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University of Georgia
(Risk Management and Insurance Program)
State Insurance Claims Adjusters Certification
Georgia Claims Adjuster Exam
Course Title and Number: Claims Adjuster Exam Exam Title: Board Exam Exam Date: Exam 2024- 2025 Instructor: [Insert Instructor’s Name] Student Name: [Insert Student’s Name] Student ID: [Insert Student ID]
Examination
180 minutes Instructions:
**1. Read each question carefully.
- Answer all questions.
- Use the provided answer sheet to mark your responses.
- Ensure all answers are final before submitting the exam.
- Please answer each question below and click Submit when you have** **completed the Exam.
- This test has a time limit, The test will save and submit automatically** **when the time expires
- This is Exam which will assess your knowledge on the course Learning** Resources.
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State Insurance Claims Adjusters Certification 2024- Georgia G.A Claims Adjuster- Insurance Rules and Regulations Exam Review Questions and Answers | 100% Pass Guaranteed | Graded A+ | Read All Instructions Carefully and Answer All the Questions Correctly Good Luck: - In Georgia, an individual has ________________ to file a lawsuit for libel. - =Answer>> 1 year Resident Georgia insurance adjusters who have been licensed for less than 20 years are required to complete ____ hours of continuing education every ____ year(s). - =Answer>> 24 hours, 2 years Georgia Emergency Management Authority (GEMA) - =Answer>> In the event of a Georgia Emergency Management Authority (GEMA) declared disaster, insurers must send by electronic file a list of the non-licensed staff adjusters and out of state adjusters who will be working on disaster related claims. The insurer will then receive a permit allowing the temporary adjusters to work in the state for a maximum of 60 days. In the case of a non-GEMA declared disaster, adjusters licensed in another state can work in Georgia up to 60 days if they notify the Commissioner prior to arriving in the state. They should send their name, address, and anticipated date Need Writing 🤔Help? We've Got You Covered! ✍️ 100% NO A I or Plagiarism Guaranteed🤔
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- Once license has been refused or revoked, the person is ineligible to apply again for 5 years Third Party Administrators (TPAs) - =Answer>> Although many outside the insurance industry are unaware, insurers commonly outsource a large percentage of their claims adjusting and processing to Third Party Administrators, or TPAs. For example... Because of the huge overflow of claims during Hurricane Katrina, insurers outsourced tens of thousands of overflow claims to TPA's who specialize in handling hurricane claims. It is important to note, however, that a TPA does not assume any of the risk for the policies they handle. Rather, the insurer always retains all risk. Any business entity acting as a TPA must be licensed, and the license must be renewed annually. Failure to acquire the necessary license is grounds for fines and penalties. Elements of a TPA application: - =Answer>> The state of Georgia takes the licensure of Third Party Administrators very seriously. In order to become licensed in Georgia, a TPA must pay a fee and submit an application, along with several other documents. These include, among other things, the company's Articles of Incorporation; its by-laws; a description of the applicant's business plan; a list of the current officers and directors Need Writing 🤔Help? We've Got You Covered! ✍️ 100% NO A I or Plagiarism Guaranteed🤔
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with relevant information for each; financial statements from the past two calendar years; a $100,000 surety bond; and a $100,000 errors and omissions insurance policy. Both the bond and the insurance policy must be maintained the entire time the TPA license is in place and for an entire year after the TPA license expires. This in-depth application process ensures that only competent TPAs are licensed, since TPAs are often responsible for important aspects of the insurance business. For example, they can collect premiums, adjust and settle claims, handle claims funds, underwrite policies, and pre- certify or pre-authorize hospitalizations on behalf of the insurer. Commissioner can refuse, suspend, or revoke a TPAs license for the following reasons: - =Answer>> The Commissioner reserves the right to refuse, suspend, or revoke the license of a Third Party Administrator for certain unfair or illegal practices. Some acts that can lead to disciplinary action include: violating any state insurance provisions; misrepresenting or concealing facts in an application; obtaining or attempting to obtain a license by fraud; misappropriating or illegally withholding money belonging to an insurer, insured, or beneficiary; committing fraudulent or dishonest insurance practices; misrepresenting the terms and conditions of insurance policies; violating any order, rule, or regulation of the Commissioner; not carrying on business in good faith as an administrator; failing to maintain an adequate net Need Writing 🤔Help? We've Got You Covered! ✍️ 100% NO A I or Plagiarism Guaranteed🤔
