Florida Claims Adjuster Exam
What are the Code of Ethics for adjusters?
Formal rules which impact on adjuster practices
1. Adjusters may not directly negotiate with a claimant who is represented by an attorney.
2. In interviewing witnesses, adjusters must avoid any actions tending to induce a suppression or
deviation from the truth. A witness who requests a copy of a statement given must be provided with a
copy.
3. Adjusters shall not give legal advice.
4. Adjusters shall not draft special releases; they are permitted only to fill in blanks of forms provided by
the insurer.
5. Adjusters will not take advantage of an incapacitated claimant which would be to the detriment of the
claimant.
6. Adjusters will not knowingly fail to advise claimants of their rights under contracts and laws of the state.
7. Adjusters will approach all aspects of the process with an unprejudiced and open mind, make truthful
and unbiased reports, handle all processes with integrity and accept no remuneration other than that to
which there is legal entitlement, and act with diligence and due dispatch in achieving proper disposition of
claims.
8. The adjuster must put the duty for fair and honest treatment of the claimant above the adjuster's own
interests, in every instance.
What types of insurance licenses are offered by the Department and how do they differ?
1. General Lines Agent 2-20: licensed to write property/casualty, surety or health insurance.
2. Customer Representative 4-40: must be licensed, appointed by a General Lines Agent and may assist
in transactions in the OFFICE ONLY
3. Limited Customer Representative 4-42: must be licensed, appointed by a General Lines Agent and
transact AUTO insurance in the OFFICE ONLY.
4. All Lines Claims Adjuster 6-20: investigates, Evaluates and Negotiates Claims
What are some reasons for suspension, revocation, or termination of a license?
1. Transacting insurance outside of scope of one's license
►For example, an individual cannot sell life insurance if he or she has a Customer Service license but
has not obtained a life license.
2. Misrepresentation or Fraud.
3. Participating in unfair methods of competition.
►Using discriminatory practices, making false entries on an insurance application or defaming others.
4. Sliding: Selling an item and stating that it is required by law (when it is not).
5. Demonstration of unworthiness or lack of fitness.
6. Misappropriation of funds.
7. Failure to inform Department of Financial Services, within 30 days, after pleading guilty or no contest to
a felony.
Compare/contrast different types of adjusters.
1. Independent Adjuster - self-employed and not affiliated with either insurers or bureaus
,2. Company/Staff Adjuster - salaried employee under supervision of home, branch, regional claims
department of insurers
3. Public Adjuster - represents the financial interests of the insured
named in the policy
4. Claims Adjuster - one who is involved in the investigation, adjustment, negotiation and/or trial
preparations of claims arising under insurance policies
5. Bureau Adjuster - agent of adjustment bureau which serves multiple
company clients
*Independent and Bureau are both "Fee Adjusters"
What is an Insurance Contract?
Insurance is a contract whereby one undertakes to indemnify another or pay or allow a specified amount
or a determinable benefit upon determinable contingencies
What are the components that make up the investigation process?
Inquiry, verification, comparison
This optional provision states that if the insured becomes totally disabled, premiums are waived but the
coverage remains in force:
A. Waiver of Subrogation
B. Waiver of Premium
C. Waiver of Value
D. None of the Above
B. Waiver of Premium
"premiums are waived"
Provides coverage for expenses, including loss of income, arising from an accident. This is defined as?
A. Accident Insurance
B. Hospitilization
C. Hospital Pay
D. None of the Above
A. Accident Insurance
Typical exclusions would be: hernia, war, disease and bacterial infections, suicide attempts, air travel
injuries, accidents while committing felony, accidents while under the influence
This type of provision states the insurer can refuse to renew the policy only under certain conditions. The
policy must state the conditions under which the policy will not be renewed. This is defined as?
A. Conditionally Renewable
B. Guaranteed Renewable
C. Optionally Renewable
D. None of the Above
A. Conditionally Renewable
vs. Optionally: company may not cancel during term but reserves right to non-renew upon expiration
vs. Guaranteed: insurer required to renew policy at stated age (typically 65); company reserves right to
increase premium
The coverage that is intended to afford protection against catastrophic losses is defined as?
,A. Major Medical
B. HMO
C. PPO
D. None of the Above
A. Major Medical
Some forms designed to supplement basic policies; others provide both basic and catastrophic coverage
A policy may contain a provision which states a period of time between issuance and acceptance before
sickness benefits begin. This is defined as:
A. Waiting Period
B. Elimination Period
C. Both A & B
D. None of the Above
C. Both A & B
This helps keep premiums reasonable by eliminating chance of persons buying coverage only when they
are sick
Characteristics of an HMO plan usually include:
A. Small of non-existent Deductibles
B. Fewer Exclusions
C. Insurance services to members through employed physicians
D. All of the Above
D. All of the Above
Also included: broad coverage, coinsurance provisions
Provides indemnification to the insured for basic hospitalization of room and board in the hospital, nursing
care, laboratory fees, operating room, medical supplies, etc. This is defined as?
