324 questions

Policy Structure & Provisions

The entire contract provision in a property and casualty policy means that:

  • a.The agent's spoken promises modify the contract
  • b.The insurer's underwriting file is part of the deal
  • c.The company's advertising becomes a warranty
  • d.The policy and application are the whole contract✓

The provision confines the agreement to the written policy plus whatever is attached to it, so nothing outside the four corners of the document adds to or subtracts from coverage. That is why an agent's oral assurance cannot rewrite the form and why the underwriting file and the company's brochures are not part of the bargain. Any change must be made by a written endorsement made part of the contract.

Policy Structure & Provisions

An applicant says nothing about a fire that destroyed an earlier building at the same location, and the insurer does not ask about it. This is best described as:

  • a.Concealment of a material fact✓
  • b.A warranty the insured breached
  • c.A misrepresentation of a fact
  • d.An immaterial omission of history

Concealment is silence about a material fact the applicant knew and had a duty to disclose; a misrepresentation, by contrast, is an untrue statement actually made. Loss history at the very same location is plainly material, since it would change how an underwriter rates or accepts the risk, so calling it immaterial fails. A warranty is a promise written into the contract, not information withheld before it issues.

Policy Structure & Provisions

Immediately after a covered fire, which action is a duty the policy places on the insured?

  • a.Discard the damaged property to clear the site
  • b.Protect the property from further damage✓
  • c.Begin permanent repairs before an inspection
  • d.Settle directly with anyone who was injured

Duties after loss include giving prompt notice, protecting the property from additional damage, preparing an inventory, cooperating with the investigation and submitting to examination under oath. Making permanent repairs or throwing out damaged goods first destroys the evidence the adjuster needs to value the claim, and settling voluntarily with a claimant is barred because it prejudices the insurer's defense.

Policy Structure & Provisions

In the claim process, a proof of loss is best described as:

  • a.The insurer's formal offer to settle a claim
  • b.A receipt showing the insured paid the premium
  • c.The adjuster's written estimate of repair cost
  • d.A sworn statement of the loss and its amount✓

The proof of loss is the insured's own signed and sworn statement of the time, cause and amount of the loss and of the insured's interest in the property, and the policy requires it before the insurer must pay. It is not the adjuster's estimate, which is the insurer's own valuation of the same damage, and it is not a settlement offer, which comes later once the claim has been reviewed.

Policy Structure & Provisions

The insured and the insurer agree the fire loss is covered but cannot agree on what it is worth. Under the appraisal condition:

  • a.The insurer's adjuster sets the binding amount
  • b.Each picks an appraiser and they pick an umpire✓
  • c.The claim is denied until the parties agree
  • d.A court decides the amount before any payment

Appraisal is a valuation mechanism, not a coverage mechanism: each side names a competent independent appraiser, the two of them select an umpire, and agreement between any two of the three sets the amount of loss. It is available only where coverage itself is not in dispute. Nothing in it lets the adjuster fix the figure alone or forces the insured into court, and the claim is not denied merely for want of agreement.

Policy Structure & Provisions

The suit against us condition in a property policy provides that the insured may sue the insurer only if:

  • a.The insured hires counsel approved by the insurer
  • b.The loss exceeds the deductible by a wide margin
  • c.The insurer has refused arbitration in writing
  • d.The insured has complied with the policy terms✓

The condition bars an action unless there has been full compliance with the terms of the policy, including notice, proof of loss and cooperation, and unless suit is brought within the time the policy allows, a period that varies by jurisdiction. Its purpose is to make the insured exhaust the claim process first. The insurer does not select the insured's lawyer, and the size of the loss is not a condition of suing.

Policy Structure & Provisions

After a covered glass loss, the insurer notifies the insured that it will replace the glass rather than pay cash. This is permitted because:

  • a.The deductible was not yet collected
  • b.The insured waived cash by filing a claim
  • c.Repair is required whenever it costs less
  • d.The policy gives the insurer that option✓

Loss settlement conditions reserve to the insurer the choice of paying the loss in money or of repairing or replacing the damaged property with material of like kind and quality, after telling the insured what it intends to do. It is the insurer's election, not a rule that the cheaper route must be taken, and not something the insured surrenders by filing. The deductible is subtracted from the settlement either way.

Policy Structure & Provisions

A warehouse is covered by two policies on the same property, one for $100,000 and one for $300,000, each with a pro rata other-insurance clause. A $40,000 covered loss occurs. The $100,000 policy pays:

  • a.$10,000✓
  • b.$20,000
  • c.$40,000
  • d.$30,000

Pro rata sharing gives each policy the share its limit bears to the total insurance in force: $100,000 out of $400,000 is one quarter, so that policy pays one quarter of the $40,000 loss, or $10,000, while the larger policy pays $30,000. Splitting the loss evenly at $20,000 apiece ignores the limits, and no single policy pays the whole loss where a pro rata clause governs.

