Associate in Claims Examination

1.Mara tells her insurer that a kitchen fire damaged her home and asks the insurer to pay for repairs under her policy. In claims practice, what is that request?

2.After a water loss at Ken's store, the handler must decide what the policy owes. Which sequence is sound claim handling?

3.While Lena's fire claim is still open, the insurer writes that it is investigating and may later deny coverage. What is that letter?

4.Before inspecting a disputed theft, the insurer and the insured sign a paper saying the inspection will not waive a coverage defense. What is that paper?

5.Omar must send a sworn statement that lists the property taken in a burglary and the amount he claims. What is that statement?

6.Rita and her insurer agree a fire is covered, but they disagree on the dollar amount of the building damage. Which process is used to resolve that amount?

7.A covered roof costs 20,000 dollars to replace, and depreciation is 4,000 dollars. What is the actual cash value before any deductible?

8.A covered contents loss is valued at 8,000 dollars, and the policy deductible is 1,000 dollars. How much remains after the deductible?

9.After paying Noah's covered auto claim, the insurer seeks repayment from the driver who caused the crash. What is that recovery called?

10.The insurer pays a total loss on a stolen car. The car is later found, and the insurer keeps its remaining value. What is that remaining value called?

11.A guest says Priya was negligent. Which set of elements must be shown to establish negligence?

12.In a comparative-negligence state, a claimant's damages are 10,000 dollars and the claimant is 20 percent at fault. What is the recovery?

13.Priya's liability coverage applies to a guest injured by Priya's negligence. What does that coverage pay?

14.A claimant has 3,000 dollars in medical bills and 2,000 dollars in lost wages from a covered injury. How are those items classified?

15.A guest asks to be paid for physical pain after a fall, apart from the medical bills. How is that pain classified?

16.After a fair payment, the claimant signs a paper that ends the bodily injury claim being settled. What does that paper do?

17.An occurrence liability policy runs from January 1 through December 31. A guest is hurt on June 1 of that year, and the suit is filed the next year. Which fact puts the injury inside this policy?

18.A claims-made policy covers this calendar year and has a retroactive date of March 1 of last year. The injury happened on February 1 of last year, and the claim is first made this April. What is the result?

19.Which practice meets the duty of good faith on a first-party property claim?

20.Which act is bad faith in handling a covered property claim?

21.In a recorded statement, an insured says a television was stolen from the house. Receipts and a buyer show the insured sold it months earlier. What is that false statement?

22.A claims-made policy covers this calendar year. Its retroactive date is January 1 of last year. The injury happened on June 15 of last year, and the claim is first made on March 10 of this year. What is the result?

23.Adele's handler may settle up to 15,000 dollars. The agreed covered loss is 18,000 dollars. What must the handler do?

24.Bruno calls to report a warehouse fire a few hours after it starts. What should the handler do with that first notice?

25.A windstorm has just opened the roof of Cora's warehouse. Why should the handler inspect the scene promptly?

26.Why does the handler take a recorded statement from Devon after a reported theft?

27.Elise hits another car. Both cars are damaged. Her policy has liability coverage only. The body shop asks the liability insurer to repair Elise's own car. What does liability pay for her car?

28.A claimant submits 4,000 dollars of medical bills and 1,500 dollars of lost wages from a fall. No other bills are claimed. What is the total of the special damages?

29.A covered liability judgment against Farid is 40,000 dollars. The occurrence limit is 25,000 dollars. What does the insurer pay?

30.Which statement about an occurrence liability policy is correct?

31.Gina's policy requires her to answer questions about a theft under oath. The insurer schedules that questioning as part of the investigation. What is that event?

32.Hassan's policy requires him to show the damaged property. He refuses every inspection and will not explain the refusal. What is the handling issue?

33.A full investigation shows Iris's water damage is excluded. What should the coverage decision communicate?

34.The insurer learns Jules reported a loss late. It then writes that it will not use the late report as a defense. What did the insurer do?

35.An adjuster tells Amina, incorrectly, that her loss is covered. Relying on that, she throws away the damaged goods needed for inspection. A coverage defense is found later. Which doctrine fits her reliance?

36.A lease required tenant Carl to cover landlord Daphne for the tenant's operations. A visitor hurt by Carl's employee sues Daphne, who tenders the suit to Carl's liability insurer. What is the handler deciding?

37.A bank holds a 90,000 dollar mortgage on Rosa's house. A covered fire causes 12,000 dollars of building damage. Why is the bank named on the building payment?

38.Ellis transferred title to his car on Monday. The buyer damaged it on Friday. Ellis then asks his insurer to pay him for that Friday damage. What is the coverage problem?

39.Fiona's policy excludes a loss she intentionally causes. The investigation shows she set the fire herself. What is the coverage result for Fiona?

40.George's policy covers sudden and accidental discharge of water and excludes wear and seepage over a period of weeks. A slow leak dripped for two months and warped the floor. There was no sudden burst. How is the loss treated?

41.A policy asks for a sworn proof of loss within 60 days after it is requested. Hana sends it on day 90 and explains a hospital stay. What should the handler do?

