eSecuritel NY Insurance Adjuster's License
Terms in this set (572)
Law of Large Numbers definition?
is a statistical concept that relates to probability and the insurer is able to make predictions of possible loss
What does the Law of Large Numbers determine with respect to insurance?
is the process of selecting certain types of risks that have historically produced a profit and rejecting those risks that do not fit the underwriting criteria of the insurer
contract of indemnity against liability by liability by reason of the original insurance
4 Parts of Insurance Contract?
Declarations Page, Insuring Agreement, Conditions, and Exclusions/Limitations
Declarations Page of Insurance Contract?
amount of insurance
limits of liability
premiums and deductibles
list of endorsements
Tells the who, what, where, and premium info.
Insuring Agreement of Insurance Contract?
the insuring agreement describes the covered perils, or risks assumed, or nature of coverage, or make some reference to the contractual agreement between insurer and insured.
Conditions of Insurance Contract?
policy conditions set provisions, rules of conduct, duties, and obligations for the parties
Exclusions of Insurance Contract?
may describe property, perils, hazards or losses arising from specific causes that are not covered by the policy
Limitations of Insurance Contract?
may eliminate or reduce coverage, but only under certain circumstances or when specified conditions apply
Standardized Policies definition?
refer to form that have filed by Insurance Services Office, Inc. (ISO) to the individual state insurance departments for approval. Many insurance companies use the approved ISO forms rather than developing and filing their own forms in each individual state.
a sudden and unforeseen event resulting in a financial loss.
ambiguous language (language that is vague and creates doubt) in the policy provisions will usually be resolved by the courts in favor of the insured.
Appraisal Clause definition?
when the dispute involved a property claim, both parties select an appraiser to determine the value of the loss. The appraisers choose an umpire. The appraisers will state separately the value of the property and amount of loss. If they fail to agree, they will submit their differences to the umpire. A decision agreed to by any two will be binding.
insurance binders serve as temporary evidence that coverage is in effect until the policy is issued. They can be either oral or written.
this is the self-insured part of the insured loss.
Direct Loss definition?
is one that is a direct consequence of a particular peril. Fire damage to an apartment building is an example of a direct loss.
Indirect Loss definition?
loss result from a direct loss. The loss of rental income as a result of the fire is an indirect loss. You cannot have an indirect loss without first having a direct loss.
the principle of indemnity assumes that a claimant should only be restored to the approximate financial condition that existed prior to the loss, no better, no worse.
a clause in property/casualty insurance contracts which states that if the policy or endorsement forms are broadened and no additional premium is required, then all existing similar policies or endorsements will be construed to include the broadened coverage.
a sudden and unforeseen event resulting in financial loss. It may also be a continuous or repeated exposure to an event that results in a financial loss. More inclined to liability.
Other Insurance Clause definition?
some claims are paid based on a pro-rata approach. This means that each insurer will pay its percentage of the claim as limit bears to the total amount of coverage in force.
Pair or Set Clause definition?
this is a loss settlement condition that appears in many property insurance contracts including inland marine. It states that if part of a pair or set is lost or damaged, the loss will be valued as a fair proportion of the total value of the set.
Proximate Clause definition?
an unbroken chain of events that causes a loss. An event that, in a natural and continuous sequence, produces a claim.
if the insurer pays a loss on behalf of the insured, the insurer is entitled to the salvage to reduce the claim.
Subrogation Clause definition?
this clause is used when the insurer has paid a covered claim on behalf of the insured that is caused by another party. The insurance company is entitled to the insured's right of recovery from the negligent party. Includes insured deductible
Named Peril definition?
lists the specific perils to be covered in the policy.
Open Peril definition?
does not list the perils but provides broader coverage. All perils are includes except for those excluded on exclusions section of the policy.
Two types of loss evaluation methods?
actual cash value and replacement
Actual Cash Value definition?
-the cost of replacement less depreciation
the current cost to purchase new, the item that was lost, with no deduction for depreciation. The full value will be paid up to the limit of the policy less any depreciation.
Coinsurance Clause definition?
is a method of requiring the insured to insure at least 80% of the value of the property in exchange for a premium discount. This clause is used whether the insured insures the property on an actual cash value basis or on a replacement cost basis. If the insured's policy contains this clause and the insured carries less than this amount, a penalty will occur in case of partial loss.
No Benefits to Bailee definition?
an insured's property insurance policy protects the insured and not a bailee of the insured's property.
Liability Losses definition?
occurs when a person or entity is determined to have been responsible, or legally liable, for injury or loss to another person or liable for damage to another's property and the law requires them to make financial restitution. These are called third party losses. Liability losses are paid by casualty insurance type policies.
for a liability policy to respond the insured must be guilty of "negligence" and coverage must be granted by the policy. Intentional acts are never covered by liability policies. Negligence is defined as the lack of unreasonable chance of harm.
a person becomes legally liable by committing a tort. Generally (but not always) a court of law must determine negligence.
What are the two categories of compensatory damages?
Special and General
Under compensatory damages, what are special damages?
type of compensatory damages the injured party receives for direct and specific expenses involved in the loss, such as medical expenses and loss of wages. These damages pay for so-called 'economic losses'. Economic losses are measurable.
Under compensatory damages, what are general damages?
type of compensatory damages that reimburse the injured party for such things as pain/suffering, disfigurement, and life-altering issues such as loss of mobility and loss of consortium no readily defined by actual incurred expenses. These damages pay for so-called 'non-economic' losses. Non-economic losses are not measurable.
Punitive Damages (Exemplary Damages) definition?
are often awarded by the court and intended to punish the defendant.
Comparative Negligence definition?
law that allows an injured party to collect from another party for a loss, even when the injured party contributed to his/her own loss. Damages are reduced to the extent of the injured party's negligence.
Assumption of Risk definition?
applies when a person knowingly exposes himself or herself to danger or injury.
Absolute Liability definition?
is imposed by law on those participating in certain activities that are considered especially hazardous.
Absolute liability is most frequently applied to activities involving:
Vicarious Liability definition?
there are times when a person may be held responsible for the negligent acts of another person. This is known as vicarious liability or imputed liability. A common form of vicarious liability involves the relationship between an employer and an employee
There are three ways in which the limits of a liability policy insuring agreement may be expressed?
single limit, split limits, and/or aggregate limits (usually for commercial).
Single Limit definition?
pays up to one amount as the maximum limit of liability of the insurer with respect to any one accident/occurrence involving either or both bodily injury and property damage
Split Limit definition?
are expressed by 3 figures (3rd limit is for property damage). There may be a limit representing the maximum payable for each person injured per occurrence for bodily injury and another limit applicable to the claims of all persons injured in the accident or occurrence.
For the split limit example, $25,000/$50,000/$50,000 /$100,000/$10,000, explain what each of these figures mean?
$25K Bodily injury per person/$50K Per accident/$50K Death per person/$100K Death per accident/$10K Property
What is risk?
the possibility (uncertainty) that a loss might occur and is the reason that people buy insurance
What is peril?
actual cause of a loss (fire, windstorm, or hail)
What is a hazard?
any condition that increases the possibility of a loss
What is physical hazard?
any hazard arising from the material, structural, or operational features of the risk itself apart from the person owning or managing it
What is moral hazard?
a condition of morals or habits that increases the probability of a loss from a peril.
What is morale hazard?
hazards arising out of an insured's indifference to loss because of the existence of insurance
What is pure risk?
a situation where there is only the possibility of loss. (Example: damage to property by fire). Pure risks are insurable.
What is speculative risk?
a situation where either profit or loss is possible. (Example: gambling). Speculative risks are not insurable.
Characteristics of Insurable Interest?
1. Not all pure risks are insurable.
2. The following characteristics create an insurable risk:
-Loss must be definite and definable
-Loss must be accidental
Parties to an Insurance Contract?
1. First party (insured)
2. Second party (the insurance company)
3. Third party (in liability insurance, this is the party that has been damaged by the first party)
What are the elements of a valid contract (CLOC)?
1. Capacity to Contract
2. Legal Purpose
3. Offer and Acceptance
What is Capacity to Contract?
in order for the contract to be binding, all parties must have the necessary capacity to enter into the contract. Cases where capacity has been deemed insufficient include: minors, mental incompetents, and those who have not signed the contract while under the influence of drugs/alcohol.
For a minor to contract to life insurance, they must be at what age?
What is Legal Purpose?
an insurance contract must not be written to cover an illegal activity or immoral purposes.
What is Offer and Acceptance?
an applicant completes an application for coverage (makes an offer) and the insurance company accepts it and returns a policy or binder. If the insurance company issues an altered policy, the altered policy becomes a counter offer.
What is Consideration?
something that has value in the eyes of the law in which a promise receives something in return for promise. The insured (the promisee) gives the application and premium to the agent and/or company in return for their promise to pay in the future.
What is Aleatory Contract?
an insurance contract is aleatory, which means it is contingent on an uncertain event (loss). Insureds who pay premium but have no losses will not receive claim payments under the policy. However, they will have peace of mind knowing they are covered if a loss occurs. On the other hand, insureds who suffer a loss often receive a great deal more from the insurer than they have paid in premiums. Therefore, there is unequal value. The insured pays a lower premium than the ultimate obligation of the insurer in case of a covered claim.
What is Contract of Adhesion?
the insurance company is the author of the contract and the insured must accept it "as is." There is an unequal bargaining strength between the parties; therefore, any ambiguous language will bring a court decision in favor of the insured.
What is Executory Contract?
both sides must perform certain acts to make the contract legally enforceable.
What is Representations?
statements made on an application for insurance that the applicant believes to be true to the best of his/her knowledge and belief are known as representatives.
What is Misrepresentation?
are untrue statements made by the insured, usually at the time when an application is made.
What is the McCarren-Ferguson Act?
Since responsibility to regulate the insurance industry is shared jointly by state and federal government, the authority granted to the state government was granted by passing the McCarren-Ferguson Act. This Act, reserved for the federal government, the authority to regulate insurance in areas such a fair labor standards and anti-trust matters. All other insurance matters is reserved to the states.
What is an admitted company?
a company approved to do business in a given state and considered authorized
What is a nonadmitted company?
a company not approved to do business in a given state and is considered unauthorized
What is certificate of authority?
when an insurer is approved to do business in a certain state, they are issued a certificate of authority to operate in that state
Some nonadmitted companies can be authorized to work in the state, they are called _________?
Surplus line broker
What are surplus line brokers?
Companies that nonadmitted but are authorized to work in a certain state. They market their products through surplus line agents. Surplus line brokers will write coverage on types of risks that other insurers will not write.
What is domestic insurer?
an insurance company formed and domiciled under the laws of their home state.
What is foreign insurer?
an insurance company formed under the laws of the United States or a particular state of the US that is not their home state.
What is alien insurer?
an insurance company formed under the laws of country other than the United States and its districts/terriorites
What is Stock Company?
an incorporated insurance company with its capital divided into shares. Stock companies are owned by their shareholders.
What is Mutual Company?
an incorporated insurance company without permanent stock. Mutual companies are owned by its policyholders.
What is self-insurance?
some companies/individuals choose to self-insure. with this option, part or all risk of loss is borne without the benefit of insurance coverage to fall back on if a loss occurs.
What is the Terrorism Risk Insurance Act (TRIA) and how did it come about?
-Prior to 9/11 terrorist attacks on the USA, insurers generally did not exclude or separately charge for coverage of terrorism risk. In response to 9/11, Congress passed the Terrorism Risk Insurance Act.
-This Act establishes a temporary federal program through which the federal government shares with insurance industry losses resulting from acts of terrorism.
-The Act compels insurers to offer terrorism coverage and in the event of a terrorist attack, will provide federal funds to assist insurers in paying claims.
What does Terrorism Risk Insurance Act (TRIA) cover?
Commercial property insurance
Commercial casualty insurance
Directors/Officers liability insurance
Workers compensation insurance
What is act of terrorism? Who certifies this?
any act certified by the Secretary of Treasury in concurrence with the Secretary of State, and Attorney General, to be an act that is dangerous to human life, property, and/or infrastructure and to have resulted in damage within the USA
No act will be certified by the Secretary of Treasury as an act of terrorism if:
Property and casualty insurance losses resulting from the act, in the aggregate, DO NOT exceed $5,000,000. Therefore, if losses do not exceed $5,000,000 it will not be certified an act of terrorism by the Secretary.
What happens when an act is declared and certified as an act of terrorism?
the insurers pay losses without subsidy from the Federal Government up to $100 million dollars. After the combined losses of all insurers exceed $100 million dollars, the Federal Government subsidizes the insurers for the loss. When the combined losses of all insurers involved in the event exceed $100 million dollars, the program trigger is applicable requiring the government to share in the losses.
What is the aggregate limit for losses in terrorist acts?
What is the trigger limit for losses in terrorist acts?
