Your Exam Content Outline - Prometric

1 your Exam Content Outline The following Outline describes the Content of one of the New York insurance examinations. The examination will contain questions on the subjects contained in the Outline . The percentages indicate the relative weight assigned to each section of the examination. For example, 10 percent means that 6 questions will be drawn from the section on a 60-question exam, 10 will be drawn on a 100-question exam and 15 will be drawn on a 150-question exam New York Independent General Adjuster Fraud and false statements including 1033. Examination waiver (18 USC 1033, 1034). Series 17-70 Terrorism Risk Insurance Act of 2002 and Extension Act of 2015 (15 USC 6701; S467). 100 questions - 2-hour time limit Live Date-September 20, 2017 Insurance Basics 6%. Contract basics Insurance Regulation 6%.

2 Elements of a legal contract Licensing requirements Offer and acceptance Qualifications (2108(c, g)). Consideration Process (2108(d), (f)). Competent parties Bond (2108(l)). Legal purpose Fingerprints (2108(d)(2)). Distinct characteristics of an insurance Temporary adjuster permit (2108(h, n)). contract Superintendent's general duties and powers Contract of adhesion (2404, Financial Services 201, 202, 301). Aleatory contract Maintenance and duration Personal contract Renewal (2108(i, j)). Unilateral contract Assumed names (2102(f)). Conditional contract Change of address Reg 25, Part ). Legal interpretations affecting contracts Reporting of actions (2110(i)(j)). Indemnity Cyber Regulation (23 NYCRR 500). Utmost good faith Disciplinary actions Representations/misrepresentations Cease and desist (2405). Warranties Suspension, revocation, and nonrenewal (2110) Concealment Penalties (2127) Fraud Claim settlement laws and regulations Waiver and estoppel (Reg 25, Part 216).

3 Insurance principles and concepts Unfair claim practices (2601). Insurable interest Misrepresentation (2108(o)). Hazards Suit against insurer (3404). Physical Prohibitions (Reg 25, Part ). Moral Consumer privacy regulation (Reg 169, Parts to ) Morale Federal regulation Negligence 1. Elements of a negligent act Pro rata Defenses against negligence Contribution by equal shares Damages Limits of liability Compensatory special versus general Per occurrence (accident). Punitive Per person Absolute liability Aggregate Strict liability Split Vicarious liability Combined single Named perils versus open perils (All risk) Reinstatement of limits Direct loss Coinsurance Consequential or indirect loss Vacancy or unoccupancy Blanket versus specific insurance Named insured provisions Basic types of construction Assignment Loss valuation Abandonment Actual cash value Duties after loss Broad evidence rule Insurer provisions Replacement cost Liberalization Guaranteed Subrogation Functional Salvage Market value Loss settlement options Agreed value Duty to defend Stated amount Third-party provisions Policy structure Standard mortgage clause Declarations Loss payable clause Definitions No benefit to the Bailee Insuring agreement or clause Adjusting Losses 11%.

4 Additional/supplementary coverage Role of the adjuster Conditions Duties and responsibilities Exclusions Staff and independent adjuster versus public adjuster Endorsements Relationship to the legal profession Common policy provisions Claim reporting Insureds named, first named, additional, defined Claim investigation Policy period Claim file documentation of events Policy territory Types of reports Cancellation and nonrenewal Initial or first field Deductibles Interim or status Other insurance Full formal Nonconcurrency Property losses Primary Duties of insured after a loss Excess Notice to insurer 2. Mitigating the loss Non-Waiver Agreement Proof of loss Accident and Health Insurance Basics 6%. Special requirements Definition of potential claims Produce books and records Accidental injury Abandonment Sickness and health Determining value and loss Principal types of claims and benefits Burden of proof of value and loss Loss of income from disability Estimates Hospital and medical expense Depreciation Long-term care expense Salvage Classes of accident and health insurance policies Claim settlement options Individual and group Payment and discharge Private versus government Total Loss Valuation Methods (Reg 64, Part (c)(1))

5 Limited versus comprehensive Liability losses Self-insured versus insured Investigation procedures Limited policies Verify coverage Limited benefits and amounts Determine liability Required notice to insured Gathering evidence Types of limited policies Physical evidence Accident-only Witness statements Specified (dread) disease Determining value of intangible damages Hospital indemnity (income). Coverage problems Dental insurance Dealing with coverage disputes Credit disability Reservation of rights letter Vision care Nonwaiver agreement Common exclusions from coverage Declaratory judgment action Cosmetic Claims adjustment procedures Experimental/investigation Settlement procedures Medical necessities Advance payments Workers compensation Draft authority Accident and health insurance claims Execution of releases Insured's notice Subrogation procedures Standard claim forms Alternative dispute resolution Insurers' responsibility to provide claim forms Appraisal Insured's submission of proof of loss Competitive estimates Insurer's Negotiation Investigations/verification of loss Arbitrator Insurer's payment of claim Mediator Physical examination and autopsy Coverage Problems Legal actions

