Claims Adjuster Test PDF

Terms Tuesday, October 22, 2024 4:31 PM Producers license -Individual, partnership or corporation is permitted to transact business and enter into contracts on behalf of an insurer Resident Producer license - any producer who resides within a given state or who retains a principal place of busin...

Terms Tuesday, October 22, 2024 4:31 PM Producers license -Individual, partnership or corporation is permitted to transact business and enter into contracts on behalf of an insurer Resident Producer license - any producer who resides within a given state or who retains a principal place of business in that state. Must complete a pre - licensing education, pass an exam and complete forms. Non resident licenses- issued to the parties looking to transact insurance business in states in which they do not reside. Usually only issued on a temp basis. Expiration of 180 days. Surplus lines broker- person or business that obtains or negotiates insurance coverage with insurance companies. Do not need a license. Must receiv e approval. Resident surplus lines broker- must hold property and casualty license for at least 2 years or 2 years of professional experience. Nonresident - must submit a letter of certification to the depart of insurance Producer Misconduct must be reported -will be subjected to disciplinary action -reported within 30 days. Contract- agreement between 2 or more pirates to exchange things of value or refrain from doing particular things. Not considered valid if it requires one of the parties to do something illegal. ▪ To be valid must have Mutual assent □ All involved parties must agree to all terms of the contract. Only exist when both understand all terms and can abide by them. To be valid the following must be met -Must have series intent -expressed clearly and in reasonably definite terms -must be communicated to the offeree Serious intent - assures the offeree the offeror is intending to enter into a binding agreement. Consideration - exchange of benefits o5r sacrifices by the parties. Must have a mutual exchange of gains or losses Legal detriment- sacrifice made by each party Forbearance -refraining from doing something which one has a legal right to do Waiver -intentional abandonment or delegation of a right Risk - Uncertainty of chance of loss occurring Pure - Loss or nothing -no chance of gain (insurable) Speculative - Lose or win (uninsurable) Hazard- factor that increases the chance of loss. Can be physical, moral, political or legal. Physical- Material derives from the use, conditions or occupancy of a property Moral- caused by the negligence or irresponsible behavior of the insurance party, lying on purpose Political -related to the passage of a law or ordinance Legal- regulatory environment within the insured party is operating. Morale - Carelessness Peril- specific cause of loss or damage (flood and earth movement always exclude) Economic loss- total estimated cost of repairing or replacing the property that has been damaged or lost. Indemnity- compensation for loss provided by a property and casualty liability insurance policy. Usually insurance company will seek to restore the position of the insured to where it was before the loss Insurable interest -a party will have interest when damage or loss to a specific property would cause financial loss for that party. Deductible -amount of a loss above which the insurance company will make payment. Direct loss- financial loss caused by the damage or destruction of a covered property or covered peril. Consequential or indirect loss- financial loss that is covered by some policies. To be covered a specific peril must be explicitly covered by the policy. Nam ed peril Special or open peril coverage -any peril not specifically excluded by the policy is covered Specific coverage single -a single type of property is covered at one location Blanket coverage -extends to more than one type of property in the same location, the same type of property in multiple locations or multiple t ypes of property in multiple locations. Valuation of a property loss is the basis on which the cost of loss if paid Actual cash value- the value of the loss is the cost of replacing the damaged or destroyed property with new property of similar value taking account of depreciation and obsolescence. Replacement cost- if deductions for depreciation or obsolescence are eliminated. Functional replacement cost - the expense that would be incurred in the process of restoring a commercial building to a functional condition. Salvage value - amount that the insurer could expect to receive fort the property it takes possession of after providing replacement or resto ration payment to the PH Market value- or actual cash value - amount the property could be bought or sold for at the present time. Claims Adjuster Test Page 1 Market value- or actual cash value - amount the property could be bought or sold for at the present time. Stated Value -a value often supplied by the property owner, that establishes the maximum amount that the insurance company is required to p ay out in the event of a loss. Agreed Value- Value specified in the contract for how much will be paid out in the event if a loss. It may exceed or be less than the marke t value. Value Policy- policy that requires an agreed value payout. Usually used when market value does not reflect their value to the owner or item s for a sufficient market does not exist. Loss Payee- party to whom insurance payments are made in the event of a loss. May or may not be property owner, Essentials of a Contract Legal contract between two parties One is insured and other is insurer Policy will always stipulate obligation and rights of both parties Legal Principles of Contract Agreement- one party makes an offer that is accepted by another party For contract to be legal-nature of policy must by legal. Can not be asked to do illegal things and insurer will not cover ciminal acts Consideration -exchange of values is stated. Insured -Premium and contained statement -promise to reimburse according to contract Competency-mental ability of either party to understand contract Concealment Failure to disclose information that could affect the policy. Insurer has the right to cancel policy Claim Reports 3 different types must be submitted Initial or first field report- preliminary summation of the evidence related to the claim. Should include any potentially pertinent info during the first as sessment Interim or status report- while claim is being processed this will be issued. Indicated the rage of possible outcomes Full formal report- final report contains the final verdict of the claim. Reservation of rights letter- formal warning to other parties that the letter writer plans to maintain their full rights with respect to a property and the refore that these rights should be respected. If an insurance company decides to investigate a claim a letter may be issued so the insure d party will be alerted of the possibility of a claim disruption. non -waiver agreement- formal statement that both parties agree not to waive certain rights with respect to their contract. Declaratory judgment action- indicates whether potential litigants have the legal standing to bring the charges planned. Parties will often ask for this i n advance of a more formal trial. Arbitration- the parties refer their dispute to a neutral third party or group. Mediation- a third party is called in to help the disputing parties come to an agreement Negotiation- least formal. The creation of a dialogue between the disputing parties with the aim of reaching a compromise or agreement Warranty - must be true. Used for auto and home insurance. Representation - Believed to be true. "statements" -used in life and health. True to the best of my knowledge Misrepresentation - the statement is not true. Doesn’t mean insured lied. Forgot, misspoke, didn’t