CCA Claims Handling and Investigation 1 — Questions and Answers
Question 1: What is the first step in the claims handling process?
- Evaluate the damages
- Make payment to the claimant
- Acknowledge and set up the claim (Correct answer)
- Negotiate settlement
Correct answer: Acknowledge and set up the claim
The initial step in the claims process is to acknowledge and record the claim, establishing the claim file and beginning the investigation.
Question 2: Which of the following is a key purpose of claims investigation?
- To delay payment
- To determine if fraud occurred (Correct answer)
- To contact law enforcement
- To adjust premium rates
Correct answer: To determine if fraud occurred
Investigation helps verify the facts of loss and determine coverage, liability, and potential fraud.
Question 3: What is the role of the recorded statement in claims investigation?
- To increase settlement value
- To offer legal advice
- To document claimant’s account of the incident (Correct answer)
- To close the claim immediately
Correct answer: To document claimant’s account of the incident
Recorded statements allow the adjuster to capture the claimant’s version of events, which is essential for verifying facts and consistency.
Question 4: Which tool is most commonly used to document physical damage during a claims inspection?
- Policy declaration
- Witness affidavit
- Inspection checklist
- Photographs of the damage (Correct answer)
Correct answer: Photographs of the damage
Photographs provide visual evidence of damages and support the written findings in the adjuster’s report.
Question 5: Why is it important to maintain accurate documentation throughout the claims process?
- To calculate premium refunds
- To verify claimant income
- To reduce company overhead
- To support claim decisions and legal compliance (Correct answer)
Correct answer: To support claim decisions and legal compliance
Accurate documentation ensures transparency, protects against legal liability, and provides a record of actions taken.
Question 6: What action should an adjuster take if fraud is suspected during a claim?
- Close the claim immediately
- Pay the claim partially
- Refer to Special Investigations Unit (SIU) (Correct answer)
- Ignore and proceed as usual
Correct answer: Refer to Special Investigations Unit (SIU)
If fraud is suspected, the adjuster should follow internal procedures and escalate the claim to the special investigations unit (SIU).
CCA Claims Handling and Investigation 1
What is the first step in the claims handling process?