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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Medical Reports and Terminology | 4% | - Basic Human Anatomy
|
| Topic 2: Homeowners Policy | 10% | - Liability Coverages
|
| Topic 3: Adjusting Losses | 11% | - Claim Settlement
|
| Topic 4: Insurance Basics | 6% | - Insurance Contracts
|
| Topic 5: Insurance Regulation | 6% | - Licensing Requirements
|
| Topic 6: Commercial Package Policy | 38% | - Commercial Inland Marine
|
| Topic 7: Personal Inland Marine | 13% | - Personal Property Floater
|
| Topic 8: Accident and Health Insurance Basics | 6% | - Types of Coverage
|
| Topic 9: Dwelling Policy | 6% | - Exclusions, Conditions and Endorsements
|
>> NY-Independent-General-Adjuster Reliable Test Questions <<
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NEW QUESTION # 105
A travel accident policy and a dread-disease contract are examples of
Answer: A
Explanation:
The correct answer is D - limited health insurance policies. Limited health insurance is designed to provide benefits for a narrowly defined event, disease, service, or category of loss rather than the broad spectrum of expenses normally addressed by comprehensive medical coverage.
A travel accident policy provides narrowly focused accident protection associated with travel or specified transportation exposures. Similarly, a specified or dread-disease policy pays benefits only when the insured experiences a specifically designated condition, such as cancer or another condition listed in the contract.
Because their benefit triggers and covered losses are intentionally restricted, both fit the limited-policy classification.
The Series 17-70 examination outline makes this distinction directly. It includes Limited versus comprehensive coverage, "Limited policies," "limited benefits and amounts," and specifically identifies Accident-only and Specified (dread) disease policies among the tested forms.
Options A and B describe methods of organizing insured persons rather than the limited nature of the coverage. Option C, "personal health policies," is too broad and does not identify the essential characteristic being tested.
An adjuster must recognize that a limited policy does not provide general medical insurance merely because an insured experiences medical expenses. Benefits are payable only when the loss falls within the policy's narrowly stated coverage trigger.
Therefore, D is correct.
NEW QUESTION # 106
When investigating a liability claim against your insured, the insured calls you and requests that you deny the claim because the insured believes the claim lacks merit. As the adjuster you CANNOT
Answer: B
Explanation:
The correct answer is B. An independent adjuster's claim decision must be based on the policy, facts, evidence, applicable law, and authority received from the insurer, not merely on the insured's preference that a third-party claim be rejected. An insured's assertion that a claim is meritless is relevant information, but it does not substitute for an objective investigation.
New York Regulation 64 establishes prompt and fair claims-handling standards. DFS states that insurers should assist in claim processing, obtain verification where reasonably necessary, clearly communicate positions on disputed matters, and respond promptly to interested parties. DFS also identifies unfair claims settlement practices as prohibited conduct.
Accordingly, the adjuster may inform the insurer of the insured's position, making A permissible. The adjuster can also decline to follow an unsupported instruction to deny the claim, so C is permissible. Contacting the claimant to investigate the circumstances is an appropriate fact-development step, making D permissible.
What the adjuster cannot properly do is deny liability simply because the insured wants a denial. Such action would bypass the required investigation and professional evaluation.
The Series 17-70 outline specifically tests the adjuster's role, duties and responsibilities, claim investigation, liability-loss investigation procedures, verification, and settlement procedures.
NEW QUESTION # 107
An adjuster cannot contact the insured or claimant once they retain the services of
Answer: A
Explanation:
The correct answer is A - an attorney except with permission. Once an insured or claimant is represented by counsel regarding a particular claim or dispute, communications concerning that represented matter must respect the attorney-client relationship. New York's Rule of Professional Conduct 4.2 prohibits an attorney from communicating, or causing another person to communicate, about the subject of the representation with a person known to be represented by another lawyer unless prior consent is obtained from that lawyer or the communication is otherwise authorized by law.
For adjusters, this means claim communications involving a represented claimant should ordinarily be routed through the claimant's attorney when the representation encompasses the matter being adjusted. The purpose is to prevent interference with legal representation, inappropriate direct negotiation, or uncounseled disclosure concerning the claim.
Retention of an appraiser, physician, or private investigator does not automatically establish the same restriction. Those professionals may participate in valuation, treatment, or investigation, but they do not substitute for legal counsel.
The Series 17-70 outline expressly tests the role and responsibilities of the adjuster and the adjuster's relationship to the legal profession, making recognition of represented parties an important claims-handling principle.
Therefore, A is correct.
NEW QUESTION # 108
Long-term care policies cover expenses for care when the insured CANNOT perform all of the following activities of daily living EXCEPT
Answer: C
Explanation:
The correct answer is B - Shopping. Long-term care insurance commonly uses the insured's inability to perform specified Activities of Daily Living (ADLs) as a benefit eligibility trigger. New York DFS identifies the principal ADLs as dressing, eating, bathing, toileting, continence, and transferring. Most long-term care policies require inability to perform a specified number of these activities without substantial assistance before benefits become payable, subject to the contract's precise benefit trigger.
Bathing, option A, is a recognized ADL. Toileting, option C, is also a recognized ADL. Transferring, option D, refers generally to the ability to move into or out of a bed, chair, or similar position and is another standard ADL.
Shopping, by contrast, is generally classified as an Instrumental Activity of Daily Living (IADL). IADLs involve more complex activities necessary for independent community living, such as shopping, housekeeping, transportation, managing finances, meal preparation, and telephone use. New York health guidance similarly distinguishes shopping as an instrumental activity rather than a basic ADL.
Therefore, shopping is the activity that does not belong to the standard basic ADL group.
Series 17-70 reference topics: Other Coverages - Long-Term Care Insurance, Benefit Triggers, Activities of Daily Living, and Eligibility for Benefits.
NEW QUESTION # 109
Which of the following provides high-quality magnetic images of body areas without the use of ionizing radiation?
Answer: C
Explanation:
The correct answer is C - MRI. Magnetic Resonance Imaging (MRI) produces detailed images by using a powerful magnetic field, radiofrequency energy, and computer processing. Unlike conventional X-rays and computed tomography (CAT/CT), MRI does not use ionizing radiation.
The U.S. Food and Drug Administration confirms that MR images are created without ionizing radiation and notes that MRI provides especially strong soft-tissue contrast, allowing differentiation among structures such as muscle, fat, water-containing tissues, joints, the brain, and other organs.
CAT or CT scanning, option A, uses X-ray technology and therefore involves ionizing radiation.
Conventional X-rays, option D, obviously also rely on ionizing radiation. Ultrasound, option B, does not use ionizing radiation either; it uses high-frequency sound waves. However, the question specifically asks for high-quality magnetic images, which uniquely identifies MRI among the choices.
An adjuster handling accident, disability, health, or workers compensation claims must understand diagnostic terminology because medical imaging reports may establish the existence, severity, location, and causation of an alleged injury.
The Series 17-70 outline specifically tests Understanding the Language of Medical Reports, including medical terminology and abbreviations, basic anatomy, and common injuries and diseases.
NEW QUESTION # 110
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