Oklahoma Adjuster License Exam

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Here are 14 in-depth Q&A study notes to help you prepare for the exam.

Explain the concept of “bad faith” in insurance claims handling in Oklahoma, detailing specific actions that could be considered bad faith on the part of an adjuster, and referencing relevant sections of the Oklahoma Insurance Code.

“Bad faith” in Oklahoma insurance claims handling refers to an insurer’s unreasonable and unwarranted actions in denying or delaying payment of a legitimate claim. An adjuster commits bad faith when they intentionally disregard the insured’s rights or act without a reasonable basis for their actions. Examples include: failing to promptly investigate a claim, unreasonably delaying payment, denying a claim without proper investigation, misrepresenting policy provisions, or offering a settlement substantially less than the claim’s value. Oklahoma law, specifically the Oklahoma Insurance Code (Title 36), implies a duty of good faith and fair dealing in every insurance contract. While the code doesn’t explicitly define “bad faith,” court decisions have established its parameters. An insurer’s conduct is evaluated based on whether a reasonable insurer, under the circumstances, would have acted in the same manner. Punitive damages may be awarded in bad faith cases if the insurer’s conduct demonstrates reckless disregard for the insured’s rights.

Describe the process for handling a claim involving a total loss vehicle in Oklahoma, including the requirements for determining the actual cash value (ACV) and the obligations of the insurer regarding sales tax and title transfer fees. Reference specific Oklahoma statutes.

When handling a total loss vehicle claim in Oklahoma, the adjuster must determine the Actual Cash Value (ACV) of the vehicle immediately before the loss. This is typically determined by considering factors like the vehicle’s age, mileage, condition, and comparable sales in the local market. Oklahoma Statute Title 36, Section 4405 outlines requirements for total loss settlements. The insurer is obligated to offer a settlement that reflects the ACV. Furthermore, the insurer is generally responsible for paying applicable sales tax and title transfer fees associated with the replacement vehicle, ensuring the insured is made whole. The insurer must provide a written explanation of how the ACV was calculated, including the sources used for valuation. If the insured disputes the ACV, they have the right to present their own valuation and negotiate with the insurer. Failure to properly determine and compensate for the total loss, including sales tax and title fees, can expose the insurer to potential penalties.

Explain the concept of “comparative negligence” as it applies to liability claims in Oklahoma, and how an adjuster would determine the degree of fault for each party involved in an accident. Provide an example scenario.

Oklahoma operates under a modified comparative negligence system, as outlined in Title 23, Section 13 of the Oklahoma Statutes. This means that a claimant can recover damages even if they were partially at fault for the accident, but their recovery is reduced by their percentage of fault. However, if the claimant’s negligence is greater than the combined negligence of all other parties, they cannot recover any damages. An adjuster must carefully investigate the accident to determine the degree of fault for each party. This involves gathering evidence such as police reports, witness statements, and expert opinions. For example, if a driver ran a red light and collided with another vehicle that was speeding, the adjuster would need to assess the degree to which each driver’s actions contributed to the accident. If the driver who ran the red light was found to be 70% at fault and the speeding driver 30% at fault, the speeding driver could recover 70% of their damages. However, if the speeding driver was found to be 51% or more at fault, they would be barred from recovering any damages.

Describe the duties of a licensed adjuster in Oklahoma regarding continuing education requirements, and the potential consequences of failing to meet these requirements, referencing the relevant sections of the Oklahoma Insurance Code and Administrative Rules.

Licensed adjusters in Oklahoma are required to complete continuing education (CE) courses to maintain their licenses. The specific requirements are outlined in the Oklahoma Insurance Code and the Oklahoma Administrative Code (OAC) Title 36. Generally, adjusters must complete a certain number of CE hours within a specified period, often biennially. These hours must cover approved topics related to insurance laws, regulations, ethics, and claims handling practices. Failure to meet the CE requirements can result in penalties, including fines, suspension of the license, or revocation of the license. The Oklahoma Insurance Department (OID) monitors compliance with CE requirements and may conduct audits to verify that adjusters have completed the necessary coursework. Adjusters are responsible for tracking their CE credits and ensuring that they are reported to the OID in a timely manner. It is crucial for adjusters to stay informed about the specific CE requirements and deadlines to avoid any disciplinary actions.

