Texas Adjuster Practice Test

What must an adjuster do if they deny a claim?

1. Notify the insured within 24 hours

2. Acknowledge the claim

3. Wait for the insured to appeal

4. Submit the denial to the state

The correct answer is: Acknowledge the claim

When an adjuster denies a claim, they must acknowledge the claim in their communication with the insured. Acknowledgment is a crucial step in the claims handling process, as it serves to formally inform the insured that their claim has been received and is being considered. This step also allows the adjuster to begin the dialogue regarding the particulars of the claim, including the reasons for the eventual denial. Acknowledge the claim ensures the insured understands that their situation is being taken seriously, and it lays the groundwork for the adjuster to explain how the decision was reached. It creates a transparency that is essential in maintaining trust in the insurance process. The acknowledgment may also include information about the next steps the insured can take, whether that involves providing further information, appealing the decision, or understanding the claims process moving forward. This acknowledgment does not necessarily mean that the adjuster agrees with the claim but rather confirms receipt and processing. It is integral in complying with regulatory requirements and best practices in the field of insurance claims.