TX ADJUSTER TEST QUESTIONS AND ANSWERS ALREADY PASSED

TX ADJUSTER TEST QUESTIONS AND ANSWERS ALREADY PASSED While investigating a claim, you determine that the loss was caused by a defective mechanism in the dishwasher. You would attempt to_________________________? ✔✔Su ...

TX ADJUSTER TEST QUESTIONS AND ANSWERS ALREADY PASSED While investigating a claim, you determine that the loss was caused by a defective mechanism in the dishwasher. You would attempt to_________________________? ✔✔Subrogate Subrogation is the right for an insurer to legally pursue a third party that caused an insurance loss to the insured. This is done as a means of recovering the amount of the claim paid by the insurance carrier to the insured for the loss. What is the process when an insurer and an insured have a dispute regarding the amount of damage? ✔✔Appraisal __________________________________________________is a significant misstatement in an application form. If a company had access to the correct information at the time of application, the company might not have agreed to accept the application. ✔✔Material Misrepresentation As an adjuster, you should base depreciation on these three factors? ✔✔Age, Condition and Life Expectancy An_________________ is a person hired by the property owner to settle the claim with insurance company on their behalf. ✔✔Umpire This type of policy provides coverage only for those perils that are listed in the policy? ✔✔HOA _________________________ are extra charges covered by homeowner's policies over and above the policyholder's customary living expenses. ✔✔Additional Living Expenses _______________________is an event that results in an insured loss/damages? ✔✔Occurrence What is value of your property, based on the current cost to replace it, minus depreciation? ✔✔Actual Cash Value Expenses that have already sustained and that have not yet been paid are known as ____________________________________. ✔✔Incurred Expenses ________________________________is the part of the written insurance policy that states all the policy's specific's, including the name of the policyholder, the type of property insured, the premiums, and the term limits for the coverage. ✔✔Declarations Page What is the failure to use that degree of care which an ordinary person of reasonable prudence would use under similar circumstances? ✔✔Negligence ______________________________is the amount of money dedicated to a general contractor's cost of doing a business and earning a profit. ✔✔Overhead and Profit ____________________________is a situation involving a person other than an insurer and the insured. ✔✔Third Party Loss What is the amount representing actual or potential liabilities kept by and insurer to cover debts to policyholder? ✔✔Reserves This loss involves only the insurer and the insured? ✔✔First Party Loss What is the responsibility to another for one's negligence? ✔✔Liability _____________________ is the size of a loss, the extent of damages. ✔✔Severity ___________________________ is the amount paid by an insured to an insurance company to obtain or maintain an insurance policy ✔✔Premium __________________________________is the cost associated with replacing property at the current market price. ✔✔Replacement Cost The period of a policy is in force, from the beginning or effective date to the expiration date is the ________________________________? ✔✔Policy Period The amount the insured must pay in a loss before any payment is due is known as the ____________________________________. ✔✔deductible A person who investigates and settles insurance claims is the ______________________? ✔✔Adjuster Mary Johnson has an HO-B policy. Her coverage A limit of liability is $250,000 and her coverage B limit is $125,000. Her policy has a 2% deductible. What is her deductible? ✔✔$5000.00 If your policyholder has a 1% deductible, this percentage would be taken from what coverage? ✔✔Coverage A The Homeowner's policy provides coverage's for Personal Property that is away from the residence premises. The total limit of liability for off premises losses is ______________________________? ✔✔10% of COV B When handing a homeowner's content claim, you should establish if the loss happened __________________________________________ to help determine the total limit of liability that will apply to the claim. ✔✔at the residence or elsewhere Your policyholder has a Homeowner's Policy with the following limits on it COV A limit is $158,000 COV B limit is $90,000 His home has a detached garage. His home and detached garage were completely destroyed in a fire loss. What is the maximum that he can receive for his detached garage? $15,800 MINUS A 1% DEDUCTIBLE= ✔✔$14,220 COV A limit is $85,000 COV B limit is $ 46,000Your policyholder lives in Houston, Texas. While on vacation in Detroit, Michigan someone steals the following items from his house in Houston. How much will you pay for this loss? Electronics $1,600, Clothing $850, Golf Clubs $1,500, Shoes $600, Luggage $400, ✔✔Total Loss is $4950.00 less 1% deductible OF $85,000 = $850.00 = $4100.00 COV A limit is $75,000 COV B limit is $36,000 Your policyholder lives in Houston, Texas. While on vacation in Detroit, Michigan someone steals the following items from his house in Houston. How much will you pay for this loss? Electronics $1,600, Clothing $850, Business Laptop $3000 ONLY PAYS $2500, Music CD's $500, Golf Clubs $1,500, Shoes $900 ✔✔Loss is $7850 is the total loss. 1% of COV A =$750.00 Amount to be paid is $7100.00 Name 3 things that are subject to "Special Limits of Liability" under the HO-B ✔✔1. Money or Bank Cards 2. Valuable Papers, deeds, stamps BULLIONS etc. 3. Jewelry Watches or furs Under a HO-B policy, the dwelling/structure is covered for what types