Explain the concept of “subrogation” in insurance, and how an adjuster would handle a subrogation claim in Oklahoma, including the insurer’s rights and responsibilities.

Subrogation is the legal right of an insurer to pursue a third party who caused a loss to the insured, in order to recover the amount of the claim paid to the insured. In Oklahoma, an adjuster handling a subrogation claim must first ensure that the insured has been fully compensated for their loss. The insurer’s right to subrogation is typically outlined in the insurance policy. The adjuster must then investigate the circumstances of the loss to determine if a third party was responsible. If a third party is identified, the adjuster will notify them of the insurer’s subrogation claim and attempt to negotiate a settlement. The insurer has a duty to act in good faith and to mitigate damages in pursuing the subrogation claim. If a settlement cannot be reached, the insurer may file a lawsuit against the third party to recover the amount paid to the insured. The insured has a duty to cooperate with the insurer in the subrogation process, including providing information and testimony. Any recovery from the third party is typically used to reimburse the insurer for the claim payment, and any remaining funds are returned to the insured.

Describe the process for handling a workers’ compensation claim in Oklahoma, including the adjuster’s responsibilities regarding medical benefits, temporary disability benefits, and permanent disability benefits, referencing relevant Oklahoma statutes.

Handling a workers’ compensation claim in Oklahoma involves several key steps and adjuster responsibilities, governed by the Oklahoma Workers’ Compensation Act (Title 85A of the Oklahoma Statutes). First, the adjuster must promptly investigate the claim to determine its validity. This includes verifying the employee’s employment status, the occurrence of a work-related injury, and the causal connection between the injury and the employment. If the claim is accepted, the adjuster is responsible for coordinating and authorizing medical treatment for the injured employee. This includes ensuring that the employee receives necessary and reasonable medical care. The adjuster must also determine eligibility for temporary disability benefits, which are paid to the employee while they are unable to work due to the injury. These benefits are typically a percentage of the employee’s average weekly wage. Once the employee reaches maximum medical improvement (MMI), the adjuster must assess whether the employee has sustained any permanent disability. This may involve obtaining a medical evaluation from a qualified physician. If a permanent disability is found, the adjuster must calculate the appropriate permanent disability benefits based on the impairment rating and the employee’s average weekly wage. The adjuster must also ensure that all benefits are paid in a timely and accurate manner, and that the employee is kept informed throughout the claims process.

Explain the requirements for an adjuster to act as a public adjuster in Oklahoma, including licensing, bonding, and the specific regulations governing their interactions with insureds, referencing the Oklahoma Insurance Code and Administrative Rules.

To act as a public adjuster in Oklahoma, an individual must meet specific requirements outlined in the Oklahoma Insurance Code and the Oklahoma Administrative Code (OAC). First, they must obtain a public adjuster license from the Oklahoma Insurance Department (OID). This typically involves passing an examination, completing pre-licensing education, and submitting an application with the required fees. Public adjusters are required to post a surety bond with the OID to protect insureds from potential misconduct. The bond amount is specified by law and must be maintained throughout the licensure period. Regulations govern the interactions between public adjusters and insureds. These regulations typically address issues such as contract requirements, fee limitations, and disclosure obligations. Public adjusters must enter into a written contract with the insured that clearly outlines the scope of services, the fee arrangement, and the insured’s rights. The fees charged by public adjusters are often capped by law or regulation to prevent excessive charges. Public adjusters have a fiduciary duty to act in the best interests of the insured and must avoid conflicts of interest. They are prohibited from soliciting business during certain periods after a loss and must disclose any relationships with contractors or other service providers. Failure to comply with these requirements can result in disciplinary action, including fines, suspension, or revocation of the public adjuster license.

Explain the concept of “bad faith” in insurance claims handling in Oklahoma, providing specific examples of actions that would constitute bad faith on the part of an adjuster, and referencing relevant sections of the Oklahoma Insurance Code.

