Assignment 2 Flashcards
How does an auto lx ins policy pay out
on behalf of the insd to the parties who are damaged or injured as a result of negligence of the insd
Who does the auto lx ins policy protect
the insd
Who is considered “the insd” on a lx auto policy? (4)
- named insured
- family members
- permissive driver
- someone who is responsible for the acts of the insd such as an employer who is vicariously liable
When does legal lx generally arise on an auto lx insurance policy
arises from the negligent act associated with the maintenance, use, or ownership of an automobile
bodily injuries (def) (4*)
includes physical harm, sickness, disease or death resulting from the physical harm, sickness, or disease associated with the acciden t
property damage (def)
physical injury to tangible property, including loss of use
How do prejudgment and post judgment interest relate to the settlement amount (2)
- included in the definition of the damages
2. interest is supplemental and above/beyond the limits of the policy
Auto lx limits may be expressed in what two types of limits?
- split
2. single
The insurance company has what duty and right with lx claims?
- duty to defend the insd
2. right to settle claims in any manner it sees fit
What is the lowest single limit for auto lx in FL?
$30,000
Do policy limits apply to cost of defense & interest payments?
no, limits only apply to damages
Is auto lx insurance primary, secondary or excess for vehicles owned by the insd? (2)
- primary for veh owned by the insd
2. excess for veh not owned by the insd
What does PAP stand for?
Personal Auto Policy
Who does PAP provide coverage for? (3)
- individuals
- related persons
- unrelated persons who live together w/insd
Who is PAP not available for? (3)
- corporation
- partnership
- combination of business and individual interests
In PAP, who does “You” and “Yours” refer to?
named insd and residing spouse
In PAP, what does “Business” refer to
trade, profession or occupation
In PAP, who does “Family Member” refer to
relatives and foster children in the household of the named insd
What does “occupying” mean
in, upon,getting in, on, out or off a vehicle
What is the purpose of lx auto coverage?
pay damages to others who are injured or damaged by an insd’s negligence, on behalf of the insd
What types of loss are exclusions under auto LX coverage? (5)
- intentional injury or damage
- property owned or being transported by the insd
- injuries to an employee while on the job
- using the veh w/out reasonable belief of permission
* 5. adjuster must read policy to see all exclusions that may apply
What three types of vehs are generally excluded from auto lx policies?
- veh w/less than 4 wheels
- those designed mainly for use off public roads
- veh owned by, or available for regular use of a family member that is not insured
What does PIP pay for? (4)
- medical bills
- lost wages
- replacement services
- death benefits
What change was made to PIP for FL on 01/01/2013?
those seeking PIP medical benefits must receive initial services and care w/in 14 days after an MVA
Who can provide care that qualifies for PIP medical? (6)
- licensed physician
- osteopathic doctor
- chiropractic physician
- dentist
- hospital or facility owned by hospital
- licensed emergency provider
What happens if an Emergency Medical Condition is not dx?
basic PIP medical benefit of $10K is reduced to $2500
What two types of treatment are now excluded from treatment as of 01/01/2013?
- massage therapy
2. acupuncture
What happens if medical care is not rendered w/in 14 days of the DOL in regards to PIP benefits?
no PIP benefits will be available
What % of medical expenses are paid under PIP, and including what types of care? (6)
80% of reasonable med exp including med, surgical, x-x-ray, dental and rehab
What % of lost wages are paid under PIP
60% of lost wages based on gross income
What % of replacement services are paid under PIP?
100%
replacement services (def)
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)
What is the death benefit under PIP as of 01/01/13?
$5000 in addition to the $10K medical/disability benefit
How were PIP death benefits paid prior to 2013?
The total max payout on PIP was $10K, including death.
What does Additional PIP do?
Adds money to basic PIP (amounts vary)
What does Extended PIP do? (3)
increases the % of benefits paid to 100% of medical, 80% of lost wages.
Replacement services and death benefits are unchanged.
What does the No-Fault law require? (2)
- 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
What are penalties for failure to comply with No-Fault Law? (3)
- owner is denied immunity for legal lx
- owner is liable for pmt of benefits to those entitled to PIP
- owner’s drivers license and registration are subject to suspension
Is PIP primary over workers comp?
no, WC will be primary
When is PIP available when an insd is out of state? (2)
- if insd was occupying her own veh
2. if insd was occupying a veh owned by residing relative at TOL
When is FL PIP available as a pedestrian?
