CIA Claims Investigation & Reporting Standards 3

Question 1

An auto liability claim involves a claimant who alleges soft-tissue injuries. Which investigative tool is MOST useful for identifying pre-existing conditions?

Accepted Answer

Independent Medical Examination (IME) and prior medical record review

Answer

An IME combined with prior medical records directly identifies pre-existing conditions that may affect causation and damages.

Question 2

The concept of 'contributory negligence' in a liability claim investigation is important because it can:

Accepted Answer

Reduce or bar the claimant's recovery depending on state law

Answer

Contributory or comparative negligence rules, which vary by state, can reduce or completely bar a claimant's recovery when they share fault.

Question 3

When preparing a claim investigation report, the adjuster should present findings in what manner?

Accepted Answer

Objectively, based on facts gathered, with analysis tied to policy language

Answer

Investigation reports must be objective, fact-based, and directly tied to policy terms to support defensible claim decisions.

Question 4

A homeowner files a water damage claim but the adjuster suspects the damage pre-dates the policy period. The BEST investigative approach is to:

Accepted Answer

Order a coverage inspection, review prior insurance history, and consult a moisture or construction expert

Answer

Determining when damage occurred requires expert analysis, inspection history, and prior coverage records to establish a timeline.

Question 5

What is 'index bureau' data used for in claims investigation?

Accepted Answer

Identifying prior claims history across multiple insurers to detect patterns of fraud

Answer

Index bureau databases (such as ISO ClaimSearch) aggregate claims data across insurers to reveal suspicious patterns or prior losses.

(CIA) Certified Insurance Appraiser Practice Test

(CIA) Certified Insurance Appraiser Practice Test

CIA Claims Investigation & Reporting Standards 3