Final Test Study Guide Flashcards
What are the part of an insurance contract? (4)
- Declarations;
- Insuring Agreement;
- Exclusions;
- Conditions.
What info is in the declarations section of the policy/contract? (4)
- Insured info
- Premiums
- Period of Coverage
- Policy Limits
What is in the Insuring Agreement section of the policy/contract?
defines the coverages contained w/in the policy
What is found in the Exclusions section of the policy/contract?
eliminated coverages
What is found in the Conditions section of the policy/contract?
the requirements that must be met before a payment will be made
What is a contract of adhesion?
means that one party, the insured, cannot negotiate the terms of the contract.
What is required to win a claim for negligence? (4)
- defendant had a duty to act or not act
- defendant breached that duty
- defendant’s breach of duty was the cause of the plaintiff’s injury
- there was actual injury to the plaintiff
What is Direct Loss and Indirect Loss?
Direct Loss: physical harm/damage to tangible property
Indirect Loss: economic loss that results from the direct loss
What time is required to cancel an auto binder?
5 days
What is the definition of Property Insurance (vs LX)?
any insurance where the payment by the insurance company is made to the insured or others with an interest similar to the insured
What is the definition of Liability Insurance (vs Prop)?
payment by the insurance company will be made to a
third-party injured or damaged by the insured.
What is a peril?
an event that may cause a loss
What is a hazard?
something that may increase the risk of loss by peril
What are the three types of hazard?
- moral
- morale
- physical
How does a straight deductible work?
a set amount that is subtracted from the loss, that the insd has agreed to be responsible for
How does a franchise deductible work?
If value of the loss is equal to, or more than, the deductible, the full loss will be paid (no deductible).
If the value of the loss does not meet the deductible, then there is no payment made.
What is Valued Policy Law?
If there is a covered total loss to building, structure, mobile home, or manufactured housing unit, the ins company must pay policy limits, and not ACV.
What is a Mortgagee Clause?
Clause that protects a lender as an insured, that makes a loan secured by real property
What is a Loss Payable Clause?
Clause that protects a lender as an insured, that makes a loan secured by personal property (called loss payee)
What is the Principal of Utmost Good Faith? (2)
- all insurance contracts based on this
- assumed that parties to an insurance policy have disclosed all relevant fact and intend to carry out their obligations
What is a waiver?
act of voluntarily giving up a known right
What types of waivers are applicable to insurance? (2)
- Express: written waiver of giving up a right under the contract
- Implied: giving up a right due to violation/negligence
What is the Principal of Indemnity?
An insured may recover loss to the point of being made whole, but cannot profit from a payment made for a loss
What is Proximate Cause?
all damages that result from an unbroken chain between a covered event and damage that grows out of the event are covered
What is negligence?
failure to exercise the same degree of care a reasonable person would use to protect others from an unreasonable risk of harm
What is the Burden of Proof if a Civil Case?
that the evidence was more likely than not, the greater weight of evidence
How does Co-Insurance Work?
The insd must carry a specific amount/% of coverage to recover 100% of a covered loss limit.
If this min % isn’t carried, than the insd’s settlement will be reduced by the short %.
How does a percentage deductible work?
requires a deduction of a percentage of the value of the property or a percentage of the policy limits
What type of releases are available to settle a claim? (3)
- can take several forms - simple to complicated
- an adjuster can only fill in the blanks on a printed release prepared by co’s legal dept
- “contract of release” generally used, extinguishes any cause of action arising from the occurrence, whether known or unknown
What is a tort? (2)
- a civil wrong, not arising from a contract, for which money damages may be had
- Civil and Criminal
What are compensatory damages? (2)
- money awarded to a plaintiff to compensate for damages, injury, or another incurred loss.
- awarded in civil court cases for loss that was result of negligence or unlawful conduct of another party.
What are punitive damages?
awarded when the acts of a defendant are so outrageous that it is necessary to punish that defendant and deter others
What is a complaint in a lawsuit? (4)
- initial document a plaintiff files with the Clerk of Court to begin a lawsuit.
- The complaint will list:
- the facts of the case or event,
- what the defendant(s) did wrong and
- what the plaintiff is seeking in damages
What is an answer in a lawsuit?
the defendant’s response to the initial complaint, denying or affirming the charges
What are the elements of a proof of loss? (5)
- origin of loss
- proximate cause
- interest of the insd and all other persons in the property
- changes to title, location. use or possession
- all contracts of insurance that applied to the property
What do property and liability policies cover?
the person/insured, transfer the risk to the company
What is the primary function of the Dept of Financial Services?
oversees the Dept of Insurance
Is the information in an insurance application a warranty?
Yes - in regard to the insured answering truthfully. Any false answers can void the policy.
(1) A guarantee of the performance of a product. Product warranties are included within the definition of the named insured’s product in general liability policies. (2) A statement of fact given to an insurer by the insured concerning the insured risk which, if untrue, will void the policy.
What are the elements an adjuster investigates in a liability claim? (6) (FIB-CAR)
- was insd was guilty of negligent act
- was clmt guilty of comparative negligence
- was risk of injury assumed
- is claim actionable because of relationship of parties
- facts surrounding claim
- can clmt meet burden of proof the law requires
What is comparative negligence?
a verdict that allows a verdict in favor of defendant to be reduced by % of negligence that the plaintiff contributed to the loss
What is contributory negligence?
if a plaintiff is found to be even 1% AF, the plaintiff will recover nothing.
What is rule 69B-220.201?
Under FL Administrative Code: Code of Ethics.
Short: Provides that the work of adjusting insurance claims engages the public trust and adjuster must put the duty for fair and honest treatment of the clmt above the adjuster’s own interests.
What is assumption of risk?
plaintiff knowingly exposed herself to danger of injury
What is the FL statute of limitations in which to file a lawsuit?
4 years
What is the definition of damages in FL?
money
What does being a fiduciary mean?
having a responsibility of loyalty to the interest of the principal, insurance company and insured
What is a charge or encumbrance on a claim called? (3)
interest party (lienholder/loss payee)
What is an encumbrance? (3)
- An encumbrance is a claim against a property by a party that is not the owner.
