Bodily Injury Claim Evaluation Flashcards
7 cards from real CAIA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Bodily Injury Claim Evaluation flashcards as text
A claimant involved in a minor fender-bender with minimal vehicle damage claims severe back injuries. What investigative tool might an adjuster use to assess claim credibility?
Answer: Order an independent medical examination (IME)
An IME provides an objective medical opinion on injury causation and severity when the claim appears disproportionate to the accident facts.
Under a comparative negligence system, a claimant is found 30% at fault for an accident. If total damages are $50,000, what is the maximum bodily injury recovery?
Answer: $35,000
In a comparative negligence state, the claimant's recovery is reduced by their percentage of fault: $50,000 × 70% = $35,000.
What is the significance of a 'reservation of rights' letter in a bodily injury claim?
Answer: It notifies the insured that the insurer is investigating coverage while preserving its right to deny coverage later
A reservation of rights letter protects the insurer's ability to deny coverage while still conducting a defense or investigation.
Which document is the MOST important for evaluating a claimant's lost wage claim following an auto accident injury?
Answer: Employer verification letter and pay stubs showing pre-accident earnings
Lost wage claims require documentation of pre-accident earnings and employer confirmation of missed work days to establish the economic loss.
A claimant treats exclusively with a chiropractor for six months following a minor accident. What concern might an adjuster have about this treatment pattern?
Answer: Prolonged chiropractic treatment without medical physician oversight may indicate over-treatment
Lengthy chiropractic treatment without medical physician supervision can signal over-treatment or soft tissue claim padding, affecting claim valuation.
What is 'future medical expense' in bodily injury claims, and who typically establishes it?
Answer: Anticipated ongoing medical costs beyond settlement, typically established by a treating physician or life care planner
Future medical expenses are projected costs for ongoing treatment, often supported by a physician's prognosis or a formal life care plan.
When a claimant presents both medical bills and a pain diary as evidence, what does the pain diary primarily support?
Answer: General damages, specifically the nature and duration of pain and suffering
A pain diary documents daily impact on the claimant's life, directly supporting the general damages calculation for pain and suffering.