What are the penalties for insurance fraud and/or false statements?
fines and/or imprisonment for up to 10 years
Who created the Telemarketing and Consumer Fraud and Abuse Prevention Act?
The Federal Trade Commission (FTC)
What is the Telemarketing and Consumer Fraud and Abuse Prevention Act?
Unless a telemarketer has a person's prior consent to do otherwise, it is a violation of this rule to make outbound telemarketing calls to the person's home outside the hours of 8 am and 9 pm. The TSR prohibits prerecorded commercial telemarketing calls to consumers (robocalls) unless the telemarketer has obtained permission in writing from the consumer who want to receive such calls. Sellers and telemarketers who violate this will face up to $16,000 per call.
What is the NY State Standard Fire Policy?
In most states, dwelling insurance was previously written using the 165 line 1943 NY State Standard Fire Policy. This form provided protection against direct loss from fire, lightning, and removal which covers property being removed from the premises to protect it from further damage from the perils insured against.
Main differences between Dwelling Policy and Homeowner's Policy?
Dwelling insurance does not require the risk to be owner occupied. Nor does the Dwelling Policy automatically contain the peril of theft or personal liability coverages. These coverages must be added by endorsement.
The Homeowner's Policy automatically covers theft and includes personal liability coverages without endorsements. The Dwelling Policy is usually used to cover risks that may not qualify for the Homeowner's Policy. This could consist of rental property, older homes, hunting cabins in rural areas, etc.
Eligibility requirements for a residence/incidental business under the Dwelling Policy?
Single family home
1-4 family houses
Maximum 5 roomers/boarders
Are farm dwellings or other farm property eligible for the Dwelling Policy?
What are the 3 perils covered under the DP-1 Basic Dwelling Policy? What endorsements can be added to increase perils covered?
-fire, lightning, internal explosions
-Extended Coverage (EC) Perils and Vandalism & Malicious Mischief (VMM) endorsement
For the Extended Coverage (EC) Perils, what perils are covered under this form?
Riot (not done by wild animal)
What perils are covered for DP-2 Broad Dwelling Policy?
-all perils in DP-1 which includes EC Perils and Vandalism and MM endorsement
-Broad form perils
What are the Broad form perils for DP-2?
Accidental discharge (overflow of water/steam)
Freezing of pipes
What perils are covered for DP-3 Special Dwelling Policy?
Open perils for Dwelling and Other structures. Provides Broad form perils for personal property
What is the definition of fire? Name the two types and define them.
Fire-is a rapid oxidation, accompanied by a flame, spark, or glow. It must also be sudden and unexpected, no a long-term, predictable process such as scorching.
1. Friendly fire-one that is contained in the place intended for it (fireplace)
2. Hostile fire-one that has spread beyond its intended place
Define windstorm coverage.
includes high winds, cyclones, tornadoes, and hurricanes.
Define volcanic eruption coverage and what is excluded?
-covers damage caused by the eruption of a volcano, including the ensuing lava flow and airborne particles. One or more volcanic eruptions that occur within a 72 hour period will be considered as one volcanic eruption.
-Excludes loss caused by earthquakes, land shock waves, and/or tremors.
What is the Vandalism & Malicious Mischief (VMM) endorsement?
Optional coverage which applies only if a premium is shown on the Declarations page of the policy. It covers loss caused by intentional and malicious damage to insured property. All dwelling forms state there is no coverage for vandalism or malicious mischief if the dwelling has been vacant for more than 30 consecutive days.
NY LAW: What is name of the person who is in charge of Department of Insurance/Financial Services for the State of NY?
NY LAW: Who appoints the Superintendent?
governor of NY
NY LAW: If the Superintendent is absent or unable to perform duties for 30 consecutive days, who appoints a deputy to serve?
governor of NY
NY LAW: What are the powers of the Superintendent?
-Conduct investigations, research, studies, and analyses of matters affecting the interests of consumers of financial products and services, including tracking and monitoring complaints
-Protect users of financial products and services
-Examination of insurer records/affairs/transactions
NY LAW: Insurers conducting business in New York must be examined in detail at least once every ___ years.
NY LAW: An insurer has no less than ___ days to respond to Superintendent's request for information. What can the Superintendent do if a response is not made?
-the Superintendent is authorized after notice and hearing to levy a civil penalty against such a person in an amount not to exceed $500 per day for each day. In no event, will the penalty exceed $10,000.
NY LAW: The Superintendent levies ___ separate civil penalties against any one person within ___ years for failure to comply for information request. What are the penalties?
-penalties cannot exceed $50,000
NY LAW: Why would a Superintendent conduct a hearing?
-believe that a person has committed or is committing an unfair method of competition or unfair and deceptive act
NY LAW: Superintendent must give written notice of such a hearing at least ___ days in advance and identify the time, date, location, and purpose of the hearing
NY LAW: What are the licensing requirements for being a public adjuster in the State of NY?
• Must be at least 18 years of age when the license is issued
• Must submit to fingerprinting
• The application for the license must be approved by at least five reputable citizens of the community where the applicant resides. They must certify that they have known the applicant for at least five years and believe the statements in the application are true. Each of these citizens must sign an affidavit which reads: "Under penalty of perjury, I affirm that the statements made in the foregoing affidavit are and hereby subscribe thereto."
NY LAW: What is a public adjuster? What is the maximum compensation fee? How many years must they retain their book?
-a person, firm, or corporation that, for compensation, acts on behalf of an insured in negotiating the settlement of certain claims for loss or damage of property.
-12.5% of the recovery
-3 years from the date of compensation
NY LAW: Who are the individuals not required to secure an Adjuster's License?
• An officer, director, or regular salaried employee or manager of an authorized insurer, or attorney in fact of any reciprocal insurer of Lloyds underwriter, or marine underwriting office unless they are acting as an auto body repair estimator.
• A licensed agent of an authorized insurer who adjusts losses solely for policies issued through the agent's insurance agency as long as the agent receives no compensation in excess of $50 per loss adjusted.
• An average adjuster of maritime losses.
NY LAW: The Superintendent of Insurance can issue a temporary adjuster permit in ___ situations for up to ___ days to assist in the adjustment of claims arising from a common ____.
NY LAW: When's does the adjuster's license expire for the State of NY?
expire on December 31 of even numbered years and may be renewed for the ensuing two calendar years
NY LAW: What bond is required for an adjuster's license? What is the amount that must be paid and to whom is it paid?
surety bond is needed for every adjuster's license. The amount is $1000 and must be paid to the people of the State of New York.
NY LAW: Every licensee must notify the Insurance Department of any change in the business or residence address within ___days of the change.
NY LAW: What are the fingerprint requirements?
individual signing an application for a license must submit with the application to the Superintendent fingerprints of his/her two hands recorded in such manner as may be specified by the Superintendent or his authorized representative.
NY LAW: Any administrative action taken against the licensee must be reported within ___ days of the final deposition of the matter.
NY LAW: When must the hearing be held?
The hearing must be held at least 10 days after the date the notice is served.
NY LAW: What is the violation of Cease/Desist orders?
penalty of up to $5000 for each violation
NY LAW: Instead of revoking/suspending the license, the Superintendent may order the licensee to pay a penalty of up to ___.
$500 for each offense up to an aggregate penalty of $2,500 for all offenses
NY LAW: Unfair settlement practices include?
-Knowingly misrepresent to a claimant pertinent facts or policy provisions related to the coverage at issue.
-Failing to acknowledge within reasonable time, communications with respect to claims arising out of its policies.
-Not attempting in good faith to effectuate prompt, fair, and equitable settlements of claims submitted in which liability has become reasonable clear.
NY LAW: What is the fine for Unfair settlement practices?
A fine in the amount of $500 will be made against the insurance company for each violation
NY LAW: Insurer must maintain a complaint record for ___ calendar years after all elements of the complaint are resolved and the file is closed.
NY LAW: No suit or action on a policy for the recovery of any claim will be sustainable in any court of law or equity unless all the requirements of the policy have been compiled with, unless commenced within ___months next after inception of the loss.
NY LAW: Every insurer, upon notification of a claim, must within __ working days, acknowledge the receipt of such notice
NY LAW: Every insurer, upon receipt of any injury from the Insurance Department respecting a claim, must, within ___ business days, furnish the Department with the available information requested respecting the claim.
NY LAW: Every insurer must establish procedures to commence an investigation of any claim filed by a claimant, or by a claimant's authorized representative, within ___ business days of receipt of notice of claim.
NY LAW: Within ___ business days after receipt by the insurer of a properly executed proof of loss and/or receipt of all items, statements and forms which the insurer requested from the claimant, or the claimant's authorized representative, must be advised in writing of the acceptance or rejection of the claim by the insurer.
NY LAW: Every insurer must pay any amount finally agreed upon in settlement of all or part of any claim not later than ___ business days from the receipt of such agreement by the insurer or from the date of the performance by the claimant of any condition set by such agreement, whichever is later, except as provided by law with to respects liens by tax districts on fire insurance proceeds.
NY LAW: With respect to motor vehicle claims, substantially similar vehicle means?
a vehicle of the same make, model, year, and condition, including all major options of the insured vehicle. Mileage must not exceed that of the insured vehicle by more than 4,000 miles or 10% of the mileage on the vehicle at the date of loss, whichever is greater
NY LAW: With respect to motor vehicle claims, what does OEM stand for?
Original equipment manufacturer
NY LAW: With respect to motor vehicle claims, local market area means?
a 100-mile radius, limited to within the United States, of the place of principal garagement of the insured's motor vehicle.
NY LAW: With respect to motor vehicle claims, a location reasonably convenient to the insured means?
-in Nassau, Suffolk and Westchester counties and cities with 100,000 or more population, 10 miles-and in all other areas of the State
-25 miles-from the place where the motor vehicle is principally garaged; or the location of the insured's repair facility.
NY LAW: What are the names of the manuals approved for retail values for a substantially similar vehicles?
the Redbook (published by National Market Reports) and NADA Official Used Car Guide (published by the National Automobile Dealers Used Car Guide Company). The use of other manuals must be approved by this Department.
NY LAW: What is the distance that is reasonably convenient for the insured, when getting a quotation for a substantially similar vehicle?
25 miles of the place of principal garagement of the motor vehicle
NY LAW: With respect to motor vehicle claims, the quotation obtained from a computerized database, approved by the Superintendent, that produces statistically valid fair market values for a substantially similar vehicle, within the local market area that meets all the following minimum criteria?
-It must produce values for at least 85% of all makes and models of private passenger automobiles, for the last 15 models years, and take into account the values of all major options for such vehicles.
-It will rely upon values derived from licensed dealers, which have minimum sales of 100 motor vehicles per year in the local market area for all vehicles of seven model years or less of age, and be based upon the physical inventory of vehicles sold within the 90 days prior to the loss and vehicles which are available.
-It will monitor the average retail price of private passenger automobiles when there is insufficient data or inventory available from licensed dealers to ensure statistically valid local market area values.
NY LAW: With respect to motor vehicle claims, if the settlement offer is greater than the purchase price plus the cost of substantiated improvements paid by the insured for a vehicle purchased within the ___calendar days prior to date of loss, the insurer's offer of settlement may be limited to the purchase price, plus the cost of any substantiated improvements, less the deductible.
NY LAW: With respect to motor vehicle claims, if within ___ calendar days after mailing of the claim payment, the insured notifies the insurer in writing that the insured cannot purchase a comparable vehicle for the market value, as determined above, the insurer must reopen its claim file and offer, in its discretion and subject to applicable deductions, one the following options to the insured:
-the insurer must identify and offer for settlement an amount sufficient to purchase a substantially similar vehicle, as provided in this section.
-the insurer must pay the insured the difference between the amount of its claim payment and the cost of a substantially similar vehicle, located by the insured, or the insurer, upon consent of the insured, may purchase that vehicle for the insured.
NY LAW: With respect to third party property claims, if the insurer determines that there was no policy in force or that it is disclaiming liability because of a breach of policy provisions by the policyholder, the insurer must inform the claimant in writing within ___ business days of such determination.
NY LAW: With respect to third party property claims, insurers must report to the NICB, vehicles involved in a property damage claim where the damage to the motor vehicle is in excess of $___.
NY LAW: With respect to third party property claims, within ___ business days of the completion of its investigation of a property damage claim, the insurer must?
-Must make a written offer which is first computed in the same manner as would be used if the claim were made under a first party coverage by one of its insureds.
-May deny the claim in writing giving specific reason therefore.
NY LAW: With respect to third party property claims, the investigation is not complete ___ calendar days subsequent to the claimant's notice of loss, the insurer must send a written explanation of the specific reasons for the delay in claim settlement.
NY LAW: What is Gramm-Leach-Bliley Act (GLBA)?
-requires that state insurance authorities establish appropriate consumer privacy standards for insurance providers
NY LAW: What does opt out?
means a direction by a consumer that the licensee not disclose nonpublic personal financial information about the consumer to a nonaffiliated third party.