Policy Structure & Provisions

A policy contains an excess other-insurance clause. When another policy also covers the same loss, the excess policy:

  • a.Shares in proportion to the two policy limits
  • b.Pays half the loss alongside the other insurer
  • c.Is void because of the duplicate coverage
  • d.Pays only after the other insurance is used up✓

An excess clause puts that policy behind any other collectible insurance, so it pays nothing until the primary limit is exhausted and then only what remains. That differs from pro rata sharing, where each policy contributes according to its limit. When two policies are written on different terms, the resulting non-concurrency can leave the clauses in conflict and the insured with less than expected.

Policy Structure & Provisions

After a driver damages the insured's fence, the insured signs a paper releasing that driver from all claims and then files with his own insurer. The effect is that:

  • a.The release transfers to the insurer on payment
  • b.The insurer's recovery right has been impaired✓
  • c.The insurer must still pay and pursue the driver
  • d.The driver's insurer now owes the whole loss

The subrogation condition requires the insured to do nothing after a loss that would prejudice the insurer's right to step into his shoes and recover from the party at fault. Signing a release destroys that right, and the insurer may reduce or deny the claim to the extent it was harmed. A waiver given before any loss can sometimes stand, but a release signed afterward cannot be handed on to the insurer.

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Policy Structure & Provisions

A homeowner intentionally sets fire to his own insured house. Under the standard mortgage clause, the mortgagee:

  • a.Receives only the unearned premium back
  • b.Is paid to the extent of its interest✓
  • c.Loses its claim along with the owner's
  • d.Must first sue the owner for the balance

The standard mortgage clause creates a separate contract between the insurer and the mortgagee, so the mortgagee's interest survives acts of the owner that would defeat the owner's own claim, arson and misrepresentation included. Having paid, the insurer takes an assignment of the mortgage or subrogates against the owner. The mortgagee need not sue first, and it is owed its interest rather than a premium refund.

Policy Structure & Provisions

An insured sells his building and tries to hand the property policy to the buyer. That assignment is effective only if:

  • a.The policy has run half of its term
  • b.The buyer assumes the unpaid premium
  • c.The insurer consents to it in writing✓
  • d.The deed and policy are recorded together

A property policy is a personal contract between the insurer and the particular insured whose character, loss history and use of the property were underwritten, so it cannot be handed to a stranger without the insurer's written consent. Paying the outstanding premium or recording documents at the courthouse does nothing to bind an insurer to someone it did not evaluate, and the age of the policy is irrelevant.

Policy Structure & Provisions

The difference between cancellation of a policy and non-renewal of a policy is that cancellation:

  • a.Returns the entire premium to the insured
  • b.Terminates the contract before it expires✓
  • c.Declines to continue it past expiration
  • d.Requires the insured's written agreement

Cancellation cuts the contract short while the term is still running, and either party may do it on the terms the policy and the law of the jurisdiction allow. Non-renewal is a decision made at the end of a term not to offer another one, so the contract simply runs out on schedule. Neither one needs the other party's agreement, and cancellation returns unearned premium only, not the whole premium.

Policy Structure & Provisions

A policy carries a $1,000 deductible for each occurrence. A windstorm damages the roof for $12,000 and, three months later, a separate hailstorm causes $4,000 of damage. The insurer pays in total:

  • a.$14,000✓
  • b.$16,000
  • c.$11,000
  • d.$15,000

A per-occurrence deductible is subtracted from each separate loss, so the insured absorbs $1,000 twice: $11,000 is paid on the wind claim and $3,000 on the hail claim, a total of $14,000. Applying one deductible to the whole year yields $15,000, and ignoring the deductible altogether yields the full $16,000. The deductible reduces the payment; it is not a bill sent to the insured.

Policy Structure & Provisions

A bank that financed the insured's equipment is shown on the declarations as a loss payee. That means the bank:

  • a.Owes the premium if the insured does not
  • b.Can cancel the policy and collect a refund
  • c.Is paid for damage to that equipment✓
  • d.Receives liability coverage as an insured

A loss payee has a financial interest in specific property and is named so that payment for damage to that property runs to it along with the insured; its rights reach no further than that property. An additional insured, by contrast, is brought under the liability coverage. Only the named insured holds the right to change or cancel the policy and the duty to pay the premium.

Policy Structure & Provisions

A customer slips in the insured's store and sues him. What the insured presents to his liability insurer is:

  • a.A third-party claim, defended by the insurer✓
  • b.A subrogation claim against the customer
  • c.An excess claim over the customer's health plan
  • d.A first-party claim for the insured's own loss

A first-party claim is the insured presenting his own loss to his own insurer, such as fire damage to the store itself. When someone outside the contract asserts a claim against the insured, it is a third-party claim, and the liability policy owes both a defense and payment of damages up to the limit. Subrogation runs the other way, against whoever caused the insured's loss.

