CCP First Notice of Loss Procedures 3 — Questions and Answers
Question 1: An adjuster receives an FNOL for a fire loss at a rental property. Which initial coverage question is unique to rental property claims?
- Whether the insured has a mortgage
- Whether the policy covers loss of rental income in addition to structural damage (Correct answer)
- Whether the tenant had renters insurance
- Whether the fire department was called
Correct answer: Whether the policy covers loss of rental income in addition to structural damage
Rental property policies may include loss of rental income coverage, which must be identified and reserved for at FNOL.
Question 2: Under most state prompt payment statutes, what is the typical timeframe for an insurer to acknowledge receipt of a claim after FNOL?
- Within 5 days
- Within 10 to 15 days (Correct answer)
- Within 30 days
- Within 60 days
Correct answer: Within 10 to 15 days
Most state prompt payment statutes require acknowledgment within 10 to 15 days of receiving notice of a claim.
Question 3: A claimant submits an FNOL via a mobile app and uploads photos of damage. What should the adjuster do with these photos at the FNOL stage?
- Discard them as unofficial evidence
- Attach them to the claim file as initial documentation and note their receipt (Correct answer)
- Use them as the sole basis for settlement
- Forward them only to the SIU
Correct answer: Attach them to the claim file as initial documentation and note their receipt
Photos submitted at FNOL should be documented in the claim file as initial evidence, though further investigation is typically needed.
Question 4: Which scenario would most likely trigger an immediate referral to the Special Investigations Unit (SIU) at the FNOL stage?
- A claimant who speaks a foreign language
- A newly issued policy with a large loss reported within days of inception (Correct answer)
- A claimant who is represented by an attorney
- A loss that occurred on a weekend
Correct answer: A newly issued policy with a large loss reported within days of inception
A large loss reported shortly after policy inception is a red flag indicator for potential fraud and warrants SIU referral.
Question 5: During FNOL, a claimant mentions they already hired a contractor to begin repairs before the adjuster could inspect. What should the adjuster do?
- Deny the claim for failure to preserve evidence
- Request that the contractor document all damage with photos before repairs proceed further (Correct answer)
- Ignore the issue since repairs are already underway
- Automatically reduce the claim payment by 50%
Correct answer: Request that the contractor document all damage with photos before repairs proceed further
Requesting pre-repair documentation protects the insurer's ability to assess damages even when repairs have already begun.
Question 6: What is the primary purpose of establishing an initial reserve at the time of FNOL?
- To signal claim approval to the claimant
- To set aside estimated funds to cover the anticipated cost of the claim (Correct answer)
- To freeze the claimant's bank account
- To determine the adjuster's commission
Correct answer: To set aside estimated funds to cover the anticipated cost of the claim
Initial reserves represent the insurer's best estimate of the total claim cost and are required for accurate financial reporting.
Question 7: An FNOL is received for a workers' compensation claim. Which piece of information is most critical to capture immediately?
- The employee's years of service
- The date, time, and specific circumstances of the workplace injury (Correct answer)
- The employer's gross revenue
- The employee's educational background
Correct answer: The date, time, and specific circumstances of the workplace injury
The exact date, time, and circumstances of a workplace injury are critical for coverage verification and compensability determination.
CCP First Notice of Loss Procedures 3
An adjuster receives an FNOL for a fire loss at a rental property.
Which initial coverage question is unique to rental property claims?