CALA Risk Management & Fraud Prevention in Claims Handling 3

Question 1

What is the primary purpose of a Suspicious Activity Report (SAR) filed by an insurer?

Accepted Answer

To alert state insurance fraud bureaus of potential criminal activity

Answer

SARs are filed with state insurance fraud bureaus to report suspected fraudulent activity for potential criminal investigation.

Question 2

Which vehicle damage pattern is a known indicator of a 'swoop and squat' fraud scheme?

Accepted Answer

Rear-end damage to the squat vehicle with no front damage to the swoop vehicle

Answer

In swoop and squat, the squat vehicle sustains rear damage after the swoop vehicle cuts it off, but the swoop vehicle typically shows no front damage.

Question 3

An insured claims a catalytic converter theft but the exhaust system shows no fresh tool marks or cuts. What investigative step is MOST appropriate?

Accepted Answer

Request an EUO and retain a forensic mechanic

Answer

The absence of physical evidence warrants an Examination Under Oath and forensic inspection before any coverage decision.

Question 4

Which principle requires an insurer to conduct a reasonable investigation before denying a claim, even when fraud is suspected?

Accepted Answer

Good faith and fair dealing obligation

Answer

The duty of good faith and fair dealing requires insurers to investigate reasonably before denial, even in suspected fraud cases.

Question 5

A claimant's medical bills show treatment for whiplash, but surveillance video shows them loading heavy furniture the day after the accident. This evidence is BEST described as:

Accepted Answer

Direct evidence contradicting claimed injury severity

Answer

Surveillance footage showing physical activity inconsistent with claimed injuries is direct evidence contradicting the severity of the alleged injuries.

(CALA) Certified Automotive Loss Adjuster Practice Test

(CALA) Certified Automotive Loss Adjuster Practice Test

CALA Risk Management & Fraud Prevention in Claims Handling 3