- An encumbrance can impact the transferability of the property and restrict its free use until the encumbrance is lifted.
- The most common types of encumbrance apply to real estate; these include mortgages, easements and property tax liens.
What is salvage?
property that is a total loss (cost of repair is higher than the value of the property)
What is the requirement to settle the claim of a minor child? (3)
- settled w/both parents/guardians
- amount cannot exceed $15,000
- if larger than $15,000 must be approved by courts
What does that FL Unfair Insurance Trade Practices Act penalize? (6)
- misrepresentation to an insd, clmt, and for certain business practices including:
- failing to act promptly
- denying claims w/out investigation
- not affirm/deny claim w/in 30 days
- not explaining claim denials in writing
- not maintaining complaint handling procedures
What is FL statute 626.9541?
FL Unfair Insurance Trade Practices Act
What type of release is an adjuster permitted to prepare?
can only fill in blanks on form that was prepared by company’s legal dept
Who does lx insurance protect?
the defendant
What does tort lx insurance provide coverage for? (1)
tort liability for unintentional tort (sometimes intentional)
Who has the right to settle auto lx claims?
insurance company when acting in good faith and reasonable judgment
What does the Financial Responsibility Law require? (2)
- if you own a registered veh in FL, that you carry sufficient financial insurance to pay for damages in an accident,
- specifically 10/20/10 LX insurance
What is a form SR-22? (3)
- form filed by insurance that certifies LX coverage of 10/20/10 is in effect
- required when insd didn’t have lx coverage at time of accident
- must be done to avoid suspension of DL and veh reg
What is the statue of limitations for Medical Payment coverage?
for services rendered w/in 3 years from DOL
When is Med Pay available? (2)
- when in covered auto with more than 4 wheels
2. applies to NI, family members, other person occupying auto
An insured has basic PIP with a $1000 deductible. If the insured is injured in an accident and has $2,000 in covered medicals, how much will PIP pay?
a. $1,000 b. $800 c. $600 d. Not enough information to determine
b. $800
2000-1000 = 1000 post ded
1000*.80=800
An insured had basic PIP coverage with no deductible. He had an accident that occurred January 2, 2018 and sought medical treatment within 14 days, but was not diagnosed as having an emergency medical condition. Medical bills totaled $3000. What will PIP pay?
a. $3000 b. $2500 c. $2400 d. $1600
c. $2400
3000-0=3000 post ded
No emc dx = 2500 limit
3000*.8=2400
I have Additional PIP-$90,000 and Extended PIP. I was in an accident in 2017 and have $100,000 in medicals and $1,000 in lost wages. What will PIP pay?
a. $100,800
b. $100,000
c. $90,800
d. $90,600
b. $100,000
Addtl PIP = 10000+90000=100,000 basic + addtl
Extend PIP = 100% med, 80% LW
Assuming no ded
Med: 100000100%=100,000
LW: 1000.80=800
Max limit = $100,000, maxed by the med bills.
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. $160 Assuming basic PIP = $10K Ded = $1K 1200 - 1000 = 200 post ded 200*.80=160
An insured had basic PIP. He had an auto accident in 2017. Medicals were $8,000. Lost wages were $2000. What is left from basic PIP for death?
a. $5000 b. $2800 c. $2400 d. $0
Assume no ded Basic $10K Med pay 80%, Lost 60% Med: 8000*.8=6400 Lost: 2000*.6=1200.0 6400 -1200=5200 10000-5200 = 4800 remain overall Death = 5000 - post 2013 sep from rest
What vehicles are covered by auto lx insurance? (2) (re: ownership)
- primary coverage for veh owned by the insd
2. excess coverage on veh not owned by insd
What vehicles are excluded by auto lx insurance? (3) (types of veh)
- veh owned by or available for regular use of family member that is not insd
- veh w/less than 4 wheels
- veh designed mainly for use off public roads
What is the definition of bodily injury?
bodily harm, sickness, disease or death resulting from the proximate cause
What is excluded from auto lx coverage? (4) (IEUT)
- 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
What coverage is primary to PIP?
worker’s compensation
What is an uninsured motorist claim? (4)
- clmt carried no lx insurance
- clmt doesn’t carry enough lx insurance to pay for insd’s dammages
- clmt who lx insurance co is insolvent
- hit and run driver
What is Additional PIP?
Adds an additional $90K to Basic PIP, giving $100K total
What is Extended PIP? (3)
Increases the % of reasonable Pip Med and Pip Lost Wages, (not exceeding PIP limits)
PIP Med Exp = 100%
PIP Lost Wages = 80%
How is a UM claim settled? (4)
- No duplicate coverage/recovery permitted. So any WC, Med Pay, PIP, Disability is deducted from settlement before paying on UM
- Damages determined by:
a. agreement between insd & UM insurer
b. arbitration between insd & UM insurer
c. if insd refuses arb, litigation against AF driver & UM insurer
How much can an insd recover from his own 10/20/10 lx policy?
none, only pays out to clmt
How does the PIP tort exemption work?
person who is AF is excused from responsibility for damages based on amt PIP actually pays injured party or would have paid the party, as long as AF has the required PIP ins
What is Part D of a Personal Auto Policy?
Other Damages to your Auto (Coll & Comp)
In which coverage is the insurance company’s promise to defend the insured? (3)
Auto - A/LX
Property - E
LX policy
What does ‘occupying’ mean in regard to auto?
in, upon, getting in, on , out or off
How does the PIP deductible work? (2)
- It is applied before the %’s are figured (taken from the loss amount, even if more than the PIP limit)
- only applies NI and family members
When is PIP available to the insured? (6)
- NI, family when riding in any veh in FL
- NI, family when pedestrian in FL
- any psgr riding in insd’s veh who doesn’t have PIP & doesn’t own a reg veh in FL
- if insd strikes pedestrian who is FL res and pedestrian doesn’t have/isn’t required to have PIP from any other source, pedestrian collects from insd
- NI and family when in insd veh out of state
- psgr that isn’t family doesn’t collect when out of state
If you know how much Coverage A is in a Homeowners policy, do you know how much Coverage B and Coverage C would be?
Yes -
Cov B is normally 10% of A.
Cov C is normally 50% of Cov A.
