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
A building adjuster notes that fire damage to a load-bearing wall may have compromised structural integrity. What should the adjuster do?
Answer: Recommend that a structural engineer inspect the building before repair estimates are finalized
Structural safety issues require a qualified engineer's assessment; adjusters should engage experts when damage may affect building integrity.
Which statute of limitations issue is MOST relevant when handling a liability claim?
Answer: The date by which the claimant must file suit or lose the right to do so
Adjusters must track the claimant's statute of limitations to ensure any settlement occurs before the claimant's right to sue expires, protecting all parties.
Under the principle of indemnity, what is the maximum amount an insured should receive for a covered loss?
Answer: An amount sufficient to restore the insured to their pre-loss financial position
The principle of indemnity prohibits profiting from insurance; payment should restore—not improve—the insured's financial position.
An adjuster suspects arson in a fire loss claim. Which investigative resource is MOST appropriate to engage?
Answer: A certified fire investigator or origin and cause expert
A certified fire investigator specializes in determining the origin and cause of fires, including identifying whether a fire was intentionally set.
What does 'coverage territory' in a commercial general liability (CGL) policy define?
Answer: The geographic area within which covered injuries or damages must occur
Coverage territory limits where a bodily injury or property damage claim must arise for coverage to apply under the CGL policy.
A claimant presents medical bills totaling $50,000 for injuries allegedly caused by the insured. The adjuster determines the treatment was excessive for the injuries. What is the appropriate course of action?
Answer: Conduct a medical bill review and negotiate based on reasonable and customary charges
Adjusters are expected to evaluate medical bills for reasonableness and necessity, often using bill review services, and negotiate accordingly.
Which of the following BEST describes the 'duty to defend' in a liability insurance policy?
Answer: The insurer's obligation to provide legal defense for claims that potentially fall within coverage, even if the claim is ultimately not covered
The duty to defend is broader than the duty to indemnify; if any allegation in a complaint potentially triggers coverage, the insurer must defend the insured.