West Virginia Insurance
Content Outlines
• for examinations taken before January 20, 2012
• for examinations taken on or after January 20, 2012
Examination Content Outlines
West Virginia
Insurance Supplement Effective: February 15, 2011
LIFE – GENERAL KNOWLEDGE 5. Owner’s rights
CONTENT OUTLINE 6. Beneficiary designations
a. Primary and contingent
Product Knowledge, Terms, and Concepts
b. Revocable and irrevocable
(50 scoreable questions plus 10 pretest questions) c. Changes
d. Common disaster
I. TYPES OF POLICIES.......................................................... 12 e. Minor beneficiaries
A. Traditional whole life products 7. Premium Payment
1. Ordinary (straight) life a. Modes
2. Limited-pay and single-premium life b. Grace period
3. Adjustable life c. Automatic premium loan
B. Interest/market-sensitive life products d. Level or flexible
1. Universal life 8. Reinstatement
2. Variable whole life 9. Policy loans, withdrawals, partial surrenders
3. Variable universal life 10. Non-forfeiture options
4. Interest-sensitive whole life 11. Dividends and dividend options
5. Equity-indexed life 12. Incontestability
C. Term life 13. Assignments
1. Types 14. Suicide
a. Level 15. Misstatement of age and gender
b. Decreasing 16. Settlement options
c. Return of premium 17. Accelerated death benefits
d. Annually renewable C. Policy exclusions
e. Increasing term
2. Special features III. COMPLETING THE APPLICATION, UNDERWRITING, AND
DELIVERING THE POLICY ...........................................11
a. Renewable
A. Completing the application
b. Convertible
1. Required signatures
D. Annuities
2. Changes in the application
1. Single and flexible premium
3. Consequences of incomplete applications
2. Immediate and deferred
4. Warranties and representations
3. Fixed and variable
5. Collecting the initial premium and issuing the receipt
4. Indexed
6. Replacement
E. Combination plans and variations
7. Disclosures at point of sale (e.g., HIPAA, HIV consent)
1. Joint life
8. USA PATRIOT Act/anti-money laundering
2. Survivorship life (second to die)
B. Underwriting
II. POLICY RIDERS, PROVISIONS, OPTIONS, AND 1. Insurable interest
EXCLUSIONS .................................................................. 19 2. Medical information and consumer reports
A. Policy riders 3. Fair Credit Reporting Act
1. Waiver of premium and waiver of premium with disability 4. Risk classification
income 5. Stranger-originated life insurance (STOLI)
2. Guaranteed insurability 6. Investor-originated life insurance (IOLI)
3. Payor benefit C. Delivering the policy
4. Accidental death and/or accidental death and 1. When coverage begins
dismemberment 2. Explaining the policy and its provisions, riders,
5. Term riders exclusions, and ratings to the client
6. Other insureds (e.g., spouse, children, nonfamily )
7. Long term care IV. TAXES, RETIREMENT, AND OTHER INSURANCE
CONCEPTS........................................................................8
8. Return of premium
A. Third-party ownership
B. Policy provisions and options
B. Group life insurance
1. Entire contract
1. Conversion privilege
2. Insuring clause
2. Contributory vs. noncontributory
3. Free look
C. Retirement plans
4. Consideration
1. Tax-qualified plans
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2. Nonqualified plans c. Nonrenewal
D. Life insurance needs analysis/suitability Ref: 33-12-24
1. Personal insurance needs 4. Limitation of license
2. Business insurance needs Ref: 33-12-18, 33-12-19, 33-12-20, 33-12-21
a. Key person 5. Appointment
E. Social Security benefits and taxes Ref: 33-23-3(d), 33-12-17, 33-12-18(a), 33-12-24
F. Tax treatment of insurance premiums, proceeds, and 6. Education requirements
dividends a. Continuing education
1. Individual life Ref: 33-12-8; Rule 114-25-1, 2, 3, 4, 7
2. Group life 7. Mandatory reporting requirements
3. Modified Endowment Contracts (MECs) a. Criminal prosecution and administrative action
Ref: 33-12-34
LIFE–WEST VIRGINIA SPECIFIC b. Fraud
CONTENT OUTLINE Ref: 33-41-5
D. Unfair Trade Practices ............................................6
State Laws and Rules 1. Unfair claims methods and practices
(28 scoreable questions plus 6 pretest questions) Ref: 33-11-4(9); 33-43-2, Rule 114-14-5, 6
2. Excessive charges
I. WEST VIRGINIA LAWS AND RULES COMMON TO LIFE, Ref: Information letter No. 6
ACCIDENT AND SICKNESS INSURANCE ................... 21
3. Rebating
Ref: All statutory references are taken from Chapter 33 of the
Ref: 33-11-4(8), Rule 114-70
West Virginia Code and West Virginia Code of State Rules Series
4. Coercion
14, 15, and 25, unless otherwise noted.
Ref: 33-11-5, 33-11-4(4)
A. Insurance Commissioner....................................... 2
5. Misrepresentation
1. Broad powers
Ref: 33-11-4(1)
Ref: 33-2-1, 33-2-3, 33-2-4, 33-12-6, 9
6. Defamation
2. Examination of records
Ref: 33-11-4(3)
Ref: 33-2-4, 33-2-9
7. Advertising
3. Notice and conduct of hearing
Ref: 33-11-4(2); Rule 114-11-4
Ref: 33-2-12, 33-2-13
8. Penalties
4. Penalties
Ref: 33-11-6, 33-11-8
Ref: 33-2-9, 33-2-11, 33-3-11, 33-11-6,
E. Mass Marketed Life and Sickness Insurance .......1
33-11-8, 33-12-24, 33-44-7
Ref: 33-6-35, 33-6-8(e)
5. Filing and approval of forms
F. West Virginia Life and Health Guaranty
Ref: 33-6-8, 33-6-9
Association ..............................................................1
B. Definitions ............................................................... 4
Ref: 33-26A-2 through 33-26A-8
1. Domestic, foreign, alien, nonadmitted, and
unauthorized companies II. WEST VIRGINIA LAWS AND RULES PERTINENT TO LIFE
Ref: 33-1-6, 33-1-7, 33-1-8, 33-44-3 INSURANCE ONLY ........................................................7
2. Stock and mutual A. Replacement............................................................3
Ref: 33-1-18, 33-1-19 1. Definitions
3. Transacting insurance Ref: Rule 114-8-1, 2
Ref: 33-3-1, 33-12-2(m), (o), (p), 33-12-21 2. Duties of producers
4. Producer Ref: Rule 114-8-4.2(d)
Ref: 33-1-12, 33-12-22 3. Duties of insurance companies
C. Licensing ................................................................. 7 Ref: Rule 114-8-5
1. Purpose/Requirements 4. Exemptions
Ref: 33-12-2, 33-12-6 Ref: Rule 114-8-3
2. Qualifications B. Disclosure................................................................1
a. Producer Ref: Rule 114-11A-5
Ref: 33-12-2, 33-12-6, 33-12-9 C. Policy Clauses and Provisions ..............................1
b. Direct response 1. Protection, beneficiaries, and creditors
Ref: 33-6-35(a)(1), 33-28-3(c),33-28-3(e) Ref: 33-6-20, 33-6-27, 33-6-28
c. Nonresident Life/A&H producer 2. Policy loan interest rate
Ref: 33-12-12 Ref: 33-13-8, 33-13-8(a)
d. Fingerprinting D. Group Life ................................................................2
Ref: 33-12-37 1. Assignment of proceeds
3. Termination of license Ref: 33-14-28
a. Expiration and cancellation
Ref: 33-12-17
b. Revocation and suspension
Ref: 33-11-6, 33-12-24
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2. Employee and debtor groups 7. Proof of loss
