Intro. To Claims Adjusting - Module E

Which of the following types of investigations would an adjuster undertake to determine if the medical treatment a claimant is receiving is appropriate for the injuries claimed?

A medical investigation

Molly is a staff adjuster who works for Indemnify Insurance, Inc. The evidence in the investigation has caused Molly to suspect that the claim is fraudulent. She is told to put the claim file in order and transfer it to Meg, an adjuster who specializes in fraud. Which of the following reports should Molly prepare and send to Meg along with the claim file?

A summarized report

An adjuster is conducting a prior claims investigation. She will be searching a database provided by:

An index bureau

Fred is an adjuster with Indemnify Insurance, Inc. He is authorized by the company to pay insureds or claimants up to $75,000 on Homeowners claims and up to $40,000 on health insurance claims. This is known as:

Draft authority

An adjuster's report that contains all the facts, evidence and disposition of the claim and is considered to be the final report is known as the:

Full or formal report

Which of the following is NOT an "alternative dispute resolution" (ADR) used to deal with coverage disputes in the claim settlement process?

Litigation

An alternative dispute resolution (ADR) method by which disputing parties use a neutral outside party to examine the issues and develop a mutually agreeable settlement is known as:

Mediation

What is the main difference between arbitration and mediation in dealing with coverage disputes in the claims adjusting process?

Mediation is not binding on the parties involved, but with arbitration the decision is final and binding

The importance of an "Insured or Witness Investigation" is that:

Obtaining their statements is very important in determining who is liable.

A claim is being litigated in court by Michael on behalf of Janet who was physically injured by a negligent party. Michael has called Janet's doctor to the stand to describe to the court the severity of Janet's injuries. The doctor is presenting which of the following types of evidence?

Oral evidence.

Which of the following would NOT be included in an adjuster's initial / field / preliminary report?

The results of mediation

All of the following actions must be taken before a claim settlement will be considered "executed", EXCEPT:

When the insurer has approved the adjuster's final report