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AK Claims Adjuster practice questions

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Question 1Alaska Workers' Compensation Statute and Regulations

Under the Alaska Workers' Compensation Act, which employer is required to secure payment of compensation for its employees?

  1. Only employers whose payroll exceeds a stated annual threshold
  2. Every employer, with limited statutory exceptions Correct answer.
  3. Only employers with five or more full-time employees
  4. Only employers engaged in construction or mining

Explanation

Alaska law generally requires every employer to secure workers' compensation coverage for its employees, subject only to narrow statutory exceptions. There is no general small-employer payroll or headcount exemption that applies across industries.

Question 2Alaska Workers' Compensation Statute and Regulations

An injured worker's claim is filed with the Alaska Workers' Compensation Division. Which body ultimately decides contested compensation claims?

  1. The superior court in the first instance
  2. The Department of Labor's wage and hour section
  3. The Division of Insurance
  4. The Alaska Workers' Compensation Board Correct answer.

Explanation

The Alaska Workers' Compensation Board hears and decides contested claims, with appeals going to the Alaska Supreme Court. The Division administers filings and processes but does not adjudicate disputes.

Question 3Alaska Workers' Compensation Statute and Regulations

For an injury that is not otherwise covered by a specific statutory provision, Alaska's statute requires the employer to furnish medical and related benefits for how long after the injury?

  1. The period the employee remains disabled, without limit Correct answer.
  2. Five years
  3. Two years
  4. One year

Explanation

Alaska requires medical benefits to be provided for as long as the employee's condition requires treatment related to the injury, without a fixed cutoff. Time limits elsewhere in the statute address other benefit types, not the medical treatment duty.

Question 4Alaska Workers' Compensation Statute and Regulations

An employee suffers a back injury at work. Under Alaska's statute, the employer must pay temporary total disability benefits when the employee is unable to work and the employer has not controverted the claim. When do those benefits begin?

  1. After a 14-day waiting period
  2. On the fourth day after the injury in all cases
  3. On the first day of disability following the injury Correct answer.
  4. Only after the Board issues an order

Explanation

Alaska requires compensation for temporary total disability to begin on the first day of disability, without a waiting period. Some jurisdictions impose waiting periods, but Alaska's statute does not.

Question 5Alaska Workers' Compensation Statute and Regulations

An adjuster is calculating the compensation rate for an injured worker. Under Alaska law, the rate is generally based on which measure?

  1. The employee's gross earnings in the highest quarter of the prior year
  2. The employee's spendable weekly wage, subject to statutory maximums Correct answer.
  3. The federal minimum wage times hours worked
  4. The average wage in the employee's industry statewide

Explanation

Alaska computes compensation using the employee's spendable weekly wage, which reflects gross earnings less certain deductions, capped by statutory maximum and minimum rates. Industry averages and federal minimum wage figures are not the measure.

Question 6Alaska Workers' Compensation Statute and Regulations

An employee dies from a work-related injury leaving a surviving spouse and two dependent children. Under Alaska's statute, death benefits to dependents are subject to what limit?

  1. A limit set by the employer's insurer
  2. A statutory maximum on total benefits, adjusted periodically Correct answer.
  3. A limit equal to the employee's annual wage
  4. No limit of any kind

Explanation

Alaska caps death benefits payable to dependents at a statutory maximum that is adjusted over time. The cap is set by statute rather than by the employer or insurer.

Question 7Alaska Workers' Compensation Statute and Regulations

An employer wishes to dispute a claim. Under Alaska procedure, what must the employer do to avoid paying benefits while the dispute is pending?

  1. Simply stop paying benefits and notify the employee verbally
  2. File a motion in superior court
  3. Wait for the Board to rule before taking any action
  4. File a notice of controversion within the statutory time frame Correct answer.

Explanation

To avoid liability for benefits during a dispute, the employer must file a timely notice of controversion stating the grounds. Merely withholding payment without a proper controversion exposes the employer to further liability.