6 Reservation of Rights Letter 3. Understanding the Language of Medical Myelography Reports 4% Arthroscopy Medical terminology and abbreviations Electrocardiogram (EKG or ECG). Location terms Electroencephalography (EEG). Movement terms Dwelling (2014) Policy 6%. Prefixes, suffixes and root words Coverage forms Perils insured against Abbreviations used in medical reports Basic Medical specialties Broad Basic human anatomy Special Skeletal structure Property coverages Nervous system Coverage A Dwelling Respiratory system Coverage B Other structures Cardiovascular system Coverage C Personal property Abdominal organs Coverage D Fair rental value Common injuries and diseases Coverage E Additional living expense Strains and sprains Other coverages Dislocations General exclusions Fractures Conditions Soft tissue injuries Selected endorsements Brain injuries Special provisions New York (DP 01 31).

7 Burn classifications Broad theft coverage (DP 04 83). Cumulative trauma Dwelling under construction (DP 11 43). Repetitive motion injuries Personal liability supplement Lung disease Homeowners (2011) Policy 10%. Diabetes mellitus Coverage forms Glaucoma HO-2 through HO-6, HO-8. Hypertension Definitions Arthritis Section I Property coverages Osteomyelitis Coverage A Dwelling Stroke Coverage B Other structures Tachycardia Coverage C Personal property Atherosclerosis Coverage D Loss of use Coronary thrombosis Additional coverages Mental wellness Section II Liability coverages Medical tests Coverage E Personal liability Laboratory Coverage F Medical payments to others Radiography (X-ray). Additional coverages Magnetic resonance imaging (MRI) Perils insured against Computerized tomography (CT or CAT) Exclusions Electromyography (EMG) Conditions Nerve conduction studies Selected endorsements 4.

8 Special provisions New York (HO 01 31) Definitions Earthquake (HO 04 54) Optional Identity fraud expense (HO 04 55) Nonstacking Scheduled personal property (HO 04 61) Coverage limits Personal property replacement cost (HO 04 Mandatory inspection requirements for 90) private passenger automobiles (Reg 79, Parts to ). Home business (HO 07 01). Cancellation/nonrenewal (3425). Personal injury New York (HO 24 86). Grounds Workers' compensation certain residence employees New York (HO 24 93) Notice Water Back Up and Sump Discharge or Choice of repair shop (2610). Overflow (HO 23 85). Supplemental spousal liability (3420(g)). Auto Insurance 9% Vehicle parts and construction Laws Body New York Motor Vehicle Financial Responsibility Law Front end Required limits of liability (Veh & Traf Rear body 333) Quarter panels Required proof of insurance (Veh & Traf Doors 311(3)).

9 Roof New York Automobile Insurance Plan (Assigned Risk) (5301 5304) Bumpers/urethane repairs Comprehensive Motor Vehicle Insurance Lamps Reparations Act (PIP) (5101 5108) Cowl Notice of claim Floor pan Medical Rocker panels Rehabilitation Pillars Loss of earnings Substructure Funeral Frame Substitution services Unibody Tort limitation/verbal threshold Mechanical Optional coverages Engine OBEL Cooling system Additional PIP Electrical system/computers Motor vehicle accident indemnification Exhaust system Corporation Act (5201-5225) Fuel system Uninsured/Underinsured motorist (3420(f)) Heating and air conditioning systems Definitions Brakes/ABS. Bodily injury only Steering Required limits Suspension Mandatory coverage Transmission Supplementary uninsured/underinsured Air bags/SRS (seat belts). motorist coverage (3420(f)(2)(A)(B); Reg 35-D, Parts to ) Glass 5.

10 Interior Coverage form sections Paint Covered autos Personal (2005) auto policy Liability coverage Definitions Garagekeepers coverage Liability coverage Physical damage coverage Bodily injury and property damage Exclusions Supplementary payments Conditions Who is insured Definitions Exclusions Hired auto and non-owned auto liability - New York Medical payments coverage Selected endorsements Coverage for damage to your auto Lessor additional insured and loss Collision payee (CA 20 01). Other than collision/Comprehensive Mobile equipment (CA 20 24). Deductibles Auto medical payments coverage (CA 99. Transportation expenses 03). Exclusions Drive other car coverage (CA 99 10). Duties after an accident or loss Individual named insured (CA 99 17). Selected endorsements Employees as insureds (CA 99 33). Amendment of policy provisions New New York mandatory personal injury York (PP 01 79) protection (CA 22 32).