Ref: 33-14-2, 33-14-3 8. Time of payment of claims
3. Labor union and trustee groups 9. Payment of claims
Ref: 33-14-4, 33-14-5 10. Physical examination and autopsy
4. Conversion on termination of policy 11. Legal actions
Ref: 33-14-17 12. Change of beneficiary
5. Conversion on termination of employment 13. Misstatement of age
Ref: 33-14-16 B. Optional provisions
E. Suitability in Annuity Transactions C. Other provisions and clauses
Ref: Rule 114-11B-1 through 114-11B-7 1. Insuring clause
2. Free look
ACCIDENT & HEALTH–GENERAL KNOWLEDGE 3. Consideration clause
CONTENT OUTLINE 4. Probationary period
5. Elimination period
Product Knowledge, Terms, and Concepts 6. Waiver of premium
(50 scoreable questions plus 10 pretest questions) 7. Exclusions
8. Preexisting conditions
I. TYPES OF POLICIES.......................................................... 14 9. Recurrent disability
A. Disability income 10. Coinsurance
1. Individual disability income policy 11. Deductibles
2. Business overhead expense policy 12. Eligible expenses
3. Business disability buyout policy 13. Copayments
4. Group disability income policy 14. Pre-authorizations and prior approval requirements
5. Key employee/partner policies 15. Usual, reasonable, and customary (URC) charges
B. Accidental death and dismemberment 16. Lifetime, annual, or per cause maximum benefit limits
C. Medical expense insurance D. Riders
1. Basic hospital, medical, and surgical policies 1. Impairment/exclusions
2. Major medical policies 2. Guaranteed insurability
3. Health Maintenance Organizations (HMOs) 3. Multiple indemnity (double, triple)
4. Preferred Provider Organizations (PPOs) E. Rights of renewability
5. Point of Service (POS) plans 1. Noncancelable
6. Flexible Spending Accounts (FSAs) 2. Cancelable
7. Health Reimbursement Accounts (HRAs) 3. Guaranteed renewable
8. High Deductible Health Plans (HDHPs) and related 4. Conditionally renewable
Health Savings Accounts (HSAs) 5. Optionally renewable
9. Stop loss 6. Period of time for renewal
D. Medicare supplement policies
E. Group insurance III. SOCIAL INSURANCE........................................................3
1. Group conversion A. Medicare
2. Differences between individual and group contracts 1. Primary, secondary payor
3. General concepts 2. Medicare Parts A, B, C, D
4. COBRA B. Medicaid
5. HIPAA C. Social Security benefits
F. Long Term Care (LTC) IV. OTHER INSURANCE CONCEPTS ...................................4
1. Individual LTC contracts A. Total, partial, and residual disability
2. Group/voluntary LTC contracts B. Owner’s rights
G. Limited Benefit Plans C. Dependent children benefits
1. Cancer (or specified diseases) plans D. Primary and contingent beneficiaries
2. Critical illness plans E. Modes of premium payments (annual, semiannual, etc.)
3. Worksite (employer-sponsored) plans F. Nonduplication and coordination of benefits (e.g.,
4. Hospital indemnity plans primary vs. excess)
5. Dental G. Occupational vs. non-occupational
6. Vision H. Tax treatment of premiums and proceeds of insurance
II. POLICY PROVISIONS, CLAUSES, AND RIDERS ............ 20 contracts (e.g., disability income and medical
A. Mandatory provisions expenses, etc.)
1. Entire contract I. Managed care
2. Time limit on certain defenses (incontestable) J. Workers Compensation
3. Grace period K. Subrogation
4. Reinstatement
5. Notice of claim
6. Claim forms
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L. Field underwriting procedures................................... 9 Ref: 33-12-2, 33-12-6, 33-12-9
M. Completing application and obtaining necessary b. Direct response
signatures Ref: 33-6-35(a)(1), 33-28-3(c), 33-28-3(e)
N. Explaining sources of insurability information (e.g., MIB c. Nonresident Life/A&H producer
Report, Fair Credit Reporting Act, etc.) Ref: 33-12-12
O. Initial premium payment and receipt and consequences d. Fingerprinting
of the receipt (e.g., medical examination, etc.) Ref: 33-12-37
P. Submitting application (and initial premium if collected) 3. Termination of license
to company for underwriting a. Expiration and cancellation
Q. Ensuring delivery of policy and related documents to Ref: 33-12-17
client b. Revocation and suspension
R. Explaining policy and its provisions, riders, exclusions, Ref: 33-11-6, 33-12-24
and ratings to clients c. Nonrenewal
S. Replacement Ref: 33-12-24
T. Contract law 4. Limitation of license
1. Elements of a contract Ref: 33-12-18, 33-12-19, 33-12-20, 33-12-21
2. Insurable interest 5. Appointment
3. Warranties and representations Ref: 33-23-3(d), 33-12-17, 33-12-18(a), 33-12-24
4. Unique aspects of the health contract 6. Education requirements
a. Conditional a. Continuing education
b. Unilateral Ref: 33-12-8; Series 42: 1,2,3,4,7
c. Adhesion 7. Mandatory reporting requirements
a. Criminal prosecution and administrative action
ACCIDENT & SICKNESS Ref: 33-12-34
b. Fraud
WEST VIRGINIA SPECIFIC
Ref: 33-41-5
CONTENT OUTLINE
D. Unfair Trade Practices.............................................6
State Laws and Rules 1. Unfair claims methods and practices
(30 scoreable questions plus 6 pretest questions) Ref: 33-11-4(9), 33-43-2; Rule. 114-14-5, 6
2. Excessive charges
I. WEST VIRGINIA LAWS AND RULES COMMON TO LIFE Ref: Information Letter No. 6
AND ACCIDENT AND SICKNESS INSURANCE........... 21 3. Rebating
Ref: All statutory references are taken from Chapter 33 of the Ref: 33-11-4(8), Rule 114-70
West Virginia Code and West Virginia Code of State Rules Series 4. Coercion
14, 15, and 25, unless otherwise noted. Ref: 33-11-5, 33-11-4(4)
A. Insurance Commissioner....................................... 2 5. Misrepresentation
1. Broad powers Ref: 33-11-4(1)
Ref: 33-2-1, 33-2-3, 33-2-4, 33-12-6, 9 6. Defamation
2. Examination of records Ref: 33-11-4(3)
Ref: 33-2-4, 33-2-9 7. Advertising
3. Notice and conduct of hearing Ref: 33-11-4(2); Rule 114-11-4
Ref: 33-2-12, 33-2-13 8. Penalties
4. Penalties Ref: 33-11-6, 33-11-8
Ref: 33-2-9, 33-2-11, 33-3-11, 33-11-6, E. Mass Marketed Life & Sickness Insurance...........1
33-11-8, 33-12-24, 33-44-7 Ref: 33-6-35, 33-6-8(e)
5. Filing and approval of forms F. West Virginia Life and Health Guaranty
Ref: 33-6-8, 33-6-9 Association ..............................................................1
B. Definitions ............................................................... 4 Ref: 33-26A-2, 33-26A-9 (a), 33-26A-3(c)(2)(A)
1. Domestic, foreign, and alien companies
Ref: 33-1-6, 33-1-7, 33-1-8 II. WEST VIRGINIA LAWS AND RULES PERTINENT TO
2. Stock and mutual ACCIDENT AND SICKNESS INSURANCE ONLY.........9
A. Required Disclosure Provisions; Individual
Ref: 33-1-18, 33-1-19
Minimum A&S Standards .......................................1
3. Transacting insurance
Ref: Rule 114-12-5, 6
Ref: 33-3-1, 33-12-2(m), (o), (p), 33-12-21
B. Requirements for Replacement; Individual
4. Producer
Minimum A&S Standards .......................................1
Ref: 33-1-12, 33-12-23
Ref: Rule 114-12-7
C. Licensing ................................................................. 7
C. Medicare Supplement Insurance ...........................2
1. Purpose/Requirements
Ref: 33-6-11(a), 33-16-3(d), 33-28-5(b); Rule 114-17, 24
Ref: 33-12-2, 33-12-6
2. Qualifications
a. Producer
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D. Health Maintenance Organization Act 1 1. Law of Large Numbers
Ref: 33-25A-2, 33-25A-14 B. Insurable interest
1. Definitions C. Risk
2. Deceptive practices 1. Pure vs. Speculative Risk
E. Corporations ........................................................... 1 D. Hazard
Ref: 33-24-2, 33-24-4 1. Moral
1. Hospital service corporations 2. Morale
2. Medical service corporations 3. Physical
3. Dental service corporations E. Peril
4. Health service corporations F. Loss
F. Coverage for Newborn Children............................ 1 1. Direct
Ref: 33-6-32 2. Indirect
G. Long-Term Care ...................................................... 1 G. Loss Valuation
Ref: 33-15A, Rule 114-32-4.2 1. Actual cash value
H. Small Employer Group ........................................... 1 2. Replacement cost
Ref: 33-16D-2 3. Market value
I. Model Health Plan for Uninsurable Individuals 4. Stated value
Ref: 33-48 5. Salvage value
H. Proximate cause
PROPERTY–GENERAL KNOWLEDGE I. Deductible
CONTENT OUTLINE J. Indemnity
K. Limits of liability
Product Knowledge, Terms, and Concepts L. Coinsurance/Insurance to value
(50 scoreable questions plus 10 pretest questions) M. Occurrence
N. Cancellation
I. TYPES OF POLICIES.......................................................... 25 O. Nonrenewal
A. Homeowners P. Vacancy and unoccupancy
1. HO-2 Q. Liability
2. HO-3 1. Absolute
3. HO-4 2. Strict
4. HO-5 3. Vicarious
5. HO-6 R. Negligence
6. HO-8 S. Binder
B. Dwelling policies T. Endorsements
1. DP-1 U. Medical Payments
2. DP-2 V. Blanket vs. Specific
3. DP-3 W. Burglary, Robbery, Theft, and Mysterious
C. Commercial lines Disappearance
1. Commercial Package Policy (CPP)
2. Commercial property III. POLICY PROVISIONS AND CONTRACT LAW ................11
a. Commercial building and business personal property A. Declarations
form B. Insuring agreement
b. Causes of loss forms C. Conditions
c. Business income D. Exclusions
d. Extra expense E. Definition of the insured
3. Business Owners Policy (BOP) F. Duties of the insured
4. Builders Risk G. Obligations of the insurance company
D. Inland marine H. Mortgagee rights
1. Personal Articles floaters I. Proof of loss
2. Commercial Property floaters J. Notice of claim
3. Nationwide Definition K. Appraisal
E. National Flood Insurance Program L. Other Insurance Provision
F. Others M. Assignment
1. Earthquake N. Subrogation
2. Mobile Homes O. Elements of a contract
3. Watercraft P. Warranties, representations, and concealment
4. Farm Owners Q. Sources of underwriting information
5. Crop/hail R. Fair Credit Reporting Act
6. Windstorm S. Privacy Protection (Gramm Leach Bliley)
T. Policy Application
II. INSURANCE TERMS AND RELATED CONCEPTS.......... 14 U. Terrorism Risk Insurance Act (TRIA)
A. Insurance
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(3) Disability
CASUALTY–GENERAL KNOWLEDGE (4) Vocational Rehabilitation
(5) Death/Survivor
CONTENT OUTLINE
2. Work-related vs. non-work-related
Product Knowledge, Terms, and Concepts 3. Other states’ insurance
(50 scoreable questions plus 10 pretest questions) 4. Employers Liability
5. Exclusive remedy
I. TYPES OF POLICIES, BONDS, AND
RELATED TERMS ............................................................. 23 6. Premium Determination
A. Commercial general liability D. Crime
1. Exposures 1. Employee Dishonesty
a. Premises and Operations 2. Theft
b. Products and Completed Operations 3. Robbery
2. Coverage 4. Burglary
a. Coverage A: Bodily Injury and Property Damage 5. Forgery and Alteration
Liability E. Bonds
(1) Occurrence 1. Surety
(2) Claims made 2. Fidelity
(a) Extended Reporting Periods: Basic and F. Professional liability
Supplemental 1. Errors and Omissions
(b) Retroactive Date 2. Medical Malpractice
b. Coverage B: Personal Injury and Advertising Injury 3. Directors and Officers (D&O)
c. Coverage C: Medical Payments 4. Employment Practices Liability (EPLI)
d. Supplemental Payments G. Umbrella/Excess Liability
e. Who is an insured II. INSURANCE TERMS AND RELATED CONCEPTS ..........15
f. Limits A. Risk
g. Damage to Property of Others B. Hazards
(1) Per occurrence 1. Moral
(2) Annual Aggregate 2. Morale
B. Automobile: personal auto and business auto 3. Physical
1. Liability C. Indemnity
a. Bodily Injury D. Insurable interest
b. Property Damage E. Actual cash value
c. Split Limits F. Negligence
d. Combined Single Limit G. Liability
2. Medical Payments H. Occurrence
3. Physical Damage (collision; other than collision; I. Binders
specified perils) J. Warranties
4. Uninsured motorists K. Representations
5. Underinsured motorists L. Concealment
6. Who is an insured M. Deposit Premium/Audit
7. Types of Auto N. Certificate of Insurance
a. Owned O. Law of Large Numbers
b. Non-owned P. Pure vs. Speculative Risk
c. Hired Q. Endorsements
d. Temporary Substitute R. Damages
e. Newly Acquired Autos 1. Compensatory
f. Transportation Expense and Rental Reimbursement a. General
Expense b. Special
8. Garage Coverage Form, including Garagekeepers 2. Punitive
Insurance S. Compliance with provisions of Fair Credit Reporting Act
9. Exclusions
10. Individual Insured and Drive Other Car (DOC) III. POLICY PROVISIONS.......................................................12
A. Declarations
C. Workers Compensation Insurance, Employers Liability
B. Insuring agreement
Insurance, and Related Issues
C. Conditions
(This section does not deal with specifics of state law, which are
D. Exclusions and Limitations
addressed elsewhere in this outline.)