Question 8Alaska Workers' Compensation Statute and Regulations

An employee is injured while traveling on a business errand for the employer. Under Alaska's going-and-coming rule, the injury is generally compensable when the employee is:

  1. Commuting from home to the regular workplace
  2. On a special mission for the employer Correct answer.
  3. Traveling to a personal appointment during a break
  4. Driving a personal vehicle on a routine commute

Explanation

Alaska recognizes an exception to the going-and-coming rule when the employee is on a special mission or errand for the employer. Ordinary commuting is generally not compensable.

Question 9Alaska Workers' Compensation Statute and Regulations

An injured employee's physician releases the employee to return to light-duty work that the employer makes available. What effect does this generally have on temporary total disability benefits?

  1. Benefits terminate because the employee is no longer totally disabled Correct answer.
  2. Benefits are suspended permanently
  3. Benefits double to compensate for reduced hours
  4. Benefits continue unchanged until the employee reaches maximum medical improvement

Explanation

Temporary total disability requires that the employee be unable to work. When suitable light-duty work is offered and the employee can perform it, total disability ends, though other benefits may apply.

Question 10Alaska Workers' Compensation Statute and Regulations

An employer believes an injury was intentionally self-inflicted. Under Alaska law, which party bears the burden of proving an exclusion such as intentional self-injury?

  1. The employee
  2. The treating physician
  3. The Board, acting on its own motion
  4. The employer asserting the exclusion Correct answer.

Explanation

The party asserting an affirmative defense or statutory exclusion bears the burden of proving it. The employer claiming intentional self-injury must establish the facts supporting that exclusion.

Question 11Alaska Workers' Compensation Statute and Regulations

Which of the following best describes Alaska's approach to the exclusive remedy doctrine in workers' compensation?

  1. The employer is liable in tort only if the injury is serious
  2. The employee may sue the employer in tort in addition to collecting benefits
  3. Exclusive remedy applies only to out-of-state employers
  4. The employer is immune from tort suits by the employee for covered injuries in exchange for providing statutory benefits Correct answer.

Explanation

Workers' compensation is generally the exclusive remedy for covered work injuries, shielding the employer from tort liability in exchange for no-fault statutory benefits. This trade-off is central to the system.

Question 12Alaska Workers' Compensation Statute and Regulations

An employee seeks compensation for a pre-existing condition aggravated by work. Under Alaska law, how is a pre-existing condition generally treated?

  1. It shifts all liability to the employee
  2. It is compensable only if the employer knew of it at hire
  3. It is never compensable
  4. It is compensable if the employment aggravates or accelerates the condition Correct answer.

Explanation

Alaska follows the rule that a work-related aggravation or acceleration of a pre-existing condition can be compensable, even if the underlying condition predates employment. The focus is on the work's contribution to the disability.

Question 13Alaska Workers' Compensation Statute and Regulations

An injured worker's claim is contested, and the Board issues a decision. To which court does an appeal from a Board decision generally go?

  1. The Alaska Court of Appeals
  2. The Alaska Supreme Court Correct answer.
  3. The federal district court
  4. The U.S. Court of Appeals for the Ninth Circuit

Explanation

Appeals from Alaska Workers' Compensation Board decisions go directly to the Alaska Supreme Court. The Court of Appeals handles criminal and certain other appeals, not workers' compensation.

Question 14Alaska Workers' Compensation Statute and Regulations

Which of the following injuries is most likely to be considered compensable under Alaska's occupational disease provisions?

  1. An injury sustained during an unpaid lunch break off premises
  2. A repetitive-motion condition developing gradually from years of the same job tasks Correct answer.
  3. A fight started by the employee for personal reasons
  4. An injury from a one-time slip on an icy sidewalk at work

Explanation

Occupational disease provisions address conditions that develop gradually from the nature of the employment rather than from a single traumatic event. Repetitive-motion conditions are a common example.

Question 15Alaska Workers' Compensation Statute and Regulations

Under Alaska law, an employer must provide which of the following to an injured employee at the time of injury or upon receiving notice of the injury?

