CALA Documentation & Reporting Standards 3 — Questions and Answers
Question 1: When documenting a recorded statement from a claimant, which practice is MOST important?
- Asking leading questions to confirm the adjuster's theory of the loss
- Obtaining verbal consent from the claimant before recording begins (Correct answer)
- Recording the statement without informing the claimant to get candid answers
- Summarizing the statement in writing instead of actual recording
Correct answer: Obtaining verbal consent from the claimant before recording begins
Obtaining informed consent before recording is legally required in many states and is an ethical best practice to ensure admissibility.
Question 2: An adjuster's diary system is primarily used to:
- Record the adjuster's personal opinions about claimants
- Track pending tasks and deadlines to ensure timely claim handling (Correct answer)
- Store copies of all policy documents permanently
- Replace the formal claim file
Correct answer: Track pending tasks and deadlines to ensure timely claim handling
A diary system (or bring-forward system) tracks follow-up dates and deadlines so claims are handled within required timeframes.
Question 3: In workers' compensation claims, the 'First Report of Injury' (FROI) must be filed:
- Only if the employee requires hospitalization
- Within the timeframe specified by state law, typically within 3–10 days of the employer learning of the injury (Correct answer)
- After the claim is fully investigated and resolved
- Only when the employee files a lawsuit
Correct answer: Within the timeframe specified by state law, typically within 3–10 days of the employer learning of the injury
Most states mandate timely FROI filing within days of the employer's knowledge of injury, and failure to comply can result in penalties.
Question 4: Which document formally closes a claim file and documents the basis for settlement?
- Reservation of rights letter
- Closing report or final report (Correct answer)
- Notice of loss form
- Subrogation demand letter
Correct answer: Closing report or final report
A closing or final report summarizes the claim, the investigation findings, and the basis for the settlement or denial, formally concluding the file.
Question 5: When an adjuster prepares a diagram of a vehicle collision scene, it should include:
- Only the damaged vehicle without road markings
- Scale measurements, compass direction, road markings, vehicle positions, and point of impact (Correct answer)
- The adjuster's opinion of fault only
- Insurance policy numbers of all parties
Correct answer: Scale measurements, compass direction, road markings, vehicle positions, and point of impact
Accurate scene diagrams must include measurable, objective data such as road layout, vehicle positions, and impact points to support the investigation.
Question 6: The 'chain of custody' documentation for physical evidence in a claim refers to:
- The list of all insurers on a claim
- A chronological record tracking who collected, handled, and stored physical evidence (Correct answer)
- The order of payments made to claimants
- The sequence of coverage layers that apply to a loss
Correct answer: A chronological record tracking who collected, handled, and stored physical evidence
Chain of custody documentation ensures physical evidence integrity by recording every person who handled it, which is critical if the claim is litigated.
Question 7: A 'coverage analysis worksheet' in a claim file is used to:
- Calculate the adjuster's commission
- Document the systematic comparison of policy terms against the facts of loss to determine what is covered (Correct answer)
- Track litigation costs only
- Request additional premium from the insured
Correct answer: Document the systematic comparison of policy terms against the facts of loss to determine what is covered
A coverage analysis worksheet methodically maps each coverage element, exclusion, and condition to the loss facts, ensuring a thorough and defensible coverage determination.
CALA Documentation & Reporting Standards 3
When documenting a recorded statement from a claimant, which practice is MOST important?