Claims Investigation Process 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 Investigation Process flashcards as text
When investigating a total loss vehicle claim, which document is most critical for establishing the vehicle's pre-loss market value?
Answer: A CCC ONE or comparable market valuation report
Market valuation reports from tools like CCC ONE use comparable sales data to establish fair market value for total loss settlements.
During a recorded statement, a claimant's account of the accident contradicts the physical evidence on the vehicle. The adjuster should:
Answer: Document the inconsistency and continue investigating without confrontation
Inconsistencies should be documented and investigated further; premature denial or accusation can expose the insurer to bad faith claims.
Which type of lien search is most important when settling a total loss claim on a vehicle?
Answer: DMV title and lien search
A DMV title and lien search confirms ownership and identifies any lienholder who must be included in the settlement payment.
An adjuster discovers the insured vehicle has aftermarket modifications not listed on the policy. How should these be handled?
Answer: Investigate whether modifications were undisclosed and apply policy terms accordingly
Policy terms govern coverage of aftermarket parts; undisclosed modifications may affect coverage, requiring investigation before inclusion or exclusion.
What is the primary purpose of an examination under oath (EUO) in the claims investigation process?
Answer: To obtain a formal, sworn statement when fraud or material misrepresentation is suspected
An EUO is a formal, sworn examination conducted when there are serious questions about claim validity or potential fraud.
When should an adjuster request a vehicle inspection by a Special Investigations Unit (SIU)?
Answer: When red flags such as recent policy changes, multiple prior claims, or conflicting damage patterns are present
SIU referrals are triggered by specific red flags indicating potential fraud, not automatically by claim value or legal representation.
A claimant submits receipts for rental vehicle expenses that exceed the policy's daily rental limit. The adjuster should:
Answer: Pay only up to the policy's stated daily limit per the policy terms
Policy limits cap reimbursement; the adjuster must pay up to the contractual limit regardless of actual expenses incurred.