Florida Claims Adjuster Exam Review

Key Insurance Terms

• Peril: An event that causes a loss.
• Hazard: An element that increases the likelihood of a loss occurring.
• Warranty: A guarantee related to policy information, either from the insured's application or inserted by the insurer.
• Misrepresentation: An incorrect statement by the insured in the insurance application not included in the policy.
• Concealment: Failure by the insured to disclose significant facts when applying for insurance.
• Abandonment: Policy clause preventing the insured from discarding damaged property to claim full value.
• Severability: Each insured is treated independently under the policy.
• Proximate Cause: Most significant factor causing loss in a first-party property insurance context, crucial in liability disputes.
• Direct Loss: Physical damage to tangible property.
• Indirect Loss: Economic consequences resulting from direct loss.

Valuation and Coverage Concepts

• Actual Cash Value (ACV): Calculated as Replacement Cost minus Depreciation.
• Coinsurance: Percentage of a claim that must be paid by the insured after the deductible, can reduce premium costs.
• Conditional Contract: A contract enforceable only after certain conditions are met.
• Contract of Indemnity: Principle ensuring the insured is restored to their pre-loss financial condition.
• Insurable Interest: The requirement for a person to have a legitimate interest in the insurance being provided.
• Waiver: Relinquishing a known right or claim, can be explicit (express waiver) or inferred from actions (implied waiver).

Claims Handling and Adjusters

• Claims Adjuster: Individual responsible for investigating and negotiating claims.
• Public Adjuster: Represents policyholders in claims negotiations.
• Independent Adjuster: Self-employed adjuster not affiliated with insurers or bureaus.
• Fee Adjusters: Paid by the insurer for services rendered, representing multiple clients.

Policy Information

• Policy Period: Coverage applies only for incidents occurring during the specified time frame.
• Policy Territory: Limits coverage to specified geographic areas.
• Other Insurance: Principle to prevent duplicate claims for the same loss.
• Cancellation: Insured can cancel without notice; insurers must give notice before canceling.

Special Insurance Conditions

• Comprehensive Coverage: Covers all losses except for collision, generally subject to a standard deductible.
• Employee Theft: Coverage for losses due to theft by employees.
• Building Ordinance Coverage: Protection against costs due to law enforcement requiring demolition of undamaged structure portions.

Legal Framework

• Florida Unfair Insurance Trade Practices Act: Addresses misconduct in insurance dealings, including timely claim responses and proper handling procedures.
• Financial Responsibility Law: Mandates coverage requirements and penalties for non-compliance, including property damage liability.
• No-Fault Law: Limits legal liability for bodily injuries under specific conditions, ensuring claims are settled via Personal Injury Protection (PIP).

Miscellaneous

• SR-22: A form confirming the insured's responsibility for future accidents, primarily for non-owners.
• Estoppel: Prevents a party from denying facts that another party relied on to their detriment.
• Apportionment: Divides a claim's loss across multiple insurance contracts.

Claims Process

• Investigation: Assessing coverage and liability, verifying damage qualifications for claims.
• Evaluation: Determining fair compensation based on contract and laws.
• Negotiation: Arriving at quality settlements based on investigative findings.### Owner Liabilities
• Owners forfeited immunities from legal liabilities granted under compliance.
• Owners are personally accountable for paying Personal Injury Protection (PIP) benefits.
• Driver's license and vehicle registration of the owner may face suspension under the Financial Responsibility Law.

Extended PIP

• Medical benefits increase from 80% to 100% under Extended PIP.
• Income loss benefits rise from 60% to 80%.
• Coverage is limited to named insured individuals and their family members.

Additional PIP

• Additional PIP raises the initial $10,000 limit by specified amounts like $10,000, $25,000, $40,000, or $90,000, contingent on premium increase.
• Increases do not alter the $5,000 death benefit.
• Coverage applies to the insured and their family members only.

Personal Auto Policy

• Personal Auto Policy is designed to insure individual and family automobile exposures.

Business Auto Policy

• Business Auto Policy provides coverage for the automobile exposures related to businesses.

Types of Autos Covered Under Business Auto Policy

• Private Passenger Type Autos include station wagons, jeeps, pickups, panel trucks, vans, and utility trailers.
• Public Autos encompass buses and taxicabs.
• Commercial Autos cover truck tractors, semi-trailers, commercial trailers, and service trailers.
• Special Vehicles include cherry pickers and air compressors.

Garage Coverage Form

• Garage Coverage Form is utilized to insure businesses involved in selling, servicing, repairing, parking, or storing automobiles.

Truckers Coverage Form

• Truckers Coverage Form is designed for businesses contracted to transport goods for third parties.

Business Auto Coverage Form

• Business Auto Coverage Form insures automobile exposures for all businesses excluding garage or trucking operations.

Commercial General Liability Contract

• Includes key components like Declarations, common policy conditions, and one of two coverage forms: Occurrence or Claims-Made.
• Contains a Nuclear Energy Liability Exclusion endorsement.
• Additional endorsements may be attached to either extend or limit the coverage offered.

Declarations

• Declarations section specifies the named insured, address, policy period, premium, and limits of coverage applicable.