AIC 300 - Claims in an Evolving World
B. By certified mail with a return receipt requested.
Some will also send a copy via regular mail in case the certified letter is not
accepted. - ANSWER-Insurers usually send denial letters
Select one:
A. By email to ensure prompt receipt by the insured.
B. By certified mail with a return receipt requested.
C. By overnight courier.
D. By registered mail.
D. Subpoenaed.
Any written claims communication may be subpoenaed. - ANSWER-As methods
of communication evolve, it's important for claims professionals to remember that
any written claims communication may be
Select one:
A. Replaced with verbal communication.
B. Misinterpreted.
C. Edited later.
D. Subpoenaed.
D. An insured's negotiations with the insurer on a complex claim are not going
well.
If a claim is complex, or if settlement negotiations are not progressing with the
insurer, the insured may hire a public adjuster to protect his or her interests. -
ANSWER-In which one of the following scenarios is a public adjuster most likely
to become involved?
Select one:
A. An insurer finds it financially unfeasible to hire its own claims staff in a given
state.
,B. An insured is unable to afford legal representation to contest a claim.
C. A catastrophic disaster strikes, involving damage to many properties.
D. An insured's negotiations with the insurer on a complex claim are not going
well.
B. TPAs handle claims, keep claims records, and perform statistical analyses. -
ANSWER-Which one of the following statements regarding third-party
administrators (TPAs) is most accurate?
Select one:
A. TPAs are typically used by businesses that have chosen not to self-insure.
B. TPAs handle claims, keep claims records, and perform statistical analyses.
C. TPAs are generally found in an insurer's claims department.
D. TPAs are employed only by independent adjusting firms.
A. Proper releases taken
Proper releases taken is a qualitative audit factor; the others are quantitative. -
ANSWER-Hugo is conducting an audit of a branch office claims operation. He is
evaluating timeliness of reports, number of files opened, proper releases taken,
and accuracy of data entry. Which one of Hugo's metrics is a qualitative audit
factor?
Select one:
A. Proper releases taken
B. Timeliness of reports
C. Number of files opened
D. Accuracy of data entry
D. Line underwriter.
Line underwriter. This describes the duties of a line underwriter, rather than a
staff underwriter. There is not enough information to determine which line of
business is being written. A public underwriter does not exist. Line underwriters
evaluate new submissions and perform renewal underwriting, usually by working
directly with insurance producers and applicants. Staff underwriters, meanwhile,
manage risk selection by working with line underwriters and coordinating
decisions about products, pricing and guidelines. - ANSWER-Aaron works for a
,multi-line insurer. He works with insurance producers and applicants to evaluate
new business submissions and conduct renewal underwriting. Aaron is a
Select one:
A. Staff underwriter.
B. Public underwriter.
C. Personal lines underwriter.
D. Line underwriter.
D. Listening.
Claims professionals should first listen carefully to understand what the claimant
is saying. - ANSWER-The first key to communicating empathetically as a claims
professional is
Select one:
A. A comprehensive understanding of relevant insurance policies.
B. Speaking calmly and clearly.
C. Being prepared with all documentation relating to the claim.
D. Listening.
C. Cost to investigate, defend, and settle claims.
Cost to investigate, defend, and settle claims. LAE is the expense that an insurer
incurs to investigate, defend, and settle claims according to the terms specified in
the insurance policy. - ANSWER-Mia tracks loss adjustment expense (LAE) as
part of her management of the claims department for an insurer. Mia considers
LAE to be the
Select one:
A. Total amount of loss reserves of all claims.
B. Paid portion of claims.
C. Cost to investigate, defend, and settle claims.
D. Total incurred amount of claims.
D. Claim representative.
Claim reps collaborate with more than other insurer employees. Many insurers
employ a panel of experts that the claims rep can select according to the
investigation's needs. - ANSWER-In her role with an insurer, Katarina has
, opportunity to collaborate with not only employees from her company, but also
external experts with particular expertise. For example, as part of her
investigation, she hired an engineer to conduct a review of a machine that was
involved in a personal injury. Katarina is a(n)
Select one:
A. Medical provider.
B. Expert Witness.
C. Premium auditor.
D. Claim representative.
A. Open-ended
Open-ended questions can be used to clarify an interviewee's statements. -
ANSWER-When Mehmet interviews witnesses as part of his claims investigation,
he asks different types of questions based on need, such as open-ended, direct,
indirect, and leading. Which type of question should Mehmet ask when he wants
to set the interviewee at ease and he is looking for explanation or elaboration of
details in the interviewee's own words?
