Claims Investigation Techniques 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 Claims Investigation Techniques flashcards as text
An adjuster receives a claim where the at-fault driver fled the scene and cannot be identified. Under which coverage would the claimant typically seek compensation for vehicle damage?
Answer: Uninsured motorist property damage
Uninsured motorist property damage (UMPD) is designed to cover vehicle damage caused by a hit-and-run or uninsured driver when the at-fault party cannot be identified.
When documenting vehicle damage during a physical inspection, what is the primary advantage of using a standardized damage diagram?
Answer: It provides a consistent, universally understood record of damage location
Standardized diagrams use zone codes and directional references that any adjuster, appraiser, or court can interpret consistently without ambiguity.
A claimant states the accident occurred at 2:00 PM, but the responding police officer's report notes arrival at 1:45 PM. Which document controls for establishing the timeline?
Answer: The police report, which is a contemporaneous official record
Police reports are contemporaneous official records prepared by a neutral third party and carry greater evidentiary weight than self-reported claimant statements.
An adjuster discovers that the VIN plate on a claimed vehicle does not match the confidential secondary VIN found on the engine block. This discrepancy most likely indicates:
Answer: A stolen or salvage vehicle with a swapped VIN
Mismatched primary and secondary VINs are a classic indicator of a 'VIN swap,' where a stolen vehicle is given the identity of a legitimately titled vehicle.
Which of the following is a red flag that may indicate an auto insurance fraud ring rather than a single isolated claim?
Answer: Multiple unrelated claimants using the same attorney and treatment facility
Fraud rings coordinate participants to use the same legal and medical providers, creating a detectable pattern when multiple claims are cross-referenced.
When an adjuster orders a police report and it is unavailable because the insured did not report the accident, what alternative documentation should be obtained?
Answer: A self-prepared incident report and witness statements
When no police report exists, adjusters collect witness statements, photos, insured's written account, and any other corroborating documentation to reconstruct the loss.
An adjuster reviewing a bodily injury claim notes that the claimant sought chiropractic treatment beginning three weeks after the accident. What concern does this delay raise?
Answer: The delay may weaken the causal link between the accident and the claimed injury
A significant gap between the accident and first medical treatment raises questions about causation and may indicate the injuries were pre-existing or unrelated to the collision.