  1. A written report of injury and information about the employee's rights and benefits Correct answer.
  2. A waiver of the employee's right to benefits
  3. A list of approved attorneys
  4. A settlement offer

Explanation

Alaska requires employers to report injuries and provide employees with information about their rights and benefits. Settlement offers and waivers are not required at the outset and would be inappropriate.

Question 16Alaska Workers' Compensation Statute and Regulations

An injured employee fails to give the employer notice of the injury within the statutory period. What is the general consequence under Alaska law?

  1. The employee must pay a fine
  2. The claim may be barred unless the employer had actual knowledge or was not prejudiced Correct answer.
  3. The claim is automatically barred in every case
  4. The employer must still pay double benefits

Explanation

Late notice can bar a claim, but Alaska excuses the failure where the employer had actual knowledge of the injury or was not prejudiced by the delay. The result is fact-specific rather than automatic.

Question 17Alaska Workers' Compensation Statute and Regulations

Alaska's statute sets a time limit for filing a claim for compensation after an injury. Which statement best reflects the general rule?

  1. A claim must be filed within a set statutory period, subject to tolling in certain circumstances Correct answer.
  2. Only the employer may file a claim
  3. There is no time limit for filing any claim
  4. A claim must be filed within 30 days in all cases

Explanation

Alaska imposes a statutory limitations period for filing claims, subject to tolling rules where the employer has failed to provide required notices or benefits. The period is not 30 days and is not unlimited.

Question 18Alaska Workers' Compensation Statute and Regulations

An adjuster is evaluating whether a worker is an employee or an independent contractor for coverage purposes. Which approach is most consistent with Alaska law?

  1. Labeling in the contract controls conclusively
  2. Only the worker's preference controls
  3. The employer's tax filing status is conclusive
  4. The relationship is assessed using a multi-factor test focused on control and the nature of the work Correct answer.

Explanation

Alaska applies a multi-factor analysis to determine employment status, looking at factors such as control, integration, and the nature of the work. Contract labels alone are not conclusive.

Question 19Alaska Workers' Compensation Statute and Regulations

Under Alaska law, an employer may require an injured employee to submit to a medical examination by a physician of the employer's choosing. What is the general condition on this right?

  1. The examination may be repeated as often as the employer wishes without limit
  2. The examination results are confidential from the employee
  3. The examination may be required at reasonable times, and the employee may be entitled to a copy of the report Correct answer.
  4. The employee must pay for the examination

Explanation

Employers may require reasonable medical examinations, and employees are generally entitled to copies of the resulting reports. The right is not unlimited and the employee is not required to pay.

Question 20Alaska Workers' Compensation Statute and Regulations

An employee receives a settlement of a workers' compensation claim. Under Alaska law, which of the following is generally true about settlements?

  1. Settlements must be approved by the Board to be effective in many circumstances Correct answer.
  2. Settlements require the insurer's unilateral consent only
  3. Settlements may only cover past benefits
  4. Settlements are automatically void

Explanation

Alaska requires Board approval of many settlements to protect injured workers, particularly where benefits are being compromised. Settlements are not automatically void, and approval processes exist for a reason.

Question 21Alaska Workers' Compensation Statute and Regulations

Which of the following best describes the role of the Alaska Workers' Compensation Division in the claims process?

  1. It acts as the final appellate court
  2. It defends employers in litigation
  3. It sets the compensation rate for each individual employer
  4. It administers filings, processes claims, and provides dispute resolution services Correct answer.

Explanation

The Division handles the administrative side of the system, including claim filings and dispute resolution assistance, while the Board adjudicates contested matters. The Division does not act as an appellate court or set individual rates.

Question 22Alaska Workers' Compensation Statute and Regulations

An injured worker's average weekly wage calculation is disputed. Which factor is most relevant under Alaska's statutory method?

  1. The employer's total annual revenue
  2. The worker's age
  3. The number of employees at the worksite
  4. The worker's earnings history over the relevant lookback period Correct answer.