What is generally the limit for property of insd located at the residence other than the main dwelling?
10% of Cov C, but not less than $1000
What is generally the limit to the loss of money, precious metals, stored value cards, and smart cards?
$200
What is generally the limit per occurrence for securities, watercraft, trailer accessories/equipment, trailers not used withwatercraft, loss by theft of jewelry, watches, furs, precious/semi precious stones, electronics (cell phone, stero, computer)?
$1500
What is generally the limit for business property on residence premises, or loss by theft of silverware, gold-ware, firearms and related equipment?
$2500
What is ‘all risk” coverage in a HO policy
Means all named risks are covered unless specifically excluded
What are the covered “nature” risks in an All Risk policy? (9) (THINK EARTH, WIND & FIRE)
- fire
- lightning
- windstorm
- hail
- smoke
- falling objects
- weight of ice/snow/sleet
- volcanic eruption
- catastrophic ground cover collapse (sinkhole - FL endorsement)
What are the more man-made risks in an All Risk policy? (7)
- explosion
- riot or civil commotion
- aircraft
- vehicles
- vandalism or malicious mischief
- theft
- sudden/accidental damage from artificial generated electrical current
What are the water/damage risks in an All Risk policy? (6)
- accidental discharge or overflow of water or steam from:
- plumbing
- heating
- a/c
- sprinkler system
- household appliance
In an HO-3 policy, is the coverage all risk or named peril for A-C? (3)
- A = all risk
- B = all risk
- C = named peril
What type of coverage (all risk or named peril) apply to HO-4 and HO-6?
named peril for both
What is Inland Marine Coverage?
provides coverage for cargo traveling overland, instead of by sea
What type of property does Inland Marine coverage not protect?
stationary property (real estate, furniture, fixtures in the course of manufacture)
What are the eligible risks in Inland Marine insurance? (6) (BIPECD)
- Imports
- Exports
- Domestic shipments
- Instrumentalities of Transportation or Communication
- Personal Property Floater risks
- Commercial Property Floater Risks
What is Ocean Marine coverage?
coverage for perils associated with water transport
What is hull insurance in an Ocean Marine policy?
provides coverage for loss or damage to a vessel named risks
What are the named risks on hull coverage? (8) (FLEA-JOB-P)
- fire
- lightning
- earthquake
- assailing thieves (pirates)
- perils of the sea
- jettison
- barratry of matter
- other like perils
What is barratry under Ocean Marine Insurance?
raud or gross negligence of a ship’s master or crew at the expense of its owners or users.
What is jettison under Ocean Marine Insurance?
throw or drop (something) from an aircraft or ship.
What is an “average deductible form” for ocean marine insurance?
a stated, flat deduction for any loss
What is freight coverage? (2)
coverage for the vessel owner when freight charges aren’t paid (ie - money that was to be earned on the cargo)
What is Protection and Indemnity coverage? (4)
covers liabilities such as:
- injuries to passengers
- members or crew
- persons on other ships
- damage to cargo/docs/other property
What does “average” mean in ocean marine insurance?
loss or damage
What is the general average clause in ocean marine insurance?
loss which is a voluntary sacrifice on part of ship or cargo, made by the master of the ship to avoid a common peril that might destroy the entire ship/cargo unless sacrifice was made
What does workers’ compensation provide for funeral expense?
actual funeral expenses,not exceeding $7500
What is the limit of medical expenses in workers’ comp? (2)
- any required medical treatment, including medicines, nursing care, or hospital care
- there is no dollar limitation
What are the types of health insurance? (5)
- Social Security Rider
- COLA rider
- Medicare supplement insurance
- Health Maintenance Organization (HMO)
- Preferred Provider Org (PPO)
What is the deductible in an umbrella policy? (2)
called a self-insured retention or retainer, generally $250
How is employee theft coverage written (types of coverage)? (3)
- Scheduled Persons Coverage
- Scheduled Position Coverage
- Blanket Coverage
How does a crime policy value money and securities? (2)
- Money is valued at face value
2. securities valued on day the losses are discovered
What are the parties to a surety bond? (4)
- Principal: party who is expected to perform/fulfill contract/meet obligation
- Obligee: party who is guaranteed that the principal will perform
- Surety: party who guarantees the performance of the principal to the obligee
- Indemnitor: party who agrees to reimburse the surety for any loss suffered from having bonded the principal
Who are the principal, obligee, surety and indmenitor in a bail bond?
- principal: defendant
- obligee: court
- surety: individual/person issuing bond
- indemnitor: person putting up collateral for bond
Who is the principal, obligee, surety and indemnitor in a bid bond?
- principal: bidding company
- obligee: contracting company
- surety: company issuing the bond
- indemnitor: bidding company
What is the waiting period for workers’ compensation disability?
waiting period of 7 days prior to payment of disability pmts
What is casual labor in workers compensation? (3)
- work that is not in the usual course of trade, business, occupation or profession of the employer (contracting party).
- Ex: insurance agency hiring a carpenter to upgrade the office. The contractors hired are not performing duties that would normally be done by any employee; they are doing work outside the normal operational requirements.
- casual laborer is one that does not directly promote or advance the employer’s business or operation.
Do all Homeowner’s policies contain coverage A?
No - renters policies (HO-4) generally don’t include A, this is usually covered in the landlord policy
What are the main homeowner policy forms? (3)
HO-3: special form
HO-4: contents broad form (renters)
HO-6: unit owners form (condo coverage)
What are the 3 main dwelling program forms?
- DP-1: Dwelling property basic
- DP-2: dwelling property broad
- DP-3: Dwelling property special
What type of property does a dwelling policy insure? (2)
investment property that is rented out, provides coverage for dwelling & lx
What is Builders’ Risk Coverage?
policy that insures a building in the process of construction. Covers 100% of the valued of finished building.
