Claims Processing & Documentation Flashcards
7 cards from real CALA 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 Processing & Documentation flashcards as text
What is the primary purpose of an Examination Under Oath (EUO) in the claims process?
Answer: To obtain sworn testimony from the insured about the loss
An EUO is a formal proceeding where the insured provides sworn testimony, allowing the insurer to investigate the claim details thoroughly.
When processing a claim involving a lienholder on the vehicle, the settlement check should typically be made payable to:
Answer: Both the insured and the lienholder
When a vehicle has an active lien, settlement checks must name both the insured and the lienholder to protect the lender's financial interest.
A claimant submits repair invoices totaling $4,200 but the adjuster's estimate is $3,500. The most appropriate action is to:
Answer: Contact the repair facility to reconcile the difference before issuing payment
Reconciling differences with the repair facility through a supplement review ensures accurate and fair payment.
Which type of coverage pays for the insured's vehicle damage regardless of who was at fault?
Answer: Collision coverage
Collision coverage pays for damage to the insured's own vehicle resulting from a collision, regardless of fault.
In claims documentation, 'subrogation potential' should be evaluated:
Answer: At the time the claim is reported and throughout the investigation
Subrogation potential should be identified early and tracked throughout the process to preserve the insurer's recovery rights.
What does a 'non-waiver agreement' accomplish in the claims process?
Answer: Allows the insurer to investigate a claim without waiving the right to later deny coverage
A non-waiver agreement lets the insurer conduct a full investigation while reserving the right to assert coverage defenses later.
When documenting a rental car reimbursement claim, which factor determines the maximum daily benefit?
Answer: The limits specified in the rental reimbursement endorsement
Rental reimbursement benefits are capped by the daily limit stated in the policy endorsement, regardless of actual rental costs.