E. Definition of the insured
1. Standard policy concepts
F. Duties of the insured after a loss
a. Who is an employee/employer
G. Cancellation and nonrenewal provisions
b. Compensation
H. Additional (supplementary) payments
(1) Loss of wages
I. Proof of loss
(2) Medical
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J. Notice of claim d. Fingerprinting
K. Arbitration Ref: 33-12-37
L. Other insurance 3. Termination of license
M. Subrogation a. Expiration
N. Loss settlement provisions including consent to settle Ref: 33-12-17
a loss b. Revocation and suspension
O. Terrorism Risk Insurance Act (TRIA) Ref: 33-12-24
c. Nonrenewal
PROPERTY & CASUALTY Ref: 33-12-24
4. Limitation of license
WEST VIRGINIA SPECIFIC
Ref: 33-12-6(a)(7), 33-12-18, 33-12-19, 33-44-4(b)
CONTENT OUTLINE
5. Appointment
State Laws and Rules Ref: 33-12-3(d), 33-12-18(a)
(40 scoreable questions plus 8 pretest questions) 6. Educational requirements
a. Continuing education
I. WEST VIRGINIA LAWS AND RULES PERTINENT TO Ref: 33-12-8; Rule.114- 42-1, 2, 3, 4, 7
PROPERTY AND CASUALTY INSURANCE ................. 40 7. Mandatory reporting requirements
Ref: All statutory references are taken from Chapter 33 of the a. Criminal prosecution and administrative action
West Virginia Code and West Virginia Code of State Rules Series Ref: 33-12-34
14, 15, and 25, unless otherwise noted. b. Fraud
A. Insurance Commissioner....................................... 2 Ref: 33-41-5
1. Broad powers D. Unfair Trade Practices ............................................6
Ref: 33-2-1, 33-2-3, 33-2-4, 33-12-6, 9 1. Unfair claims methods and practices
2. Examination of records Ref: 33-11-4(9); Rule 114-14-5, 6
Ref: 33-2-4, 33-2-9 2. Excessive charges
3. Notice and Conduct of hearing Ref: Information Letter No. 6
Ref: 33-2-12, 33-2-13
4. Penalties 3. Rebating
Ref: 33-2-9, 33-2-11, 33-3-11, 33-11-6, 33-11-8, Ref: 33-11-4(8), Rule 114-70
33-12-24, 33-44-7 4. Coercion
B. Definitions, Restrictions, and Ref: 33-11-4(4), 33-11-5
Responsibilities ...................................................... 7 5. Misrepresentation
1. Licensed and unlicensed companies Ref: 33-11-4(1)
Ref: 33-3-1, 33-12C-3, 33-44-3 6. Defamation
2. Domestic, foreign, alien, nonadmitted and Ref: 33-11-4(3)
unauthorized companies 7. Advertising
Ref: 33-1-6, 33-1-7, 33-1-8, 33-12C-3, 33-44-3 Ref: 33-11-4(2)
3. Stock and mutual companies 8. Unfair discrimination
Ref: 33-1-18, 33-1-19 Ref: 33-11-4(7)
4. Selling, soliciting, and negotiating insurance 9. Penalties
Ref: 33-3-1,33-12-2, 33-12-21 Ref: 33-11-6, 33-11-8
5. Producer E. Insurable Interest in Property ................................1
Ref: 33-1-12, 33-12-23 Ref: 33-6-3
6. Surplus lines F. Binders.....................................................................1
Ref: 33-12C Ref: 33-6-18
7. Valued policy law G. Approval of Rates and Forms ................................1
Ref: 33-17-9 Ref: 33-6-8, 33-17-8, 33-20-4
8. Comparative negligence H. Compensation of Licensees ..................................2
Ref: West Virginia Supreme Court ruling, 1. Payment of commissions
Bradley v. Appalachian Power Co., Ref: 33-12-23, 33-12-27
163 WV 332, 256 SE2d 879 (1979) I. West Virginia Essential Insurance Coverage Act
C. Licensing ................................................................. 6 (FAIR) Plan ...............................................................1
1. Purpose/Requirements Ref: 33-20A-1 through 33-20A-3; Series 21: Sec. 8, 9, 11,
Ref: 33-12-2, 33-12-6 13, 14
2. Qualifications J. Automobile Insurance.............................................8
a. Producer 1. Provisions
Ref: 33-12-6 Ref: 33-6-31
b. Nonresident licensing a. Coverage
Ref: 33-12-12 b. Uninsured motorists
c. Company requirements Ref: 17D-4-2
Ref: 33-12-3(d)
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c. Underinsured motorists Ref: 33-6-31; 17D-4-2 (Motor Vehicle Safety
2. Financial responsibility and required minimum liability Responsibility Law)
limits 2. Guest passenger law
Ref: Ch. 17A-3-3 and 17D Motor Vehicle laws Ref: 33-6-29
3. Renewal, nonrenewal, and cancellation 3. Comparative negligence doctrine
Ref: 33-6A-1 through 33-6A-4; 17D Ref: West Virginia Supreme Court ruling,
4. West Virginia Automobile Insurance Plan Bradley v. Appalachian Power Co.,
(Assigned Risk) 163 WV 332, 256 SE2d 879 (1979)
Ref: Auto manual 4. Standards for settling auto claims
K. West Virginia Insurance Guaranty Association…1 Ref: 33-6-33; Rule 114-14-7
Ref: 33-26A-2 through 33-26A-8
II. COMMERCIAL LINES COVERAGE...............................6
L. Mine Subsidence .................................................... 1
Ref: Standard insurance textbooks and policies
Ref: 33-30-3, 33-30-4, 33-30-6, 33-30-7, 33-30-10
A. Commercial Property Forms
M. Malpractice Policies ............................................... 1
B. Commercial General Liability Policy
Ref: 33-20C
C. Businessowners Policy
N. Risk Retention Act of West Virginia...................... 1
D. Commercial Auto Forms
Ref: 33-32-1, 33-32-2, 33-32-21
E. Commercial Crime Forms
O. Homeowner's Insurance ........................................ 1
F. Surety Bonds
1. Declination, termination, and disclosure
Ref: 33-17a III. PERSONAL LINES COVERAGE....................................8
P. Workers’ Compensation Ref: Standard insurance textbooks and policies
Ref: 23-2-1(a), 23-2-1(b), 23-2-1(i), 33-1-10(e)(14) A. Dwelling Forms/Standard Fire Policy
B. Homeowner’s Forms
WEST VIRGINIA C. Personal Property Floaters
ADJUSTER EXAMINATION D. Personal Excess Liability Coverage
CONTENT OUTLINE E. Personal Auto Policy
F. Mobile Home Coverage
(45 scoreable questions)
IV. MISCELLANEOUS COVERAGE ....................................1
I. WEST VIRGINIA LAWS AND RULES PERTINENT TO Ref: Standard insurance textbooks and policies
ADJUSTERS .................................................................. 20 A. Watercraft Coverage
Ref: All statutory references are taken from Chapter 33 of the B. Flood Insurance
West Virginia Code and West Virginia Code of State Rules Series
14, 15, and 25, unless otherwise noted. V. INSURANCE TERMS AND CONCEPTS ........................10
A. General Adjusting ................................................... 9 Ref: Standard insurance textbooks and policies
1. State licensing and regulation of adjusters A. Abandonment
Ref: 33-12B(1); Rule 114-25-7, 9 B. Accident
2. Unfair claim settlement practices C. Actual Cash Value
Ref: 33-11-4(9); Rule 114-14-1, 6, 8, 9 D. Appraisal Clause
3. Insurable interest in property E. Arbitration
Ref: 33-6-3 F. Coinsurance
4. Binders G. Concealment
Ref: 33-6-18 H. Deductible
5. West Virginia Property and Casualty Insurance I. Depreciation
Guaranty Association J. Direct Loss
Ref: 33-26-10 through 33-26A-13 K. Fraud
B. Property Adjusting.................................................. 5 L. Hazard
1. Valued policy law M. Indemnity
Ref: 33-17-9 N. Indirect Loss
2. Cooperation with fire marshal in fire loss investigation O. Liability
Ref: 29-3-12a (Fire Prevention and Control Act) P. Loss of Use
3. Mine subsidence coverage Q. Market Value
Ref: 33-30-1 through 33-30-3; 33-30-6; 33-30-7; R. Misrepresentation
33-30-10; 33-30-12; 33-30-13 S. Mortgagee Rights
4. West Virginia Essential Property Insurance T. Names Perils Coverage
Association (FAIR plan) U. Negligence
Ref: 33-20A-1 through 33-20A-3; Rule 114-21-1, 2, V. Occurrence
8, 9, 13 W. Open Perils (all-risk) Coverage
C. Automobile Adjusting............................................. 6 X. Other Insurance Provision
1. Required liability coverage. Uninsured and Y. Overinsurance
underinsured motorists coverage. Named driver Z. Pair and Set Clause
exclusion.
West Virginia Insurance Supplement – Examination Content Outlines Effective: February 15, 2011
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AA. Peril Q. Vacancy and Unoccupancy
BB. Proximate Cause R. Right of Salvage
CC. Replacement Cost S. Abandonment
DD. Representations T. Liability
EE. Subrogation U. Negligence
FF. Warranties V. Theft
W. Burglary
X. Robbery
PERSONAL LINES–GENERAL KNOWLEDGE Y. Mysterious Disappearance
CONTENT OUTLINE Z. Binders
Product Knowledge, Terms, and Concepts AA. Bodily Injury Liability
BB. Property Damage Liability
(75 questions plus 11 pretest questions)
