Claims Investigation and Damage Assessment
This domain tests how a public adjuster investigates a loss: securing the scene, determining cause and origin, separating covered from excluded damage, preserving evidence, and building a claim file that supports both the scope and the amount. The exam emphasizes sequence and documentation, not just damage descriptions.
Investigation sequence
- Take prompt notice, advise emergency mitigation, and document pre-mitigation conditions.
- Identify cause and origin with photographs, moisture readings, diagrams, and witness statements; retain an expert when the cause is technical or disputed.
- Separate damage by cause and trade: fire, smoke, water, mold, structural, contents, and additional living expense.
- Preserve evidence and maintain a chain of custody for samples or damaged items.
- Request the insurer's reservation of rights, and respond to examinations under oath and proof-of-loss requirements accurately.
- Watch for fraud indicators such as inconsistent timelines, inflated inventories, or pre-existing damage, and report concerns appropriately.
Worked example
A second-floor supply line bursts. The adjuster documents the crimp fitting, category-1 water, extraction, opened ceiling, and moisture readings. Photos show fresh staining at the fitting but old discoloration near the chimney. The covered scope includes access, drying, and repair of the active leak; the old chimney stain is excluded absent a covered cause. The adjuster writes a cause-and-origin narrative, separates the scopes, and inventories damaged contents room by room.
Traps that cost marks
- Photographing damage after repairs begin without documenting the original condition.
- Treating all water damage as one cause.
- Missing additional living expense or contents.
- Accepting a cause label without testing or expert support.
- Discussing causation with the insurer without a written record.