Casualty Actuarial Society (CAS) Practice Exam

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What distinguishes independent adjusters from third-party administrators (TPAs)?

  1. Independent adjusters are internal staff members

  2. TPAs manage claims for self-insured businesses

  3. Independent adjusters operate only in office settings

  4. TPAs solely handle claim investigations

The correct answer is: TPAs manage claims for self-insured businesses

Independent adjusters and third-party administrators (TPAs) serve different roles in the insurance and claims management process. The correct answer highlights that TPAs manage claims specifically for self-insured businesses. This means that TPAs take on the responsibility of overseeing and handling claims when a business has opted to self-insure, as opposed to transferring risk entirely to an insurance carrier. Independent adjusters, on the other hand, are typically hired by insurance companies to conduct investigations and assess claims made under the terms of an insurance policy. They operate as external contractors and can work on a variety of claims for different insurance companies, providing the expertise needed to evaluate claims fairly, based on the information available. The other options either mischaracterize the roles of independent adjusters and TPAs or make incorrect statements about their operations. Internal staff members do not accurately define independent adjusters, as they are external professionals. Additionally, while TPAs manage claims, they do more than just claims management for self-insured businesses; they can handle various administrative functions as well, but it is the focus on self-insurance that distinguishes their primary role. The suggestion that independent adjusters operate only in office settings is incorrect, as they often conduct field work and engage directly with claimants. Lastly