NY LAW: How must a licensee treat nonpublic personal information about consumers?
-Requires a licensee to provide notice to individuals about its privacy policies and practices.
-Provides methods for individuals to prevent a licensee from disclosing that information.
-Provides a method for individuals to prevent a licensee from disclosing nonpublic personal health information by not affirmatively consenting to such disclosure.
What are the elements of a legal contract?
• Competent parties (C)
• Legal purpose (L)
• Offer and Acceptance (O)
• Consideration (C)
In a legal contract, what are competent parties?
• The parties to the contract must be of legal age, sane, sober, of sound mind and under no legal handicap or duress. Persons who might lack legal capacity are minors, people who are intoxicated or those adjudged incompetent.
In a legal contract, what is a legal purpose?
• The purpose of the contract itself must be legal. Insurance contracts are generally considered to serve a legal purpose, but it is certainly possible for a mechanism like life insurance which pays one person upon another's death, to be misused.
In a legal contract, what is an offer and acceptance?
• To form a contract, there first must an offer followed by an acceptance.
In a legal contract, what is a consideration?
• In order for the agreement to become binding, each party must give the other something of value, such as money, promises, property or service.
In a legal contract, what are the elements in an applicant's consideration?
settlement (payment) of the first premium, and statement made in the application.
What is Doctrine of Utmost Good Faith?
to form an insurance contract, each party must substantially rely on the integrity of the other party.
What is Doctrine of Reasonable Expectations?
says that one's insurance policy should do for him and/or his beneficiaries what he could reasonably expect it to do.
How is an insurance contract a contract of adhesion?
the insurance company is the author of the contract and the insured must accept it "as is."
Since there is an unequal bargaining strength between the parties; therefore any ambiguous language will bring a court decision in favor of the ___.
How are insurance contracts aleatory contracts?
an insurance contract is said to be aleatory or dependent upon chance or uncertain outcome, because one party may receive much more in value than he/she gives in value under the contract.
How are insurance contracts personal contracts?
generally insurance policies are personal contracts between the insured and the insurer.
How are insurance contracts unilateral?
after the premium is paid by the insured, only one party has an obligation to do anything further (insurance company).
How are insurance contracts ambiguous?
since the insurance contracts are contracts of adhesion, meaning the insured has no part in determining the wording of the contract, therefore the courts will interpret the contract in favor of the policy owner, insured, or beneficiary.
means to compensate or reimburse. Insurance contracts are contracts of indemnity, meaning the purpose of the contract is to reimburse an insured for a covered loss, thereby, restoring the insured to the financial position that he/she enjoyed prior to the loss.
What are representation statements?
statements believed to be true to the best of one's knowledge, but they are not guaranteed to be true.
What is misrepresentation?
refers to inaccurate, incomplete or false statements made by either party to the contract.
What is concealment?
-failure of an applicant to reveal all the facts that should have been divulged to the insurance company.
-Under certain state statues, this will void coverage under a contract.
What is estoppel?
a legal bar to changing or denying a fact because of one's own previous actions or words to the contrary. The doctrine of estoppel prevents, one from changing his mind once committed to a course of action
What is waiver?
-giving up or surrendering a right or privilege that is known to exist.
-May be affected orally or in writing by an agent or company official.
NY LAW: Define accidental injury.
generally traumatic damage to the body, of external origin, unexpected and unintended by the injured person.
NY LAW: Define sickness.
includes physical illness, disease, pregnancy, but does not include mental illness.
NY LAW: What are 4 classifications of disability and define them?
-Permanent total-is the most severe; the insured will never work again.
-Temporary total-renders an insured incapable of working for a given time, but recovery is seen.
-Permanent partial-involves an injury that is permanent in nature (loss of an arm, leg) but will not stop the individual from eventually returning to work.
-Temporary partial-is the least severe classification; an injury that keeps the individual out of work for a few days (sprain); "light duty" can be given to such a disability.
NY LAW: Disability insurance is designed to provide a reasonable and predetermined income to a disabled party a set period of time subject to a "time deductible" known as an ___.
NY LAW: What are group under Medical Expense Insurance?
basic hospital, surgical, and medical policies and major medical policies
NY LAW: Why is Medical Expense Insurance referred to as first-dollar coverage?
These types of coverage are often referred to as first-dollar coverage because they usually do not require the insured to pay a deductible.
NY LAW: What is Basic Hospital Expense Coverage?
hospital expense policies cover hospital room and board, and miscellaneous hospital expenses, such as lab, x-ray charges, medicines, use of operating room/supplies, while the insured is confined in a hospital.
NY LAW: What are Miscellaneous Hospital Expenses?
normally have separate limits from other coverages, and pays for other miscellaneous expenses associated with an in-hospital stay. The benefits provided by this coverage are drugs, x-rays, and lab expenses (DXL).
NY LAW: What is Basic Medical Expense Coverage?
known as Basic Physicians Nonsurgical Expense Coverage since it provides coverage for nonsurgical services a physician provides.
NY LAW: What is Basic Surgical Expense Coverage?
is often written in conjunction with Hospital Expense policies. Each contract has a surgical schedule that list the types of operations covered. If the operation is not listed, the contract may pay for a comparable operation.
NY LAW: What are Major Medical Policies?
offers a broad range of coverage under one policy. These policies are intended to provide the insured with catastrophic medical expense protection. Major medical contracts usually provide high maximum limits ($1mill to $2mill). Policies written on a lifetime basis provide coverage under one policy up to a stated limit for the "lifetime" of the policy.
NY LAW: What is Long Term Care Expense?
Insurance that provides coverage for a specified number of consecutive months in a setting other than an acute care unit of a hospital.
NY LAW: Long term care policies are designed to provide the following types of care in a nursing home setting? Define them.
-Skilled nursing care-daily nursing and rehabilitative care that can only be provided by medical personnel, under the direction of a physician. Skilled care is almost always provided in an institutional setting.
-Intermediate care-occasional nursing and rehabilitative care provided by medical personnel. Not 24 hour care.
-Custodial care/residential care-care for meeting personal needs such as assistance in eating, dressing, or bathing provided under a doctor's orders, but by nonmedical personnel.
-Respite care-designed to provide relief to the family care giver, and can include a service such as someone coming to the home while the caregiver goes out for a while.
NY LAW: What are characteristics of long term care policies?
-Eligible age groups (usually 50-80)
-Renewability: must be issued as guaranteed renewable (not cancelable)
-Policy benefit period (usually 2-5 years)
NY LAW: What are activities of daily living (ADL)?
Perform other acts of personal hygiene
Transfer from bed to sofa/chair
NY LAW: What are guaranteed renewable health insurance contracts?
are "guaranteed" from the insured's point of view (usually to age 65/70 at which the insured is eligible for Medicare benefits). Guaranteed renewable contracts "guarantee" the continuation of health protection, but not the continuation of the same premium charges.
NY LAW: What is Group Health Insurance?
is provided by an employer or other group sponsor for eligible employees/members. The actual policy, called a master contract, is issued to the group sponsor, while the individual insureds are issued certificates of insurance as proof of their coverage.
NY LAW: Under Group Health Insurance, how can terminated employees convert their polices?
are permitted to convert their group insurance to individual insurance without evidence of insurability. This option must be initiated during the conversion period, which is within 31 days of termination of employment.
NY LAW: Under Group Health Insurance, group policies must contain?
-Grace period-usually 31 days
-Entire contract-the master application must attached to and made part of the contract.
NY LAW: Define Private Health Insurance Coverage.
insurers of private health insurance coverage are the traditional stock and mutual companies, Blue Cross/Blue Shield, as well as the health maintenance organizations and preferred provider organizations formed by hospitals and physicians to deliver health care directly to enrollees in their plans.
NY LAW: Define Blue Cross Blue Shield.
-usually are community sponsored, nonprofit organizations, under special state legislation.
-Blue Cross is a membership hospital plan, providing the following benefits to insureds (known as subscribers) for:
Hospital expenses (room/board)
Outpatient services (X-rays, emergency care)
Supplementary benefits (nursing care)
-Blue Shield is a membership medical-surgical plan, providing the following benefits for insureds known as "subscribers" for:
NY LAW: Define Health Maintenance Organization (HMOs).
were established to manage health care and the associated costs by providing prepaid care that emphasizes preventive care.
NY LAW: Define Preferred Provider Organizations (PPOs).
is seen as the traditional medical systems' answer to HMOs. In the PPO system, the physicians are paid fees for their services rather than a salary, but the member is encouraged to visit approved member physicians that have previously agreed upon the fees to be charged. This encouragement comes in the form of benefits.
NY LAW: Define Government Health Insurance
both the federal and state government offer statutory health insurance programs. On the federal level, Social Security provides disability income benefits and administers the Medicare program. On the state level, all states have workers compensation laws and Medicaid or some form of state subsidized health care.
NY LAW: Define Medicare
is a federal health insurance program for persons 65 or older, persons of any age with permanent kidney failure and certain disabled persons.
NY LAW: What does Medicare consist of?
-Hospital Insurance (Part A) provides institutional care, including inpatient hospital care, skilled nursing home care, home health care and under certain circumstances, hospice care. Hospital Insurance is financed for the most part by Social Security payroll deductions which are deposited in the Federal Hospital Insurance Trust Fund. Medicare beneficiaries also participate in the financing of Hospital Insurance by paying deductibles, coinsurance and premiums.
-Medical Insurance (Part B) is a voluntary program of health insurance which covers physician's services, outpatient hospital care, physical therapy, ambulance trips, medical equipment, prosthesis and a number of other services not covered under Hospital Insurance. It is financed through monthly premiums paid by those who enroll and contributions from the federal government.
NY LAW: When do Medicare become available?
become available at the beginning of the month in which the individual reaches age 65.
NY LAW: The Social Security Program was known as?
Old Age, Survivors, Disability and Health Insurance (OASDHI)
NY LAW: What requirement must be met in order to receive Social Security benefits?
requirement that must be met for Social Security disability benefits is the satisfaction of a five-month waiting period. The disabled worker must wait five full calendar months before the first disability income payment will be made.
NY LAW: Social Security Program provides four principle benefits?
NY LAW: Workers Compensation pays what four types of benefits?
-Medical benefits-provided without limit
-Income benefits-paid to employees who suffer work-related disabilities. For permanent total disability or temporary total disability, the benefit is 66 2/3% of weekly wages
-Death benefits-up to a certain dollar amount is provided as a burial allowance, and the state also provides weekly income payments for a surviving spouse and/or children. Weekly benefits are 66 2/3% of the deceased worker's wages.
NY LAW: Define/Describer Medicaid
-a federal and state funded program for those whose income and resources are insufficient to meet the cost of necessary medical care.
-Individual states design and administer the Medicaid program under broad guidelines established by the federal government. The federal government provides about 56 cents for every Medicaid dollar spent, and the states provide the balance.
-Before Medicaid will reimburse a patient for any nursing home costs, he or she must first pass certain income and asset limitation tests, called means tests.
-Individuals must disclose all assets and income in a questionnaire. Certain assets are not considered in the test and are referred to as non countable assets. These types of assets include a primary residence, one car, wedding ring, and certain life insurance cash values. All other assets are referred to as countable assets and are taken into consideration under the limitation tests.
