GUIDEWIRE PART 3 EXAM
QUESTIONS WITH CORRECT
ANSWERS RATED A+
Adjudication:GTheGfunctionalGperspectiveG-GCORRECTGANSWERS-
AdjudicationGisGtheGprocessGofGdeterminingGifGaGclaimGwillGbeGpaid,GandGifGso,GhowGmuchGyouGareG
goingGtoGpay.GItGincludesGeverythingGfromGwhenGtheGclaimGisGfirstGreported,GtoGissuingGtheGfinalGpa
ymentGandGclosingGtheGclaim.GInGClaimCenter,GthisGincludesGcompletingGallGofGtheGrelevantGactiviti
esGonGtheGclaimGandGitsGexposures.GMovingGtheGclaimGandGexposuresGtoGabilityGtoGpay,GmeansGup
datingGtheGdataGonGthoseGobjectsGsoGthatGallGofGtheGdataGrequirementsGareGmetGtoGmakeGthemGpa
yable.
CommonGquestionsGduringGadjudicationG-GCORRECTGANSWERS-
ThereGmayGbeGtwoGissuesGinvolvedGinGevaluatingGanGinsurer'sGresponsibilityGregardingGaGloss.GFirst
.GwasGthereGaGpolicyGinGeffectGatGtheGtimeGofGtheGloss?GAnd,GdoGanyGofGtheGcoveragesGonGtheGpolic
yGcoverGtheGloss?GNotGonlvGmustGaGpolicyGbeGinGeffectGatGtheGtimeGofGtheGloss,GbutGthereGmustGbeG
coverageGforGtheGspecificGloss.
CoverageGTerms,GsuchGasGdeductiblesGandGlimitsGwillGdetermineGifGaGpaymentGshouldGbeGmadeGan
dGhowGhighGitGshouldGbe
ToGhelpGdetermineGtheGinsurer'sGresponsibility,GtheGclaimGmustGincludeGtheGwhere,GwhenGandGho
wGtheGlossGoccurred.GIt'sGalsoGimportantGtoGknowGifGotherGpartiesGwereGinvolved.GThisGmayGhaveGa
GbearingGonGpaymentGtoGthirdGparties,GorGtoGdetermineGshared
responsibilityGforGtheGclaim.
Sometimes,GthereGisGrelevantGinformationGavailableGfromGotherGagencies.GTheGMetropolitanGRep
ortingGBureauGprovidesGnationwideGpoliceGaccidentGandGincidentGreportsGinGtheGUnitedGStatesGCla
imCenterGhasGbuilt-
inGsupportGforGthisGservice.GForGWorkers'GCompGclaims,GotherGrelevantGinformationGmayGincludeG
medicalGbillsGandGreports.
AdjudicationGincludes
,determiningGhowGmuchGtoGpayGeachGclaimant.GSometimesGthisGisGaGsimpleGprocess,GbutGitGmayGin
cludeGevaluatingGtheGcostGofGrepairGversusGtheGcostGofGreplacementGorGvalue.GForGexampleGifGaGcar
GisGheavilvGdamaged,GtheGcostGtoGrepairGitGmayGbeGhigherGthanGtheGvalueGofGtheGcar.GInGthatGcase,Gt
heGinsurerGwillGpayGtheGclaimantGtheGvalueGofGtheGcar
AdjudicationG-GIncidentsG-GCORRECTGANSWERS-
InGClaimCenterGterms,GanGincidentGisGaGsingleGinstanceGofGloss.GItGisGtheGdamagedGpropertyGorGinju
redGperson.GInGthisGexample,GtheGclaimGisGanGautoGclaim.GAutoGclaimsGmayGincludeGvehicle,Gproper
ty,GandGbodilyGinjuryGincidents.GThisGclaimGincludesGtwoGinjuryGincidentsGsinceGtwoGpeopleGwereGi
njured,GandGoneGvehicleGincident.GAGpropertyGclaim,GsuchGasGaGhomeownersGclaim,GwouldGtypicall
yGincludeGaGpropertyGincident,Ghowever,GitGcouldGalsoGincludeGaGbodilyGinjuryGincident.
Workers'GCompGclaimsGonlyGhaveGinjuryGincidents.