CC. Personal Injury Liability
I. TYPES OF PROPERTY POLICIES................................ 10 DD. Certificate of Insurance
A. Property: Personal Lines EE. Risk Management
1. Dwelling and contents (DP forms) FF. Professional Designations
2. Homeowners (HO forms)
IV. PROPERTY AND CASUALTY POLICY PROVISIONS AND
B. Inland Marine
CONTRACT LAW ..........................................................24
1. Personal floaters
A. Declarations
C. Other Types of Property Policies
B. Insuring Agreement
1. Flood
C. Conditions
2. Personal watercraft
D. Exclusions
3. Earthquake
E. Definitions
4. Mobile homes
F. Duties of the Insured After a Loss
II. TYPES OF CASUALTY POLICIES…………………………13 G. Obligations of the Insurance Company
A. Personal Automobile H. Mortgagee Rights
1. Liability I. Proof of Loss
2. Medical payments J. Notice of Claim
3. Physical damage (collision and other than collision) K. Appraisal
4. Uninsured motorists L. Other Insurance
5. Underinsured motorists M. Assignment
6. Who is an insured? N. Subrogation
7. Types of auto O. Elements of a Contract
a. Owned P. Sources of Underwriting Information
b. Temporary substitute Q. Compliance with Provisions of Fair Credit
8. Use and eligibility of auto Reporting Act
B. Personal Liability R. Cancellation and Nonrenewal Provisions
C. Umbrella/Excess Liability S. Additional (supplementary) Payments
D. Other Personal Exposures T. Loss Settlement Provisions Including
1. Errors and omissions Consent to Settle a Loss
U. Limitations
III. PROPERTY AND CASUALTY INSURANCE TERMS AND
V. Representations and Misrepresentations
RELATED CONCEPTS .................................................. 28
W. Concealment
A. Insurable Interest
X. Arbitration
B. Risk
Y. Coinsurance
C. Hazard
Z. Endorsements
D. Peril
AA. Premium Payments
E. Loss
BB. Effective Dates of Coverage
1. Direct
2. Indirect
F. Proximate Cause PERSONAL LINES–WEST VIRGINIA SPECIFIC
G. Deductible CONTENT OUTLINE
H. Indemnity State Laws and Rules
I. Actual Cash Value
J. Replacement Cost (38 scoreable questions)
K. Limits of Liability I. WEST VIRGINIA LAWS AND RULES PERTINENT TO
L. Pair and Set Clause PERSONAL LINES INSURANCE...................................38
M. Extensions of Coverage Ref: All statutory references are taken from Chapter 33 of the
N. Additional Coverages West Virginia Code and West Virginia Code of State Rules Series
O. Accident 14, 15, and 25, unless otherwise noted.
P. Occurrence A. Insurance Commissioner .......................................2
West Virginia Insurance Supplement – Examination Content Outlines Effective: February 15, 2011
S9
1. Broad powers D. Unfair Trade Practices ............................................6
Ref: 33-2-1, 33-2-3, 33-2-4, 33-12-6, 9 1. Unfair claims methods and practices
2. Examination of records Ref: 33-11-4(9); Rule 114-14-5, 6
Ref: 33-2-4, 33-2-9 2. Excessive charges
3. Notice and conduct of hearing Ref: Information Letter No. 6
Ref: 33-2-12, 33-2-13 3. Rebating
4. Penalties Ref: 33-11-4(8), Rule 114-70
Ref: 33-2-9, 33-2-11, 33-3-11, 33-11-6, 33-11-8, 4. Coercion
33-12-24, 33-44-7 Ref: 33-11-4(4), 33-11-5
B. Definitions, Restrictions, and Responsibilities…7 5. Misrepresentation
1. Licensed and unlicensed companies Ref: 33-11-4(1)
Ref: 33-3-1, 33-12C-3, 33-44-3 6. Defamation
2. Domestic, foreign, alien, nonadmitted, and Ref: 33-11-4(3)
unauthorized companies 7. Advertising
Ref: 33-1-6, 33-1-7, 33-1-8, 33-12C-3, 33-44-3 Ref: 33-11-4(2)
3. Stock and mutual companies 8. Unfair discrimination
Ref: 33-1-18, 33-1-19 Ref: 33-11-4(7)
4. Selling, soliciting, and negotiating insurance 9. Penalties
Ref: 33-3-1, 33-12-2, 33-12-21 Ref: 33-11-6, 33-11-8
5. Producer 10. Undefined acts
Ref: 33-1-12, 33-12-23 Ref: 33-11-7
6. Surplus lines E. Insurable Interest in Property ................................1
Ref: 33-12C Ref: 33-6-3
7. Valued policy law F. Binders.....................................................................1
Ref: 33-17-9 Ref: 33-6-18
8. Comparative negligence G. Approval of Rates and Forms ................................1
Ref: West Virginia Supreme Court ruling Ref: 33-6-8, 33-17-8, 33-20-4
Bradley v. Appalachian Power Co., H. Compensation of Licensees ..................................2
163 WV 332, 256 SE2d 879 (1979) 1. Payment of commissions
C. Licensing ................................................................. 6 Ref: 33-12-23, 33-12-27
1. Purpose/Requirements I. West Virginia Essential Insurance Coverage Act
Ref: 33-12-2, 33-12-6 (FAIR) Plan ...............................................................1
2. Qualifications Ref: 33-20A-1 through 33-20A-3; Series 21: Sec. 8, 9, 11,
a. Producer 13, 14
Ref: 33-12-6 J. Automobile Insurance.............................................8
b. Nonresident licensing 1. Provisions
Ref: 33-12-12 Ref: 33-6-31
c. Company requirements a. Coverage
Ref: 33-3-14(d) b. Uninsured motorists
d. Fingerprinting Ref: 17D-4-2
Ref: 33-12-37 c. Underinsured motorists
3. Termination of license 2. Financial responsibility and required minimum liability
a. Expiration limits
Ref: 33-12-17 Ref: Ch. 17A-3-3 and 17D Motor Vehicle laws
b. Revocation and suspension 3. Renewal, nonrenewal, and cancellation
Ref: 33-12-24 Ref: 33-6A-1 through 33-6A-4; 17D
c. Nonrenewal 4. West Virginia Automobile Insurance Plan (Assigned
Ref: 33-12-24 Risk)
4. Limitation of license Ref: Auto manual
Ref: 33-12-6(a)(7), 33-12-18, 33-12-19, 33-44-4(b) K. West Virginia Property and Casualty Insurance
5. Appointment Guaranty Association .............................................1
Ref: 33-12-3(d), 33-12-18(a) Ref: 33-26A-2 through 33-26A-8
6. Educational requirements L. Mine Subsidence.....................................................1
a. Continuing education Ref: 33-30-3, 33-30-4, 33-30-6, 33-30-7, 33-30-10
Ref: 33-12-8; Rule 114-42-1, 2, 3, 4, 7 M. Homeowner's Insurance.........................................1
7. Mandatory reporting requirements 1. Declination, termination, and disclosure
a. Criminal prosecution and administrative action Ref: 33-17a
Ref: 33-12-34
b. Fraud
Ref: 33-41-5
West Virginia Insurance Supplement – Examination Content Outlines Effective: February 15, 2011
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WEST VIRGINIA
VIATICAL SETTLEMENT BROKER
EXAMINATION
CONTENT OUTLINE
State Laws and Rules
(35 scoreable questions)
I. WEST VIRGINIA LAWS AND RULES PERTINENT TO
VIATICAL SETTLEMENTS ............................................ 35
Ref: All statutory references are taken from Chapter 33-13C of the
West Virginia Code and §114-80 of the State Rules.
A. Definitions
Ref: §33-13C-2; Rule §114-80-2
B. Licensing and Renewal Requirements
Ref: §33-13C-3; Rule §114-80-4
C. Reporting Requirements
Ref: §33-13C-6; Rule §114-80-6
D. Disclosures
Ref: §33-13C-5, §33-13C-8; Rule §114-80-10
E. Contracts and Payments of Proceeds
Ref: Rule §114-80-8
F. Examination or Investigation
Ref: §33-13C-7
G. Standards for Evaluation of Reasonable Payments to
Terminally or Chronically Ill Insureds
Ref: Rule §114-80-5
H. General Rules
Ref: §33-13C-10; Rule §114-80-7
I. Prohibited Practices
Ref: §33-13C-11, §33-13C-12; Rule §114-80-11
J. Advertising and Marketing
Ref: §33-13C-13; Rule §114-80-9
K. Fraud Prevention and Control
Ref: §33-13C-15
L. Criminal Penalties
Ref: §33-13C-16