understand the question. Mostly not intentiona l Material Misrepresentation -lied. And proven to be a lie. If insurer had known a different decision would have been made. Fraud - cheat or deceive. Concealment - withholding or hiding information Elements of a contract Agreement - offer and acceptance. Consideration - bring Value from both parties to each other. App plus premium - customer Promise to pay for losses - insurer Competent parties - old enough/ of sound mind. Legal Purpose - contract could Not go against the law Named peril - lists the perils insured against "if it aints named it aints covered" all even number homeowners are named peril ex. HO2 HO4 HO6 HO8 Open Peril - covered any peril that is not excluded "special" "comprehensive" all odd number homeowners are open peril ex HO3 HO5 Burglary - breaking in Robbery - threaten a person "rob was there" Theft - Act of stealing Vacant - No people no stuff/ lose coverage after 60 days Claims Adjuster Test Page 2 Unoccupied - no people has stuff "vacation" intend to return Types of liability Absolute - absolutely dangerous -swimming pool, animal Vicarious - parent is responsible for the child, employer responsible for employee "old English law" Strict - strictly products, company responsible for products it makes. Don’t agree on the claim payout Appraisal - property claims "me and my stuff" Arbitration - Casualty claims "others" Implied Authority - things that are assumed the agent will do without it being written down by the company Expressed authority - written in contracts. States what agent is allowed to do. Apparent Authority - "perceived" its what the customer believes that an agent can do things. Indemnity - restoring to the previous financial state. Replacement cost - replacement of the item/ property to the present value / todays price Actual cash value - Aleatory - unequal exchange, Adhesion- following the contract, stick to what you say. Take it or leave it Unilateral - one sided Aggregate - Policy Max Claims Adjuster Test Page 3 Dwellings Tuesday, October 22, 2024 4:32 PM Coverage A Relates to the dwellings. Cover all dwellings on the location described on the declarations page. As long as dwellings are used for residence purposes Applies to the structures attached to the dwellings. Applies to the materials and supplies found on or next to the described location. Provided that these are used to construct or repair the dwellings or related structures. Applies to any building or outdoor equipment used to service the dwellings, assuming is not covered elsewhere in the policy. Does not apply to land Coverage B Applies to other structures found on the described location, Specifically structures set apart from the location by defined space. Applies to structures connected to dwelling by utility line or fence. Does not apply to land, including the land on which the other structures are build. Does not apply to structures rented or held for rental to anyone who is not a tenant of the dwelling. Does not apply to structures that are used for farming, commercial operations or manufacturing. Applies to structures that house commercial, farming or manufacturing property as long as property does not include fuel tanks. Does not apply to gravesites or mausoleums Coverage C Relates to personal property. Covers the property of the insured that is within the dwelling or that is used by the insured or members of the insured while residing in the dwelling. Does not cover animals, including birds and fish, Does not cover motor vehicles including watercraft, aircraft or hovercraft. Does not cover any accounts, letters or credit, manuscripts, bank notes, bills, deeds, or currency. Does not cover gold, silver or platinum other then goldware, silverware or platinum ware Does not cover any data or records, regardless of computer or paper Does not cover credit cards or electronic funds transfer cards. Does not cover water or steam. Coverage D Related to the fair rental value. -the policy states that when losses to property in coverages a, b, or c make a location unfit for its normal use the fair rental value of the rentable portion of the swelling will be covered. Does not include any expenses that do not continue while the property is not being rented. Payments made under coverage D will only be made for the smaller amount of time required to repair or replace the damaged part of the rental property. Only applies for a max of 2 weeks if a civil authority forbids occupancy. Losses or expenses caused by the cancellation of a lease or agreement are not covered here Miscellaneous Coverages Insured parties are entitled to use up to 10% of the limit of liability under coverage a to pay for damages to other structures in coverage b. It will reduce coverage A limit of liability by the amount paid for the same loss. Will also include any reasonable expense for the removal of debris left over from a covered loss. Any ash, dust, or particles resulting from volcanic eruption. If an insured party is a tenant of the location they may use up to 10% of the coverage C limit of liability for covered losses to improvements, alterations and additions. Under Standard dwelling policy Will allow insured parties to use up to 10% of the limit pof liability under Coverage C for covered property anywhere in the world. Does not apply to servants or guests. Does give the insured party to use up to 20% of the limit under coverage C for losses of fair rental value. Each month that the location is unfit, will pay out a max of 1/12 of the 20% When covered property is damaged, will pay out any reasonable cost incurred as part of necessary measures to prevent further damages. Will cover property that is damaged while being removed from the premises because of an impending peril. Applies for a max of 5 days. Will pay up to $500 of the liability incurred when the fire department must come to protect or save the covered property. The Claims Adjuster Test Page 4 Will pay up to $500 of the liability incurred when the fire department must come to protect or save the covered property. The fire department service charge is additional insurance and not subject to deductible. Does not cover when property is within the city or district limits of the fire department. Provides insurance for physical losses that are caused by fire or lightning. Cover loss due to internal explosion. Does not cover broken water pipes, broken pressure relief devices or electric arcing. Internal explosion coverage does not apply to losses related to steam pipes or steam boilers when devices are owned or operated by the tenant. Must have extended coverage for windstorms or hail, riot or civil commotion, aircraft including spacecraft and self propelled missiles. Some losses caused by vehicles are covered but not when caused by vehicles to driveways or fences. Not covered if the vehicle is owned or operated by the insured or resident. Will cover damage caused by smoke including related to boilers or furnaces. Smoke caused by fireplaces or agriculture is not covered. Does cover loss due to volcanic eruption Does not cover caused by tremors or earthquakes, If extended coverage for vandalism or malicious mischief it is covered. Does not include damage to glass or safety glazing material Exclusions Ordinance or law. -excludes losses related to ordinances or laws that mandate or groven the construction, repair or removal of property. Excludes losses sustained by requirements cause a decrease in the value. Excludes losses that require insured to monitor, test, treat or neutralize pollutants. Earth movement or water- earthquake, landslide, mudslide, sinkholes. Excluded regardless if movement is caused by human, animal or natural forces. Only exception if earth movement is caused by fire or explosion. Water damage caused by flood, waves, tidal water or wind driven spray. Applies to any water that bakes up or overflows from