CA Project Management & Workflow 3

Question 1

An adjuster sets an initial reserve of $10,000 but new information shows the actual exposure is $85,000. What is the correct action?

Accepted Answer

Adjust the reserve upward and document the basis for the change

Answer

Reserves must reflect the current best estimate of ultimate liability; prompt adjustment with documentation is required.

Question 2

What is the purpose of a 'diary' system in claims workflow?

Accepted Answer

Scheduling future follow-up actions on open claims

Answer

A diary (or bring-forward) system ensures no claim task is overlooked by scheduling reminders for required actions.

Question 3

Which of the following is a leading indicator that a claim file may be approaching bad faith exposure?

Accepted Answer

The adjuster failed to respond to a policy limits demand within a reasonable time

Answer

Failure to timely respond to a policy limits demand is a classic bad faith trigger in California.

Question 4

In a multi-party liability claim involving several claimants, what workflow approach prevents inadvertent overpayment?

Accepted Answer

Track all demands against the per-occurrence policy limit simultaneously

Answer

Monitoring cumulative exposure against the per-occurrence limit prevents exhausting coverage before all claimants are resolved.

Question 5

What is the primary purpose of an 'authority level' in claims workflow?

Accepted Answer

Setting the maximum dollar amount an adjuster can settle without supervisor approval

Answer

Authority levels ensure appropriate oversight by routing large settlements through supervisory review.

(CA) Certified Adjuster Designation Practice Test