Project Management & Workflow Flashcards
7 cards from real CA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Project Management & Workflow flashcards as text
An adjuster sets an initial reserve of $10,000 but new information shows the actual exposure is $85,000. What is the correct action?
Answer: Adjust the reserve upward and document the basis for the change
Reserves must reflect the current best estimate of ultimate liability; prompt adjustment with documentation is required.
What is the purpose of a 'diary' system in claims workflow?
Answer: Scheduling future follow-up actions on open claims
A diary (or bring-forward) system ensures no claim task is overlooked by scheduling reminders for required actions.
Which of the following is a leading indicator that a claim file may be approaching bad faith exposure?
Answer: The adjuster failed to respond to a policy limits demand within a reasonable time
Failure to timely respond to a policy limits demand is a classic bad faith trigger in California.
In a multi-party liability claim involving several claimants, what workflow approach prevents inadvertent overpayment?
Answer: Track all demands against the per-occurrence policy limit simultaneously
Monitoring cumulative exposure against the per-occurrence limit prevents exhausting coverage before all claimants are resolved.
What is the primary purpose of an 'authority level' in claims workflow?
Answer: Setting the maximum dollar amount an adjuster can settle without supervisor approval
Authority levels ensure appropriate oversight by routing large settlements through supervisory review.
An adjuster receives a demand package from a claimant's attorney. What is the correct initial workflow step?
Answer: Log receipt, review coverage, and calendar the response deadline
Proper intake, coverage review, and deadline calendaring are the foundational first steps before evaluating or responding.
Which workflow document formally notifies a claimant that an investigation is ongoing and a coverage decision has not yet been made?
Answer: Reservation of rights letter
A reservation of rights letter preserves the insurer's ability to deny coverage while the investigation continues.