Claims Investigation and Settlement Flashcards
6 cards from real Claims Adjuster Test practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Claims Investigation and Settlement flashcards as text
An insured's building is damaged in a storm. To prevent further water damage from an impending rainstorm, the insured pays a contractor for emergency tarping of the roof before the adjuster has inspected the property. Which of the following policy duties has the insured performed?
Answer: Duty to Mitigate Damages
The insured has a duty to take reasonable steps to protect the covered property from further damage after a loss. In this scenario, paying for emergency tarping is a direct action to mitigate, or lessen, the potential for additional water damage.
An adjuster is investigating a liability claim where coverage is questionable under the policy. To proceed with the investigation without admitting liability, the insurer sends a letter to the insured explaining the potential coverage issue and stating that the investigation will continue while it reserves its right to deny the claim later. What is this letter called?
Answer: A Reservation of Rights Letter
A Reservation of Rights letter is a unilateral notice from the insurer to the insured that it will proceed with investigating a claim, but reserves the right to deny coverage later based on policy terms and conditions. It prevents the insured from later claiming the insurer waived its right to deny by investigating.
In a third-party liability claim, which category of damages is intended to compensate a claimant for quantifiable monetary losses, such as medical bills and lost wages?
Answer: Special Damages
Special damages, also known as economic damages, are awarded to compensate for specific, quantifiable monetary losses. This includes medical expenses, lost income, and property repair costs.
An insured is involved in a hit-and-run accident. The at-fault driver cannot be identified. The insured files a claim with their own insurance company for their bodily injuries, as they would have against the at-fault driver. Which type of coverage would respond to this claim?
Answer: Uninsured Motorist Coverage
Uninsured Motorist (UM) coverage is designed to cover bodily injury (and in some states, property damage) for the insured when they are injured by a driver who has no insurance or by a hit-and-run driver who cannot be identified.
During settlement negotiations, an adjuster's primary objective is to:
Answer: Reach a fair and equitable settlement based on the facts of the loss and the terms of the policy.
The core duty of a claims adjuster is to investigate the claim, evaluate the damages against the policy, and negotiate a settlement that is fair to the claimant while adhering to the obligations and limits outlined in the insurance contract.
Which of the following is NOT a primary duty of the claims adjuster during the investigation phase?
Answer: Advancing a portion of the settlement before completing the investigation.
While an adjuster may make advance payments in some situations, it is not a primary duty during the initial investigation. The primary duties are to gather facts, determine cause, interview relevant parties, and collect evidence to evaluate coverage and liability before making payments.