CALA Claims Processing & Documentation 4

Question 1

Which of the following is considered a 'red flag' indicator of potential claims fraud during documentation review?

Accepted Answer

The insured recently increased coverage limits before a major loss

Answer

Significantly increasing coverage shortly before filing a large claim is a common fraud indicator that warrants further investigation.

Question 2

A properly completed proof of loss statement must be submitted within what timeframe under most standard auto policies?

Accepted Answer

60 days after the insurer's request

Answer

Most auto policies require the insured to submit a signed proof of loss within 60 days after the insurer formally requests it.

Question 3

When an adjuster identifies pre-existing damage during vehicle inspection, the correct documentation approach is to:

Accepted Answer

Note and photograph it separately, clearly distinguishing it from loss-related damage

Answer

Pre-existing damage must be documented separately with photos to ensure the insurer only pays for loss-related repairs.

Question 4

The 'Agreed Value' method of settling total loss claims differs from ACV because it:

Accepted Answer

Uses the value stated in the policy without depreciation deductions

Answer

Agreed Value policies pay a predetermined amount stated in the policy, eliminating depreciation disputes common with ACV settlements.

Question 5

Under the Fair Claims Settlement Practices Act, insurers must acknowledge receipt of a claim within:

Accepted Answer

10 business days

Answer

Most state regulations based on the UCSPA require insurers to acknowledge claims within 10 working days of receipt.

(CALA) Certified Automotive Loss Adjuster Practice Test