Insurance Licensing NY-Independent-General-Adjuster Dumps Full Questions - Exam Study Guide

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| Section | Weight | Objectives |
|---|
| Adjusting Losses | 11% | - Claim Settlement
- 1. Negotiation and Releases
- 2. Subrogation, Appraisal and Arbitration
- Claim Investigation
- 1. Evidence and Witness Statements
- 2. Claim Reporting and Documentation
- Property and Liability Losses
- 1. Estimates, Depreciation and Salvage
- 2. Coverage Verification and Loss Evaluation
- Role of the Adjuster
- 1. Independent, Staff and Public Adjusters
- 2. Duties and Responsibilities
|
| Insurance Basics | 6% | - Insurance Principles
- 1. Causes and Valuation of Loss
- 2. Insurable Interest and Indemnity
- 3. Hazards, Negligence and Liability
- Policy Structure
- 1. Limits, Deductibles and Other Insurance
- 2. Subrogation, Salvage and Loss Settlement
- 3. Declarations, Conditions and Exclusions
- Insurance Contracts
- 1. Elements and Characteristics
- 2. Representations, Warranties and Concealment
|
| Homeowners Policy | 10% | - Selected Endorsements
- 1. New York Special Provisions
- 2. Earthquake, Identity Fraud and Home Business
- Coverage Forms
- 1. HO-8
- 2. HO-2 through HO-6
- Perils, Exclusions and Conditions
- 1. Perils Insured Against
- 2. Exclusions and Conditions
- Property Coverages
- 1. Dwelling, Other Structures and Personal Property
- 2. Loss of Use and Additional Coverages
- Liability Coverages
- 1. Personal Liability
- 2. Medical Payments to Others
|
| Personal Inland Marine | 13% | - Personal Articles Floater
- 1. Scheduled Personal Property
- Personal Effects Floater
- 1. Coverage and Loss Settlement
- Personal Property Floater
- 1. Coverage and Eligible Property
|
| Accident and Health Insurance Basics | 6% | - Accident and Health Claims
- 1. Notice and Proof of Loss
- 2. Investigation and Payment of Claims
- Limited Policies
- 1. Hospital, Dental and Vision Coverage
- 2. Accident-Only and Specified Disease
- Types of Coverage
- 1. Accidental Injury and Sickness
- 2. Disability, Medical and Long-Term Care
|
| Insurance Regulation | 6% | - License Maintenance
- 1. Renewal and Changes
- 2. Assumed Names and Reporting
- Claim Settlement Regulations
- 1. Consumer Privacy
- 2. Unfair Claim Practices
- Licensing Requirements
- 1. Qualifications and Application
- 2. Bond and Fingerprinting
- Disciplinary Actions
- 1. Penalties and Cease and Desist Orders
- 2. Suspension and Revocation
|
| Commercial Package Policy | 38% | - Transportation Coverages
- 1. Common Carrier Legal Liability
- 2. Transit Coverage
- 3. Motor Truck Cargo
- Commercial Inland Marine
- 1. Accounts Receivable and Valuable Papers
- 2. Jewelers Block, Signs and Electronic Data Processing
- 3. Contractors Equipment and Installation Floaters
- 4. Marine Definition and Conditions
- Commercial Policy Components
- 1. Common Policy Conditions
- 2. Common Policy Declarations
|
| Medical Reports and Terminology | 4% | - Medical Terminology
- 1. Prefixes, Suffixes and Abbreviations
- 2. Medical Specialties
- Injuries, Diseases and Medical Tests
- 1. Diagnostic Tests
- 2. Common Injuries and Diseases
- Basic Human Anatomy
- 1. Cardiovascular and Abdominal Systems
- 2. Skeletal, Nervous and Respiratory Systems
|
| Dwelling Policy | 6% | - Exclusions, Conditions and Endorsements
- 1. New York and Selected Endorsements
- 2. General Exclusions and Conditions
- Coverage Forms and Perils
- 1. Covered Perils
- 2. Basic, Broad and Special Forms
- Property Coverages
- 1. Dwelling and Other Structures
- 2. Personal Property and Loss of Use
|
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Insurance Licensing NewYorkIndependent General Adjuster (Series 17-70) Sample Questions (Q46-Q51):
NEW QUESTION # 46
Which of the following factors is NOT used to determine if an injury qualifies for Workers' Compensation coverage?
- A. Circumstances of injury.
- B. Place of occurrence.
- C. Time of occurrence.
- D. Severity of injury.
Answer: D
Explanation:
The correct answer is D - Severity of injury. For an accidental injury to qualify under New York Workers' Compensation Law, the central coverage inquiry is whether the injury arose out of and occurred in the course of employment. The New York Workers' Compensation Board specifically explains that "in the course of employment" concerns whether an injury occurred at a time, place, and under circumstances related to employment.
