Study 1 - Investigating Bodily Injury Claims

Question 1

Types of Injuries

Answer 1

• • Soft tissue Injuries
• • Catastrophic Injuries
• • Psychological Injuries
• • Slip and fall injuries

Question 2

Role of a Bodily Injury Adjuster

Answer 2

• • Advises claimants and insureds how to proceed with the claim process and outlines the benefits they may be entitled to
• • Adjuster clarifies exactly what policy entitlements may be.
• • Payments of first party benefits are issued promptly. Third party may be issued interim or advance payments.

Question 3

Characteristics of a Bodily Injury Adjuster

Answer 3

• • Good Communication Skills
• • A professional and courteous Manner
• • An understanding of medical terminology and injuries
• • An ability to show empathy and understand
• • Knowledge and good analytical skills
• • Familiarity with laws and theories of defence

Question 4

Investigating Claims

Answer 4

• • Confirm Policy Coverage
• • Gather information
• • Verify facts

Question 5

Procedure for Written Statements

Answer 5

• • Choose a location
• • Prepare for the interview
• • Guide the process
• • Get the statement giver to sign the statement

Question 6

Ideal location to do written statements

Answer 6

At an adjuster’s office or nearby coffee shop

Question 7

Statement Checklist

Answer 7

• • Claimant info
• • Pre-accident
• • Accident
• • Injury
• • Damages
• • Other Eligible Claimants

Question 8

Questions following a motor vehicle incident

Answer 8

• • Type of Impact
• • Position of Claimant
• • Injury
• • Initial Treatment
• • Diagnosis
• • Prognosis

Question 9

Possible Fraud Indicators

Answer 9

o Exceptional unusual circumstances
o Connections between many claimants
o A rental car involved in the accident
o An employer who is difficult to contact
o A claimant who refuses to meet with the adjuster
o A claimant who does not disclose a source of collateral benefits

Question 10

Fraud Indicators Specific To Injury Claims

Answer 10

o A claimant with a lengthy claims history or extensive pre-existing medical history
o A claimant who uses doctors or other professionals known to represent claimants in prior suspicious claims
o A claimant with subjective soft tissue injuries
o Many subjective symptoms

Question 11

Common Defenses for Liabiliy

Answer 11

• • Volenti Non Fit Injuria: risk voluntarily assumed activity. Example: Hockey players
• • Act of god
• • Inevitable Damage
• • Remoteness of damage

Question 12

Types of liablility

Answer 12

• • Contributory Negligence
• • Joint and Several Liability: when two or more people are found at fault
• • % rule – if the insured is found as little as 1% liable it may be possible for the plaintiff to collect the full amount from the insured

Question 13

Judgement Proof

Answer 13

Relates to joint and several liability: When tortfeasors don’t have enough insurance coverage to cover loss