Florida ACA Claims Licensing Exam Already Passed

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Florida ACA Claims Licensing Exam Already Passed Insurance ✔✔transfer of risk by contract to insurers who agree to indemnify insureds for losses Risk ✔✔chance of loss pure risk ✔✔only ... outcomes are loss or no loss personal risk ✔✔premature death, insufficient income, poor health, unemployment property risk ✔✔loss of real property or personal property (on the land not the land itself) Liability risk ✔✔something that results in loss to another (3rd party buyout) Controlling risk ✔✔risk management; minimal loss speculative risk ✔✔either profit or loss is possible (NOT insurable) indemnify ✔✔compensate for loss, damage, or injury; reimburse; repay Law of Large Numbers ✔✔must have a large pool of insureds to be able to predict losses so that the outcomes will reflect the probability of the results Direct loss ✔✔Results from the damage, destruction, or theft of property by a covered peril indirect loss ✔✔a financial loss that results from the occurrence of a direct physical damage or theft loss When can there be a pay out on liability risk ✔✔negligence is proven negligence ✔✔failure to use due care; otherwise known as the prudent person rule Strict or Absolute Liability ✔✔Liability assigned by statute without regard for negligence (set by the state or industry, no allowable defense) Indemnity Principle ✔✔one should be in approximately the same position after a loss as he was before the loss Insurer ✔✔A person or company that underwrites an insurance risk; the party in an insurance contract undertaking to pay compensation. Insured ✔✔one who is named or covered by insurance Insurable interest ✔✔must exist at the time of loss and usually means an economic or other interest in the event or in a particular property ex: bank loans or mortgage companies What is the measure of insurable interest ✔✔the extent to which the insured might be damnified by loss, injury, or impairment thereof Policy ✔✔a written document containing coverage, exclusions, conditions and endorsements Binder ✔✔can be oral or written and places the insurance "in effect" Requirements of a valid contract ✔✔consent of all parties (offer and acceptance), valuable consideration (monetary exchange), all parties must be of legal capacity (competent), and it must be for legal purposes to be enforceable Characteristics of an insurance contract ✔✔personal, conditional, contract of adhesion (gray area, will side on the behalf of the insured), principle of indemnity, aleatory (exchange is not equal), unilateral (payment for a promise) Domestic insurance company ✔✔A company that resides and is incorporated under the laws of the state in which it is operating Foreign Insurance Company ✔✔An insurance company that is incorporated outside the state where it is conducting business Alien Insurance Company ✔✔An insurance company incorporated outside the country Peril ✔✔something that causes a loss ex: Fire, lightening Hazard ✔✔something that increases the probability a loss will occur or increases the severity Physical hazard ✔✔A physical characteristic that may increase the likelihood of loss (wet floor, icy roads) Moral hazard ✔✔a conscious act that may cause a loss to occur (deliberate theft) Morale hazard ✔✔an unconscious act that may cause a loss to occur (out of your control) Proximate cause ✔✔if there is an unbroken chain of events from the occurrence and damage from that occurrence, all damage is a result of that occurrence (water damage from a fire) property insurance ✔✔A type of insurance that covers damage to property, such as a home. Liability/Casualty Insurance ✔✔Payable to a third party on behalf of the insured (bodily injury to another) assumption of risk ✔✔A defense against negligence that can be used when the plaintiff was aware of a danger and voluntarily assumed the risk of injury from that danger. Comparative Negligence ✔✔the apportioning of blame in an accident (both parties are at fault) actual cash value ✔✔current cost less depreciation replacement cost ✔✔current cost (no depreciation) valued policy ✔✔pays the face amount of insurance if a total loss occurs Florida Valued Policy Law applies to ✔✔total loss of a building, home or manufactured home based on insured value Coinsurance ✔✔the sharing of expenses by the policyholder and the insurance company ex: a homeowner fails to increase insurance policy after renovations, therefore the DID/Should model is applied and the insurance company only pays out partially on the loss specific insurance ✔✔When each property is named and specifically covered for a set amount blanket insurance ✔✔When a single amount of coverage applies to any loss of property or injury up to the single limit amount (one bucket for multiple properties) mortgage clause ✔✔establishes rights of mortgagee (lender) in the policy. Generally used in fixed property (real estate). Loss Payable Clause ✔✔Establishes rights of a lender having interest in personal property. Sometimes called loss payee clause Subrogation ✔✔when insured transfers right to his company to collect damages ex: collecting funds from an at fault driver's insurance company severability ✔✔Insurance applies separately to each insured as if other insureds did not exist. (usually applies to spouses) liberalization ✔✔used when a company increases benefits with no additional premium (new benefits extend to existing policy holders) warranty ✔✔a guarantee of fact representation ✔✔a material statement by applicant in an insurance situation misrepresentation ✔✔A false statement or lie that can render the contract void. primary coverage ✔✔must pay first Excess Coverage ✔✔Coverage, which applies only after limits of primary insurance have been exhausted. See Primary Insurance. Part A (personal auto policy) ✔✔liability coverage Part B (personal auto policy) ✔✔Medical Payments Coverage Part C (personal auto policy) ✔✔Uninsured/Underinsured Motorist Part D (personal auto