Florida Public Adjuster State Test 2023 Questions and Answers (Verified Answers)

Florida No-Fault Tort Exemption
Those who comply with the law are granted limited immunity from suits of others through PIP coverage.

4 Exceptions to Tort Exemption(Threshold of No-Fault)

Significant and Permanent loss of bodily function.
2.Permanent injury other than scarring and disfigurement.
3.Significant and Permanent scarring or disfigurement.
4.Death

What does NFIP stand for?
National Flood Insurance Program

Form SR-22
Drivers Convicted of DUI or a traffic felony over the prior 3 years are required to have 100/300/50 coverage or a certificate of self insurance of $350,000.

Contents of a CGL Contract
1.Declarations Form
2.Common Policy Conditions Form

One of:
A.Occurrence Form
B.Claims Made Form
4.Nuclear Energy Liability Exclusion Endorsement.

Declarations of a CGL Contract(4)
1.Named Insured(including address)
2.Policy Period
3.Premium
4.Limits of Coverage

7 Common CGL Conditions
1.Cancellation(30 Days by insurer option, 10 Days By no payment).
2.Changes
3.Examination of Books
4.Inspections and Surveys
5.Premiums
6.Transfer
7.Nuclear Endorsement

CGL Coverage A
Bodily Injury and Property Damage Insuring Agreement

The 3 Conditions that define work as “completed”
1.When all work called for in the contract is completed.
2.When all work to be done at the site has been completed if one contract calls for work at more than one site.
3.When that part of the work done at a job site has been put to its intended use by any person or organization other than another contractor or subcontractor.

Occurance
An accident, including continuous or repeated exposure to substantially the same general harmful conditions.

accident
Sudden, unexpected event

The Difference between “Occurance” and “Claims Made” CGL Coverages
The Coverage Trigger:
The Occurance Form applies to BI and PD regardless of any later time at which the claim is made.
The Claims-Made Form applies only to BI and PD that occurs on or after the “Retro-Active date”

Retro-Active Date
The date on which the coverage legally began.

Basic Extended Reporting Period for CGL
60 Days after expiration

Why is the term “Coverage Trigger” misleading?
Because it intends to refer to the time period during which the insurance contract is in effect.

Umbrella
Covers Excessive Liability

A Homeowners Policy consists of(3 components):
1.Declarations
2.One of 6 Homeowners forms
3.Mandatory and optional endorsements

If a unit is co-owned, May one co-owner be insured as the renter(HO-4)?
Yes

What are the two main divisions of a Home Owners Form?
Section I-Property
&
Section II-Liability

4 Subsections of Section I of a Property Coverage Policy

Coverages
2.Perils Insured Against
3.Exclusions
4.Conditions

Who determines how much HO-6 coverages a Condominium Owner needs?
The Association

Homeowners Coverage A
“Dwelling” covers the dwelling building and structures attached; also construction materials and supplies on or adjacent to the premises.

Homeowners Coverage B
“Other Structures” covers private structures on the residence premises that are not attached to the main dwelling.

4 Examples of “Other Structures” Per Coverage B of a Homeowner’s policy(book gives 5)
1.Detached Garage.
2.Guest House.
3.Fence
4.Tennis Court
5.Storage Building

Homeowner’s Coverage C
“Personal Property” covers Property, wherever it is located, that is owned or used by “an Insured”.

Homeowners Coverage D
“Loss of Use” covers increases over normal living costs if damage from a covered Peril makes the residence unfit for occupancy.

What is the standard limit for Homeowners Coverage B?
10% of the amount Insured for Coverage A and may not be increased or decreased.

What is the standard amount for Coverage C
50% of Coverage A.

What is the standard limit of Homeowner’s Coverage D for: HO-2, HO-3 & HO-5?
30% Coverage A

How many Perils are listed as “General Exclusions” in your textbook?
9

What is the most important Condition that has direct impact on Homeowners Coverage?
Loss Settlement

When might “Loss Settlement” cover buildings under Coverages A & B to Full Replacement Cost?
If the limit of Insurance at the time of Loss is equal to 80% or more of the replacement value of the building.

Statute that requires that when Property is Insured for replacement cost is deemed a total loss, the full replacement cost without reservation or holdback of depreciation must be paid.
627.7011

627.7011
Statute that requires that when Property Insured for replacement cost is deemed a total loss, the full replacement cost without reservation or holdback of depreciation must be paid.

Four Additional Homeowners Coverages

Claims Expense
First Aid Expenses
Damage to Property of Others
Loss Assessment

Does Hurricane Coverage Occur on a Per Occurrence or an Annual Basis
An annual basis

What if there is more than one applicable deductible?
Only the highest deductible applies.

What must the Insured do if they wish to completely reject Windstorm Coverage?
Hand write “I DO NOT WANT THE INSURANCE ON MY (HOME/MOBILE HOME/CONDOMINIUM UNIT) TO PAY FOR DAMAGE FROM WINDSTORMS OR HURRICANES. I WILL PAY THOSE COSTS. MY INSURANCE WILL NOT.”

How much notice must the insurer give the insured of non-renewal of a homeowner’s Policy?
120 Days

4 Elements of a Valid Contract?
1.A manifestation of assent to its terms by parties who make the contract.
2.A sufficient consideration (value or payment) for each promise.
3.Legal Capacity of the parties to contract.
4.Legal Subject matter.

Insurance
A contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit upon determinable contingencies.

4 Elements of an Insurance Contract
D.I.C.E.

1.Declarations
2.the Insuring Agreement
3.Exclusions
4.Conditions

Example of Subrogation
Insurance Company pays the victim and collects for the DUIer or liable party of any sort.

Example of Severability
Tom and Eva are insured for liability of injury. Tom intentionally injured someone(intention voiding coverage for Tom), Eva is still covered.

Valued Policy Law
The value of the property is agreed to as part of the policy.

Coinsurance
A policy for less than the entire value of the insured property and cover pro-rata whether or not other insurance exists. 80% actually means (pro-rata share)/80%

Beginning statement of a liability insurance policy
Insurer agrees “to pay on behalf of the insured all sums the insured becomes legally obligated to pay as damages” or equivalent wording.

Three Ways in which the limits to a liability insurance policy Insuring Agreement can be expressed?
1.single limit
2.split limit
3.Aggregate limit

2 Types of Tort Liability
1.Negligent Liability(Unintentional)
2.Strict Liability(Intentional)

What is the difference between Common Law and Statute Law?
Common Law is based on stare decisis, whereas statutory law is explicit with a statute number.

What are the two broad classifications of damages that a plaintiff can seek in an action for money damages?
1.Compensatory
2.Punitive

Two main defenses against Negligence

Assumption of Risk
2.Comparative Negligence

Why is it common to have the attorney’s name on the settlement draft?
Because should the insurer pay over the money solely to the claimant, the attorney may sue the company for the fee.

Contracts wherein the parties are of unequal bargaining power are called?
Contracts of Adhesion

What is the rule of law’s attempt to counter balance a contract of Adhesion?
To have any ambiguities resolved in favor of the insured.

Two types of Waivers
1.Explicit
2.Implied

Statute 627.409
Statute covering misrepresentation by the insured. Only a defense for the insurer if they didn’t know and it would have affected the coverage offer.

How long does a residential property policy have to be in effect to hold the insured immune to 627.409(fraud by insured)
90 Days

What does “OIR” stand for?
Office of Insurance Regulation

What is the OIR’s role?
To examine the qualification of insurance companies seeking to do business in this state.

3 Types of Adjusters
1.Staff Adjusters
2.Fee Adjusters
A.Independent Adjusters
B.Bureau Adjusters
3.Public Adjusters

Company or Staff Adjusters
Salaried Employees under the supervision of the insurer.