sewers or drains or leak s through a driveway, building, sidewalk or other structures. Any loss that is sustained from fire or explosion is covered. Power failure, neglect or war- excludes power failure when failure takes place off of premises. Does not cover losses when the insured has not used all reasonable means to preserve property before, during or after a loss. Excluded for war or milita ry action. Accidental discharge of military weapons may be considered a warlike act. Nuclear hazard. Intentional loss, and governmental action - losses caused by nuclear hazard whether related to radiation or contamination is not covered. Any loss that is caused by an action taken by the insured on purpose. Losses caused by governmental action are not covered. Destruction or confuscation of covered property by gov agency or public authority. Exception is any action taken by the government during a fire to prevent further damages. Does not cover any loss to plants, trees, shrubs or lawns that is the result of gov action. Conditions Only applies to losses made within policy period The limit of liability for any loss will not exceed the applicable limit of liability or the interest of a person insured und er the policy at the time of loss. Will not provide coverage for parties who intentionally conceal or misrepresent material facts or engage in fraudulent conduc t or make false statements. Duties after loss Immediately after loss an insured must provide prompt notice either to the insurance company or agent. Responsible for avoiding any further damage. Main an accurate set or records for repair expenses. Insured party must cooperate with any investigation. Must compile an inventory of the property that has been damaged. Must be prepared to show the property, provide records and submit an examination. Obligated to send a signed and sworn proof of loss to the company within 60 days of a request. Loss settlement, loss to a pair and glass Settlement of loss- any losses to covered property will be settled at the actual cash value at the time of loss. No more value will be supplied than the amount is required to repair or replace the damaged property. If damage is done to a pair or set it is up to the company to decide whether to repair or replace the necessary part to resto re to its pre loss value or pay the difference between actual cash value both pre and post loss. Glass replacement- promises to render sufficient coverage so glass may be replaced with safety glazing material when required by law as long as the original glass breakage was caused by a covered peril. Appraisal Occurs when the insurance company and the insured disagree about the amount of loss. Either side is entitled to request an appraisal. Each side Must select an impartial and qualified appraiser within 20 days of the appraisal request. The 2 chosen appraisers will select an umpire. Claims Adjuster Test Page 5 The 2 chosen appraisers will select an umpire. Must submit their estimates of the loss. If estimates agree, that is the amount of the loss. If they disagree then the differ ences will be submitted to the umpire. Umpire will make an estimate and that will be the final loss value. No Benefits to bailees and cancellation Will not provide any coverage that provides benefit to a party that stores or transports property for a fee. IN the first 60 days insurance companies may cancel for any reason and must give 10 days notice. May be canceled upon the anniversary (renewal date) for sny reason but must gve 30 days notice. Any policy in effect for at least 60 days may be canceled if there is a change in risk. Companies have the right to not renew a policy. Must have written notice at least 30 days before expiration. Any change or waivers must be presented in writing to be considered valid. Upon a death insurance company will provide coverage to legal rep. Dwelling (landlords) Does not come with liability -landlord doesn’t need but tentent does. Does not come with contents -tenant needs to get Don’t require the policy holder to live at residence Insects and vermin are not covered unless hidden from view (DP2,3) EARTH QUAKE IS ALWAYS EXLUDED Tree Coverage $500 per tree only on DP2 and DP3. None on DP1 WHARVES -ECP (extended coverage perils) -Windstorms -Hail -aircraft -riot -Vec -explosion -Smoke VMM- Vandalism and Malicious Mischief DP1-Basic -Fire, Lightning and internal explosions. Can add ECP Can then add VMM (Must have ECP to add VMM) Actual Cash Value (used value) for the structure (walls and roof) NO TREE COVERAGE DP2-Broad - DP1 and added perils Has ECP and VMM BBBicegolf Burgherly, Bursting, weight of ice snow, glass, falling objects, collapse, freezing. Freezing is only covered if insured took steps to maintain heat. Tree coverage for up to $500 per tree NO THIEF DP3-Special -Open perils (unless excluded) Thief is covered Trees up to $500 pre tree Coverages A -Dwelling walls and roof of house, anything that is used to service the property. Materials or supplies that are next to house that will become part of the house. (A-Shaped like a house) Replacement cost B - Other Structures (shed) (B -Backyard) 10% of A C- D -loss of use E -Liability F -medpay Claims Adjuster Test Page 6 Claims Adjuster Test Page 7 Aviation Tuesday, October 22, 2024 4:32 PM Package policy that provides coverage against physical damage and legal liability for a complete aircraft. Does not cover personal property. Does cover frame, engine, controls, electronics and communication equipment. Required for certification by the Federal Aviation administration Include coverage for all damage, medical payments, bodily injury and property damage. Can cover passengers and all does extend when on the ground, in motion and in flight. Claims Adjuster Test Page 8 Bonds Tuesday, October 22, 2024 4:32 PM Surety Bonds Asserts that either a certain action will be performed or a third party will make a payment to the party injured by the failure to perform that action. Principal-Party promising to perform the action, will purchase the bond Obligee- Party that will be paid by the company should action not be performed. Obligor-Insurance company that makes the payment Bid-provides assurance that the purchasing contractor will obtain the performance and do the required work if awarded the contract. Performance- guarantees that the contract will perform the work according to the required specifications. Labor and material payment bond- guarantees that the contractor will pay for the labor and material costs as they occur. Supply bond- guarantees that the contractor will provide all required supplies, products and equipment. May require the contractor to install certain equipment Judicial bond- AKA Court Bond- may be either the fiduciary or litigation variety. Fiduciary-Obtained by the guardians, administrators or trustees of an estate to manage the property of some other party Litigation- assert that the principle in a trial will pay any appeal or court costs. License and Permit- license issues by govt agencies Claims Adjuster Test Page 9 Workers Comp Tuesday, October 22, 2024 4:32 PM Establish that employers have certain responsibilities with regard to their employees. Employers are obligated to provide a safe place to work and safe tools and equipment. Employers must provide reasonable warnings about any dangers that might exist. Policy -Information page followed by general introduction. 