policy) ✔✔Damage to your auto Part E (personal auto policy) ✔✔Duties after an accident or loss Part F (personal auto policy) ✔✔general provisions where are loss payees listed on a personal auto policy ✔✔declarations page owned vehicles ✔✔leased for six months or more occupying ✔✔in, upon, getting in, on, out, or off Personal auto eligibility ✔✔title must be to a person (not a corporation) must be under 10,000 pounds may not be used on a regular basis for delivery of goods and materials "Your covered auto" ✔✔Any vehicle in the declarations A newly acquired auto Trailer owned by the named insured Temporary substitute vehicle Florida No-Fault Law ✔✔All vehicle owners must have PIP coverage, provides limited immunity from tort action (torts may still be brought upon at fault persons in cases where damages exceed the PIP limit), verbal threshold for noneconomic claims such as pain and suffering Tort Thresholds for PIP (allows for economic damage lawsuits) ✔✔death significant and permanent scarring, disfigurement or loss of bodily function permanent injury Subject to No-fault law ✔✔owners of motor vehicles: title holders, debtor in possession, long term lessee, lease option purchase, non resident auto in FL over 90 days cumulative What constitutes a motor vehicle ✔✔four or more wheels, licensed and designed for highway use, includes trailer or semi trailers PIP percentages ✔✔Medical: 80% work loss: 60% Replacement services: 100% Death: $5,000 Calculating PIP coverage ✔✔apply deductible, apply percentage, look at policy limit PIP is always collected from ✔✔the insured's policy. exclusions under PIP ✔✔self-inflicted injury injury during a felony only works in insured vehicles PIP territory ✔✔In FL in any insured car outside FL in the policy holders car PIP coverage applies as ✔✔a per person per occurrence policy PIP is in excess to ✔✔Workers' Compensation payments. medical PIP coverage ✔✔basic: 80% Extended: up to $100,000 Additional: above $100,000 Loss PIP coverage ✔✔basic: 60% Extended: 80% Additional: 100% Replacement coverage ✔✔Basic: 100% Extended: Up to 100,000 Additional: above 100,000 Does PIP apply to those driving work vehicles ✔✔No, workers comp Does PIP extend to other people's children if they have their own PIP policy ✔✔no Does PIP extend to those passengers in a car without PIP insurance ex: Grandma ✔✔Yes Minimum requirement for liability insurance in FL ✔✔10/20/10 insurance Intent of the Florida Financial Responsibility law ✔✔to make owners and operators financially responsible for damage they cause others Triggers of FL financial responsibility law ✔✔accident involving bodily injury accident rendering vehicle inoperative serious traffic violations or DUI Penalties of FL financial responsibility law ✔✔suspension of drivers license and registration responsible for damages up to 10/20/10 SR-22 with DMV for 3 years DUI- 100/300/50 for 3 years (FR44) Governing body of the Florida financial responsibility law ✔✔DMV Named non-owner coverage ✔✔Provides coverage for the use of non-owned autos to individuals who do not own a car. Vicarious Liability ✔✔responsibility for the damage done by others Single Limit Liability ✔✔minimum florida limit is $30,000 Split Limit Liability ✔✔minimum in FL is 10/20/10 defense costs are paid ✔✔in excess of liability limits supplementary payments paid in excess of the liability payments ✔✔Bail bonds up to 250 Appeal bond premiums and bonds to release attachments Interest accruing after a judgement Loss of wages up to 200 per diem incurred at the request of the insurance company expenses incurred at the request of the insurance company exclusions to liability limit insurance ✔✔intentional acts property owned or transported workers comp non permissive users business parking or selling auto vehicles with less than 4 wheels vehicles owned by insured but not covered Med pay ✔✔responds regardless of fault or liability per person per occurrence covers occupants or pedestrians struck Primary in owned vehicles, excess in non owned exclusions of med pay ✔✔less than 4 wheels if in excess of PIP or workers comp non permissive users Owned by not insured Order of insurance pay outs in an auto accident ✔✔personal PIP, med pay of car owner, liability of at fault driver. Any excess can be paid by civil action or out of pocket uninsured motorist coverage ✔✔covers: at fault drivers Underinsured motorists at fault drivers insurance company is insolvent hit and run at fault driver's insurance denies coverage Methods of purchasing UM ✔✔bodily injury only in FL Single or split limit UM will be provided at the same limits as BI unless otherwise rejected IN WRITING Stacked or unstacked (will be stacked unless rejected in writing) Physical damage has two segments ✔✔comprehensive and collision comprehensive coverage ✔✔missiles, falling objects, explosions, earth quakes, fire, theft, vandalism, hitting an animal, glass breaking, flood, rising water, riot and civil commotion collision coverage ✔✔colliding with an object, upset or impact with another vehicle or object exclusions to physical damage policies ✔✔electronic equipment not permanently installed or exceeding 1,000 tapes, records, and CDS Camper bodies no designated in declarations awnings, cabanas, custom furnishings radar detection devices confiscations by governmental bodies Duties after an accident or loss ✔✔give prompt notice of claim cooperate with insurer provide police information and names of any witnesses Endorsements of a personal auto policy ✔✔PIP extended PIP Additional PIP extended non owned coverage named non own coverage towing and labor coverage for excluded equipment miscellaneous type vehicle joint ownership coverage increased limits transportation coverage Mechanical breakdown coverage ✔✔covers cost and labor for part to a limit may have rental reimbursement Policy term and territory (new car, 36,000 miles or 36 months; used car 12,000 miles or 12 months) [Show More]

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