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
What is 'mediation' in the context of insurance claims?
Answer: A voluntary dispute resolution process in which a neutral third party helps the parties reach a settlement
Mediation is a non-binding, voluntary process where a neutral mediator facilitates negotiation between parties to help them reach a mutually acceptable settlement.
An adjuster sends an acknowledgment letter within 10 days of receiving a claim. What purpose does this serve?
Answer: It demonstrates compliance with prompt payment statutes and sets claimant expectations
Timely acknowledgment letters satisfy regulatory prompt response requirements and inform the claimant that the claim is being handled, setting expectations for the process.
When preparing for a negotiation with a claimant's attorney, the adjuster should first:
Answer: Review the complete claim file, liability assessment, damages documentation, and reserve analysis
Thorough preparation — including reviewing all file materials, liability assessments, and reserves — ensures the adjuster can negotiate from an informed, documented position.
What is the significance of a 'Stowers demand' (or Stowers doctrine) in a liability claim?
Answer: It creates a duty for the insurer to accept a reasonable settlement offer within policy limits to protect the insured from excess liability
The Stowers doctrine (originating in Texas but followed in various forms in many states) requires an insurer to accept a settlement demand within policy limits when a reasonably prudent insurer would do so, to protect the insured from an excess judgment.
Which factor most directly determines whether a claimant's settlement demand is 'reasonable' from a claims adjuster's perspective?
Answer: Whether the demand is supported by documented damages, liability evidence, and applicable coverage
Reasonableness in settlement valuation is grounded in documented evidence — medical records, repair estimates, liability analysis — not in how forcefully a claimant negotiates.
When an insured disagrees with the adjuster's valuation of their property claim, the most appropriate first step for the adjuster is to:
Answer: Explain the methodology used to reach the valuation and review any additional documentation the insured can provide
Transparent communication about valuation methodology and openness to additional documentation can resolve many disputes without formal procedures.