CA Claims Investigation & Evaluation 3 — Questions and Answers
Question 1: Which doctrine holds that a plaintiff cannot recover damages if they were also at fault in causing the accident, regardless of degree?
- Comparative negligence
- Contributory negligence (Correct answer)
- Res ipsa loquitur
- Assumption of risk
Correct answer: Contributory negligence
Contributory negligence is a complete bar to recovery if the plaintiff had any role in causing the accident, though most states now use comparative negligence instead.
Question 2: What is the primary purpose of an 'examination under oath' (EUO) in a claims investigation?
- To formally deny the claim without further review
- To obtain sworn testimony from the insured about the loss (Correct answer)
- To settle the claim without litigation
- To transfer the claim to a different adjuster
Correct answer: To obtain sworn testimony from the insured about the loss
An EUO is a formal, sworn examination required by most policies that allows the insurer to question the insured in depth about the circumstances of a loss.
Question 3: A claimant alleges soft-tissue injuries after a low-speed collision with minimal vehicle damage. Which investigative tool is most useful for evaluating injury causation?
- A title search on the claimant's vehicle
- Biomechanical analysis correlating impact forces to injury potential (Correct answer)
- A review of the insured's credit history
- An appraisal of the vehicle's market value
Correct answer: Biomechanical analysis correlating impact forces to injury potential
Biomechanical analysis examines whether the forces involved in a low-speed impact are sufficient to cause the alleged soft-tissue injuries.
Question 4: Under the concept of 'proximate cause,' which loss scenario would most likely NOT be covered?
- A fire that starts from a covered lightning strike
- Mold growth occurring two years after an undetected slow leak (Correct answer)
- Wind damage that breaks a window during a named storm
- Theft of property following a covered break-in
Correct answer: Mold growth occurring two years after an undetected slow leak
Long-term neglect of a slow leak breaks the chain of proximate causation; mold resulting from maintenance failure is typically excluded as it is not a sudden and accidental loss.
Question 5: What does 'reservation of rights' (ROR) notify the insured about?
- The insurer's right to increase premiums mid-term
- The insurer's intent to investigate while preserving the right to deny coverage (Correct answer)
- The insured's right to choose their own repair vendor
- The insurer's right to cancel the policy retroactively
Correct answer: The insurer's intent to investigate while preserving the right to deny coverage
A reservation of rights letter informs the insured that the insurer will handle the claim but reserves the right to disclaim coverage if investigation reveals a basis for denial.
Question 6: When calculating loss of income damages for a self-employed claimant, which document is most probative?
- The claimant's personal bank statements alone
- Federal income tax returns showing historical earnings (Correct answer)
- The claimant's verbal estimate of annual income
- The insured's payroll records for the period
Correct answer: Federal income tax returns showing historical earnings
Federal tax returns provide verified, historically documented income figures that are the most reliable evidence of a self-employed claimant's actual earnings.
Question 7: Which investigation technique is specifically designed to detect staged auto accidents involving organized fraud rings?
- Reviewing the claimant's credit score
- Performing a link analysis of all claimants, attorneys, and medical providers (Correct answer)
- Ordering a structural inspection of the vehicle
- Requesting a gap in treatment explanation
Correct answer: Performing a link analysis of all claimants, attorneys, and medical providers
Link analysis maps relationships between claimants, attorneys, clinics, and repair shops to identify networks that repeatedly appear together — a hallmark of organized fraud.
CA Claims Investigation & Evaluation 3
Which doctrine holds that a plaintiff cannot recover damages if they were also at fault in causing the accident, regardless of degree?