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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Property & Casualty Coverages | 25% | - Specialty lines — Inland Marine, Flood, Workers' Compensation, Crime - Dwelling and Homeowners policies - General Liability and Commercial General Liability - Commercial Property and Businessowners policies - Automobile coverages — Personal and Commercial |
| Topic 2: Claims Investigation & Adjusting Procedures | 20% | - Settlement negotiation, reservation of rights, and denial procedures - Evidence gathering, coverage analysis, and policy interpretation - Claim intake, notice of loss, and initial investigation - Loss valuation, damage assessment, and estimating |
| Topic 3: Insurance Fundamentals & General Principles | 15% | - Risk management and insurable interest - Insurance contract elements and legal structure - Indemnity, subrogation, utmost good faith |
| Topic 4: Ethics & Professional Responsibility | 15% | - Fraud detection and reporting obligations - Fiduciary duty, conflict of interest, and confidentiality - Fair claims handling standards and professional conduct |
| Topic 5: 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 |
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質問 # 88
A broken bone is the same as a
正解：C
解説：
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.
質問 # 89
A travel accident policy and a dread-disease contract are examples of
正解：D
解説：
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.
質問 # 90
The final step of the claims process usually involves which of the following?
正解：D
解説：
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.
質問 # 91
Which of the following is an exclusion on the Businessowners Policy (BOP) under the liability section?
正解：D
解説：
The correct answer is A - Liquor liability. The Businessowners liability section includes a Liquor Liability exclusion addressing bodily injury or property damage for which an insured may be held liable because of causing or contributing to intoxication, furnishing alcoholic beverages to underage or intoxicated persons, or violating laws concerning the sale, gift, distribution, or use of alcoholic beverages.
Under the standard BOP formulation, the exclusion principally applies when the named insured is engaged in the business of manufacturing, distributing, selling, serving, or furnishing alcoholic beverages. Thus, it should not be interpreted as eliminating every alcohol-related incident for every BOP insured. Host-liquor situations may remain covered when the insured is not engaged in the liquor business, subject to the actual form.
Options B, C, and D identify important liability exposures ordinarily included within the BOP's liability framework. Products and completed operations liability is part of the business liability protection, while personal and advertising injury is a separate liability coverage component subject to its own exclusions.
The Series 17-70 examination outline expressly requires knowledge of the Businessowners Liability Coverage Form-Coverages and Exclusions. It also separately identifies Liquor Liability as a specialty liability subject.
Therefore, among the listed choices, Liquor Liability is the correct exclusion.
質問 # 92
Under the Businessowners Policy (BOP), business income loss coverage begins after a covered loss has occurred and continues for a MAXIMUM of
正解：C
解説：
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.
質問 # 93
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