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
In a multi-vehicle accident with three at-fault parties, how does 'joint and several liability' affect the claimant's ability to recover?
Answer: The claimant can recover the full judgment amount from any single defendant
Under joint and several liability, each defendant is individually responsible for the entire judgment, allowing the claimant to collect fully from any defendant regardless of individual fault percentages.
Coordination of benefits (COB) in health and disability claims is designed to ensure that:
Answer: Total benefits paid across all policies do not exceed the actual loss
COB rules prevent over-insurance windfalls by coordinating multiple policies so aggregate payments equal but do not exceed 100% of covered losses.
A statute of limitations in insurance claims is most significant because it defines:
Answer: The deadline by which a claimant must file a lawsuit to enforce claim rights
The statute of limitations sets the outer boundary for filing suit; claims not litigated within this period are barred regardless of their underlying merit.
During a catastrophe event with mass claim volume, which triage approach allows insurers to prioritize the most vulnerable claimants first?
Answer: Severity-based triage that prioritizes habitability and life-safety losses
Catastrophe protocols prioritize habitability losses—homes uninhabitable due to structural damage—because displaced families face the most immediate hardship.
When reinsurance applies to a primary insurer's claim, the reinsurer's obligation to the original insured is best described as:
Answer: Indirect—the reinsurer reimburses the primary insurer, not the original claimant
Reinsurance is a contract between insurers; the original insured has no direct claim against the reinsurer—only the primary insurer can collect from its reinsurer.
Which of the following best describes 'claims leakage' in insurance operations?
Answer: Payments made in excess of the correct claim value due to errors or process failures
Claims leakage refers to the cumulative financial loss from overpayments, missed recoveries, and process inefficiencies that result in paying more than the correct claim value.
In claims mediation, the mediator's role is best characterized as:
Answer: Facilitating negotiation between parties without imposing a resolution
A mediator is a neutral facilitator who helps parties communicate and explore settlement options but has no authority to compel either party to accept any particular outcome.