NY LAW Medial Prefix: ANTI
NY LAW Medial Prefix: BI
NY LAW Medial Prefix: ECTO
NY LAW Medial Prefix: ENDO
NY LAW Medial Prefix: HEMI
NY LAW Medial Prefix: HYPER
NY LAW Medial Prefix: HYPO
NY LAW Medial Prefix: MICRO
NY LAW Medial Prefix: PARA
NY LAW Medial Prefix: PERI
NY LAW Medial Prefix: POST
NY LAW Medial Prefix: SEMI
NY LAW Medial Prefix: TACHY
NY LAW Medial Prefix: TRI
NY LAW Medial Prefix: UNI
NY LAW Medial Suffix: ECTOMY
EXCISION, SURGICAL REMOVAL
NY LAW Medial Suffix: EXTOPIC
NY LAW Medial Suffix: EMIA
NY LAW Medial Suffix: GRAPH
INSTRUMENT USED TO RECORD
NY LAW Medial Suffix: GRAPHY
PROCESS OF RECORDING
NY LAW Medial Suffix: IATRY
NY LAW Medial Suffix: ISM
NY LAW Medial Suffix: LEPSY
NY LAW Medial Suffix: MORPH
NY LAW Medial Suffix: OLD
NY LAW Medial Suffix: OLOGY
NY LAW Medial Suffix: OTOMY
CUT INTO OR INCISION
NY LAW Medial Suffix: SARCOMA
NY LAW Medial Suffix: URIA
NY LAW Medial Root Words: ARTERI
NY LAW Medial Root Words: CEREBR
NY LAW Medial Root Words: DERM
NY LAW Medial Root Words: PLASM
NY LAW Medial Root Words: GINGIV
NY LAW Medial Root Words: GLOSS
NY LAW Medial Root Words: GYNEC
NY LAW Medial Root Words: HEPAT
NY LAW Medial Root Words: NEPHR
NY LAW Medial Root Words: STOMAT
NY LAW Medial Report Abbreviations: ABG
ARTERIAL BLOOD GAS
NY LAW Medial Report Abbreviations: ADL
ACTIVITIES OF DAILY LIVING
NY LAW Medial Report Abbreviations: DNA
NY LAW Medial Report Abbreviations: DPT
DIPTHERIA PERTUSSIS TETNUS
NY LAW Medial Report Abbreviations: EEG
NY LAW Medial Report Abbreviations: FDA
Food & Drug Admin
NY LAW Medial Report Abbreviations: GI
NY LAW Medial Report Abbreviations: CCU
coronary care unit
NY LAW Medial Report Abbreviations: COPD
chronic obstructive pulmonary disease
NY LAW Medial Report Abbreviations: CPR
NY LAW Medial Report Abbreviations: MRI
magnetic resonance imaging
NY LAW Medial Report Abbreviations: OBGYN
obstetrics and gynecology
NY LAW Medial Report Abbreviations: GP
NY LAW Medial Report Abbreviations: ICU
intensive care unit
NY LAW Medial Report Abbreviations: MD
NY LAW Medial Report Abbreviations: RN
NY LAW Medial Report Abbreviations: ROM
range of motion
NY LAW Medial Report Abbreviations: SOB
short of breath
NY LAW Medial Report Abbreviations: URI
upper respiratory infection
NY LAW Medial Report Abbreviations: UTI
urinary tract infection
Skeleton is composed of ___ bones.
Face is composed of ___ bones.
Medical Terms: mandible
Medical Terms: coccyx
Medical Terms: sacrum and iliac bones make up?
Medical Terms: thorax
chest area comprised of 12 pairs of ribs
Medical Terms: clavical
Medical Terms: zygomas
Medical Terms: maxillae
upper cheek bone
NY LAW: Strain is?
tearing injuries to muscles. Usually causes some degree of bleeding within the muscle tissue
NY LAW: Sprain is?
tearing injuries to ligaments
NY LAW: Soft tissue injury is?
-injury to soft tissue of the body including contusions (bruises), ligament sprain, tendon and/or muscle strain
NY LAW: What are the burn classifications?
o First degree-damage only to the top layer of skin and results in reddened, dry skin which is minor and heals quickly
o Second degree-damage the top layer of skin and some portion of the second layer of skin which result in blistered skin and requires prompt medical attention.
o Third degree-burns that destroy the top layer of skin and the second layer of skin resulting in charred tissue surrounded by blistered areas and are considered severe and require immediate medical attention
NY LAW: Repetitive Motion Injuries are?
injuries resulting from performing repetitive tasks. (example: carpel tunnel syndrome)
NY LAW: What is Magnetic Resonance Imaging (MRI)?
a test that provides pictures of organs and structures inside the body by using a magnetic field and pulses of radio wave energy. In many cases, MRI provides information that cannot be obtained with the use of x-rays. No x-rays are used in an MRI scanner. Tissues and organs that contain water provide the most detailed MRI pictures, while bones and other hard materials in the body do not show up well on MRI pictures.
NY LAW: What is Electromyography (EMG)?
a test which measures muscle response to nerve stimulation. Used to evaluate muscle weakness and to determine if the weakness is related to the muscles themselves or a problem with the nerves that supply the muscles.
NY LAW: What is Electrocardiogram (EKG)?
the recording of the electrical activity of the heart on a moving strip of paper. The electrocardiogram detects and records the electrical potential of the heart during contraction.
NY LAW: What is Electroencephalography (EEG)?
the recording of the electrical currents developed in the brain, by means of electrodes applied to the scalp, to the surface of the brain or placed within the substance of the brain.
NY LAW Automotive Abbreviations: ABS
antilock braking system
NY LAW Automotive Abbreviations: CNG
compressed natural gas
NY LAW Automotive Abbreviations: OEM
original equipment manufacturer
NY LAW Automotive Abbreviations: PZEV
partial zero emission vehicle
NY LAW Automotive Abbreviations: RPM
revolutions per minute
NY LAW Automotive Abbreviations: ZEV
zero emission vehicle
NY LAW: In regards to automotive insurance, inspections can be waive if?
o A new, unused automobile purchased from a franchised dealer where the insured provides the company with a copy of the bill of sale containing the full particulars of the automobile.
o An automobile insured under a fleet policy consisting of five or more automobiles.
o An additional or replacement automobile if the insured has been continuously insured for physical damage with the same insurer for 4 years.
NY LAW: In regards to automotive insurance, what is the inspection report used for?
The inspection report is not a safely inspection. If the insured makes a claim for damage to or theft of their automobile, the inspection report will be used to determine the condition of the automobile and its equipment before the loss occurred.
NY LAW: In regards to automotive insurance, what is the Financial Responsibility Law?
• Most states have some form of financial responsibility law that affects owners of vehicles.
• Proof of financial responsibility in New York can be evidenced by one of the following:
o An automobile liability insurance policy
o A financial security bond or security deposit
o Becomes a qualified self-insurer
NY LAW: In regards to automotive insurance, for the Financial Responsibility Law, the minimum amount of coverages are...
o $25,000 per person and $50,000 per accident for bodily injury
o $50,000 per person and $100,000 per accident per death
o $10,000 per accident for property damage to others
NY LAW: In regards to automotive insurance, an uninsured motor vehicle means?
o A stolen vehicle
o An unregistered vehicle
o A motor vehicle operated without permission of the owner
o An unidentified motor vehicle which leaves the scene of an accident
o A motor vehicle registered in New York for which a policy of liability insurance was not in effect at the time of accident
o An insured motor vehicle for which the insurer denies liability or coverage or insolvency
NY LAW: In regards to automotive insurance, what are the minimum limits for coverage?
The minimum limits are 25/50 with a wrongful death limit of 50/100
NY LAW: In regards to automotive insurance, is stacking of uninsured motorists limits allowed?
NY LAW: In regards to automotive insurance, what are the maximum limits for supplementary uninsured motorists coverage?
the policy must provide supplementary uninsured motorists coverage (also known as SUM) for bodily injury in an amount up to the bodily injury liability limits of insurance provided under the policy. Insurers are not required to provide more than a maximum limits of $250,000 per person, and $500,000 per accident, but are permitted to offer high SUM limits if they wish.
NY LAW: What is the Rental Vehicle Coverage Endorsement?
the intent of the endorsement is to provide coverage for vehicles that an insured rents. It eliminates the question of whether or not collision deductible (CDW) waivers should be purchased, and it standardizes the question of coverage for rental vehicles when there is damage to the vehicle.
NY LAW: The Rental Vehicle Coverage Endorsement only applies to vehicles rented for how many days?
NY LAW: The Rental Vehicle Endorsement (Rental Endorsement) is mandatory coverage in New York for all policies with ___ private passenger motor vehicles.
NY LAW: The Rental Vehicle Coverage Endorsement has what type of limit?
no set limit
NY LAW: Under the Rental Vehicle Coverage Endorsement, what is the deductible a car agency can charge for property damage?
NY LAW: In regards to automotive insurance, the first ___ days an automobile policy is in effect, no notice of cancellation is valid unless is states the specifics reasons for the action.
NY LAW: In regards to automotive insurance, after a policy has been in effect for more than 60 days the insurer can only terminate the policy for the following reasons?
o Nonpayment of premium
o Suspension or revocation of the driver's license of the named insured or any other person who regularly operates an insured vehicle
o Evidence of fraud or material misrepresentation in obtaining a policy or presenting a claim
NY LAW: In regards to automotive insurance, an insurer is entitled to cancel a policy it may in lieu of the cancellation, reduce the limits (but not less than those required by law), or the lawful elimination of coverage provided the insured is sent a written notice ___ days in advance of the changes.
NY LAW: In regards to automotive insurance, the insurer can a nonrenewal notice or an offer of a conditional renewal by sending the insured a written notice at least 45 days but not in excess of ___ days in advance of the policy expiration date.
NY LAW: In regards to automotive insurance, the insurer can only nonrenewal a policy for certain reason, including the same reasons for allowable cancellations of the policy. They are...
o Operating a vehicle while under the influence of alcohol or drugs
o Homicide or assault or criminal negligence while operating a motor vehicle
o Using the vehicle while committing a felony
o Operating a vehicle in a reckless manner or driving in excess of the speed limit resulting in injury or death
o Driving without a valid driver's license
o Leaving the scene of an accident
o Operating the vehicle in a race or speed test
o Three or more accidents by any insured driver where bodily injury or property damage is in excess of $200
NY LAW: In regards to automotive parts, floorplan is?
-the metal structures on the bottom of the car that your feet rest on while in the car.
-Almost all cars are unit body (or unibody) construction, and the floorplan provides the foundation for chassis stiffness.
-The floorplan forms the floor and fixes the dimensions for most the car's external and structural panels. It is also the foundation for many of the car's mechanical parts.
NY LAW: In regards to automotive parts, rear quarter panel is?
a rear section of the body shell which incorporates the rear fender and usually also the C-pillar. In modern car bodies, the rear fender usually is no longer a separate welded or bolt-on panel. Instead it blends smoothly into the bottom of the rear window frame and rear panel.
NY LAW: In regards to automotive parts, the Door Skins, Inside the Car Door is?
most sheet metal doors are made in three pieces, the frame (which the inner door panel and armrest attach to), the window channel (which is welded to the doorframe), and the skin (which attaches to the doorframe and the outside of the window channel).
NY LAW: In regards to automotive parts, the Cowl is?
-the part of the vehicle body between the engine firewall and the front of the dashpanel.
-It usually houses the instruments and the plenumchamber for the heater-ventilation system.
-The cowl is also the part of the bodywork which protects and/or provides streamlining for a usually projecting component.
NY LAW: In regards to automotive parts, the cowl hood is?
-a cowl hood most often describes a complete, factory-designed automobile hood assembly.
-The cowl hood allows air to be forced quickly and directly into the air inducers in turn into the combustion chambers.
NY LAW: In regards to automotive parts, the cowl section is?
a subassembly of the body shell that includes the bulkhead, cowl, and windscreen pillars, it is preassembled in the factory and spot-welded with the other subassemblies to form the body shell.
NY LAW: In regards to automotive parts, the cowl shake is?
this is a vibration or shake of a vehicle, usually a convertible type, in the cowl area due to lack of torsional rigidity of the frame and body. A certain amount is almost unavoidable in convertibles unless frame-strengthening weight penalties are of no concern.
NY LAW: In regards to automotive parts, the Cowl Side Panel is?
a vertical panel at either end of the cowl.
NY LAW: In regards to automotive parts, the Rocker Panel is?
-is a three or four inch piece of metal that runs along the bottom of the vehicles body underneath the doors.
-Rocker panels are usually coated with a rock proof protectant which rubberizes the exterior surface before the car or truck is painted.
NY LAW: In regards to automotive parts, unibody construction is?
by far the most common design in use today, sometimes referred to as a sort of frame. But the distinction still serves a purpose: if a unibody is damaged in an accident, getting bent or warped, in effect its frame is too, and the vehicle is undrivable. If the body of a body-on-frame vehicle is similarly damaged, it might be torn in places from the frame, which may still be straight, in which case the vehicle is simpler and cheaper to repair.
NY LAW: In regards to automotive parts, the antilock brakes are?
- the antilock brake controller is known as the controller antilock brake (CAB). A typical ABS is composed of a central electronic unit, four speed sensors (one for each wheel), and two or more hydraulic valves on the brake circuit. The electronic unit constantly monitors the rotation speed of each wheel. When it senses that one or more wheel is rotating slower than the others (a condition that will bring it to lock), moves the valves to decrease the pressure on the braking circuits, effectively reducing the braking force on that wheel.
NY LAW: In regards to automotive insurance, the reasons for New York Comprehensive Automobile Insurance Reparations Act (No Fault)?
o Prompt payment of economic loss to injured persons
o Reduction of lawsuits
o Insurance premium savings
NY LAW: In regards to automotive insurance, the mandatory benefits for New York Comprehensive Automobile Insurance Reparations Act (No Fault)?
-Up to $50,000 per person for:
All reasonable and necessary medical and rehabilitation expenses.
80% of loss earnings up to $1000 per month and $2000 for lost wages
Up to $25 per day for 1 year for other reasonable expenses (hiring housekeeper)
-$2000 death benefit
NY LAW: In regards to automotive insurance, the New York Comprehensive Automobile Insurance Reparations Act (No Fault) has the doctor and hospital expenses paid according to what schedule?
