WITH ALL CORRECT ANSWERS 2025
NEW UPDATE
The claims litigation process begins with the receipt of - Answer-A summons and
complaint.
Soft fraud, also called opportunity fraud, occurs when - Answer-A legitimate claim is
exaggerated.
The first step in the data mining process is to - Answer-Understand what a business
wants to achieve.
Which one of the following statements regarding state versions of the NAIC model act is
correct? - Answer-Some states allow insureds and claimants to bring lawsuits against
insurers, while others allow only insureds.
Which one of the following is a data mining technique an insurer applies when it knows
what information it wants to predict? - Answer-Classification
Which one of the following statements regarding third-party administrators (TPAs) is
most accurate? - Answer-TPAs handle claims, keep claims records, and perform
statistical analyses.
As methods of communication evolve, it's important for claims professionals to
remember that any written claims communication may be - Answer-Subpoenaed.
In which one of the following scenarios is the right of subrogation most likely to be
employed by the insurer? - Answer-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.
Riko is an experienced settlement negotiator. When negotiating with claimant
representatives, she uses techniques such as timing settlements effectively, enticing a
reasonable demand, making concessions cautiously, and leaning on the evaluation.
She understands that her current claimant is eager to receive money, so she is delaying
the negotiations as long as possible. Which negotiation technique is Riko using? -
Answer-Timing settlements effectively
, Linnea is an attorney who is preparing to defend an insurer in a workers compensation
case. Discovery produced several documents that are being presented as witnesses
statements, but the witnesses admit in the statements to not actually seeing the
accident. Linnea would like to omit these statements from the proceedings, so she is
filing a - Answer-Motion in limine.
The first key to communicating empathetically as a claims professional is - Answer-
Listening.
In which one of the following scenarios is a public adjuster most likely to become
involved? - Answer-An insured's negotiations with the insurer on a complex claim are
not going well.
Mitsuki was severely injured when the safety latch on an amusement park ride failed
and she was thrown from the ride. In her lawsuit with the amusement park, Mitsuki was
awarded payment for pain and suffering, emotional distress, disfigurement, and loss of
earnings. Which one of Mitsuki's awards is considered special damages? - Answer-Loss
of earnings
Claims rep Lily is negotiating a claim settlement with an unrepresented claimant and
wishes to smooth the process. She is matching her demeanor, tone, and mannerisms to
those of the claimant. Lily is using which one of the following negotiation techniques? -
Answer-Using traditional sales techniques
To determine whether an insurer typically underreserves or overreserves claims,
actuaries compare the insurer's paid losses to - Answer-The insurer's case reserves.
Rin works for an insurer designing and using techniques to process large amounts of
data from various sources and providing knowledge based on the analysis of that data.
Rin is a(n) - Answer-Data scientist.
Tobias is a claims representative who understands the importance of good-faith claims
handling, including fair evaluation, good-faith negotiation, complete and accurate
documentation, and timely contact with all parties to a claim. Which one of Tobias'
good-faith claims handling practices helps his employer because the parties will be
more likely to remember details of the loss accurately? - Answer-Timely contact with all
parties to a claim
Although most policies are occurrence forms, covering claims that occur during the
policy period, some are claims-made forms. Which one of the following types of loss is
most likely to involve a claims-made form? - Answer-A medical malpractice claim.
Ella sued her insurer and alleged bad-faith claim handling after the insurer settled a
claim against her that Ella thought should have been denied. As a result of the
settlement, Ella's premium increased. In her suit, Ella claimed that the insurer rushed
the investigation and did not take all of her facts into consideration in her defense. While