Download New York Health Insurance Adjuster Test Prep. 2025 || Questions & Answers (Graded A+) and more Exams Insurance law in PDF only on Docsity!
New York Health Insurance Adjuster Test
Prep. 2025 || Questions & Answers
(Graded A+)
The Liability section of the Farmowners Policy would exclude coverage for which of the following operations? - ANSWER - Repairing tractors owned by neighboring farmers. All of the following are tax qualified retirement plans EXCEPT - ANSWER - Section 529 plan. Which policy condition encourages policyholder to insure to at least 80% of replacement value to avoid a penalty with partial losses? - ANSWER - coinsurance Which one of the following represents an advantage of obtaining a policy loan vesus a withdrawal? - ANSWER - the loan is not taxed while a withdrawal is taxed for amounts above the contract cost basis A Basic Hospital Policy pays expenses for - ANSWER - hospital room and board. Which type of bond specifically protects against dishonesty by employees whose names or positions are listed in the policy? - ANSWER โ scheduled Which of the following is covered by a dread disease policy? - ANSWER - illnesses that do not occur frequently but incur significant costs when they do occur Which of the following professionals would purchase Directors and Officers (D &O) insurance to manage the liability risk associated with their activities? - ANSWER - chief executive officer For the commercial general liability coverages of bodily injury, property damage and medical payments, which of the following limits of insurance apply if the aggregate limit is NOT met? - ANSWER - per occurrence An injured employee covered under workers' compensation is entitled to reasonably justifiable expenses for retraining. This benefit falls under which of the following? - ANSWER - vocational rehabilitation Which of the following is the party who agrees to be responsible for loss in the case of a fidelity bond? - ANSWER - the surety
What increases the potential loss of an unforeseen event that causes injury to an insured or damage to property? - ANSWER - Hazard Which of the following sides represent the front surface of the patient? - ANSWER - anterior Which party is required to provide proof of loss to establish entitlement? - ANSWER - the insured What does homeowners Coverage B - Other Structures cover? - ANSWER - structures located on the insured's property separated from the dwelling by clear space Which of the following is a duty of the insured after a loss? - ANSWER - minimizing further loss When an agent tries to convince a policyholder to replace an existing policy to buy another one, what are they practicing? - ANSWER - misrepresentation How long is the broad theft coverage endorsement invalid if the property is vacant? - ANSWER - More than 60 consecutive days The insured is mowing his lawn when a stranger is noticed in the backyard. The stranger claims to be a substitute delivery person. Several days later a gold watch can not be found. Which of the following describes the loss? - ANSWER - mysterious disappearance Before taking legal action, what third-party can help end disputes over the value of a loss? - ANSWER - arbitrator Exclusions common to liability coverage for both the personal auto policy and the business auto policy include all of the following EXCEPT - ANSWER - for liability arising while the insured auto is being used in an auto business. All of the following are TRUE regarding underinsured motorists coverage EXCEPT - ANSWER - it is of little consequence who was at fault for the coverage to apply. Which type of endorsement covers causes of loss specifically listed in the policy? - ANSWER - named perils Which of the following is TRUE for a flexible premium annuity? - ANSWER - The purchaser has the option to vary the amount of each premium payment falling between a minimum and maximum amount. Which of the following is NOT a nonforfeiture option available in a Whole Life Policy? - ANSWER - Accumulation at interest
As a general rule, commercial inland marine insurance covers all of following EXCEPT - ANSWER - merchandise while it is being manufactured. The Terrorism Risk Insurance Act and the National Flood Insurance Program are similar by providing which of the following? - ANSWER - subsidies, loss sharing or excess coverage With which of the following methods are losses settled on an actual cash value (ACV) basis? - ANSWER - less depreciation All of the following types of personal property are covered under Coverage C EXCEPT - ANSWER - collectable gold coins. Standard nonforfeiture benefits include - ANSWER - reduced paid-up insurance. In a case where an individual's health is insured by both their own policy and their spouse's policy, which policy pays in the event of an illness? - ANSWER - The individual's policy pays first, the spouse's policy pays the remaining up to coverage amount. The insured carries uninsured motorist coverage limits of 100/300/100 and is struck by an uninsured motorist, who will pay insured's bodily injury damages claimed for $100,000? - ANSWER - the insured's insurance company An insured has transportation expenses coverage under Part D of the personal auto policy when involved in a collision. Coverage provides which of the following? - ANSWER - rental reimbursement until claim is settled by insurance According to the Nationwide Definition of marine insurance, which category is an eligible marine risk? - ANSWER - imported goods When an employer sends employees out of state on work related business, which of the following must he do to ensure the appropriate workers' compensation coverage - ANSWER - list the state on the information page for other states' coverage In a Surety Bond, the principal is the person who - ANSWER - performs certain acts under the contract. All of the following situations represent additional personal liability exposures that can be met with an umbrella policy EXCEPT - ANSWER - liability arising out of business pursuits. When an insured disagrees with the valuation of a loss and his appraiser and the insurance company's appraiser disagree, how will the loss be settled? - ANSWER - the amount agreed to by any two of the three
Which type of coverage would be appropriate for a detached garage in a DP-1 policy? - ANSWER - Coverage B Which of the following represents the maximum amount reimbursable for tree debris removal for one occurrence under all Homeowners forms? - ANSWER - $1, All of the following are TRUE regarding torts EXCEPT - ANSWER - a tort is always unintentional What is the purpose of the causes of loss form that lists specific exclusions? - ANSWER