Fee Adjusters
Offer their services on a Fee for Service Basis including Bureau Adjusters and Independent Adjusters

Bureau Adjusters
Serve National Insurance Firms

What is the difference between a Bureau Adjuster and an Independent Adjuster
A Bureau Adjuster is an employee of the insurer and an Independent Adjuster is an Independent Contractor

A Public Adjuster
Aside from attorneys, Public Adjusters are the only Adjusters who legally represent the rights of the insured.

6 Responsibilities of the Public Adjuster
1.Evaluate
2.Substantiate
3.Determine values
4.Negotiate
5.Recommend(upgraded insurance)
6.Re-Open Claims

626.8796
Public Adjuster Fraud Statement

How long must a Public Adjuster wait after an event that leads to a claim to contact the claimant?
48 hours. (626.854(13))

What format must the advertisement disclaimer be in?
Bold caps, but no specific type size. :-)(626.854(7))(b))

What must Public Adjuster Contracts Contain regarding fraud by insured
Felony Warnings (626.8796) is the requirement for the Public Adjuster. 817.234 is the felony, 775.082, 775.083 & 775.084 are the punishments.

What is the limit to the Public Adjuster’s share of a re-opened claim
20% (626.854(10)(a)).

How long does the client have to cancel the Public Adjuster’s Contract
3 Business Days

How long must the Public Adjuster keep his written estimate of the claimant’s Loss.
5 years

If a time consuming process to resolution is more lucrative, may the Public Adjuster loan the client an advance on the claim?
No. (626.854(8)).

Can the Public Adjuster acquire an interest in Salvaged Property, for example as payment for Services?
Not without written consent and a signed affidavit. (626.854(11))

Insurer’s 3 Goals when handling a claim

Comply with the Contract
Control Costs
Cultivate Good Customer Relations

3 Basic Claims Handling activities?

Investigate
2.Evaluate
3.Negotiate

5 Technical Expertise for a successful negotiation
1.The Insurance Contract
2.Reparable from replacement requiring damages.
3.Law
4.Insurer’s goals
5.Computer Estimating Systems being utilized by the insurance industry.

Duration of the statute of limitations to claim windstorm damage.
3 years (627.70132)

5 Questions to establish the contract coverage
1.Did a covered Peril Occur?
2.When?
3.Were there more than one?
4.Which one was the proximate cause?
5.Was there a mix of covered and uncovered losses?

5 Ways to appraise damages
1.Survey and Estimate of Determination
2.Acceptance of Cost or Quality shown by records.
3.Actual repair or replacement
4.Sale of Salvage
5.Appraisal(after 2 parties have failed to agree).

7 Settlement and Release Options
1.Full release Settlement
2.Open Ended Release
3.Payment of PD, BI pending
4.No Release
5.Advanced Payment
6.Structured Settlement
7.Rehabilitation, including provisions for rehabilitative treatment of the claimant.

What is called when 2 or more contracts cover the same claim and have to pay proportionate amounts?
Apportionment

What are the principles that guide apportionment to avoid controversy that could delay adjustment called?
Guiding Principles

What is the maximum injury to a minor that can be settled out of court, preferably with both parents.
$15,000 (statute 744.387)

A contract by whereby the person executing the instrument gives up a right, claim or privilege to the person against whom it might have been demanded or enforced is called a:
Release

What must a release be supported by to be a binding contract?
Valuable Consideration

5 Practices that the Insured are protected from under the “Florida Unfair Insurance Trade Practices Act.”
1.failing to act promptly
2.denying claims without reasonable investigation
3.failure to affirm or deny a claim when an insured is entitled thereto
4.failure to explain claim denials in writing
5.failure to maintain complaint-handling procedures, such as keeping accurate records of complaints.

The Department requires each adjusting form and each of it’s branches to designate an Adjuster to be responsible for the supervision of all individuals within an adjusting firm. This individual is called the:
Primary Adjuster(626.8695)

How long do Insurance Companies have to acknowledge Claims?
14 Days(627.70131)

How long do Insurance Companies have to pay or deny property claims?
90 Days

7 Ethics to the code of Ethics

No negotiating with an attorney’s client.
No misleading in any way.
3.No legal advice
4.No special releases, fill in the blanks only
5.No exploiting incapacitated clients
6.Advise the client of rights under the contract and by the state.
7.Act with no bias.

6 Rights of the Insured

Acknowledgement in 14 Days
Approval or denial in 30 Days
Full payment as applicable in 90 Days
4.Free Mediation
5.a neutral evaluation of a sinkhole claim
6.Availability of assistance from the department of consumer services

What does the Homeowners Flood Insurance Affordability Act of 2014 do?
Allows private carriers to write off four different types of Flood Coverages.

FAJUA
Florida Automobile Joint Underwriting Association

FIGA
Florida Insurance Guaranty Association

Citizens Property Insurance
Residual Property Insurance

FRPCJUA
Florida Residential Property and Casualty Joint Underwriting Association. Merged with FWUA to become Citizens

FWUA
Florida Windstorm Underwriting Association. Merged with the FRPCJUA as Citizens.

The insurer and insured agree to a specific value of insured item
Agreed Value Policies

Someone who has care, custody or control of another’s property
Bailee

Claim filed by policy holder against his _
First Party Claim

When a person who entrusts another with an object and it results in injury to someone can be held liable for the injury to someone. Can be held liable for the injury i.e. Firearm or DWI
Negligent Entrustment

Hazard that results from a conscious decision made by an insured to participate in a manner or behavior more likely to result in a loss because they have insurance
Moral Hazard

Used to provide temporary insurance coverage until an insurance policy can be written
Binder

Required by lenders to guarantee that outstanding loans against a job are paid upon completion
Completion Bonds

The section of an insurance policy identifying the insured, endorsements, coverages, limits, and premiums
Declarations

Policyholder cannot transfer the policy to someone else without written permission from their insurance company
Assignment

An instance, behavior or environment that increases the likelihood of a loss on an insured item
Hazard

Actual cause or source of an incidence of destruction, injury, or loss
Peril

An insurance company organized and domiciled outside the US
Alien

When there is an unbroken chain of events between an occurrence and a loss, then the loss is part of the original occurrence
Proximate Cause

Is proximate cause of all subsequent damages
Original Occurance

An individual who contracts with an adjusting firm as an independent contractor and handles claims for the insurance companies
Independent Adjuster

Action or practice of the insured party is permitted to continue because any defense against a continuation of said action or practice has been waived by the insurer
Estoppel

Operate for profit, collect premiums, reserve a portion of premiums to pay claims
Commercial Insurers

Any person who investigates or adjusts losses on behalf of either an insurer or a self-insured
Independent Adjuster

The result of an insured’s tort or wrongdoing. Consequences of a loss or amount or type of losses suffered
Damages

Requires the insured to insure the named property for a specific amount of insurance as required by the insurance company
Agreed Value

Physical harm to tangible property caused by peril (loss to property or person in which a covered peril is the proximate cause of damage or destruction)
Direct loss

The entity that is the “recipient” to the Principal
Obligee

Insurance contracts are written on a take it or leave it basis to the policy owner.
Adhesion

Event or circumstance that causes damage
Occurance

Coverage provides for payment of losses if civil authority denies access to the insured premises due to a covered peril
Civil Authority

Voluntary relinquishment of a known legal right
Waiver

An insurer domiciled outside the state where it writes insurance
Foreign

A state officer who administers the state’s insurance laws and regulations
Commissioner

Used as a promise to accept a bid if awarded to a company
Bid bond

Damaged property an insurer takes over to reduce their loss after paying a claim
Salvage

Factual statements upon which an insurance policy is based
Representations

A contract between two parties that offer the consumer little to no leeway to negotiate the terms of the contract
Contract of adhesion

Publication in any media by the insured about goods or services
Advertisements

Also known as Absolute Liability, based on the theory of the duty of making something sage that is inherently dangerous
Strict Torts

A house, structure, also referred to as a “primary risk”
Dwelling

Condition enforced by the courts to do something bound under law or in a contract
Strict Torts

Amount of loss paid by the policy holder
Deductible

Violation of an agreement between a seller and buyer in reference to the condition, content, quality, or title of an item sold
Breach of Warranty

