Claims Investigation & Evaluation Flashcards
7 cards from real CCP 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 Investigation & Evaluation flashcards as text
Which method is most appropriate for determining the Actual Cash Value (ACV) of a damaged personal property item?
Answer: Original purchase price minus applicable depreciation
ACV is generally calculated as replacement cost minus depreciation based on the item's age, condition, and useful life.
A claimant submits receipts for items allegedly destroyed in a fire, but the receipts appear to be altered. The adjuster should:
Answer: Document the suspected alterations and refer to the SIU for forensic document examination
Suspected document fraud should be referred to the Special Investigations Unit for professional forensic analysis before any coverage decision is made.
In a workers' compensation claim, what does 'maximum medical improvement' (MMI) signify?
Answer: The point where the worker's medical condition has stabilized and is unlikely to improve further with treatment
MMI is the medical determination that the worker's condition has plateaued, after which permanent impairment ratings and future benefits are assessed.
Which of the following best describes 'subrogation' in the context of claims?
Answer: The insurer's right to pursue a third party responsible for causing a covered loss
Subrogation allows the insurer to 'step into the shoes' of the insured and recover paid claim amounts from the at-fault third party.
An adjuster notices that a claimant filed a nearly identical property loss claim with the same insurer two years prior. What is the most appropriate action?
Answer: Review the prior claim file for patterns and consider SIU referral if indicators of fraud are present
Prior similar claims are a recognized fraud indicator and should prompt a deeper review; however, a denial requires substantive evidence, not merely a prior claim.
When investigating a commercial general liability (CGL) claim, which coverage trigger doctrine applies to most CGL policies?
Answer: Occurrence trigger based on when the bodily injury or property damage occurred
Standard CGL policies use an occurrence trigger, meaning coverage is determined by when the bodily injury or property damage actually happened, not when it was discovered or claimed.
What is the significance of a 'reservation of rights' letter in a liability investigation?
Answer: It notifies the insured that the insurer is investigating while preserving the right to deny coverage later
A reservation of rights letter protects the insurer from waiver or estoppel by allowing investigation to proceed without prejudicing the right to deny coverage.