West Virginia Insurance Supplement – Examination Content Outlines Effective: February 15, 2011
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Examination Content Outlines
West Virginia
Insurance Supplement Effective: January 20, 2012
LIFE 5. Owner’s rights
GENERAL KNOWLEDGE 6. Beneficiary designations
CONTENT OUTLINE a. Primary and contingent
b. Revocable and irrevocable
Product Knowledge, Terms, and Concepts c. Changes
(50 scoreable questions plus 10 pretest questions) d. Common disaster
e. Minor beneficiaries
I. TYPES OF POLICIES.......................................................... 12
7. Premium Payment
A. Traditional whole life products
a. Modes
1. Ordinary (straight) life
b. Grace period
2. Limited-pay and single-premium life
c. Automatic premium loan
3. Adjustable life
d. Level or flexible
B. Interest/market-sensitive life products
8. Reinstatement
1. Universal life
9. Policy loans, withdrawals, partial surrenders
2. Variable whole life
10. Non-forfeiture options
3. Variable universal life
11. Dividends and dividend options
4. Interest-sensitive whole life
12. Incontestability
5. Equity-indexed life
13. Assignments
C. Term life
14. Suicide
1. Types
15. Misstatement of age and gender
a. Level
16. Settlement options
b. Decreasing
17. Accelerated death benefits
c. Return of premium
C. Policy exclusions
d. Annually renewable
e. Increasing term III. COMPLETING THE APPLICATION, UNDERWRITING, AND
2. Special features DELIVERING THE POLICY ...........................................11
a. Renewable A. Completing the application
b. Convertible 1. Required signatures
D. Annuities 2. Changes in the application
1. Single and flexible premium 3. Consequences of incomplete applications
2. Immediate and deferred 4. Warranties and representations
3. Fixed and variable 5. Collecting the initial premium and issuing the receipt
4. Indexed 6. Replacement
E. Combination plans and variations 7. Disclosures at point of sale (e.g., HIPAA, HIV consent)
1. Joint life 8. USA PATRIOT Act/anti-money laundering
2. Survivorship life (second to die) B. Underwriting
1. Insurable interest
II. POLICY RIDERS, PROVISIONS, OPTIONS, AND 2. Medical information and consumer reports
EXCLUSIONS .................................................................. 19
3. Fair Credit Reporting Act
A. Policy riders
4. Risk classification
1. Waiver of premium and waiver of premium with disability
5. Stranger-originated life insurance (STOLI)
income
6. Investor-originated life insurance (IOLI)
2. Guaranteed insurability
C. Delivering the policy
3. Payor benefit
1. When coverage begins
4. Accidental death and/or accidental death and
2. Explaining the policy and its provisions, riders,
dismemberment
exclusions, and ratings to the client
5. Term riders
6. Other insureds (e.g., spouse, children, nonfamily ) IV. TAXES, RETIREMENT, AND OTHER INSURANCE
7. Long term care CONCEPTS........................................................................8
8. Return of premium A. Third-party ownership
B. Policy provisions and options B. Group life insurance
1. Entire contract 1. Conversion privilege
2. Insuring clause 2. Contributory vs. noncontributory
3. Free look C. Retirement plans
4. Consideration 1. Tax-qualified plans
West Virginia Insurance Supplement – Examination Content Outlines Effective: January 20, 2012
S1
2. Nonqualified plans Ref: 33-11-6, 33-12-24
D. Life insurance needs analysis/suitability c. Nonrenewal
1. Personal insurance needs Ref: 33-12-24
2. Business insurance needs 4. Limitation of license
a. Key person Ref: 33-12-18, 33-12-19, 33-12-20, 33-12-21
E. Social Security benefits and taxes 5. Appointment
F. Tax treatment of insurance premiums, proceeds, and Ref: 33-23-3(d), 33-12-17, 33-12-18(a), 33-12-24
dividends 6. Education requirements
1. Individual life a. Continuing education
2. Group life Ref: 33-12-8; Rule 114-25-1, 2, 3, 4, 7
3. Modified Endowment Contracts (MECs) 7. Mandatory reporting requirements
a. Criminal prosecution and administrative action
LIFE Ref: 33-12-34
WEST VIRGINIA SPECIFIC b. Fraud
Ref: 33-41-5
CONTENT OUTLINE
D. Unfair Trade Practices ............................................6
State Laws and Rules 1. Unfair claims methods and practices
(28 scoreable questions plus 6 pretest questions) Ref: 33-11-4(9); 33-43-2, Rule 114-14-5, 6
2. Excessive charges
I. WEST VIRGINIA LAWS AND RULES COMMON TO LIFE, Ref: Information letter No. 6
ACCIDENT AND SICKNESS INSURANCE ................... 21 3. Rebating
Ref: All statutory references are taken from Chapter 33 of the Ref: 33-11-4(8), Rule 114-70
West Virginia Code and West Virginia Code of State Rules Series 4. Coercion
14, 15, and 25, unless otherwise noted. Ref: 33-11-5, 33-11-4(4)
A. Insurance Commissioner....................................... 2 5. Misrepresentation
1. Broad powers Ref: 33-11-4(1)
Ref: 33-2-1, 33-2-3, 33-2-4, 33-12-6 6. Defamation
2. Examination of records Ref: 33-11-4(3)
Ref: 33-2-4, 33-2-9 7. Advertising
3. Notice and conduct of hearing Ref: 33-11-4(2); Rule 114-11-4
Ref: 33-2-12, 33-2-13 8. Penalties
4. Penalties Ref: 33-11-6, 33-11-8
Ref: 33-2-9, 33-2-11, 33-3-11, 33-11-6, E. Mass Marketed Life and Sickness Insurance .......1
33-11-8, 33-12-24, 33-44-7 Ref: 33-6-35, 33-6-8(e)
5. Filing and approval of forms F. West Virginia Life and Health Guaranty
Ref: 33-6-8, 33-6-9 Association ..............................................................1
B. Definitions ............................................................... 4 Ref: 33-26A-2 through 33-26A-8
1. Domestic, foreign, alien, nonadmitted, and
unauthorized companies II. WEST VIRGINIA LAWS AND RULES PERTINENT TO LIFE
Ref: 33-1-6, 33-1-7, 33-1-8, 33-44-3 INSURANCE ONLY ........................................................7
2. Stock and mutual A. Replacement............................................................3
Ref: 33-1-18, 33-1-19 1. Definitions
3. Transacting insurance Ref: Rule 114-8-1, 2
Ref: 33-3-1, 33-12-2(m), (o), (p), 33-12-21 2. Duties of producers
4. Producer Ref: Rule 114-8-4.2(d)
Ref: 33-1-12, 33-12-22 3. Duties of insurance companies
C. Licensing ................................................................. 7 Ref: Rule 114-8-5
1. Purpose/Requirements 4. Exemptions
Ref: 33-12-2, 33-12-6 Ref: Rule 114-8-3
2. Qualifications B. Disclosure................................................................1
a. Producer Ref: Rule 114-11A-5
Ref: 33-12-2, 33-12-6, 33-12-9 C. Policy Clauses and Provisions ..............................1
b. Direct response 1. Protection, beneficiaries, and creditors
Ref: 33-6-35(a)(1), 33-28-3(c),33-28-3(e) Ref: 33-6-20, 33-6-27, 33-6-28
c. Nonresident Life/A&H producer 2. Policy loan interest rate
Ref: 33-12-12 Ref: 33-13-8, 33-13-8(a)
d. Fingerprinting D. Group Life ................................................................2
Ref: 33-12-37 1. Assignment of proceeds
3. Termination of license Ref: 33-14-28
a. Expiration and cancellation 2. Employee and debtor groups
Ref: 33-12-17 Ref: 33-14-2, 33-14-3
b. Revocation and suspension 3. Labor union and trustee groups
West Virginia Insurance Supplement – Examination Content Outlines Effective: January 20, 2012
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Ref: 33-14-4, 33-14-5 9. Payment of claims
