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SC Adjuster > Assignment 2 > Flashcards

Assignment 2 Flashcards

1
Q

How does an auto lx ins policy pay out

A

on behalf of the insd to the parties who are damaged or injured as a result of negligence of the insd

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2
Q

Who does the auto lx ins policy protect

A

the insd

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3
Q

Who is considered “the insd” on a lx auto policy? (4)

A
  1. named insured
  2. family members
  3. permissive driver
  4. someone who is responsible for the acts of the insd such as an employer who is vicariously liable
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4
Q

When does legal lx generally arise on an auto lx insurance policy

A

arises from the negligent act associated with the maintenance, use, or ownership of an automobile

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5
Q

bodily injuries (def) (4*)

A

includes physical harm, sickness, disease or death resulting from the physical harm, sickness, or disease associated with the acciden t

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6
Q

property damage (def)

A

physical injury to tangible property, including loss of use

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7
Q

How do prejudgment and post judgment interest relate to the settlement amount (2)

A
  1. included in the definition of the damages

2. interest is supplemental and above/beyond the limits of the policy

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8
Q

Auto lx limits may be expressed in what two types of limits?

A
  1. split

2. single

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9
Q

The insurance company has what duty and right with lx claims?

A
  1. duty to defend the insd

2. right to settle claims in any manner it sees fit

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10
Q

What is the lowest single limit for auto lx in FL?

A

$30,000

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11
Q

Do policy limits apply to cost of defense & interest payments?

A

no, limits only apply to damages

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12
Q

Is auto lx insurance primary, secondary or excess for vehicles owned by the insd? (2)

A
  1. primary for veh owned by the insd

2. excess for veh not owned by the insd

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13
Q

What does PAP stand for?

A

Personal Auto Policy

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14
Q

Who does PAP provide coverage for? (3)

A
  1. individuals
  2. related persons
  3. unrelated persons who live together w/insd
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15
Q

Who is PAP not available for? (3)

A
  1. corporation
  2. partnership
  3. combination of business and individual interests
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16
Q

In PAP, who does “You” and “Yours” refer to?

A

named insd and residing spouse

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17
Q

In PAP, what does “Business” refer to

A

trade, profession or occupation

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18
Q

In PAP, who does “Family Member” refer to

A

relatives and foster children in the household of the named insd

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19
Q

What does “occupying” mean

A

in, upon,getting in, on, out or off a vehicle

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20
Q

What is the purpose of lx auto coverage?

A

pay damages to others who are injured or damaged by an insd’s negligence, on behalf of the insd

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21
Q

What types of loss are exclusions under auto LX coverage? (5)

A
  1. intentional injury or damage
  2. property owned or being transported by the insd
  3. injuries to an employee while on the job
  4. using the veh w/out reasonable belief of permission
    * 5. adjuster must read policy to see all exclusions that may apply
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22
Q

What three types of vehs are generally excluded from auto lx policies?

A
  1. veh w/less than 4 wheels
  2. those designed mainly for use off public roads
  3. veh owned by, or available for regular use of a family member that is not insured
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23
Q

What does PIP pay for? (4)

A
  1. medical bills
  2. lost wages
  3. replacement services
  4. death benefits
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24
Q

What change was made to PIP for FL on 01/01/2013?

A

those seeking PIP medical benefits must receive initial services and care w/in 14 days after an MVA

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25
Q

Who can provide care that qualifies for PIP medical? (6)

A
  1. licensed physician
  2. osteopathic doctor
  3. chiropractic physician
  4. dentist
  5. hospital or facility owned by hospital
  6. licensed emergency provider
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26
Q

What happens if an Emergency Medical Condition is not dx?

A

basic PIP medical benefit of $10K is reduced to $2500

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27
Q

What two types of treatment are now excluded from treatment as of 01/01/2013?

A
  1. massage therapy

2. acupuncture

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28
Q

What happens if medical care is not rendered w/in 14 days of the DOL in regards to PIP benefits?

