AIC 300 Questions And Answers With Verified Updates

classification tree parts - root node: first node in a classification tree leaf nodes: terminal node that is used to classify an instance recursively: successfully applying a model training data: used to train a predictive model, has known values holdout data: existing data not used for training, tests the model 3 Quality Measures of a Claims Dept - - best practices - claims audits - customer satisfaction data Diff types of claims investigations - - accident scene investigation - property damage investigation - medical investigation - prior claim investigation - subrogation investigation and recovery 3 types of legal approaches - mediation: neutral mediator to reach settlement appraisal: professional appraiser evaluates dollar portions litigation: court, creates a binding decision 5 Methods of Case Reserving - 1. Individual case method - based on claims circumstances and claim reps experience/opinion 2. Roundtable method - consensus of 2+ claims personnel 3. Avg value method - establishes a predetermined amount of reserve for each claim 4. Formula method - using a mathematical formula 5. Expert system method - software application estimates losses and LAEs7 Parts of Effective (sworn) Statements - 1. Permission and introduction (date/time of int, name of person, etc) 2. Identification (info of person being int) 3. Setting (who was involved, where) 4. Incident (step by step of what occurred) 5. Post incident injuries/damages (property damage, bodily injury) 6. Miscellaneous 7. Conclusion (confirm statement taken w permission) Activities in the claims handling process - 1. Acknowledge a claim and assigning it to a claims rep 2. Identifying the policy 3. Contacting the insured of the insured's representative 4. Investigating and documenting the claim 5. Determining the cause of loss and the loss amount 6. Concluding the claim bad faith claims - CLAIMS PRACTICES CAN BE USED AS GROUNDS FOR BAD FAITH - INAPPROPRIATE CLAIM DENIALS - EVEN IF GOOD-FAITH IS FOLLOWED, COURT CAN FIND COVERAGE DOES APPLY blockchain - a digital ledger that facilitates secure transactions without the need for a third party (ex: 1 car has 6 diff insureds/policies on it --> must be stopped) Claims Acknowledgement - claims process begins when an insurer receives a claim. this advises that the claim was received Claims denial - - denial letters are sent out, sometimes drafted by lawyers to ensure they comply with requirements - sent by certified mail, sometimes requested to be signed by addressee or marked confidentialClaims diary system - suspense/pending system combines work on a claim with documentation Claims file reports - - made for various parties (internal reports, large loss reports) - preliminary, status, and summarized reports may have attachments - some external reports for producers, advisory org, etc Claims file status notes - - activity log, accurately reflects and documents investigations, evaluations of claims, decisions to decline coverage, and decisions to settle claims - chronological account of claim rep's actions - open as long as claim is open coinsurance clauses - require the insured to carry insurance equal to at least a specified percentage of the insured property's value complex claims - a claim that contains one or more characteristics that cause it to cost more than the average claim contributory vs comparative negligence - Contributory is when an individual does not exercise reasonable care for their own safety. Comparative is the degree of negligence or carelessness of each party in a lawsuit. (can be split up % of who is to blame) critical aspects of contacting the insured - - Timing and method of contact - preparation and initial contact (prepare questions) Cross Industry Standard Process for Data Mining (CRISP-DM) - an accepted standard for the steps in any data mining process used to provide business solutionsbusiness understanding --> data understanding --> prepare data --> modeling