Are Builders Risk written on All Perils or Named Peril basis?
most written all perils
What is an eligible building for flood insurance? (4)
- 2 or more outside rigid walls and full secured roof
- built on a permanent site
- 50% or more of value above ground level
- located w/in eligible community
How does the limit change on a flood policy if insd lives at the dwelling 80% of the time and insd at least 80% of replacement cost, vs less than 80%? (2)
- replacement cost applies to single-family building losses & insd’s principal residence
- others settled at ACV
What are the coverages in Farm Property? (7) (ALPHA)
- Cov A - dwelling
- Cov B - private structures adjacent to dwelling
- Cov C - household private prop
- Cov D - ALE
- Cov E - sched farm personal property
- Cov F - unsched farm personal prop
- Cov G - other farm stuctures
On a farm policy, what can be included in Cov E - scheduled farm personal property? (3)
- grain
- farm produce poultry and livestock
- machinery and equipment incidental to farm use
On a farm policy, what can be included in Cov G - other farm structures? (3)
farm buildings such as barns, silos and fences
What are the two optional forms for a Farm policy? (2)
- Mobile Agricultural Machinery and Equipment coverage
2. Livestock coverage
What are the differences between the Annual Transit Policy, Trip Transit Policy, and Motor Truck Cargo policy? (3)
- Annual Transit: protects shipper/receiver of goods against loss of goods in transit, covers any and all shipments during a policy term (ie- Hope Shopping Network since they have thousands a month)
- Trip Transit: used to insure a single shipment of goods for only occasional shipments to ensure (florist)
- Motor Truck Cargo: protects the carrier instead of shipper, for losses to domestic shipments in transit (FedEx)
What are the underwriting requirements for an Aviation policy? (4)
- pilot’s qualifications and experience
- size of the aircraft
- type of aircraft
- age and condition of the aircraft
What does the Miscellaneous Type Vehicle endorsement cover? (4)
equipment such as:
- motor homes
- motorcycles
- golf-carts
- all-terrain veh
What coverage does Garage insurance provide? (2)
- covers losses in which insd is liable to customer for car that insd has for service, repair, parking or storing
- similar to APD coverage
What are the 2 endorsements available for Garage Keepers insurance?
- Dealers Drive away Coll: dev being driven/transported from POP to POD if more than 50 mi apart
- False Pretense: PD coverage for dealers against voluntary parting w/covered veh by trick/scheme or acquiring auto from someone who doesn’t have legal title
What coverages does Mechanical Breakdown insurance provide? (3)
- car repairs unrelated to an accident (takes place of dealer warranty)
- major failures that can occur in your car, which is often excluded in basic auto insurance.
- bad brakes, transmission issues or electrical system or any other major vehicle system malfunctions
What type of disability policies are available? (4)
- Disability Income Insurance: income pmts when insd is unable to work because of sickness or injury
- Non-pro rating disability: benefits that won’t be reduced if insd changes to a more dangerous position
- Social Security rider: income when insd is eligible for SS bens - but those haven’t yet begun/denied/reduced to less than rider
- COLA rider: indexing the benefit payable under policy to changes in the consumer price index
What is a rider in insurance:
like an endorsement, adds to or amends the coverage or terms usually for additional cost
What is the FAJUA? (3)
- FL Auto Joint Underwriting Association
- like RI RIsk
- for people unable to purchase auto ins in voluntary insurance market
What are the Ethical Requirements in FL Statutes? (9) COINS-RALF
- Code 69B-220.201
- cannot negotiate directly w/clmt who is represented by atty
- when interviewing witnesses, must avoid any interaction must avoid actions that tend to induce witness to suppress or deviate from truth.
- witness who requests copy of statement must be provided a copy.
- cannot give legal advice
- cannot draft special releases, can only fill in the blanks on pre-made form from legal
- cannot take advantage of incapacitated clmt
- cannot knowingly fail to advise clmt of rights under insurance contract and law of state
- approach all aspects of process w/unprejudiced and open mind, make truthful and unbiased reports, handle all process w/integrity, accept no pmts when no legal entitlement, act w/diligence in achieving proper disposition of claims
If an adjuster has a change in name, phone, or address, in what time frame must an adjuster notify the department?
30 days
Emergency adjusters may be appointed for what period of time?
For the time declared by the Dept of length of cat/emergency
What is the difference between a Domestic, Foreign, or Alien Insurance company? (3)
- Domestic: formed under FL laws
- Foreign: formed under US, but outside FL
- Alien: formed outside US and FL
What is the bonding requirement for a public adjuster?
50K
How long does an adjuster have to answer a written inquiry from the Dept?
21 calendar days
What is a derivative claim?
a claim in which the insd is found lx, related to clmt’s injuries
What are the rules for filing a request for ‘mediation’? (4)
- either party may demand mediation prior to litigation beginning
- must be filed w/dept on form approved by dept
- ins policy must specify the TandC for mediation of 1st party claim
- cost of mediation will be borne equally by both parties, unless mediator determines one party didn’t act in good faith
What limit, if any, is put on advertising gifts? (4)
- Statute 626.9541(1)(m)
- gift must be an article of merchandise (fob, mug, et)
- cash and debit cards don’t apply
- cannot be valued more than $75 per item, and no more than total of $100 per insd per calendar year
https://www.colodnyfass.com/blog/breaking-news-floridas-insurance-advertising-and-promotional-gift-law-expanded/
How many total hours of CE is required of a new adjuster? (3)
- 24 hours every 2 years
- 5 must be course related specific to license (ethics, etc)
- 19 hours general topic
What document governs the adjustment of claims? (2)
- FL Code of Ethics: 69B-220.201
2. FL Unfair Insurance Trade Practices Act: 626.9541
What is the requirement for dealing with elderly clients?
exercise extraordinary care
What parties pay the cost of mediation?
both parties will equally pay, unless mediator finds one partied did not act in good faith
What is an authorized insurer? (3)
- Authorized by the Office of Insurance Regulation to write insurance under a Certificate of Authority.
- An Admitted/Authorized insurer files an application with the Office of Insurance Regulation and provides detailed background information on its officers/directors/certain shareholders and is subject to a financial review as part of the application process.
- A person insured by an Admitted/Authorized insurer has the protection of the Florida Insurance Guaranty Act in the event of an insolvency of the
insurer, subject to certain excluded coverages.