Select one:
A. Open-ended
B. Direct
C. Indirect
D. Leading
D. Large loss report.
Most insurers have guidelines outlining when and under what circumstances
large loss reports should be prepared. - ANSWER-Charlotte is handling a new
claim and she has set the initial reserves at $1,000,000. She has been asked to
complete an internal report summarizing all the file status information for
distribution to management and updated as more information is received. The
report Charlotte is completing is most likely a
Select one:
A. Status report.
B. Summarized report.
C. Preliminary report.
D. Large loss report.
B. By certified mail with a return receipt requested.
Some will also send a copy via regular mail in case the certified letter is not
accepted. - ANSWER-Insurers usually send denial letters
Select one:
A. By email to ensure prompt receipt by the insured.
B. By certified mail with a return receipt requested.
C. By overnight courier.
D. By registered mail.
D. Subpoenaed.
Any written claims communication may be subpoenaed. - ANSWER-As methods
of communication evolve, it's important for claims professionals to remember that
any written claims communication may be
Select one:
A. Replaced with verbal communication.
B. Misinterpreted.
C. Edited later.
D. Subpoenaed.
D. An insured's negotiations with the insurer on a complex claim are not going
well.
If a claim is complex, or if settlement negotiations are not progressing with the
insurer, the insured may hire a public adjuster to protect his or her interests. -
ANSWER-In which one of the following scenarios is a public adjuster most likely
to become involved?
Select one:
A. An insurer finds it financially unfeasible to hire its own claims staff in a given
state.
,B. An insured is unable to afford legal representation to contest a claim.
C. A catastrophic disaster strikes, involving damage to many properties.
D. An insured's negotiations with the insurer on a complex claim are not going
well.
B. TPAs handle claims, keep claims records, and perform statistical analyses. -
ANSWER-Which one of the following statements regarding third-party
administrators (TPAs) is most accurate?
Select one:
A. TPAs are typically used by businesses that have chosen not to self-insure.
B. TPAs handle claims, keep claims records, and perform statistical analyses.
C. TPAs are generally found in an insurer's claims department.
D. TPAs are employed only by independent adjusting firms.
A. Proper releases taken
Proper releases taken is a qualitative audit factor; the others are quantitative. -
ANSWER-Hugo is conducting an audit of a branch office claims operation. He is
evaluating timeliness of reports, number of files opened, proper releases taken,
and accuracy of data entry. Which one of Hugo's metrics is a qualitative audit
factor?
Select one:
A. Proper releases taken
B. Timeliness of reports
C. Number of files opened
D. Accuracy of data entry
D. Line underwriter.
Line underwriter. This describes the duties of a line underwriter, rather than a
staff underwriter. There is not enough information to determine which line of
business is being written. A public underwriter does not exist. Line underwriters
evaluate new submissions and perform renewal underwriting, usually by working
directly with insurance producers and applicants. Staff underwriters, meanwhile,
manage risk selection by working with line underwriters and coordinating
decisions about products, pricing and guidelines. - ANSWER-Aaron works for a
,multi-line insurer. He works with insurance producers and applicants to evaluate
new business submissions and conduct renewal underwriting. Aaron is a
Select one:
A. Staff underwriter.
B. Public underwriter.
C. Personal lines underwriter.
D. Line underwriter.
D. Listening.
Claims professionals should first listen carefully to understand what the claimant
is saying. - ANSWER-The first key to communicating empathetically as a claims
professional is
Select one:
A. A comprehensive understanding of relevant insurance policies.
B. Speaking calmly and clearly.
C. Being prepared with all documentation relating to the claim.
D. Listening.
C. Cost to investigate, defend, and settle claims.
Cost to investigate, defend, and settle claims. LAE is the expense that an insurer
incurs to investigate, defend, and settle claims according to the terms specified in
the insurance policy. - ANSWER-Mia tracks loss adjustment expense (LAE) as
part of her management of the claims department for an insurer. Mia considers
LAE to be the
Select one:
A. Total amount of loss reserves of all claims.
B. Paid portion of claims.
C. Cost to investigate, defend, and settle claims.
D. Total incurred amount of claims.
D. Claim representative.
Claim reps collaborate with more than other insurer employees. Many insurers
employ a panel of experts that the claims rep can select according to the
investigation's needs. - ANSWER-In her role with an insurer, Katarina has
, opportunity to collaborate with not only employees from her company, but also
external experts with particular expertise. For example, as part of her
investigation, she hired an engineer to conduct a review of a machine that was
involved in a personal injury. Katarina is a(n)
Select one:
A. Medical provider.
B. Expert Witness.
C. Premium auditor.
D. Claim representative.
A. Open-ended
Open-ended questions can be used to clarify an interviewee's statements. -
ANSWER-When Mehmet interviews witnesses as part of his claims investigation,
he asks different types of questions based on need, such as open-ended, direct,
indirect, and leading. Which type of question should Mehmet ask when he wants
to set the interviewee at ease and he is looking for explanation or elaboration of
details in the interviewee's own words?
Select one:
A. Open-ended
B. Direct
C. Indirect
D. Leading
D. Large loss report.
Most insurers have guidelines outlining when and under what circumstances
large loss reports should be prepared. - ANSWER-Charlotte is handling a new
claim and she has set the initial reserves at $1,000,000. She has been asked to
complete an internal report summarizing all the file status information for
distribution to management and updated as more information is received. The
report Charlotte is completing is most likely a
Select one:
A. Status report.
B. Summarized report.
C. Preliminary report.
D. Large loss report.