42.Ivan and his insurer are headed toward appraisal on a building fire they agree is covered. Which issue should not be sent to appraisal?

43.Two primary policies cover the same 10,000 dollar property loss and share it in proportion to their limits. Policy A has a 40,000 dollar limit and Policy B has a 60,000 dollar limit. What does Policy A pay?

44.Nia's policy says it is excess over any other valid insurance. A primary policy covers the same 6,000 dollar property loss and pays all 6,000 dollars. What does Nia's excess policy pay?

45.A policy pays actual cash value. Replacement cost of a covered machine is 15,000 dollars. Depreciation is 3,000 dollars. The deductible is 1,000 dollars. What is payable?

46.On a covered sofa loss, the handler must state what replacement cost means before talking about depreciation. Which meaning is correct?

47.A policy pays actual cash value until repairs are finished, then pays replacement cost. The insurer already paid the 6,000 dollar actual cash value. Finished repairs cost 10,000 dollars, which equals replacement cost. No deductible applies. How much more is owed?

48.Repairs to Carla's car would cost 12,000 dollars. The car's actual cash value is 9,000 dollars. This insurer treats a vehicle as a total loss when repair cost exceeds actual cash value. Before the deductible, what is the amount of the loss?

49.An insurer pays 8,000 dollars for a total loss of a boat and later sells the recovered boat for 2,000 dollars. What is the insurer's net cost after salvage?

50.The insurer wants to pursue an at-fault driver for a covered collision, but it has not paid its insured. May it use subrogation now?

51.In a comparative-negligence state, a driver's damages are 20,000 dollars and that driver is 25 percent at fault. What is the recovery?

52.Hank bought liability coverage only. He hits a tree and damages only his own car. No one else is hurt and no other property is damaged. What will liability pay for the car?

53.A bodily injury evaluation is 4,000 dollars in medical bills, 2,000 dollars in lost wages, and 6,000 dollars for pain and suffering. Fault is not shared, and the total is within the limit. What is the total evaluation?

54.A claimant signs a release that covers only the property-damage claim and then sues for bodily injury from the same crash. What is the effect of that release?

55.Liability is clear. Bills and lost wages total 8,000 dollars, and pain and suffering is fairly valued at 4,000 dollars. The claimant will accept 12,000 dollars. The limit is 50,000 dollars and the handler's authority is 20,000 dollars. What does good faith support?

56.Liability is clear and the damages are well above the limit. The claimant demands 100,000 dollars. The liability limit is 50,000 dollars. What is the most the policy pays?

57.A jury awards a guest 80,000 dollars. The liability limit is 50,000 dollars, and the insurer pays that limit. Who is exposed for the remaining 30,000 dollars?

58.This claims-made policy applies only if the claim is first made and reported during the policy period. A guest first makes the claim in May, while the policy is in force. The insured first tells the insurer the next February, after expiration. There is no extended reporting period. What is the result?

59.A claims-made policy ended last December 31, and an extended reporting period is now in force. The injury occurred last September, after the retroactive date and before the policy ended. The claimant first makes the claim during the extended reporting period. What is the result?

60.On a claims-made policy, what does the retroactive date do?

61.A liability policy promises to defend a suit seeking damages the policy would cover. The complaint alleges one injury that would be covered if proved and another injury the policy excludes. What should the handler do while the facts are investigated?

62.An insurer defends its insured for months. It knew of a coverage defense from the start and never sent a reservation of rights or signed a nonwaiver agreement. What is the risk?

63.How is a nonwaiver agreement different from a reservation of rights letter?

64.A house fire is out and the cause is not obvious. Why does the handler bring in a fire-origin investigator?

65.A supply line in Karl's kitchen bursts without warning and floods the room in one afternoon. The policy covers sudden and accidental discharge of water. How should this cause be treated?

66.River water enters Lila's first floor after the river overflows its banks. Her policy excludes flood, and the river water is the only cause of the damage. What is the coverage result?

67.Wind, a covered cause, blows off part of Mateo's roof. Rain then soaks the ceiling through that opening. The policy covers rain that enters through an opening the wind made. What is covered?

68.The only water in Nina's basement came from a sewer backup. Her policy excludes sewer backup. Is the damage covered?

69.Oscar reports a theft of several items. There is no sign of forced entry, and he has not yet shown that he owned the items. What is the sound next step?

70.Which statement is a misrepresentation on a burglary claim?

71.Which statement is a material misrepresentation on Pia's theft claim?

72.A stove would cost 2,000 dollars to replace. It has a 10-year useful life and is 5 years old, so depreciation is half the replacement cost. What is the actual cash value?

73.A covered chair can be repaired in like kind and quality for 2,000 dollars. The insured wants a better fabric that raises the cost to 2,600 dollars. Depreciation is already in the 2,000 dollar figure, and there is no deductible. What should the insurer pay?

74.A pair of earrings was worth 1,000 dollars. One earring is stolen, and the remaining earring is worth 200 dollars. The policy pays the value of the pair before the loss minus the value of what remains. There is no deductible. What is payable?