A

no PIP benefits will be available

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29
Q

What % of medical expenses are paid under PIP, and including what types of care? (6)

A

80% of reasonable med exp including med, surgical, x-x-ray, dental and rehab

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30
Q

What % of lost wages are paid under PIP

A

60% of lost wages based on gross income

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31
Q

What % of replacement services are paid under PIP?

A

100%

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32
Q

replacement services (def)

A

services the insd normally would have done, but has to bring in someone else to do due to injury related to the accident (cleaning, cooking, driving, etc)

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33
Q

What is the death benefit under PIP as of 01/01/13?

A

$5000 in addition to the $10K medical/disability benefit

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34
Q

How were PIP death benefits paid prior to 2013?

A

The total max payout on PIP was $10K, including death.

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35
Q

What does Additional PIP do?

A

Adds money to basic PIP (amounts vary)

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36
Q

What does Extended PIP do? (3)

A

increases the % of benefits paid to 100% of medical, 80% of lost wages.
Replacement services and death benefits are unchanged.

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37
Q

What does the No-Fault law require? (2)

A
  1. PIP be carried by owners of motor vehs

2. in the event of an accident, regardless of fault, a FL resident must look to their own PIP coverage first

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38
Q

What are penalties for failure to comply with No-Fault Law? (3)

A
  1. owner is denied immunity for legal lx
  2. owner is liable for pmt of benefits to those entitled to PIP
  3. owner’s drivers license and registration are subject to suspension
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39
Q

Is PIP primary over workers comp?

A

no, WC will be primary

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40
Q

When is PIP available when an insd is out of state? (2)

A
  1. if insd was occupying her own veh

2. if insd was occupying a veh owned by residing relative at TOL

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41
Q

When is FL PIP available as a pedestrian?

A

Only when it occurs in-state

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42
Q

How does tort exemption apply in FL for PIP?

A

Those who comply w/No-Fault law are not liable for personal injuries that are paid or would be paid by the PIP benefits of others

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43
Q

Is tort exemption tied to the veh or to the person?

A

to the veh

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44
Q

piercing the threshold (def)

A

pain and suffering, mental anguish, and inconvenience can only be recovered when the accident results in significant and permanent loss of a bodily function (must be done by civil suit)

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45
Q

What is the statute of limitations on med pay

A

3 years from DOL

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46
Q

Who does med pay apply to? (3)

A
  1. named ins
  2. family members
  3. other persons in the veh at TOL
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47
Q

what type of veh is excluded from med pay?

A

any veh with less than 4 wheels

48
Q

Does med pay apply if there is workers comp?

A

No, workers comp must be used

49
Q

Is med pay based on negligence?

A

nope

50
Q

How does med pay relate to PIP in order of payout?

A

PIP is primary, then med pay is excess

51
Q

What does the FL Financial Responsibility Law require

A

each owner carry a min of 10/20/10 lx coverage

52
Q

What must happen to avoid penalties in FL if the owner did not have lx insurance on DOL, and what happens if they’re not met? (3)

A
  1. legally valid claims must be paid up to the 10/20/10 requirement
  2. owner/operator must provide cert that lx ins is in place for future accidents
  3. If not met, operator license and veh reg of owner are suspended
53
Q

What limits must a person convicted of DUI purchase for lx?

A

100/300/50

54
Q

What must be filed if a person did not comply w/lx coverage law at time of accident? (2)

A

ins must be purchased and SR-22 must be filed by ins co and remain on file for 3 years

55
Q

When does UMBI coverage apply? (4)

A
  1. AF party carries no lx insurance
  2. AF party doesn’t carry enough lx to pay insd’s damages
  3. AF party’s lx ins co is insolvent
  4. AF party was a hit & run driver
56
Q

How is the UMBI payable amount figured w/other exposures?

A

any payout from workers’ comp, med pay, PIP and disability are deducted from remaining amount that can be paid under UMBI first.

57
Q

Who and where is UMBI coverage available to? (r)

A
  1. named insd
  2. family members
  3. in any motor veh and as pedestrians
  4. in and out of state
58
Q

When can an insd have unstacked UMBI coverage

A

When they reject it in writing, or select lower limits, otherwise will be stacked

59
Q

How are UM damages determined overall?