What is ‘transacting’ insurance? (def 624.10) (4) (pest)
- solicitation or inducement
- preliminary negotiations
- effectuation of a contract of insurance
- transaction of matters subsequent to effectuation of contact of insurance and arising out of it
What is the standard deductible in a Comm policy? (2)
For commercial property:
- standard is $500 for all loss
- hurricanes: min of $500, max of 10% of policy limits
What does the policy limit represent?
The maximum amount the ins co will pay out in the event of a covered loss
When is a public adjuster allowed to acquire an interest in Salvaged Property?
with written consent and permission of the insured
What is the FWCJUA? (2)
- FL Workers Comp Joint Underwriting Association
- provides WC coverage for those employers unable to either self-insure or secure coverage through normal market channels
What are the differences between an HMO and PPO? (6)
- HMO: health maintenance org,
1a. doesn’t provide insurance.
1b. Provides health service to members for a fixed fee.
1c. Physicians work directly for the HMO. - PPO: preferred provider organization
2a. groups of hospitals and doctors that have joined together to reduce medical costs
2b. they contract w/ins company to provide services at prearranged cost
2c. they do not work directly for a PPO
How does mechanical breakdown insurance pay repairs? (5)
- pre-auth through ins co
- can usually take to SOP
- SOP provides dx code and estimate to ins co
- if covered loss, pay ded to shop, and ins company pays rest up to limits
- normal wear and tear and maintenance usually excluded
What are the definitions of ‘accident’ and ‘bodily injuries’ in a Business Auto Policy? (2)
- accident: continuous or repeated exposure to the same conditions resulting in bodily injury or prop damage that is neither expected nor intended by the insd
- bodily injury: bodily harm, sickness, disease, or death resulting from accident
What is the deductible in a Personal Articles Floater?
no deductible applies
What are the requirements for a Principal Residence in flood? (2)
- if insd lives in dwelling at least 80% of time and dwelling is insd at least 80% of replacement cost, then RCV applies
- all other settled at ACV
What is the definition of ‘Business Income’? (2)
- net profit or loss, before income taxes, that would have resulted had loss not occurred
- plus continuing normal operating expense that would have been incurred through period of restoration
What is ‘preservation of property’? (2)
- secure vacant properties until they are sold.
- applies to right of possession and use, in that a renter has an insurable interest in the property being maintained (they put money into equip/furnishings)
What do Coverages A, B, C, D provide in a homeowner’s policy?
A: Building/Dwelling
B: App Structures
C: Personal Property
D: ALE
What are the categories of benefits under Workers’ Comp? (3)
- medical expenses
- compensation for disability
- death benefits
What are ‘expediting expenses’ in Boiler and Machinery? (3)
- for expenses of temporary repairs and costs incurred to speed up permanent repair or replacement of covered prop/equipment.
- usually limited extent that expenses service to reduce the loss
- coverage can be arranged for full reimbursement
What is the definition of ACV? (2)
- actual cash value
2. replacement cost - depreciation
What is a ‘Payment Bond’?
surety bond issued to contractors prior to start of project, that guarantees that the contractor will pay their subcontractors, material suppliers, and laborers in a timely fashion
What does the Wrongful Death Act provide? (2)
defines the recovery rights of survivors of a deceased person.
No action permitted for pain & suffering of the deceased.
What UCF designation allows an applicant to be exempt from the adjuster licensing exam, and required for public adjusters?
UCF Accredited Claims Adjuster Designation
An insurer gives which of the following as Consideration for an insurance policy?
a. A Promise
b. A Premium
c. Value
d. A Binder
a. A Promise
The interest of the insured and all other persons in the property involved in a claim is found in______;
a. The Policy
b. A Proof of Loss
c. The Declarations
d. The Insuring Agreement
b. A Proof of Loss
An insured rear-ends another driver’s vehicle. The auto policy that pays damages to repair the damaged vehicle is a _______?
a. Property policy
b. Liability policy
c. Property and Liability policy
d. Collision policy
b. Liability policy
For insurance to pay damages, an insurable interest must exist:
a. When the property is purchased
b. When the claim is made
c. When the loss takes place
d. When the proof of loss is submitted
c. When the loss takes place
Texting while driving is best described as a:
a. Peril
b. Hazard
c. Tort
d. Peril, hazard and tort
b. Hazard
A covered loss is $90,000. Policy A has a limit of $100,000. Policy B has a limit of $200,000. Both policies are pro-rata policies. How much will policy B pay for this loss?
a. $90,000
b. $60,000
c. $300,000
d. -0- (Policy A has sufficient funds to pay the claim)
b. $60,000
A + B = $100,000+$200,000=$300,000.00 A = 1/3 B = 2/3 $90,000*2/3=$60,000.00
Giving prompt notice of loss is best described as a policy:
a. Condition
b. Agreement
c. Proof of Loss
d. Obligation
a. Condition
If there is a total loss by an insured peril to a FL building, the insurer must pay:
a. All claims
b. Replacement Cost
c. Actual Cash Value
d. Policy limits
d. Policy limits
Valued Policy Law
- My coin collection was appraised and my insurance company specifically insured the valued of that collection. That is an example of:
a. The Valued Policy Law
b. A Valued Policy
c. Appraisal
d. Liability Insurance
b. A Valued Policy
Which loss settlement valuation may be a violation of the Principle of Indemnity?
a. Valued Policy
b. Actual Cash Value
c. Structured Settlement
d. Replacement Cost
d. Replacement Cost
If the policy limit is $60,000; 80% coinsurance requirement; loss of $60,000 and the value of the property is $100,000, what loss amount will the insurer pay?
a. $15,000
b. $30,000
c. $45,000
d. $60,000
c. $45,000 Limit: 60K 80% coins req Loss: 60K Prop value: 100K Req check: 100,000*.80 = 80,000 (prop value * 80% req), UNDER LIMIT Find % cov held: 60/80=0.75 60,000*.75=45,000.0
The insured has a Homeowner’s insurance policy with a 5% Hurricane deductible. If a hurricane loss of $6,000 occurs to the home that is valued and insured for $100,000, how much will the policy pay?
a. $1,000
b. $2000
c. $5000
d. $6,000
a. $1,000
100,000*.05=5,000.0 ded
6000-5000=1000 payout
An insured signs a release to settle a claim. In the event the insured discovers injuries or damages that were unknown at the time of settlement, what is generally true?
a. Unknown injuries/damages covered
b. Unknown injuries/damages covered for 90 days following settlement
c. Release extinguished all causes of action
d. Release may be voided within 30 days of settlement
c. Release extinguished all causes of action
Which of the following is not a tort:
a. Slander
b. Assault
c. Auto accident
d. Breach of contract
d. Breach of contract
The type of damages that pays medical bills is known as:
a. Punitive
b. General
c. Special
d. Money
c. Special
A marine policy has a $1 million limit and a $100,000 franchise deductible. A covered loss is $110,000. How much will the policy pay?
a. $-0-
b. $10,000
c. $110,000
d. Not enough information to determine
c. $110,000
Which of the following is NOT included in a proof of loss?
a. Origin of loss
b. Replacement cost of each item
c. Interest of insured in each damaged item
d. All contracts of insurance covering any of the property
b. Replacement cost of each item
Property and Liability policies cover:
a. Persons, Property and Operations
b. Persons
c. Property
d. Operations
b. Persons
What type of tort arises from a negligent act?
a. Unintentional
b. Intentional
c. Intentional and Unintentional
d. Negligence
a. Unintentional
A car crash victim sued the negligent-drunk driver for damages 5 years after the
accident. What is true in FL?
a. Mediation required
b. Arbitration applies
c. Statute of Limitations applies
d. Assumption of Risk applies
c. Statute of Limitations applies
The best statement regarding the Appraisal process is:
a. Appraisal determines the value of a loss
b. Appraisal determines liability
c. Appraisal applies separately to each insured as if the other does not exist
d. Appraisal broadens coverage
a. Appraisal determines the value of a loss
Florida is a ____Negligence state.
a. Comparative
b. Contributory
c. Intentional
d. Unintentional
a. Comparative
Rule 69B-220.201 prohibits adjusters from:
a. Filling in the blanks on a release
b. Handling claims with integrity
c. Giving legal advice
d. Giving a witness a copy of their statement
c. Giving legal advice
In Florida property claims must be paid within __ days of notice of claims.
a. 120
b. 90
c. 60
d. 14
b. 90
FL statute 627.70131
‘Liability’ refers to:
a. Negligence
b. The merits of the claim
c. Risk
d. Burden of Proof
b. The merits of the claim
A single claimant was injured in an accident with a FL State Employee. What is
true?
a. No lawsuit is permitted against the state
b. The maximum recovery is $100,000
c. The maximum recovery is $200,000
d. He must obtain a Waiver of Sovereign Immunity
c. The maximum recovery is $200,000
Single person in acc = 200K, $300 is for all clmts involved
The FL Unfair Insurance Trade Practices Act penalizes all of the following,
EXCEPT:
a. Failing to Act Promptly
b. Denying Claims without reasonable investigation
c. Failing to explain claim denials in writing
d. Keeping accurate records of complaints
d. Keeping accurate records of complaints
The No Fault Law requires:
a. 10/20/10 & PIP
b. PIP only
c. Liability only
d. Medical Payment Coverage
b. PIP only
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
An insured has stacked 50/100 UM coverage for 3 cars. The maximum the policy will pay for the one insured’s injuries in one accident caused by an uninsured motorist is:
a. 300
b. 150
c. 100
d. 50
b. 150
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-
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
**no med pay coverage if workers comp bens payable
‘Direct and Accidental Damage’ to a Business Vehicle is the definition of:
a. Accident
b. Loss
c. Damages
d. Liability
b. Loss
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
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
prior 2013 - up to $5K for death included in basic PIP $10K
$9600 paid in med at 80%
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
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
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
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
PIP is primary against all of the following, EXCEPT:
a. Workers’ Compensation
b. Health Insurance
c. Disability
d. Liability Coverage
a. Workers’ Compensation
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
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-
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
I was in an auto accident on March 2017. I have $1500 in emergency room charges from the day of the accident, and $2000 in massage therapy from a physical therapist. I have basic PIP with a $1000 deductible. How much will PIP pay?
a. $3500 b. $2500 c. $500 d. $400
d. $400 Basic PIP: $10K Med: 80% Ded: 1000 1500 - covered ER treatment 2000 - excluded massage 1500-1000=500 post ded 500*.8=400 settle
An insured had basic PIP with a $1000 deductible. A friend was riding in the insured’s car in Orlando at the time of an accident. The friend did not have PIP but she did own an automobile registered in FL. In the event of an accident, what is true?
a. The friend is covered by the insured’s PIP subject to the deductible b. The friend is covered by the insured’s PIP without the deductible c. The friend is only covered in FL d. The friend is not covered by the insured’s PIP
d. The friend is not covered by the insured’s PIP
NOTES:
- If the friend was covered by the insured’s PIP, the friend would not be subject to the deductible
- A non-family passenger is only covered in FL
An insured rear-ended an auto at 80 mph in 2017. The insured was injured and had Additional PIP-$90,000 and Extended PIP. The insured has medicals of $90,000 and lost wages of $2000. What will PIP pay?
a. $92,000 b. $91,800 c. $91,600 d. $73,200
c. $91,600 PIP: 10,000+90,000=100,000 overall Med Exten: 100% Wages Exten: 80% Med: 90,000*1.=90,000 Wage: 2,000*.8=1,600 Assume no ded 90,000+1,600=91,600 in range
An insured negligently struck a motorcycle rider with his vehicle, causing the rider to incur $5000 in covered medicals. The motorcyclist also owned a car insured for PIP. How much is the insured’s tort exemption?
a. $5000 b. $4000 c. $3200 d. $0
d. $0
* * pg 38 - no exemption when insd AF and hits motorcycle. MC can sue for all damages.
A speeding driver struck a FL pedestrian crossing the street. The driver was insured for PIP, Liability insurance and Uninsured Motorist Coverage. The pedestrian did not own a vehicle and had no PIP. The pedestrian may be entitled to recover damages from which of the insured’s coverages?
a. PIP and Liability
b. Liability only
c. PIP only
d. Medical Payment coverage
a. PIP and Liability
Passengers on a cruise ship contracted a serious illness due to the ship’s cleanliness and they are now presenting claims for medicals and damages. This type of claim would be covered by the ship’s _______coverage.
a. Jettison
b. Perils of the Seas
c. Freight
d. Protection and Indemnity
d. Protection and Indemnity
A business has been accused of detaining a customer resulting in a false arrest for shoplifting. This claim would be covered by:
a. Personal and Advertising Injury
b. Premises and Operations Exposure
c. Crime Coverage
d. Medical Payment Coverage
a. Personal and Advertising Injury
Which of the following is not considered a ‘product’ under Products/Completed Operations exposure?
a. Acreage sold by a realtor
b. Food sold by a restaurant
c. Motorcycle sold by a dealer
d. Toys sold by a manufacturer
a. Acreage sold by a realtor
A best-selling novelist had computer fraud coverage. His computer was vandalized and the manuscript of his latest novel was destroyed. What is the best description of coverage provided?
a. Replacement cost provided
b. Actual cash value of manuscript and computer provided
c. Up to $5000 for computer, manuscript excluded
d. Up to $5000 for manuscript, vandalism excluded
d. Up to $5000 for manuscript, vandalism excluded
An employee stole merchandise from a business on three separate occasions. The value of each theft was more than the Employee Theft policy limit. The business wants the limit to apply separately to each incident. What is true?
a. The limit applies separately to the losses from each theft
b. The limit applies once to all loss caused by the three thefts
c. The limit is divided between the losses from the three thefts
d. More than one theft voids coverage
b. The limit applies once to all loss caused by the three thefts
A dry cleaner damages a customers clothes. Damages would be covered by:
a. Bailee’s customer policy
b. Bailor’s customer policy
c. Dry cleaner’s liability policy
d. Customer’s homeowner’s policy
a. Bailee’s customer policy
Hackers damaged broke into a bank’s system, transferred money, client’s information and inserted a virus that damaged the computers. A claim for damages under Computer Fraud coverage has been presented. What may be covered?
a. Money
b. Client Information
c. Computer Damage
d. Money, Client Information and Computer Damage
a. Money
Which of the following is not an employee under Workers’ Compensation?
a. Sole Proprietor of roofing company
b. County Sheriff
c. Public-School Teacher
d. NFL Quarterback
d. NFL Quarterback
A building contractor hired a plumbing company to complete the plumbing in a house that the contractor was building. One of the plumbers was injured on the job and it was determined that that plumbing company did not carry the required Workers’ Compensation. All of the following are true, EXCEPT:
a. The plumbing company may be fined
b. The failure to carry Workers’ Compensation is a crime
c. The state of FL will now pay the plumber’s benefits
d. The plumbing company may be prevented from conducting business until benefits are provided
c. The state of FL will now pay the plumber’s benefits
All of the following may be covered under a Homeowner’s policy, EXCEPT:
a. Single family rental home
b. Owner-occupied duplex
c. Condominium
d. Renters
a. Single family rental home
All of the following are perils under Homeowners’ Coverage C, EXCEPT:
a. Malicious mischief
b. Weight of ice, snow or sleet
c. Rust
d. Hail
c. Rust
A commercial building was vacant for 90 consecutive days prior to a fire loss. What is true?
a. Coverage is suspended
b. The amount payable is reduced by 15%
c. $2500 coverage is available
d. 100% of completed value available
b. The amount payable is reduced by 15%
If a building is vacant for more than 60 consec days prior , what happens to the coverage if the cause of loss is any of the following: vandalism, sprinkler leakage, building glass breakage, water damage, theft or attempted theft? (2)
Coverage is suspended.
Any other loss, the amt payable is reduced by 15%
Inland Marine insurance provides coverage for which of the following?
a. Real estate
b. Building fixtures
c. Bridges
d. Stationary furniture
c. Bridges
Commercial vehicles under the FAJUA residual market may purchase which of the following coverages?
a. PIP, Liability and Med Pay
b. Liability, PIP and UM
c. Liability, UM and Med Pay
d. PIP and Med Pay
b. Liability, PIP and UM for veh under 10K lb
* *standard business auto and garage policies also available
What coverage is available under FAJUA for private passenger veh? (5)
- lx coverage up to 100/300/50
- PIP
- UMBI
- Med Pay up to 500, 1000 or 2000
- PD w/ded 250, 500 or 1K
Transaction of matters arising out of a contract of insurance is governed by Florida Statute \_\_\_\_\_\_? a. 624.02 b. 624.10 c. 624.155 d. 624.401
b. 624.10
A public adjuster may represent a claimant in all of the following matters, EXCEPT:
a. Workers’ compensation claim
b. Commercial Property claim
c. Homeowner’s claim
d. Flood damage claim
a. Workers’ compensation claim
An Auto Policy Physical Damage Coverage has a $500 deductible. The deductible
does not apply to:
a. Auto glass damage
b. Windshield glass damage
c. Damage caused by the negligence of the insured
d. Damage caused by a permissive driver
b. Windshield glass damage
A request for mediation of a personal injury claim applies to a claim with a value of ___ or less.
a. $5000
b. $10,000
c. $25,000
d. $50,000
b. $10,000
All of the following apply to public adjuster contracts, EXCEPT:
a. Must be in writing
b. Signed by the owner of the public adjuster firm
c. Show the public adjuster’s license number
d. Show the public adjuster’s home address and phone number
b. Signed by the owner of the public adjuster firm
A total loss vehicle has two liens on the title. The adjuster is required to:
a. Make payment to the owner
b. Make payment to the owner and both lien holders
c. Make payment to the owner and first lien holder
d. Make payment to the lien holders only
c. Make payment to the owner and first lien holder
An adjuster must pay or deny a property damage claim within___, unless there are factors beyond his control.
a. 90 days
b. 120 days
c. 180 days
d. One year
a. 90 days
Denying claims without ____ is a violation of Ethical Requirements.
