West Virginia Adjusters Practice Exam

An adjuster can rightfully deny a claim when there is insufficient evidence of loss because claims are based on the principle of substantiation. Evidence is essential in establishing the validity and legitimacy of a claim. When the claimant fails to provide adequate documentation such as receipts, photos, or necessary reports that illustrate the extent of the loss, the adjuster cannot accurately assess the claim. In the absence of this proof, the adjuster's ability to evaluate the claim fairly is compromised, making it reasonable to deny the claim.

The other conditions mentioned may influence the decision but do not inherently justify a denial in the same direct way. For example, if a claim is excessive but still has valid evidence, it may need negotiation rather than outright denial. A customer's uncooperativeness may complicate the process, but that alone is not typically a sufficient reason for denial unless it directly prevents validation of the claim. Similarly, while a late submission of a claim can result in denial based on policy terms, it usually requires clarification of the circumstances rather than an automatic rejection based solely on timeliness. Each of these cases could necessitate further evaluation or attempts at resolution rather than immediate denial based on insufficient evidence.