Only when it occurs in-state
How does tort exemption apply in FL for PIP?
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
Is tort exemption tied to the veh or to the person?
to the veh
piercing the threshold (def)
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)
What is the statute of limitations on med pay
3 years from DOL
Who does med pay apply to? (3)
- named ins
- family members
- other persons in the veh at TOL
what type of veh is excluded from med pay?
any veh with less than 4 wheels
Does med pay apply if there is workers comp?
No, workers comp must be used
Is med pay based on negligence?
nope
How does med pay relate to PIP in order of payout?
PIP is primary, then med pay is excess
What does the FL Financial Responsibility Law require
each owner carry a min of 10/20/10 lx coverage
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)
- legally valid claims must be paid up to the 10/20/10 requirement
- owner/operator must provide cert that lx ins is in place for future accidents
- If not met, operator license and veh reg of owner are suspended
What limits must a person convicted of DUI purchase for lx?
100/300/50
What must be filed if a person did not comply w/lx coverage law at time of accident? (2)
ins must be purchased and SR-22 must be filed by ins co and remain on file for 3 years
When does UMBI coverage apply? (4)
- AF party carries no lx insurance
- AF party doesn’t carry enough lx to pay insd’s damages
- AF party’s lx ins co is insolvent
- AF party was a hit & run driver
How is the UMBI payable amount figured w/other exposures?
any payout from workers’ comp, med pay, PIP and disability are deducted from remaining amount that can be paid under UMBI first.
Who and where is UMBI coverage available to? (r)
- named insd
- family members
- in any motor veh and as pedestrians
- in and out of state
When can an insd have unstacked UMBI coverage
When they reject it in writing, or select lower limits, otherwise will be stacked
How are UM damages determined overall?
- Agreement between the insured and UM insurer;
- Arbitration between the insured and UM insurer;
- If the insured refuses to arbitration, litigation against the at-fault driver and the
UM insurer.
Who does Business Auto ins cover? (3)
- named insd
- permissive drivers
- anyone liable for conduct of the same
accident (def)
continuous or repeated exposure to the same conditions resulting in BI or PD that is neither expected or intended by the insd
loss (def)
direct and accidental damage or loss
auto (def)
land motor veh, trailer or semi-trailer designed for travel on public roads
mobile equipment (def)
off-road and unlicensed veh such as bulldozers, forklifts adn veh traveling on crawler treads
Truckers Coverage (def)
form recognizes hazards unique to those whose businesses hauling goods for others
Trailer Interchange (def)
coverage provides legal liability coverage for damage to trailers owned by others.
Garage Insurance (def)
specifically designed for those in the business of selling, servicing,repairing or parking automobiles
How is LX coverage structured for Bus Auto?
structured in a way that dealers are covered for liability for any auto
Garage operations (def)
the ownership, maintenance or use of locations for a garage business and all operations incidental to the
business.
For Dealer Risks, when is a customer not an insd?
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
Auto Physical Damage Insurance (def)
first party insurance for damage to motor vehicles,
providing coverage without regard to fault
What veh are eligible for coverage under APD? (3)
- 4–wheel private passenger vehicles, not used for public or livery (vehicle for hire) purposes
- pickup or van type vehicles not used in business, other than farming or ranching
- may be owned by the insured, or leased for a period of 6 months or more.
What does “your covered auto” include for APD? (4)
- veh declared in the policy
2.An eligible vehicle, acquired during the policy as an added vehicle or replacement vehicle. - Any owned trailer
- 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.
How does broadest coverage apply for an added/replaced veh? (2)
- 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.
- 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.
What is Part D of the auto policy?
insurance company agrees to pay for the direct and accidental loss to your covered auto or to any non-owned auto, including their equipment
collision (def)
means upset or impact with another object
Other Than Collision (def) (17)
covers the perils of:
- missiles
- following objects
- fire
- theft
- larceny
- explosion
- earthquake
- windstorm
- hail
- water
- flood
- vandalism
- riot
- civil commotion
- contact with a bird or animal
- glass breakage
- all direct and accidental loss not covered by collision coverage.
