CAIA Bodily Injury Claim Evaluation 2 — Questions and Answers
Question 1: A claimant reports whiplash after a rear-end collision but has no documented medical treatment for three weeks. How does this gap typically affect the bodily injury evaluation?
- It has no impact on the claim value
- It may suggest the injury was not serious or treatment-related to the accident (Correct answer)
- It automatically increases the settlement to cover delayed treatment
- It shifts liability entirely to the claimant
Correct answer: It may suggest the injury was not serious or treatment-related to the accident
A gap in treatment raises questions about injury severity and causation, potentially reducing the claim's value.
Question 2: When evaluating a soft tissue injury claim, which factor is LEAST relevant to establishing injury severity?
- MRI findings showing no structural damage
- Treating physician's narrative report
- The color of the claimant's vehicle (Correct answer)
- Duration and frequency of physical therapy
Correct answer: The color of the claimant's vehicle
Vehicle color is irrelevant to injury severity; medical records, imaging, and treatment duration are the key indicators.
Question 3: A claimant's medical records show pre-existing degenerative disc disease at the same spinal level injured in the accident. How should the adjuster handle this?
- Deny the claim entirely due to the pre-existing condition
- Apportion damages between the pre-existing condition and the accident-aggravated portion (Correct answer)
- Pay full damages without any reduction
- Require the claimant to obtain a second vehicle inspection
Correct answer: Apportion damages between the pre-existing condition and the accident-aggravated portion
Adjusters must apportion damages, paying only for the aggravation of the pre-existing condition caused by the accident.
Question 4: What does the term 'subrogation' mean in the context of a bodily injury claim?
- The claimant waives all future injury rights
- The insurer's right to recover paid losses from the at-fault third party (Correct answer)
- The process of calculating pain and suffering damages
- A court order requiring the insurer to pay immediately
Correct answer: The insurer's right to recover paid losses from the at-fault third party
Subrogation allows the insurer to step into the claimant's shoes and pursue recovery from the responsible party after paying the claim.
Question 5: A claimant submits $8,000 in medical bills, but the adjuster finds that $2,000 reflects charges for unrelated dental work. What is the correct course of action?
- Accept all $8,000 because the claimant submitted them
- Deduct the $2,000 and evaluate only the $6,000 related to the accident injuries (Correct answer)
- Deny the entire claim due to fraudulent billing
- Refer the claim to the state insurance department immediately
Correct answer: Deduct the $2,000 and evaluate only the $6,000 related to the accident injuries
Only medical expenses causally related to the accident are compensable; unrelated charges are excluded from the evaluation.
Question 6: Which of the following best describes 'loss of consortium' as a compensable bodily injury damage?
- Wages lost by the injured claimant due to hospitalization
- A spouse's claim for loss of companionship and services due to the partner's injuries (Correct answer)
- Property damage resulting from the bodily injury accident
- Future medical expenses for the claimant's recovery
Correct answer: A spouse's claim for loss of companionship and services due to the partner's injuries
Loss of consortium is a derivative claim by a spouse for deprivation of companionship, affection, and services caused by the partner's injuries.
Question 7: When using a multiplier method to estimate general damages, what does the adjuster multiply?
- The claimant's annual salary by the number of injury days
- Total special damages (medical bills + lost wages) by a factor typically ranging from 1.5 to 5 (Correct answer)
- The vehicle repair cost by the number of passengers injured
- The at-fault percentage by the policy limit
Correct answer: Total special damages (medical bills + lost wages) by a factor typically ranging from 1.5 to 5
The multiplier method applies a factor (based on injury severity) to the total special damages to estimate pain and suffering.
CAIA Bodily Injury Claim Evaluation 2
A claimant reports whiplash after a rear-end collision but has no documented medical treatment for three weeks.
How does this gap typically affect the bodily injury evaluation?