6 different parts General section -General agreement -indicates that the payment of the premium will guarantee the insurance. -Information page -will list the name and address of employer, type of business, will also have policy term info. Also list states in which the workers comp coverage will apply. - Liability coverage limits -100000 per accident for injuries -100000 per employee for disease with a 500000 annual aggregate limit for disease. -list job classifications and codes, estimated payrolls, estimated premiums and rates. Workers compensation law usually refers to the workers or workmen's compensation law and occupational disease law. Standard policies do not include any federal workers or workmen's compensation law, any occupational disease law or any law that provides non-occupational disability benefits. Part One Workers compensation insurance applies to bodily injury, including death, caused by accident or disease. The bodily injury must occur within the policy period. Bodily injury by disease may qualify if it is caused or exacerbated by the conditions of employment. Pays medical benefits, income benefits, death benefits and rehabilitation benefits. Will also pay reasonable expenses incurred by the PH at the request of the company during an investigation. Insurance companies are not obliged to compensate the ph for lost earnings. May guarantee reimbursement for litigation costs as well as interest on judgements required by law. Will noy pay more than its share of benefits and cost covered by this insurance. Employer is responsible for making payments in excess to the insurance. Subrogation clause- Gives insurance company the right to recover any payments it's made if a third party is found responsible for the workers injury. Statutory provisions- considered to apply automatically when they are the law of the relevant jurisdiction. -Notice of injury -given to the employer by the workers has the same legal effect as notice given to the insurer. -Insurer will not be relieved of its duties should the employer default, go bankrupt or become insolvent. -Insurer agrees to be directly and primarily liable to anyone entitled to benefits. -the insurer agrees to be bound by any decisions made against the employer under the law. -Policy will abide by the workers compensation law with respect to benefits payable by the insurance. -Assure the PH that any terms of the insurance policy that conflict with workers compensation law will be changed automatically to conform to that law. Part Two Details the damages that will be paid by the insurer. Will pay all sums legally owed by the employer as damages because of bodily injury to the employees. Claims Adjuster Test Page 10 Will pay all sums legally owed by the employer as damages because of bodily injury to the employees. Will pay for care and loss of services as well as any consequential bodily injury to a spouse, child, parent, brother, or sister of the employee who is injured. Assuming that injury can be proved to be a direct consequence of the injured employee. Exclusions Does not cover any liability assumed under a contract. Not cover any punitive or exemplary damages resulting from an employee who is working in violation of law. Will not cover any bodily injury to an employee who is employed in violation of law with actual knowledge. Does not cover the obligations imposed by the workers comp law. Does not cover any injury intentionally caused or exacerbated by the employer. Does not cover any bodily injury that occurs outside the US or canada. However does not apply to citizens or residents of the US or Canada who are temporarily elsewhere. Does not cover any damages arising out of coercion, criticism, demotion, evaluation, reassignment, discipline, defamation, harassment, humiliation, discrimination against or firing of any employees. Any damages related to personnel practices, policies, acts or omissions. Claims Adjuster Test Page 11 Farm Property Tuesday, October 22, 2024 4:32 PM Coverage A Dwellings Direct physical loss of or damage to covered property Cover each dwelling owned by the policyholder Cover ay structures attached to covered dwellings unless structure is attached by a utility line or fence. Cover any materials on the location that are meant to be used in the construction or repair of covered dwellings or structures Cover any building or outdoor equipment that is primarily used in the service of covered dwelling. Not covered by coverage A and special limits Does not apply to land water or plants. Some plants can be covered with extended coverage. Special limit for outdoor radio and television satellite dishes and antennas - $1000 per single event Loss conditions-valuation Loss settlement is determined by ration of the limit of insurance to the full replacement cost Full replacement cost will not consider excavations, footings, foundations, piers, or other support structures. Will not consider cost of underground drains, pipes, flues or wiring. When limit of insurance is at 80% of the full replacement cost. The awarded cost will be the smallest of the following. Applicable limit of insurance Amount actually spent to repair or replace The cost of replacing the damaged part with similar material Lower then 80% the loss will be the larger of the following Actual cash value of the structure Proportion of the repair or replacement cost Claims Adjuster Test Page 12 Auto Tuesday, October 22, 2024 4:32 PM Personal Auto Policy Who is insured - named insured, family member, extended to any person who is using a covered auto by the insured. Covered Auto- Any vechicle on the dec page. Any private passenger auto Pick up trucks Vans -only if they weigh less than 10000lbs and not used to transport materials unless used for farming. Part A -Liability (protects the other person) pays out to them Limits of liability -the max the insurer will pay (per accident) Max Bodily Injury per person/All bodily injury/max property damage Also includes prejudgement intersest the insurer is ordered to pay by a court. Insurance company reserves the right to settle or defend any claim or suit. -All costs incurred during defense will be paid IN ADDITION TO THE LIMITS -once limit is reached the responsibility to settle is finished. Supplementary Payments Falls under Part A Up tp $250 for bail bonds stemming from an accident. MADE IN ADDITION TO THE LIMITS. Insurer will also make supp payments for any premiums on appeal bonds or bonds to release attachments. Will pay interest that accrues after judgment. Pay$50 a day for loss of earnings due to hearings and trials. Exclusions -Part A Will not cover if done on purpose Will not cover property that is owned or being transported by insurer. Will not cover propety that is used by, rented to or in the care of the insured party besides propety damage to a private garage Will not cover a employee of the insurer Will not cover if it is a public conveyance. Will not cover insuer while they are employed, in a sale, repair, service, storage or parking vehicles that are mainly used on highways. Not cover any auto used for business Will not cover anything with fewer then 3 wheels. Out of state coverage If happens in a state with higher limits the insurer will pay up tp the higher specified limit. If it happens in a state that requires nonresidents to have insurance the insurer will pay that states required minimum. Part B- Medical Payments -for yourself and inside your car PER PERSON Claims Adjuster Test Page 13 Part B- Medical Payments -for yourself and inside your car PER PERSON Pay all reasonable expenses incurred for necessary and appropriate medical and funeral services. Limit these payment to expenses incurred within the 3 years following the accident. Also applies to insured and their family when they are pedestrians struck by an auto Exclustions -Part B Will not cover payments by accident with auto with fewer than 4 wheels. Will not cover auto used by a public conveyance Will not cover any auto being used on residence or premises. Will not cover employee Will not cover stolen car Not cover business purposes No war, nuclear or military actions. No radioactive contamination or radiation Limits of Part B On the Dec page Part C - Uninsured/underinsured -this is supplement to the person who hurt you and they don’t have enough Subtract what you received Arbitration of disputes -between the insured and the