Compensation, reparation
Indemnify

Provides property coverage on a contractor’s interest in equipment intended for permanent installation while it is being transported, unloaded, and installed
Installation Floater

A beneficiary of a contract only as a result of the First Party’s negligence
Third Party

Reinsurance agreement where the insurers involved will pay claims in direct relationship with the % of the risk that they are insuring
Quota Share

Sharing the cost of replacement
Risk Sharing

A legal action filed by one or more persons on behalf of themselves and others having an identical interest in the alleged wrongdoing
Class-Action

A specific risk or cause of loss covered by an insurance policy, such as fire, windstorm, flood, theft, etc.
Peril

Dangers in a store, warehouse, or office; circumstances of risks and perils determine who is responsible for _
Premises Liability

A loss or risk the policy doesn’t cover
Exclusions

Technique used to transfer the risk of a person, business, or organization in another through the use of a two-party contract
Insurance

A legal two-party document describing the relationship between the insured and the insurance company
Indemnity Contract

Legal document that makes some person responsible for damages their actions or products cause regardless of any fault on their part
Strict Liabilty

The intention to withhold relative information about the risk from the insurance company
Concealment

A subset of the claims function whereby suspicious losses are investigated separately from the normal claims adjusters’ activities
Special Investigations Unit

An insurer takes no action upon realizing material changes in a contract
Implied Waiver

Acts committed without negligence but result in damages
Intentional Tort

Willful and illegal sinking of a ship at sea or its cargo
barratry

Covers physical damage as well as liability and tends to be very broad in coverage
Commercial Inland Marine

Single insurance for only one kind of property at only one location of an insured
Specific Coverage

Legislative Acts or Laws
Statutes

The insurance company to which the risk is transferred to by the contract
Second Party

Hazards on private property that might attract trespassing such as swimming pools or trampolines
Attractive Nuisance

An approximate calculation of amount, extent, quality, magnitude, position, degree or worth of something
Estimages

Insurance company assesses, mitigates, and monitors the items of risk that potential customers want to insure
Risk management

Granting the privileges and licensing in a state based on having a license in another state that is deemed equivalent by the granting state
Reciprocity

Specific protection in an insurance policy
Coverage

An individual holding a license under the authority of the State
Licensee

Means any solid, liquid, gaseous or thermal irritant or contaminant including smoke, vapor, soot, fumes, acids, alkalis and chemicals
Pollutants

A package insurance policy that combines both property and casualty coverages into a single policy
Homeowners policy

Legal term applying the third party claims meaning ” to pay back or to make whole”
Indemnification

An agreement by one party, the guarantor to answer to a 3rd person for the debt of default of a responsible party called the Principal
Surety bonds

The necessary increase in living expense resulting from a loss by a covered peril, and incurred by the insured
Additional Living Expense (ALE)

The replacement cost of like kind and quality at the time of loss, less a reasonable amount of depreiciation
Actual cash value

Physical condition that increases the change of loss
Physical Hazard

Openness to loss or damage
Exposure

Any changes that broaden coverage on the edition of the policy that the insured holds will automatically apply without premiums
liberalization cluse

Bonds that protect an employer form losses by an employee
fidelity bonds

A combination of property and liability coverages of two or more separate policies in one premium
Package policy

Fire that is not contained in the vessel in which it was set. Example:
Hostile Fire

Written agreement attached to a policy to add or subtract insurance coverage
Endorsement

Covers a variety of issues including lease of premiums, easements, sidetrack agreements and elevator maintenance agreements.
Insured contract

The act o taking responsibility through agreement for something that person may not be legally liable
Assumption of liability

Only applies to business income coverage and not to the extra expense coverage
Actual cash value (bi)

The value of the property is decreased or reduced due to damage but the property still remains some value and can be used
Diminution of value

Depreciation that is initially held back, then disbursed after proof of repairs being performed to bring property back to whole
Recoverable depreciation

Economic loss that arises as a consequence of the direct or physical loss
indirect loss

A statement made regarding the extent of the claim, it may be requested in accordance with the conditions of the policy
Proof of loss

Tangible property other than the products or work produced
impaired property

Works upon the principal that the more times an event is repeated, the more predictable the outcome of a specific event
Law of Large Numbers

To access the eligibility of a customer to receive their products, decide how much coverage the client should receive, and how much they should pay for it.
Underwriting

Actual cost of replacing property due to a covered peril with property of like kind and quality without depreciation
replacement cost

Exaggerating an otherwise legitimate claim for profit
Soft Fraud

Unincorporated association of members in which each member insures the other members
Reciprocal insurance exchange

An Agreement and
Policy

An ongoing assurance made by one party to another that certain facts :
Warranty

Method whereby the insurer pays the amount of each claim for each risk up to a limit determined in advance, and the re-insurer pays the amount of the claim above that specified limit
Exxcess of loss

A person who voluntarily gives up possession of the property
bailor

One of the earliest forms of insurance
Ocean Marine

An insurance adjuster who works primarily outside of an office and often meets personally with the public
Field Adjuster

Purposefully setting fire to property. Not covered under the policy if the act is committed by the insured
Arson

The attempt, by an applicant to deceive an insurance company
Misrespresentation

Personal property that is not part of the dwelling or structure
Contents

An individual that is used when a claim has been questioned by either the insured or the insurer, an unbiased part is required to resolve the dispute
Umpire

Amount an insurer will have to pay an insured to meet the promises outlined in the insurance contract, reduction in value of insured item
loss

An addition, deletion or change to a legal document or policy
Amendment

The section of an insurance policy identifying the insured, endorsements, coverages, limits and premiums
The Declarations page

Reinsureance agreement where the insurers involved will pay claims in direct relationship with the % of the risk they are insuring
Co-insurance

Financial investment or financial dependency that an individual or business has in a person or property
Insurable interest

Failure to use the care that a reasonable and prudent person would have used under that same or similar circumstance
Negligence

“Insurer” has an obligation to pay covered loss, “insured” has no obligation
Unilateral insurance contract

Uninsurable because of the possibility of either loss or gain in the risk
Speculative Risk

The depreciation from the total Replacement Cost due to age, use and condition. The resulting dollar amount is Actual Cash Value
Non-recoverable Depreciation

626.854 (3)
A public adjuster may not give legal advice or act on behalf of or aid any person in negotiating or settling a claim relating to bodily injury, death, or noneconomic damages.

626.854 (5)
A public adjuster may not directly or indirectly through any other person or entity solicit an insured or claimant by any means except on Monday through Saturday of each week and only between the hours of 8 a.m. and 8 p.m. on those days.

626.854 (6)
An insured or claimant may cancel a public adjuster’s contract to adjust a claim without penalty or obligation within 3 business days after the date on which the contract is executed or within 3 business days after the date on which the insured or claimant has notified the insurer of the claim, whichever is later. The public adjuster’s contract must disclose to the insured or claimant his or her right to cancel the contract and advise the insured or claimant that notice of cancellation must be submitted in writing and sent by certified mail, return receipt requested, or other form of mailing that provides proof thereof, to the public adjuster at the address specified in the contract; provided, during any state of emergency as declared by the Governor and for 1 year after the date of loss, the insured or claimant has 5 business days after the date on which the contract is executed to cancel a public adjuster’s contract.

626.854 (7)
It is an unfair and deceptive insurance trade practice pursuant to s. 626.9541 for a public adjuster or any other person to circulate or disseminate any advertisement, announcement, or statement containing any assertion, representation, or statement with respect to the business of insurance which is untrue, deceptive, or misleading.

626.854 (7) (a)
The following statements, made in any public adjuster’s advertisement or solicitation, are considered deceptive or misleading:

A statement or representation that invites an insured policyholder to submit a claim when the policyholder does not have covered damage to insured property.
A statement or representation that invites an insured policyholder to submit a claim by offering monetary or other valuable inducement.
A statement or representation that invites an insured policyholder to submit a claim by stating that there is “no risk” to the policyholder by submitting such claim.
A statement or representation, or use of a logo or shield, that implies or could mistakenly be construed to imply that the solicitation was issued or distributed by a governmental agency or is sanctioned or endorsed by a governmental agency.

