CAIA Bodily Injury Claim Evaluation 5

Question 1

A claimant settles a bodily injury claim and signs a release. Three months later, they discover a more serious injury from the same accident. What is the typical legal outcome?

Accepted Answer

The signed release generally bars recovery for subsequently discovered injuries from the same accident

Answer

A general release typically extinguishes all claims arising from the accident, including injuries discovered after signing, which is why claimants should ensure full recovery before settling.

Question 2

What does 'maximum medical improvement' (MMI) mean, and why is it important in bodily injury claim timing?

Accepted Answer

The claimant's condition has stabilized and further significant recovery is not expected, making it the ideal time to evaluate final damages

Answer

MMI marks the point where treatment has achieved its maximum benefit, allowing adjusters to accurately assess total past and future medical needs for final settlement.

Question 3

An adjuster discovers through social media that a claimant claiming severe mobility limitations is playing recreational basketball. How can this information be used?

Accepted Answer

It can be used as evidence to challenge the credibility and severity of the claimed injuries during claim evaluation

Answer

Publicly available social media posts showing activities inconsistent with claimed injuries are legitimate evidence that can be used to challenge damage claims.

Question 4

When a claimant has health insurance that paid their accident-related medical bills, what is the insurer's potential obligation regarding those payments?

Accepted Answer

The bodily injury settlement may need to account for the health insurer's subrogation lien against the recovery

Answer

Health insurers often assert subrogation liens, requiring repayment from the BI settlement, which the adjuster must factor into evaluating the claimant's net recovery.

Question 5

A claimant is self-employed and claims $15,000 in lost income due to accident injuries. What documentation should the adjuster require?

Accepted Answer

Tax returns, business financial records, and documentation showing income loss during the disability period

Answer

Self-employed claimants must provide tax returns and business records to objectively establish actual income loss, since no employer can verify wages.

(CAIA) Certified Automotive Insurance Adjuster Practice Test

(CAIA) Certified Automotive Insurance Adjuster Practice Test

CAIA Bodily Injury Claim Evaluation 5