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The Insurance Information & Privacy Protection Act (IIPPA) - =Answer>> One of the model laws proposed by the National Association of Insurance Commissioners in 1980, and adopted by most states. Unlike the Fair Credit Reporting Act, which focuses on regulating financial institutions, this act deals specifically with how insurance companies collect, use, and share personal information about their policy holders. IIPPA requires that the insurer provide a statement to the policyholder that explains how they will treat personal information. This statement tells the consumer how his personal information will be safeguarded. The notice also explains how information could be shared and gives the consumer the opportunity to prevent certain information from being shared. IIPPA requires that insurers tell consumers why insurance coverage was declined or why insurance claims were denied. It also mandates that an insurer must give reasonable notice for policy renewal and that it notify clients of other policy changes it implements. Health Insurance Portability and Accountability Act (HIPAA) - =Answer>> The Health Insurance Portability and Accountability Act, or HIPAA, was enacted by the U.S. Congress in 1996. HIPAA deals mainly with the portability of health insurance. Need Writing 🤔Help? We've Got You Covered! ✍️ 100% NO A I or Plagiarism Guaranteed🤔
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Statutes of Limitations in Georgia include: - =Answer>> - Personal injury: 2 years
- Trespassing: 4 years
- Fraud: 2 years
- Medical malpractice: 2 years
- Defamation of character (libel): 1 year Discovery Rule - =Answer>> In the state of Georgia, many statutes of limitations are based on when an injury is discovered, or when it reasonably should have been discovered. This is called the discovery rule. In some cases, however, this rule does not apply. For example, in the case of Medical Malpractice, the statute of limitations is 2 years after the date of the alleged act, omission, or neglect, except that a minor under 5 years old has until the minor's 7th birthday to file. The statute of limitations for:
- Personal injury: 2 years with the discovery rule
- Product liability: 2 years with the discovery rule or 1 year from date of death
- Fraud: starts when the fraud is discovered Medical Malpractice: Statute of limitations: usually 2 years after the date of the alleged act Exceptions: Need Writing 🤔Help? We've Got You Covered! ✍️ 100% NO A I or Plagiarism Guaranteed🤔
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On the flip side, if James were to sue Gil for his injuries and property damage, James' damages would be reduced by 20%, since he was 20% responsible for the accident. Rules for Cancellation & Nonrenewal: - =Answer>> - Insurers must give policyholders 30 days notice
- For non-payment of premiums: 10 days notice
- Policies in effect for less than 60 days: 10 days notice
- Notification must be delivered in person or by first class mail
- If sending by mail, insurer must keep receipt Insurers must refund unearned premiums to the policyholder in the case of cancellation: - =Answer>> In the case of a cancellation, any unearned premium that the insured has paid will be refunded on a pro rata basis. The insurer must return this unearned premium on or before the cancellation date either directly to the named insured or to the insured's agent. (If it goes to the insured's agent, then the agent must return the unearned premium to the insured within 10 days or on the date of cancellation, whichever is later.) If an insurer fails to return the unearned premiums, it must pay the insured a penalty equal to 25% of the unearned premium, plus interest of 18% per year until the unearned premiums have been returned. The maximum amount of penalty and interest cannot be more than 50% of the amount of refund due. Need Writing 🤔Help? We've Got You Covered! ✍️ 100% NO A I or Plagiarism Guaranteed🤔