626.854 (7) (B)
For purposes of this paragraph, the term “written advertisement” includes only newspapers, magazines, flyers, and bulk mailers. The following disclaimer, which is not required to be printed on standard size business cards, must be added in bold print and capital letters in typeface no smaller than the typeface of the body of the text to all written advertisements by a public adjuster:
“THIS IS A SOLICITATION FOR BUSINESS. IF YOU HAVE HAD A CLAIM FOR AN INSURED PROPERTY LOSS OR DAMAGE AND YOU ARE SATISFIED WITH THE PAYMENT BY YOUR INSURER, YOU MAY DISREGARD THIS ADVERTISEMENT.”

626.854 (8)
A public adjuster, a public adjuster apprentice, or any person or entity acting on behalf of a public adjuster or public adjuster apprentice may not give or offer to give a monetary loan or advance to a client or prospective client.

626.854 (9)
A public adjuster, public adjuster apprentice, or any individual or entity acting on behalf of a public adjuster or public adjuster apprentice may not give or offer to give, directly or indirectly, any article of merchandise having a value in excess of $25 to any individual for the purpose of advertising or as an inducement to entering into a contract with a public adjuster.

626.854 (10)(A)
If a public adjuster enters into a contract with an insured or claimant to reopen a claim or file a supplemental claim that seeks additional payments for a claim that has been previously paid in part or in full or settled by the insurer, the public adjuster may not charge, agree to, or accept from any source compensation, payment, commission, fee, or any other thing of value based on a previous settlement or previous claim payments by the insurer for the same cause of loss. The charge, compensation, payment, commission, fee, or any other thing of value must be based only on the claim payments or settlement obtained through the work of the public adjuster after entering into the contract with the insured or claimant. Compensation for the reopened or supplemental claim may not exceed 20 percent of the reopened or supplemental claim payment. In no event shall the contracts described in this paragraph exceed the limitations in paragraph (b).

626.854 (10) (b)
A public adjuster may not charge, agree to, or accept from any source compensation, payment, commission, fee, or any other thing of value in excess of:

Ten percent of the amount of insurance claim payments made by the insurer for claims based on events that are the subject of a declaration of a state of emergency by the Governor. This provision applies to claims made during the year after the declaration of emergency. After that year, the limitations in subparagraph 2. apply.
Twenty percent of the amount of insurance claim payments made by the insurer for claims that are not based on events that are the subject of a declaration of a state of emergency by the Governor.

626.854 (10) (c)
Insurance claim payments made by the insurer do not include policy deductibles, and public adjuster compensation may not be based on the deductible portion of a claim.

626.854 (10) (d)
Any maneuver, shift, or device through which the limits on compensation set forth in this subsection are exceeded is a violation of this chapter punishable as provided under s. 626.8698.

626.854 (11)
Each public adjuster must provide to the claimant or insured a written estimate of the loss to assist in the submission of a proof of loss or any other claim for payment of insurance proceeds. The public adjuster shall retain such written estimate for at least 5 years and shall make the estimate available to the claimant or insured, the insurer, and the department upon request.

626.854(12)
A public adjuster, public adjuster apprentice, or any person acting on behalf of a public adjuster or apprentice may not accept referrals of business from any person with whom the public adjuster conducts business if there is any form or manner of agreement to compensate the person, directly or indirectly, for referring business to the public adjuster. A public adjuster may not compensate any person, except for another public adjuster, directly or indirectly, for the principal purpose of referring business to the public adjuster.

626.854 (13)
A company employee adjuster, independent adjuster, attorney, investigator, or other persons acting on behalf of an insurer that needs access to an insured or claimant or to the insured property that is the subject of a claim must provide at least 48 hours’ notice to the insured or claimant, public adjuster, or legal representative before scheduling a meeting with the claimant or an onsite inspection of the insured property. The insured or claimant may deny access to the property if the notice has not been provided. The insured or claimant may waive the 48-hour notice.

626.854 (14)
The public adjuster must ensure that prompt notice is given of the claim to the insurer, the public adjuster’s contract is provided to the insurer, the property is available for inspection of the loss or damage by the insurer, and the insurer is given an opportunity to interview the insured directly about the loss and claim. The insurer must be allowed to obtain necessary information to investigate and respond to the claim.

626.854 (14) (a)
The insurer may not exclude the public adjuster from its in-person meetings with the insured. The insurer shall meet or communicate with the public adjuster in an effort to reach agreement as to the scope of the covered loss under the insurance policy. The public adjuster shall meet or communicate with the insurer in an effort to reach agreement as to the scope of the covered loss under the insurance policy. This section does not impair the terms and conditions of the insurance policy in effect at the time the claim is filed.

626.854 (14) (b)
A public adjuster may not restrict or prevent an insurer, company employee adjuster, independent adjuster, attorney, investigator, or other person acting on behalf of the insurer from having reasonable access at reasonable times to any insured or claimant or to the insured property that is the subject of a claim.

626.854 (14) (c)
A public adjuster may not act or fail to reasonably act in any manner that obstructs or prevents an insurer or insurer’s adjuster from timely conducting an inspection of any part of the insured property for which there is a claim for loss or damage. The public adjuster representing the insureds may be present for the insurer’s inspection, but if the unavailability of the public adjuster otherwise delays the insurer’s timely inspection of the property, the public adjuster or the insureds must allow the insurer to have access to the property without the participation or presence of the public adjuster or insureds in order to facilitate the insurer’s prompt inspection of the loss or damage.

626.854 (15)
A licensed contractor under part I of chapter 489, or a subcontractor, may not adjust a claim on behalf of an insured unless licensed and compliant as a public adjuster under this chapter. However, the contractor may discuss or explain a bid for construction or repair of covered property with the residential property owner who has suffered loss or damage covered by a property insurance policy, or the insurer of such property, if the contractor is doing so for the usual and customary fees applicable to the work to be performed as stated in the contract between the contractor and the insured.

626.854 (16)
A public adjuster shall not acquire any interest in salvaged property, except with the written consent and permission of the insured through a signed affidavit.

626.854 (17)
A public adjuster, a public adjuster apprentice, or a person acting on behalf of an adjuster or apprentice may not enter into a contract or accept a power of attorney that vests in the public adjuster, the public adjuster apprentice, or the person acting on behalf of the adjuster or apprentice the effective authority to choose the persons or entities that will perform repair work in a property insurance claim or provide goods or services that will require the insured or third-party claimant to expend funds in excess of those payable to the public adjuster under the terms of the contract for adjusting services.

626.854 (18)
Subsections (5)-(17) apply only to residential property insurance policies and condominium unit owner policies as described in s. 718.111(11).

626.854 (19)
Except as otherwise provided in this chapter, no person, except an attorney at law or a public adjuster, may for money, commission, or any other thing of value, directly or indirectly:

626.854 (19) (a)
Prepare, complete, or file an insurance claim for an insured or a third-party claimant;

626.854 (19) (b)
Act on behalf of or aid an insured or a third-party claimant in negotiating for or effecting the settlement of a claim for loss or damage covered by an insurance contract;

626.854 (19) (c)
Advertise for employment as a public adjuster; or

626.854 (19) (d)
Solicit, investigate, or adjust a claim on behalf of a public adjuster, an insured, or a third-party claimant.

Under a dwelling broad or special form, what is the maximum that would be paid for “loss of use”?
20% of the Dwelling Coverage

Under a dwelling (DP-2 or DP-3) policy, what is the maximum % that would be paid for ALE?
20%

626.854 (3)
A public adjuster may not give legal advice or act on behalf of or aid any person in negotiating or settling a claim relating to bodily injury, death, or noneconomic damages.

