CALA Claims Handling Procedures & Ethics 3

Question 1

An insured submits a theft claim but the police report does not match the timeline provided in the sworn statement. What should the adjuster do first?

Accepted Answer

Request a recorded statement to clarify the discrepancy before making a coverage decision

Answer

Inconsistencies should be explored through additional investigation, including a recorded statement, before making a coverage determination.

Question 2

What does the principle of 'utmost good faith' (uberrimae fidei) require of an adjuster during claims handling?

Accepted Answer

Honest, transparent, and fair dealing in all aspects of the claims process

Answer

Utmost good faith requires both parties—insurer and insured—to deal honestly and transparently without concealment or misrepresentation.

Question 3

During a bodily injury claim, an adjuster receives a demand letter from the claimant's attorney that exceeds policy limits. What is the adjuster's priority obligation?

Accepted Answer

Notify the insured that the demand exceeds policy limits so they can seek personal counsel

Answer

When demands exceed policy limits, the adjuster must promptly notify the insured of potential personal exposure so they can retain independent counsel.

Question 4

An adjuster is offered a gift by a contractor who frequently works on insured properties. The most ethical course of action is to:

Accepted Answer

Decline the gift to avoid any actual or perceived conflict of interest

Answer

Accepting gifts from contractors can create conflicts of interest that compromise objectivity; the ethical standard is to decline entirely.

Question 5

A claimant speaks limited English and is having difficulty understanding settlement terms. What is the adjuster's ethical responsibility?

Accepted Answer

Arrange for translation or interpreter services to ensure informed consent

Answer

Fair claims handling requires that claimants fully understand settlement terms, which may require providing translation or interpreter assistance.

(CALA) Certified All-Lines Adjuster Practice Test

(CALA) Certified All-Lines Adjuster Practice Test

CALA Claims Handling Procedures & Ethics 3