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
When an adjuster suspects a claimant is exaggerating injuries, which investigative tool is most appropriate to document daily activities?
Answer: Surveillance video
Surveillance video provides objective, real-time documentation of a claimant's physical activities that can contradict exaggerated injury claims.
A vehicle is submitted with alleged hail damage but the roof shows indentations only on horizontal panels. What does this pattern suggest?
Answer: Possible staged damage using a tool
Genuine hail strikes random surfaces, including vertical panels and trim, so damage limited to horizontal areas suggests mechanical staging.
Which database is primarily used by adjusters to check whether a vehicle has prior reported accident history?
Answer: CarFax/AutoCheck
CarFax and AutoCheck compile vehicle history reports from title records, odometer readings, and reported accidents, giving a comprehensive ownership history.
An insured reports a theft claim but the vehicle's GPS data shows it traveled 80 miles on the night of the alleged theft. What is the adjuster's best next step?
Answer: Obtain a recorded statement addressing the GPS data
Confronting the discrepancy during a recorded statement under oath allows the adjuster to document the insured's explanation and preserve evidence for potential fraud referral.
What is the purpose of an Examination Under Oath (EUO) in an auto insurance claim investigation?
Answer: To compel the insured to testify under oath about claim circumstances
An EUO is a contractual right allowing the insurer to question the insured under oath, with the transcript admissible as evidence if the claim goes to court.
During a scene inspection after a single-vehicle rollover, the adjuster finds no gouge marks or debris field consistent with the claimed impact point. This finding most likely indicates:
Answer: The loss occurred at a different location
Physical evidence at an accident scene should correspond to the reported impact point; its absence suggests the vehicle was moved or the incident occurred elsewhere.
Which of the following best describes 'index bureau' resources used in claims investigation?
Answer: Shared databases where insurers report claims to identify patterns across carriers
Index bureaus like ISO ClaimSearch aggregate claim data across multiple insurers so adjusters can spot claimants with suspicious frequency of prior claims.