CAIA Bodily Injury Claim Evaluation 2

Question 1

A claimant reports whiplash after a rear-end collision but has no documented medical treatment for three weeks. How does this gap typically affect the bodily injury evaluation?

Accepted Answer

It may suggest the injury was not serious or treatment-related to the accident

Answer

It has no impact on the claim value

Answer

It automatically increases the settlement to cover delayed treatment

Answer

It shifts liability entirely to the claimant

Question 2

When evaluating a soft tissue injury claim, which factor is LEAST relevant to establishing injury severity?

Accepted Answer

The color of the claimant's vehicle

Answer

MRI findings showing no structural damage

Answer

Treating physician's narrative report

Answer

Duration and frequency of physical therapy

Question 3

A claimant's medical records show pre-existing degenerative disc disease at the same spinal level injured in the accident. How should the adjuster handle this?

Accepted Answer

Apportion damages between the pre-existing condition and the accident-aggravated portion

Answer

Deny the claim entirely due to the pre-existing condition

Answer

Pay full damages without any reduction

Answer

Require the claimant to obtain a second vehicle inspection

Question 4

What does the term 'subrogation' mean in the context of a bodily injury claim?

Accepted Answer

The insurer's right to recover paid losses from the at-fault third party

Answer

The claimant waives all future injury rights

Answer

The process of calculating pain and suffering damages

Answer

A court order requiring the insurer to pay immediately

Question 5

A claimant submits $8,000 in medical bills, but the adjuster finds that $2,000 reflects charges for unrelated dental work. What is the correct course of action?

Accepted Answer

Deduct the $2,000 and evaluate only the $6,000 related to the accident injuries

Answer

Accept all $8,000 because the claimant submitted them

Answer

Deny the entire claim due to fraudulent billing

Answer

Refer the claim to the state insurance department immediately

Question 6

Which of the following best describes 'loss of consortium' as a compensable bodily injury damage?

Accepted Answer

A spouse's claim for loss of companionship and services due to the partner's injuries

Answer

Wages lost by the injured claimant due to hospitalization

Answer

Property damage resulting from the bodily injury accident

Answer

Future medical expenses for the claimant's recovery

Question 7

When using a multiplier method to estimate general damages, what does the adjuster multiply?

Accepted Answer

Total special damages (medical bills + lost wages) by a factor typically ranging from 1.5 to 5

Answer

The claimant's annual salary by the number of injury days

Answer

The vehicle repair cost by the number of passengers injured

Answer

The at-fault percentage by the policy limit