Hawaii Insurance License Practice Exam

What may trigger an insurer's investigation into a claim?

1. The insured's request for a payout

2. Inconsistencies in the claim submission

3. The nature of the loss

4. The insurance agent's recommendation

The correct answer is: Inconsistencies in the claim submission

An insurer's investigation into a claim is primarily triggered by inconsistencies in the claim submission. When an insured submits a claim, the insurer is obligated to assess its validity, ensuring that all details align with policy provisions and the terms of coverage. If there are discrepancies in the information provided — such as conflicting statements, missing documentation, or anomalies in the amount claimed versus prior records or assessments — these inconsistencies can raise red flags for the insurer. The investigation is conducted to determine the legitimacy of the claim and to ensure that the insurer is not paying out a fraudulent or inflated claim. This process helps maintain the integrity of the insurance system and protects against potential losses from dishonest claims. Other aspects of the claim, like the request for payout or the nature of the loss, do not inherently suggest a need for investigation unless they align with inconsistencies or unusual circumstances within the submission itself. The insurance agent’s recommendation could also be irrelevant unless it points out specific concerns or contradictions in the claim.