NY LAW: In regards to the New York Comprehensive Automobile Insurance Reparations Act (No Fault), the right to sue is retained for certain cases in bodily injury such as...
o Significant disfigurement
o Permanent loss of use of a body organ, member, function or system
o In case of serious injury, pain and suffering and economic loss that exceeds basic no-fault coverage
NY LAW: In regards to automotive insurance, explain Bodily Injury Liability (Compulsory) coverage(s).
-pays if you are legally liable for injury or death caused by your vehicle.
-Legal fees, bail bonds, and court costs are also covered.
-Pays up to the first limit for any one person and up to the second limit for two or more persons injured. Pays up to the greater of limits selected, or up to $50,000 for death of one person in any one accident, or up to $100,000 for death of two or more persons in any one accident.
NY LAW: In regards to automotive insurance, explain Property Damage Liability (Compulsory) coverage(s).
pays when you are legally liable for damage to the property of others caused by your vehicle. Pays for the damage up the limit selected plus the cost of any legal expenses.
NY LAW: In regards to automotive insurance, explain Basic Personal Injury Protection (Compulsory) coverage(s).
pays for necessary medical, dental, hospital and rehabilitation expenses
80% of your lost earning up to a maximum payment of $2000 per month for three years, and up to $25 per day for other expenses for a period of one year from the date of the accident causing the injury.
You, household relative, occupants of your vehicle and pedestrians are protected for accidents occurring inside New York State.
You and household relatives are also protected for accidents occurring in any state or Canadian province.
New York state residents are also protected in any state or Canadian province provided they are pedestrians, or occupants of your vehicle.
The coverage limit is $50,000 per person per accident with an additional death benefit of $2,000 per person. Duplicate benefits will not be paid to a person when covered by other primary benefits such as certain sick pay plans.
Option A indicates non-deductible PIP coverage for insured and spouse.
Option B indicates $200 deductible PIP coverage. Other option coverage descriptions are available upon request. You must select one of the options.
NY LAW: In regards to automotive insurance, explain Uninsured Motorist (Compulsory) coverage(s).
pays you, and passengers in the insured automobile any monetary damages you are legally entitled to recover as a result of bodily injury or death caused by an uninsured or hit-and-run motorist. The maximum amounts of coverage are:
o Up to $25,000 per person, and $50,000 per accident for bodily injury
o Up to $50,000 per person, and $100,000 per accident for death
NY LAW: In regards to automotive insurance, explain Optional Basic Economic Loss (OBEL) Coverage.
in addition to basic no-fault coverage, you may now also purchase OBEL coverage that will pay certain expenses up to $25,000 above the basic no-fault limit of $50,000.
NY LAW: In regards to automotive insurance, explain, Assigned Risk Plan.
• All insurers licensed to write motor vehicle insurance in New York must subscribe to and participate in the automobile insurance assigned risk plan approved by the Superintendent.
• The plan has been established to provide for the equitable apportionment among insurers of applicants who are entitled to automobile insurance, but who are unable to obtain coverage through ordinary methods.
• The applicant must certify that he tried unsuccessfully to get automobile insurance the past 60 days. When a risk is assigned, the application must be accepted or rejected by the company within two working days.
• This risk is assigned for three consecutive years to the same company
• If the applicant is rejected, he can appeal to the governing committee of the Plan, and as a last recourse he can appeal to the Superintendent of Insurance.
NY LAW: In regards to automotive insurance, what are the grounds for rejection for the Assigned Risk Plan.
o If any person who usually drives the auto does not have a driver's license or is not eligible to obtain one.
o If the applicant or anyone who usually drives the auto owes premium for previous automobile policy issued during the immediately preceding 12 months.
NY LAW: In regards to Personal Auto-Selected Endorsements, explain Joint Ownership Coverage.
o Individuals, other than the husband/wife residing in the same household
o 'Non-resident relatives'-who jointly own a private passenger auto or a pickup or van with a gross vehicle weight of 10,000 lbs or less and is not used in the delivery or transportation of goods and materials.
NY LAW: In regards to Personal Auto-Selected Endorsements, explain Towing and Labor Costs.
provides limited coverage to pay for the repair costs at the place of disablement or the towing cost to place where the vehicle can be repaired.
NY LAW: In regards to Personal Auto-Selected Endorsements, explain Rental Vehicle Endorsement.
provides no-fault coverage for the insured's obligations for damage to or loss of a vehicle rented by the insured under a rental agreement with a term of 30 days or less.
NY LAW: In regards to Personal Auto-Selected Endorsements, explain the amendments of the policy provisions.
o The definition of newly acquired auto is changed. It means a private auto or a pickup or van that is predominately used for non-business purposes that the insured becomes the owner during the policy period.
o This endorsement also modifies low collision and other than collision coverage is provided for newly acquired autos. Coverages will begin on the date the insured becomes the owner of the vehicle is all of the following apply:
-The newly acquired auto replaces a vehicle shown in the Declarations
-The insurer provided Collision or Other Than Collision coverage on the vehicle that was replaced for at least 12 months prior to the date of replacement.
-The insured requests coverage on the new vehicle within three days after he/she becomes the owner.
NY LAW: In regards to the Dwelling Policy, what is not covered under Glass or Safety Glazing Material Other Coverage.
o Any loss if the dwelling has been vacant for more than 30 consecutive days immediately before the loss, unless the breakage results directly from earth movement.
NY LAW: In regards to the Dwelling Policy, explain the power of failure exclusion.
is modified to provide that if a power failure or utility failure results in a loss from a covered peril on the described location, the insurer will pay for the loss caused by the covered peril.
NY LAW: In regards to the Dwelling Policy, explain the conditions.
• A new provision applicable only to three and four family dwellings is added to the loss payment condition. It provides that the insurer will pay certain tax liens before paying for any loss caused by fire.
• The cancellation and nonrenewal conditions are modified to reflect the requirements of New York law. In general, these requirements are as follows:
o A policy may be canceled for nonpayment of premium at any time upon 15 days written notice
o If a policy has been in effect for less than 60 days and is not a renewal, it may be canceled for any reason upon 30 days' notice
o If a policy has been in effect for 60 days or more or is a renewal, it may be canceled only for certain reasons specified by law and only upon 30 days' notice
o A policy may be non-renewed only for certain reasons specified by law; the insurer must provide notice at least 45 days but no more than 60 days before the policy expiration date
NY LAW: In regards to the Homeowner-Selected Endorsements, explain Personal Injury.
provides for the including of coverages such as false arrest, detention, or imprisonment, wrongful eviction, wrongful entry into or invasion of the right of privacy. Libel and slander are also included.
NY LAW: In regards to the Homeowner-Selected Endorsements, explain Personal Property Replacement Cost.
since Coverage C of the homeowner policy covers personal property on an actual cash value basis, this endorsement provides that losses will be adjusted on replacement cost basis.
NY LAW: In regards to the Homeowner-Selected Endorsements, explain Scheduled Personal Property.
some personal property items under the homeowner policy are subject to limitations or should be insured on a broader basis. This endorsement is used to specifically schedule these items. Jewelry, furs, guns or other collectible items can be added. Once these are covered specifically by this endorsement, coverage no longer applies under Coverage C of the HO policy.
NY LAW: In regards to the Homeowner-Selected Endorsements, explain Special Provisions.
New York-this form must be added to all Homeowner policies issued in New York. A summary of its provisions follows:
o The limit of insurance under the credit card, electronic fund transfer card or access device, forgery, and counterfeit money additional coverage is increase from $500 to $1000.
o In provisions that restrict coverage for vacant dwellings, the allowed vacancy period is reduced from 60 days to 30 days.
o In the accidental discharge or overflow of water or steam peril, the exclusion for the loss caused by mold is deleted. The mold exclusion is also removed from the Coverage A and Coverage B exclusions in the HO-3 and the HO-5 forms.
o In the Section II Conditions, the statement that the insurer's duty to defend ends when the limit of liability is exhausted does not apply.
NY LAW: In regards to Worker's Compensation, explain Methods of Coverage.
• State workers compensation laws are either compulsory or elective.
• Able to purchase workers compensation insurance from a state fund or a private insurance company.
• The workers compensation law in New York is a compulsory law.
NY LAW: In regards to Worker's Compensation, explain Exclusive Remedy.
• The remedy provided by the workers compensation law is the exclusive remedy available to an employee or the employee's dependents or representatives against an employer of work-related injuries or death.
NY LAW: In regards to Worker's Compensation, explain the State Insurance Fund (SIF).
• Because of the compulsory nature of the workers compensation law, the Legislature created the State Insurance Fund in 1914 to provide insurance to employers.
NY LAW: In regards to Worker's Compensation, who is covered?
• Virtually all employers in New York State must provide workers compensation coverage for their employees.
• Only needs one employee to have to have worker's compensation coverage.
NY LAW: In regards to Worker's Compensation, who is eligible.
o Workers in all employments conducted for profits. Part-time employees, family members and volunteers are also included under the workers compensation law.
o Employees of the State of New York including some volunteer workers.
o Domestic workers employed forty or more hours per week by the same employer (including full-time sitters or companions, and live-in maids).
o Farm workers whose employer paid $1200 or more for farm labor in the preceding calendar year.
NY LAW: In regards to Worker's Compensation, how are Corporate Officers with Employees affected?
• Any two executive officers of a corporation who each own at least one share of stock and between them own all the shares of stock and have employees are included in the law. One or both the officers may choose to exclude themselves by filing an exclusion form with their insurance carrier at the time the policy is written or renewed.
NY LAW: In regards to Worker's Compensation, how are Corporate Officers with No Employees?
• Any two executives officers of a corporation who each own at least one share of stock and between them own all the shares of stock and have no other persons in their employ are automatically excluded from the law.
NY LAW: In regards to Worker's Compensation, how can businesses comply?
o Obtaining and maintaining a workers compensation insurance policy
o Being self-insured or workers compensation
o Being legally exempt from having to obtain workers compensation coverage
NY LAW: In regards to Worker's Compensation, what businesses are exempt?
o The business is owned by one individual with no employees and is not a corporation
o The business is a partnership under the laws of New York State, and there are no employees
o The business is a one-or-two person owned corporation, with those individuals owning all of the stock and holding all offices of the corporation and there are no employees
NY LAW: In regards to Worker's Compensation, what are some covered injuries?
• The workers compensation law provides compensation only for accidental injuries arising out of and in the course of employment and any disease or infection that may naturally and unavoidably result from them.
NY LAW: In regards to Worker's Compensation, what injuries are not covered?
o Injuries caused solely by the injured employee's intoxication from alcohol or a controlled substance while on duty
o Injuries resulting from the willful intention of the injured employee to injure or kill himself or someone else
o Injuries sustained in the voluntary participation in an off-duty athletic activity not constituting part the employee's work related duties, unless the employer requires the employee to participate in the activity and compensates the employee for doing so or otherwise sponsors the activity
NY LAW: In regards to Worker's Compensation, what benefits are provided?
• The workers compensation law provides four major categories of benefits medical benefits, income benefits, death benefits, and rehabilitation benefits.
• Medical benefits are provided on an unlimited basis. There is no dollar limit or time limit on covered expenses.
• Income benefits (loss of time benefits) are paid to an eligible worker who is disabled because of a job-related accidental injury or occupational disease. Benefits begin after a seven day waiting period, and retroactive benefits will be paid if the disability continues beyond a period of two weeks. Whether the disability is permanent or temporary, the benefit amount is 66 2/3% of lost wages, subject to maximum and minimum dollar amount per week.
• Death benefits include a burial allowance and income benefits for a surviving spouse and/or children. Income benefits to survivors are subject to the same limits that apply to disability benefits: 66 2/3% or the worker's lost wages and a maximum dollar benefit. A spouse is eligible for benefits for life or until remarriage, in which case a two-year lump sum benefit is paid.
NY LAW: Explain Volunteer Firefighters' and Volunteer Ambulance Workers Benefit.
• Introduction to the VFAW Law-the Volunteer Firefighters' and Volunteer Ambulance Workers Benefits Laws provide cash benefits and/or medical care for volunteer members who are injured or become ill in the line of duty.
NY LAW: In regards to Worker's Compensation, how can employers self insure?
• Employers who wish to self-insure for either workers compensation or disability benefits must apply to and be approved by the Board's Office or Self Insurance.
NY LAW: In regards to Worker's Compensation, why should a company choose to become self-insured?
o If there is a potential to reduce the cost and number of claims by:
-Increase commitment to safety
-Loss control techniques such as return to work or light duty programs.
-To improve cash flow
-To avoid the carrier overhead expenses included in the cost of a policy.
NY LAW: What are Disability Benefits?
• New York is one of a handful of states that require employers to provide disability benefits coverage to employees for an off-the-job injury or illness.
• Disability benefits are temporary cash benefits paid to an eligible wage earner, when he/she is disabled by an off the job injury or illness.
