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Insurance · Claim Investigation

What is a primary goal of the claims investigation an adjuster conducts?

Reviewed by Jordan Morley, Editorial Lead at 247SimpleTests. Written by the 247SimpleTests Editorial Team from the official source material cited on every question.

Correct answer

To determine the facts of the loss, whether the policy covers it, who or what caused it, and the extent of the damages, so the claim can be handled fairly and accurately

  1. A To raise the insured's premium
  2. B To sell additional coverage
  3. C To deny every claim
  4. D To determine the facts of the loss, whether the policy covers it, who or what caused it, and the extent of the damages, so the claim can be handled fairly and accurately

Why this is the answer

The claims investigation aims to establish the facts needed to handle a claim fairly and accurately: what happened (the cause and circumstances of the loss), whether the policy in force covers the loss (and any exclusions or conditions that apply), who or what was responsible, and the extent and value of the damages or injuries. The adjuster gathers evidence — such as the loss notice, photos, documents, statements, and expert reports — to reach a supported conclusion. The goal is a correct, fair determination, not to deny claims reflexively. Understanding the purpose and scope of the claims investigation is core content for the adjuster exam.
Source: NAIC Adjuster, Claims Investigation

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About this topic: Claim Investigation

Claim investigation questions cover gathering evidence, taking statements, inspecting damage, establishing coverage and cause of loss, and spotting fraud indicators — while meeting the time limits set by unfair-claims-practice rules. This is one of 10 Insurance Adjuster questions on claim investigation, each with a full explanation on a single study page.

New to this exam? Our Insurance exam guide explains the format, scoring, and how to prepare.

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