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Claims Processing & Documentation Flashcards

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Read the first 7 Claims Processing & Documentation flashcards as text
  1. After paying a collision claim, an insurer wants to recover from the at-fault driver. Which document best supports its subrogation claim?

    Answer: Signed subrogation receipt or loan receipt from the insured

    A subrogation receipt documents the payment and confirms the insured has transferred recovery rights to the insurer.

  2. A third-party claimant settles and signs a general release. What is the main effect of that release?

    Answer: It discharges the released parties from all claims arising from the incident

    A general release ends all known and unknown claims from the occurrence against the released parties.

  3. An insurer takes ownership of a total-loss vehicle after paying its actual cash value. What is the money it later gets from selling that vehicle called?

    Answer: Salvage

    Salvage is the value the insurer recovers from damaged property it took over after paying the claim.

  4. A homeowners claim shows these signs: the policy was bought recently, coverage was increased shortly before the loss, the insured has financial trouble, and receipts are missing. What should the adjuster do?

    Answer: Refer the file to the Special Investigation Unit (SIU) according to company guidelines

    Fraud indicators justify an SIU referral for more investigation, not an automatic denial.

  5. What is the main purpose of checking a claim against ISO ClaimSearch?

    Answer: To find prior or duplicate claims across insurers that may point to fraud

    ISO ClaimSearch is an industry database that helps find prior losses, duplicate claims, and patterns that suggest fraud.

  6. Why does an adjuster usually confirm the policy period, named insureds, and covered property at first notice of loss?

    Answer: To find out early whether a policy was in force and applies to the reported loss

    Checking coverage first confirms there is a policy in force that may respond before investigation resources are spent.

  7. An insured disagrees only with the amount of a covered property loss, not with coverage itself. Which policy provision usually settles this?

    Answer: Appraisal clause

    The appraisal clause settles disputes over the amount of loss, using two appraisers and an umpire.

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