626.854 (6)
An insured or claimant may cancel a public adjuster’s contract to adjust a claim without penalty or obligation within 3 business days after the date on which the contract is executed or within 3 business days after the date on which the insured or claimant has notified the insurer of the claim, whichever is later. The public adjuster’s contract must disclose to the insured or claimant his or her right to cancel the contract and advise the insured or claimant that notice of cancellation must be submitted in writing and sent by certified mail, return receipt requested, or other form of mailing that provides proof thereof, to the public adjuster at the address specified in the contract; provided, during any state of emergency as declared by the Governor and for 1 year after the date of loss, the insured or claimant has 10 business days after the date on which the contract is executed to cancel a public adjuster’s contract.

626.854 (7) (a)
The following statements, made in any public adjuster’s advertisement or solicitation, are considered deceptive or misleading:

A statement or representation that invites an insured policyholder to submit a claim when the policyholder does not have covered damage to insured property.
A statement or representation that invites an insured policyholder to submit a claim by offering monetary or other valuable inducement.
A statement or representation that invites an insured policyholder to submit a claim by stating that there is “no risk” to the policyholder by submitting such claim.
A statement or representation, or use of a logo or shield, that implies or could mistakenly be construed to imply that the solicitation was issued or distributed by a governmental agency or is sanctioned or endorsed by a governmental agency.

626.854 (7) (b)
For purposes of this paragraph, the term “written advertisement” includes only newspapers, magazines, flyers, and bulk mailers. The following disclaimer, which is not required to be printed on standard size business cards, must be added in bold print and capital letters in typeface no smaller than the typeface of the body of the text to all written advertisements by a public adjuster:
“THIS IS A SOLICITATION FOR BUSINESS. IF YOU HAVE HAD A CLAIM FOR AN INSURED PROPERTY LOSS OR DAMAGE AND YOU ARE SATISFIED WITH THE PAYMENT BY YOUR INSURER, YOU MAY DISREGARD THIS ADVERTISEMENT.”

626.854 (10) (a)
If a public adjuster enters into a contract with an insured or claimant to reopen a claim or file a supplemental claim that seeks additional payments for a claim that has been previously paid in part or in full or settled by the insurer, the public adjuster may not charge, agree to, or accept from any source compensation, payment, commission, fee, or any other thing of value based on a previous settlement or previous claim payments by the insurer for the same cause of loss. The charge, compensation, payment, commission, fee, or any other thing of value must be based only on the claim payments or settlement obtained through the work of the public adjuster after entering into the contract with the insured or claimant. Compensation for the reopened or supplemental claim may not exceed 20 percent of the reopened or supplemental claim payment. In no event shall the contracts described in this paragraph exceed the limitations in paragraph (b).

626.854 (10) (b)
A public adjuster may not charge, agree to, or accept from any source compensation, payment, commission, fee, or any other thing of value in excess of:

Ten percent of the amount of insurance claim payments made by the insurer for claims based on events that are the subject of a declaration of a state of emergency by the Governor. This provision applies to claims made during the year after the declaration of emergency. After that year, the limitations in subparagraph 2. apply.
Twenty percent of the amount of insurance claim payments made by the insurer for claims that are not based on events that are the subject of a declaration of a state of emergency by the Governor.

626.854 (10) (c)
Insurance claim payments made by the insurer do not include policy deductibles, and public adjuster compensation may not be based on the deductible portion of a claim.

626.854 (12)
A public adjuster, public adjuster apprentice, or any person acting on behalf of a public adjuster or apprentice may not accept referrals of business from any person with whom the public adjuster conducts business if there is any form or manner of agreement to compensate the person, directly or indirectly, for referring business to the public adjuster. A public adjuster may not compensate any person, except for another public adjuster, directly or indirectly, for the principal purpose of referring business to the public adjuster.

626.854 (14) (b)
The insurer may not exclude the public adjuster from its in-person meetings with the insured. The insurer shall meet or communicate with the public adjuster in an effort to reach agreement as to the scope of the covered loss under the insurance policy. The public adjuster shall meet or communicate with the insurer in an effort to reach agree

626.854 (16)
A public adjuster shall not acquire any interest in salvaged property, except with the written consent and permission of the insured through a signed affidavit.

626.854 (18)
Subsections 5-17 only apply to homeowners and condominium policies

626.854 (19)
Except as otherwise provided in this chapter, no person, except an attorney at law or a public adjuster, may for money, commission, or any other thing of value, directly or indirectly:
(a) Prepare, complete, or file an insurance claim for an insured or a third-party claimant;
(b) Act on behalf of or aid an insured or a third-party claimant in negotiating for or effecting the settlement of a claim for loss or damage covered by an insurance contract;
(c) Advertise for employment as a public adjuster; or
(d) Solicit, investigate, or adjust a claim on behalf of a public adjuster, an insured, or a third-party claimant.

There are several important statutory requirements pertaining to contracts made by public adjusters:
Must state the type of claim, including an emergency claim, non-emergency claim or supplemental claim.
Requires the signatures of all named insureds.
If the signatures of all named insureds are not available, the public adjuster must submit an affidavit signed by the available named insureds attesting that they have authority to enter into the contract and settle all claim issues on behalf of the named insureds.
An unaltered copy of the contract must be remitted to the insurer within 30 days after execution. This means the contract provided to the insurer must also contain the agreed upon fee percentage.

True or False: Both mediation and sinkhole neutral evaluation are non-binding. Neither the insured nor the insurance company is legally obligated to accept the outcome of the mediation conference.
True

The __ is intended for use by parties who are beginning the process of filing suit against an insurer, when a party feels they have been damaged by specific acts of the insurer. The Notice is intended to meet a portion of legal requirements set forth in Section 624.155, Florida Statutes, which requires a party to file Notice with both the insurer and the Department of Financial Services (DFS) at least 60 days prior to bringing an action against the insurer. The DFS does not involve itself in the pre-suit negotiations or communications related to Notices as such actions are not within the scope of its statutory authority.
Civil Remedies Notice

Mediation Statute 627.7015
The department shall adopt by rule a property insurance mediation program to be administered by the department or its designee. The department may also adopt special rules which are applicable in cases of an emergency within the state. The rules shall be modeled after practices and procedures set forth in mediation rules of procedure adopted by the Supreme Court. The rules shall provide for:(a) Reasonable requirement for processing and scheduling of requests for mediation.(b) Qualifications, denial of application, suspension, revocation of approval, and other penalties for mediators as provided in s. 627.745 and the Florida Rules for Certified and Court-Appointed Mediators.(c) Provisions governing who may attend mediation conferences.(d) Selection of mediators.(e) Criteria for the conduct of mediation conferences.(f) Right to legal counsel.
(5) All statements made and documents produced at a mediation conference shall be deemed to be settlement negotiations in anticipation of litigation within the scope of s. 90.408. All parties to the mediation must negotiate in good faith and must have the authority to immediately settle the claim. Mediators are deemed to be agents of the department and shall have the immunity from suit provided in s. 44.107.
(6)(a) Mediation is nonbinding; however, if a written settlement is reached, the policyholder has 3 business days within which the policyholder may rescind the settlement unless the policyholder has cashed or deposited any check or draft disbursed to the policyholder for the disputed matters as a result of the conference. If a settlement agreement is reached and is not rescinded, it is binding and acts as a release of all specific claims that were presented in that mediation conference.
(b) At the conclusion of the mediation, the mediator shall provide a written report of the results of mediation, including any settlement amount, to the insurer, the policyholder, and the policyholder’s representative if the policyholder is represented at the mediation.
(7) If the insurer fails to comply with subsection (2) by failing to notify a policyholder of its right to participate in the mediation program under this section or if the insurer requests the mediation, and the mediation results are rejected by either party, the policyholder is not required to submit to or participate in any contractual loss appraisal process of the property loss damage as a precondition to legal action for breach of contract against the insurer for its failure to pay the policyholder’s claims covered by the policy.
(8) The department may designate an entity or person to serve as administrator to carry out any of the provisions of this section and may take this action by means of a written contract or agreement.
(9) For purposes of this section, the term “claim” refers to any dispute between an insurer and a policyholder relating to a material issue of fact other than a dispute:(a) With respect to which the insurer has a reasonable basis to suspect fraud;(b) When, based on agreed-upon facts as to the cause of loss, there is no coverage under the policy;(c) With respect to which the insurer has a reasonable basis to believe that the policyholder has intentionally made a material misrepresentation of fact which is relevant to the claim, and the entire request for payment of a loss has been denied on the basis of the material misrepresentation;(d) With respect to which the amount in controversy is less than $500, unless the parties agree to mediate a dispute involving a lesser amount; or(e) With respect to a windstorm or hurricane loss that does not comply with s. 627.70132.