“Bad faith” in insurance claims handling refers to an insurer’s unreasonable and unwarranted actions in denying or delaying payment of a legitimate claim. In Oklahoma, the duty of good faith and fair dealing is implied in every insurance contract. An adjuster acts in bad faith when they intentionally disregard the insured’s rights or act in a manner that is unreasonable and unfair. Examples include: failing to promptly investigate a claim, unreasonably delaying payment, denying a claim without a reasonable basis, misrepresenting policy provisions, or failing to communicate with the insured. Oklahoma law, specifically the Oklahoma Insurance Code (Title 36), addresses unfair claim settlement practices. While there isn’t a single section explicitly defining “bad faith,” several sections outline prohibited conduct that would constitute it. For instance, 36 O.S. § 1250.5 prohibits unfair claim settlement practices, including knowingly misrepresenting facts or policy provisions, failing to acknowledge and act promptly upon communications, and failing to adopt and implement reasonable standards for the prompt investigation of claims. A pattern of such behavior can lead to a finding of bad faith, potentially resulting in compensatory and punitive damages against the insurer.

Describe the duties and responsibilities of an adjuster in Oklahoma regarding the handling of claims involving uninsured or underinsured motorist (UM/UIM) coverage, including the notification requirements and the process for settling such claims. Reference relevant Oklahoma statutes.

In Oklahoma, an adjuster handling UM/UIM claims has specific duties to the insured. These claims arise when an insured is injured by a negligent driver who is either uninsured or has insufficient insurance to cover the damages. The adjuster must conduct a thorough investigation to determine the liability of the uninsured/underinsured motorist and the extent of the insured’s damages. Notification requirements are crucial. The insured must notify their own insurer of a potential UM/UIM claim. The insurer then has a duty to investigate and evaluate the claim. Oklahoma Statute 36 O.S. § 3636 outlines the requirements for UM/UIM coverage. It mandates that insurers offer UM/UIM coverage to their insureds. The statute also dictates the process for settling these claims, including the right of the insurer to subrogate against the uninsured/underinsured motorist. The adjuster must also inform the insured of their rights under the policy and applicable law. Settlement negotiations must be conducted in good faith, and the adjuster must make a reasonable offer based on the damages sustained by the insured. If a settlement cannot be reached, the insured may pursue legal action against the uninsured/underinsured motorist, and the insurer may be bound by the outcome of that litigation.

Explain the concept of “actual cash value” (ACV) and “replacement cost value” (RCV) in property insurance claims in Oklahoma. Detail how depreciation is calculated in determining ACV and the conditions under which an insured can recover the difference between ACV and RCV.

In Oklahoma property insurance, “actual cash value” (ACV) represents the replacement cost of property minus depreciation. Depreciation accounts for the decrease in value due to age, wear and tear, and obsolescence. “Replacement cost value” (RCV), on the other hand, is the cost to replace the damaged property with new property of like kind and quality, without deducting for depreciation. Depreciation is typically calculated based on the age and condition of the property at the time of the loss, using methods such as straight-line depreciation or percentage-based depreciation. The specific method used should be clearly outlined in the insurance policy. Many Oklahoma property insurance policies offer RCV coverage, but with specific conditions. Typically, the insured must actually repair or replace the damaged property to recover the difference between ACV and RCV. The insurer will initially pay the ACV, and then, upon completion of the repairs or replacement, the insured can submit documentation to recover the remaining amount up to the RCV. Failure to repair or replace the property within a specified timeframe (as defined in the policy) may result in the insured only receiving the ACV. The policy will dictate the timeframe and documentation needed.

Discuss the legal implications of an adjuster providing legal advice to a claimant in Oklahoma. What constitutes legal advice, and what are the potential consequences for an adjuster who crosses the line into unauthorized practice of law?

In Oklahoma, adjusters are specifically prohibited from engaging in the unauthorized practice of law. Providing legal advice to a claimant constitutes such unauthorized practice and carries significant legal implications. Legal advice involves interpreting laws, applying laws to specific facts, or recommending a course of action based on legal principles. Examples include advising a claimant on the legal merits of their claim, interpreting complex policy language beyond a simple explanation, or recommending specific legal strategies. The line between providing information and providing legal advice can be blurry, but the key is whether the adjuster is offering an opinion or interpretation of the law. The unauthorized practice of law is a violation of Oklahoma law and can result in various consequences for the adjuster. These consequences may include disciplinary action by the Oklahoma Insurance Department, such as suspension or revocation of the adjuster’s license. Additionally, the adjuster could face civil liability for damages caused by their unauthorized legal advice. Claimants who rely on such advice may have grounds to sue the adjuster for negligence or misrepresentation. Furthermore, the adjuster could potentially face criminal charges for engaging in the unauthorized practice of law, although this is less common.

