Claims Investigation Process Flashcards
6 cards from real CALA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Claims Investigation Process flashcards as text
During the initial phase of a claims investigation, what is the primary purpose of obtaining a recorded statement from the insured?
Answer: To gather a detailed, first-hand account of the incident to assess coverage and liability.
A recorded statement is a critical tool used early in the investigation to capture the insured's detailed recollection of the event. This helps the adjuster understand the facts of the loss, determine if the policy covers the incident, and make a preliminary assessment of liability.
A Certified Automotive Loss Adjuster is investigating a claim where the repair estimate is significant. Which of the following is the most critical comparison the adjuster must make to determine if the vehicle is a total loss?
Answer: The cost of repairs plus the vehicle's salvage value versus the vehicle's Actual Cash Value (ACV).
The standard industry formula for declaring a vehicle a total loss is when the cost to repair it, plus its remaining value as salvage, exceeds its Actual Cash Value (ACV) just before the loss occurred. This is often referred to as the total loss formula. Some states use a Total Loss Threshold (TLT), where a vehicle is totaled if repair costs exceed a certain percentage of its ACV.
Which of the following is a key component of the claims investigation process that primarily focuses on determining the cause and fault of an accident?
Answer: Liability investigation
The liability investigation is the part of the process where the adjuster gathers and analyzes evidence to determine who is at fault for the accident. This involves reviewing police reports, interviewing parties and witnesses, and examining the accident scene.
An insured reports their vehicle stolen. After taking the initial report, what is a crucial next step for the claims adjuster in the investigation process?
Answer: Verify that the insured has filed a police report and obtain a copy.
For a theft claim, it is essential to verify that the event has been officially reported to law enforcement. Obtaining the police report is a fundamental step in the investigation to confirm the details of the loss, gather information, and prevent fraud.
During a complex collision investigation, an adjuster might need to gather additional evidence beyond driver statements and photos. Which of the following would be an appropriate action to take?
Answer: Hire an accident reconstruction expert to analyze the physical evidence.
In complex cases with conflicting information or severe damages, hiring an accident reconstruction expert is a standard practice. These experts can analyze vehicle damage, scene evidence, and other data to provide a scientific opinion on how the accident occurred.
If an insured decides to keep their vehicle after it has been declared a total loss (owner-retained salvage), how is the final settlement amount typically calculated?
Answer: The Actual Cash Value (ACV) minus both the salvage value and the policy deductible.
When an owner retains a totaled vehicle, the insurance company pays the Actual Cash Value (ACV) of the vehicle, but first subtracts the amount they would have received from selling it at a salvage auction. The policyholder's deductible is also subtracted from this amount.