AIC 300 - Claims in an Evolving World
Questions & Answers
1.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
ANS 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.
2.As methods of communication evolve, it's important for claims
profession- als to remember that any written claims communication may be
Select one:
A. Replaced with verbal communication.
B. Misinterpreted.
C. Edited later.
D. Subpoenaed
ANS D. Subpoenaed.
Any written claims communication may be subpoenaed.
,3.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
ANS 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.
4.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
ANS B. TPAs handle claims, keep claims records, and perform
,statistical analyses.
5.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:
ANS A. Proper releases taken
Proper releases taken is a qualitative audit factor; the others are
quantitative.
6.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
ANS 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.
7.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
ANS D. Listening.
Claims professionals should first listen carefully to understand what the
claimant is saying.
8.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.
Questions & Answers
1.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
ANS 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.
2.As methods of communication evolve, it's important for claims
profession- als to remember that any written claims communication may be
Select one:
A. Replaced with verbal communication.
B. Misinterpreted.
C. Edited later.
D. Subpoenaed
ANS D. Subpoenaed.
Any written claims communication may be subpoenaed.
,3.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
ANS 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.
4.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
ANS B. TPAs handle claims, keep claims records, and perform
,statistical analyses.
5.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:
ANS A. Proper releases taken
Proper releases taken is a qualitative audit factor; the others are
quantitative.
6.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
ANS 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.
7.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
ANS D. Listening.
Claims professionals should first listen carefully to understand what the
claimant is saying.
8.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.
