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 reports whiplash after a rear-end collision but has no documented medical treatment for three weeks. How does this gap typically affect the bodily injury evaluation?
Answer: It may suggest the injury was not serious or treatment-related to the accident
A gap in treatment raises questions about injury severity and causation, potentially reducing the claim's value.
When evaluating a soft tissue injury claim, which factor is LEAST relevant to establishing injury severity?
Answer: The color of the claimant's vehicle
Vehicle color is irrelevant to injury severity; medical records, imaging, and treatment duration are the key indicators.
A claimant's medical records show pre-existing degenerative disc disease at the same spinal level injured in the accident. How should the adjuster handle this?
Answer: Apportion damages between the pre-existing condition and the accident-aggravated portion
Adjusters must apportion damages, paying only for the aggravation of the pre-existing condition caused by the accident.
What does the term 'subrogation' mean in the context of a bodily injury claim?
Answer: The insurer's right to recover paid losses from the at-fault third party
Subrogation allows the insurer to step into the claimant's shoes and pursue recovery from the responsible party after paying the claim.
A claimant submits $8,000 in medical bills, but the adjuster finds that $2,000 reflects charges for unrelated dental work. What is the correct course of action?
Answer: Deduct the $2,000 and evaluate only the $6,000 related to the accident injuries
Only medical expenses causally related to the accident are compensable; unrelated charges are excluded from the evaluation.
Which of the following best describes 'loss of consortium' as a compensable bodily injury damage?
Answer: A spouse's claim for loss of companionship and services due to the partner's injuries
Loss of consortium is a derivative claim by a spouse for deprivation of companionship, affection, and services caused by the partner's injuries.
When using a multiplier method to estimate general damages, what does the adjuster multiply?
Answer: Total special damages (medical bills + lost wages) by a factor typically ranging from 1.5 to 5
The multiplier method applies a factor (based on injury severity) to the total special damages to estimate pain and suffering.