- to state which perils are insured against Under an Equipment Breakdown Insurance Policy, suspended coverage can ONLY be reinstated by - ANSWER - an endorsement for that equipment from the insurance company Which of the following is a qualified plan? - ANSWER - 401(k) Which of the following liability insurance policies would provide coverage to ABC Company in a suit brought by a fired employee for wrongful discharge? - ANSWER - Employment Practices Liability Which of the following professionals would purchase Errors And Omissions insurance to manage the liability risk associated with their business endeavors? - ANSWER - attorney Which of the following is one of the objectives of the Terrorism Risk Insurance Act of 2002? - ANSWER - It limits the exposure of individual insurers and the insurance industry as a whole. Which of the following statements BEST describes Credit Life Insurance? - ANSWER - Insurance issued on a debtor to cover outstanding debt. Which of the following situations under dwelling policy conditions describe how the insurance company will settle a loss? - ANSWER - company has the option to repair to pre-loss condition When does the coverage begin for a builders risk form? - ANSWER - On the date construction starts above the lowest basement floor if there is a basement Which of the following may be waived in an insurance contract? - ANSWER - statements made by agents representing the insurer The following is true regarding deductibles EXCEPT - ANSWER - the benefit can exceed the policy limitations when the deductible is paid
coverage that includes all of the following EXCEPT - ANSWER - a detailed and comprehensive summary of the accelerated benefit All of the following areas of supplementary payments are paid in addition to the regular limit for coverage in a liability policy EXCEPT - ANSWER - prejudgment interest when it is included as part of the damages for the insured is paid Employees are barred from suing employers in court to obtain compensation for injuries covered by workers' compensation because of which of the following doctrines? - ANSWER - exclusive remedy Accidental Injury - ANSWER - Generally causes traumatic damage to the external parts of the body and was unexpected by the injured person. Sickness - ANSWER - Includes physical illness, disease, and pregnancy, but does not include mental illness. What are the three basic categories of claims and benefits? - ANSWER - Loss of income from disability, hospital and medical expenses, and long term care expenses What are Individual Health Insurance contracts? - ANSWER - They are issued to cover individuals and usually dependents of individuals. How often can an underwriter change the premiums, conditions, and benefits of an individual health insurance contract? - ANSWER - Annually - on the anniversary date of the contract. Define "Cancellable health insurance". - ANSWER - Most states prohibit this type of insurance as it is often seen as non-favorable to the consumer public. But, cancellable health insurance allows the insurer to cancel the policy at any time with as little as 5 days' notice. Which type of health insurance policies are written as noncancellable contracts? - ANSWER - Disability income policies Define "Non-cancellable insurance contracts" - ANSWER - They can't be cancelled by the insurer unless there is a fraudulent claim or if the premium is not paid. They guarantee a stated amount of coverage for a stated amount of time (which is usually until the insured is 65) for a guaranteed premium rate. Which type of policies are written on a Guaranteed Renewable basis? - ANSWER - Disability income policies and medical coverage policies What does a "Guaranteed Renewable health insurance policy" mean? - ANSWER - It means the insurance company guarantees the same level of coverage, but not necessarily the same premium charge. The premium for an individual person remains
the same, but the premium for the type of class an insured person may be in can increase. Define "conditionally renewable health insurance policies" - ANSWER - In these policies, the insurer can refuse to renew coverage for certain conditions. Under conditionally renewable health insurance policies, can an insurer refuse to renew coverage for certain conditions of a select individual? - ANSWER - No. But they can refuse to renew coverage for certain conditions of an entire class of people. Which type of policies are written on a conditionally renewable basis? - ANSWER - Disability income policies and medical coverage policies Define Optionally Renewable Health Insurance Policies - ANSWER - They are policies that give the insurer the right to renew or terminate the time of premium payment. It can't be cancelled at any other time. Also, the insurer can choose to increase premiums or add restrictions to a particular class of insureds. What's another name for a group health insurance policy? - ANSWER - Master Contract What is group health insurance? - ANSWER - It's provided by an employer or group sponsor who receives the master contract (policy) and each employee or member receives a certificate of insurance. This policy may have a limited on pre-existing conditions, but otherwise acts much like group life insurance policies. Group health insurance can't be cancelled for an individual unless the contract is cancelled for the entire group. Other names for insureds: - ANSWER - Subscribers and members What are limited coverage policies? - ANSWER - They are specialized health insurance policies which provide limited coverage such as vision, dental, or accident-only policies. What is Medicaid? - ANSWER - It's a state and Federally funded program for those whose incomes and resources are insufficient to cover the cost of necessary medical care. What types of injuries are common exclusions from health insurance policies? - ANSWER - Self-inflicted injuries, military or war injuries, dental, cosmetic surgeries, care in government facilities, pre-existing conditions, and participation in a felony. Additionally, most policies will temporarily suspend policies while an insured is out of country. Medical coverage under a personal auto policy will cover the insured if he/she is injured while: - ANSWER - Passenger on a bus.