of losses? ✔✔Coverage A Under a HO-B policy, the contents are covered under what Coverage? ✔✔Coverage B List the 12 named perils that contents are covered for under the HO-B? ✔✔1)Fire and Lightening, 2) Sudden and Accidental Damage from Smoke, 3) Windstorm , Hurricanes and Hail, 4)Explosion 5) Aircraft 6) Vandalism and Malicious Mischief 7) Riot and Civil Commotion 8) Collapse of a building, or part of a building 9) accidental discharge overflow of water or Steam form plumbing, heating, air conditioning, system or household appliance 10) Falling objects, 11) Freezing, 12) theft or attempted theft What is the maximum amount for coverage for a covered loss to a tree? ✔✔$250 Your policyholder sustained a theft loss. His roommate's personal laptop, plasma television and Sony stereo were all stolen. What are you going to tell him regarding his roommate's property? (Explain your answer and cite where you found it in the policy) ✔✔Not Covered Found on HOB PG 2 Under Property Under Section I Exclusions, what does Exclusions c. (3). Say? ✔✔personal property contained in a building unless direct force of wind or hail makes an opening in a roof or wall and rain, snow, sand or dust enters through this opening and causes the damage. Your aunt is caring for a 22 year old female. Is this 22 year old female an Insured under the HO-B policy? ✔✔NO. She is OVER 21. Your policyholder misplaced his watch somewhere in his house. The watch costs $800. How much are you going to pay him? ✔✔$0 not covered During the storm, your policyholder's dwelling sustained 12ft of flood water. He provides you with receipts for his Additional Living Expenses. The expenses are all reasonable. What do you tell the policyholder? ✔✔Floods are not covered During a recent windstorm, your policyholder's cloth awning sustains damage. The damage to the cloth awning is $400. How much can you pay for the cloth awning? ✔✔$0 not covered Found in SECTION 1 Exclusions C1 While working on a claim with an approved vendor, he invites you to the Cowboys game. What should you do? ✔✔Not GO!! When dealing with a customer, you should always behave_________________? ✔✔Professionally ________________________is critical to keep your Policy holder informed during the claims process. ✔✔Timely Follow Up While handling an auto claim, your policyholder seems confused about your coverage determination. At this time, what should you do? ✔✔Show them where it is in the policy. Why should you keep a chronological detailed log of all the activity on a claim? ✔✔To organize the claims so you know dates, times and facts for each claim. Full or partial denial of claims must be __________________________. ✔✔done in Writing Claim adjusting is what type of profession: ✔✔Customer Service When setting appointments, getting an agreed time should be a balance between what? ✔✔Adjuster Me and Insured You should always handle claims based on their _____________________________? ✔✔own Merits Your actions do matter, you should always be aware of how you are ✔✔Perceived! To what standard will FEMA repair a home to? ✔✔Safe, Secure and Sanitary What are the 4 sections of the Flood Policy? ✔✔Dwelling, Contents, Debris Removal and ICC (Increased Cost of Compliance) In order for a building to apply for Replacement Cost, it must be at least be insured for_______________________? ✔✔80% of the Replacement Cost What is the maximum amount of coverage you can get on a building under the Flood policy? ✔✔$250,000 What is the maximum amount a person can receive for Additional Living Expenses (ALE) under the Flood Policy? ✔✔$0 Stevens Jones has excess continuing education hours in a reporting period. Can he carry the hours over? ✔✔No True OR False?Licensees must obtain 40 hours of Continuing Education every 3 years? ✔✔False 30 Hours The Texas Department of Insurance specifically requires the adjuster applicants complete at least two hours of continuing education in: ✔✔a. Consumer Protection b. Adjuster Ethics Mike's license expires in two weeks. What should he do to renew his license? ✔✔Go online and renew. What are the types of adjusters licenses approved for insurance in Texas? ✔✔a. All Lines b. Property c. Property and Casualty d. Surety e. Workers Compensation Do you have to be a resident of Texas to obtain a Texas Adjuster's License? ✔✔NO The Texas Department of Insurance does not track completion of continuing educations hours, but you must ---------------------------- in the event you are _______________________________. ✔✔Complete and comply audited by TDI To qualify to become an adjuster in Texas, you must be at least _____________________ of age. ✔✔18 years In the event you do not complete the adjuster CE requirements, you will be fined __________________ per hour. ✔✔$50.00 True or False: As an adjuster, you have up to 48 hours to make reasonable contact with your insured? ✔✔False 24hours An insurance company can refuse to renew a policyholder under what circumstances? ✔✔If Homeowner has 3 or more non-weather related claims w/in a 3 year period. True OR False? Is it a violation of the Unfair Claim Settlement Practices Act to provide the policyholder with the pertinent information regarding their claim ✔✔False If you deny a claim you must? ✔✔Issue a full denial of the claim within 5 days. Promptly! Within 15 days after we receive written notice of your claim we must: ✔✔a. Acknowledge the Claim b. Begin the Investigation c. Request all items needed to evaluate the claim. Once you have accepted or rejected an insurance claim, you have_____________ to issue the payment or issue the written denial letter. ✔✔5 Days During the course of your investigation, you may request an additional 45 calendar days to complete your investigation under what circumstances? ✔✔?You need type of