Documentation & Reporting Flashcards

A sworn proof of loss in property claims is primarily used to:

Answer: Formally state the insured's claimed amount and circumstances of the loss under oath

A proof of loss is a sworn statement by the insured detailing the loss and the amount claimed, as required by many property policies.

A large-loss report to management or a reinsurer typically includes all of the following EXCEPT:

Answer: The adjuster's personal opinion of the claimant's character

Large-loss reports focus on facts, coverage, liability, damages, and reserves, not personal judgments.

Prompt notice of a significant claim to a reinsurer is important mainly because:

Answer: Reinsurance treaties often require timely notice as a condition of recovery

Late notice can jeopardize reinsurance recovery under treaty notice provisions.

Which practice best preserves the chain of custody for a failed product removed from a fire scene?

Answer: Documenting each person who handled, stored, or transferred the item, with dates

An unbroken, documented chain of custody supports admissibility and protects subrogation rights.

Before issuing a claim payment, many U.S. insurers screen payees against which list to comply with federal sanctions law?

Answer: The OFAC Specially Designated Nationals list

OFAC regulations prohibit payments to sanctioned parties, so insurers screen payees against the SDN list.

A status report from an adjuster to defense counsel's client (the insurer) in a litigated claim should ideally include:

Answer: Current developments, evaluation of liability and damages, and a recommended plan of action

Effective status reports update facts, evaluation, and strategy so management can make informed decisions.

During a state market conduct examination, regulators reviewing claim files mainly look for:

Answer: Documentation showing timely, fair, and compliant claim handling

Market conduct exams test whether files show compliance with timeliness, fairness, and unfair claims practice requirements.