4. Conversion on termination of policy 10. Physical examination and autopsy
Ref: 33-14-17 11. Legal actions
5. Conversion on termination of employment 12. Change of beneficiary
Ref: 33-14-16 13. Misstatement of age
E. Suitability in Annuity Transactions B. Optional provisions
Ref: Rule 114-11B-1 through 114-11B-7 C. Other provisions and clauses
1. Insuring clause
ACCIDENT & HEALTH 2. Free look
GENERAL KNOWLEDGE 3. Consideration clause
4. Probationary period
CONTENT OUTLINE
5. Elimination period
Product Knowledge, Terms, and Concepts 6. Waiver of premium
(50 scoreable questions plus 10 pretest questions) 7. Exclusions
8. Preexisting conditions
I. TYPES OF POLICIES.......................................................... 14 9. Recurrent disability
A. Disability income 10. Coinsurance
1. Individual disability income policy 11. Deductibles
2. Business overhead expense policy 12. Eligible expenses
3. Business disability buyout policy 13. Copayments
4. Group disability income policy 14. Pre-authorizations and prior approval requirements
5. Key employee/partner policies 15. Usual, reasonable, and customary (URC) charges
B. Accidental death and dismemberment 16. Lifetime, annual, or per cause maximum benefit limits
C. Medical expense insurance D. Riders
1. Basic hospital, medical, and surgical policies 1. Impairment/exclusions
2. Major medical policies 2. Guaranteed insurability
3. Health Maintenance Organizations (HMOs) 3. Multiple indemnity (double, triple)
4. Preferred Provider Organizations (PPOs) E. Rights of renewability
5. Point of Service (POS) plans 1. Noncancelable
6. Flexible Spending Accounts (FSAs) 2. Cancelable
7. Health Reimbursement Accounts (HRAs) 3. Guaranteed renewable
8. High Deductible Health Plans (HDHPs) and related 4. Conditionally renewable
Health Savings Accounts (HSAs) 5. Optionally renewable
9. Stop loss 6. Period of time for renewal
D. Medicare supplement policies
E. Group insurance III. SOCIAL INSURANCE........................................................3
1. Group conversion A. Medicare
2. Differences between individual and group contracts 1. Primary, secondary payor
3. General concepts 2. Medicare Parts A, B, C, D
4. COBRA B. Medicaid
5. HIPAA C. Social Security benefits
F. Long Term Care (LTC) IV. OTHER INSURANCE CONCEPTS ...................................4
1. Individual LTC contracts A. Total, partial, and residual disability
2. Group/voluntary LTC contracts B. Owner’s rights
G. Limited Benefit Plans C. Dependent children benefits
1. Cancer (or specified diseases) plans D. Primary and contingent beneficiaries
2. Critical illness plans E. Modes of premium payments (annual, semiannual, etc.)
3. Worksite (employer-sponsored) plans F. Nonduplication and coordination of benefits (e.g.,
4. Hospital indemnity plans primary vs. excess)
5. Dental G. Occupational vs. non-occupational
6. Vision H. Tax treatment of premiums and proceeds of insurance
II. POLICY PROVISIONS, CLAUSES, AND RIDERS ............ 20 contracts (e.g., disability income and medical
A. Mandatory provisions expenses, etc.)
1. Entire contract I. Managed care
2. Time limit on certain defenses (incontestable) J. Workers Compensation
3. Grace period K. Subrogation
4. Reinstatement (Continued on the next page.)
5. Notice of claim
6. Claim forms
7. Proof of loss
8. Time of payment of claims
West Virginia Insurance Supplement – Examination Content Outlines Effective: January 20, 2012
S3
L. Field underwriting procedures................................... 9 Ref: 33-12-2, 33-12-6, 33-12-9
M. Completing application and obtaining necessary b. Direct response
signatures Ref: 33-6-35(a)(1), 33-28-3(c), 33-28-3(e)
N. Explaining sources of insurability information (e.g., MIB c. Nonresident Life/A&H producer
Report, Fair Credit Reporting Act, etc.) Ref: 33-12-12
O. Initial premium payment and receipt and consequences d. Fingerprinting
of the receipt (e.g., medical examination, etc.) Ref: 33-12-37
P. Submitting application (and initial premium if collected) 3. Termination of license
to company for underwriting a. Expiration and cancellation
Q. Ensuring delivery of policy and related documents to Ref: 33-12-17
client b. Revocation and suspension
R. Explaining policy and its provisions, riders, exclusions, Ref: 33-11-6, 33-12-24
and ratings to clients c. Nonrenewal
S. Replacement Ref: 33-12-24
T. Contract law 4. Limitation of license
1. Elements of a contract Ref: 33-12-18, 33-12-19, 33-12-20, 33-12-21
2. Insurable interest 5. Appointment
3. Warranties and representations Ref: 33-23-3(d), 33-12-17, 33-12-18(a), 33-12-24
4. Unique aspects of the health contract 6. Education requirements
a. Conditional a. Continuing education
b. Unilateral Ref: 33-12-8; Series 42: 1,2,3,4,7
c. Adhesion 7. Mandatory reporting requirements
a. Criminal prosecution and administrative action
ACCIDENT & SICKNESS Ref: 33-12-34
b. Fraud
WEST VIRGINIA SPECIFIC
Ref: 33-41-5
CONTENT OUTLINE
D. Unfair Trade Practices.............................................6
State Laws and Rules 1. Unfair claims methods and practices
(30 scoreable questions plus 6 pretest questions) Ref: 33-11-4(9), 33-43-2; Rule. 114-14-5, 6
2. Excessive charges
I. WEST VIRGINIA LAWS AND RULES COMMON TO LIFE Ref: Information Letter No. 6
AND ACCIDENT AND SICKNESS INSURANCE........... 21 3. Rebating
Ref: All statutory references are taken from Chapter 33 of the Ref: 33-11-4(8), Rule 114-70
West Virginia Code and West Virginia Code of State Rules Series 4. Coercion
14, 15, and 25, unless otherwise noted. Ref: 33-11-5, 33-11-4(4)
A. Insurance Commissioner....................................... 2 5. Misrepresentation
1. Broad powers Ref: 33-11-4(1)
Ref: 33-2-1, 33-2-3, 33-2-4, 33-12-6 6. Defamation
2. Examination of records Ref: 33-11-4(3)
Ref: 33-2-4, 33-2-9 7. Advertising
3. Notice and conduct of hearing Ref: 33-11-4(2); Rule 114-11-4
Ref: 33-2-12, 33-2-13 8. Penalties
4. Penalties Ref: 33-11-6, 33-11-8
Ref: 33-2-9, 33-2-11, 33-3-11, 33-11-6, E. Mass Marketed Life & Sickness Insurance...........1
33-11-8, 33-12-24, 33-44-7 Ref: 33-6-35, 33-6-8(e)
5. Filing and approval of forms F. West Virginia Life and Health Guaranty
Ref: 33-6-8, 33-6-9 Association ..............................................................1
B. Definitions ............................................................... 4 Ref: 33-26A-2, 33-26A-9 (a), 33-26A-3(c)(2)(A)
1. Domestic, foreign, and alien companies
Ref: 33-1-6, 33-1-7, 33-1-8 II. WEST VIRGINIA LAWS AND RULES PERTINENT TO
2. Stock and mutual ACCIDENT AND SICKNESS INSURANCE ONLY.........9
A. Required Disclosure Provisions; Individual
Ref: 33-1-18, 33-1-19
Minimum A&S Standards .......................................1
3. Transacting insurance
Ref: Rule 114-12-5, 6
Ref: 33-3-1, 33-12-2(m), (o), (p), 33-12-21
B. Requirements for Replacement; Individual
4. Producer
Minimum A&S Standards .......................................1
Ref: 33-1-12, 33-12-23
Ref: Rule 114-12-7
C. Licensing ................................................................. 7
C. Medicare Supplement Insurance ...........................2
1. Purpose/Requirements
Ref: 33-6-11(a), 33-16-3(d), 33-28-5(b); Rule 114-17, 24
Ref: 33-12-2, 33-12-6
D. Health Maintenance Organization Act……………1
2. Qualifications
Ref: 33-25A-2, 33-25A-14
a. Producer
1. Definitions
West Virginia Insurance Supplement – Examination Content Outlines Effective: January 20, 2012
S4
2. Deceptive practices C. Risk
E. Corporations ........................................................... 1 1. Pure vs. Speculative Risk
Ref: 33-24-2, 33-24-4 D. Hazard
1. Hospital service corporations 1. Moral
2. Medical service corporations 2. Morale
3. Dental service corporations 3. Physical
4. Health service corporations E. Peril
F. Coverage for Newborn Children............................ 1 F. Loss
Ref: 33-6-32 1. Direct
G. Long-Term Care ...................................................... 1 2. Indirect
Ref: 33-15A, Rule 114-32-12.2 G. Loss Valuation
H. Small Employer Group ........................................... 1 1. Actual cash value
Ref: 33-16D-2 2. Replacement cost
I. Model Health Plan for Uninsurable Individuals 3. Market value
Ref: 33-48 4. Stated value
5. Salvage value
PROPERTY H. Proximate cause
GENERAL KNOWLEDGE I. Deductible
J. Indemnity
CONTENT OUTLINE
K. Limits of liability
Product Knowledge, Terms, and Concepts L. Coinsurance/Insurance to value
(50 scoreable questions plus 10 pretest questions) M. Occurrence
N. Cancellation
I. TYPES OF POLICIES.......................................................... 25 O. Nonrenewal
A. Homeowners P. Vacancy and unoccupancy
1. HO-2 Q. Liability
2. HO-3 1. Absolute
3. HO-4 2. Strict
4. HO-5 3. Vicarious
5. HO-6 R. Negligence
6. HO-8 S. Binder
B. Dwelling policies T. Endorsements
1. DP-1 U. Medical Payments
2. DP-2 V. Blanket vs. Specific
3. DP-3 W. Burglary, Robbery, Theft, and Mysterious
C. Commercial lines Disappearance
1. Commercial Package Policy (CPP)
2. Commercial property III. POLICY PROVISIONS AND CONTRACT LAW ................11
a. Commercial building and business personal property A. Declarations
form B. Insuring agreement
b. Causes of loss forms C. Conditions
c. Business income D. Exclusions
d. Extra expense E. Definition of the insured
3. Business Owners Policy (BOP) F. Duties of the insured
4. Builders Risk G. Obligations of the insurance company
D. Inland marine H. Mortgagee rights
1. Personal Articles floaters I. Proof of loss
2. Commercial Property floaters J. Notice of claim
3. Nationwide Definition K. Appraisal
E. National Flood Insurance Program L. Other Insurance Provision
F. Others M. Assignment
1. Earthquake N. Subrogation
2. Mobile Homes O. Elements of a contract
3. Watercraft P. Warranties, representations, and concealment
4. Farm Owners Q. Sources of underwriting information
5. Crop/hail R. Fair Credit Reporting Act
6. Windstorm S. Privacy Protection (Gramm Leach Bliley)
T. Policy Application
II. INSURANCE TERMS AND RELATED CONCEPTS.......... 14 U. Terrorism Risk Insurance Act (TRIA)
A. Insurance (Continued on the next page.)
1. Law of Large Numbers
B. Insurable interest
West Virginia Insurance Supplement – Examination Content Outlines Effective: January 20, 2012
S5
c. Nonrenewal
PROPERTY Ref: 33-12-24
WEST VIRGINIA SPECIFIC 4. Limitation of license
Ref: 33-12-6(a)(7), 33-12-18, 33-12-19, 33-44-4(b)
CONTENT OUTLINE
5. Appointment
State Laws and Rules Ref: 33-12-3(d), 33-12-18(a)
(30 scoreable questions plus 5 pretest questions) 6. Educational requirements
a. Continuing education
I. WEST VIRGINIA LAWS AND RULES PERTINENT TO Ref: 33-12-8; Rule 114- 42-1, 2, 3, 4, 7
PROPERTY INSURANCE .............................................. 30 7. Mandatory reporting requirements
Ref: All statutory references are taken from §114-25 and Section a. Criminal prosecution and administrative action
33-12B of the West Virginia Code of State Rules, which are Ref: 33-12-34
available at www.wvinsurnace.gov/PolicyLegislation.aspx. b. Fraud
A. Insurance Commissioner....................................... 2 Ref: 33-41-5
1. Broad powers D. Unfair Trade Practices ............................................5
Ref: 33-2-1, 33-2-3, 33-2-4, 33-12-6 1. Unfair claims methods and practices
2. Examination of records Ref: 33-11-4(9); Rule 114-14-5, 6
Ref: 33-2-4, 33-2-9 2. Excessive charges
3. Notice and Conduct of hearing Ref: Information Letter No. 6
Ref: 33-2-12, 33-2-13 3. Rebating
4. Penalties Ref: 33-11-4(8), Rule 114-70
Ref: 33-2-9, 33-2-11, 33-3-11, 33-11-6, 33-11-8, 4. Coercion
33-12-24, 33-44-7 Ref: 33-11-4(4), 33-11-5
B. Definitions, Restrictions, and 5. Misrepresentation
Responsibilities ...................................................... 7 Ref: 33-11-4(1)
1. Licensed and unlicensed companies 6. Defamation
Ref: 33-3-1, 33-12C-3, 33-44-3 Ref: 33-11-4(3)
2. Domestic, foreign, alien, nonadmitted and 7. Advertising
unauthorized companies Ref: 33-11-4(2)
Ref: 33-1-6, 33-1-7, 33-1-8, 33-12C-3, 33-44-3 8. Unfair discrimination
3. Stock and mutual companies Ref: 33-11-4(7)
Ref: 33-1-18, 33-1-19 9. Penalties
4. Selling, soliciting, and negotiating insurance Ref: 33-11-6, 33-11-8
Ref: 33-3-1,33-12-2, 33-12-21 E. Insurable Interest in Property ................................1
5. Producer Ref: 33-6-3
Ref: 33-1-12, 33-12-23 F. Binders.....................................................................1
6. Surplus lines Ref: 33-6-18
Ref: 33-12C G. Approval of Rates and Forms ................................1
7. Valued policy law Ref: 33-6-8, 33-17-8, 33-20-4
Ref: 33-17-9 H. Compensation of Licensees ..................................1
8. Comparative negligence 1. Payment of commissions
Ref: West Virginia Supreme Court ruling, Ref: 33-12-23, 33-12-27
Bradley v. Appalachian Power Co., I. West Virginia Essential Insurance Coverage Act
163 WV 332, 256 SE2d 879 (1979) (FAIR) Plan ...............................................................1
C. Licensing ................................................................. 6 Ref: 33-20A-1 through 33-20A-3; Series 21: Sec. 8, 9, 11,
1. Purpose/Requirements 13, 14
Ref: 33-12-2, 33-12-6 J. Mine Subsidence.....................................................0-1