Explanation

Average weekly wage is derived from the worker's earnings over the statutory lookback period, then adjusted to a spendable weekly wage subject to caps. Employer revenue, headcount, and age do not determine the wage base.

Question 23Alaska Workers' Compensation Statute and Regulations

An employee is injured while engaging in horseplay at work that is unrelated to job duties. Under Alaska law, how is compensability generally analyzed?

  1. The injury may be excluded if the horseplay was unrelated to the employment and not condoned Correct answer.
  2. Horseplay is always compensable
  3. The employer must pay benefits regardless of the circumstances
  4. Any injury at work is automatically compensable

Explanation

Alaska examines whether the conduct was within the course of employment, and horseplay unrelated to job duties and not condoned by the employer may fall outside coverage. The analysis is fact-specific rather than automatic.

Question 24Alaska Workers' Compensation Statute and Regulations

Which benefit category under Alaska law is intended to compensate an employee for permanent loss of function of a body part, independent of lost wages?

  1. Temporary partial disability
  2. Vocational rehabilitation benefits
  3. Permanent partial impairment benefits Correct answer.
  4. Medical benefits

Explanation

Permanent partial impairment benefits compensate for lasting functional loss, often based on a rating, independent of wage loss. Temporary partial disability addresses reduced earnings during recovery, and vocational benefits address reemployment.

Question 25Alaska Workers' Compensation Statute and Regulations

An employer rehires an injured employee at reduced hours and wages after a partial recovery. Which benefit type is most likely implicated?

  1. Permanent total disability
  2. Temporary partial disability Correct answer.
  3. Temporary total disability
  4. Death benefits

Explanation

Temporary partial disability compensates for the difference in earnings when an employee returns to work at reduced capacity before reaching maximum medical improvement. Total disability applies only when the employee cannot work at all.

Question 26Alaska Workers' Compensation Statute and Regulations

Under the Alaska Workers' Compensation Act, which of the following is generally required for an injury to be compensable?

  1. The injury must arise out of and in the course of employment. Correct answer.
  2. The injury must result in at least three days of lost work.
  3. The injury must occur on the employer's premises during scheduled work hours.
  4. The injury must be witnessed by a supervisor or co-worker.

Explanation

Alaska law requires that a compensable injury arise out of and in the course of employment. This is the fundamental coverage test, connecting the injury to both the employment activities and the time and place of work.

Question 27Alaska Workers' Compensation Statute and Regulations

An employer has actual knowledge of a work-related injury but fails to file a timely report with the Alaska Workers' Compensation Division. What is the most likely consequence under Alaska law?

  1. The statute of limitations for the employee's claim is extended by two years.
  2. The employer may be subject to a civil penalty for failure to report. Correct answer.
  3. The employer's insurance carrier must pay a fine to the employee.
  4. The employee's claim is automatically denied for lack of a report.

Explanation

Alaska law imposes a duty on employers to report work-related injuries to the Division within a specified time. Failure to do so can result in a civil penalty against the employer, separate from the compensability of the claim.

Question 28Alaska Workers' Compensation Statute and Regulations

An injured worker in Alaska wishes to pursue a claim for compensation. Which of the following best describes the initial step in the formal dispute process before the Alaska Workers' Compensation Board?

  1. The worker must submit to an independent medical examination.
  2. The worker must file a civil lawsuit in superior court.
  3. The worker must file a written claim with the Division. Correct answer.
  4. The worker must request a hearing before the Board.

Explanation

The claim process begins with filing a written claim for compensation with the Division. This filing initiates the administrative process and preserves the worker's rights.

Question 29Alaska Workers' Compensation Statute and Regulations

Under Alaska's workers' compensation statute, which of the following is true regarding the payment of temporary total disability (TTD) benefits?

  1. TTD benefits are payable for the first seven days of disability only.
  2. TTD benefits are payable only if the employee is hospitalized.
  3. TTD benefits are payable when the employee is unable to work at all due to the injury. Correct answer.
  4. TTD benefits are payable only after the employee reaches maximum medical improvement.