Accordingly, the time of the accident, its location, and the circumstances surrounding the event are directly relevant to determining whether the necessary employment nexus exists. For example, an injury at the employer's premises while performing assigned work normally presents a much stronger employment connection than an injury sustained during an unrelated personal activity.
The severity of an injury is different. Severity may materially affect medical treatment, disability classification, duration of benefits, permanency, lost wages, and the amount ultimately payable. It does not, however, determine whether the injury initially arose out of and in the course of employment. Even a comparatively minor qualifying workplace injury can fall within Workers Compensation.
The Series 17-70 outline expressly tests employment covered, covered injuries, benefits provided, occupational disease, and New York Workers' Compensation Law.
Therefore, the factor not used to establish the employment relationship of the injury is D.
NEW QUESTION # 47
Charges for transporting a person injured in an aircraft accident by ambulance are covered under
- A. deductibles.
- B. fiduciary liability.
- C. premiums.
- D. medical payments.
Answer: D
Explanation:
The correct answer is A - medical payments. Aircraft Medical Payments coverage is designed to pay specified reasonable medical expenses resulting from bodily injury sustained in connection with a covered aircraft accident, generally without requiring a determination of legal liability.
Aviation insurance guidance specifically identifies ambulance expenses among the costs payable under Aircraft Medical Payments coverage. AOPA explains that aircraft medical-payments protection can pay expenses including ambulance, surgical, dental, professional nursing, and related medical costs for qualifying injuries involving the insured aircraft. Standard aircraft liability wording likewise describes Medical Payments coverage as including necessary medical, surgical, ambulance, hospital, professional nursing, and funeral services, subject to the stated policy terms and limits.
A deductible, option B, is an amount retained by the insured and therefore is not a coverage category paying transportation charges. Premiums, option C, are the consideration paid for insurance. Fiduciary liability, option D, addresses breaches of fiduciary duties and has no connection with emergency medical transportation following an aircraft accident.
Medical Payments should also be distinguished from Aircraft Bodily Injury Liability. Liability coverage depends upon legal responsibility, whereas medical-payments protection is generally intended to fund relatively immediate medical expenses without first establishing negligence.
Therefore, A is correct.
NEW QUESTION # 48
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
- A. deny the claim simply because of the insured's request.
- B. notify the insurer of the insured's request.
- C. contact the claimant to further explore the facts of the claim.
- D. refuse the insured's request.
Answer: A
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 # 49
Under the Businessowners Policy (BOP), business income loss coverage begins after a covered loss has occurred and continues for a MAXIMUM of
- A. 6 consecutive months.
- B. 12 consecutive months.
- C. 1 month.
- D. 3 consecutive months.
Answer: B
Explanation:
The correct answer is D - 12 consecutive months. Under the ISO Businessowners Coverage Form applicable to the form generation tested by this examination material, Business Income coverage pays the actual loss of Business Income sustained during the applicable period of restoration, subject to the contractual maximum of
12 consecutive months after the date of direct physical loss or damage. Policy schedules describing BP 00 03 likewise identify Business Income and Extra Expense as actual-loss-sustained coverage not exceeding 12 consecutive months.
Business Income protection is intended to place the insured, within policy limitations, in approximately the financial position it would have occupied had the covered interruption not occurred. It generally incorporates net income that would have been earned plus continuing normal operating expenses, subject to the particular form.
Options A, B, and C materially understate the maximum period prescribed by the BOP wording tested here.
They should not be confused with separate time restrictions that may apply to specific additional coverages, waiting periods, extended business income provisions, payroll limitations, or endorsements.
The Series 17-70 official outline assigns a specific section to the Businessowners (2010) Policy, including property coverage, additional coverages, causes of loss, exclusions, loss conditions, and definitions.
Therefore, the examination answer is D.
NEW QUESTION # 50
A broken bone is the same as a
- A. dislocation.
- B. strain.
- C. sprain.
- D. fracture.
Answer: D
Explanation:
The correct answer is A - fracture. A fracture is the medical term for a break in a bone. The break may be complete or partial and can be classified in numerous ways, including open versus closed, displaced versus nondisplaced, transverse, oblique, comminuted, stress, or other fracture patterns. MedlinePlus expressly identifies a fracture as a break in a bone and lists "broken bone" as an alternative description.
A dislocation differs because it involves bones being forced out of their normal relationship at a joint. A sprain involves ligaments, while a strain typically involves muscles or tendons. Although a serious traumatic event can produce more than one of these injuries simultaneously-for example, a fracture-dislocation-they remain medically distinct conditions.
For an independent general adjuster, accurate medical terminology is important when reviewing bodily injury claims. A diagnosis of fracture may affect emergency treatment, immobilization, surgery, rehabilitation, duration of disability, medical expenses, and the eventual evaluation of damages. The adjuster should therefore distinguish structural injury to bone from injuries involving joints, ligaments, muscles, and tendons.
Accordingly, the medical equivalent of a broken bone is a fracture, making A the only correct choice.
NEW QUESTION # 51
......
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