AIC 300 CLAIMS IN AN EVOLVING WORLD
FINAL COMPREHENSIVE ASSESSMENT TEST
PAPER QUESTIONS AND SOLUTIONS
⩥ Indemnify.
Answer: to restore a party that sustain a loss to the financial position
they had before. wont just pay anything - insurer's Claims Department
will conduct a good-faith investigation of a claim and pay only
legitimate claims that are covered by the policy.
⩥ Claims and insurer primary goals.
Answer: 1. Keep promise -fair prompt and equitable service when losses
involve 1st or 3rd party claims. 2. support the insurer profit goal
⩥ 1st party insurance.
Answer: Property insurance is considered first-party insurance because
the insurer, or second party, makes payment for covered losses directly
to the policyholder, or first party.
⩥ 3rd party insurance.
Answer: Liability insurance is considered third-party insurance because
the insurer makes payments on behalf of the policyholder to a claimant
(third party) who is injured or whose property is damaged by the
policyholder.
,⩥ claims department structure.
Answer: headed by a senior claims officer reporting to CEO or CFO
⩥ Insurance fraud costs how much per year.
Answer: Costs roughly $40 billion per year, excluding health insurance
⩥ third party administrators (TPAs).
Answer: an organization that administrative services associated with risk
financing and insurance. They are often associated with large
independent adjusting firms or with subsidiaries of insurers.
⩥ TPAs job.
Answer: TPAs handle claims, keep claims records, and perform
statistical analyses.
⩥ Claims representatives.
Answer: a person in charge of investigating, evaluating, and settling
claims
⩥ producers.
Answer: any of several kinds of personal (agents, brokers, sales reps)
who place insurance and surety business with insurers and who
,represents insurers or insureds or both. who insurer goes to. some even
pay small claims
⩥ public adjusters.
Answer: an outside organization or person hired by an insured to
represent in a claim in exchange for a fee. Some states have statutes that
govern the services public adjusters can provide. But, in general, a
public adjuster prepares an insured's claim and negotiates the settlement
with the staff claims representative or independent adjuster.
⩥ when are independent adjusters used.
Answer: used by insurers to handle claims in strategic locations, when
they don't need claims offices there. Could also be used to handle field
work, for specialized skills or when claims staff are too busy.
⩥ Line underwriters.
Answer: evaluate new submissions and perform renewal underwriting,
usually by working directly with insurance producers and applicants
⩥ Staff underwriters.
Answer: manage risk selection by working with line underwriters and
coordinating decisions about products, pricing, and guidelines
⩥ Underwriter key activates.
, Answer: 1. minimize adverse selection, 2. ensure adequate policy
surplus, 3. Enforce underwriting guidelines
⩥ The Claims Department relies on underwriters for.
Answer: thorough, accurate data about the circumstances under which
coverage was written.
⩥ Claims personnel help underwriters by.
Answer: ensuring that claims are paid fairly and according to their
respective policy. Proper, consistent, and efficient claims handling
enables underwriters to evaluate, select, and appropriately price loss
exposures.
⩥ claims & premium audits.
Answer: claims information benefits the premium audit function by
verifying employment classifications. Premium auditors can provide
inventory values, contractors' equipment lists, and other facts that are
important to the claims function.
⩥ The goal of insurer marketing is to.
Answer: effectively communicate to target audiences that the insurer's
products and services will meet their needs and to subsequently secure
customers, in support of the insurer's strategies and objectives.
⩥ An insurer's management team must decide.
FINAL COMPREHENSIVE ASSESSMENT TEST
PAPER QUESTIONS AND SOLUTIONS
⩥ Indemnify.
Answer: to restore a party that sustain a loss to the financial position
they had before. wont just pay anything - insurer's Claims Department
will conduct a good-faith investigation of a claim and pay only
legitimate claims that are covered by the policy.
⩥ Claims and insurer primary goals.
Answer: 1. Keep promise -fair prompt and equitable service when losses
involve 1st or 3rd party claims. 2. support the insurer profit goal
⩥ 1st party insurance.
Answer: Property insurance is considered first-party insurance because
the insurer, or second party, makes payment for covered losses directly
to the policyholder, or first party.
⩥ 3rd party insurance.
Answer: Liability insurance is considered third-party insurance because
the insurer makes payments on behalf of the policyholder to a claimant
(third party) who is injured or whose property is damaged by the
policyholder.
,⩥ claims department structure.
Answer: headed by a senior claims officer reporting to CEO or CFO
⩥ Insurance fraud costs how much per year.
Answer: Costs roughly $40 billion per year, excluding health insurance
⩥ third party administrators (TPAs).
Answer: an organization that administrative services associated with risk
financing and insurance. They are often associated with large
independent adjusting firms or with subsidiaries of insurers.
⩥ TPAs job.
Answer: TPAs handle claims, keep claims records, and perform
statistical analyses.
⩥ Claims representatives.
Answer: a person in charge of investigating, evaluating, and settling
claims
⩥ producers.
Answer: any of several kinds of personal (agents, brokers, sales reps)
who place insurance and surety business with insurers and who
,represents insurers or insureds or both. who insurer goes to. some even
pay small claims
⩥ public adjusters.
Answer: an outside organization or person hired by an insured to
represent in a claim in exchange for a fee. Some states have statutes that
govern the services public adjusters can provide. But, in general, a
public adjuster prepares an insured's claim and negotiates the settlement
with the staff claims representative or independent adjuster.
⩥ when are independent adjusters used.
Answer: used by insurers to handle claims in strategic locations, when
they don't need claims offices there. Could also be used to handle field
work, for specialized skills or when claims staff are too busy.
⩥ Line underwriters.
Answer: evaluate new submissions and perform renewal underwriting,
usually by working directly with insurance producers and applicants
⩥ Staff underwriters.
Answer: manage risk selection by working with line underwriters and
coordinating decisions about products, pricing, and guidelines
⩥ Underwriter key activates.
, Answer: 1. minimize adverse selection, 2. ensure adequate policy
surplus, 3. Enforce underwriting guidelines
⩥ The Claims Department relies on underwriters for.
Answer: thorough, accurate data about the circumstances under which
coverage was written.
⩥ Claims personnel help underwriters by.
Answer: ensuring that claims are paid fairly and according to their
respective policy. Proper, consistent, and efficient claims handling
enables underwriters to evaluate, select, and appropriately price loss
exposures.
⩥ claims & premium audits.
Answer: claims information benefits the premium audit function by
verifying employment classifications. Premium auditors can provide
inventory values, contractors' equipment lists, and other facts that are
important to the claims function.
⩥ The goal of insurer marketing is to.
Answer: effectively communicate to target audiences that the insurer's
products and services will meet their needs and to subsequently secure
customers, in support of the insurer's strategies and objectives.
⩥ An insurer's management team must decide.