Explanation

Temporary total disability benefits compensate an employee who is temporarily unable to work at all because of the work injury. They continue until the employee can return to work or reaches maximum medical improvement.

Question 30Alaska Workers' Compensation Statute and Regulations

An employee suffers a permanent partial impairment and receives a rating from a physician. Under Alaska law, how is the amount of permanent partial impairment (PPI) benefits determined?

  1. Based on the number of dependents the employee has.
  2. Based on the employee's age at the time of injury.
  3. Based solely on the employee's actual lost wages.
  4. Based on the physician's impairment rating and the employee's weekly wage. Correct answer.

Explanation

Alaska uses a schedule that considers the impairment rating assigned by the physician and the employee's weekly wage to calculate PPI benefits. The rating reflects the permanent loss of function.

Question 31Alaska Workers' Compensation Statute and Regulations

In Alaska, an employer may require an injured employee to submit to a medical examination by a physician selected by the employer. Which of the following is true about this examination?

  1. The examination must be performed by the employee's treating physician.
  2. The employee is entitled to have a representative present during the examination.
  3. The employee may refuse the examination without any consequence.
  4. The employer must pay for the examination and any related travel expenses. Correct answer.

Explanation

Alaska law requires the employer to pay for the medical examination it requests and for reasonable travel expenses. The employee's attendance can be compelled, and refusal may affect benefits.

Question 32Alaska Workers' Compensation Statute and Regulations

An employee is injured while performing a personal task during a break at the employer's premises. Under Alaska's going-and-coming rule, which of the following is the most important factor in determining compensability?

  1. Whether the injury occurred during a break period.
  2. Whether the employee was engaged in activities incidental to employment. Correct answer.
  3. Whether the employer had expressly prohibited the activity.
  4. Whether the employee was on the employer's premises at the time of injury.

Explanation

Under Alaska's going-and-coming rule, injuries during breaks may be compensable if the activity is incidental to employment. The key is whether the activity is sufficiently connected to the employment.

Question 33Alaska Workers' Compensation Statute and Regulations

Under Alaska law, which of the following is a requirement for an employee to receive compensation for a mental injury or stress-related condition?

  1. The mental injury must be diagnosed by a psychiatrist.
  2. The mental injury must result in hospitalization.
  3. The mental injury must arise from a work-related physical injury or be caused by work-related stress. Correct answer.
  4. The mental injury must be witnessed by a supervisor.

Explanation

Alaska law allows compensation for mental injuries if they are causally linked to a work-related physical injury or to work-related stress. There are specific statutory requirements for establishing compensability.

Question 34Alaska Workers' Compensation Statute and Regulations

An employee's average weekly wage (AWW) is being calculated for workers' compensation benefits. Which of the following best describes how AWW is generally determined under Alaska law?

  1. By averaging the employee's earnings for the 13 weeks preceding the injury. Correct answer.
  2. By using the employee's annual salary divided by 52.
  3. By using the state's average weekly wage for all workers.
  4. By using the employee's highest weekly wage during the past year.

Explanation

Alaska calculates average weekly wage based on the employee's earnings during the 13 weeks before the injury. This method aims to reflect the employee's regular weekly income.

Question 35Alaska Workers' Compensation Statute and Regulations

An employer wishes to controvert a claim for workers' compensation benefits in Alaska. What must the employer do to initiate a controversion?

  1. Stop paying benefits immediately and await a hearing.
  2. Request a conference with the employee's physician.
  3. File a written notice of controversion with the Division within a specified time. Correct answer.
  4. File a lawsuit in superior court to deny the claim.

Explanation

To controvert a claim, an employer must file a written notice of controversion with the Division within the statutory time frame. This provides notice to the employee and the Division.

Question 36Alaska Workers' Compensation Statute and Regulations

Under Alaska's workers' compensation law, which of the following is true regarding the payment of medical benefits?

  1. Medical benefits are limited to treatment provided within the first year after injury.
  2. The employee must pay a deductible before medical benefits apply.
  3. The employer may choose the employee's treating physician without limitation.
  4. The employer must pay for all reasonable and necessary medical treatment related to the work injury. Correct answer.