A. Hospitalization Expense
B. Hospital Indemnity
C. Accident Policy
D. All of the Above
A. Hospitalization Expense
Associated with a daily limit, not to exceed specified maximum
A(n) __________ provides comprehensive health services to its members for a prepaid fixed fee,
equivalent to an insurance premium.
A. HMO
B. PPO
C. Major Medical Plan
D. All of the Above
A. HMO
Referred to as an emerging and increasingly important non-insurance alternative to dealing with risk of
health care costs
Established in 1973, this association was created for applicants who are unable to obtain insurance in the
private market:
A. FWCJUA
, B. FWUA
C. Citizens
D. FRPCJUA
E. FAJUA
E. FAJUA
In 2002, the Florida Residential Property and Casualty Joint Underwriting Association (FRPCJUA) and
the Florida Windstorm Joint Underwriting Association (FWUA), were combined to create:
A. FWCJUA
B. FWUA
C. Citizens
D. FRPCJUA
E. FAJUA
C. Citizens
Passed during a legislative session in 1993, this association was created for employers who cannot
obtain workers compensation insurance in the private market:
A. FWCJUA
B. FWUA
C. Citizens
D. FRPCJUA
E. FAJUA
A. FWCJUA
A General Lines Agent instructs a licensed Customer Representative 4-40 to thoroughly cover the details
of a new life insurance product with every Homeowner customer who calls or visits the office. The agent
provides training on the new product. Although the Customer Representative does not have a Life
License, he or she feels comfortable with the training and does as requested.
Which of the following is true?
A. This practice is acceptable if done in the office under supervision of General Lines Agent
B. This practice is acceptable because adequate training and product knowledge was provided
C. This practice is unacceptable and may result in the suspension or revocation of the Customer
Representative's license
D. This practice is only acceptable if the product training was certified by the Life Insurance Company
C. This practice is unacceptable and may result in the suspension or revocation of the Customer
Representative's license
Unlike a Customer Representative, a General Lines Claim Adjuster need not be appointed with the
Department of Financial Services.
A. True
B. False
B. False
While selling an Automobile policy to a customer, an agent tells them that they are also required to
purchase an Emergency Road Service Plan, even though that is not true. This is an example of:
A. Misrepresentation
What are the Code of Ethics for adjusters?
Formal rules which impact on adjuster practices
1. Adjusters may not directly negotiate with a claimant who is represented by an attorney.
2. In interviewing witnesses, adjusters must avoid any actions tending to induce a suppression or
deviation from the truth. A witness who requests a copy of a statement given must be provided with a
copy.
3. Adjusters shall not give legal advice.
4. Adjusters shall not draft special releases; they are permitted only to fill in blanks of forms provided by
the insurer.
5. Adjusters will not take advantage of an incapacitated claimant which would be to the detriment of the
claimant.
6. Adjusters will not knowingly fail to advise claimants of their rights under contracts and laws of the state.
7. Adjusters will approach all aspects of the process with an unprejudiced and open mind, make truthful
and unbiased reports, handle all processes with integrity and accept no remuneration other than that to
which there is legal entitlement, and act with diligence and due dispatch in achieving proper disposition of
claims.
8. The adjuster must put the duty for fair and honest treatment of the claimant above the adjuster's own
interests, in every instance.
What types of insurance licenses are offered by the Department and how do they differ?
1. General Lines Agent 2-20: licensed to write property/casualty, surety or health insurance.
2. Customer Representative 4-40: must be licensed, appointed by a General Lines Agent and may assist
in transactions in the OFFICE ONLY
3. Limited Customer Representative 4-42: must be licensed, appointed by a General Lines Agent and
transact AUTO insurance in the OFFICE ONLY.
4. All Lines Claims Adjuster 6-20: investigates, Evaluates and Negotiates Claims
What are some reasons for suspension, revocation, or termination of a license?
1. Transacting insurance outside of scope of one's license
►For example, an individual cannot sell life insurance if he or she has a Customer Service license but
has not obtained a life license.
2. Misrepresentation or Fraud.
3. Participating in unfair methods of competition.
►Using discriminatory practices, making false entries on an insurance application or defaming others.
4. Sliding: Selling an item and stating that it is required by law (when it is not).
5. Demonstration of unworthiness or lack of fitness.
6. Misappropriation of funds.
7. Failure to inform Department of Financial Services, within 30 days, after pleading guilty or no contest to
a felony.
Compare/contrast different types of adjusters.
