Question

After receiving a claim assignment, a claim representative will identify the policy and assess the coverage available. Which one of the following statements is correct with respect to this activity?

1) The claim representative does not need to identify the policy before assessing the coverage.
2) The claim representative will assess the coverage before identifying the policy.
3) The claim representative will identify the policy before assessing the coverage.
4) The claim representative does not need to assess the coverage after identifying the policy.

Answer 1

The claim representative must identify the policy first and then assess the coverage available; this is crucial to ensure the assessment is based on the accurate policy details.

Step-by-step explanation:

Among the given statements about the responsibilities of a claim representative, the correct one is that the claim representative will identify the policy before assessing the coverage.

This is because a claim representative needs to verify that the claim pertains to a valid policy and determine the specifics of that policy before they can accurately assess the coverage that applies to the claimed event. It is a sequential process where identifying the policy is a prerequisite to evaluating coverage because the terms, limits, and exclusions specific to the identified policy will dictate the coverage available for a claim.