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 notes that a claimant's medical bills include treatment dates that fall after the policy's lapse date. How should this affect the claim?
Answer: Treatment received after the policy lapsed is not covered under that policy
Coverage is limited to the policy period; medical expenses incurred after the policy lapsed are not the insurer's obligation under that contract.
Which method of vehicle valuation is most commonly used for total-loss settlement in the United States?
Answer: Actual Cash Value (ACV) based on comparable vehicles in the local market
ACV reflects the vehicle's market value immediately before the loss, determined by comparing similar vehicles sold in the local market, not retail guides or original purchase price.
An adjuster suspects a claimant is fabricating a stolen-parts claim. Which investigative step would most effectively verify whether the parts were legitimately owned?
Answer: Ask the claimant to provide purchase receipts or financial records for the parts
Purchase receipts, bank statements, or installation records establish that the claimant legitimately owned the claimed items and paid documented amounts for them.
A third-party claimant disputes the adjuster's liability determination. What is the most appropriate escalation path before litigation?
Answer: Offer mediation or arbitration to resolve the dispute
Mediation and arbitration are cost-effective alternative dispute resolution methods that can resolve liability disagreements without the expense and delay of litigation.
When inspecting a vehicle for flood damage as part of a comprehensive claim, which indicator is most definitive?
Answer: Waterline marks and sediment deposits inside the vehicle consistent with submersion
Consistent waterline staining and sediment inside the passenger compartment, seatbelts, and trunk indicate the vehicle was submerged to a measurable depth.
Under the principle of 'indemnity,' how much compensation should a claimant receive for a covered auto loss?
Answer: The amount that restores them to their pre-loss financial position, no more and no less
Indemnity requires that the claimant be made whole — restored to the financial position they were in immediately before the loss — without profiting from the claim.
An adjuster is reviewing a diminished value claim after a vehicle was repaired following a collision. Which type of diminished value is most commonly recognized by courts and insurers?
Answer: Inherent diminished value
Inherent diminished value is the loss in market value a repaired vehicle suffers simply because it has an accident history, even after a perfect repair.