IncidentsGrecordGwhatGwasGdamaged,GwithoutGhavingGtoGcreateGexposures.GForGexample,GifGaGvehi
cleGisGdamaged,GrepairingGtheGdamageGmayGcrossGmultipleGcoverages.GItGmayGinvolveGcollisionGco
verageGforGtheGvehicleGrepairGasGwellGasGtowingGcoverageGtoGgetGtheGvehicleGtoGtheGshop.
Note:GNotGallGinsurersGseparateGtheseGtwoGcoverages.GThisGisGanGexampleGofGhowGseparatingGtheG
damagedGitemGfromGtheGcoverageGworks.GIfGtheGcoverageGandGincidentsGwereGtheGsameGobject,Gt
henGtheGvehicleGinformationGwouldGbeGrecordedGtwice,GonceGforGtheGcollisionGandGonceGforGtowin
g.
AdjudicationG-GCoverageG-GCORRECTGANSWERS-InGpropertyGandGcasualty
insurance,GtheGgoalGisGtoGrestoreGaGpolicyholderGtoGtheGsameGfinancialGpositionGtheyGwereGinGprior
GtoGtheGloss.GPoliciesGhaveGspecificGcoveragesGforGspecificGtypesGofGloss.GAGgivenGcaseGofGlossGmayGi
nvolveGmultipleGcoveragesGandGclaimants.GForGexample,GinGanGautoGaccident,GtheGinsuredGdriverGh
itsGanotherGcarGandGbothGcarsGhaveGbodyGdamage.GTheGinsured'sGautoGmayGneedGtoGbeGtowedGwh
ichGfallsGunderGtowingGcoverage.GInGtheGsameGaccident,GonlyGtheGpassengerGofGtheGotherGvehicleGi
sGinured.GTheGcoveragesGinvolvedGinGthisGexampleGwouldGbe,GCollisionG-
GcoveringGdamageGtoGtheGinsured'sGcar,GLiabilityG-GpropertyGdamageG-
GcoveringGtheGdamageGtoGtheGotherGparty'sGvehicle,GandGLiabilityG-GbodilyGinjuryG-
GcoveringGtheGinjuriesGofGtheGpassengerGinGtheGotherGvehicle.
ThisGaccidentGalsoGinvolvesGmultipleGclaimants.GtheGinsured,GtheGownerGofGtheGotherGvehicle,Gand
GtheGpassengerGthatGwasGinjured.
,AdjudicationG-GTheGprimaryGelementsGofGanGexposureG-GCORRECTGANSWERS-
AnGexposureGisGtheGmechanismGthatGClaimCenterGusesGtoGtrackGpotentialGpaymentsGforGoneGcove
rageGtoGoneGclaimant.GThereGareGfourGprimaryGelementsGwithinGanGexposure.
-GTheGcoverageGfromGtheGpolicyGthatGmavGcoverGtheGloss
-GTheGclaimantGtoGwhomGpaymentGmayGbeGmade.
-GTheGincident,GwhichGisGtheGitemGwhichGwasGlostGorGdamaged,
-GTheGreserveGlines,GwhichGisGtheGmoneyGsetGasideGtoGmakeGtheGpayments
WhenGanGexposureGisGcreated,GtheGuserGmustGspecifyGtheGcoverage,GtheGclaimant,GandGtheGincide
nt.
ReserveGlines,GwhichGisGtheGmoneyGfromGwhichGpaymentsGareGmade,GmayGbeGaddedGlaterGasGmor
eGinformationGisGgatheredGaboutGtheGexposure.GInGtheGautoGaccidentGexample,GearlyGinGtheGproce
ss,GthereGwouldGbeGaGcollisionGexposureGforGtheGinsuredGandGtheirGvehicle.GHowever,GtheGadjuster
GmayGnotGknowGhowGmuchGmoneyGshouldGbeGsetGasideGinGtheGreserveGlineGuntilGafterGaGrepairGesti
mateGisGreceived
AdjudicationG-GExposuresG-GCORRECTGANSWERS-
InGtheGautoGclaimGexample,GtheGinsuredGandGaGthirdGpartyGareGbothGinjured.GTheGinsured'sGvehicle
GisGalsoGdamaged.GwhichGmeansGthreeGexposuresGareGrequired:GoneGtoGindemnifyGtheGinsuredGforG
damageGdoneGtoGhisGcar,GoneGtoGindemnifyGtheGinsuredGforGmedicalGbillsGrelatedGtoGhisGinjury,Gand
GoneGtoGindemnifyGtheGthirdGpartyGforGherGmedicalGbills.GInGthisGcase,GthereGareGtwoGclaimantsGan
dGthreeGexposures.GRemember,
exposuresGconnectGtheGcoveragesGinvolvedGtoGaGclaimant.