Louisiana P&C Law & Regulation

Which agency licenses resident property and casualty insurance producers in Louisiana?

  • a.Louisiana Department of Insurance✓
  • b.Louisiana Office of Motor Vehicles
  • c.Louisiana Office of Financial Institutions
  • d.Louisiana Public Service Commission

Louisiana regulates insurance and licenses producers through the Louisiana Department of Insurance (LDI), headed by the elected Commissioner of Insurance. The Office of Motor Vehicles enforces vehicle registration and proof of insurance but does not license producers.

Louisiana Auto & Property Coverage

What are Louisiana's minimum auto liability limits for a private passenger vehicle?

  • a.$15,000 / $30,000 / $25,000✓
  • b.$25,000 / $50,000 / $25,000
  • c.$50,000 / $100,000 / $25,000
  • d.$10,000 / $20,000 / $10,000

Louisiana's minimum liability limits are 15/30/25: $15,000 bodily injury per person, $30,000 per accident, and $25,000 property damage, per the Insurance Information Institute state financial-responsibility chart. These are minimums that can change by law, so confirm current figures with the Louisiana Department of Insurance.

Louisiana Auto & Property Coverage

How does Louisiana generally handle auto injury claims?

  • a.As a pure no-fault state where each driver's own insurer pays regardless of fault
  • b.As a traditional at-fault (tort) state, where injury claims are pursued against the responsible driver✓
  • c.By barring all lawsuits arising from auto accidents
  • d.Through a state-run fund that pays all injury claims

Louisiana is a traditional at-fault (tort) state, not a no-fault state: bodily injury and property damage liability are the required coverages and injury claims are pursued against the at-fault driver, per the Insurance Information Institute state chart, which lists only BI and PD liability as required in Louisiana.

Louisiana Auto & Property Coverage

In Louisiana, how is uninsured/underinsured motorist (UM/UIM) coverage generally handled on a personal auto policy?

  • a.It is never available in Louisiana
  • b.It is mandatory and cannot be waived
  • c.It must be offered by the insurer but may be rejected or reduced by the insured in writing✓
  • d.It is automatically included at $1,000,000

Louisiana does not compel UM/UIM as a flat minimum; instead insurers must offer UM coverage and the insured may reject it or select lower limits in writing. Producers should document the insured's election. Confirm the current UM selection/rejection rules with the Louisiana Department of Insurance.

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Louisiana P&C Law & Regulation

A Louisiana producer offers part of his commission back to a customer to close a homeowners sale. This is:

  • a.Permitted if disclosed to the insurer
  • b.Permitted for new customers only
  • c.Prohibited rebating under Louisiana's unfair trade practices law✓
  • d.Required to be reported but otherwise lawful

Rebating, giving any part of the premium or commission or other valuable consideration as an inducement to buy, is a prohibited unfair trade practice in Louisiana and can bring fines and license action by the Louisiana Department of Insurance.

Louisiana P&C Law & Regulation

After a Louisiana personal auto or homeowners policy has been in force beyond its initial underwriting period, mid-term cancellation by the insurer is generally allowed only:

  • a.For specific statutory reasons such as nonpayment of premium, fraud, or a substantial change in the risk, with required advance written notice✓
  • b.For any reason, with no notice to the insured
  • c.Only during the first 24 hours after issuance
  • d.Never under any circumstances

Louisiana limits mid-term cancellation of seasoned personal-lines policies to defined grounds such as nonpayment, fraud, or a material increase in hazard, and requires advance written notice so the insured can replace coverage. The exact notice day-counts are set by statute; verify current figures with the Louisiana Department of Insurance.

Louisiana Licensing & CE

After a producer is licensed in Louisiana, what must happen before she can transact business for a specific insurer?

  • a.Nothing further once the license is issued
  • b.The insurer must appoint the producer and file the appointment with the Louisiana Department of Insurance✓
  • c.The producer must post a surety bond with the state treasurer
  • d.The producer must establish residency in the insurer's home state

A license lets a person act as a producer, but to represent a specific company that insurer must appoint the producer, with the appointment filed with the Louisiana Department of Insurance. A producer may hold appointments from several insurers at once.

Louisiana Licensing & CE

Which best describes continuing education for a Louisiana resident P&C producer?

  • a.No CE is ever required
  • b.CE is required only in the first renewal and never again
  • c.State-approved continuing education, including an ethics component, is required each renewal period to keep the license active✓
  • d.CE can be met only by retaking the licensing exam

Following the NAIC model, Louisiana requires resident producers to complete approved continuing education each renewal cycle, including an ethics portion. The exact hour totals are set by the Louisiana Department of Insurance and should be verified before renewal.

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