insurance company. When they don’t agree on damages or amount. Either can make a request. Must be made in writing. Each gets 2 arbitrations. If cannot settle and a 3rd is requested. The 3rd decision is made by a judge or a court. Each side is responsible for expenses incurred and the expenses of the 3rd arbitrators spilt. Part D - Damage to your auto (theft of personal property is never covered) Collision -you hit anything Other than collision / comprehensive -animal or mother nature/flood -anything out of your control Insurnace company promise to pay for any direct or accidental loss to an auto or non owned auto including replacement or repair of equipment. Transportation Expenses $30 a day up to $900 Accident - wait 24 hours before the money kicks in Theft - wait 48 hours Exclusions Not cover if auto is a public conveyance Not cover freezing, normal wear, mechanical failure, electrical problems, or road damage to tires. Not cover radioactive contamination, nuclear weapons, war, military action Not cover losses to radar detection equipment, custom furnishings, or decorations. Limits Actual cash value or stolen or damaged property or the amount to replace or repair (which is smaller) Max of $500 for damages to trailers that are not owned by insured Claims Adjuster Test Page 14 Non owned auto- any private passenger auto that is being operated by the named insured or a family member. It can not be owned by or used as regular use. Temporary Subsitute -insured will get coverage for any auto or trailer that it does not own but is being used in a short time framewhile the regualr cover auto is not being used due to breakdown, loss, repair, servicing or destruction. Benefits to Bailee, Other Recovery and Appraisal Coverage can not directly or indirectly benefit any carrier or other bailee for hire Insurance company will only pay its share of the loss when other sources of recovery are available to the insured If insurance company and insured do not agree to value either can request appraisal Boith side must select appraiser Appraisers will select an umpire Both will submit an estimate. If they dotn agree. Then it will go to umpire. Part E -Duties after loss Must notify the insurer immediately of the location, time, and circumstances of the accident or loss. Must provide all injured persons and witnesses. Must cooperate during investigation, defense, or settlement of any claims or suits. Must also give notices or legal papers associated ASAP. Must submit to physical exam at the expense of the insurance company if requested. Must authorize the insurance company to obtain any medical records Must notify police if in a hit and run situation Must take steps to prevent auto from further loss. Must permit the insurer to inspect and appraise the damaged property before it is fixed. Business Auto Have 2 kinds of dec page Monoline policy Package policy Dec page is Divided into 6 sections/items 1- General info about risk 2- Coverages, coverage symbols, limits, required premium 3- Schedule of the autos owned by the business 4- Schedule of autos that are hired or borrowed by the business 5- Schedule for non ownership liability 6- Schedule of gross receipts or mileage for lability for leasing rental or public auto Structure of a policy Divided into 5 sections 1 describes the covered autos 2 liability coverage 3 physical damage 4 business auto conditions 5 definitions Does not include for med pays or uninsured coverage (need endorsements) Covered Autos Symbols 1 - any auto 2 - autos that are owned by the business 3 - Owned Private passenger auto only Claims Adjuster Test Page 15  3 - Owned Private passenger auto only 4 -all owned autos besides private passenger autos 5 - all autos that are required to have no fault benefits in the state where they are garaged or licensed 6 - all owned that are subject to uninsured motorists law 7 - autos that are described in item 3 of the dec page and needs a special premium 8 - autos that are hired, leased, rented, or borrowed 9 - autos that are used in the business but are not owned, leased, hired, rented or borrowed Section 2 - Coverage Pay for any bodily injury or property damage caused by an accident Insurer promised to pay all amounts legally owed by the insured as pollution costs or expenses Who is insurer under section 2 Named insurer is considered an assured for any covered auto Any person who is using a covered auto with permission Anyone who hires or borrows is not covered An employee is not covered if the auto is owned by the employee or his household. Supplementary payments Pay for $250 bail bonds Pay for bonds to release attachments related to any suits Pay all reasonable expenses incurred by the insured party at the request of the insurer. Loss of earnings up to $100 a day All costs that are taxed against the insured. All interest Out of state coverage Promise to increase the limit of liability to meet minimum requirements of the state. Exclusions Not cover expected or intended damage Does not cover emplioyees (works comp does) Not cover any damage caused by handling of property before ot after it is in the auto Does not cover damage to work that has been completed ir abandoned Section 3 - Physical damage coverage (Actual cash value) Loss coverage Comprehensive coverage for losses to covered autos unless it’s a collision Will pay for specified causes Fire, lightning, explosion, theft, windstorm, hail, earthquake, floo, mischief, sinking, burning, collision. Towing and glass breakage Pay up to the limit for any towing and labor costs incurred when auto is disabled All labor must be preformed at the site of the breakdown Glass breakage caused by a bird, animal, missiles, or falling objects Coverage extension Theft - max pay of $30 a day up to $900 for transportation expenses caused by theft Section 4 - Conditions Loss conditions and general conditions Loss Conditions Appraisal of physical damage loss -if disagree either party can request an appraisal Duties after loss Tell insurer ASAP Claims Adjuster Test Page 16 Tell insurer ASAP Must provide Location and time, sequence of events, name and address, names and addresses of other injured and witnesses Do not pay any expense without the consent of the insurance company Must send any request, demand, notice, order, legal paper or summons Should cooperate with investiagtion Claims Adjuster Test Page 17 Commercial Tuesday, October 22, 2024 4:32 PM Commercial Business owner policy - eligibility -small to med businesses. (BOP) Commercial package policy - Policy structure common numbers, larger business. Can customize and add according to business needs. (CPP) Commercial General Liability (CGL) - Claims made vs occurrence Auto - Business auto- has auto Garage - business of auto Garage keeper- added to the garage Motor carrier - moving things inside trucks Claims Adjuster Test Page 18 Business Tuesday, October 22, 2024 4:32 PM Apartment and Office Associations Coverage Standard business owners policy -multi-peril policy for all small businesses in retail locations, offices, apartments, residences and condos. Does include selected processing and servicing risk protection Restrictions for apartment and residential condominium associations Buildings may not be more than six stories tall May not have more than 60 units. To be coerced an office condo may not exceed 6 stores or 100000 sq ft. Mercantile Service or Processing Occupancies Coverage Be no more than 25000 sq ft.. May include a separate storage building though only business personal property will be covered. In order to be eligible, may not have gross sales of more than 3 million at any one insured location. Ineligible for coverage under standard business owners policy Auto repair stations, bars and restaurants, contractors, businesses that include more than one manufacturing, processing or serving operation, household property, amusement parks, financial