CPHRM Claims Management 3

Question 1

Under a claims-made insurance policy, coverage applies when:

Accepted Answer

Both the incident and report occur during the policy period

Answer

A claims-made policy provides coverage only when both the alleged incident and the claim are reported while the policy is active.

Question 2

A risk manager is asked to preserve all records related to a patient who has threatened litigation. This obligation is known as:

Accepted Answer

Litigation hold

Answer

A litigation hold (or legal hold) is a directive to preserve all relevant documents and records once litigation is reasonably anticipated.

Question 3

Which type of damages compensates a plaintiff for lost wages, medical expenses, and future care costs?

Accepted Answer

Economic damages

Answer

Economic damages are quantifiable monetary losses including medical bills, lost income, and costs of future medical care.

Question 4

An independent medical examination (IME) in a claims context is typically used to:

Accepted Answer

Obtain an objective assessment of the claimant's injuries and prognosis

Answer

An IME provides an independent clinical opinion on the claimant's condition, causation, and future care needs to inform claims valuation.

Question 5

What is the purpose of a subrogation clause in a healthcare liability policy?

Accepted Answer

To allow the insurer to recover payments from a responsible third party

Answer

Subrogation allows the insurer, after paying a claim, to seek reimbursement from a third party who was actually responsible for the loss.

CPHRM Exam Practice Test