AIC 300 - Claims in an Evolving World Questions and Answers well Explained Latest 2024/2025 Update 100% Correct.

Hanna is in IT and works on data analytics projects for an insurer. These projects involve analyzing large amounts of data to help underwriting to select risks and price policies. Hanna knows that collaboration between data science, IT, underwriting, and actuary is critical to the success of these projects. In Hanna's experience, as soon as the need for a data project arises, the key to collaborating effectively is to engage which one of the following teams as soon as possible? a. Data science b. Actuary c. Underwriting d. IT - a. Data science Carla is investigating a claim for a stolen car. The insured provided a copy of the police report, but she notices that the account in the police report differs from the insured's version of events. At this point, Carla should a. Refer the case to the SIU. b. Deny the claim. c. Contact the police. d. Continue with her investigation. - d. Continue with her investigation Soft fraud occurs when a claim is exaggerated and is also referred to as a. Opportunity fraud b. Financial fraud c. Reimbursement fraud d. Victimless fraud - a. Opportunity fraudIn which one of the following scenarios is the right of subrogation most likely to be employed by the insurer? a. An insured files a homeowners claim for stolen jewelry. An investigation reveals that the jewelry is still in the insured's possession. b. A claims rep discovers that their insured's car accident was caused by a road contractor who left equipment lying in the travel lanes of a highway. c. An investigation reveals that an insured set her own business on fire. d. An insured files a claim for collision damage from a hit and run accident, when in fact he backed into a utility pole. - b. A claims rep discovers that their insured's car accident was caused by a road contractor who left equipment lying in the travel lanes of a highway. In which one of the following scenarios is a public adjuster most likely to become involved? a. A catastrophic disaster strikes, involving damage to many properties. b. An insurer finds it financially unfeasible to hire its own claims staff in a given state. c. An insured is unable to afford legal representation to contest a claim. d. An insured's negotiations with the insurer on a complex claim are not going well. - d. An insured's negotiations with the insurer on a complex claim are not going well. Which one of the following methods of establishing case reserves is used most often when there are small variations in loss size for a particular type of claim? a. Individual case method. b. Formula method. c. Average value method. d. Roundtable method. - c. Average value method Chloe is an insurer defense attorney who is preparing a trial strategy. She has researched a court decision that was made in a similar case and is basing the defense on that precedent. Chloe is relying on the principle of stare decisis, which is thata. Lower courts must follow precedents set by any other courts. b. Lower courts must follow precedents set by higher courts. c. Higher courts must follow precedents set by lower courts. d. Higher courts must follow precedents set by any other counts. - b. Lower courts must follow precedents set by higher courts Which one of the following statements regarding state versions of the NAIC model act is correct? a. Only insureds may bring lawsuits against insurers. b. Only claimants may bring lawsuits against insurers. c. Some states allow insureds and claimants to bring lawsuits against insurers, while others allow only insureds. d. Both insureds and claimants may bring lawsuit against insurers. - c. Some states allow insureds and claimants to bring lawsuits against insurers, while others allow only insureds. In the process of assigning a claim, an internal claims handler will often transfer information to the insurer's standard form, called the a. Standard claims handling (SCH) form. b. Claim intake (CI) form. c. Initial acknowledgment of notice (IAN) form. d. First notice of loss (FNOL) form. - d. First notice of loss (FNOL) form 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? a. Leading b. Open-ended c. Indirectd. Direct - b. Open-ended As a claims representative, Beatrice is on the front lines for protecting her employer from insurance fraud. Beatrice should understand that insurance fraud a. Accounts for 25% of the P&C industry incurred losses. b. Costs roughly $40 billion per year, excluding health insurance. c. Is the costliest white-collar crime in the U.S. d. Costs each American family between $2,000 and $4,000 per year. - b. Costs roughly $40 billion per year, excluding health insurance. 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 a. Staff underwriter. b. Public underwriter. c. Personal lines underwriter. d. Line underwriter. - d. Line underwriter