Claims Processing & Investigation Flashcards
7 cards from real CAP 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 & Investigation flashcards as text
What is the primary purpose of a recorded statement taken from a claimant during the investigation phase?
Answer: To lock the claimant into a version of events early in the process
Recorded statements capture the claimant's account of the loss while details are fresh and establish a baseline that can be compared against other evidence.
Which of the following documents serves as the insured's formal notice to the insurer detailing the scope and value of a covered loss?
Answer: Proof of loss
A proof of loss is the insured's sworn statement describing the circumstances, nature, and dollar amount of the claimed loss.
When an adjuster identifies a claim that may fall outside policy coverage, the appropriate immediate action is to:
Answer: Issue a reservation of rights letter while continuing the investigation
A reservation of rights letter protects the insurer's right to deny coverage while allowing the investigation to continue without waiving coverage defenses.
In property claims, 'actual cash value' (ACV) is most commonly calculated as:
Answer: Replacement cost minus depreciation
ACV equals the cost to replace the damaged property with a like kind and quality item, reduced by accumulated depreciation.
An independent adjuster (IA) differs from a staff adjuster primarily because the IA:
Answer: Is contracted per-claim rather than employed by the insurer
Independent adjusters are third-party contractors hired on a fee-per-claim basis, giving insurers flexible surge capacity without adding permanent staff.
Which ISO database is most commonly used by claims professionals to identify potential fraud through cross-insurer claim matching?
Answer: ClaimSearch
ISO ClaimSearch aggregates claim data from thousands of insurers, allowing adjusters to identify duplicate claims, prior losses, and suspicious patterns across carriers.
Subrogation in insurance claims refers to the insurer's right to:
Answer: Pursue a third party responsible for the insured's loss after paying the claim
Subrogation allows the insurer, after compensating its insured, to step into the insured's shoes and recover that payment from the negligent third party.