Code of ethics (FAC 69B-220.201)
The work of adjusting insurance claims engages the public trust. An adjuster shall put the duty for fair and honest treatment of the claimant above the adjuster’s own interests in every instance. … (b) An adjuster shall treat all claimants equally.

Florida Insurance Guaranty Association
establishes and maintains a service-oriented operation for processing covered claims of insolvent members. FIGA is a nonprofit corporation created by the Florida Legislature in 1970. FIGA services pending claims by or against Florida policyholders of member insurance companies which become insolvent and are ordered liquidated.

The Residential Property and Casualty Joint Underwriting Association originally created by this statute shall be known as the Citizens Property Insurance Corporation
The corporation shall provide insurance for residential and commercial property, for applicants who are entitled, but, in good faith, are unable to procure insurance through the voluntary market.

Business auto coverage form Section 3 Physical Damage Coverage
We will pay for “loss” to a covered “auto” or its equipment under:
a. Comprehensive Coverage From any cause except: (1) The covered “auto’s” collision with another object; or (2) The covered “auto’s” overturn.
b. Specified Causes Of Loss Coverage Caused by: (1) Fire, lightning or explosion; (2) Theft; (3) Windstorm, hail or earthquake; (4) Flood; (5) Mischief or vandalism; or (6) The sinking, burning, collision or derailment of any conveyance transporting the covered “auto”.
c. Collision Coverage Caused by: (1) The covered “auto’s” collision with another object; or (2) The covered “auto’s” overturn.

Part D – Coverage for damage to your auto
the insurance company agrees to pay an amount in excess of your deductible for direct and accidental loss to your covered car or any other car specified in the agreement. Thus, it pays for damage or theft to your car.

627.70131 Insurer’s duty to acknowledge communications regarding claims; investigation.
(1) Upon an insurer’s receiving a communication with respect to a claim, the insurer shall, within 14 calendar days, review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the insurer which reasonably prevent such acknowledgment. If the acknowledgment is not in writing, a notification indicating acknowledgment shall be made in the insurer’s claim file and dated. A communication made to or by an agent of an insurer with respect to a claim shall constitute communication to or by the insurer.
(2) Such acknowledgment shall be responsive to the communication. If the communication constitutes a notification of a claim, unless the acknowledgment reasonably advises the claimant that the claim appears not to be covered by the insurer, the acknowledgment shall provide necessary claim forms, and instructions, including an appropriate telephone number.
(3) Unless otherwise provided by the policy of insurance or by law, within 10 working days after an insurer receives proof of loss statements, the insurer shall begin such investigation as is reasonably necessary unless the failure to begin such investigation is caused by factors beyond the control of the insurer which reasonably prevent the commencement of such investigation.
(4) For purposes of this section, the term “insurer” means any residential property insurer.
(5)(a) Within 90 days after an insurer receives notice of an initial, reopened, or supplemental property insurance claim from a policyholder, the insurer shall pay or deny such claim or a portion of the claim unless the failure to pay is caused by factors beyond the control of the insurer which reasonably prevent such payment. Any payment of an initial or supplemental claim or portion of such claim made 90 days after the insurer receives notice of the claim, or made more than 15 days after there are no longer factors beyond the control of the insurer which reasonably prevented such payment, whichever is later, bears interest at the rate set forth in s. 55.03. Interest begins to accrue from the date the insurer receives notice of the claim. The provisions of this subsection may not be waived, voided, or nullified by the terms of the insurance policy. If there is a right to prejudgment interest, the insured shall select whether to receive prejudgment interest or interest under this subsection. Interest is payable when the claim or portion of the claim is paid. Failure to comply with this subsection constitutes a violation of this code. However, failure to comply with this subsection does not form the sole basis for a private cause of action.
(b) Notwithstanding subsection (4), for purposes of this subsection, the term “claim” means any of the following:1. A claim under an insurance policy providing residential coverage as defined in s. 627.4025(1);2. A claim for structural or contents coverage under a commercial property insurance policy if the insured structure is 10,000 square feet or less; or3. A claim for contents coverage under a commercial tenant policy if the insured premises is 10,000 square feet or less.
(c) This subsection shall not apply to claims under an insurance policy covering nonresidential commercial structures or contents in more than one state.

Valuation of Mobile/Manufactured Homes
If the manufactured home’s homeowners’ policy has a value on it, and you’re in a valued policy state, the insurance company will pay up to the limit listed on the policy if the home is deemed a total loss.
Some manufactured home policies will have a provision that allows for homes less than a certain age (10 years for example) to be valued at replacement cost. This has been done in part because some companies recognize that construction methods have changed over the years and that the home is newer. It’s kind of like getting new car replacement on your auto policy, but only for late models.

DP-1 Basic Form
Perils insured against are fire, lightning, and internal explosion.

DP-2 Broad Form
This dwelling coverage form covers perils included under the DP-1 with ECE and optional VMM endorsement attached,

plus: burglars; falling objects; weight of snow, ice, sleet; accidental discharge or overflow of water or steam; sudden and accidental tearing apart, cracking, burning or bulging of a steam or hot water heating system, or an air conditioning or automatic fire protective sprinkler system, or an appliance for heating water; freezing of a plumbing, heating, air conditioning, or automatic fire protective sprinkler system, or of a household appliance; and sudden and accidental damage from artificially generated electrical current.

DP-3 Special Form
covers the dwelling and other structures on an open perils basis, except for the perils specifically excluded.

Basic Form
covers these 11 “perils” or causes of loss: Fire or Lightning, Smoke, Windstorm or Hail, Explosion, Riot or Civil Commotion, Aircraft (striking the property), Vehicles (striking the property), Glass Breakage, Vandalism & Malicious Mischief, Theft, and Volcanic Eruption.

Broad Form
covers the same 11 perils, but adds 6 more: Falling objects, Weight of ice, snow or sleet, accidental discharge or overflow of water or stream from within plumbing or related systems; does not include discharge or overflow of water from a sump, sudden and accidental rupture of heating, air conditioning, fire protective sprinkler, or hot water heating system. Freezing of plumbing or related systems. And Sudden and accidental damage from artificially generated electrical current.

Special Form
does not specifically list perils, rather it is “all risk” coverage unless otherwise specifically excluded.

HO-2 Policy
home insurance policy covers only your home and personal property against threats specifically named on the policy’s declarations page. named peril policy — the covered threats are specifically listed. Below are the 16 named perils covered:.
Lightning or fire
Hail or windstorm
Damage caused by aircraft
Explosions
Riots or civil disturbances
Smoke damage
Damage caused by vehicles
Theft
Vandalism
Falling objects
Volcanic eruption
Damage from the weight of snow, ice, or sleet
Water damage from plumbing, heating, or air conditioning overflow
Water heater cracking, tearing, and burning
Damage from electrical current
Frozen pipes
These policies are uncommon. Most insurance companies only write an_____ if they deem the risk presented by you and your property to be too great for a higher-level policy. An __ policy can leave you and your belongings vulnerable to many unnamed perils.