AdjudicationG-GWhoGcreatesGexposures?G-GCORRECTGANSWERS-
ExposuresGcanGbeGcreatedGautomaticallyGbyGbusinessGrules
TheGautomaticGcreationGofGexposuresGisGdoneGasGpartGofGtheGAutomatedGClaimGSetupGwhichGisGex
ecutedGwithinGtheGNewGClaim
, Wizard.GExposuresGcanGalsoGbeGcreatedGmanuallyGbyGaGCustomerGServiceGRepresentative,GanGAdju
ster,GorGanyGuserGwithGtheGproperGrole.GTheyGcanGbeGcreatedGduringGtheGintakeGprocessGasGpartGofG
theGNewGClaimGWizard,GorGanyGtimeGafterGtheGclaimGisGcreated.
AdjudicationG-GExposuresGandGcoveragesG-GCORRECTGANSWERS-
ThereGareGtwoGoptionsGforGaGuserGtoGmanuallyGaddGanGexposureGtoGaGclaim.GTheGfirstGisGtoGaddGitGb
yGtheGCoverageGType.GThisGoptionGallowsGtheGuserGtoGaddGanGexposureGagainstGanyGCoverageGTyp
e,GevenGifGtheGpolicyGattachedGtoGtheGclaimGdoesGnotGincludeGthatGcoverageGtype.GThisGcouldGbeGu
sefulGifGtheGpolicyGisGunderGreviewGevenGwhileGtheGadiusterGisGobtainingGmoreGinformationGaboutG
theGclaim
TheGsecondGoptionGisGtoGaddGanGexposureGbyGcoverage.GOnlyGtheGCoverageGtypesGonGtheGpolicyGat
tachedGtoGtheGclaimGwillGbeGavailableGasGoptions.GInGthisGexample,GtheGpolicyGincludesGcoverageGfo
rGLiability,GCollision,GComprehensive,GandGMedicalGpayments.
AdjudicationG-GFinancialsG-GCORRECTGANSWERS-
TheGfinancialGsideGofGadiudicationGisGtheGprocessGofGsettingGasideGmoneyGandGissuingGpaymentsGt
oGclaimants.GAnGexposureGtracksGpotentialGpaymentsGfromGoneGcoverageGtoGoneGclaimant.
AlthoughGanGexposureGisGtheGlinkGbetweenGcoveragesGandGclaimants,GitGdoesGnotGrecordGamounts
GofGmoney,GpaidGorGreserved.GThoseGamountsGofGmoneyGareGrecordedGinGReserve
lines.
AdjudicationG-GReserveGlinesG-GCORRECTGANSWERS-
AGreserveGlineGcanGbeGthoughtGofGasGanGaccountGsetGasideGforGoneGspecificGaspectGofGexposureGpr
ocessing.GItGcontainsGbothGcreditsGandGdebits,GandGitsGsizeGisGequalGtoGtheGsumGofGtheGcreditsGmin
usGtheGsumGofGtheGdebits.GTheGcreditsGareGaddedGtoGaccountGforGmoneyGthatGwillGpotentiallyGbeGp
aidGagainstGanGexposure,GandGtheGdebitsGareGusuallyGpaymentsGagainstGtheGexposure.GAnGexposur
eGmustGhaveGaGreserveGlineGinGorderGforGitGtoGbeGpayable.
WithoutGaGreserveGline,GthereGisGnoGmoneyGsetGasideGtoGpayGtheGexposure.GClaimCenterGusesGtheG
termG"reserveGline"GtoGreferGtoGtheGtotalGamountGofGmoneyGsetGasideGforGexposureGpayment,Gand
"reserveGtransaction"GrefersGtoGtheGtransactionGthatGincreasesGorGdecreasesGinGtheGamountGofGmo
neyGsetGasideGforGexposureGpayment.
