California 6-20 Claims Adjuster Mock Exam-
Updated Question and Answers [100%
Correct] 2025/2026
What is the first step an adjuster should take when a claim is reported?
The adjuster should immediately acknowledge the claim, begin gathering relevant information,
and set up an investigation process to assess the facts of the incident.
How does an adjuster determine whether a claim falls within the scope of coverage?
The adjuster reviews the policy’s terms, endorsements, and exclusions to determine if the loss is
covered under the specific circumstances of the claim.
When a claim involves bodily injury, what documentation is crucial for an adjuster to review?
The adjuster must obtain medical records, injury reports, and any related documents to assess
the extent of injury and determine compensation under the policy.
How should an adjuster respond if a claimant submits an incomplete claim form?
The adjuster must promptly notify the claimant, explain what information is missing, and provide
a reasonable timeframe to submit the missing documentation.
What is the primary responsibility of an adjuster when dealing with a claim involving a total loss of a
vehicle?
The adjuster must assess the vehicle’s pre-loss value, including depreciation, and offer
compensation based on either the actual cash value (ACV) or replacement cost, depending on the policy.
How does an adjuster handle a situation where there is a conflict in witness statements?
The adjuster must conduct further investigation, gather additional evidence, and possibly
interview more witnesses to resolve inconsistencies and arrive at a fair assessment.
What should an adjuster do if fraud is suspected during the claim process?
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, The adjuster must refer the claim to the Special Investigations Unit (SIU), document all concerns,
and follow legal and ethical guidelines for handling suspected fraud.
How do adjusters assess claims for damage caused by natural disasters?
The adjuster evaluates the physical damage, reviews policy provisions for catastrophic events,
and ensures timely claims processing in accordance with disaster response protocols.
When is it appropriate for an adjuster to issue a reservation of rights letter?
When the adjuster has concerns about coverage and needs more time to investigate, a
reservation of rights letter informs the claimant that the insurer is reserving its right to deny the claim.
How should an adjuster address a situation where a policyholder is unhappy with a settlement offer?
The adjuster should listen to the claimant’s concerns, provide a clear explanation of how the
settlement was calculated, and explore options for further review or negotiation.
What factors must an adjuster consider when evaluating a homeowner’s insurance claim for water
damage?
The adjuster needs to determine the cause of the water damage, whether it’s covered under the
policy (e.g., flooding vs. a burst pipe), and assess the extent of the damage for compensation.
When does an adjuster need to notify the California Department of Insurance (CDI)?
An adjuster must notify CDI if there is a complaint, dispute, or indication of bad faith, as well as
when they encounter systemic issues that affect claim processing.
What role does an independent appraiser play in the claims process?
An independent appraiser provides an unbiased evaluation of property damage or loss when the
insurer and policyholder cannot agree on the amount of the claim.
How should an adjuster handle a claim where the damage is partially caused by the policyholder’s
negligence?
The adjuster must determine the extent of the policyholder’s responsibility and ensure the claim
is adjusted fairly, potentially involving deductibles or policy exclusions.
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,What action should an adjuster take when the policyholder requests an advance on a claim?
The adjuster should review the policy for provisions allowing for advance payments, ensure it’s
within the coverage limits, and document the request and approval process thoroughly.
In a case where a claim involves multiple parties, how does an adjuster handle apportioning liability?
The adjuster must investigate each party’s involvement, determine fault, and negotiate
settlements proportionally, ensuring equitable distribution based on the evidence.
How does an adjuster ensure that settlements are fair and comply with legal requirements?
The adjuster follows guidelines for fairness, reviews state regulations, ensures compliance with
policy terms, and keeps accurate records of all settlement negotiations and decisions.
What steps should an adjuster take when an insured requests to settle their claim quickly due to
financial hardship?
The adjuster must balance the need for a quick settlement with a thorough investigation,
ensuring that the settlement is fair and meets policy terms.
What is the purpose of a claims audit, and when should an adjuster expect one?
A claims audit ensures that the claim is processed correctly, and adjusters may undergo audits to
review decisions and ensure compliance with internal standards and regulations.
What is the adjuster's responsibility when dealing with claims involving loss of use, such as rental car
expenses?
The adjuster must review the policy to determine coverage for loss of use, ensure expenses are
reasonable, and verify the claimant’s eligibility for reimbursement.
How should an adjuster handle a situation where a claimant has a pre-existing condition that may affect
the outcome of the claim?
The adjuster must investigate the relationship between the pre-existing condition and the current
claim, applying policy exclusions as necessary and documenting findings clearly.
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, When can an adjuster approve a claim settlement without further investigation?
An adjuster can approve a settlement if the facts are clear, the policy terms are straightforward,
and the settlement falls within the policy limits and coverage.
How does an adjuster determine the correct policy limits for a claim?
The adjuster reviews the declarations page of the insurance policy, confirms any endorsements or
changes, and ensures the policyholder is compensated up to the correct limit.
What actions must an adjuster take when handling a claim for personal property loss?
The adjuster must assess the value of the lost items, verify coverage under the policy, and apply
any applicable deductions for depreciation or policy limits.
How should an adjuster manage a claim for a business that has been temporarily shut down due to a
covered loss?
The adjuster must calculate business interruption losses, considering lost income, operating
costs, and the duration of the shutdown, based on the policy terms.
When reviewing a commercial property claim, how does an adjuster calculate the repair cost?
The adjuster must assess the damage, obtain repair estimates, and ensure that the repairs are
consistent with the policy’s coverage for actual cash value or replacement cost.
What is the purpose of a claim diary, and why is it important for an adjuster?
A claim diary serves as a chronological record of all actions, communications, and decisions
related to the claim, ensuring transparency and providing documentation for potential audits.
How should an adjuster approach a claim involving both physical damage and bodily injury?
The adjuster must separately assess the physical damage to property and the medical expenses
for bodily injury, applying the appropriate coverage for each part of the claim.
What steps should an adjuster take when a policyholder disputes a denial of their claim?
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