CCA CCA Negotiation and Communication in Claims 2

Question 1

An adjuster receives a policy limits demand with a short deadline. What is the primary risk to the insurer if they fail to respond in time?

Accepted Answer

The insurer could face a bad faith claim if a subsequent verdict exceeds policy limits

Answer

Failing to respond to a policy limits demand within a reasonable time can expose the insurer to bad faith liability for amounts above the policy limit if the case goes to verdict.

Question 2

When a represented claimant's attorney is involved, the adjuster should typically:

Accepted Answer

Direct all communications through the attorney and avoid direct claimant contact

Answer

Once a claimant is represented by an attorney, ethical rules and professional standards require adjusters to communicate through the attorney rather than contacting the claimant directly.

Question 3

What is the purpose of a 'recorded statement' in a claims investigation?

Accepted Answer

To obtain a documented, verbatim account of the events surrounding the loss from the insured or witnesses

Answer

A recorded statement captures an accurate, contemporaneous account of the events from the claimant, insured, or witnesses, creating a reliable record for the claims file.

Question 4

Which communication technique is most useful when a claimant is emotional or upset during a claim interview?

Accepted Answer

Empathetic listening and acknowledging their feelings before proceeding

Answer

Acknowledging the claimant's emotional state and demonstrating empathy helps de-escalate tension and creates a more productive communication environment.

Question 5

A claimant's attorney sends a lien from a health insurer for medical payments. What obligation does this create for the adjuster?

Accepted Answer

The adjuster must account for the lien in the settlement and ensure it is resolved before or as part of payment

Answer

Health insurer liens must be acknowledged and addressed in the settlement process; ignoring them can expose the insurer to additional liability for failing to protect the lienholder's interest.

(CCA) Certified Claims Adjuster Practice Test

(CCA) Certified Claims Adjuster Practice Test

CCA CCA Negotiation and Communication in Claims 2