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

Acknowledging the claim is the initial and critical step to initiate communication and begin documentation.

Question 2

Which of the following is considered an unethical claims practice?

Accepted Answer

Delaying payment of a valid claim without cause

Answer

Delaying claim payments without valid reason is an unfair claims practice under most state regulations.

Question 3

Why is accurate documentation essential in claims handling?

Accepted Answer

It creates a clear record for compliance and communication

Answer

Documentation supports transparency, regulatory compliance, and helps resolve disputes if they arise.

Question 4

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

Accepted Answer

Disclose the conflict of interest to appropriate parties

Answer

The adjuster must disclose the conflict and may need to recuse themselves to uphold ethical standards.

Question 5

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

Accepted Answer

To determine facts and coverage

Answer

The goal is to determine the facts of the claim, coverage, liability, and extent of damages to make a fair decision.

(CALA) Certified All-Lines Adjuster Practice Test