A
  1. Agreement between the insured and UM insurer;
  2. Arbitration between the insured and UM insurer;
  3. If the insured refuses to arbitration, litigation against the at-fault driver and the
    UM insurer.
60
Q

Who does Business Auto ins cover? (3)

A
  1. named insd
  2. permissive drivers
  3. anyone liable for conduct of the same
61
Q

accident (def)

A

continuous or repeated exposure to the same conditions resulting in BI or PD that is neither expected or intended by the insd

62
Q

loss (def)

A

direct and accidental damage or loss

63
Q

auto (def)

A

land motor veh, trailer or semi-trailer designed for travel on public roads

64
Q

mobile equipment (def)

A

off-road and unlicensed veh such as bulldozers, forklifts adn veh traveling on crawler treads

65
Q

Truckers Coverage (def)

A

form recognizes hazards unique to those whose businesses hauling goods for others

66
Q

Trailer Interchange (def)

A

coverage provides legal liability coverage for damage to trailers owned by others.

67
Q

Garage Insurance (def)

A

specifically designed for those in the business of selling, servicing,repairing or parking automobiles

68
Q

How is LX coverage structured for Bus Auto?

A

structured in a way that dealers are covered for liability for any auto

69
Q

Garage operations (def)

A

the ownership, maintenance or use of locations for a garage business and all operations incidental to the
business.

70
Q

For Dealer Risks, when is a customer not an insd?

A

if they have their own liability
coverage for at least 10/20/10.
*If a customer does not have their own insurance, then the garage policy does protect them as an insured, but only up to 10/20/10

71
Q

Auto Physical Damage Insurance (def)

A

first party insurance for damage to motor vehicles,

providing coverage without regard to fault

72
Q

What veh are eligible for coverage under APD? (3)

A
  1. 4–wheel private passenger vehicles, not used for public or livery (vehicle for hire) purposes
  2. pickup or van type vehicles not used in business, other than farming or ranching
  3. may be owned by the insured, or leased for a period of 6 months or more.
73
Q

What does “your covered auto” include for APD? (4)

A
  1. veh declared in the policy
    2.An eligible vehicle, acquired during the policy as an added vehicle or replacement vehicle.
  2. Any owned trailer
  3. Any non-owned vehicle used as a temporary substitute for any of eligible vehicle
    that is out of use because of breakdown, repair, servicing, loss or destruction.
    Note: this does not apply to part D of the policy.
74
Q

How does broadest coverage apply for an added/replaced veh? (2)

A
  1. An insured must ask to insure an added or replacement vehicle for Other Than Collision Coverage and Collision coverage within 14 days from the time the vehicle is acquired for the broadest coverage on any insured vehicle to apply.
  2. If no Other Than Collision or Collision coverage applied to any insured vehicle, the
    insured must ask to insure the added vehicle or replacement vehicle within 4 days for collision or other than collision coverage to apply.
75
Q

What is Part D of the auto policy?

A

insurance company agrees to pay for the direct and accidental loss to your covered auto or to any non-owned auto, including their equipment

76
Q

collision (def)

A

means upset or impact with another object

77
Q

Other Than Collision (def) (17)

A

covers the perils of:

  1. missiles
  2. following objects
  3. fire
  4. theft
  5. larceny
  6. explosion
  7. earthquake
  8. windstorm
  9. hail
  10. water
  11. flood
  12. vandalism
  13. riot
  14. civil commotion
  15. contact with a bird or animal
  16. glass breakage
  17. all direct and accidental loss not covered by collision coverage.
78
Q

What items exclusions under Part D APD (7)

A
  1. Electronic sound equipment, video equipment and computer equipment that is not permanently installed in the vehicle; equipment permanently installed in a spot not designed by the manufacturer for such equipment is subject to a limit of $1000;
  2. Tapes, records, and other media and accessories used with equipment described in number one above;
  3. A vehicle that is destroyed or confiscated by the government or civil authorities;
  4. A camper body or trailer not shown in the declarations and not reported to the carrier within 30 days of purchase;
  5. Awnings, and equipment designed to create additional living facilities;
  6. Radar detection or laser equipment;
  7. Custom furnishings or equipment in a pickup or van including furniture, cooking and sleeping facilities, custom murals, paintings and decals.
79
Q