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There are some exceptions to this. The insurer is exempt from this requirement if the cancellation results from the insured's failure to pay premiums; or if the policy specifies a different way of calculating penalties that has been approved by the commissioner. Cancellation by the Insured - =Answer>> When the policyholder wants to cancel an insurance policy, she can simply return the policy to the insurer or write to the insurance company to let them know the date on which she'd like the policy to be cancelled. When it receives a cancellation request from a policyholder, the insurance company must send the insured a receipt confirming the date and time the policy will be cancelled. If there is a third party involved, such as a mortgage company, governmental agency, or lender, they also will receive notice, at least ten days before the cancellation is effective. In the event that the insurance company fails to cancel the policy as requested, it will automatically be cancelled as soon as the policyholder has a replacement policy with the same or similar coverage. Rules for Prompt Settlement - =Answer>> After receiving a claim, the insurer must, within 15 days: -Acknowledge receipt of the claim -Begin investigating circumstances of the claim -Give claimant necessary forms Need Writing 🤔Help? We've Got You Covered! ✍️ 100% NO A I or Plagiarism Guaranteed🤔
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required. After this notice has been made, the insurer has an additional 45 days to make a decision on the claim. If arson is suspected, the insurance company is given 30 days to affirm or deny coverage. If the insurance company ultimately rejects the claim, it must notify the claimant in writing, explaining why the claim was rejected. Covered claims must be paid within 10 days after the insurer determines the amount of indemnification. Once insurer receives all paperwork, it has __ days to make a decision regarding payment - =Answer>> 15 days If unable to make decision in 15 days, the insurer can take __ more days after notifying claimant - =Answer>> 45 more days If arson is suspected, insurer has __ days to affirm or deny coverage - =Answer>> 30 days Covered claims must be paid within __ days after insurer makes a decision - =Answer>> 10 days Cancellation and Nonrenewal - Advance notice required: In most cases: __ days - =Answer>> 30 days Cancellation and Nonrenewal - Advance notice required: For non-payment of premiums: __ days - =Answer>> 10 days Need Writing 🤔Help? We've Got You Covered! ✍️ 100% NO A I or Plagiarism Guaranteed🤔
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Cancellation and Nonrenewal - Advance notice required: For new policies (less than 60 days in): __ days - =Answer>> 10 days Cancellation and Nonrenewal - Advance notice required: Insurer refunds unearned premiums to policyholder on _________ basis - =Answer>> pro rata Cancellation and Nonrenewal - Advance notice required: Penalty for not returning unearned premiums on time: __% (plus __% interest) - =Answer>> 25%, 18% interest In Georgia, after a policyholder files a claim, the insurer has ______ days to send proof of loss forms. - =Answer>> 15 days If a claimant in Georgia has completed a proof of loss form, an insurer has ____ days to accept or deny a claim before it must contact the claimant to explain why more time is required. In that case, the insurer has an additional ____ days to make a decision on the claim. - =Answer>> 15, 45 The _________________ is the Federal Law that regulates the collection, dissemination and use of consumer information by insurance companies, credit agencies, and financial institutions. - =Answer>> FCRA- Fair Credit Reporting Act The set of patient privacy rules that all health care providers, insurance companies, physicians offices, hospitals and pharmacies must follow is called the: - Need Writing 🤔Help? We've Got You Covered! ✍️ 100% NO A I or Plagiarism Guaranteed🤔
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In Georgia, once an insurer has received all pertinent information about a claim, it must accept or deny the claim within a specified period of time. If the insurer needs more time to come to a decision, it must: - =Answer>> notify the claimant, stating the reasons for the delay. When Jane is involved in an accident in Georgia, she immediately calls her insurer and files a claim. Her insurer is required by law to do all of the following EXCEPT: - =Answer>> refrain from paying or denying the claim until the claimant submits proof of loss forms. Libel - =Answer>> a published false statement that is damaging to a person's reputation; a written defamation. According to the general rules for cancellation of insurance policies in Georgia, how many days notice must an insurer give the insured before cancelling a policy? - =Answer>> 30 days McCarran-Ferguson Act - =Answer>> Passed in 1945, allowing the individual states to regulate the insurance industry The National Association of Insurance Commissioners (NAIC) - =Answer>> is a non-profit coalition of state insurance agencies. It works to harmonize state laws and regulations by drafting model legislation, which is frequently adopted by all or most states. Need Writing 🤔Help? We've Got You Covered! ✍️ 100% NO A I or Plagiarism Guaranteed🤔
