CAIA Bodily Injury Claim Evaluation 4 — Questions and Answers
Question 1: A claimant's treating physician states the injuries are 'consistent with' the reported accident. What does this phrase mean in bodily injury evaluation?
- The physician has confirmed beyond doubt that the accident caused the injuries
- The medical findings do not contradict accident causation, though the physician is not giving absolute certainty (Correct answer)
- The physician denies causation between the accident and injuries
- The claim is automatically approved based on the physician's statement
Correct 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.
Question 2: In which situation would a bodily injury claim most likely be evaluated under a 'no-fault' insurance framework?
- When the claimant files suit in federal court
- When the accident occurs in a state requiring PIP coverage and the damages fall below the tort threshold (Correct answer)
- When both drivers are insured by the same company
- When the claimant is a pedestrian
Correct 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.
Question 3: A claimant fails to mitigate their damages by refusing reasonable medical treatment recommended by their physician. How does this affect the bodily injury claim?
- The insurer must pay all claimed damages regardless of the claimant's choices
- The insurer may reduce the settlement to exclude damages that could have been avoided with reasonable treatment (Correct answer)
- The claim is automatically denied due to the refusal of treatment
- The claimant receives additional compensation for exercising their rights
Correct 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.
Question 4: What is the primary purpose of a 'demand package' submitted by a claimant's attorney in a bodily injury claim?
- To formally request a vehicle inspection from the insurer
- To present a comprehensive summary of damages, liability, and a settlement demand to initiate negotiations (Correct answer)
- To notify the insurer of the attorney's hourly billing rate
- To request a copy of the insured's policy limits
Correct 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.
Question 5: When evaluating a bodily injury claim involving a passenger in the at-fault vehicle, which coverage typically applies?
- The passenger's uninsured motorist coverage only
- The at-fault driver's bodily injury liability coverage (Correct answer)
- The passenger's medical payments coverage only, with no liability claim available
- The vehicle owner's comprehensive coverage
Correct 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.
Question 6: A claimant experienced emotional distress and anxiety following a serious auto accident but had no physical injuries. Can these be compensable damages?
- No, emotional damages are never compensable in auto accident claims
- Yes, many states allow recovery for emotional distress, especially when accompanied by a physical impact (Correct answer)
- Yes, but only if the claimant is the vehicle owner
- No, only the at-fault driver can claim emotional distress
Correct 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.
Question 7: What is 'stacking' of coverage limits in the context of uninsured/underinsured motorist bodily injury claims?
- Combining medical bills from multiple providers into one demand
- Adding coverage limits from multiple vehicles or policies to increase available BI recovery (Correct answer)
- Dividing a single policy limit among multiple claimants
- Layering deductibles from two separate insurance companies
Correct 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.
CAIA Bodily Injury Claim Evaluation 4
A claimant's treating physician states the injuries are 'consistent with' the reported accident.
What does this phrase mean in bodily injury evaluation?