A New York licensee subject to an administrative action in another jurisdiction or governmental agency must report such action to the Superintendent within: - ANSWER
- 30 days.. Oliver Dogwood was in an auto accident which destroyed his car. While investigating the accident, Adjuster Doright found that Mr. Dogwood paid $1,000 for the vehicle. After checking with others he found the same vehicle with an asking price of $1,700, a retail price of $2,150 and a dealer price of $1,750. What amount will Mr. Dogwood receive? - ANSWER - Mr. Dogwood will receive $2,150 plus any sales tax. The insured is required to pay retail price plus sales tax. In insurance terms, the party who has been wronged is known as the _____ party, and the person causing the injury is the _____ party. - ANSWER - third / first. EXPLANATION: The third party would be the claimant and the person committing the wrongful act would be the first party. The second party is the insurance company. Bodily injury claims are usually classified as types of damages. Which of the following is considered "exemplary" damages? - ANSWER - Punitive Damages. EXPLANATION: Punitive damages (also known as exemplary damages) are damages intended to reform or deter the defendant and others from engaging in similar conduct which formed the basis of the lawsuit. An example would be a driver going 120 miles per hour in a school zone and hits a school bus. Punitive damages would punish this driver and others from repeating the same offense. What is the automobile property damage limit that is required in New York to satisfy the financial responsibility law? - ANSWER - $10,000. John does not own a vehicle and borrows a friend's car and has an accident. John carries named non-owned auto coverage. Which of the following applies to the accident? - ANSWER - John's coverage is excess. EXPLANATION: The named non-owned auto coverage is excess coverage. An insured carries a general liability policy and has hired a trucking company to transport equipment to the business location. The trucking company carries a commercial auto policy. The insured loads a piece of machinery onto the truck and fails to secure it properly. The trucking company is transporting the cargo and it falls off the truck and hits another car. Which policy or policies would cover this claim? - ANSWER - The trucking company's commercial auto policy would cover the claim.. EXPLANATION:
The commercial auto policy would respond to cover the claim for damages to the damaged party. The damage to the cargo itself would not be covered. The trucking company and the insured should both carry cargo coverage. All of the following would be excluded under Coverage D - Physical Damage of a Personal Automobile Policy, EXCEPT: - ANSWER - Permanently-installed telephones.. EXPLANATION: Permanently installed electronic equipment (except radar detectors) is covered, but no custom equipment is covered in a van unless endorsed onto the policy and an additional premium paid. The New York Superintendent of Insurance is: - ANSWER - Appointed by the governor of New York A road construction contractor has mobile equipment used in his business. The state has changed the law and now requires some of the equipment to carry liability insurance to comply with the financial responsibility laws of the state. What symbol will the insurance company use to add these items to the insured's commercial auto policy?
- ANSWER - Symbol 19 The named insured has a business auto policy issued by Company A and another auto policy issued by Company B. Company A's BAP has a limit of insurance for liability coverage of $100,000. Company B's policy provides $25,000 of liability coverage. If both policies apply to an accident on the same basis, how much of a $100,000 liability loss will Company A pay under its BAP? - ANSWER - $80,000.. EXPLANATION: The two companies provide a combined limit of $125,000. Company A provides 80% of the limits in place. In case of a $100,000 loss, company A would pay $80,000. If a person is qualified to receive benefits from the Motor Vehicle Accident Indemnification Corporation and are injured by an owner of a vehicle that can be identified, how many days do they have to file a claim? - ANSWER - 180 Which of the following would NOT be excluded from coverage under Section D, auto physical damage under the Personal Auto Policy? - ANSWER - A car telephone stolen from Mr. Cranbury's car. According to the commercial auto policy definitions, an "accident:" - ANSWER - Includes continuous or repeated exposure to the same conditions.. Transportation expenses under the auto physical damage coverage would be considered: - ANSWER - An indirect loss.. EXPLANATION:
