Bodily Injury Claim Evaluation Flashcards
7 cards from real CAIA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Bodily Injury Claim Evaluation flashcards as text
A claimant's treating physician states the injuries are 'consistent with' the reported accident. What does this phrase mean in bodily injury evaluation?
Answer: The medical findings do not contradict accident causation, though the physician is not giving absolute certainty
'Consistent with' means the medical evidence is compatible with the claimed mechanism but does not constitute absolute proof of causation.
In which situation would a bodily injury claim most likely be evaluated under a 'no-fault' insurance framework?
Answer: When the accident occurs in a state requiring PIP coverage and the damages fall below the tort threshold
No-fault states require injured parties to first seek compensation through their own PIP coverage, with tort claims only available above the state's injury threshold.
A claimant fails to mitigate their damages by refusing reasonable medical treatment recommended by their physician. How does this affect the bodily injury claim?
Answer: The insurer may reduce the settlement to exclude damages that could have been avoided with reasonable treatment
Claimants have a duty to mitigate damages; unreasonable refusal of beneficial treatment can reduce the compensable portion of the claim.
What is the primary purpose of a 'demand package' submitted by a claimant's attorney in a bodily injury claim?
Answer: To present a comprehensive summary of damages, liability, and a settlement demand to initiate negotiations
A demand package consolidates medical records, bills, lost wage documentation, and a settlement figure to open formal settlement negotiations.
When evaluating a bodily injury claim involving a passenger in the at-fault vehicle, which coverage typically applies?
Answer: The at-fault driver's bodily injury liability coverage
Passengers injured due to the driver's negligence may make a bodily injury liability claim against the at-fault driver's liability policy.
A claimant experienced emotional distress and anxiety following a serious auto accident but had no physical injuries. Can these be compensable damages?
Answer: Yes, many states allow recovery for emotional distress, especially when accompanied by a physical impact
Most states allow emotional distress claims when tied to a physical impact or when the distress is severe and documented, though rules vary by jurisdiction.
What is 'stacking' of coverage limits in the context of uninsured/underinsured motorist bodily injury claims?
Answer: Adding coverage limits from multiple vehicles or policies to increase available BI recovery
Stacking allows an insured to combine UM/UIM limits from multiple vehicles or policies when one policy's limits are insufficient to cover damages.