2. Qualifications Ref: 33-30-3, 33-30-4, 33-30-6, 33-30-7, 33-30-10
a. Producer K. Homeowner's Insurance.........................................1
Ref: 33-12-6 1. Declination, termination, and disclosure
b. Nonresident licensing Ref: 33-17a
Ref: 33-12-12 L. West Virginia Insurance Guaranty Association ...1
c. Company requirements Ref: 33-26A-2 through 33-26A-8
Ref: 33-12-3(d) M. Risk Retention Act of West Virginia ......................1
d. Fingerprinting Ref: 33-32-1, 33-32-2, 33-32-21
Ref: 33-12-37
3. Termination of license (Continued on the next page.)
a. Expiration
Ref: 33-12-17
b. Revocation and suspension
Ref: 33-12-24
West Virginia Insurance Supplement – Examination Content Outlines Effective: January 20, 2012
S6
CASUALTY (1) Loss of wages
GENERAL KNOWLEDGE (2) Medical
CONTENT OUTLINE (3) Disability
(4) Vocational Rehabilitation
Product Knowledge, Terms, and Concepts (5) Death/Survivor
(50 scoreable questions plus 10 pretest questions) 2. Work-related vs. non-work-related
3. Other states’ insurance
I. TYPES OF POLICIES, BONDS, AND 4. Employers Liability
RELATED TERMS ............................................................. 23 5. Exclusive remedy
A. Commercial general liability 6. Premium Determination
1. Exposures D. Crime
a. Premises and Operations 1. Employee Dishonesty
b. Products and Completed Operations 2. Theft
2. Coverage 3. Robbery
a. Coverage A: Bodily Injury and Property Damage 4. Burglary
Liability 5. Forgery and Alteration
(1) Occurrence E. Bonds
(2) Claims made 1. Surety
(a) Extended Reporting Periods: Basic and 2. Fidelity
Supplemental F. Professional liability
(b) Retroactive Date 1. Errors and Omissions
b. Coverage B: Personal Injury and Advertising Injury 2. Medical Malpractice
c. Coverage C: Medical Payments 3. Directors and Officers (D&O)
d. Supplemental Payments 4. Employment Practices Liability (EPLI)
e. Who is an insured G. Umbrella/Excess Liability
f. Limits
g. Damage to Property of Others II. INSURANCE TERMS AND RELATED CONCEPTS ..........15
(1) Per occurrence A. Risk
(2) Annual Aggregate B. Hazards
B. Automobile: personal auto and business auto 1. Moral
1. Liability 2. Morale
a. Bodily Injury 3. Physical
b. Property Damage C. Indemnity
c. Split Limits D. Insurable interest
d. Combined Single Limit E. Actual cash value
2. Medical Payments F. Negligence
3. Physical Damage (collision; other than collision; G. Liability
specified perils) H. Occurrence
4. Uninsured motorists I. Binders
5. Underinsured motorists J. Warranties
6. Who is an insured K. Representations
7. Types of Auto L. Concealment
a. Owned M. Deposit Premium/Audit
b. Non-owned N. Certificate of Insurance
c. Hired O. Law of Large Numbers
d. Temporary Substitute P. Pure vs. Speculative Risk
e. Newly Acquired Autos Q. Endorsements
f. Transportation Expense and Rental Reimbursement R. Damages
Expense 1. Compensatory
8. Garage Coverage Form, including Garagekeepers a. General
Insurance b. Special
9. Exclusions 2. Punitive
10. Individual Insured and Drive Other Car (DOC) S. Compliance with provisions of Fair Credit Reporting Act
C. Workers Compensation Insurance, Employers Liability III. POLICY PROVISIONS.......................................................12
Insurance, and Related Issues A. Declarations
(This section does not deal with specifics of state law, which are B. Insuring agreement
addressed elsewhere in this outline.) C. Conditions
1. Standard policy concepts D. Exclusions and Limitations
a. Who is an employee/employer E. Definition of the insured
b. Compensation F. Duties of the insured after a loss
West Virginia Insurance Supplement – Examination Content Outlines Effective: January 20, 2012
S7
G. Cancellation and nonrenewal provisions Ref: 33-12-12
H. Additional (supplementary) payments c. Company requirements
I. Proof of loss Ref: 33-12-3(d)
J. Notice of claim d. Fingerprinting
K. Arbitration Ref: 33-12-37
L. Other insurance 3. Termination of license
M. Subrogation a. Expiration
N. Loss settlement provisions including consent to settle Ref: 33-12-17
a loss b. Revocation and suspension
O. Terrorism Risk Insurance Act (TRIA) Ref: 33-12-24
c. Nonrenewal
CASUALTY Ref: 33-12-24
4. Limitation of license
WEST VIRGINIA SPECIFIC
Ref: 33-12-6(a)(7), 33-12-18, 33-12-19, 33-44-4(b)
CONTENT OUTLINE
5. Appointment
State Laws and Rules Ref: 33-12-3(d), 33-12-18(a)
(30 scoreable questions plus 5 pretest questions) 6. Educational requirements
a. Continuing education
I. WEST VIRGINIA LAWS AND RULES PERTINENT TO Ref: 33-12-8; Rule.114- 42-1, 2, 3, 4, 7
CASUALTY INSURANCE .............................................. 30 7. Mandatory reporting requirements
Ref: All statutory references are taken from §114-25 and Section a. Criminal prosecution and administrative action
33-12B of the West Virginia Code of State Rules, which are Ref: 33-12-34
available at www.wvinsurnace.gov/PolicyLegislation.aspx. b. Fraud
A. Insurance Commissioner Act ................................ 2 Ref: 33-41-5
1. Broad powers D. Unfair Trade Practices ............................................6
Ref: 33-2-1, 33-2-3, 33-2-4, 33-12-6 1. Unfair claims methods and practices
2. Examination of records Ref: 33-11-4(9); Rule 114-14-5, 6
Ref: 33-2-4, 33-2-9 2. Excessive charges
3. Notice and Conduct of hearing Ref: Information Letter No. 6
Ref: 33-2-12, 33-2-13 3. Rebating
4. Penalties Ref: 33-11-4(8), Rule 114-70
Ref: 33-2-9, 33-2-11, 33-3-11, 33-11-6, 33-11-8, 4. Coercion
33-12-24, 33-44-7 Ref: 33-11-4(4), 33-11-5
B. Definitions, Restrictions, and 5. Misrepresentation
Responsibilities ...................................................... 7 Ref: 33-11-4(1)
1. Licensed and unlicensed companies 6. Defamation
Ref: 33-3-1, 33-12C-3, 33-44-3 Ref: 33-11-4(3)
2. Domestic, foreign, alien, nonadmitted and 7. Advertising
unauthorized companies Ref: 33-11-4(2)
Ref: 33-1-6, 33-1-7, 33-1-8, 33-12C-3, 33-44-3 8. Unfair discrimination
3. Stock and mutual companies Ref: 33-11-4(7)
Ref: 33-1-18, 33-1-19 9. Penalties
4. Selling, soliciting, and negotiating insurance Ref: 33-11-6, 33-11-8
Ref: 33-3-1,33-12-2, 33-12-21 E. Binders.....................................................................0-1
5. Producer Ref: 33-6-18
Ref: 33-1-12, 33-12-23 F. Approval of Rates and Forms ................................0-1
6. Surplus lines Ref: 33-6-8, 33-17-8, 33-20-4
Ref: 33-12C G. Compensation of Licensees ..................................0-1
7. Valued policy law 1. Payment of commissions
Ref: 33-17-9 H. Automobile Insurance.............................................5
8. Comparative negligence 1. Provisions
Ref: West Virginia Supreme Court ruling, Ref: 33-6-31
Bradley v. Appalachian Power Co., a. Coverage
163 WV 332, 256 SE2d 879 (1979) b. Uninsured motorists
C. Licensing ................................................................. 6 Ref: 17D-4-2
1. Purpose/Requirements c. Underinsured motorists
Ref: 33-12-2, 33-12-6 2. Financial responsibility and required minimum liability
2. Qualifications limits
a. Producer Ref: Ch. 17A-3-3 and 17D Motor Vehicle laws
Ref: 33-12-6 3. Renewal, nonrenewal, and cancellation
b. Nonresident licensing Ref: 33-6A-1 through 33-6A-4; 17D
West Virginia Insurance Supplement – Examination Content Outlines Effective: January 20, 2012
S8
4. West Virginia Automobile Insurance Plan M. Extensions of Coverage
(Assigned Risk) N. Additional Coverages
Ref: Auto manual O. Accident
I. Malpractice Policies ............................................... 0-1 P. Occurrence
Ref: 33-20C Q. Vacancy and Unoccupancy
J. Workers’ Compensation ........................................ 0-1 R. Right of Salvage
Ref: 23-2-1(a), 23-2-1(b), 23-2-1(i), 33-1-10(e)(14) S. Abandonment
K. West Virginia Insurance Guaranty Association ... 0-1 T. Liability
Ref: 33-26A-2 through 33-26A-8 U. Negligence
V. Theft
W. Burglary
PERSONAL LINES X. Robbery
GENERAL KNOWLEDGE Y. Mysterious Disappearance
CONTENT OUTLINE Z. Binders
Product Knowledge, Terms, and Concepts AA. Bodily Injury Liability
BB. Property Damage Liability
(75 questions plus 11 pretest questions)
CC. Personal Injury Liability
I. TYPES OF PROPERTY POLICIES................................ 10 DD. Certificate of Insurance
A. Property: Personal Lines EE. Risk Management
1. Dwelling and contents (DP forms) FF. Professional Designations
2. Homeowners (HO forms)
IV. PROPERTY AND CASUALTY POLICY PROVISIONS AND
B. Inland Marine CONTRACT LAW ..........................................................24
1. Personal floaters A. Declarations
C. Other Types of Property Policies B. Insuring Agreement
1. Flood C. Conditions
2. Personal watercraft D. Exclusions
3. Earthquake E. Definitions
4. Mobile homes F. Duties of the Insured After a Loss
II. TYPES OF CASUALTY POLICIES…………………………13 G. Obligations of the Insurance Company
A. Personal Automobile H. Mortgagee Rights
1. Liability I. Proof of Loss
2. Medical payments J. Notice of Claim
3. Physical damage (collision and other than collision) K. Appraisal
4. Uninsured motorists L. Other Insurance
5. Underinsured motorists M. Assignment
6. Who is an insured? N. Subrogation
7. Types of auto O. Elements of a Contract
a. Owned P. Sources of Underwriting Information
b. Temporary substitute Q. Compliance with Provisions of Fair Credit
8. Use and eligibility of auto Reporting Act
B. Personal Liability R. Cancellation and Nonrenewal Provisions
C. Umbrella/Excess Liability S. Additional (supplementary) Payments
D. Other Personal Exposures T. Loss Settlement Provisions Including
1. Errors and omissions Consent to Settle a Loss
U. Limitations
III. PROPERTY AND CASUALTY INSURANCE TERMS AND V. Representations and Misrepresentations
RELATED CONCEPTS .................................................. 28
W. Concealment
A. Insurable Interest
X. Arbitration
B. Risk
Y. Coinsurance
C. Hazard
Z. Endorsements
D. Peril
AA. Premium Payments
E. Loss
BB. Effective Dates of Coverage
1. Direct
2. Indirect
(Continued on the next page.)