• Disability benefits include cash payments only. Medical care is the responsibility of the claimant. It is not paid for by the employer or insurance carrier. Cash benefits are 50% of a claimant's average weekly age, but no more than the maximum benefit allowed currently $170 per week.
NY LAW: In regards to Worker's Compensation, explain policy cancellations.
• The workers compensation law requires insurance carriers to notify the employer by certified mail 10 days prior to the cancellation of an insurance policy for nonpayment. When cancellation is due to any reason other than nonpayment of premiums, the carrier must provide at least 30 days' notice to the employer by certified mail and to the Chair of the Workers Compensation Board.
NY LAW: Explain The Jones Act.
• A federal law that allows members of ships crews to sue their employer or ship owner at common law for injuries caused by the employer's or ship owner's negligence.
NY LAW: Explain Federal Employer's Liability Act.
• This Act protects interstate railroad workers only. It allows the injured worker (or representative of the deceased worker) to sue the employer for negligence and removes contributory negligence and assumption of risk.
• As states began passing workers compensation laws, railroad workers and their unions were unwilling to trade their favorable legal position for statutory benefits.
NY LAW: Explain Federal Longshore and Harbor Workers Compensation Act.
• Some workers are required to be covered under the federal Longshore and Harbor Workers Compensation Act, which takes precedence over any state law that may cover the same workers.
NY LAW: In regards to Worker's Compensation, what is the employer liability for noncompliance?
• The workers compensation law says an employer is liable for penalty of $1000 per 10-day period of noncompliance, plus the actual award (including both compensation and medical costs).
Describe Basic (DP1)
-fewest number of named perils
-have only Coverages A-D
-Coverage E is only added when an endorsement is added to the policy
Describe Broad (DP2)
-most named perils
-have all Coverages A-E
Describe Special (DP3)
-open for all perils on dwelling/structures
-named perils for contents
-have all Coverages A-E
Under Special (DP3), what perils are covered for contents? What aren't?
Covered: perils listed on DP2 with EC and VMM
Not covered: Gradual/expected losses (wear/tear), loss caused by birds, vermin/rodents, insects, or domestic animals, VMM/burgulary/glass damage is property has been vacant for more than 30 days
Describe Coverage A Dwelling under Dwelling Fire Policy
-covers residence and anything attached
-example: garage, deck, carpet, plumbing, light fixtures, ceiling fan
-requires a limit for coverage, which equals cost of construction (labor and materials)
Describe Coverage B Other Structures under Dwelling Fire Policy
-covers a structure that is on the premises but is separated from dwelling by clear space
-example: unattached garage, in ground pool, guest house, fence, utility house, gazebo
-10% of Coverage A; more can be added
Describe Coverage C Personal Property under Dwelling Fire Policy
-based on ACV
-10% of Coverage C limit for worldwide contents
What items are excluded for Coverage C Personal Property under Dwelling Fire Policy?
-accounts, bank notes, bulloins, coins, currency, deeds, gold
-animals, birds, fish
-watercraft (except canoes/rowboats)
Describe Coverage D Loss of Rental Value under Dwelling Fire Policy
-first time there is an indirect loss coverage in a policy
-loss of rental income paid by tenants to the insured because of physical destruction loss
-10% of Coverage A
For Coverage D Loss of Rental Value under Dwelling Fire Policy, what is Fair Rental Value?
is rental value minus expenses which do not continue while the property is unfit for use
Describe Coverage E Additional Living Expense under Dwelling Fire Policy
-second indirect loss coverage
-covers temporary living expenses above normal living expenses when there is a covered physical loss (hotel, meals, laundry)
-10% of Coverage A
What is collapse?
abrupt falling down or caving in
Explain Glass or Safety Glazing Material coverage under the Dwelling Policy.
-Glass coverage is considered and additional coverage only under the DP2 and DP3 forms and is treated differently than some of the other perils insured against.
-Does not apply if vacant for more than 30 days.
What is a Dwelling Policy general exclusion?
Power failure off premises
What is Policy Period?
All covered losses must occur during the policy period. All policies are effective at 12:01 am
What is liberalization clause?
Sometimes insurance company will add coverage to policy that will change benefits of the insurer and they don't charge premium for that change, that change becomes automatic (added-value)
What is an insurer's duties after a loss occurs?
-Must give insurer prompt notice of loss
-Protect property from further loss
-Keep accurate records
-Cooperate with the insurer and show damage property
-Send proof of loss within 90 days
Under Dwelling Policy, describe the two types of theft coverage for the Theft Coverage Endorsement?
1. Broad-provides coverage for property on/off covered premises
2. Limited-provides coverage for property on premises only
Under Dwelling Policy, what is Automatic Increase in Insurance Endorsement (Inflation Guard)?
provides an annual increase in the Coverage A amount of 4%, 6%, or 8%
What structures does a homeowner's policy cover?
-houses under construction
-structures containing up to 4 units (must be side by side)
-permanently located mobile homes
Describe Basic Ho8 Form.
-covers older homes where there is a huge gap between purchase price and replacement value
-limitations: $1000 per occurrence
-dwelling: basic named perils
-structure: basic named perils
-contents: basic named perils
Describe Broad Ho2 Form.
-dwelling: broad form named perils
-structures: broad form named perils
-contents: broad form named perils
-has the 3rd most named perils
Describe Special Ho3 Form.
-dwelling: all risk for perils
-structures: all risk for perils
-contents: broad form named perils
Describe Tenant Ho4 Form.
-does not cover dwelling or structures
-contents: broad form named perils
Describe Comprehensive Ho5 Form.
-dwelling: all risk for perils
-structures: all risk for perils
-contents: all risk for perils
Describe Condo Broad Ho6 Form.
-dwelling: additions/alterations: $1000 (can be increased if upgrades are done
-contents: broad form named perils
Describe property coverage for Ho8
Coverage A (dwelling): AVC
Coverage B (structures): 10% A
Coverage C (contents): 50% A
Coverage D (loss of use): 10% A
Describe property coverage for Ho2
Coverage A (dwelling): replacement
Coverage B (structures): 10% A
Coverage C (contents): 50% A
Coverage D (loss of use): 30% A
Describe property coverage for Ho3
Coverage A (dwelling): replacement
Coverage B (structures): 10% A
Coverage C (contents): 50% A
Coverage D (loss of use): 30% A
Describe property coverage for Ho4
Coverage A (dwelling): none
Coverage B (structures): none
Coverage C (contents): stated amount
Coverage D (loss of use): 30% C
Describe property coverage for Ho5
Coverage A (dwelling): replacement
Coverage B (structures): 10% A
Coverage C (contents): 50% A
Coverage D (loss of use): 30% A
Describe property coverage for Ho6
Coverage A (dwelling): $1000
Coverage B (structures): none
Coverage C (contents): stated amount
Coverage D (loss of use): 50% C
What is the liability coverage under homeowner's policy?
Coverage E (personal liability): $100,000 per occurrence
Coverage F (medical payments): $1000 per person per occurrence
Explain Coverage D Loss of Use?
If there is a loss of home, there may be a loss of income and have extra expenses
Name the personal property limitations under the homeowner's policy?
-accounts, deeds, evidence of debit $1500
-watercraft $1500 (would need extra coverage if expensive vessel
-theft of jewelry $1500
-theft of silverware $2500
-theft of guns $2500
-business property on premises $2500
-business property off premises $500
Under Homeowner's, what is Coverage F?
-Medical Payments to others
-Med pay limit is $1,000 per injured person, up to 3 years from date of accident
What is an insured location, under Coverage F in a Homeowner's Policy? List all examples.
- including all locations when the insured is at fault, locations owned by the insured, locations rented by the insured, locations the insured might occupy or control.
1. Residence premises- insured location for covering claims
2. Secondary Home- all meets standards of insured claims
3. Premises used connection with the residence
4. Non-owned premises where the insured temporarily resides
a. Vacation cottage
5. Vacant land- not a trespasser; only invited guest
6. Home construction activity
7. Cemetery location
8. Premises occasionally rented by the insured (non-business, i.e. wedding)
What are some additional coverages under Homeowners?
1. Debris removal
2. Reasonable repairs
3. Tree, shrubs, plants-max limit is $500 per plant
4. Fire Department Service Charge-coverage up to 5. $500
6. Removal Clause
7. Credit card, ETF Card, Access Device, Forgery, Counterfeit money-covered up to $1000
8. Loss Assessment-covered up to $1000
9. Landlord furnishing-covered up to $2500
10. Ordinance or Law-covered up to 10% of A
11. Gravemarkers-pays up to $5000
Under Homeowner's for Coverage E & F, what are exclusions?
-off premise business
-ownership, maintenance, use, loading, or unloading watercraft: with motors that are greater than 50 horsepower, sailing vessel greater than 25 feet and/or with more than 25 horsepower
Explain earthquake endorsement?
-has a percentage deductible
-first 72 hr of earthquake damage is deemed to be one occurrence (includes aftershocks)
Sewer Backup Endorement
-$5000 per loss caused by water backed up via sewers and drains
What is the Mobile Home Endorsement attachment?
-covers collision damage if the home is on wheels and being moved to a safer location (from tornadoes and/or hurricanes)
-covers expenses of moving mobile home to safer location (covers up to $500)
-covered by replacement value
Farm Property Coverage Form, what are the 3 peril choices?
basic, broad, special
Under Farm Insurance, what is special limit under Coverage A?
-$1000 per occurrence for loss/damage of antennae, outdoor radio, satellite dishes
Under Farm Insurance, explain Coverage E Scheduled Farm Personal Property.
covers property such as grain, farm products, poultry, livestock, computers and related software
Under Farm Insurance, explain Coverage F Unscheduled Farm Personal Property.
-covers property on a blanket basis
-blanket limit for head of livestock is $2000 (less than one year of age is $1000)
Under Farm Insurance, explain Coverage G Barns, Outbuildings and Other Farm Structures.
-covers barns, silos, fences, radio equipment, and other farm buildings that aren't dwellings
Under Farm Insurance, Cause of Loss-Basic Form include...
Under Farm Insurance, Farm Property and Farm Structures covers for collision that results in...
damage to farm machinery and death of liverstock
Under Farm Insurance, Cause of Loss-Broad Form include...
-electrocution of covered livestock
-attacks on livestock by wild animals or dogs
-drowning of covered livestock
-accidents involving loading/unloading of livestock
-accidental shooting of livestock
Under Farm Insurance, Cause of Loss-Special Form covers what and excludes what?
-open for all perils
-excludes: dishonest acts, pollutants
Under Farm Insurance, what is a Livestock Floater?
-allows livestock to be covered on schedule or blanket basis
-named peril form which includes cattle, sheep, swine, goats, horses, mules, and donkeys
-must be insured on 80% of its value
-poultry NOT covered
Under Farm Insurance, Coverage I Personal and Advertising Injury Liability has the following exclusions...
-expected or intended injury
-injury to farm employees
What is custom farming?
Farming for others
What is Custom Farming Liability Coverage?
this endorsement adds coverage for custom farming, which is generally excluded if receipts are greater than $5000
What is the term for Flood Insurance?
What is the waiting period for Flood Insurance?
30 days from date of application
The premiums for Flood Insurance are sent to?
NFIP (Nat'l Flood Insurance Program)
The term flood under the NFIP means...
-overflow of inland/tidal waters
-unusual/rapid accumulation or runoff of surface
What is eligible under Flood Insurance?
-residential and nonresidential buildings
-building in course of construction
Under Flood Insurance, the Regular Program...
-goes into effect after the land use control requirements are met and a flood study of the community has been completed
-limit for 5 or more families $250,000
-deductible is $1000
Under Flood Insurance, what the amount for loss of avoidance (prevent flood damage) and what does this include?
-sandbags, supplies and labor
Under Flood Insurance, what is the amount that will be paid to assist in moving property?
$1000 for 45 days
Watercraft Policy protects the vessel only if it is ___ miles from shore, Great Lakes, or inland waters and has to located in ___.
-US, territories, Canada
Describe Watercraft Policy's policy structure.
Part A Liability-bodily injury or 3rd party property damage caused by insured's vessel. Newly acquired watercraft is covered from 14 of acquisition.
Part B Medical Payments-covers medical expenses for up to 3 years
Part C Uninsured Boaters
Part D Coverage for Damage to Your Watercraft-includes boat, motor, trailer, and accessories. Coverage is open peril and is known as hull coverage.
Yacht Policy covers...
-yachts, sailboats, and inland motor boats
-personal property is covered under open peril basis
For Yacht Policy, underwriting will involve...
reviewing manufacturer and model, year built, hull material, and style, type of motor/engine, value, and recommended speed
For Yacht Policy, the territories included are...
large rivers, the ocean, intra-coastal waterways, and the Great Lakes
For Yacht Policy, Medical Payment Coverage covers..
all necessary medical expenses for up to one year
The Federal Longshore and Harbor Workers Compensation Act...