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Insurance Commissioners' responsibilities - =Answer>> 1. Maintaining insurer solvency
- Regulating rates
- Protecting consumers
- Making insurance available for all individuals State commissioners and departments of insurance are responsible for regulating many aspects of the insurance industry (especially those concerning the financial solvency of the insurers doing business in their state). The commissioners and departments oversee the financial stability of insurers and regulate the rates that insurers charge. They also protect consumers and ensure that insurance is available for all individuals. Insurance and Safety Fire Commissioner - =Answer>> 1. Elected position
- Four year term
- Can appoint deputies
- Attorney general decides legality of rules if disputed
- Must not have financial interest in any insurance company or agency The commissioner is the most senior person in the Office of Insurance, and his or her formal title is Insurance and Safety Fire Commissioner. Elected by the citizens of Georgia to a four year term, the commissioner is responsible for enforcing the laws related Need Writing 🤔Help? We've Got You Covered! ✍️ 100% NO A I or Plagiarism Guaranteed🤔
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managers. If he believes that there has been a violation of insurance law, he may schedule a hearing on the matter, and will serve notice of the hearing by registered mail. If the commissioner receives a complaint about an insurance agent or company, and believes the complaint is credible, he will schedule a hearing within 30 days of the complaint, again serving notice by registered mail. The Commissioner also has the power to: - =Answer>> 1. Prohibit any person he suspects of breaking insurance law from continuing that illegal action
- Impose penalties against any person found guilty of breaking insurance law, even without a hearing
- Place any insurer on probation for up to one year for each violation Administrative Fines - After a hearing, Commissioner can fine insurers up to $5,000 for regularly: - =Answer>> Encouraging claimants to accept less than they're due Failing to process and pay claims in a timely manner Refusing to pay proper claims Accepting money or gifts to send work to another company Three Classes of Insurers - =Answer>> Domestic: Based in Georgia Foreign (a.k.a. Surplus): Based in another state Alien: Based outside the United States To maintain a Certificate of Authority, insurers must: - =Answer>> 1. Comply with all insurance laws Need Writing 🤔Help? We've Got You Covered! ✍️ 100% NO A I or Plagiarism Guaranteed🤔
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- Be financially sound
- Give claimants their due
- Provide necessary access and information for renewal
- Pay final judgements within 30 days in order to conduct insurance business in the state of Georgia, insurers must have a certificate of authority. Insurers are also required to have a certificate of authority for every agent who represents their company. There are several things insurers need to do to obtain this certificate and keep it current. They must comply with all insurance rules, regulations, and directives of the commissioner; be financially sound; deal with claimants fairly; be open to examination and provide all information necessary for the certificate of authority renewal; and, pay any judgment rendered against them within 30 days. Commissioner's Authority- If an insurer does not follow state laws, the Commissioner can: - =Answer>> Refuse to issue or renew its certificate of authority Revoke or suspend its certificate of authority Place the insurer under administrative supervision The commissioner has the authority to revoke, suspend, or refuse to renew an insurer's certificate of authority if these requirements are not met. He can also place the company under administrative supervision. If the commissioner finds out that an insurance company has proceedings against it in any state for financial distress, Need Writing 🤔Help? We've Got You Covered! ✍️ 100% NO A I or Plagiarism Guaranteed🤔