QUESTIONS WITH CORRECT
ANSWERS RATED A+
Adjudication:GTheGfunctionalGperspectiveG-GCORRECTGANSWERS-
AdjudicationGisGtheGprocessGofGdeterminingGifGaGclaimGwillGbeGpaid,GandGifGso,GhowGmuchGyouGareG
goingGtoGpay.GItGincludesGeverythingGfromGwhenGtheGclaimGisGfirstGreported,GtoGissuingGtheGfinalGpa
ymentGandGclosingGtheGclaim.GInGClaimCenter,GthisGincludesGcompletingGallGofGtheGrelevantGactiviti
esGonGtheGclaimGandGitsGexposures.GMovingGtheGclaimGandGexposuresGtoGabilityGtoGpay,GmeansGup
datingGtheGdataGonGthoseGobjectsGsoGthatGallGofGtheGdataGrequirementsGareGmetGtoGmakeGthemGpa
yable.
CommonGquestionsGduringGadjudicationG-GCORRECTGANSWERS-
ThereGmayGbeGtwoGissuesGinvolvedGinGevaluatingGanGinsurer'sGresponsibilityGregardingGaGloss.GFirst
.GwasGthereGaGpolicyGinGeffectGatGtheGtimeGofGtheGloss?GAnd,GdoGanyGofGtheGcoveragesGonGtheGpolic
yGcoverGtheGloss?GNotGonlvGmustGaGpolicyGbeGinGeffectGatGtheGtimeGofGtheGloss,GbutGthereGmustGbeG
coverageGforGtheGspecificGloss.
CoverageGTerms,GsuchGasGdeductiblesGandGlimitsGwillGdetermineGifGaGpaymentGshouldGbeGmadeGan
dGhowGhighGitGshouldGbe
ToGhelpGdetermineGtheGinsurer'sGresponsibility,GtheGclaimGmustGincludeGtheGwhere,GwhenGandGho
wGtheGlossGoccurred.GIt'sGalsoGimportantGtoGknowGifGotherGpartiesGwereGinvolved.GThisGmayGhaveGa
GbearingGonGpaymentGtoGthirdGparties,GorGtoGdetermineGshared
responsibilityGforGtheGclaim.
Sometimes,GthereGisGrelevantGinformationGavailableGfromGotherGagencies.GTheGMetropolitanGRep
ortingGBureauGprovidesGnationwideGpoliceGaccidentGandGincidentGreportsGinGtheGUnitedGStatesGCla
imCenterGhasGbuilt-
inGsupportGforGthisGservice.GForGWorkers'GCompGclaims,GotherGrelevantGinformationGmayGincludeG
medicalGbillsGandGreports.
AdjudicationGincludes
,determiningGhowGmuchGtoGpayGeachGclaimant.GSometimesGthisGisGaGsimpleGprocess,GbutGitGmayGin
cludeGevaluatingGtheGcostGofGrepairGversusGtheGcostGofGreplacementGorGvalue.GForGexampleGifGaGcar
GisGheavilvGdamaged,GtheGcostGtoGrepairGitGmayGbeGhigherGthanGtheGvalueGofGtheGcar.GInGthatGcase,Gt
heGinsurerGwillGpayGtheGclaimantGtheGvalueGofGtheGcar
AdjudicationG-GIncidentsG-GCORRECTGANSWERS-
InGClaimCenterGterms,GanGincidentGisGaGsingleGinstanceGofGloss.GItGisGtheGdamagedGpropertyGorGinju
redGperson.GInGthisGexample,GtheGclaimGisGanGautoGclaim.GAutoGclaimsGmayGincludeGvehicle,Gproper
ty,GandGbodilyGinjuryGincidents.GThisGclaimGincludesGtwoGinjuryGincidentsGsinceGtwoGpeopleGwereGi
njured,GandGoneGvehicleGincident.GAGpropertyGclaim,GsuchGasGaGhomeownersGclaim,GwouldGtypicall
yGincludeGaGpropertyGincident,Ghowever,GitGcouldGalsoGincludeGaGbodilyGinjuryGincident.
Workers'GCompGclaimsGonlyGhaveGinjuryGincidents.
