CAIA Claims Investigation Techniques 3 — Questions and Answers
Question 1: An adjuster receives a claim where the at-fault driver fled the scene and cannot be identified. Under which coverage would the claimant typically seek compensation for vehicle damage?
- Collision coverage
- Uninsured motorist property damage (Correct answer)
- Comprehensive coverage
- Medical payments coverage
Correct answer: Uninsured motorist property damage
Uninsured motorist property damage (UMPD) is designed to cover vehicle damage caused by a hit-and-run or uninsured driver when the at-fault party cannot be identified.
Question 2: When documenting vehicle damage during a physical inspection, what is the primary advantage of using a standardized damage diagram?
- It eliminates the need for photographs
- It provides a consistent, universally understood record of damage location (Correct answer)
- It automatically calculates repair costs
- It replaces the need for an independent appraisal
Correct answer: It provides a consistent, universally understood record of damage location
Standardized diagrams use zone codes and directional references that any adjuster, appraiser, or court can interpret consistently without ambiguity.
Question 3: A claimant states the accident occurred at 2:00 PM, but the responding police officer's report notes arrival at 1:45 PM. Which document controls for establishing the timeline?
- The claimant's recorded statement
- The police report, which is a contemporaneous official record (Correct answer)
- The insured's written statement
- The repair shop's intake form
Correct answer: The police report, which is a contemporaneous official record
Police reports are contemporaneous official records prepared by a neutral third party and carry greater evidentiary weight than self-reported claimant statements.
Question 4: An adjuster discovers that the VIN plate on a claimed vehicle does not match the confidential secondary VIN found on the engine block. This discrepancy most likely indicates:
- A factory recall modification
- A stolen or salvage vehicle with a swapped VIN (Correct answer)
- A clerical error at the DMV
- An aftermarket engine replacement
Correct answer: A stolen or salvage vehicle with a swapped VIN
Mismatched primary and secondary VINs are a classic indicator of a 'VIN swap,' where a stolen vehicle is given the identity of a legitimately titled vehicle.
Question 5: Which of the following is a red flag that may indicate an auto insurance fraud ring rather than a single isolated claim?
- Multiple unrelated claimants using the same attorney and treatment facility (Correct answer)
- A claimant who hires an attorney before filing
- A vehicle with pre-existing damage
- A single-vehicle accident with no witnesses
Correct answer: Multiple unrelated claimants using the same attorney and treatment facility
Fraud rings coordinate participants to use the same legal and medical providers, creating a detectable pattern when multiple claims are cross-referenced.
Question 6: When an adjuster orders a police report and it is unavailable because the insured did not report the accident, what alternative documentation should be obtained?
- A neighbor's verbal statement
- A self-prepared incident report and witness statements (Correct answer)
- The insured's social media posts
- A news clipping
Correct answer: A self-prepared incident report and witness statements
When no police report exists, adjusters collect witness statements, photos, insured's written account, and any other corroborating documentation to reconstruct the loss.
Question 7: An adjuster reviewing a bodily injury claim notes that the claimant sought chiropractic treatment beginning three weeks after the accident. What concern does this delay raise?
- The treatment may not be covered under the policy
- The delay may weaken the causal link between the accident and the claimed injury (Correct answer)
- The adjuster must automatically deny the claim
- The statute of limitations has expired
Correct answer: The delay may weaken the causal link between the accident and the claimed injury
A significant gap between the accident and first medical treatment raises questions about causation and may indicate the injuries were pre-existing or unrelated to the collision.
CAIA Claims Investigation Techniques 3
An adjuster receives a claim where the at-fault driver fled the scene and cannot be identified.
Under which coverage would the claimant typically seek compensation for vehicle damage?