F. Proximate Cause
G. Deductible
H. Indemnity
I. Actual Cash Value
J. Replacement Cost
K. Limits of Liability
L. Pair and Set Clause
West Virginia Insurance Supplement – Examination Content Outlines Effective: January 20, 2012
S9
Ref: 33-12-24
PERSONAL LINES 4. Limitation of license
WEST VIRGINIA SPECIFIC Ref: 33-12-6(a)(7), 33-12-18, 33-12-19, 33-44-4(b)
5. Appointment
CONTENT OUTLINE
Ref: 33-12-3(d), 33-12-18(a)
State Laws and Rules 6. Educational requirements
(38 scoreable questions) a. Continuing education
Ref: 33-12-8; Rule 114-42-1, 2, 3, 4, 7
I. WEST VIRGINIA LAWS AND RULES PERTINENT TO 7. Mandatory reporting requirements
PERSONAL LINES INSURANCE .................................. 38 a. Criminal prosecution and administrative action
Ref: All statutory references are taken from Chapter 33 of the Ref: 33-12-34
West Virginia Code and West Virginia Code of State Rules Series b. Fraud
14, 15, and 25, unless otherwise noted. Ref: 33-41-5
A. Insurance Commissioner....................................... 2 D. Unfair Trade Practices ............................................6
1. Broad powers 1. Unfair claims methods and practices
Ref: 33-2-1, 33-2-3, 33-2-4, 33-12-6 Ref: 33-11-4(9); Rule 114-14-5, 6
2. Examination of records 2. Excessive charges
Ref: 33-2-4, 33-2-9 Ref: Information Letter No. 6
3. Notice and conduct of hearing 3. Rebating
Ref: 33-2-12, 33-2-13 Ref: 33-11-4(8), Rule 114-70
4. Penalties 4. Coercion
Ref: 33-2-9, 33-2-11, 33-3-11, 33-11-6, 33-11-8, Ref: 33-11-4(4), 33-11-5
33-12-24, 33-44-7 5. Misrepresentation
B. Definitions, Restrictions, and Responsibilities…7 Ref: 33-11-4(1)
1. Licensed and unlicensed companies 6. Defamation
Ref: 33-3-1, 33-12C-3, 33-44-3 Ref: 33-11-4(3)
2. Domestic, foreign, alien, nonadmitted, and 7. Advertising
unauthorized companies Ref: 33-11-4(2)
Ref: 33-1-6, 33-1-7, 33-1-8, 33-12C-3, 33-44-3 8. Unfair discrimination
3. Stock and mutual companies Ref: 33-11-4(7)
Ref: 33-1-18, 33-1-19 9. Penalties
4. Selling, soliciting, and negotiating insurance Ref: 33-11-6, 33-11-8
Ref: 33-3-1, 33-12-2, 33-12-21 10. Undefined acts
5. Producer Ref: 33-11-7
Ref: 33-1-12, 33-12-23 E. Insurable Interest in Property ................................1
6. Surplus lines Ref: 33-6-3
Ref: 33-12C F. Binders.....................................................................1
7. Valued policy law Ref: 33-6-18
Ref: 33-17-9 G. Approval of Rates and Forms ................................1
8. Comparative negligence Ref: 33-6-8, 33-17-8, 33-20-4
Ref: West Virginia Supreme Court ruling H. Compensation of Licensees ..................................2
Bradley v. Appalachian Power Co., 1. Payment of commissions
163 WV 332, 256 SE2d 879 (1979) Ref: 33-12-23, 33-12-27
C. Licensing ................................................................. 6 I. West Virginia Essential Insurance Coverage Act
1. Purpose/Requirements (FAIR) Plan ...............................................................1
Ref: 33-12-2, 33-12-6 Ref: 33-20A-1 through 33-20A-3; Series 21: Sec. 8, 9, 11,
2. Qualifications 13, 14
a. Producer J. Automobile Insurance.............................................8
Ref: 33-12-6 1. Provisions
b. Nonresident licensing Ref: 33-6-31
Ref: 33-12-12 a. Coverage
c. Company requirements b. Uninsured motorists
Ref: 33-3-14(d) Ref: 17D-4-2
d. Fingerprinting c. Underinsured motorists
Ref: 33-12-37 2. Financial responsibility and required minimum liability
3. Termination of license limits
a. Expiration Ref: Ch. 17A-3-3 and 17D Motor Vehicle laws
Ref: 33-12-17 3. Renewal, nonrenewal, and cancellation
b. Revocation and suspension Ref: 33-6A-1 through 33-6A-4; 17D
Ref: 33-12-24 4. West Virginia Automobile Insurance Plan (Assigned
c. Nonrenewal Risk)
West Virginia Insurance Supplement – Examination Content Outlines Effective: January 20, 2012
S10
Ref: Auto manual
II. COMMERCIAL LINES COVERAGE...............................6
K. West Virginia Property and Casualty Insurance
Ref: Standard insurance textbooks and policies
Guaranty Association............................................. 1
A. Commercial Property Forms
Ref: 33-26A-2 through 33-26A-8
B. Commercial General Liability Policy
L. Mine Subsidence .................................................... 1
C. Businessowners Policy
Ref: 33-30-3, 33-30-4, 33-30-6, 33-30-7, 33-30-10
D. Commercial Auto Forms
M. Homeowner's Insurance ........................................ 2
E. Commercial Crime Forms
1. Declination, termination, and disclosure
F. Surety Bonds
Ref: 33-17a
III. PERSONAL LINES COVERAGE....................................8
Ref: Standard insurance textbooks and policies
WEST VIRGINIA A. Dwelling Forms/Standard Fire Policy
ADJUSTER EXAMINATION B. Homeowner’s Forms
CONTENT OUTLINE C. Personal Property Floaters
D. Personal Excess Liability Coverage
State Laws and Rules E. Personal Auto Policy
(45 scoreable questions) F. Mobile Home Coverage
I. WEST VIRGINIA LAWS AND RULES PERTINENT TO IV. MISCELLANEOUS COVERAGE ....................................1
ADJUSTERS .................................................................. 20 Ref: Standard insurance textbooks and policies
Ref: All statutory references are taken from Chapter 33 of the A. Watercraft Coverage
West Virginia Code and West Virginia Code of State Rules Series B. Flood Insurance
14, 15, and 25, unless otherwise noted.
V. INSURANCE TERMS AND CONCEPTS ........................10
A. General Adjusting ................................................... 9 Ref: Standard insurance textbooks and policies
1. State licensing and regulation of adjusters A. Abandonment
Ref: 33-12B(1); Rule 114-25-7, 9 B. Accident
2. Unfair claim settlement practices C. Actual Cash Value
Ref: 33-11-4(9); Rule 114-14-1, 6, 8, 9 D. Appraisal Clause
3. Insurable interest in property E. Arbitration
Ref: 33-6-3 F. Coinsurance
4. Binders G. Concealment
Ref: 33-6-18 H. Deductible
5. West Virginia Property and Casualty Insurance I. Depreciation
Guaranty Association J. Direct Loss
Ref: 33-26-10 through 33-26A-13 K. Fraud
B. Property Adjusting.................................................. 5 L. Hazard
1. Valued policy law M. Indemnity
Ref: 33-17-9 N. Indirect Loss
2. Cooperation with fire marshal in fire loss investigation O. Liability
Ref: 29-3-12a (Fire Prevention and Control Act) P. Loss of Use
3. Mine subsidence coverage Q. Market Value
Ref: 33-30-1 through 33-30-3; 33-30-6; 33-30-7; R. Misrepresentation
33-30-10; 33-30-12; 33-30-13 S. Mortgagee Rights
4. West Virginia Essential Property Insurance T. Names Perils Coverage
Association (FAIR plan) U. Negligence
Ref: 33-20A-1 through 33-20A-3; Rule 114-21-1, 2, V. Occurrence
8, 9, 13 W. Open Perils (all-risk) Coverage
C. Automobile Adjusting............................................. 6 X. Other Insurance Provision
1. Required liability coverage. Uninsured and Y. Overinsurance
underinsured motorists coverage. Named driver Z. Pair and Set Clause
exclusion. AA. Peril
Ref: 33-6-31; 17D-4-2 (Motor Vehicle Safety BB. Proximate Cause
Responsibility Law) CC. Replacement Cost
2. Guest passenger law DD. Representations
Ref: 33-6-29 EE. Subrogation
3. Comparative negligence doctrine FF. Warranties
Ref: West Virginia Supreme Court ruling,
Bradley v. Appalachian Power Co., (Continued on the next page.)
163 WV 332, 256 SE2d 879 (1979)
4. Standards for settling auto claims
Ref: 33-6-33; Rule 114-14-7
West Virginia Insurance Supplement – Examination Content Outlines Effective: January 20, 2012
S11
WEST VIRGINIA WEST VIRGINIA
PUBLIC ADJUSTER EXAMINATION VIATICAL SETTLEMENT BROKER
CONTENT OUTLINE EXAMINATION
State Laws and Rules CONTENT OUTLINE
(35 scoreable questions) State Laws and Rules
(35 scoreable questions)
I. WEST VIRGINIA LAWS AND RULES PERTINENT TO
PUBLIC ADJUSTERS I. WEST VIRGINIA LAWS AND RULES PERTINENT TO
All statutory references are taken from §114-25 and Section 33- VIATICAL SETTLEMENTS.............................................35
12B of the West Virginia Code of State Insurance Rules at Ref: All statutory references are taken from Chapter 33-13C of the
http://www.wvinsurance.gov/PolicyLegislation.aspx. West Virginia Code and §114-80 of the State Rules.
A. Public Adjusters A. Definitions
1. License requirements Ref: §33-13C-2; Rule §114-80-2
a. Administrative actions B. Licensing and Renewal Requirements
b. Definition of public adjuster Ref: §33-13C-3; Rule §114-80-4
Ref: §114-25-2.10, §114-25-11.6.a.2, §114-25-11.6.g, C. Reporting Requirements
33-12B-1, 33-12B-3, 33-12B-4 Ref: §33-13C-6; Rule §114-80-6
c. Hearings D. Disclosures
Ref: 33-12B-14 Ref: §33-13C-5, §33-13C-8; Rule §114-80-10
d. Penalties E. Contracts and Payments of Proceeds
Ref: 33-12B-14 Ref: Rule §114-80-8
2. Standards of Conduct F. Examination or Investigation
Ref: §114-25-10, §114-25-2.10, §114-25-10.2h, Ref: §33-13C-7
§114-25-14 G. Standards for Evaluation of Reasonable Payments to
3. Compensation Terminally or Chronically Ill Insureds
Ref: §114-25-10.1.d, §114-25-10.e, §114-25-11.2.a, Ref: Rule §114-80-5
§114-25-11.2.b, §114-25-10.2c, §114-25-11.3, H. General Rules
§114-25-12.4, §114-25-15.2 Ref: §33-13C-10; Rule §114-80-7
a. Disclosure I. Prohibited Practices
Ref: §114-25-10.1.h Ref: §33-13C-11, §33-13C-12; Rule §114-80-11
b. Obligation J. Advertising and Marketing
Ref: §114-25-11 Ref: §33-13C-13; Rule §114-80-9
c. Ownership K. Fraud Prevention and Control
d. Referrals Ref: §33-13C-15
Ref: §114-25-10.1.f L. Criminal Penalties
4. Record keeping Ref: §33-13C-16
a. Reporting changes to the Commissioner of
Insurance
Ref: §114-25-17, 33-12B-10a
b. Record retention
Ref: §114-25-8.2, §114-25-11.1
5. Contracts
a. General requirements
Ref: §114-25-10.2 §114-25-10.2.d, §114-25-11,
§114-25-11.1, §114-25-11.2, §114-25-11.5,
§114-25-11.5c, §114-25-11.6.f, §114-25-11.6.i,
§114-25-15.4
b. Rescinding
Ref: §114-25-11.6.h
c. Voiding
Ref: §114-25-15.4
6. Claims
a. Catastrophe fees
Ref: §114-25-12.4
b. Disclosure process
Ref: §114-25-11.6
c. Settlement
Ref: §114-25-11.6, §114-25-13, §114.25-15.3
West Virginia Insurance Supplement – Examination Content Outlines Effective: January 20, 2012
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