice of cancellation of a binder? -
ANSWERS5 days.
Property Insurance - ANSWERSAny insurance wherein payment by the insurer will be
paid directly to the insured or other specifically named interests.
Liability Insurance - ANSWERSPayment will be on behalf of the insured to another,
based upon the insureds liability to the recipient. Simply stated, Liability is "Negligence
of the Insured".
Loss Payee Clause - ANSWERSA Clause in a contract of insurance that provides, in
the event of payment being made under the policy in relation to the insured risk, that
payment will be made to a 3rd party rather than to the insured beneficiary of the policy.
Mortgage Clause - ANSWERSA property insurance provision granting special
protection for the interest of a mortgagee named in the policy, in effect setting up a
separate content between the insurer and the mortgagee.
Other Structures - ANSWERSCovers items that are not permanently attached to the
main dwelling, such as a shed, fence, etc.
,Commercial Inland Marine - ANSWERSHelps identify the kinds of risk which are eligible
for either ocean or inland Marine insurance.
Building Ordinance Coverage - ANSWERSThis endorsement covers the insured for
enforcement of laws which require demolition of undamaged portions of buildings.
Umbrella Policy - ANSWERSCovers a much higher limit and goes above and beyond
claims directly relating to your home and auto, it provides your assets from an
unforeseen event, such as a tragic accident in which you are held responsible for
damages or bodily injuries.
Known Loss - ANSWERSPrevents an insured from coverage if the insured knew the
loss was probable at the time of the insurance contract.
Value Reporting - ANSWERSThe limit of coverage is set at an amount somewhat
higher than expected peak values.
Commercial Property Insurance - ANSWERSCovers direct and indirect losses related to
properties other than one to four family dwellings and farm properties.
Employee Theft - ANSWERSProvides coverage for loss of or damage to money,
securities, and other property resulting from theft committed by an employee. Theft is
defined as the unlawful taking of money, securities or other property to the deprivation
of the insured.
Bid - ANSWERSAggreement to fulfill a contractual obligation used frequently in
construction and supplying goods.
Health Maintenance Organization (HMO) - ANSWERSProvides comprehensive health
services to its members for a prepaid fixed fee, equivalent to an insurance premium.
Preferred Provider Organization
(PPO) - ANSWERSA selected group of hospital's and medical practitioners in a given
area who have joined together in an effort to reduce medical costs.
Estoppel - ANSWERSIs an equitable principle to the effect that if one intentionally or
unintentionally creates the impression that a certain fact exists, and an innocent party
relies on that impression and is damaged as a result, the guilty party may be legally
prohibited(estopped) from asserting that the fact does not exist.
Salvage - ANSWERSMotor vehicle or mobile home is a total loss.
Junk - ANSWERSAny material which is or may have been a motor vehicle or mobile
home, with or without all component parts, which is inoperable and which material is in
such condition that its highest or primary value is either in its sale or transfer as scrap
metal.
Fiduciary Agent - ANSWERSAgent for a principal/Client. The legal or special
relationship of trust, confidence, or responsibility between 2 or more parties.
Domestic Insurer - ANSWERSInsurer is one formed under the laws of its this state.
Foreign Insurer - ANSWERSInsurer is one formed under the laws of any state, district
territory, or commonwealth of the United States other than this State.
Alien Insurer - ANSWERSInsurer is an insurer other than a domestic or foreign insurer.
Appointment - ANSWERSThe authority given by an insurer or employer to a licensee to
transact insurance or adjust claims on behalf an insurer or employer.
Derelict - ANSWERSMaterial which is or may have been a motor vehicle or mobile
home, with or without all component parts, which is inoperable and which material is in
such condition that its highest or primary value is either in its sale or transfer as scrap
metal or component parts or both.
, Mechanical Breakdown Coverage - ANSWERSCovers repairs to mechanical parts of
your vehicle that break. Even covers break in events not related to an accident.
Sliding - ANSWERSSelling an item and stating that it is required by law.
What is the Death Benefit amount for PIP ? - ANSWERS$5,000
What is the amount for medical and disability benefits afforded by PIP ? -
ANSWERS$10,000
Who is the Financial Responsibility Law administered by ? - ANSWERSThe Department
of Highway Safety and Motor Vehicles.
What are the Basic PIP Benefits ? - ANSWERS-Medical-80% of responsible expenses
are paid for necessary medical, surgical, X-Ray and dental.
-Work Loss-60% of any loss of gross income and loss of earning capacity reimbursed.
-Replacement Services-100% for the cost of having household services performed by
others.
-Death-Effective 01/01/2013 the death benefit will be $5,000 in addition to the $10,000
in medical and disability benefits afforded by PIP.
Company or Staff Adjuster - ANSWERSAre salaried employees under the supervision
of the home, branch or regional claims department of insurers.
Fee Adjusters - ANSWERSOffer their services on a fee-for-service basis. They
represent many insurers.
Bureau Adjuster - ANSWERSEmployee or agent of an adjustment bureau which serves
multiple company clients such as the GAB Business Services, Inc and Underwriters
Adjusting Company both national firms.
Independent Adjuster - ANSWERSAre Self-Employed and are not affiliated with either
insurers or bureaus. They serve as adjuster representatives of insurers, and their
services are compensated on a fee-plus-expenses basis for each loss handled.
Public Adjuster - ANSWERSIs a claims adjuster who is an advocate for the policyholder
in appraising and negotiating an insurance claim.
What are the Characteristics of a Personal Auto Policy Declaration Page ? -
ANSWERS-Liability(Bodily Injury)
-Property Damage
-Uninsured Motorist
-Medical Payments
-Personal Injury Protection
-Collision Deductible
-Comprehensive Deductible
-Towing Coverage
-Rental Coverage
What are examples of Transacting Insurance? - ANSWERS-Solictitation of Insurance
-Negotiation of Insurance
-Effecting Coverage (Binding insurance coverage)
-Transacting Insurance Matters(during and after insurance is bound).
What are thresholds of the No-Fault Law ? - ANSWERS-Significant and permanent loss
of a bodily function or
-Permanent injury other than scarring and disfigurement or
-Significant and permanent scarring or disfigurement or
-Death