institutions, gas stations and wholesalers. Common Conditions for the Standard Business owners policy Similar to commercial package policy Many coverages are automatic. Business income and peak season coverage are automatic Covered buildings include any named in policy as well as any additions, fixtures or outdoor fixtures. Coverage also extends to personal property in apartments which the insured owns as well as any equipment that is required to maintain the property. Business personal property includes all the business property owned by the insured or all the property in the care of the named insured. Improvements made by tenants and leased personal property are also covered. Business Personal Property Coverage Includes the property owned by the named insured, property in custody or control of the insured, improvements made by tenants and leased property personal property. Only covers loss and damage caused by named perils. Covers loss caused by -fire and lightning -vandalism -sprinkler leakage -sinkholes -building collapse -volcanic action -damage that occurs while property is in transit. Does not cover loss of income. Conditions, limits, deductible, and additional coverage Does not require coinsurance Losses are settled at actual cash value. Expect in cases when the property was insured to at least 805 of its value, then the losses will be settled on a replacement cost Maximum coverage that is away from location is 1000 250/500/1000/2500 are deductibles that are available. Fire department service charge do not go towards deductible Claims Adjuster Test Page 19 Fire department service charge do not go towards deductible Coverage Extensions, Limited Perils and Exclusions Personal property at newly acquired premises may receive extended coverage up to 10000 Personal property located off of the named premises may receive extended coverage up to 1000 Outdoor property may receive extended coverages up 1000 Trees, plants, and shrubs may receive extended coverages up to 500 Signs, important papers and records are only eligible to 1000 Does not cover loss or damage caused by govt action, nuclear hazard, war or military, water and flood, power surge, damage to steam apparatus, delay due t strike, earth movement, or poor design, workmanship or materials, Claims Adjuster Test Page 20 Homeowners Tuesday, October 22, 2024 4:32 PM Standard Policy Section One Coverage A and Coverage B Coverage A -Applies to dwellings -Applies to any structures attached to the dwelling -Applies to any materials and supplies on or adjacent to the residence premises used to create, adjust, or repair the dwelling or other structures on premises. -Does not apply to land Coverage B -Applies to other structures located on premises and separated from the dwelling by a clear space. Structures connected to the dwelling by a fence or utility line Does not apply to other structures that are used for business or are rented to a person who is not a tenant of the dwelling. Limit of liability will not be greater than 10% of the limit of liability for coverage A The use of Coverage B does not reduce the limits of liability under Coverage A Coverage C Applies to personal property Cover any personal property that is used or owned by the insured party regardless of where it is located. Also cover at the request of the insured any personal property owned by others while it is on the premises, and any property owned by a guest of the residence owned by the insured. Any personal property that is usually located at an insured's residence but not the residence premises is subject to a smaller limit of liability -10% of the limit of liability for coverage C or 1000 which is greater. If an insured acquires a new residence, personal property is not subject to limitation for the first 30 days after property is moved. Special Limits of Coverage C These limits do not increase the overall Coverage C limit of liability. -200 limit on money, bank notes, gold other than goldware, silver other then silverware, platinum, coins and medals. -1000 limit on securities, accounts, deeds, letters of credit, notes other than bank notes, personal records, manuscripts, passports, stamps, and tickets. -1000 limit on watercraft, including related outboard engines, equipment, furnishings, motors, and trailers. -1000 limit on trailers not used with watercraft. -1000 on loss related to theft of jewelry, furs, watches and precious and semiprecious stones. -2000 limit for loss of firearms by theft. -2500 limit for loss by theft of silverware, pewterware and any silver/gold plated ware. -2500 limit on property located on the residence premises but used for business purposes. -250 limit on property located away from the residence premise and used for business. -1000 limit for electronic apparatus, antennas, tapes, discs and while in or on a motor vehicle. -1000 limit for loss to other electronics on premises if it used for business Property Not Covered under Coverage C Claims Adjuster Test Page 21 Property Not Covered under Coverage C Not cover any articles that are separately described and subject to specific coverage in the policy or any other insurances. Does not apply to animals, fish or birds. Does not apply to motor vehicles, vehicle equipment, vehicle accessories. Does not cover aircraft or related parts Does not cover property to boarders, roomers or other tenants. Not cover any property located in an apartment that is rented Does not cover business data Coverage D Pertains to the loss of use Limit of liability for coverage is the sum total of all the coverage that is subsequently described. When a loss covered makes the residence unfit for habitation the insurer promises to pay either additional living expenses or fair rental value. Fair rental value is the agreed upon rental price for the part of the residence that cannot be used. Premises rented to others Will provide fair rental value for a loss of use to any portion of the residence premises that is rented to others. Payment under coverage D will be made either for the residents to relocate or for the minimum amount of time necessary to repair or replace the damaged areas. Additional Coverages Debris removal- pay any reasonable expense for the removal of the debris of covered property if the loss was caused by a peril named on policy. Pay for removal of ash, dust or particles from a volcanic eruption. Reasonable repairs and trees shrubs and other plants Covered if loss is due to fire, lightning, explosion, riot, aircraft, vandalism and theft. Fire Department Service Charge and property removed Will pay up to 500 for any charges due to visit the fire department. Section II Coverage E Applies to personal liability If a claim or suit is brought against the insured because of bodily injury or property damage the insurance company will pay damages up to the limit of liability. Will also psy for the defenses of the insured party. But the legal rep will be selected by the insurer. Coverage F Refers to Medical payments to others Insurer will promise to cover any medical expenses that are incurred within 3 years of bodily injury. Does not apply to the insured or regular residents of the insured household unless they are employees. Exclusions Does not cover injury that is expected or intended Does not apply to injury or damage that's from insurance business activities. Does not apply to injury or damage arising out of the rental if any part of the property. Does not apply to injury or damage related to the provision of professional services. Does not apply to motor vehicles Does not apply to watercraft. Claims Adjuster Test Page 22 ○ HO1 Policy – Basic Coverage: This covers an owner-occupied standalone home against 10 named perils. ○ Rarely used insures at cash value. Only covered for its depreciated value. Does not cover belongings, other structures, personal liability loss of use or medical payments. ○ Fire or lightning ○ Windstorm or hail ○ Explosion ○ Aircraft ○ Riot or civil commotion ○ Smoke ○ Vehicles ○ Vandalism ○ Theft ○ Falling objects ○ ○ HO2 Policy – Broad Coverage: This can cover the home against 16 named perils. ○ Covers at replacement cost. And belongings for actual cash value Unlike HO1, the HO2 form covers other structures, belongings, personal liability, loss of use, and medical payments coverage. ○ Fire or lightning ○ Windstorm or hail ○ Explosion ○ Aircraft ○ Riot or civil commotion ○ Smoke ○ Vehicles ○ Vandalism ○ Theft ○ Falling objects ○ Weight of ice, snow, or sleet ○ Accidental discharge or overflow of water or stream ○ Freezing ○ Volcanic eruption ○ Sudden, accidental tearing apart, cracking, or burning or a built-in appliance such as a water heater or an oven ○ Sudden and accidental damage from a generated electrical current ○ HO3 Policy – Special Coverage: This is the most common Claims Adjuster Test Page 23 ○ HO3 Policy – Special Coverage: This is the most common type of homeowners insurance. It offers replacement cost coverage for the home and covers all perils except those the policy names as exclusions. ○ Ordinance or law ○ Earth movement ○ Backup of sewer or drain ○ Power failure ○ Neglect ○ War ○ Nuclear hazard ○ Intentional loss ○ Government action ○ Theft to a dwelling under construction ○ Vandalism from vacancy of 60 days or more ○ Mold, fungus, or rot ○ Wear and tear ○ Mechanical breakdown ○ Smog, rust, or corrosion ○ Smoke from industrial operations or agricultural smudging ○ Discharge, dispersal, or seepage of pollutants ○ Settling, shrinking, bulging, or expanding of structure such as foundation ○ Birds, vermin, rodents, insects ○ Animals owned by insured ○ ○ HO4 Policy – Contents Broad Coverage for Renters: This provides coverage for a renter’s belongings, personal liability, and loss of use. ○ Fire or lightning ○ Windstorm or hail ○ Explosion ○ Riot or civil commotion ○ Aircraft ○ Vehicles ○ Smoke ○ Vandalism ○ Theft ○ Volcanic eruption ○ Falling object ○ Weight of ice, snow, or sleet ○ Accidental water overflow or steam Sudden and accidental tearing apart, cracking, burning, or Claims Adjuster Test Page 24  ○ Sudden and accidental tearing apart, cracking, burning, or bulging of certain household systems ○ Freezing ○ Sudden and accidental damage from artificially generated electrical current ○ ○ HO5 Policy – Comprehensive Coverage: This protects the home and personal property for their replacement cost. It also covers all perils except those named as exclusions. ○ HO5s offers all-risk coverage for your home and belongings. Remember, HO3 defaults to named-perils coverage for belongings. ○ The HO-5 policy usually offers higher coverage limits for expensive belongings like electronics, jewelry, and furs. ○ ○ HO6 Policy – Condo Unit Owners Coverage: This policy protects the interior of a condo, belongings, loss of use, personal liability, and more. ○ HO7 Policy – Mobile Home Coverage: This is like an HO3 policy but for folks who have mobile or manufactured homes. ○ HO8 Policy: Modified Coverage: This policy insures older homes with replacement costs that outweigh their market value. It offers coverage for 10 named perils. An HO8 policy may be a good fit your home is: ○ Older, especially more than 40 years old. ○ A registered landmark. ○ An architecturally significant home. ○ Constructed of hard-to-replace materials. The HO8 covers the home for its actual cash value against 10 named perils like the HO1: Fire or lightning Windstorm or hail Explosion Aircraft Riot or civil commotion Smoke Vehicles Vandalism Theft Falling objects Unlike the HO1, it also covers other structures, belongings, loss of use, personal liability, and medical payments. Claims Adjuster Test Page 25 use, personal liability, and medical payments. ○ Homeowners Section 1 -Me and my stuff Coverage A - Dwelling (walls and roof) Coverage B - other structures (backyard) 10% of A Coverage C - contents (personal property -all the stuff) 1500 for jewelry 2500 for guns Coverage D - loss of use (no longer have the house) (fair rental value) (ex hotel if house burns down) Section 2 -Other people Coverage E -Liability - you are at fault (min 100k) Coverage F -Med pay Named perils - 2, 4, 6, 8 Open perils - 3, 5 For Houses HO2 -Broad -only what is named HO3 - Special -open peril for structure not contents. HO5 - Comprehensive -open for everything HO4- Rentals -Contents only - (4Rent) no A B Coverage -only cover named HO6 -Condo (upgrades) Building owner will pay for structure. HO6 will pay for upgrades HO8 - Modified (old house never updated) -market value is always less then rebuild, only cover up to 1000 from premise Fire Policy Covered Fire, Lightning, Removal Exclusions War, Neglect, Theft Perils Vs Coverage Peril-cause of loss (Cause of filing a claim) Coverage -Pay outs to fix the damage Claims Adjuster Test Page 26 Other Tuesday, October 22, 2024 4:37 PM Umbrella Policies and Exclusions Provide broad coverage in excess of underlying liability policies To be issued the insurance company must know the limit of the underlying policy. If the underlying policy is allowed to lapse it will require the insured to make payment equal to the policy limits of the lapsed policy before the payment of excess liability. May include coverage for some risks not covered by underlying policy. Exclusions are intentional acts, events caused by workers comp and events that occur while at work or in pursuit of business objectives. Umbrella Insurance It rides on top of the home/auto insurance. 1 mill limit. Covers what the home doesn’t once home/auto hits limit Known as Secondary / Excess Home and Auto - Primary / Underlying Excess lines- AKA Follow form - Follows the coverage of home/auto Umbrella - Stand Alone. Can cover outside of home / auto - Personal Injury. Labile and slander. Can cover overseas. Has a deductible for stand alone situations. Known as SIR (Self insured retention) Professional Liability Policies Specialty liability insurance policies for certain occupations. Cover loss due to negligence, error or omission during the performance of professional services. Exclusions-fraudulent, intentional, dishonest or criminal acts. Federal Crime Insurance Offers insurance against crimes like burglary and robbery. Offered by the federal government for places where private insurance refuses to offer coverage. Both businesses and homes may receive it. Possible to have insurance for employee theft, on a per loss and a per employee basis Claims Adjuster Test Page 27 Flood Wednesday, October 30, 2024 4:55 PM Flood Insurance -excluded on homeowners Gov run 2-2-2 2 walls and a roof and not all over water 2 or more acres of normally dry land OR 2 or more properties and one Is owned by you 30 day waiting period. Can be waived if refinancing a loan and it is required or if transferring to another. What is a flood Mudslide -yes Landslide- no Sewer -no Max coverage A-250k Requires 2 deductibles. One for coverage A (walls and roof) and coverage c (contents) National Flood Insurance Program Program was established by the federal emergency management agency Rate, eligibility and coverage established by the federal insurance administration. Offers a write your own policy option- companies can retain a specific portion of the premium for commission and service expense. If a business suffers any loss above the premium they will be reimbursed by the NFIP. To be eligible Must live in a participating community. Qualifying communities will receive a flood insurance rate map. General flood insurance Included a dwelling and a general property form. A special form is provided to cover condominiums and building associations. Perils covered under NFIP Flood, Overflow of inland or tidal waves, rapid accumulation or runoff of surface water, mudslide and mudflows and collapse of land along a shore. Does not cover property that extends over water. Emergency