What losses are excluded under Part D APD? (6)

A
  1. wear and tear
  2. freezing
  3. mechanical or electrical breakdown
  4. the failure of or road damage to tires,
  5. *unless any of these result from a total theft of the
    vehicle.
  6. war or nuclear causes
80
Q

Towing and Labor End. (def)

A

covers the cost of labor performed at the place of disablement.

81
Q

Sound Receiving and Transmitting Equipment End (def)

A

adds coverage, with no deductible for equipment permanently installed in the auto without requiring that installation be in the spot designed by the manufacturer

82
Q

Tapes and Records end. (def)

A

up to $200 coverage, with no deductible

83
Q

Customizing Equipment End. (def)

A

for items such as carpeting,

beds, cabinets and exterior decorating features

84
Q

Miscellaneous Type Vehicle End. (def)

A

covers equipment such as motor-homes,

motorcycles, golf carts and all–terrain vehicles.

85
Q

Business Auto PD End (def): (3)

A

provides Comp, Specified Causes of Loss, and Coll coverage

86
Q

garage keepers insurance (def)

A

covers losses for which insd is liable to customer for car that insd has for service, repair, parking or storing

87
Q

Dealers Drive Away Coll End. (def):

A

PD coverage for autos being driven/transported from point of purchase to point of distribution if distance is more than 50 miles apart

88
Q

False Pretense End. (def

A

PD coverage for dealers to insure against loss from voluntary parting w/covered auto by trick/scheme or from acquiring an auto from someone who doesn’t have legal title

89
Q

truckers insurance (def)

A

Covers auto owned by person/company who haul property for others

90
Q

Trailer Interchange End. (def)

A

pays for damage to trailers owned by others that are in insd’s possession under written agreement, under Truckers Insurance

91
Q

FS 627.728 (5)

A
  1. During first 60 dys of policy, ins co may cancel a policy for any reason except discrimination w/respect to race, color, national creed, marital status or sex
  2. After first 60 days, ins co many only cancel for
    - Nonpayment of premium
    - Material misrepresentation or fraud
    - Suspension or revocation of insd DL or registration during the policy term or w/in previous 180 days
92
Q

F.S. 627.4137 (3)

A
  1. requires lx ins company to disclose all poly info upon written request to a clmt.
  2. Clmt/clmt’s atty may request in writing:
    - Name
    - Coverage of each known ins co
  3. Agent is required to disclose that info and forward that request to all insurers that are affected
93
Q
  1. A insured and two family members were hospitalized for injuries suffered in an
    auto crash caused by a drunk driver. The insured carried a basic auto liability
    policy of 10/20/10. What is the maximum that the insured’s own liability will pay
    for these injuries?
    a. $-0-
    b. $10,000
    c. $20,000
    d. $30,000
A

a. $-0-

* *insd cannot collect on own LX policy… should be paid under PIP/MedPay

94
Q
  1. An insured had a 50/100/50 auto policy that was the subject of lawsuit.
    Judgment in the amount of $50,000 with interest was entered against the insured.
    What is true?
    a. The insurer will pay $50,000 and the cost of defense only
    b. The insured must pay interest
    c. The insurer must pay interest
    d. Interest is only covered if less than policy limits
A

c. The insurer must pay interest

* *pg 24

95
Q
  1. An insured had a 10/20/10 auto policy. The insured was at-fault for two accidents
    on two consecutive days: One on Friday morning, and another on Saturday
    afternoon. The property damage in the Friday accident was $5000; the property
    damage on Saturday was $15,000. What will the policy pay for each property
    damage claim?
    a. Friday claim-$5000/Saturday claim-$15,000
    b. Friday claim-$4000/Saturday claim-$12,000
    c. Friday claim-$4000/Saturday claim-$10000
    d. Friday claim-$5000/Saturday claim-$10,000
A