75.A covered fire drives Leo from his home during repairs. A temporary apartment costs him 1,200 dollars a month more than he normally spends to live. The policy pays the necessary increase in living costs while the home cannot be lived in. What is that extra cost?

76.A covered fire makes an apartment Willa rents to a tenant unlivable for 2 months. Fair rent is 900 dollars a month, and the policy pays lost rent for the time the unit cannot be rented. What is the lost rent?

77.A covered fire shuts Farid's shop during repairs. The policy pays lost net profit plus continuing normal operating expenses for that shutdown. What is the handler measuring?

78.To keep operating after a covered fire, Greta rents a temporary workshop for 3,000 dollars. That rent is an added cost to continue operations, and the policy covers extra expense. The amount is within the limit and no deductible remains. What is payable for the rent?

79.A covered fire causes 20,000 dollars of building damage and 4,000 dollars of debris removal, both covered. The policy applies one 1,000 dollar deductible to the combined covered loss. What is payable?

80.A building is worth 200,000 dollars. The policy limit is 120,000 dollars, and the policy requires insurance equal to 80 percent of the value. A covered loss is 40,000 dollars. There is no deductible. Payment equals the limit carried divided by the limit required, times the loss. How much is payable?

81.A building is worth 100,000 dollars. The policy requires 80 percent insurance and the insured carries 80,000 dollars. A covered loss is 10,000 dollars, and the deductible is 1,000 dollars. No coinsurance reduction applies. What is payable?

82.One explosion injures two guests. Each has 20,000 dollars of covered damages. The policy limit is 30,000 dollars for one occurrence, and there is no separate per-person limit. What total does the insurer pay for both guests?

83.An insured has two unrelated crashes on different days. Each causes 20,000 dollars of covered liability damages. The occurrence limit is 30,000 dollars for each crash. What total does the insurer pay?

84.A liability policy has a 50,000 dollar occurrence limit and a 100,000 dollar aggregate for the policy period. Earlier occurrences have already used 80,000 dollars of the aggregate. A new occurrence causes 40,000 dollars of covered damages. What does the insurer pay for the new occurrence?

85.A liability policy has a 10,000 dollar self-insured retention that is subtracted from covered damages. A covered judgment is 25,000 dollars. What does the insurer pay?

86.A policy coverage pays a guest's reasonable medical bills up to 5,000 dollars without a finding of negligence. The bills are 2,000 dollars, and fault is still unclear. What can this coverage pay?

87.In a comparative-negligence state, special damages are 8,000 dollars and general damages are 2,000 dollars. The claimant is 10 percent at fault. What is the recovery?

88.A claimant was 30 percent at fault. The file does not say which negligence rule applies, and the handler knows the rules differ from place to place. What is the right next step?

89.A driver owed a duty and was speeding. The claimant's injury came from a fall at home the next day, with no link to the speeding. Is negligence established for that injury?

90.A driver breaches a duty and nearly hits a pedestrian. There is no contact, no injury, and no property damage. Is there a negligence claim to pay?

91.A customer slips on a wet store floor that staff left unmarked. Who owed that customer the duty of reasonable care for the floor?

92.A store owner owed a customer reasonable care, left a spill with no warning, and the customer fell. Which negligence element is the failure to clean or warn?

93.On a fall in a grocery aisle, why does the handler ask how long the spill was there, whether a warning was placed, and what witnesses saw?

94.An employee, while driving across town to deliver the employer's package, negligently hits another car. Can the employer be liable for that crash?

95.An employee finishes the workday and, on a personal trip unrelated to any job errand, negligently causes a crash. Do these facts support liability of the employer?

96.How is Quinn's first-party property claim different from a liability claim against Quinn?

97.The insurer advances 2,000 dollars toward Rafael's covered property loss. No release is signed. What is true of that advance?

98.Sofia's handler has settlement authority of 10,000 dollars. The covered loss is agreed at 9,000 dollars. May the handler agree to that figure?

99.Tomas's handler has settlement authority of 10,000 dollars. The claimant will settle only for 14,000 dollars, and that figure is otherwise supported. What should the handler do?

100.Uma's property claim is ready to close after a covered payment. What should the claim file contain?

101.Why does the handler photograph a fire scene and sketch the area where the fire appears to have started?

102.Two witnesses to a store fall give conflicting accounts of how long a spill was on the floor. What should the handler do?

103.A clinic bill includes a visit dated two weeks before the auto accident that is the subject of the claim. How should that charge be treated in special damages?

104.A claimant missed 4 weeks of work. The employer confirms the wage was 500 dollars a week and confirms the 4 weeks. What lost-wage special damages are supported?

105.A claimant asks for 10 weeks of lost wages. The employer says the claimant returned after 2 weeks at 400 dollars a week. What wage loss is supported?

106.A handler is evaluating pain after a broken arm. Medical bills are already counted as special damages. Which description of the pain evaluation is correct?

107.The facts and the policy show a property loss is covered for 6,000 dollars after the deductible, and that amount is within authority. Which action fits good faith?

108.Vera accepts 15,000 dollars and signs a release of her bodily injury claim from a fall. She later sues for that same injury. What is the effect of the release?