CAIA - Certified Automotive Insurance Adjuster Bodily Injury Claim Evaluation Questions and Answers

Question 1

When evaluating a bodily injury claim, which of the following are considered 'special damages'?

Accepted Answer

Medical bills and lost wages

Answer

Special damages, also known as economic damages, refer to the specific, quantifiable monetary losses incurred by the claimant. These include medical expenses, lost income, and property damage, as they have a clear dollar value that can be documented with bills and receipts.

Question 2

An adjuster is using the 'multiplier method' to evaluate the general damages portion of a bodily injury claim. This method involves multiplying the claimant's total special damages by a number, typically between 1.5 and 5. What is the primary factor used to determine the specific multiplier?

Accepted Answer

The severity and long-term impact of the injuries

Answer

The multiplier in the multiplier method is determined by the severity of the injuries. More severe, permanent, or debilitating injuries that have a significant long-term impact on the claimant's life warrant a higher multiplier (closer to 5), while minor injuries with a quick recovery would use a lower multiplier (closer to 1.5).

Question 3

A claimant was involved in a rear-end collision and is claiming a soft tissue neck injury. They waited three weeks before seeking any medical treatment. From an adjuster's perspective, what is the MOST likely complication this delay will introduce to the claim evaluation?

Accepted Answer

It will raise questions about the causation of the injury.

Answer

A significant delay or gap in seeking medical treatment can create doubt as to whether the accident was the direct cause of the claimed injuries. The adjuster will question if the injury was caused by a separate incident during the three-week delay, which complicates the evaluation of causation, a key element of any claim.

Question 4

In the context of a bodily injury claim, which of the following is the BEST definition of 'general damages'?

Accepted Answer

Non-economic losses such as pain, suffering, and emotional distress.

Answer

General damages compensate a claimant for non-monetary losses that are subjective and do not have a specific invoice amount. These include physical pain and suffering, emotional distress, loss of enjoyment of life, and other impacts on the claimant's quality of life.

Question 5

An adjuster receives a bodily injury claim from an auto accident. The police report clearly indicates the insured was 100% at fault. The claimant has significant, well-documented injuries and medical bills exceeding the insured's policy limits. What is the primary constraining factor for the adjuster when determining the settlement offer?

Accepted Answer

The liability limits of the insured's policy

Answer

While all factors are considered in the overall evaluation, the adjuster's ability to pay is ultimately constrained by the liability limits of the insured's insurance policy. The adjuster cannot offer more than the maximum coverage amount purchased by the policyholder, regardless of the total value of the claimant's damages.

(CAIA) Certified Automotive Insurance Adjuster Practice Test

(CAIA) Certified Automotive Insurance Adjuster Practice Test

CAIA - Certified Automotive Insurance Adjuster Bodily Injury Claim Evaluation Questions and Answers