Detail the requirements for maintaining adjuster continuing education (CE) credits in Oklahoma, including the number of hours required, the types of courses that qualify, and the consequences of failing to meet the CE requirements. Reference the relevant sections of the Oklahoma Insurance Code and administrative rules.

Oklahoma requires licensed adjusters to complete continuing education (CE) to maintain their licenses. The specific requirements are outlined in the Oklahoma Insurance Code and the rules promulgated by the Oklahoma Insurance Department. Generally, adjusters must complete a certain number of CE hours every license term (typically two years). The exact number of hours required can vary, so it’s crucial to consult the current regulations. A portion of these hours must often be in ethics and Oklahoma insurance law. Qualifying CE courses must be approved by the Oklahoma Insurance Department. These courses cover various topics related to insurance adjusting, such as policy updates, claims handling procedures, legal and regulatory changes, and ethical considerations. Failure to meet the CE requirements can result in various penalties, including suspension or revocation of the adjuster’s license. Adjusters are typically given a grace period to complete the required hours, but failure to do so within the grace period will result in the license being inactivated. To reinstate the license, the adjuster may need to complete all outstanding CE hours and pay a reinstatement fee. It is the adjuster’s responsibility to track their CE credits and ensure they are reported to the Oklahoma Insurance Department within the required timeframe.

Explain the concept of “subrogation” in insurance claims, specifically in the context of Oklahoma law. Provide an example of a situation where subrogation would apply, and detail the adjuster’s responsibilities in pursuing subrogation rights on behalf of the insurer.

Subrogation is a legal doctrine where an insurer, after paying a claim to its insured, acquires the insured’s rights to recover damages from a third party who caused the loss. In Oklahoma, subrogation allows the insurer to “step into the shoes” of the insured and pursue a claim against the responsible party. For example, if an insured’s car is damaged in an accident caused by another driver’s negligence, the insured’s insurance company will pay for the damages. The insurance company then has the right to subrogate against the negligent driver (or their insurance company) to recover the amount it paid to its insured. The adjuster plays a crucial role in pursuing subrogation rights. Their responsibilities include: identifying potential subrogation opportunities during the claims investigation, preserving evidence related to the loss, notifying the responsible party of the insurer’s subrogation interest, and negotiating with the responsible party or their insurer to recover the damages. The adjuster must also be aware of any applicable statutes of limitations and ensure that the subrogation claim is filed within the required timeframe. Failure to properly pursue subrogation rights can result in the insurer losing its ability to recover the damages, potentially leading to financial losses for the company. Oklahoma law recognizes the insurer’s right to subrogation, but it is important to note that the specific terms and conditions of the insurance policy may also affect the insurer’s subrogation rights.

Describe the process for handling a claim involving a total loss of a vehicle in Oklahoma, including the determination of the vehicle’s value, the required documentation, and the adjuster’s responsibilities regarding the transfer of ownership. Reference relevant Oklahoma statutes and regulations.

Handling a total loss vehicle claim in Oklahoma requires a specific process to ensure compliance with state laws and regulations. A vehicle is considered a total loss when the cost to repair it exceeds a certain percentage of its actual cash value (ACV), often determined by state law or the insurance policy. The adjuster’s first step is to determine the vehicle’s ACV. This is typically done by using industry-standard valuation guides, considering factors such as the vehicle’s age, mileage, condition, and optional equipment. The adjuster must also research comparable vehicles in the local market to ensure the valuation is accurate. Once the ACV is determined, the adjuster must provide the insured with a written offer that includes a breakdown of the valuation. Required documentation includes the vehicle’s title, registration, and any other relevant documents. The adjuster is responsible for obtaining a properly executed title from the insured. Oklahoma law requires that the insurance company notify the Oklahoma Tax Commission of the total loss and surrender the title. The insurance company will then receive a salvage title for the vehicle. The adjuster must also ensure that the insured is aware of their options, such as retaining the salvage and receiving a reduced settlement or surrendering the vehicle to the insurance company. The process is governed by Oklahoma statutes related to vehicle titles and insurance regulations regarding total loss claims.

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