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Which of the following is not a Statutory Exclusion to No-fault coverage?
A.
Any person who intentionally causes his or her own personal injury.
B.
Any person while operating or occupying a motor vehicle known to that person to be stolen.
C.
Any person who makes fraudulent statements or engages in fraudulent conduct.
D.
Any relative while occupying, or while a pedestrian through being struck by, any motor vehicle owned by the relative with respect to which overage required by the New York Comprehensive Motor Vehicle Insurance Reparations Act is not in effect.
Correct Answer
C. Any person who makes fraudulent statements or engages in fraudulent conduct.
Explanation The given answer is not a statutory exclusion to no-fault coverage because it does not fall under any of the specific conditions mentioned in the options. The other options provide situations where coverage may be excluded, such as intentionally causing personal injury, operating a stolen vehicle, or not having the required insurance coverage. However, making fraudulent statements or engaging in fraudulent conduct is not mentioned as a specific exclusion. Therefore, it is not a statutory exclusion to no-fault coverage.
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2.
What is the time limit to send PIP forms to an Eligible Injured Person after receipt of Notice of injury?
A.
3 Business Days
B.
5 Business Days
C.
5 Calendar Days
D.
10 Calendar Days
Correct Answer
B. 5 Business Days
Explanation The correct answer is 5 Business Days. This means that once a Notice of injury is received, the PIP forms must be sent to the Eligible Injured Person within 5 Business Days. Business Days typically refer to weekdays, excluding weekends and public holidays.
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3.
What is the time limit to send NF3, NF4, NF6, NF7 forms?
A.
5 Business Days
B.
5 Calendar Days
C.
10 Business Days
D.
15 Calendar Days
Correct Answer
C. 10 Business Days
Explanation The correct answer is 10 Business Days. This means that the forms NF3, NF4, NF6, and NF7 must be sent within 10 business days. Business days refer to the days from Monday to Friday, excluding weekends and public holidays. This time limit allows for a reasonable amount of time to complete and submit the necessary forms.
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4.
What is the time limit to send a verification request after a medical bill is received?
A.
10 Business Days
B.
10 Calendar Days
C.
15 Business Days
D.
15 Calendar Days
Correct Answer
C. 15 Business Days
Explanation The time limit to send a verification request after a medical bill is received is 15 business days. This means that the request must be sent within 15 working days, excluding weekends and public holidays. It is important to adhere to this time limit in order to ensure timely processing and resolution of the verification request.
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5.
What is the time limit to send a Denial of Claim based on a Statutory Exclusion?
A.
5 Business Days
B.
10 Calendar Days
C.
10 Business Days
D.
30 Calendar Days
Correct Answer
C. 10 Business Days
Explanation The correct answer is 10 Business Days. This means that the time limit to send a Denial of Claim based on a Statutory Exclusion is 10 Business Days. Business days refer to weekdays excluding weekends and public holidays. Therefore, the insurance company has 10 working days to send a denial of claim notification to the policyholder if the claim is based on a statutory exclusion.
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6.
Which of the following is not a criteria for potential No-fault Recovery?
A.
Livery vehicle involvement
B.
Vehicle weight up to 6500 lbs
C.
Manufacturer defect
D.
APIP paid
Correct Answer
B. Vehicle weight up to 6500 lbs
Explanation The criteria for potential No-fault Recovery include livery vehicle involvement, manufacturer defect, and APIP paid. However, vehicle weight up to 6500 lbs is not a criteria for potential No-fault Recovery.
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7.
Which of the following is not considered a necessary Medical Expense in accordance with Regulation 68:
A.
Household Help Aide
B.
Prosthetic Services
C.
Occupational therapy
D.
Religious methods of healing
Correct Answer
A. Household Help Aide
Explanation Household Help Aide is not considered a necessary Medical Expense in accordance with Regulation 68. This means that the cost of hiring a household help aide is not eligible for reimbursement or coverage under medical insurance. While prosthetic services, occupational therapy, and religious methods of healing may be considered necessary medical expenses and eligible for coverage, hiring a household help aide is not typically considered a medical necessity.
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8.
Our insured struck and killed a NY State resident pedestrian in NY State. In addition to Basic PIP, our policy carries $5000.00 Med Pay coverage. What is the limit NYCM would pay up for funeral expenses?
A.
$2000.00
B.
$5000.00
C.
$7000.00
D.
None of the above
Correct Answer
A. $2000.00
Explanation Pedestrian is not eligible for Med Pay
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9.
Our policy carries Basic PIP, OBEL, APIP and Med Pay. Medical bills are received/accepted in excess of the combined limits. In which order does coverage apply?
A.
Basic, OBEL, APIP, Med Pay
B.
Basic, Med Pay, APIP, OBEL
C.
Med Pay, Basic, OBEL, APIP
D.
Basic, APIP, OBEL, Med Pay
Correct Answer
A. Basic, OBEL, APIP, Med Pay
Explanation The coverage applies in the following order: Basic, OBEL, APIP, Med Pay. This means that the Basic coverage is applied first, followed by OBEL, then APIP, and finally Med Pay.
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10.
In accordance with Regulation 68, which of the following is an Eligible Injured Person under Basic PIP Coverage is:
A.
Any NY State resident who sustains personal injury arising our of the use or operation of the insured motor vehicle outside NY while occupying another motor vehicle.
B.
Named insured and any relative who sustains personal injury arising out of the use or operation of any motorcycle, while occupying a motorcycle
C.
Any other person who sustains personal injury arising out of the use or operation of the insured motor vehicle in the State of NY while not occupying another motor vehicle
Correct Answer
C. Any other person who sustains personal injury arising out of the use or operation of the insured motor vehicle in the State of NY while not occupying another motor vehicle
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