Mixed Deck — All CCA Topics Flashcards
100 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 20 Mixed Deck — All CCA Topics flashcards as text
What is the purpose of a 'life care plan' in serious injury claims?
Answer: To outline and project costs for all future medical and care needs of a catastrophically injured person
A life care plan, prepared by a certified specialist, documents all projected future medical, rehabilitative, and personal care needs along with their projected costs for catastrophically injured claimants.
Which entity typically regulates insurance practices at the state level?
Answer: Department of Insurance
Each state’s Department of Insurance oversees licensing, compliance, and consumer protection.
In an auto claim, 'diminished value' refers to:
Answer: The reduction in a vehicle's market value after being repaired following an accident
Diminished value is the difference between a vehicle's pre-accident market value and its post-repair market value, since a repaired vehicle often sells for less.
Under a personal auto policy, 'uninsured motorist coverage' protects the insured when:
Answer: A not-at-fault insured is injured by a driver who has no liability insurance
Uninsured motorist (UM) coverage pays for the insured's bodily injury or property damage caused by a driver who carries no liability insurance.
What is a 'scheduled loss of use' award in workers' compensation?
Answer: A lump sum payment for permanent impairment to a specific body part based on a statutory schedule
Many states use a statutory schedule assigning a fixed number of weeks' compensation for permanent loss of function to specific body parts.
In evaluating a commercial liability claim for a slip-and-fall injury, which legal doctrine could reduce or eliminate the insured's liability if the claimant knew of the hazard and voluntarily assumed the risk?
Answer: Assumption of risk
Assumption of risk is a defense that reduces or eliminates liability when a claimant voluntarily exposed themselves to a known and understood risk.
A workers' compensation adjuster receives a claim for a cumulative trauma disorder. What is the key question to establish compensability?
Answer: Whether the condition arose out of and in the course of employment due to work activities
For cumulative trauma claims, the adjuster must determine whether repetitive work activities were a contributing cause of the condition, satisfying the 'arising out of employment' standard.
Which tool is most commonly used to document physical damage during a claims inspection?
Answer: Photographs of the damage
Photographs provide visual evidence of damages and support the written findings in the adjuster’s report.
When an adjuster uses the 'cost approach' to value commercial property, what three components are combined?
Answer: Land value, building replacement cost, and accumulated depreciation
The cost approach values property by adding land value to the depreciated replacement cost of improvements (replacement cost minus accumulated depreciation).
A claims adjuster who inflates repair estimates to earn higher commissions is committing:
Answer: Insurance fraud
Inflating estimates for personal financial gain constitutes insurance fraud, a criminal offense.
Which pattern is MOST consistent with a 'swoop and squat' auto fraud scheme?
Answer: A car cuts in front of another vehicle and brakes suddenly to cause a rear-end collision
A swoop and squat involves a fraud vehicle cutting in front of an innocent driver and braking suddenly so the victim rear-ends them, generating a fraudulent bodily injury claim.
What is the significance of establishing 'causation' when evaluating a medical claim?
Answer: It establishes the connection between the incident and the claimant's medical condition or injury
Causation establishes whether the claimant's injury or medical condition was caused by or directly related to the insured incident, which is fundamental to determining coverage and liability.
A commercial general liability (CGL) policy's 'products-completed operations' coverage protects the insured against claims arising from:
Answer: Bodily injury or property damage occurring after a product is sold or work is completed
Products-completed operations coverage applies to BI/PD claims arising after the insured's product leaves their custody or after contracted work has been completed.
The concept of 'waiver' in claims handling means:
Answer: The insurer intentionally relinquishes a known right under the policy
Waiver occurs when an insurer voluntarily gives up a policy defense or right it could have enforced, such as a coverage exclusion.
When an insurer denies a claim, which of the following must typically be provided to the claimant?
Answer: A written denial with the specific policy provisions relied upon
State regulations generally require written denial letters citing the specific policy language or exclusions supporting the decision.
What is the purpose of a 'non-waiver agreement' in a claims investigation?
Answer: To allow the insurer to investigate a claim without waiving any policy defenses
A non-waiver agreement, signed by both parties, allows investigation to proceed while preserving the insurer's right to later deny coverage based on policy defenses.
What is 'subrogation' in the context of claims settlement, and when does the insurer's right typically arise?
Answer: The insurer's right to pursue a negligent third party after paying the insured's claim
Subrogation allows the insurer to step into the insured's shoes and recover claim payments from the negligent third party who caused the loss.
In the context of bodily injury claims, 'pain and suffering' damages represent:
Answer: Non-economic damages for physical pain, emotional distress, and reduced quality of life
Pain and suffering are non-economic general damages compensating claimants for the physical and emotional impact of injuries beyond objectively measurable financial losses such as medical bills or lost wages.
Under an occurrence-based liability policy, coverage is triggered when:
Answer: The bodily injury or property damage occurs during the policy period
An occurrence-based policy is triggered by the date the injury or damage actually happens, regardless of when the claim is reported or lawsuit is filed.
What is an 'appraisal clause' in a property insurance policy?
Answer: A dispute resolution mechanism allowing each party to select an appraiser to determine the value of a loss
The appraisal clause provides a formal process for resolving disputes about the amount of a loss — each side appoints an appraiser, and they select an umpire if needed.