Claims Investigation Process Flashcards
7 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 7 Claims Investigation Process flashcards as text
In a multi-vehicle accident, how does the adjuster determine which state's laws govern the claim when vehicles are from different states?
Answer: The state where the accident occurred typically governs liability
Liability for an accident is generally governed by the law of the state where the loss occurred (lex loci delicti).
What does 'subrogation' mean in the context of automotive claims investigation?
Answer: The insurer's right to recover paid claim amounts from the at-fault third party
Subrogation allows the insurer to step into the insured's shoes and pursue recovery from the responsible party after paying a claim.
When photographing a damaged vehicle during investigation, which sequence best supports the investigation?
Answer: Overview shots of the scene, then mid-range vehicle photos, then close-up damage details
A systematic photo sequence from overview to detail creates a complete visual record that supports liability analysis and damage assessment.
An adjuster is investigating a hit-and-run claim where no witnesses are present. Which coverage would typically apply for the insured's vehicle damage?
Answer: Uninsured motorist property damage (UMPD) or collision coverage
Hit-and-run damage to the insured's vehicle is typically covered under UMPD (where available) or collision coverage, subject to applicable deductibles.
What is the significance of 'comparative negligence' in a claims investigation?
Answer: It allocates fault percentages among parties, potentially reducing recoverable damages proportionally
Comparative negligence systems apportion fault among parties, reducing the plaintiff's recovery by their percentage of fault.
During an investigation, the adjuster finds that the insured's vehicle had pre-existing damage in the same area as the claimed loss. The correct action is to:
Answer: Document the pre-existing damage and only compensate for damage attributable to the current loss
The insurer is only obligated to restore the vehicle to its pre-loss condition, not to repair pre-existing unrelated damage.
What is a 'reservation of rights' letter and when should it be sent?
Answer: A letter notifying the insured that coverage may be limited or denied while investigation continues
A reservation of rights letter protects the insurer's right to deny or limit coverage while fulfilling its duty to investigate and defend.