Claims Handling and Investigation Flashcards
7 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 7 Claims Handling and Investigation flashcards as text
When a claimant reports a loss, what is the adjuster's FIRST priority?
Answer: Acknowledge receipt and set expectations for the process
Prompt acknowledgment and communication of next steps is a best practice and often a regulatory requirement to initiate good-faith handling.
Which document grants an adjuster the legal authority to act on behalf of an insurer in settling claims?
Answer: Letter of Authorization
A Letter of Authorization (or similar delegation letter) formally grants the adjuster authority to act on the insurer's behalf in a specific claim.
A claimant submits a sworn Proof of Loss 65 days after a fire loss, but the policy requires submission within 60 days. What should the adjuster consider?
Answer: Waive the requirement if the insurer's conduct did not prejudice the claimant
Courts often find that an insurer waives a late Proof of Loss deadline if its own conduct (e.g., ongoing negotiations) prevented timely submission or caused no prejudice.
What is the primary purpose of an Examination Under Oath (EUO) in a claims investigation?
Answer: To allow the insurer to gather sworn testimony about the loss
An EUO is a contractual right that allows the insurer to question the insured under oath to fully investigate the facts and circumstances of a claim.
An insured's home is burglarized and personal property is stolen. The insured cannot produce original receipts. What is the BEST approach for the adjuster?
Answer: Use alternative documentation such as credit card statements, photos, or owner's manuals
Adjusters should work with claimants to gather alternative evidence of ownership and value when original receipts are unavailable.
In a liability claim, what does 'subrogation' allow the insurer to do after paying a claim?
Answer: Pursue the responsible third party to recover amounts paid
Subrogation allows the insurer to step into the insured's shoes and seek recovery from the negligent third party who caused the loss.
When investigating a workers' compensation claim, which factor is MOST important to establish compensability?
Answer: Whether the injury arose out of and in the course of employment
Workers' compensation covers injuries that both 'arise out of' (caused by work) and occur 'in the course of' (during work) employment.