15. ACA ADJUSTER PRACTICES. EXAM QUESTIONS

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15. ACA ADJUSTER PRACTICES. EXAM QUESTIONS

Qs and Ans Expert- Explanation

This Exam contains:

-Guarantee passing score -59 Questions and Answers -format set of multiple-choice -Expert- Explanation

Question 1: Investigation of Claims

Answer:

Analyze Coverage ~ insurance coverage available for property and liability claims Take formal reports or statements Photograph accident scenes or damages to property Diagram loss scene ~ liability or property Obtain official reports

• Police reports including traffic, criminal, or autopsies

• Medical reports - physician, hospital, emergency room, EMT or ambulance

• Fire Marshal Reports

• Reports of other agencies - such as: OSHA, Fraud divisions, other insurance companies

Obtain leases, association agreements, contracts or hold harmless agreements relevant to the claim Question 2: An adjuster received written notice from the Department of Financial Services regarding a claim. What length of time does he have to respond to the inquiry?A 10 calendar days B 14 calendar days C 21 calendar days D 30 calendar days

Answer:

C Question 3: Florida's Administrative Code contains a Code of Ethics for Adjuster - which of the following is FALSE?A An adjuster shall not provide favored treatment to any claimant B An adjuster shall not advise a claimant to refrain from seeking legal advice C An adjuster shall put the duty for fair and honest treatment of the claimant above the adjuster's own interests D An Adjuster owes fair and prompt treatment to their own company's policyholders only

Answer:

D

Question 4: RELIEF

Answer:

usually means compensation, or payment. It can also mean restitution (or to be made whole), or it can take the form of property vs. money.Question 5: Contract terms relating to bad faith:

Answer:

• Insurer must make contract terms clear and precise (contract of adhesion)

• Any ambiguity or uncertainty will be resolved in favor of policyholder and against the insurer

• Words in a policy are interpreted in the plain meaning of a layperson

• Insurance contracts will be interpreted by reasonable expectations of the insured

• Exclusions must be clear and unambiguous
• Policy must be read as a whole and each clause will lend meaning to other clauses in the policy

• Agent's duty to advise policyholder on sufficiency of coverage
• Generally, duty does not include advising policyholder of sufficiency

Question 6: Which of the following is NOT one of the duties of the Department of Financial Services?A License adjusters B Set rates and write policies for various company products C Supervise the claims activity of adjusters D Investigate charges of unethical conduct of adjusters

Answer:

B Question 7: The Responsibilities of an Adjuster: Fiduciary responsibility

Answer:

• Fiduciary Duty - The adjuster, or claim professional, has a fiduciary duty, or responsibility, to the

employer or client, and owes an extremely high degree of fidelity, loyalty and good faith to the interests of the employer/client.

• As a fiduciary, the claim professional should never allow self-interest to influence the representation of

a company's or client's best interests.-The claims professional should not profit, or seek to profit, from an outside source as a consequence of acting for or on behalf of the company or client.-The claim professional serves in the capacity of an agent of the company or client. The adjuster's actions become the actions of the company.

Fiduciary responsibility of adjuster:

• Duty of loyalty to principal

• Be loyal to insurer and not withhold information pertinent to a claim ~ full disclosure to principal
• Express & implied authority ~ what the public thinks an adjuster has authority to do (perceived &

)

• Not profit from an outside source on a claim

• Properly account for all monies
• Not act in a manner to cause the company embarrassment or result in defamation, libel or slander

Question 8: All of the following are part of the conditions imposed upon the insured in the event

of a loss, EXCEPT:

A Insured should inventory property.B Insured should protect damaged property to prevent further damage.C Insured should negotiate on behalf of the company for 3rd party claimants.D Insured should allow inspection of damages by the insurance company.

Answer:

C

Question 9: DIFFERENCE BETWEEN LIABILITY AND COVERAGE

Answer:

Liability-a legal doctrine Coverage-a contr obligation

Question 10: Accredited claims adjuster

Answer:

CLAIMS ADJUSTING PRACTICES

-Investigation,

• Evaluation,

-Process of Settlement, =Negotiation

ISSUES IN THE PROCESS OF RESOLVING CLAIMS:

Timeframes, -Goals, Responsibilities, -Statutes & Code of Ethics

CLAIMS ADJUSTING TERMS

SAMPLE FORMS IN THE COMMUNICATION PROCESS

NEGOTIATION & COMMUNICATION Question 11: The Claims Adjuster's role in the insurance industry includes all the following

EXCEPT:

A Facilitating payment of legitimate claims B Replies to communication on a claim within 14 calendar days C Replies to Department of Insurance inquires on a claim within 21 calendar days D Gives appropriate legal advice and writes binding contracts

Answer:

D Question 12: The adjuster has a particular relationship to his principal, the insurer. Which of the following best describes this relationship?AIt is a fiduciary relationship.BIt is a functional relationship.CIt is a final relationship.DIt is a festering relationship.

Answer:

A

Question 13: DANGEROUS INSTRUMENTALITY DOCTRINE -

Answer:

tort law - anyone who maintains a dangerous instrumentality is strictly liable for any injury or damage - in Florida, autos are dangerous instrumentalities - strict liability is not imposed on auto owners - however, owner is liable for torts of anyone using the auto with the insured's permission.