-gives workers of longshore/maritime coverage, similar to Worker's Comp
-does not apply to captain or crew who sustain injury/death. They are covered under Jones Act.
Business Owner's Policy (BOP) covers...
-property and liability of small to medium size businesses
-offers replacement cost valuation and open perils protection on covered property
-includes Business Income and Extra Expense coverage for 12 mths
-includes Business Liability
Criteria for a business to have a BOP...
must have less than 35,000 square feet and cannot gross more than $6 million
What buildings are eligible for a BOP?
Office building-no more than 6 stories
Business with more than ___of annual gross sales from retail operations or more than ___ of total floor area open to public are not eligible for BOP.
Types of businesses covered under a BOP.
Under BOP, limited cooking restaurants must meet the following criteria..
-floor area cannot exceed 7,500 square feet
-beer/wine sale cannot exceed 25% of total sales
-seasonal operations are not eligible (closed more than 30 days)
Under BOP, fast food restaurants must meet the following criteria..
-floor area cannot exceed 7,500 square feet
-beer/wine sale cannot exceed 25% of total sales
-seasonal operations are not eligible (closed more than 30 days)
Under BOP, casual dining restaurants must meet the following criteria..
-floor area cannot exceed 7,500 square feet
-beer/wine sale cannot exceed 50% of total sales
-seasonal operations are not eligible (closed more than 30 days)
Under BOP, fine dining restaurants must meet the following criteria..
-floor area cannot exceed 7,500 square feet
-beer/wine sale cannot exceed 75% of total sales
-seasonal operations are not eligible (closed more than 30 days)
Under BOP, motels are eligible if...
-less than 3 stories high
-must not be seasonal
Under BOP, convenience stores/grocery stores are eligible if...
-must have at least 3,000 square feet of total floor area when it also sells gasoline
-must not do automotive work/repair
Under BOP, contractors are excluded if...
-annual payroll is over $300,000
-manufacture or sell products under contractor's name
-annual sell over $6 million
-subcontract work exceeds 10% of sales
Who cannot be covered under a BOP because of risk?
-auto repair shop
-businesses that have multiple locations for manufacturing
-banks and loan offices
-parking lots and garages
What losses are excluded under BOP?
-continuous leakage of water
-explosion of steam boilers/pipes/turbines
-mysterious disappearance of property
What are the coverages under BOP?
-Coverage A Building (replacement cost of building, new installs, and permanently installed fixtures)
-Coverage B Business Personal Property (must be within 100 feet of premises)
-Additional Coverages: debris removal (up to $25,000), preservation of property (30 days for property removed), fire department service charge (up to $2,500), Business Income Extra Expense (72 hr waiting period, covers for 12 months), and pollution clean up and removal (up to $10,000, must be reported within 180 days)
What are the 3 packages built in the Business owners Policy?
c. Business income
What is the minimum liability coverage for BOP?
$300,000 per occurence
Under BOP, what is standard deductible for property loss?
What risk are covered under the Commercial Inland Marine?
personal/commercial property floater risks
Under Commercial Inland Marine, trip transit is?
customer buys this to cover property lost in transit
Under Commercial Inland Marine, motor truck cargo policy is...
purchased by carrier to protect carrier for liability for loss to domestic shipments in transit
Under Commercial Inland Marine, Free on Board (FOB) Shipping Point
means that the title to property in transit transfers to the buyer the moment it leaves the shipper
Under Commercial Inland Marine, Free on Board (FOB) Destination Point
means that the title to property in transit remains with the shipper until it arrives to the buyer's destination
Under Commercial Inland Marine, Accounts Receivable Coverage Form
covers sum due the insured from customers that are not collectible due to loss, damage, or destruction of accounts receivable records
Under Commercial Inland Marine, Bailee coverage...
will pay damage to property of others that you have control of (i.e. dry cleaners, tv repair, and cargo ships shipping personal items will have this)
Under Commercial Inland Marine, jewelry block coverage form..
bailee form, which covers insured's merchandise held for sale and customer property
Under Commercial Inland Marine, equipment dealers form
provides open peril coverage for dealers in mobile agriculture and construction equipment
Ocean marine insurance has four major coverages?
-oldest type of insurance
What is an implied warranty for Ocean Marine Insurance?
Under Ocean Marine Insurance, Hull Coverage is...
provides insurance for damage to or loss of the vessel
Under Ocean Marine Insurance, what is jettison?
voluntary act of destruction in which cargo is cast overboard to save the ship and crew
Under Ocean Marine Insurance, barratry is
master and mariners steal ship and its cargo, willingly sink ship, or desert ship. like mutiny
Under Ocean Marine Insurance, what is the term adventure?
commercial enterprise in which a vessel and its cargo could be subject to hazard of loss at sea
Under Ocean Marine Insurance, what is the term pilotage?
activities such as guiding vessels
Under Ocean Marine Insurance, Freight Insurance...
indirect loss coverage for shipping cargo
Under Ocean Marine Insurance, Inchmaree Clause..
-provides coverage for the ship's hull from loss or damage caused by machinery
-covers damage that is caused by negligence of ship personnel, such as engineers and captains, when navigating
Under Ocean Marine Insurance, what is general average?
any damage or loss to a ship or its cargo voluntarily sustained, as freight jettisoned in a storm, by all parties to a voyage
Under Ocean Marine Insurance, what is particular average?
a loss at sea, as through accident or negligence, that is borne solely by the owner of the lost property.
Under Ocean Marine Insurance, what is Protection and Indemnity Coverage?
bodily injury and property damage coverage:
loss of life
injuries to seamen resulting from unseaworthiness
loss of cargo through negligence
injury to longshoremen and harbor workers
Crop Insurance covers..
loss of crops due to natural disasters or the loss of income due to declining agricultural prices
Crop Hail coverage..
-written by the private insurance sector and not insured by federal government
-written on named perils
Multi-Peril Crop Insurance...
-broad based program regulated by USDA and subsidized by Federal Crop Insurance Corporation
-provides comprehensive protection against weather related causes of loss
Small Grain Policy...
insures coverage for wheat, barley, and oats
Coarse Grain Policy
insures coverage for corn, sorghum, and soybeans
Under an auto policy, what are eligible vehicles?
-four wheeled vehicles owned/leased
-Trucks < 10,000 lbs, if greater need a commercial auto insurance
-Vans < 10,000 lbs, if greater need a commercial auto insurance
What are territorial limits under a personal auto policy?
1. United States
3. United States Territories & Possessions (Not covered in Mexico)
a. Puerto Rico
c. United States Virgin Islands (St Thomas, St Croix)
What is the definition of occupying under an auto policy?
while in, while on, while upon, while entering, onto, while exiting the "vehicle"
What is the definition of your covered vehicle under a personal auto policy?
-identifying all vehicles that insured might(and all vehicles listed on declarations page) be driving for the policy will cover accidents (trailers are included)
a. Newly acquired additional vehicle- 14 days
b. Newly acquired replacement- physical damage is covered for 14 days; all other coverage- until the end of the policy term.
What is the definition of newly acquired additional vehicle under a personal auto policy?
- the insured did not tell the insurance company about the vehicle, the insured had intent to tell the insurer about the additional vehicle.
-Coverage for the newly acquired vehicle is covered for 14 days
Explain Coverage A Liability under personal auto policy?
-Insured must be negligent
-Payment is made only if the insured is negligent
o Bail bond reimbursement- must have an accident that results in your arrest.
o Loss of earnings- pay up to $200 per day (payments made here cannot be subtracted)
o Reasonable expenses
o Cost of an appeals bond
-coverage is either single ($75,000) or split (25/50/50/100/10)
Under personal auto policy, what are some Part A Coverage exclusions?
-no coverage for intentional losses
-no coverage for damage to property that is rented to, used by, or in the care of the insured except for damage to a non-owned residence or private garage.
-no coverage while the vehicle is being used to carry persons or property for a fee (does not apply to carpooling)
-no coverage for vehicles with less than 4 wheels unless the vehicle is being used in a medical emergency by the insured or a golf cart
Explain Coverage B Medical Payments under personal auto policy?
• Necessary medical payments within 3 years of the accident
• Payment is made regardless of fault
• Insured- covering bodily injury
a. Named insured
c. Family members
• Medical payments will apply for accidents occurring while occupying the vehicle
• Medical payment limits are per person/ per accident
• Occupy means (in the vehicle)
o Changing a tire is included in this
• Every coverage must have its own separate limit, Med pay has a limit of $5,000.
• We cover bodily injuries of the named insured and person of the household even if they're struck as a pedestrian.
• Clear advantage with Med pay, no coverage is needed that has a deductible.
• Your policy pays excess to the policy you have coverage in. The owner of the car covers Med pay, pays primary and if extra coverage is needed file a claim and your med pay will cover the rest.
Explain Coverage D Physical Damage under personal auto policy?
• Under coverage D each has a separate deductible, will pay for coverages/ losses involving vehicles covered by the insurer. The banks are lien holders who require their coverage not the state. Pay the loan off, coverage is not required.
• Physical damages covers ACV (replacement cost-depreciation); if repair cost is greater than ACV, the insurance company will not repair vehicle
• To cover losses involving equipment for the vehicle if must come from the original manufacturer.
• Any equipment added by the insurer customizing your vehicle, a specialized equipment endorsement is needed to cover the additional equipment.
• If you first have a covered loss involving your vehicle and your vehicle breaks down mechanically, you will be covered under approximate cause.
• Liability does not have a limit for personal automobile insurance.
• Any amount the policy will not pay for BI, the accused will have to pay
Name some of the comprehensive perils that are covered under Coverage D for personal auto?
theft or larceny
hail, water, flood
breakage of glass
malicious mischief or vandalism
contact with a bird or animal
Under Part D, under personal auto policy, what is the limit for electronic equipment that is permanently installed (factory)?
Under Part D, under personal auto policy, what is the limit for non-owned trailers?
Under the personal auto policy, where does the insured have to call the police?
theft of an auto or hit/run accident
Under personal auto, name some comprehensive and collision exclusions.
road damage to tires
radios/stereos, cd players, navigation systems, personal computers, video entertainment, telephones
Under personal auto policy, what is under-insured motorist coverage?
provides coverage for the insured when involved in an accident with a driver who has legal limits of the auto liability insurance but the limit is not sufficient to pay the claim for which they are responsible.
What are the 2 types of coverage under Coverage D for personal auto insurance?
Comprehensive and collision
What transportation expenses are covered under Coverage D for personal auto insurance?
- Automatic with physical damage coverage
- Loss compatible with coverage
- Loss of use of vehicle
- Car stolen- 48 hour waiting time
- Other than stolen- 24 hour waiting time
- Either $20 per day up to a maximum of $600
What are the exclusion for physical damage (Coverage D) for personal auto insurance?
- Nuclear hazard
- Wear and tear
- Mechanical breakdown
- Maintenance issues
- Wear and tear on tires
Under personal auto insurance, what is no fault insurance?
the insured's company pays him for certain expenses up to specified limit. Thereafter he must legal action against the person at fault for the rest of this recovery
NY LAW: what act is related to no fault insurance for personal auto?
NY Comprehensive Automobile Insurance Reparations Act
What the four different types of Commercial Auto Insurance forms?
Business Auto Coverage
Business Auto Coverage Form..
-designed to insure all types of passenger vehicles, pickups, vans, and trailers used on public roadways.
-not designed to cover truckers for hire, garage risk, taxis/limos
What are the covered autos under the Business Auto Coverage Form Section I? (hint: symbols)
Symbol 1-any auto
Symbol 7-specific describe autos, only 30 days to report newly acquired autos
Symbol 8-hired autos (leased, rented, borrowed)
Symbol 9-non owned autos
Symbol 19-mobile equipment
What is Section II under the Business Auto Policy?
covers legal liability of the insured up the liability limit, plus unlimited defense costs and supplementary payments for "auto accidents" which occur during the policy period
Who is not covered under the Business Auto Policy?
The owner of a hired or borrowed auto
What are some Business Auto Liability Exclusions?
-employee injuries (workers comp covers this)
-damage to property owned or transported by or in the care, custody, or control of the insured.
What is Section III under the Business Auto Policy?
-the physical damage coverage of the policy covers accidental direct damage to covered autos and their equipment
1. Collision-overturn of the covered vehicle or collision with another object
2. Comprehensive: any loss, other than collision or overturn. Includes glass breakage or hitting an animal.
3. Specific Cause of Loss-similar to comprehensive but is limited in coverage with specific named perils
Under Business Auto Policy, what physical damage is excluded?
damage to covered auto used in organized racing or demolition contest
continuous or repeated exposure to the same conditions resulting in bodily injury or property damage
NY LAW: what Business Auto Policy Endorsements are mandatory?
