COMPLETE SOLUTIONS 2025
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? - ANSWERProper
releases taken
The first key to communicating empathetically as a claims professional is -
ANSWERListening.
Mia tracks loss adjustment expense (LAE) as part of her management of the claims
department for an insurer. Mia considers LAE to be the - ANSWERCost to investigate,
defend, and settle claims.
As methods of communication evolve, it's important for claims professionals to
remember that any written claims communication may be - ANSWERSubpoenaed.
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) - ANSWERClaim
representative.
In which one of the following scenarios is a public adjuster most likely to become
involved? - ANSWERAn insured's negotiations with the insurer on a complex claim are
not going well.
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 -
ANSWERLine underwriter.
Which one of the following statements regarding third-party administrators (TPAs) is
most accurate? - ANSWERTPAs handle claims, keep claims records, and perform
statistical analyses.
In claims investigation, all bodily injury claims require - ANSWERA medical
investigation.
Before making initial contact with an insured or claimant, a claims representative should
- ANSWERPrepare a list of questions for the insured.
, Carolina is a claim representative handling a liability claim. She is speaking to the
claimant over the phone and has informed him that his statements must be true under
penalty of perjury. When completed, she sent a transcription of the conversation to the
claimant for him to sign before a notary. Carolina has taken a(n) - ANSWERRecorded
statement.
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 - ANSWERLarge loss
report.
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? -
ANSWERAverage value method
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? - ANSWEROpen-ended
In which one of the following scenarios is the right of subrogation most likely to be
employed by the insurer? - ANSWERA 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.
To determine whether an insurer typically underreserves or overreserves claims,
actuaries compare the insurer's paid losses to - ANSWERThe insurer's case reserves.
In the process of assigning a claim, an internal claims handler will often transfer
information to the insurer's standard form, called the - ANSWERFirst notice of loss
(FNOL) form.
One of Juan's responsibilities as a claims representative is to prepare internal reports,
such as preliminary, interim, large loss, and captioned. Which one of the reports Juan
prepares is required for claims with reserves that exceed a specified threshold? -
ANSWERLarge loss
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? -
ANSWERLoss of earnings