IncidentsGrecordGwhatGwasGdamaged,GwithoutGhavingGtoGcreateGexposures.GForGexample,GifGaGvehi
cleGisGdamaged,GrepairingGtheGdamageGmayGcrossGmultipleGcoverages.GItGmayGinvolveGcollisionGco
verageGforGtheGvehicleGrepairGasGwellGasGtowingGcoverageGtoGgetGtheGvehicleGtoGtheGshop.
Note:GNotGallGinsurersGseparateGtheseGtwoGcoverages.GThisGisGanGexampleGofGhowGseparatingGtheG
damagedGitemGfromGtheGcoverageGworks.GIfGtheGcoverageGandGincidentsGwereGtheGsameGobject,Gt
henGtheGvehicleGinformationGwouldGbeGrecordedGtwice,GonceGforGtheGcollisionGandGonceGforGtowin
g.
AdjudicationG-GCoverageG-GCORRECTGANSWERS-InGpropertyGandGcasualty
insurance,GtheGgoalGisGtoGrestoreGaGpolicyholderGtoGtheGsameGfinancialGpositionGtheyGwereGinGprior
GtoGtheGloss.GPoliciesGhaveGspecificGcoveragesGforGspecificGtypesGofGloss.GAGgivenGcaseGofGlossGmayGi
nvolveGmultipleGcoveragesGandGclaimants.GForGexample,GinGanGautoGaccident,GtheGinsuredGdriverGh
itsGanotherGcarGandGbothGcarsGhaveGbodyGdamage.GTheGinsured'sGautoGmayGneedGtoGbeGtowedGwh
ichGfallsGunderGtowingGcoverage.GInGtheGsameGaccident,GonlyGtheGpassengerGofGtheGotherGvehicleGi
sGinured.GTheGcoveragesGinvolvedGinGthisGexampleGwouldGbe,GCollisionG-
GcoveringGdamageGtoGtheGinsured'sGcar,GLiabilityG-GpropertyGdamageG-
GcoveringGtheGdamageGtoGtheGotherGparty'sGvehicle,GandGLiabilityG-GbodilyGinjuryG-
GcoveringGtheGinjuriesGofGtheGpassengerGinGtheGotherGvehicle.
ThisGaccidentGalsoGinvolvesGmultipleGclaimants.GtheGinsured,GtheGownerGofGtheGotherGvehicle,Gand
GtheGpassengerGthatGwasGinjured.
,AdjudicationG-GTheGprimaryGelementsGofGanGexposureG-GCORRECTGANSWERS-
AnGexposureGisGtheGmechanismGthatGClaimCenterGusesGtoGtrackGpotentialGpaymentsGforGoneGcove
rageGtoGoneGclaimant.GThereGareGfourGprimaryGelementsGwithinGanGexposure.
-GTheGcoverageGfromGtheGpolicyGthatGmavGcoverGtheGloss
-GTheGclaimantGtoGwhomGpaymentGmayGbeGmade.
-GTheGincident,GwhichGisGtheGitemGwhichGwasGlostGorGdamaged,
-GTheGreserveGlines,GwhichGisGtheGmoneyGsetGasideGtoGmakeGtheGpayments
WhenGanGexposureGisGcreated,GtheGuserGmustGspecifyGtheGcoverage,GtheGclaimant,GandGtheGincide
nt.
ReserveGlines,GwhichGisGtheGmoneyGfromGwhichGpaymentsGareGmade,GmayGbeGaddedGlaterGasGmor
eGinformationGisGgatheredGaboutGtheGexposure.GInGtheGautoGaccidentGexample,GearlyGinGtheGproce
ss,GthereGwouldGbeGaGcollisionGexposureGforGtheGinsuredGandGtheirGvehicle.GHowever,GtheGadjuster
GmayGnotGknowGhowGmuchGmoneyGshouldGbeGsetGasideGinGtheGreserveGlineGuntilGafterGaGrepairGesti
mateGisGreceived
AdjudicationG-GExposuresG-GCORRECTGANSWERS-
InGtheGautoGclaimGexample,GtheGinsuredGandGaGthirdGpartyGareGbothGinjured.GTheGinsured'sGvehicle
GisGalsoGdamaged.GwhichGmeansGthreeGexposuresGareGrequired:GoneGtoGindemnifyGtheGinsuredGforG
damageGdoneGtoGhisGcar,GoneGtoGindemnifyGtheGinsuredGforGmedicalGbillsGrelatedGtoGhisGinjury,Gand
GoneGtoGindemnifyGtheGthirdGpartyGforGherGmedicalGbills.GInGthisGcase,GthereGareGtwoGclaimantsGan
dGthreeGexposures.GRemember,
exposuresGconnectGtheGcoveragesGinvolvedGtoGaGclaimant.