Explanation

Alaska law requires employers to provide and pay for all reasonable and necessary medical treatment for a compensable injury. There is no deductible or arbitrary time limit for such treatment.

Question 37Alaska Workers' Compensation Statute and Regulations

An employee is injured on the job and later dies from the injury. Which of the following benefits is available to the employee's surviving spouse and dependents under Alaska law?

  1. Benefits are limited to the employee's accrued vacation pay.
  2. Death benefits, including burial expenses and weekly compensation for dependents. Correct answer.
  3. A lump-sum payment equal to the employee's remaining lifetime earnings.
  4. Only burial expenses, with no weekly benefits.

Explanation

Alaska provides death benefits to surviving spouses and dependents, which typically include burial expenses and weekly compensation based on the employee's wages. The benefits are designed to replace the deceased worker's income.

Question 38Alaska Workers' Compensation Statute and Regulations

Which of the following best describes the statute of limitations for filing a workers' compensation claim in Alaska after the employee knows or should know of the injury?

  1. The claim must be filed within one year of the injury.
  2. The claim must be filed within two years of the injury. Correct answer.
  3. There is no time limit for filing a claim.
  4. The claim must be filed within 30 days of the injury.

Explanation

Alaska law generally requires that a claim for compensation be filed within two years after the employee knows or reasonably should know of the injury and its relation to employment. This deadline can be extended in certain circumstances.

Question 39Alaska Workers' Compensation Statute and Regulations

An employee is injured while engaging in horseplay at work that is unrelated to job duties. Under Alaska law, how is compensability generally determined?

  1. The injury is never compensable because horseplay is outside job duties.
  2. The injury is compensable only if the employer expressly permitted horseplay.
  3. The injury is compensable only if the employee was not at fault.
  4. The injury is compensable if the horseplay was a regular incident of employment. Correct answer.

Explanation

In Alaska, injuries from horseplay may be compensable if the horseplay is a regular incident of the employment. The key is whether the activity is sufficiently connected to the work environment.

Question 40Alaska Workers' Compensation Statute and Regulations

Under Alaska's workers' compensation law, which of the following is true regarding the payment of benefits when an employee is temporarily partially disabled and returns to work at reduced hours?

  1. The employee must be totally disabled to receive any wage-loss benefits.
  2. The employer may reduce the employee's wages without any consequence.
  3. The employee may be entitled to temporary partial disability benefits to make up for lost wages. Correct answer.
  4. The employee is not entitled to any benefits because they are working.

Explanation

Temporary partial disability benefits are available when an employee returns to work at reduced hours or wages due to the injury. These benefits partially replace the lost wages.

Question 41Claims Handling and Investigation

An insured's home is damaged by fire on March 3. The policy requires the insured to submit a signed proof of loss within 60 days of the insurer's request. The insurer mails the request on March 10. Which statement best describes the insured's obligation?

  1. The insured has no deadline because the request was not delivered in person
  2. The insured must submit the proof of loss within 60 days of the date the request was mailed Correct answer.
  3. The insured must submit the proof of loss within 60 days of the fire date
  4. The insured may wait until the insurer completes its own investigation

Explanation

Proof-of-loss deadlines generally run from the date the insurer requests the document, not the date of loss. The request triggers the clock, and mailing is a common delivery method that starts it.

Question 42Claims Handling and Investigation

A claims adjuster is assigned a first-party property claim. Which activity is the adjuster's most important initial step?

  1. Confirming coverage and the date of loss Correct answer.
  2. Ordering a certified copy of the police report
  3. Referring the file to outside counsel
  4. Negotiating a settlement figure with the insured

Explanation

Before evaluating damages, the adjuster must confirm that the policy was in force on the loss date and that the loss falls within the grant of coverage. Settlement negotiation comes after coverage and damages are established.

Question 43Claims Handling and Investigation

During an interview, an insured gives a statement that conflicts with the information on the recorded statement taken a week earlier. What is the adjuster's best course of action?

