Claims Processing & Documentation 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 Processing & Documentation flashcards as text
In a multi-vehicle accident claim, the adjuster determines that fault is shared 30% with the insured. In a pure comparative negligence state, the insured's recovery would be:
Answer: Reduced by 30% from the total damages
In pure comparative negligence states, the claimant's recovery is reduced proportionally by their percentage of fault.
What is the purpose of a 'reservation of rights' when processing a claim under a policy with a potential coverage exclusion?
Answer: To notify the insured that coverage may be limited while investigation continues
A reservation of rights letter notifies the insured of potential coverage issues while allowing the investigation to proceed, preserving the insurer's right to deny later.
When an adjuster discovers that a claimant's recorded statement contradicts physical evidence at the scene, the correct action is to:
Answer: Document the inconsistencies and flag the claim for special investigation
Inconsistencies between statements and evidence should be documented and referred to the Special Investigations Unit (SIU) for potential fraud review.
Which of the following best describes the 'diminished value' concept in automotive claims?
Answer: The decrease in a vehicle's market value after being repaired from an accident
Diminished value refers to the loss in market value a vehicle sustains even after quality repairs, because buyers pay less for accident-history vehicles.
A statute of limitations for an auto insurance claim typically begins running from:
Answer: The date the loss occurred
The statute of limitations for property damage claims generally begins on the date the loss occurred, varying by state law.
An insured's vehicle is stolen and later recovered with $8,000 in damage. The ACV before theft was $14,000. The deductible is $500. What is the insurer's payment obligation?
Answer: $7,500 for the damage minus the deductible
When a stolen vehicle is recovered with damage, comprehensive coverage pays for the repair costs minus the deductible, not the full ACV.
Which element is NOT typically required in a complete claims file documentation package?
Answer: The adjuster's personal investment portfolio
A claims file requires evidence, statements, and reports related to the loss — personal financial information about the adjuster has no place in claims documentation.