CCA Negotiation and Communication in Claims Flashcards
6 cards from real CCA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 CCA Negotiation and Communication in Claims flashcards as text
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?
Answer: The insurer could face a bad faith claim if a subsequent verdict exceeds policy limits
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.
When a represented claimant's attorney is involved, the adjuster should typically:
Answer: Direct all communications through the attorney and avoid direct claimant contact
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.
What is the purpose of a 'recorded statement' in a claims investigation?
Answer: To obtain a documented, verbatim account of the events surrounding the loss from the insured or witnesses
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.
Which communication technique is most useful when a claimant is emotional or upset during a claim interview?
Answer: Empathetic listening and acknowledging their feelings before proceeding
Acknowledging the claimant's emotional state and demonstrating empathy helps de-escalate tension and creates a more productive communication environment.
A claimant's attorney sends a lien from a health insurer for medical payments. What obligation does this create for the adjuster?
Answer: The adjuster must account for the lien in the settlement and ensure it is resolved before or as part of payment
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.
What does 'BATNA' stand for, and why is it important in claims negotiation?
Answer: Best Alternative To a Negotiated Agreement — it defines the strongest position if negotiations fail
BATNA (Best Alternative To a Negotiated Agreement) helps negotiators understand their walkaway point and strengthens their leverage in settlement discussions.