d. Friday claim-$5000/Saturday claim-$10,000

* *pg 25

96
Q
  1. The No Fault Law requires:
    a. 10/20/10 & PIP
    b. PIP only
    c. Liability only
    d. Medical Payment Coverage
A

b. PIP only

* *pg 27

97
Q
  1. Form SR-22 certifies that:
    a. Insurance coverage is in effect
    b. Liability coverage is in effect
    c. Liability and No Fault coverages are in effect
    d. All Traffic Laws are complied with
A

b. PIP only

* *pg 29

98
Q 
6. Medical Payments pays for expenses incurred for services for all of the following
arising from an auto accident, except:
a. Lost wages from an auto accident
b. Surgical bills
c. Funeral expenses
d. Emergency room charges
A

a. Lost wages from an auto accident

* *pg 39

99
Q
  1. An insured has stacked 50/100 UM coverage for 3 cars. The maximum the policy
    will pay for the insured’s injuries in one accident caused by an uninsured motorist
    is:
    a. 300
    b. 150
    c. 100
    d. 50
A

a. 300
**is it referring to a single insd, or any insd in the veh… makes emphasis on one accident… assuming looking for accident limit.
Pg 30

100
Q
  1. An insured has PIP with a $1000 deductible. If the insured has an accident and
    incurs covered medical bills in the amount of $1200, what will PIP pay?
    a. $160
    b. $200
    c. $1000
    d. $1200
A 
b. $200
	Assuming basic PIP = $10K
	Ded = $1K
	1200 - 1000 = 200 post ded
	Pg 26
101
Q
  1. The Florida Financial Responsibility Law requires:
    a. 10/20/10 Liability and PIP
    b. 10/20/10 which includes PIP
    c. 10/20/10 Liability
    d. $10,000 Property Damage Liability and PIP
A

c. 10/20/10 Liability

* *pg 29

102
Q
  1. An insured owns two cars. One is insured for non-stacked UM. The other is not
    insured for UM. If the insured is injured by an uninsured motorist while riding in
    the auto not insured for UM, what is true?
    a. The UM policy is stacked
    b. The insured may elect to use to other UM policy
    c. No UM is available
    d. The insured may arbitrate damages with the insurer
A

c. No UM is available

* *pg 31

103
Q
  1. In a motor vehicle accident, auto liability coverage does not cover:
    a. Rear-end damage caused to another vehicle by the insured
    b. Damage to a house caused by the insured’s collision
    c. Damage to the insured’s vehicle caused by the collision
    d. The medicals and lost wages of the other driver injured by the insured
A

c. Damage to the insured’s vehicle caused by the collision

104
Q
  1. A speeder’s vehicle hit the insured’s vehicle from the rear. The speeder was
    insured for PIP and liability. The insured was a vehicle owner but not insured for
    PIP. The insured has $5,000 in medical bills and $1000 in lost wages as a result
    of the accident. If the insured files a lawsuit against the speeder, how much of the
    medicals and lost wages will be paid by the speeder’s PIP?
    a. $-0-
    b. $6000
    c. $4600
    d. $1400
A

a. $-0-

* *pg 27

105
Q
  1. The claimant was injured in a one-car auto accident while working when he lost
    control and ran off the road. The claimant is insured for Collision, PIP, Medical
    Payments and Workers Compensation. Which could not pay damages to him?
    a. PIP
    b. Collision
    c. Workers Compensation
    d. Medical Payments
A

d. Medical Payments
* *workers comp primary to PIP - pg 27
* *no med pay coverage if workers comp bens payable - pg 28

