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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Claims Investigation & Adjusting Procedures | 20% | - Claim intake, notice of loss, and initial investigation - Evidence gathering, coverage analysis, and policy interpretation - Loss valuation, damage assessment, and estimating - Settlement negotiation, reservation of rights, and denial procedures |
| Topic 2: Ethics & Professional Responsibility | 15% | - Fraud detection and reporting obligations - Fair claims handling standards and professional conduct - Fiduciary duty, conflict of interest, and confidentiality |
| Topic 3: Insurance Fundamentals & General Principles | 15% | - Indemnity, subrogation, utmost good faith - Risk management and insurable interest - Insurance contract elements and legal structure |
| Topic 4: New York Insurance Law & Regulations | 25% | - Unfair Claims Settlement Practices Act / Regulation 64 - Licensing requirements, eligibility, and examination rules - NY Insurance Law Articles and DFS regulations - State-specific policy provisions and mandatory endorsements |
| Topic 5: Property & Casualty Coverages | 25% | - Specialty lines — Inland Marine, Flood, Workers' Compensation, Crime - General Liability and Commercial General Liability - Automobile coverages — Personal and Commercial - Dwelling and Homeowners policies - Commercial Property and Businessowners policies |
>> NY-Independent-General-Adjuster試験問題 <<
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質問 # 64
Which of the following is the medical abbreviation for getting something done immediately?
正解：B
解説：
The correct answer is B - Stat. The medical abbreviation "stat" derives from the Latin statim, meaning immediately. In medical documentation and treatment instructions, a stat order indicates that the specified procedure, medication, diagnostic test, or other clinical action should be performed without ordinary scheduling delay because prompt action is required.
Option A, A and P, does not mean immediately. Depending on context, similar abbreviations may refer to anatomy and physiology or another clinical designation. Option C, Rx, commonly refers to a prescription, prescribed treatment, or therapy and does not establish urgency. Option D, DNR, means Do Not Resuscitate and identifies an instruction concerning cardiopulmonary resuscitation rather than the timing of treatment.
Medical terminology is relevant to accident and health claim adjustment because adjusters must accurately interpret medical records, physician reports, treatment documentation, hospital bills, diagnostic information, and indications of emergency care. A misunderstanding of basic medical terminology can materially affect evaluation of causation, necessity of treatment, disability periods, and damages.
Accordingly, where a medical record directs that an action be performed immediately, "stat" is the recognized term.
Series 17-70 reference topics: Other Coverages - Accident and Health Claims, Medical Terminology, Medical Documentation, and Evaluation of Treatment Records.
質問 # 65
Which of the following is covered by the Causes of Loss - Special Form under commercial property?
正解：A
解説：
The correct answer is D - Windstorm. The Commercial Property Causes of Loss - Special Form is written on an open-perils basis. Instead of providing coverage only for specifically named perils, it defines covered causes of loss broadly as risks of direct physical loss unless the cause is expressly excluded or limited.
Windstorm is not generally excluded by the standard Special Form and is therefore ordinarily covered. By contrast, the form expressly excludes smog and includes broad water exclusions encompassing flood, surface water, waves, tides, and mudslide or mudflow. The actual ISO-derived Special Form wording identifies those exclusions directly. New York case law applying the Special Form likewise recognizes flood and mudslide
/mudflow within the standard water exclusion.
This illustrates the key distinction between Basic, Broad, and Special Causes of Loss forms. With a named- peril form, the insured generally begins by demonstrating that a listed peril caused the damage. With Special Form coverage, direct physical loss is presumptively within the broad coverage grant unless an exclusion or limitation applies.
An adjuster must therefore examine the causal mechanism and then determine whether a Special Form exclusion applies.
Among the four choices, Windstorm is the covered cause of loss.
Therefore, D is correct.
質問 # 66
At the insurer's request, an insured must assist the insurer in
正解：C
解説：
The correct answer is A. Liability insurance policies impose an assistance and cooperation condition on the insured. Under the traditional policy wording, the insured must cooperate with the insurer and, when requested, assist in the conduct of suits and in enforcing rights of contribution or indemnity against persons or organizations that may be liable to the insured for the covered injury or damage. Courts reproducing standard liability-policy language confirm this contractual obligation.
Option B conflicts with another fundamental liability-policy condition: an insured generally may not voluntarily make payments, assume obligations, or incur expenses without the insurer's consent, except for specifically permitted expenses such as immediate first aid under applicable forms. Unauthorized voluntary payments can prejudice the insurer's contractual control of the claim.
Option C is imprecise. Although an insured can be required to assist the insurer in making settlements, the insurer normally controls settlement negotiations within the authority granted by the liability contract. The question asks for the specific duty expressed in standard cooperation language, making A the precise choice.
Paying legal bills, option D, is likewise not the insured's cooperation obligation where covered defense costs are contractually borne by the insurer.
The Series 17-70 outline expressly includes duties after loss, subrogation, third-party provisions, settlement procedures, and subrogation procedures.
質問 # 67
The liability section of a businessowners policy (BOP) covers which of the following?
正解：D
質問 # 68
The self-insured portion of an insurance claim is called a
正解：D
解説：
The correct answer is D - deductible. A deductible is the amount of an otherwise covered loss that the insured agrees to retain before or as part of the insurer's claim payment. In practical terms, it represents a form of self-insurance or risk retention within the policy.
New York Department of Financial Services defines an automobile physical-damage deductible as an amount the insured agrees to be responsible for in the event of a covered collision or comprehensive loss. DFS also explains that increasing the deductible generally shifts a larger portion of potential loss to the insured and can reduce the insurance premium.
For example, if a covered property loss is $8,000 and the policy contains a $1,000 deductible, the insurer ordinarily pays $7,000, assuming no other limitation applies. The insured absorbs the first $1,000.
Coinsurance is different. It is an insurance-to-value mechanism that can reduce recovery when the insured fails to maintain the required amount of insurance. A principal is a party or amount concept used in other financial or surety contexts. Liability describes legal responsibility and is not the portion of a loss retained by the insured.
The Series 17-70 outline specifically tests deductibles, loss valuation, policy limits, coinsurance, and claim settlement calculations.
Therefore, D is correct.
質問 # 69
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