Claims Investigation Techniques Flashcards
6 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 6 Claims Investigation Techniques flashcards as text
What is the primary purpose of obtaining a recorded statement from an insured as soon as possible after a loss is reported?
Answer: To lock in the individual's memory of the event before it fades or can be influenced by others.
The primary goal of taking an early recorded statement is to capture a detailed account of the incident while the person's memory is fresh. This creates a baseline record that helps prevent memory decay or later alteration of the facts due to outside influence.
An adjuster is investigating a single-vehicle accident where the insured claims their brakes failed, causing them to hit a guardrail. The vehicle has been towed to a salvage yard. To prevent an allegation of spoliation of evidence, what is the adjuster's most critical responsibility?
Answer: To place a hold on the vehicle and ensure it is preserved for expert inspection.
Spoliation of evidence is the destruction or alteration of evidence that is relevant to a legal proceeding. Since the alleged brake failure is a key component of the claim and could involve product liability, the adjuster must preserve the vehicle in its current state so that all parties (including the vehicle or parts manufacturer) have an opportunity to inspect it.
Which of the following scenarios presents the strongest justification for an insurer to request an Examination Under Oath (EUO) of the insured?
Answer: A claim for a stolen vehicle where the insured has a history of financial distress and provides conflicting details about the theft.
An Examination Under Oath (EUO) is a formal, sworn statement typically used when an insurer suspects fraud or has significant questions about coverage. A stolen vehicle claim combined with fraud indicators like financial motive and inconsistent statements provides a strong basis for invoking the EUO provision in the policy to investigate the claim's legitimacy.
During a claims investigation for a multi-vehicle pile-up, the adjuster needs to determine vehicle speeds and the sequence of impacts. Which of the following resources would be most effective for this purpose?
Answer: An accident reconstruction expert.
An accident reconstruction expert specializes in using physics and analyzing physical evidence like skid marks, vehicle damage, and event data recorder (EDR) information to scientifically determine speeds, impact angles, and the sequence of events in complex collisions.
An adjuster is interviewing a witness to an intersection collision. The witness is providing a clear verbal account, but the adjuster wants to ensure the details about vehicle positioning and movement are precise. What is the BEST technique to supplement the verbal statement?
Answer: Have the witness draw a diagram of the scene and label the vehicle paths.
Having a witness draw a diagram is an excellent non-leading technique to clarify spatial relationships, vehicle paths, and the sequence of events. It translates a mental picture into concrete evidence and can often reveal details or inconsistencies that a purely verbal description might miss.
Which of the following is considered a significant "red flag" for potential insurance fraud in an auto physical damage claim?
Answer: The claim is reported very shortly after the policy was purchased.
A claim that occurs very soon after the policy's inception date is a classic fraud indicator. It can suggest 'past-posting' (insuring a vehicle after a loss has already occurred) or that the purchase of the policy was motivated by a planned or staged event.