  1. Accept the later statement because it is more recent
  2. Disregard both statements and rely on the police report
  3. Close the file because the insured is being untruthful
  4. Document the discrepancy and seek clarification before relying on either Correct answer.

Explanation

Inconsistencies should be documented and clarified rather than resolved by assumption. The adjuster should ask the insured to explain the difference and corroborate with other evidence.

Question 44Claims Handling and Investigation

Which of the following is the primary purpose of a reservation-of-rights letter?

  1. To preserve the insurer's right to deny coverage later while it investigates Correct answer.
  2. To deny the claim outright while the investigation continues
  3. To transfer the claim to another insurer
  4. To demand that the insured submit to an examination under oath

Explanation

A reservation-of-rights letter tells the insured that the insurer is investigating and has not yet decided coverage, preserving its ability to deny later. It is not a denial and does not itself create duties on the insured.

Question 45Claims Handling and Investigation

An insured reports a theft of jewelry from a hotel room. The policy contains a special limit for jewelry and requires a police report for theft claims. Which step should the adjuster take first?

  1. Pay the full scheduled jewelry limit immediately
  2. Ask the insured to sign a release before any investigation
  3. Confirm whether a police report was filed and verify the special limit Correct answer.
  4. Deny the claim because the loss occurred away from home

Explanation

The adjuster should verify compliance with the policy condition requiring a police report and apply the special limit that caps recovery for jewelry. Both affect the amount payable and must be established early.

Question 46Claims Handling and Investigation

An adjuster suspects a fire was intentionally set. Which evidence is most probative of an incendiary origin?

  1. The home had old electrical wiring
  2. A trained canine alerted to accelerant at multiple separate locations Correct answer.
  3. The insured was behind on mortgage payments
  4. Neighbors reported the insured was away that night

Explanation

Multiple independent accelerant alerts by a trained canine support a finding of incendiary origin, especially when corroborated by laboratory testing. Financial motive and opportunity are relevant but do not establish cause.

Question 47Claims Handling and Investigation

A liability claimant demands payment before the insurer has completed its investigation. How should the adjuster respond?

  1. Tell the claimant the insurer will never pay
  2. Pay the demand to avoid a bad-faith claim
  3. Explain that the investigation is ongoing and provide a reasonable timeline Correct answer.
  4. Refuse all contact until a lawsuit is filed

Explanation

The adjuster should communicate the status of the investigation and set reasonable expectations without admitting or denying liability prematurely. Prompt, honest communication supports good-faith handling.

Question 48Claims Handling and Investigation

Which document typically establishes the scope of an insured's duties after a loss?

  1. The declarations page
  2. The agent's commission schedule
  3. The policy's duties-after-loss condition Correct answer.
  4. The certificate of insurance

Explanation

The duties-after-loss condition sets out what the insured must do, such as giving notice, protecting property, and submitting a proof of loss. The declarations page identifies the insured, limits, and policy period.

Question 49Claims Handling and Investigation

An insured fails to mitigate further damage after a covered water loss, and additional damage results. How should the adjuster handle the additional damage?

  1. Deny the entire claim including the originally covered damage
  2. Pay all damage because the original loss was covered
  3. Evaluate whether the additional damage is excluded due to failure to mitigate Correct answer.
  4. Pay the additional damage as a goodwill gesture

Explanation

The insured has a duty to take reasonable steps to protect property from further damage. Damage that results from a failure to mitigate may be excluded, while the originally covered damage is still evaluated.

Question 50Claims Handling and Investigation

What is the purpose of taking a recorded statement from a claimant in a liability investigation?

  1. To determine the claimant's creditworthiness
  2. To obtain a signed release of all claims
  3. To lock the claimant into a version of events and preserve their account Correct answer.
  4. To satisfy a statutory requirement in every state

Explanation

A recorded statement preserves the claimant's account of the accident while memories are fresh and can be compared with other evidence. It is not a release and is not required by statute in all states.