HO-3 Policy
Homeowners Policy Special Form — part of the Insurance Services Office, Inc. (ISO), homeowners forms portfolio, the _ insures the described owner-occupied dwelling, private structures in connection with the dwelling, unscheduled personal property on and away from the premises, and loss of use. Personal liability coverage and medical payments coverage are also provided by this policy. Coverage of the dwelling, related structures, and scheduled personal property is on an all risks basis, while coverage of unscheduled personal property is on a broad named perils basis. Losses to the dwelling and other structures are paid on a replacement cost basis, with no deduction for depreciation if certain conditions apply. Losses to personal property are paid on an actual cash value (ACV) basis, unless amended by endorsement.

HO-4 Policy
Renters policy. Personal property covered for broad perils.

HO-5 Policy
policies are written on open-perils forms, which means it lists the perils that your insurance doesn’t cover. Common Exclusions:
Earth movement
Ordinance or law
Water damage from flood, sewer backup, or water seepage
Power failure
War
Nuclear hazard
Intentional loss
Government action
Collapse
Theft to a dwelling under construction
Vandalism or malicious mischief if vacant more than 60 days
Mold, fungus, or wet rot
Neglect, wear and tear, and deterioration
Mechanical breakdown
Smog, rust, and corrosion
Smoke from agricultural smudging and industrial operations
Discharge, dispersal, or seepage of pollutants
Settling, shrinking, bulging, or expanding of your home’s foundation
Infestation of birds, vermin, rodents, or insects
Animals owned by insured

HO-6 Policy
is home insurance for owners of co-ops or condominiums. It provides personal property coverage, liability coverage and specific coverage of improvements to the owner’s unit. … An HO-6 policy will cover interior damage to your unit, improvements, additions and alterations you’ve made and your personal property.

HO-8 Policy
form is a modified version that provides coverage for homeowners unable to attain an HO-3 policy for their older home — typically more than 40 years old.
Under an HO-8 policy, the insured’s dwelling, personal property, liability, and loss of use are covered. However, it should be noted this insurance policy will not go as far in covering your home and personal belongings as an HO-3 or HO-5 policy. An______ will at least provide certain key coverages against the most common perils (causes of loss)

Florida No-Fault Tort Exemption
Those who comply with the law are granted limited immunity from suits of others through PIP coverage.

4 Exceptions to Tort Exemption(Threshold of No-Fault)

Significant and Permanent loss of bodily function.
2.Permanent injury other than scarring and disfigurement.
3.Significant and Permanent scarring or disfigurement.
4.Death

What does NFIP stand for?
National Flood Insurance Program

Form SR-22
Drivers Convicted of DUI or a traffic felony over the prior 3 years are required to have 100/300/50 coverage or a certificate of self insurance of $350,000.

Contents of a CGL Contract
1.Declarations Form
2.Common Policy Conditions Form

One of:A.Occurrence Form
B.Claims Made Form
4.Nuclear Energy Liability Exclusion Endorsement.

Declarations of a CGL Contract(4)
1.Named Insured(including address)
2.Policy Period
3.Premium
4.Limits of Coverage

7 Common CGL Conditions
1.Cancellation(30 Days by insurer option, 10 Days By no payment).
2.Changes
3.Examination of Books
4.Inspections and Surveys
5.Premiums
6.Transfer
7.Nuclear Endorsement

CGL Coverage A
Bodily Injury and Property Damage Insuring Agreement

Occurance
An accident, including continuous or repeated exposure to substantially the same general harmful conditions.

accident
Sudden, unexpected event

The Difference between “Occurance” and “Claims Made” CGL Coverages
The Coverage Trigger:The Occurance Form applies to BI and PD regardless of any later time at which the claim is made.The Claims-Made Form applies only to BI and PD that occurs on or after the “Retro-Active date”

Retro-Active Date
The date on which the coverage legally began.

Basic Extended Reporting Period for CGL
60 Days after expiration

Why is the term “Coverage Trigger” misleading?
Because it intends to refer to the time period during which the insurance contract is in effect.

A Homeowners Policy consists of(3 components):
1.Declarations
2.One of 6 Homeowners forms
3.Mandatory and optional endorsements

What are the two main divisions of a Home Owners Form?
Section I-Property&Section II-Liability

4 Subsections of Section I of a Property Coverage Policy

Coverage
2.Perils Insured Against
3.Exclusions
4.Conditions

Who determines how much HO-6 coverages a Condominium Owner needs?
The Association

Homeowners Coverage A
“Dwelling” covers the dwelling building and structures attached; also construction materials and supplies on or adjacent to the premises.

Homeowners Coverage B
Other Structures or Appurtenant Structures (10% of Coverage A)

Homeowners Coverage C
(Actual Cash Value) Personal Property Coverage: Usually for 50% of coverage A (in addition)

Homeowners Coverage D
Loss of Use-

What is the standard limit of Homeowner’s Coverage D for: HO-2, HO-3 & HO-5?
30% of Coverage A

Statute that requires that when Property is Insured for replacement cost is deemed a total loss, the full replacement cost without reservation or holdback of depreciation must be paid.
627.7011

Four Additional Homeowners Coverages

Claims Expense
First Aid Expenses
Damage to Property of Others
Loss Assessment

Does Hurricane Coverage Occur on a Per Occurrence or an Annual Basis
An annual basis

What if there is more than one applicable deductible?
Only the highest deductible applies.

How much notice must the insurer give the insured of non-renewal of a homeowner’s Policy?
120 Days

Valued Policy Law
requires payment of the face amount of insurance to the insured if a total loss to real property occurs from a peril specified in the law

Beginning statement of a liability insurance policy
Insurer agrees “to pay on behalf of the insured all sums the insured becomes legally obligated to pay as damages” or equivalent wording.

Coinsurance
A policy for less than the entire value of the insured property and cover pro-rata whether or not other insurance exists. 80% actually means (pro-rata share)/80%

Three Ways in which the limits to a liability insurance policy Insuring Agreement can be expressed?
1.single limit
2.split limit
3.Aggregate limit

2 Types of Tort Liability
1.Negligent Liability(Unintentional)
2.Strict Liability(Intentional)

What is the difference between Common Law and Statute Law?
Common Law is based on stare decisis, whereas statutory law is explicit with a statute number.

What are the two broad classifications of damages that a plaintiff can seek in an action for money damages?
1.Compensatory
2.Punitive

Two main defenses against Negligence

Assumption of Risk
2.Comparative Negligence

Why is it common to have the attorney’s name on the settlement draft?
Because should the insurer pay over the money solely to the claimant, the attorney may sue the company for the fee

Contracts wherein the parties are of unequal bargaining power are called?
Contracts of Adhesion

What is the rule of law’s attempt to counter balance a contract of Adhesion?
To have any ambiguities resolved in favor of the insured.

Two types of Waivers
1.Explicit
2.Implied

Statute 627.409
Statute covering misrepresentation by the insured. Only a defense for the insurer if they didn’t know and it would have affected the coverage offer.

How long does a residential property policy have to be in effect to hold the insured immune to 627.409(fraud by insured)
90 Days

6 Responsibilities of the Public Adjuster
1.Evaluate
2.Substantiate
3.Determine values
4.Negotiate
5.Recommend(upgraded insurance)
6.Re-Open Claims

626.8796
Public Adjuster Fraud Statement

How long must a Public Adjuster wait after an event that leads to a claim to contact the claimant?
48 hours. (626.854(13))

What is the limit to the Public Adjuster’s share of a re-opened claim
20% (626.854(10)(a)).

How long does the client have to cancel the Public Adjuster’s Contract
3 Business Days 626.854 (6)

How long must the Public Adjuster keep his written estimate of the claimant’s Loss.
5 years 626.854 (11)

If a time consuming process to resolution is more lucrative, may the Public Adjuster loan the client an advance on the claim?
No 626.854 (8)

Can the Public Adjuster acquire an interest in Salvaged Property, for example as payment for Services?
Not without written consent and a signed affidavit. 626.854 (16)

Insurer’s 3 Goals when handling a claim

Comply with the Contract
Control Costs
Cultivate Good Customer Relations

3 Basic Claims Handling activities?

Investigate
2.Evaluate
3.Negotiate

Duration of the statute of limitations to claim windstorm damage.
3 years (627.70132)

5 Questions to establish the contract coverage
1.Did a covered Peril Occur?
2.When?
3.Were there more than one?
4.Which one was the proximate cause?
5.Was there a mix of covered and uncovered losses?