specialist to assist with the investigation. ie structural engineer True OR False? Failing to settle claims when liability is reasonably clear is an accepted claim handling practice? ✔✔False True OR False? As an adjuster, you should advise a claimant as to their legal rights. ✔✔False True OR False? As an adjuster, you should not contact a claimant represented by an attorney. ✔✔True True OR False? As an adjuster, you should advise a claimant against seeking legal advice. ✔✔False Jacob was participating in the company softball tournament. During the game, he twists his ankle trying to run to 3rd base. Is this covered under Texas Worker's Compensation? ✔✔NO . Donyalle disagrees with the coverage determination of her Worker's Compensation claim; can she hire an attorney and take the matter to court to get resolved? ✔✔YES Worker's Compensation benefits will pay under what circumstances? ✔✔a. if they 'are injured on the job b. have a work related injury or illness. You cannot receive Worker's Compensation benefits if: ✔✔a. You were intoxicated at-the time of the injury b. You injured yourself on purpose at while trying to injure- someone else c. You were injured by another person for personal reasons; d. You were injured by an act of God e. Your injury occurred during horseplay; or Your injury occurred while voluntarily participating in an off-work activity. You have the right to an initial choice of Doctor. The Doctor you choose must? ✔✔Be on the approved DRs. List kept by the Division of Worker's Comp You must tell your employer within _________________of the date you were injured. ✔✔30 Days An employer must report the injuries within ______________ of the injury. ✔✔8 days The process an insurance company uses to decide whether to accept or reject an application for a policy. ✔✔Underwriting Employee of the insurance company's claim department is__________________ ✔✔Staff Adjuster A company's best estimate of what it will pay for claims. The amount that represents actual potential liabilities kept by an insurer to cover debts to the policyholders. ✔✔Reserves Refers to an insured's history of losses (claims) with other companies, or the company they are currently with. A company will consider "loss history" when underwriting a new policy or considering a renewal of an existing policy. ✔✔Loss History Companies view "loss history" as an indication of an insured's propensity for a claim in the future. The insurance company ✔✔Insurer The party to an insurance arrangement whom the insurer agrees to indemnify for losses, provide benefits for, or render services to. ✔✔Insured A type of Homeowner's policy that provides coverage to Coverage A Structure for All Risks of Physical Loss, unless specifically excluded from Coverage B personal Property on a Named Peril basis. ✔✔HO-B A person hired by the insured to settle the claim with the insurance company on their behalf is? ✔✔Public Adjuster The amount paid by an insured to an insurance company to obtain or maintain an insurance policy. ✔✔Premium These are the specific causes of loss that are covered under the policy. ✔✔Perils Insured Against Notice required by insurance companies immediately after an accident or other loss. Part of the standard provisions defining a policyholder's responsibilities after a loss ✔✔Notice of Loss The party to whom money or insurance proceeds is to be paid in the event of loss, such as the lien holder on an automobile or the mortgagee on real property ✔✔Loss Payee A decision by an insurance company not to renew a policy ✔✔Non-Renewal The party to whom money or insurance proceeds is to be paid in the event of loss, such as the lien holder on an automobile or the mortgagee on real property ✔✔Material Misrepresentation The amount the insured must pay in a loss before any payment is due from the company ✔✔Deductible State-level requirement that insurance licensees periodically complete a minimum number of hours of insurance-related education in order to be eligible for license renewal ✔✔Continuing Education Requirement The act of lowering an item's value due to use or wear and tear. Depreciation is based on Age, Condition and Life Expectancy ✔✔Depreciation A type of Homeowner's policy that provides coverage to both Coverage A structure and Coverage B Personal Property on a Named Peril basis. ✔✔HO-A Fraud is any intentional lying or misrepresentation by the policyholders or claims adjusters in order to inflate a claims payment or receive a claims payment that would otherwise not be paid. ✔✔Fraud The date on which an insurance policy expires ✔✔Expiration Date An endorsement is a specific addition to a policy that alters the coverage and therefore the price of that policy. Endorsements can either add or remove specific types of coverage. ✔✔Endorsement Provision in an insurance policy that indicates what is denied coverage. Examples of Exclusions are: Wear and Tear, Rust, Rot, Contamination, and Mechanical Breakdown ✔✔Exclusion An event arising out of natural causes with no human intervention which could not have been prevented by reasonable care or foresight. Examples are floods, lightning, and earthquakes. ✔✔Act of God Physical injury to a person ✔✔Bodily Injury The value of your property based on the current cost to replace it minus depreciation ✔✔Actual Cash Value The term All-Risk Insurance" is used to mean insurance against loss of or damage to property arising from any cause except those that are specifically excluded? ✔✔All Risk Insurance Extra charges covered by homeowner's policies over and above the policyholder's customary living expenses due to damage by a covered peril that makes the home temporarily uninhabitable. ✔✔Additional Living Expenses An unforeseen, unintended event; something unexpected. ✔✔Accident