CCP Claims Investigation & Evaluation 3

Question 1

Which method is most appropriate for determining the Actual Cash Value (ACV) of a damaged personal property item?

Accepted Answer

Original purchase price minus applicable depreciation

Answer

ACV is generally calculated as replacement cost minus depreciation based on the item's age, condition, and useful life.

Question 2

A claimant submits receipts for items allegedly destroyed in a fire, but the receipts appear to be altered. The adjuster should:

Accepted Answer

Document the suspected alterations and refer to the SIU for forensic document examination

Answer

Suspected document fraud should be referred to the Special Investigations Unit for professional forensic analysis before any coverage decision is made.

Question 3

In a workers' compensation claim, what does 'maximum medical improvement' (MMI) signify?

Accepted Answer

The point where the worker's medical condition has stabilized and is unlikely to improve further with treatment

Answer

MMI is the medical determination that the worker's condition has plateaued, after which permanent impairment ratings and future benefits are assessed.

Question 4

Which of the following best describes 'subrogation' in the context of claims?

Accepted Answer

The insurer's right to pursue a third party responsible for causing a covered loss

Answer

Subrogation allows the insurer to 'step into the shoes' of the insured and recover paid claim amounts from the at-fault third party.

Question 5

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?

Accepted Answer

Review the prior claim file for patterns and consider SIU referral if indicators of fraud are present

Answer

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.

(CCP) Certified Claims Professional Practice Test

(CCP) Certified Claims Professional Practice Test

CCP Claims Investigation & Evaluation 3