-medical payments and/or pip
Under Business Auto Policy, what is the Drive Other Car Coverage Endorsement?
this endorsement extends the commercial auto coverage to insure the non business exposures of named individuals who may not own an automobile and may not carry personal auto insurance
Example: company car
Under Business Auto Policy, what is the Individual Named Insured Endorsement?
endorsement may be used to add an individual and their family members to business auto insurance.
Under Business Auto Policy, what is the Employees as Additional Insureds Endorsement?
states that any employee is an insured while using an auto the business does not own, hire or borrow when the autos are used in business or personal affairs of the named insured
Under Business Auto Policy, what is the Additional Insured-Lessor Endorsement?
Leased vehicles can be considered owned vehicles for coverage purposes by attaching this endorsement
Under Business Auto Policy, what is the Mobile Equipment Endorsement?
allows for mobile equipment to be considered a covered auto
What types of businesses are covered under a Garage Policy?
car dealerships, service stations, valet services, and parking garages/lots
What are the 3 Coverages for the Garage Policy?
A. Premises & Operations
B. Products & Completed Operations Liability
C. Auto Liability and Bodily Injury/Property Damage
What are some exclusions under the Garage Policy Section II Liability?
-injuries that fall under Workers Compensation
-liability for real or personal property in the insured's care, custody or control
What is not covered under Garage Keepers Coverage?
theft by insider, products/work loss, loss of sound reproducing
What is Section III Garage Keepers Coverage?
- second coverage that will cover the damages of the Customer's vehicle that's covered by the mechanic -can coverage is car is damaged when test driven by mechanic.
What losses are not covered under the Garage Keepers Policy?
-theft by an insider
-products or work loss
-sound reproducing or receiving equipment unless permanently installed
Motor Carrier Coverage Form
coverage for anyone who transports property by auto in a commercial enterprise
Motor Carrier Act of 1980
-mandated that trucking operations must file proof of pollution liability insurance
1. Type 1-for hire transportation of nonhazardous property and must carrier at least $750,000
2. Type 2-for hire transportation of hazardous substances (gas, explosives, poison gas, and radioactive material) with a minimum limit of $5 million
3. Type 3-for hire transportation of hazardous material not listed in Type 2 with minimum limit of $1 million
What is MC-90
an endorsement attached to Motor Carrier Coverage Form which allows for liability coverage
What is Commercial General Liability (CGL)?
-is added to commercial package policy
-If you cannot qualify for BOP, need coverage for liability add this policy
-Examples: business owners, nonprofit, churches, owners of buildings, tenants of buildings, manufacturers, and contractors.
-Making contact with the public could result in a claim of injury or damage brought against the insured
What is the occurrence trigger of a CGL policy?
-is when the injury first occurs is the policy that pays regardless of when the claim is first reported.
-Focus on accident date of payment of claim and not the report date of the claim
What is the claims made trigger of a CGL policy?
- the policy in place when the claim is first reported, is the policy that pays.
-If the injury occurred on or after the policy's retroactive date.
On CGL policy, what is Retroactive date?
controls the claim and defines when coverage begins in the claims made policy.
Under the Claims-Made Form in a CGL policy, what are extended reporting periods?
-coverage is an extended reporting period for reporting claims for when the claims made policy is cancelled, non-renewed, or followed by an occurrence form.
-not an endorsement
Under the Claims-Made Form in a CGL policy, what are basic extended reporting periods?
-as long as any reported claim is reported within the first 60 days of the cancellation, the basic tail coverage kicks in.
-allows for the insurer to go back 5 years, it must meet the mini tail criteria in order to work.
Under the Claims-Made Form in a CGL policy, what is supplemental tail?
-Cannot buy anywhere!!! Must go back to cancelled claims Basic tail just to purchase the supplemental tail coverage.
-Must be purchased within 60 days from when the original policy was canceled.
-Can be charged up to 200% for premium, one time continuous coverage, paid up front, never renews or expires or cancels.
-When you buy supplemental tail you are buying a perpetual link back to the original canceled policy, not buy a new policy!!!
What are the 3 coverages under the CGL policy form?
a. Coverage A- Bodily injury and property damage liability
b. Coverage B- Personal Injury and Advertising
c. Coverage C- Medical Payments
Describe Coverage A under CGL policy form.
Coverage A- Bodily injury and Property damage liability
- Premises liability
- Completed operations liability
- Both sublines fall under coverage A
Describe Coverage B under CGL policy form.
Coverage B Advertising Liability
1. Copyright infringement
2. Use of an individual's likeness without permission
Describe Coverage C under CGL policy form.
Coverage C Medical Payments
• Covering necessary medical expenses occurred regardless of fault within one year of the accident.
• Always a 12 month term for a Commercial General Liability Policy
-$1,000,000- per occurrence for Bodily Injury and Property Damage
-$2,000,000- Aggregate Limit
Under Coverage B Advertising Liability, what does personal injury cover?
- covers liable slander (defamation of character) involving:
1. Wrongful accusation
2. Malicious prosecution
3. Invasion of privacy
4. Wrongful eviction
Professional Liability Coverages
covers the insured against legal liability from negligence, errors/omissions, poor workmanship
in the medical field, this is known as malpractice insurance
What must you have to qualify for the personal umbrella policy?
-must carry higher coverage (not the minimum coverage)
-must have to have Personal Auto and Homeowners in order to qualify
What is the deductible range for the personal umbrella and what is it referred as?
$500-$10,000; self insured retention
Commercial Umbrella Policy
-add worldwide coverage to a CGL policy
-offers an option to purchase a substantial amount of coverage per occurrence.
-pays excess to liability and auto, these policies must be included in order for the umbrella policy to satisfy the limit.
What is the Commercial Builder's Risk Form?
-a form added to a commercial policy to cover any covers building materials under construction or renovation.
-Typical construction contractors carry this coverage
-Start construction and values grow to completed value basis
-Contractors invest in a builder's risk policy to cover losses of building materials at their construction site.
What is the Business Income Form?
- covers indirect losses for commercial property
1. Loss of business income- covers the actual loss of income at the time frame the business shuts down. Only because there was a Physical destruction loss prior to it occurring. No limit for coverage, just a time frame selected by the insured.
2. Extra expenses
3. Civil authority
-Cover loss of income up to 3 weeks, after 72 hours waiting.
How can Commercial Crime coverage be added?
it can be added as a monoline (single) policy or part of a Commercial Package Policy
What are the two forms under the Commercial Crime Insurance and what is the difference between the two forms?
Loss sustained form
-the difference the two is the determination of when coverage is triggered.
What is the Commercial Crime form?
applies to a per loss basis only, regardless of the number of employees involved in the crime
Under Commercial Crime, what is the Loss Sustained form?
there is coverage while the policy is in force and for up to one year after the policy expires provided it can be proved that the actual loss occurred when the policy was in effect.
Under Commercial Crime, what is the Discovery form?
-there is coverage while the policy is in force and for up to 60 days after the policy has expired/terminated
the insured or any partner employee that has care and custody of insured property inside the premises.
Define Safe Burglary.
taking or attempting to take covered property from a locked safe or vault by unlawful entry, with visible evidence of forcible entry.
Define Premise Burglary.
requires sign of forcible entry or exit for purpose of theft. Example: marks on the door, broken lock, broken window
an insured, partners, employees, or any authorized person that custody of property outside the premises for delivery.
requires forced stealing, a threat, or actual violence or injury
unlawful taking of money, securities, or other property to the deprivation of the insured. It is the most broad of criminal activity.
What is a special exclusion to Crime Coverage in regards to employee theft?
inventory shortages are not considered a cause of loss unless it can be proved that an employee or employees acting in collusion caused the loss
What policy insuring agreement do the Loss Sustained form and the Discovery both have?
Employee theft, which pays for loss of money, securities or other property
What is Civil authority coverage?
-there is a physical destruction loss occurring near the insured, which is causing the insured to shut down because of civil authority. The Governor is the commander of civil authority in every state.
What two categories do Judicial Bonds fall into?
-Court or Litigation Bonds
Fiduciary Bonds include...
-Administrators that are appointed by the court when a person dies and does not leave a will with an appointed executor
-Executors execute the provisions of the will
What is intestate?
a person not having a will
Name some different types of Court or Litigation Bonds?
What is an Appeal Bond?
when one loses in court and is made to pay damages, they can post an appeal bond and postpone any payment pending their appeal. If they lose again, either they or the bonding company must pay the demanded damages.
What is the Replevin Bond?
guarantees that if property in the possession of Party A is determined to belong to Party B and the court orders the property to be returned to Party B, Party will do so. Party A would first have to obtain an attachment bond, also required by the court, in case the property was wrongfully expressed.
What is a Surety Bond?
Serve as a purpose for the strongest guarantee of performance.
What are Contract Surety Bonds?
bonds that guarantee the fulfillment of written contractual obligations
Who are the parties under a Contract Bond?
principal-contractor who obtains the bond
obligee-owner of the project
surety-guarantor of the bond (insurance company)
What is Performance Bond?
a surety bond guarantees the owner that the bidder will complete the work at the price that was bid as per the contract specifications.
What are Financial Institution Bonds?
bond written for financial institutions. The standard form number is 24.
Who is eligible for the Standard Form No. 14 for Brokers/Dealers?
-Stockbrokers and business dealers with securities
-Securities Investors Protection Corporation
- Investment Bankers and Investment Trusts
-Commodity Brokers who are members of a recognized Stock Exchange
-By rider, Stockbrokers operating on a partnership basis
Who is eligible for the Standard Form No. 15 for Finance Companies?
-Finance Companies the majority of whose business is financing paper for and through dealers, and Investment or Finance Companies licensed under the Small Business Administration Act
-Small Loan Companies (excluding Pawn Brokers and Factors) including Personal Finance Companies, Chattel Loan Companies and Benevolent, Charitable, Prudential or Remedial Loan Associations, and Industrial Loan Companies in the State of Washington
-Mortgage Bankers and Dealers in Mortgages (but not fiscal agencies representing another in the servicing of mortgages, etc.), Dealers in Commercial Paper and Note Brokers.
-Title Insurance Companies principally engaged in the mortgage business.
-Holding Companies that do not operate the business under their control, but merely act as managers of the stocks and securities in their custody.
-Real Estate Investment Trusts.
Who is eligible for the Standard Form No. 23 for Credit Union Blanket Bond?
-Mutual Benefit Associations and Remedial Loan Associations in Connecticut, provided they do not grant or extend accident, health, death or burial benefits to their members.
-National Credit Union Share Insurance Fund
Who is eligible for the Standard Form No. 24 Financial Institution Bond?
-National Commercial Banks, State Commercial Banks and Trust Companies.
-American Agencies of Foreign Banks, Cooperative Credit Associations of Nebraska, Industrial Banks and Morris Plan Banks
-Title Insurance Companies
-Federal Institutions, such as the Federal Reserve Banks, Federal Deposit Insurance Corporation, Joint Stock Land Banks, Federal Home Loan Banks and Federal Land Banks
-By rider, Savings Banks.
-By rider, Savings and Loan Associations and Building and Loan Associations, Cooperative Banks in Massachusetts and Homestead Associations in Louisiana.
Who is eligible for the Standard Form No. 25 Insurance Companies Blanket Bond?
used for insurance and rein-insurance companies of all kinds, including life insurance, self-insurance companies, and risk retention groups
Define Fidelity Bond. Who are those that benefit from this protection.
A bond that covers losses such as equipment, merchandise, and money resulting from acts of employees.
Those who benefit are: businesses, churches, and non-profits
Who does the Fidelity Bond pay?
The employer for money stolen by the employee
What are the parties to the Fidelity Bond and explain them?
1. Principal: the employee who is the subject of the bond, who creates the loss
2. Obligee: the employer who takes out the bond
3. Guarantor: the insurance company who issues the bond to the obligee, who compensates the employer from employee dishonesty
Aircraft Hull Polices
-written as open peril basis when aircraft in motion, taxi or in flight
-deductible does not include loss from fire, lightning, explosion, transportation, theft, robbery
-deductible is expressed as percentage of value
Aircraft Liability Coverage
-can be written to cover public and passenger liability and property damage liability.
-liability to passengers is treated as a separate exposure totally apart from the liability to others.
-a typical liability and property policy includes bodily injury liability, passenger liability, and property damage liability.
Admitted Aircraft Liability Coverage
-is coverage written as an addition to passenger liability.
-provides for principal sum payments for death or dismemberment if the named insured requests it and the company is released from further liability.
In regards to Aviation Insurance, describe Medical Payments Coverage.
-provides medical expenses for bodily injuries by accident, without regard to legal liability
-medical payments to passengers are included and members of the crew can be added for an additional premium.
Hangarkeeper's Liability Coverge for Aircraft
form of bailee insurance that covers for liability damage to aircraft stored for safekeeping or repair
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