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| Section | Weight | Objectives |
|---|---|---|
| New York Insurance Law & Regulations | 25% | - NY Insurance Law Articles and DFS regulations - Unfair Claims Settlement Practices Act / Regulation 64 - Licensing requirements, eligibility, and examination rules - State-specific policy provisions and mandatory endorsements |
| Claims Investigation & Adjusting Procedures | 20% | - Claim intake, notice of loss, and initial investigation - Evidence gathering, coverage analysis, and policy interpretation - Settlement negotiation, reservation of rights, and denial procedures - Loss valuation, damage assessment, and estimating |
| Ethics & Professional Responsibility | 15% | - Fraud detection and reporting obligations - Fiduciary duty, conflict of interest, and confidentiality - Fair claims handling standards and professional conduct |
| Property & Casualty Coverages | 25% | - Dwelling and Homeowners policies - Commercial Property and Businessowners policies - General Liability and Commercial General Liability - Specialty lines — Inland Marine, Flood, Workers' Compensation, Crime - Automobile coverages — Personal and Commercial |
| Insurance Fundamentals & General Principles | 15% | - Insurance contract elements and legal structure - Risk management and insurable interest - Indemnity, subrogation, utmost good faith |
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NEW QUESTION # 104
Which of the following is an example of an unfair claim settlement practice?
Answer: A
Explanation:
The correct answer is A. New York Insurance Law §2601 identifies specified conduct as unfair claim settlement practices when performed without just cause with sufficient frequency to constitute a general business practice. One expressly identified practice is failing to attempt in good faith to effectuate prompt, fair, and equitable settlements of claims in which liability has become reasonably clear. Deliberately or unjustifiably delaying such a settlement therefore falls directly within the regulatory concept tested by this question.
Option C describes the opposite behavior. Insurers are expected to adopt and implement reasonable standards for prompt claim investigation and settlement. Failure to establish reasonable standards may itself support an unfair-practices finding.
Option D is likewise inconsistent with an unfair-practice answer because accurate disclosure of relevant coverage or settlement provisions promotes informed claim handling. Misrepresentation or improper withholding of material policy information, rather than appropriate disclosure, raises regulatory concerns.
Option B does not describe an unfair claim settlement practice on the facts given.
The official New York Series 17-70 blueprint specifically includes Claim Settlement Laws and Regulations- Regulation 64, Part 216, and Unfair Claim Practices-Insurance Law §2601 under Insurance Regulation.
Accordingly, the conduct in A is the regulatory violation contemplated by the question.
NEW QUESTION # 105
A policy that limits coverage to specific causes of loss is called
Answer: A
Explanation:
The correct answer is D - named perils. A named-perils policy provides coverage only when the direct physical loss is caused by a peril specifically identified in the contract. Typical named perils can include fire, lightning, windstorm, hail, explosion, smoke, vandalism, or other causes expressly listed in the applicable form. If the cause of loss is not among the listed covered perils, coverage generally does not apply unless another provision or endorsement extends protection.
This contrasts with an open-perils, sometimes historically called "all risk," form. An open-perils contract generally covers direct physical loss unless the cause is specifically excluded or limited. The burden of analyzing the loss therefore differs substantially between named-perils and open-perils structures.
Option A is incorrect because exclusions remove or restrict coverage rather than define a policy that affirmatively insures only specifically listed causes. Option B concerns loss valuation rather than the scope of insured perils. Option C describes the opposite coverage approach.
The official Series 17-70 outline specifically includes "Named perils versus special (open) perils," direct loss, consequential loss, policy structure, exclusions, and conditions as tested Insurance Basics concepts.
NEW QUESTION # 106
The final step of the claims process usually involves which of the following?
Answer: B
Explanation:
The correct answer is A. After coverage has been verified, the loss investigated, evidence gathered, damages measured, and applicable policy provisions applied, the claim normally advances to settlement and payment.
At this stage, the adjuster communicates the valuation and seeks resolution of the amount payable under the policy.
A contemporary claims-process description characterizes the final stage as arranging resolution: once damages and costs are established, the adjuster discusses settlement and arranges payment.
Option B is incorrect because a historical loss run is an underwriting or loss-history document, not a mandatory final step in settling an individual claim. Option C is also incorrect; insurers are subject to regulatory reporting requirements, but an adjuster does not ordinarily submit every final claim payment to the state insurance department as the concluding step of each claim. Option D occurs earlier. Reserves are established and modified throughout investigation as the expected claim cost becomes clearer.
The official Series 17-70 outline specifically identifies Claims Adjustment Procedures, Settlement Procedures, Negotiation, Releases, Advance Payments, Draft Authority, Appraisal, and Alternative Dispute Resolution.
Therefore, A accurately describes the normal final settlement phase.
NEW QUESTION # 107
The primary purpose of the Workers Compensation Special Disability Fund is to
Answer: D
Explanation:
The correct answer is A - encourage employers to hire workers with pre-existing disabilities. New York's Special Disability Fund, historically referred to as the Second Injury Fund, was designed to reduce the financial disincentive associated with employing workers who already had permanent physical impairments.
The New York Workers' Compensation Board explains that the fund assumed, in qualifying cases, part of the permanent disability liability resulting when a worker with a pre-existing disability sustained a subsequent employment injury. The Board expressly states that one purpose was to encourage employers to hire people with disabilities by protecting employers against disproportionate liability from a subsequent workplace injury.
Therefore, option A identifies the underlying policy objective. The fund was not created simply because an employee experienced two injuries, eliminating B. It does not provide ordinary benefits for injuries unrelated to employment, so C is incorrect. Option D inaccurately describes the fund as directly compensating employees for "second partial disability claims"; its principal mechanism was reimbursement or allocation of liability involving employers and insurers under qualifying statutory circumstances.
The Fund is now closed to new claims, although historical Section 15(8) matters continue to be administered.
The Series 17-70 outline nevertheless specifically tests the Special Disability Fund under WCL §15(8).
Therefore, A is correct.
NEW QUESTION # 108
Under a Businessowners Policy, Inside the Premises - Robbery or Safe Burglary of Money and Securities, this coverage applies to robbery of
Answer: C
Explanation:
The correct answer is C - a custodian that takes place within the premises. Crime coverage titled Inside the Premises - Robbery of a Custodian or Safe Burglary of Money and Securities is specifically structured to protect money and securities against robbery of a custodian while inside the insured premises, as well as qualifying safe or vault burglary.
Current ISO commercial-crime analysis states that coverage applies to loss of money and securities resulting from the robbery of a custodian inside the insured premises or from safe or vault burglary or attempted burglary. A custodian generally includes the named insured, partners, members, or employees having care and custody of the insured property, subject to the form's definition.
Options A and B are incorrect because they place the robbery off premises. Off-premises losses are addressed by different crime insuring agreements, such as Outside the Premises coverage. Option D is incorrect because the critical insured person for this particular robbery provision is a custodian, not simply any customer or client present at the business.
The adjuster must distinguish theft, robbery, burglary, safe burglary, and employee dishonesty because each has a particular contractual meaning and may trigger different coverage.
Therefore, the event specifically contemplated by this coverage is robbery of a custodian inside the premises, making C correct.
NEW QUESTION # 109
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