program Max Limits for buildings -35000 for single family homes -100000 for other residential and non residential buildings Contents of a building -Max 10000 for residential -100000 for nonresidential buildings. Deducible-750 Regular program Max for Residential -250000 Non residential -500000 Contents Residential-100000 Nonresidential-500000 Deductible-500 Claims Adjuster Test Page 28 Math Wednesday, October 30, 2024 4:58 PM Pro Rata (fair share) Ex question. Person has a building that is insurance for 100k with company A and 50k with company B. Building has a loss of 5000. how much would company a pay? Company A / company a + b x loss = claim payout for company A. The company that is paying needs to be on top and all companies on the bottom 100000 / 100000+50000 * 5000 = payout of company A (3,333) Co Insurance Loss Assessment When living in HOA or Condo -basically have rules to follow Cover the first $1000 example: Club house in community burns down. HOA will have a deductible. HOA will come to homeowners. Loss assessment will cover the dues HOA is looking for. As long as the peril is covered by your homeowners Claims Adjuster Test Page 29 Study Guide Tuesday, October 22, 2024 4:37 PM Basic Concepts to Review for Adjuster’s Test The adjuster’s test pulls a lot of material and questions from the early chapters and relies on your knowledge of insurance vocabulary. That being said, below is a list of material from the earlier sections that is almost guaranteed to be on your test, so make sure you review these items consistently and feel confident about them before test day. These terms would be great candidates for flash cards! Topics from early sections to review: Difference between Admitted and Non-Admitted states ○ Main difference is if the insurance company is licensed and backed by the state. Domestic vs foreign vs alien insurer Fair Credit Reporting Act Definitions of risk, peril, and hazard, and the nuance between the definitions Ways to manage risk and examples Definition of Principle of Indemnity The principle of indemnity is a fundamental principle of insurance that states that an insurance company will compensate an insured party for losses up to the amount of the loss, but no more. The goal is to put the insured back in the same financial position they were in before the loss Definition of insurable interest ○ Insurable interest -a party will have interest when damage or loss to a specific property would cause financial loss for that party. Types of insurance contracts and definitions: contract of adhesion vs aleatory vs conditional vs unilateral In insurance law, a "contract of adhesion" means the insured party must accept the terms of the policy as written with little room for negotiation, while an "aleatory" contract signifies that the outcome of the contract depends on an uncertain future event, a "conditional" contract requires specific conditions to be met before a claim can be made, and a "unilateral" contract means only the insurer is legally obligated to perform under the policy, with the insured only obligated to pay premiums; essentially, in an insurance contract, all four terms usually apply simultaneously Types of valuation: replacement value vs actual cash value (ACV) vs agreed value ○ Replacement Value: Pays the full cost to replace a damaged item with a new one. Does not consider depreciation. Usually results in a higher payout than ACV. ○ Actual Cash Value (ACV): Pays the current market value of an item, taking into account depreciation. Considered the most common valuation method in insurance. Claims Adjuster Test Page 30  Considered the most common valuation method in insurance. May result in a lower payout compared to replacement value. ○ Agreed Value: A fixed value agreed upon by the policyholder and insurer beforehand. Ensures the policyholder receives the full agreed value in case of a total loss. May result in higher premiums compared to ACV policies. Example: Scenario: Your 5-year-old television is damaged in a fire. Replacement Value: The insurance company would pay the cost of a brand new, similar television. ACV: The insurance company would pay the current market value of a 5-year-old television, taking into account depreciation. Agreed Value: If you had an agreed value policy, the insurance company would pay the pre-determined value you set for the television, regardless of its current market value. Know how Actual Cash Value (ACV) is calculated Standard policy structure/parts of a policy (use acronym “DICE” to remember) 1) Declarations 2) Insuring Agreements 3) Conditions 4)Exclusions 5) Endorsements. Definition of subrogation the act of one person or party standing in the place of another person or party. Types of damages and what they mean: special, general, and punitive ○ Special damages Also known as economic damages, these are quantifiable losses that can be directly tied to the injury. Examples include medical expenses, lost wages, and property damage. ○ General damages Along with special damages, these are considered compensatory damages, which are intended to compensate the victim for non-economic losses. ○ Punitive damages These are meant to punish the defendant for particularly egregious, malicious, or reckless behavior. Punitive damages are not awarded in every case Elements of negligence Types of negligence and definitions: contributory vs comparative The main difference between contributory negligence and comparative negligence is that contributory negligence prevents a plaintiff from collecting damages if they are at fault, while comparative negligence allows a plaintiff to collect damages even if they are at fault: Contributory negligence A legal doctrine that prevents a plaintiff from collecting damages if they are found to be partially at fault for an Claims Adjuster Test Page 31  A legal doctrine that prevents a plaintiff from collecting damages if they are found to be partially at fault for an accident. For example, not wearing a seat belt or safety equipment can be considered contributory negligence. Comparative negligence A system that allows a plaintiff to collect damages if they are partially at fault, but the amount of damages they receive is reduced by their degree of fault. For example, if a plaintiff is found to be 20% at fault for an accident, they would receive 80% of the damages they are owed. Some states use a hybrid system, where a plaintiff can only recover damages if they are found to be less than 50% at fault. There are also two types of comparative negligence standards: Pure comparative negligence: Allows a plaintiff to recover damages no matter their level of fault. Modified comparative negligence: Allows a plaintiff to recover damages only if their fault is less than a certain percentage. State laws vary, so it's important to consult a personal injury attorney to understand the rules and your rights. > Types of limits: per occurrence, per person, aggregate, split limits, combined single limit Per Occurrence: This limit defines the highest amount an insurance company will pay for all claims arising from a single event, regardless of how many people are injured or how much property is damaged. Per Person: This limit specifies the maximum amount an insurer will pay for injuries to a single individual involved in an accident. Aggregate Limit: This is the total maximum amount an insurance company will pay for all claims submitted during a policy period, usually a year. Split Limits: This type of policy separates liability coverage into distinct limits for bodily injury per person, bodily injury per accident, and property damage per accident, usually listed as three separate numbers on the policy. Combined Single Limit (CSL): This policy provides a single maximum payout for all bodily injury and property damage claims arising from an accident, without separate limits for each category. Claims Adjuster Test Page 32