1. Independent Adjuster - self-employed and not affiliated with either insurers or bureaus
,2. Company/Staff Adjuster - salaried employee under supervision of home, branch, regional claims
department of insurers
3. Public Adjuster - represents the financial interests of the insured
named in the policy
4. Claims Adjuster - one who is involved in the investigation, adjustment, negotiation and/or trial
preparations of claims arising under insurance policies
5. Bureau Adjuster - agent of adjustment bureau which serves multiple
company clients
*Independent and Bureau are both "Fee Adjusters"
What is an Insurance Contract?
Insurance is a contract whereby one undertakes to indemnify another or pay or allow a specified amount
or a determinable benefit upon determinable contingencies
What are the components that make up the investigation process?
Inquiry, verification, comparison
This optional provision states that if the insured becomes totally disabled, premiums are waived but the
coverage remains in force:
A. Waiver of Subrogation
B. Waiver of Premium
C. Waiver of Value
D. None of the Above
B. Waiver of Premium
"premiums are waived"
Provides coverage for expenses, including loss of income, arising from an accident. This is defined as?
A. Accident Insurance
B. Hospitilization
C. Hospital Pay
D. None of the Above
A. Accident Insurance
Typical exclusions would be: hernia, war, disease and bacterial infections, suicide attempts, air travel
injuries, accidents while committing felony, accidents while under the influence
This type of provision states the insurer can refuse to renew the policy only under certain conditions. The
policy must state the conditions under which the policy will not be renewed. This is defined as?
A. Conditionally Renewable
B. Guaranteed Renewable
C. Optionally Renewable
D. None of the Above
A. Conditionally Renewable
vs. Optionally: company may not cancel during term but reserves right to non-renew upon expiration
vs. Guaranteed: insurer required to renew policy at stated age (typically 65); company reserves right to
increase premium
The coverage that is intended to afford protection against catastrophic losses is defined as?
,A. Major Medical
B. HMO
C. PPO
D. None of the Above
A. Major Medical
Some forms designed to supplement basic policies; others provide both basic and catastrophic coverage
A policy may contain a provision which states a period of time between issuance and acceptance before
sickness benefits begin. This is defined as:
A. Waiting Period
B. Elimination Period
C. Both A & B
D. None of the Above
C. Both A & B
This helps keep premiums reasonable by eliminating chance of persons buying coverage only when they
are sick
Characteristics of an HMO plan usually include:
A. Small of non-existent Deductibles
B. Fewer Exclusions
C. Insurance services to members through employed physicians
D. All of the Above
D. All of the Above
Also included: broad coverage, coinsurance provisions
Provides indemnification to the insured for basic hospitalization of room and board in the hospital, nursing
care, laboratory fees, operating room, medical supplies, etc. This is defined as?
A. Hospitalization Expense
B. Hospital Indemnity
C. Accident Policy
D. All of the Above
A. Hospitalization Expense
Associated with a daily limit, not to exceed specified maximum
A(n) __________ provides comprehensive health services to its members for a prepaid fixed fee,
equivalent to an insurance premium.
A. HMO
B. PPO
C. Major Medical Plan
D. All of the Above
A. HMO
Referred to as an emerging and increasingly important non-insurance alternative to dealing with risk of
health care costs
Established in 1973, this association was created for applicants who are unable to obtain insurance in the
private market:
A. FWCJUA
, B. FWUA
C. Citizens
D. FRPCJUA
E. FAJUA
E. FAJUA
In 2002, the Florida Residential Property and Casualty Joint Underwriting Association (FRPCJUA) and
the Florida Windstorm Joint Underwriting Association (FWUA), were combined to create:
A. FWCJUA
B. FWUA
C. Citizens
D. FRPCJUA
E. FAJUA
C. Citizens
Passed during a legislative session in 1993, this association was created for employers who cannot
obtain workers compensation insurance in the private market:
A. FWCJUA
B. FWUA
C. Citizens
D. FRPCJUA
E. FAJUA
A. FWCJUA
A General Lines Agent instructs a licensed Customer Representative 4-40 to thoroughly cover the details
of a new life insurance product with every Homeowner customer who calls or visits the office. The agent
provides training on the new product. Although the Customer Representative does not have a Life
License, he or she feels comfortable with the training and does as requested.
Which of the following is true?
A. This practice is acceptable if done in the office under supervision of General Lines Agent
B. This practice is acceptable because adequate training and product knowledge was provided
C. This practice is unacceptable and may result in the suspension or revocation of the Customer
Representative's license
D. This practice is only acceptable if the product training was certified by the Life Insurance Company
C. This practice is unacceptable and may result in the suspension or revocation of the Customer
Representative's license
Unlike a Customer Representative, a General Lines Claim Adjuster need not be appointed with the
Department of Financial Services.
A. True
B. False
B. False
While selling an Automobile policy to a customer, an agent tells them that they are also required to
purchase an Emergency Road Service Plan, even though that is not true. This is an example of:
A. Misrepresentation