What items exclusions under Part D APD (7)
- 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;
- Tapes, records, and other media and accessories used with equipment described in number one above;
- A vehicle that is destroyed or confiscated by the government or civil authorities;
- A camper body or trailer not shown in the declarations and not reported to the carrier within 30 days of purchase;
- Awnings, and equipment designed to create additional living facilities;
- Radar detection or laser equipment;
- Custom furnishings or equipment in a pickup or van including furniture, cooking and sleeping facilities, custom murals, paintings and decals.
What losses are excluded under Part D APD? (6)
- wear and tear
- freezing
- mechanical or electrical breakdown
- the failure of or road damage to tires,
- *unless any of these result from a total theft of the
vehicle. - war or nuclear causes
Towing and Labor End. (def)
covers the cost of labor performed at the place of disablement.
Sound Receiving and Transmitting Equipment End (def)
adds coverage, with no deductible for equipment permanently installed in the auto without requiring that installation be in the spot designed by the manufacturer
Tapes and Records end. (def)
up to $200 coverage, with no deductible
Customizing Equipment End. (def)
for items such as carpeting,
beds, cabinets and exterior decorating features
Miscellaneous Type Vehicle End. (def)
covers equipment such as motor-homes,
motorcycles, golf carts and all–terrain vehicles.
Business Auto PD End (def): (3)
provides Comp, Specified Causes of Loss, and Coll coverage
garage keepers insurance (def)
covers losses for which insd is liable to customer for car that insd has for service, repair, parking or storing
Dealers Drive Away Coll End. (def):
PD coverage for autos being driven/transported from point of purchase to point of distribution if distance is more than 50 miles apart
False Pretense End. (def
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
truckers insurance (def)
Covers auto owned by person/company who haul property for others
Trailer Interchange End. (def)
pays for damage to trailers owned by others that are in insd’s possession under written agreement, under Truckers Insurance
FS 627.728 (5)
- 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
- 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
F.S. 627.4137 (3)
- requires lx ins company to disclose all poly info upon written request to a clmt.
- Clmt/clmt’s atty may request in writing:
- Name
- Coverage of each known ins co - Agent is required to disclose that info and forward that request to all insurers that are affected
- 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. $-0-
* *insd cannot collect on own LX policy… should be paid under PIP/MedPay
- 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
c. The insurer must pay interest
* *pg 24
- 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
d. Friday claim-$5000/Saturday claim-$10,000
* *pg 25
- The No Fault Law requires:
a. 10/20/10 & PIP
b. PIP only
c. Liability only
d. Medical Payment Coverage
b. PIP only
* *pg 27
- 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
b. PIP only
* *pg 29
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. Lost wages from an auto accident
* *pg 39
- 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. 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
- 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
b. $200 Assuming basic PIP = $10K Ded = $1K 1200 - 1000 = 200 post ded Pg 26
- 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
c. 10/20/10 Liability
* *pg 29
- 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
c. No UM is available
* *pg 31
- 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
c. Damage to the insured’s vehicle caused by the collision
- 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. $-0-
* *pg 27
- 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
d. Medical Payments
* *workers comp primary to PIP - pg 27
* *no med pay coverage if workers comp bens payable - pg 28
- ‘Direct and Accidental Damage’ to a Business Vehicle is the definition of:
a. Accident
b. Loss
c. Damages
d. Liability
* *pg 31
b. Loss
* *pg 31
- 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
c. 10/20/10
* *pg 31 - dealer risks
- 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
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
- 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
b. Payment is paid to the insured
* *pg 32
- 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
d. Appeal
* *pg 31
- 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. Collision
* *pg 34 - coll = coll w/another object or overturn
- 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
b. Wear and Tear
* *pg 34
- 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. I have a tort exemption of $4,000
* *pg 38
- PIP is primary against all of the following, EXCEPT:
a. Workers’ Compensation
b. Health Insurance
c. Disability
d. Liability Coverage
a. Workers’ Compensation
* *workers comp primary to PIP - pg 27
- 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
b. Insurers may cancel for any reason within the first 60 days of a policy
* *pg 40 - statute FS 627.728
- 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-
d. $-0-
* *PG 35
- 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
c. I was occupying my vehicle, therefore PIP will pay
* *pg 37
