Los Angeles Claims Adjuster Property and Causality Practice Exam

How is a claim ultimately resolved according to the claims adjusting process?

1. The claimant accepts the policy limits

2. The insurer argues the case in court

3. The claim is either paid or denied

4. The adjuster finalizes the valuation

The correct answer is: The claim is either paid or denied

In the claims adjusting process, a claim is ultimately resolved when the insurer makes a decision to either pay the claim or deny it. This resolution follows an investigation into the circumstances of the claim, including evaluating the evidence presented and determining whether the loss is covered under the policy. When a claim is submitted, it typically goes through various stages, including reporting, investigation, and negotiations. Ultimately, the adjuster assesses the case based on the policy terms, the extent of coverage, and the validity of the claim itself. The conclusion reached by the insurer, whether that be a payment or a denial, signifies the closure of the claims process for that particular incident. This binary outcome reflects the insurer's final stance on the compensability of the claim as guided by the evidence and the policy provisions. The other options mentioned do not encapsulate the complete resolution process: accepting policy limits or arguing in court might be part of specific scenarios but do not represent the general outcome required to resolve a claim. Similarly, while finalizing the valuation is an important step in the process, it does not constitute the final resolution. Therefore, the claim's resolution hinges on the decision to either compensate the claimant or reject the claim based on the findings.