CCP Diary Management & File Review 3 — Questions and Answers
Question 1: What should a claims adjuster do when they receive a file during reassignment that contains no diary entries?
- Continue handling the file without changes
- Immediately set a diary, review the file status, and document outstanding actions (Correct answer)
- Return the file to the prior adjuster
- Close the file and reopen it under a new claim number
Correct answer: Immediately set a diary, review the file status, and document outstanding actions
Upon receiving a diary-less file, the new adjuster must establish control by reviewing status and setting immediate follow-up dates.
Question 2: During a file review, an examiner finds that reserves have not been updated in six months despite new medical bills. What is the likely root cause?
- The claimant did not submit bills
- Diary failures that led to missed reserve evaluation opportunities (Correct answer)
- The policy limit was already reached
- The claimant's attorney waived medical updates
Correct answer: Diary failures that led to missed reserve evaluation opportunities
When reserves are not updated despite new financial information, it typically traces back to inadequate diary controls and missed review triggers.
Question 3: A claims professional sets a 30-day diary for a workers' compensation file awaiting a physician's report. The report arrives in 10 days. What is the BEST practice?
- Wait for the 30-day diary to trigger before acting
- Pull the diary forward and act on the report immediately (Correct answer)
- Delete the original diary and set a new 30-day one
- Escalate the file to a supervisor for review
Correct answer: Pull the diary forward and act on the report immediately
Best practice is to advance the diary and act on newly received information promptly rather than waiting for the original trigger date.
Question 4: Which document type is MOST important to include in the initial file review checklist for a commercial general liability claim?
- Policyholder's personal tax returns
- Certificate of insurance and endorsements confirming coverage scope (Correct answer)
- Competitor insurance quotes
- Adjuster's prior claim history
Correct answer: Certificate of insurance and endorsements confirming coverage scope
Confirming coverage scope via the certificate and endorsements is foundational to any CGL claim review.
Question 5: What is the purpose of a 'critical path' diary system in complex claims?
- To track only medical payments
- To map key milestones and set diaries aligned with each phase of claim resolution (Correct answer)
- To assign the claim to multiple adjusters simultaneously
- To limit claim exposure by closing files early
Correct answer: To map key milestones and set diaries aligned with each phase of claim resolution
A critical path diary maps the major milestones of a complex claim and ensures timely action at each phase.
Question 6: An adjuster's file review reveals a signed recorded statement was taken but never transcribed or placed in the file. What action is required?
- Re-take the recorded statement
- Obtain the transcription or audio and add it to the file with a notation (Correct answer)
- Note the oversight and continue without the statement
- Close the claim since the statement was already taken
Correct answer: Obtain the transcription or audio and add it to the file with a notation
Recorded statements must be preserved and documented in the file to be usable as evidence and part of the claim record.
Question 7: When should a claims professional conduct a full file review on a long-tail liability claim?
- Only at the time of settlement
- At regular intervals (e.g., quarterly or semi-annually) aligned with diary cycles (Correct answer)
- Only when requested by the insured
- Only after litigation begins
Correct answer: At regular intervals (e.g., quarterly or semi-annually) aligned with diary cycles
Long-tail claims require periodic full reviews to ensure reserves, strategy, and action items remain current and appropriate.
CCP Diary Management & File Review 3
What should a claims adjuster do when they receive a file during reassignment that contains no diary entries?