CAP Claims Processing & Investigation 3

Question 1

Under most state unfair claims settlement practice statutes, an insurer is required to acknowledge receipt of a claim within:

Accepted Answer

A reasonable time, typically 10 to 15 working days

Answer

Most state statutes require prompt acknowledgment, generally within 10 to 15 working days, to prevent delay tactics that harm claimants.

Question 2

An Examination Under Oath (EUO) differs from a recorded statement primarily because an EUO:

Accepted Answer

Is a contractual right of the insurer and refusal may void coverage

Answer

Most policies grant the insurer the right to require an EUO as a condition of coverage; the insured's refusal to comply can result in a denial of the claim.

Question 3

When an insurer's investigation reveals comparative negligence by the claimant in a liability claim, the most likely outcome is:

Accepted Answer

Reduction of the settlement proportional to the claimant's share of fault

Answer

Under comparative negligence systems, damages are apportioned based on each party's percentage of fault, reducing (but not eliminating) the claimant's recovery.

Question 4

A 'coverage opinion' issued during claims handling is best described as:

Accepted Answer

A legal analysis evaluating whether a specific loss triggers policy coverage

Answer

A coverage opinion analyzes policy language, applicable law, and the facts of the loss to advise the insurer on whether the claim is covered.

Question 5

In the context of bad faith insurance litigation, the insurer's conduct most likely to trigger liability is:

Accepted Answer

Failing to settle a claim within policy limits when liability is reasonably clear

Answer

Refusing to settle within policy limits when liability is clear exposes the insured to excess judgment, which courts have consistently held constitutes bad faith.

(CAP) Certified Philanthropic Advisor Practice Test

(CAP) Certified Philanthropic Advisor Practice Test

CAP Claims Processing & Investigation 3