RIA TPA & Carrier Scope Negotiation 3

Question 1

A TPA 'preferred vendor' agreement typically requires restorers to:

Accepted Answer

Adhere to the TPA's pricing guidelines and reporting requirements in exchange for referrals

Answer

Preferred vendor agreements trade referral volume for compliance with the TPA's pricing, documentation, and communication protocols.

Question 2

Which negotiation tactic is most effective when a carrier denies coverage for a line item without providing a written explanation?

Accepted Answer

Request a written denial with the specific policy exclusion cited

Answer

Requiring the carrier to cite the specific policy exclusion forces accountability and often results in reversal of improper denials.

Question 3

In a water damage claim, 'scope creep' during negotiation usually refers to:

Accepted Answer

The insured adding unrelated upgrades to the claim

Answer

Scope creep in negotiations most commonly means the insured or contractor attempting to include items not caused by the covered peril.

Question 4

A restorer discovers hidden mold behind drywall removed during water mitigation. To include mold remediation in the scope, the restorer must first:

Accepted Answer

Notify the carrier or TPA and obtain written authorization before proceeding

Answer

Written authorization from the carrier or TPA must be obtained before beginning remediation to ensure coverage and avoid scope disputes.

Question 5

When a TPA's field adjuster and the restorer cannot agree on a scope, the standard next escalation step is to:

Accepted Answer

Request review by the TPA's desk adjuster supervisor or technical specialist

Answer

Escalating to a supervisor or technical specialist within the TPA is the standard internal resolution step before external options.

(RIA) Restoration Industry Association Certified Practice Test