Claims Investigation & Reporting Standards Flashcards
7 cards from real CIA 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 & Reporting Standards flashcards as text
When an insurer receives a first notice of loss (FNOL), what is the primary purpose of the immediate acknowledgment requirement?
Answer: To comply with state prompt-payment statutes and preserve the claimant's rights
State prompt-payment laws require timely FNOL acknowledgment to protect claimant rights and trigger investigation timelines.
A property adjuster discovers that a claimant's recorded statement contradicts physical evidence at the loss scene. The BEST next step is to:
Answer: Document the discrepancy and conduct further investigation to reconcile the conflict
Contradictions between statements and evidence require additional investigation rather than premature denial or acceptance.
Which document is typically used to formally transfer a claimant's right of recovery against a third party to the insurer after the insurer pays the claim?
Answer: Subrogation Receipt or Assignment
A subrogation receipt or assignment formally conveys the insured's right of action against responsible third parties to the insurer.
Under the Unfair Claims Settlement Practices Act (UCSPA) model, which of the following constitutes an unfair claims practice?
Answer: Failing to acknowledge communications within a reasonable time period
Failing to acknowledge communications within a reasonable timeframe is a defined unfair practice under most states' UCSPA statutes.
A claimant presents a claim for theft of business equipment. The adjuster should request which document to establish the value of the stolen items?
Answer: Original purchase invoices, receipts, or purchase orders
Original purchase invoices and receipts are the primary documentation to establish actual cash value or replacement cost of stolen business property.
In the context of liability claims investigation, what is the purpose of obtaining a 'preservation of evidence' letter?
Answer: To formally notify a party to retain physical evidence relevant to the claim
A preservation letter formally directs a party to retain potentially relevant evidence, reducing the risk of spoliation claims.
When an insurer issues a reservation of rights (ROR) letter, it is communicating that:
Answer: It is defending the insured while reserving the right to deny coverage if facts support it
An ROR letter allows the insurer to provide a defense while preserving its right to contest coverage based on the investigation's outcome.