Claims Processing & Investigation Flashcards
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Read the first 7 Claims Processing & Investigation flashcards as text
Which claims handling standard requires insurers to acknowledge receipt of a claim within a specified number of days under most US state regulations?
Answer: Unfair Claims Settlement Practices Act (UCSPA)
The UCSPA, adopted in various forms by states, mandates timely acknowledgment, investigation, and settlement of claims.
In a liability claim, 'comparative negligence' means:
Answer: Damages are allocated based on each party's percentage of fault
Under comparative negligence, each party's damages are reduced by their percentage of fault in causing the loss.
A 'sworn proof of loss' in property claims is a formal document that:
Answer: Requires the insured to attest under oath to the details and value of their loss
A sworn proof of loss is a legal document signed under oath by the insured detailing the circumstances, nature, and amount of the claimed loss.
Which ACORD form would typically be used to document a general liability bodily injury claim at a retail store?
Answer: ACORD 4 (General Liability Notice of Occurrence/Claim)
The ACORD 4 is the standard form for reporting general liability occurrences or claims, including slip-and-fall incidents at commercial locations.
When investigating a suspected arson claim, which evidence type carries the MOST weight in determining origin and cause?
Answer: Fire investigator's origin and cause report
A certified fire investigator's origin and cause report is the most authoritative evidence for determining whether a fire was accidental, natural, or intentional.
The 'cooperation clause' in an insurance policy requires the insured to:
Answer: Assist the insurer in investigating and defending a claim
The cooperation clause obligates the insured to provide information, submit to examinations, and otherwise assist the insurer in its claim investigation and defense.
In claims handling, 'loss adjustment expenses' (LAE) refer to:
Answer: Costs incurred by the insurer to investigate and settle a claim
LAE includes adjuster fees, legal costs, expert witness fees, and other expenses related to investigating and resolving a claim.