CAIA Regulatory Compliance and Ethics 2

Question 1

An adjuster discovers that a claimant's medical bills were inflated by their provider. What is the adjuster's primary ethical obligation?

Accepted Answer

Document the discrepancy and refer it to the Special Investigations Unit

Answer

Pay the inflated amount to avoid conflict

Answer

Deny the entire claim without investigation

Answer

Advise the claimant to find a different provider

Question 2

Under the Unfair Claims Settlement Practices Act, what is the maximum timeframe most states require for acknowledging a claim after receipt?

Accepted Answer

10 working days

Answer

5 business days

Answer

30 calendar days

Answer

60 calendar days

Question 3

A state insurance department sends an examiner to audit a claims file. Which adjuster behavior would most likely be cited as a violation?

Accepted Answer

Routinely denying claims without a written explanation

Answer

Paying a claim within 30 days

Answer

Documenting all claimant communications

Answer

Requiring a signed recorded statement

Question 4

Which of the following best describes a conflict of interest for an automotive insurance adjuster?

Accepted Answer

Referring a claim to a repair shop where the adjuster owns a financial interest

Answer

Inspecting a vehicle at the claimant's home

Answer

Using a third-party appraisal tool

Answer

Requesting a police report before settling

Question 5

What does the principle of 'utmost good faith' (uberrimae fidei) require of an automotive insurance adjuster?

Accepted Answer

Acting honestly and disclosing all material facts relevant to the claim

Answer

Settling all claims above the policy limit

Answer

Accepting every claim without investigation

Answer

Prioritizing the insurer's financial interests above all else

Question 6

An adjuster licensed in Texas handles a claim for a vehicle accident that occurred in California. Which state's regulations primarily govern the claims handling process?

Accepted Answer

California, where the loss occurred

Answer

Texas, where the adjuster is licensed

Answer

The state where the insurer is domiciled

Answer

Federal law supersedes all state rules

Question 7

Which action by an adjuster would constitute coercion under most state insurance codes?

Accepted Answer

Threatening to cancel a policyholder's coverage unless they accept a lowball settlement

Answer

Requesting a vehicle inspection before issuing payment

Answer

Requiring proof of ownership before paying a total loss

Answer

Sending a reservation of rights letter