What is called when 2 or more contracts cover the same claim and have to pay proportionate amounts?
Apportionment

What are the principles that guide apportionment to avoid controversy that could delay adjustment called?
The Guiding Principles

What is the maximum injury to a minor that can be settled out of court, preferably with both parents.
$15,000 (statute 744.387)

A contract by whereby the person executing the instrument gives up a right, claim or privilege to the person against whom it might have been demanded or enforced is called a:
Release

What must a release be supported by to be a binding contract?
Valuable Consideration

5 Practices that the Insured are protected from under the “Florida Unfair Insurance Trade Practices Act.”.
1.failing to act promptly
2.denying claims without reasonable investigation
3.failure to affirm or deny a claim when an insured is entitled thereto
4.failure to explain claim denials in writing
5.failure to maintain complaint-handling procedures, such as keeping accurate records of complaints

The Department requires each adjusting firm and each of it’s branches to designate an Adjuster to be responsible for the supervision of all individuals within an adjusting firm. This individual is called the:
Primary Adjuster(626.8695)

How long do Insurance Companies have to acknowledge Claims?
14 Days(627.70131)

How long do Insurance Companies have to pay or deny property claims?
90 Days

7 Ethics to the code of Ethics

No negotiating with an attorney’s client
No misleading in any way.
3.No legal advice
4.No special releases, fill in the blanks only
5.No exploiting incapacitated clients
6.Advise the client of rights under the contract and by the state.
7.Act with no bias.

6 Rights of the Insured

Acknowledgement in 14 Days
Approval or denial in 30 Days
Full payment as applicable in 90 Days
4.Free Mediation
5.a neutral evaluation of a sinkhole claim
6.Availability of assistance from the department of consumer services

What does the Homeowners Flood Insurance Affordability Act of 2014 do?
Allows private carriers to write off four different types of Flood Coverages.

FAJUA
Florida Automobile Joint Underwriting Association

FIGA
Florida Insurance Guaranty Association

FRPCJUA
Florida Residential Property and Casualty Joint Underwriting Association. Merged with FWUA to become Citizens

FWUA
Florida Windstorm Underwriting Association. Merged with the FRPCJUA as Citizens.

Insurance Contracts
In an ____, one party, the insured, pays a specified amount of money, called a premium, to another party, the insurer. The insurer, in turn, agrees to compensate the insured for specific future losses. The losses covered are listed in the contract, and the contract is called a policy.

Insurance Policy Conditions
The section of an insurance policy that identifies general requirements of an insured and the insurer on matters such as loss reporting and settlement, property valuation, other insurance, subrogation rights and cancellation and non-renewal.

Actual Cash Value
original cost of lost or damage property minus the depreciation of the property at the time of loss, for purposes of determining repayment or reimbursement.

Annual limit
The maximum a policy will pay for covered losses per year

Annuity
a fixed sum of money (usually a settlement) paid to someone every year, spreading a full benefit out over time

Appraisal
The act of assessing (giving an expert estimate of) the value of property

Assessed Value
The estimated monetary worth of a property (both real and personal) established by a taxing entity

Surcharge
additional cost added to the basic premium, usually due to at-fault claims or legal action

Structured Settlement
A monetary legal agreement often paid out as an annuity rater than in a lump sum

Actuary
Someone who uses statistics and mathematical models to calculated insurance risks and premiums

Company and Independent Adjuster Responsibilities
Investigate the circumstances of insurance claims by consulting with witnesses, reviewing police reports, and compiling evidence from other sources

Public Adjuster Responsibilities
Evaluate existing insurance policies in order to determine what coverage may be applicable to a claim. Prepare document and support the claim on behalf of the insured. Negotiate a settlement with the insurance company on behalf of an insured

Public Adjuster Continuing Education Requirements
5 hours of law and ethics, 19 hrs of elective credits. Every 2 years

Public Adjuster Expiration
An Adjuster license can only hold one appointment at a time. If unappointed for 48 months it will expire

Proof of Loss Requirements
Submit within 30 to 60 days after the damages occur

Commingling
An illegal practice that occurs when an agent mixes personal funds with the insured’s or insurer’s funds.

DP-1 Basic Form
Perils insured against are fire, lightning, and internal explosion.

DP-2 Broad Form
This dwelling coverage form covers perils included under the DP-1 with ECE and optional VMM endorsement attached,

DP-3 Special Form
covers the dwelling and other structures on an open perils basis, except for the perils specifically excluded.

Special Form
does not specifically list perils, rather it is “all risk” coverage unless otherwise specifically excluded.

HO-4 Policy
Renters policy. Personal property covered for broad perils.

Florida No-Fault Tort Exemption
Those who comply with the law are granted limited immunity from suits of others through PIP coverage.

4 Exceptions to Tort Exemption(Threshold of No-Fault)

Significant and Permanent loss of bodily function.
2.Permanent injury other than scarring and disfigurement.
3.Significant and Permanent scarring or disfigurement.
4.Death

What does NFIP stand for?
National Flood Insurance Program

Form SR-22
Drivers Convicted of DUI or a traffic felony over the prior 3 years are required to have 100/300/50 coverage or a certificate of self insurance of $350,000.

Contents of a CGL Contract
1.Declarations Form
2.Common Policy Conditions Form

One of:A.Occurrence Form
B.Claims Made Form
4.Nuclear Energy Liability Exclusion Endorsement.

Declarations of a CGL Contract(4)
1.Named Insured(including address)
2.Policy Period
3.Premium
4.Limits of Coverage

7 Common CGL Conditions
1.Cancellation(30 Days by insurer option, 10 Days By no payment).
2.Changes
3.Examination of Books
4.Inspections and Surveys
5.Premiums
6.Transfer
7.Nuclear Endorsement

CGL Coverage A
Bodily Injury and Property Damage Insuring Agreement

Occurance
An accident, including continuous or repeated exposure to substantially the same general harmful conditions.

accident
Sudden, unexpected event

The Difference between “Occurance” and “Claims Made” CGL Coverages
The Coverage Trigger:The Occurance Form applies to BI and PD regardless of any later time at which the claim is made.The Claims-Made Form applies only to BI and PD that occurs on or after the “Retro-Active date”

Retro-Active Date
The date on which the coverage legally began.

Basic Extended Reporting Period for CGL
60 Days after expiration

Why is the term “Coverage Trigger” misleading?
Because it intends to refer to the time period during which the insurance contract is in effect.

A Homeowners Policy consists of(3 components):
1.Declarations
2.One of 6 Homeowners forms
3.Mandatory and optional endorsements

What are the two main divisions of a Home Owners Form?
Section I-Property&Section II-Liability

4 Subsections of Section I of a Property Coverage Policy

Coverage
2.Perils Insured Against
3.Exclusions
4.Conditions

Who determines how much HO-6 coverages a Condominium Owner needs?
The Association

Homeowners Coverage A
“Dwelling” covers the dwelling building and structures attached; also construction materials and supplies on or adjacent to the premises.

Homeowners Coverage B
Other Structures or Appurtenant Structures (10% of Coverage A)

Homeowners Coverage C
(Actual Cash Value) Personal Property Coverage: Usually for 50% of coverage A (in addition)

Homeowners Coverage D
Loss of Use-

What is the standard limit of Homeowner’s Coverage D for: HO-2, HO-3 & HO-5?
30% of Coverage A

Statute that requires that when Property is Insured for replacement cost is deemed a total loss, the full replacement cost without reservation or holdback of depreciation must be paid.
627.7011

Four Additional Homeowners Coverages

Claims Expense
First Aid Expenses
Damage to Property of Others
Loss Assessment