a. Negotiation
b. Mediation
c. Arbitration
d. Investigation
d. Investigation
A public adjuster may be disciplined for all of the following, EXCEPT:
a. Violating Department rules
b. Receiving a contingency fee
c. Entering into a split fee arrangement with a non-public adjuster
d. Soliciting a vulnerable person
b. Receiving a contingency fee
An insurer is required to have a Certificate of Authority for which of the following:
a. Investigation of claims
b. Settlement of claims
c. Litigation of claims
d. Collection of new premiums
d. Collection of new premiums
The Citizens Insurance standard deductible for mobile home homeowners is:
a. $1000/2% hurricane
b. $500/2% hurricane
c. $1000/5% hurricane
d. $500/5% hurricane
b. $500/2% hurricane
All of the following are typical health insurance exclusions, EXCEPT:
a. Mental illness
b. Accidental injury
c. War
d. Childbirth
b. Accidental injury
Which is not an Aviation policy named peril?
a. Fire
b. Windstorm
c. Theft
d. Weight of ice and snow
d. Weight of ice and snow
A ship’s captain throws a portion of cargo overboard to save the ship in a storm. Losses from this voluntary sacrifice are settled under a Marine policy using:
a. Protection and Indemnity insurance
b. Liability coverage
c. The General Average clause
d. Freight coverage
c. The General Average clause
All of the following are examples of a bailment, EXCEPT a:
a. Personal Storage Unit
b. TV and Computer repair shop
c. Dry cleaner
d. Moving Warehouse
a. Personal Storage Unit
Which of the following may be covered by a Business Owners’ Policy?
a. Bars
b. Credit Unions
c. Amusement parks
d. Apartment houses
d. Apartment houses
All of the following are covered by Farm Livestock Coverage, EXCEPT:
a. Dogs
b. Horses
c. Cattle
d. Sheep
a. Dogs
A provision in a homeowners’ policy that pays additional costs required to rebuild a damaged structure so that it conforms to the latest building codes is known as:
a. Ordinance or Law
b. Additional Coverages
c. Coverage A
d. Replacement cost
a. Ordinance or Law
A Temporary Total Disability is compensated under Workers’ Compensation for a period not to exceed:
a. 52 weeks
b. 104 weeks
c. 156 weeks
d. Physician’s Recommendation
b. 104 weeks
When both an attorney and the surety are required to sign checks to disburse an estate’s funds, this is an example of:
a. Indemnification
b. Bonding
c. Joint Control
d. Collateral Disbursement
c. Joint Control
A ‘medical incident’ covered by Physician’s Professional Liability Insurance would not include:
a. Failure to treat
b. Misdiagnoses of medical condition
c. Assault of a patient
d. Leaving a sponge in a surgical patient
c. Assault of a patient
An Excess Liability policy that has the same terms and conditions as the underlying policy is an example of:
a. An Umbrella policy
b. A Follow Form policy
c. A Stand Alone policy
d. An Extra-Expense Liability policy
b. A Follow Form policy
Which of the following is NOT ‘mobile equipment’ in a Business Auto Policy?
a. Work Truck
b. Forklift
c. Bulldozer
d. Off Road Tractor
a. Work Truck
A driver convicted of driving under the influence must carry liability limits of at least:
a. 10/20/10
b. 25/50/25
c. 50/100/50
d. 100/300/50
d. 100/300/50
The right to sue when damaged by the practices of an insurance company is based upon the:
a. Unfair Trade Practices Act
b. Ethical Considerations
c. Florida Financial Responsibility Law
d. No Fault Law
a. Unfair Trade Practices Act
Auto liability insurance will pay damages to others for all of the following, EXCEPT:
a. Injuries caused while speeding
b. Injuries caused while driving drunk
c. Injuries caused while texting
d. Injuries caused by intentionally hitting someone
d. Injuries caused by intentionally hitting someone
An auto dealer allowed a customer to test drive a vehicle believing that the person was interested in buying the car. The customer tricked the dealer and stole the car. Which coverage would provide physical damage coverage if the car was damaged or wrecked by the thief?
a. Dealers Drive Away Collision
b. Garage Keepers Insurance
c. Collision
d. False Pretense
d. False Pretense
The coverage needed by a business to cover the loss of property surrendered as a result of a kidnapping threat of the insured is:
a. Extortion
b. Kidnapping
c. Crime Coverage
d. Ransom
a. Extortion
How are disability benefits figured? (2)
- based upon the “average weekly wage” of the employee at the time of injury.
- Payment is made based on the average of the prior 13 weeks of pay.
Permanent total disability is compensated at ___ ?
66 2/3% of the employee’s average weekly
wage without a limit of time.
Temporary total disability is compensated at ___ ?
66 2/3% of the employee’s average weekly
wage for a period not to exceed 104 weeks.
Permanent impairment benefits are compensated at ___ ?
rating schedule approved by the division of Worker’s Compensation.
Temporary partial disability is compensated at ___ ?
of up to 104 weeks of impaired earnings.
What is the timeline for WC death benefits? (2)
If death results within one year of an accident or, if it follows a continuous disability within 5 years after the accident
What are death benefits for WC compensated at?
- Actual funeral expenses, not exceeding $7500;
2. Benefits to dependent relatives up to a maximum of $150,000 for all claims combined
Define bailment
Temp placement of control over, or possession of personal property by one person (bailor) into the hands of another (bailee) for a designated purpose
In WC, how is eligible employment defined for govt employees, private employees and construction? (3)
- Government: any number
- Private: 4 or more
- Construction: 1 or more (incl sole prop)
In WC, what employee categories are excluded from coverage?
PFOCCDD) (7
- Domestic servants in private homes
- Small farms with 5 or less employees
- Professional athletes
- Sports officials for interschol or non prof amateur
- Court ordered labour
- State/cty prisoners working for private employ
- Employees covered by Defense Base Act
In WC, who are excluded from the definition of employee?
ICMTV) (5
- Independent contractor in non-construct trade
- Commission real-estate agent
- Certain musical and theatrical performer
- Certain trucking owner/operator
- Volunteers
How much is WC reduced if an employee was found to be under the influence?
25%
What does a computer fraud policy cover?
Pays for loss of or damage to money, securities, and other property resulting from use of a computer to fraudulently transport property from inside a bank or insd’s premises, to a person or place outside premises.
What is excluded in computer fraud coverage? (3)
- Theft of info
- Computer vandalism
- Inventory shortage
What special limit is available under computer fraud for loss of manuscripts, drawings, records, or cost of reconstructing?
$5000