106
Q
  1. ‘Direct and Accidental Damage’ to a Business Vehicle is the definition of:
    a. Accident
    b. Loss
    c. Damages
    d. Liability
    * *pg 31
A

b. Loss

* *pg 31

107
Q
  1. The insured owns a garage and sells cars. The garage policy liability limit is
    100/300/50. A customer was test-driving a car and caused an accident. At the
    time, the customer was not an owner and did not carry insurance. The garage
    policy will provide liability coverage in the amount of:
    a. –0-
    b. 100/300/50
    c. 10/20/10
    d. $10,000 PIP
A

c. 10/20/10

* *pg 31 - dealer risks

108
Q
  1. The insured was in a 2012 automobile accident and had medical bills that totaled
    $12,000. One month after the accident, and as a result of his injuries, he died.
    How much will PIP pay for death?
    a. $-0-
    b. $400
    c. $5000
    d. Not enough information to determine
A

b. $400

**pg 36, 27 - prior 2013 - up to $5K for death included in basic PIP $10K
$9600 paid in med at 80%… assuming no addtl or extended PIP

109
Q
  1. Collision is ‘first party’ insurance which means:
    a. Payment is paid to the first claimant
    b. Payment is paid to the insured
    c. Payment is based on negligence
    d. Payment is for bodily injuries caused by a collision
A

b. Payment is paid to the insured

* *pg 32

110
Q
  1. Damages in a UM claim may be achieved by any of the following, EXCEPT:
    a. Agreement
    b. Arbitration
    c. Lawsuit against negligent party and UM insurer
    d. Appeal
A

d. Appeal

* *pg 31

111
Q
  1. My car was damaged when I lost control and it overturned. What coverage am I looking for on my policy to repair my car?
    a. Collision
    b. Liability
    c. Other than Collision
    d. UM
A

a. Collision

* *pg 34 - coll = coll w/another object or overturn

112
Q
  1. My Business Auto has physical damage coverage called ‘specified causes of loss’.
    Which of the following will not be covered?
    a. Engine explosion
    b. Wear and Tear
    c. Flood damage
    d. Hail damage
A

b. Wear and Tear

* *pg 34

113
Q
  1. I am a FL resident insured for PIP. I drove my car to Miami where I rear-ended a
    van causing medicals of $5,000 to a FL driver insured for PIP. Which is true?
    a. I have a tort exemption of $4,000
    b. I have a tort exemption of $5000
    c. I have a tort exemption of $10,000
    d. I do not have a tort exemption
A

a. I have a tort exemption of $4,000

* *pg 38

114
Q
  1. PIP is primary against all of the following, EXCEPT:
    a. Workers’ Compensation
    b. Health Insurance
    c. Disability
    d. Liability Coverage
A

a. Workers’ Compensation

* *workers comp primary to PIP - pg 27

115
Q
  1. A FL insurer made the decision to reduce the number of auto policies offered in
    the state of Florida. As a result, cancellation notices were sent to insureds
    throughout the state. Which of the following is true?
    a. Insurers may cancel at anytime
    b. Insurers may cancel for any reason within the first 60 days of a policy
    c. Insurers may cancel for any reason after the first 60 days of a policy
    d. Insurers may never cancel an auto policy
A

b. Insurers may cancel for any reason within the first 60 days of a policy
* *pg 40 - statute FS 627.728

116
Q
  1. An insured was injured by a drunk driver in an auto accident that occurred on
    March 1, 2017. The insured had a basic PIP policy with a $10,000 limit. On
    March 16, 2017 the insured was examined for back pain from the accident, in a
    hospital emergency room, and it was determined that the injuries were serious and
    may require surgery. What best describes the PIP benefits available?
    a. $10,000 PIP from the insured’s policy and $10,000 PIP from the drunk driver’s
    policy
    b. $10,000 PIP from the insured’s policy
    c. $10,000 PIP from the drunk driver’s policy
    d. $-0-
A

d. $-0-

* *PG 35

117
Q
  1. I was getting out of my parked car when it was hit. The driver that hit my vehicle
    was driving drunk. At the time of the accident I was out-of-state in New York. I
    have filed a claim for my medicals with my PIP insurance. What is true?
    a. PIP always pays when an insured is out-of-state
    b. Out-of-state, Out-of Luck
    c. I was occupying my vehicle, therefore PIP will pay
    d. The claim is subject to NY law
A

c. I was occupying my vehicle, therefore PIP will pay

* *pg 37

SC Adjuster (4 decks)

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