CALA Claims Handling Procedures & Ethics

Question 1

What is the first step in the claims handling process?

Accepted Answer

Acknowledge receipt of the claim

Answer

Send a settlement check

Answer

Deny the claim

Answer

Request a police report

Question 2

Which of the following is considered an unethical claims practice?

Accepted Answer

Delaying payment of a valid claim without cause

Answer

Paying claims in a timely manner

Answer

Providing clear claim procedures

Answer

Communicating investigation results

Question 3

Why is accurate documentation essential in claims handling?

Accepted Answer

It creates a clear record for compliance and communication

Answer

It is only required in court

Answer

It reduces the adjuster’s workload

Answer

It helps prevent fraud

Question 4

What should an adjuster do if a conflict of interest arises?

Accepted Answer

Disclose the conflict of interest to appropriate parties

Answer

Ignore the conflict

Answer

Speed up the claim process

Answer

Approve the claim without review

Question 5

What is the main goal of the investigation phase in claims handling?

Accepted Answer

To determine facts and coverage

Answer

To delay claim resolution

Answer

To verify policyholder’s identity

Answer

To market new insurance products

Question 6

When must an adjuster maintain confidentiality?

Accepted Answer

Throughout the claim process

Answer

Only after claim settlement

Answer

During litigation only

Answer

Only for property damage claims