AdjudicationG-GWhoGcreatesGexposures?G-GCORRECTGANSWERS-
ExposuresGcanGbeGcreatedGautomaticallyGbyGbusinessGrules
TheGautomaticGcreationGofGexposuresGisGdoneGasGpartGofGtheGAutomatedGClaimGSetupGwhichGisGex
ecutedGwithinGtheGNewGClaim
, Wizard.GExposuresGcanGalsoGbeGcreatedGmanuallyGbyGaGCustomerGServiceGRepresentative,GanGAdju
ster,GorGanyGuserGwithGtheGproperGrole.GTheyGcanGbeGcreatedGduringGtheGintakeGprocessGasGpartGofG
theGNewGClaimGWizard,GorGanyGtimeGafterGtheGclaimGisGcreated.
AdjudicationG-GExposuresGandGcoveragesG-GCORRECTGANSWERS-
ThereGareGtwoGoptionsGforGaGuserGtoGmanuallyGaddGanGexposureGtoGaGclaim.GTheGfirstGisGtoGaddGitGb
yGtheGCoverageGType.GThisGoptionGallowsGtheGuserGtoGaddGanGexposureGagainstGanyGCoverageGTyp
e,GevenGifGtheGpolicyGattachedGtoGtheGclaimGdoesGnotGincludeGthatGcoverageGtype.GThisGcouldGbeGu
sefulGifGtheGpolicyGisGunderGreviewGevenGwhileGtheGadiusterGisGobtainingGmoreGinformationGaboutG
theGclaim
TheGsecondGoptionGisGtoGaddGanGexposureGbyGcoverage.GOnlyGtheGCoverageGtypesGonGtheGpolicyGat
tachedGtoGtheGclaimGwillGbeGavailableGasGoptions.GInGthisGexample,GtheGpolicyGincludesGcoverageGfo
rGLiability,GCollision,GComprehensive,GandGMedicalGpayments.
AdjudicationG-GFinancialsG-GCORRECTGANSWERS-
TheGfinancialGsideGofGadiudicationGisGtheGprocessGofGsettingGasideGmoneyGandGissuingGpaymentsGt
oGclaimants.GAnGexposureGtracksGpotentialGpaymentsGfromGoneGcoverageGtoGoneGclaimant.
AlthoughGanGexposureGisGtheGlinkGbetweenGcoveragesGandGclaimants,GitGdoesGnotGrecordGamounts
GofGmoney,GpaidGorGreserved.GThoseGamountsGofGmoneyGareGrecordedGinGReserve
lines.
AdjudicationG-GReserveGlinesG-GCORRECTGANSWERS-
AGreserveGlineGcanGbeGthoughtGofGasGanGaccountGsetGasideGforGoneGspecificGaspectGofGexposureGpr
ocessing.GItGcontainsGbothGcreditsGandGdebits,GandGitsGsizeGisGequalGtoGtheGsumGofGtheGcreditsGmin
usGtheGsumGofGtheGdebits.GTheGcreditsGareGaddedGtoGaccountGforGmoneyGthatGwillGpotentiallyGbeGp
aidGagainstGanGexposure,GandGtheGdebitsGareGusuallyGpaymentsGagainstGtheGexposure.GAnGexposur
eGmustGhaveGaGreserveGlineGinGorderGforGitGtoGbeGpayable.
WithoutGaGreserveGline,GthereGisGnoGmoneyGsetGasideGtoGpayGtheGexposure.GClaimCenterGusesGtheG
termG"reserveGline"GtoGreferGtoGtheGtotalGamountGofGmoneyGsetGasideGforGexposureGpayment,Gand
"reserveGtransaction"GrefersGtoGtheGtransactionGthatGincreasesGorGdecreasesGinGtheGamountGofGmo
neyGsetGasideGforGexposureGpayment.
