AIC 300 - SIMULATED EXAM CORRECT
QUESTIONS & SOLUTIONS
Insurers and claim representatives must keep the promises specified in insurance
policies, as well as those created by the law. In insurance transactions, the insured pays
a premium for the insurer's promise to - ANSWER Handle claims in good faith.
Maja handled a large liability claim that settled above the policy limits. The insured is
now charging the claim was handled in bad faith. During their investigation of the bad-
faith claim, Maja and defense counsel discovered that the claimant had received the
payment from the insurer, but not the amount above the policy limits that was to come
from the insured's assets. Which one of the following defenses would Maja's defense
most likely invoke? - ANSWER Insured's collusion with the claimant.
Bettina's apartment is burglarized and several items are stolen. In filing her claim, she
tells her insurer that her stolen television was both newer and larger than it actually was.
This constitutes which one of the following types of fraud? - ANSWER Soft Fraud.
In liability claims, the claims rep will require an authorization from the injured party to -
ANSWER Obtain medical records.
Antonia has a general liability policy with a self-insured retention of $50,000. The policy
has an occurrence limit of $250,000 and an aggregate limit of $500,000. She had
submitted one prior claim this policy term for which $100,000 was paid by the insurer.
How much will Antonia's insurer pay on a subsequent claim under the same policy
period that is valued at $400,000? - ANSWER $250,000
Claims rep Miguel is conducting a settlement with a claimant. He constructs his first
offer so that the claimant will likely find it undesirable. This becomes the basis of
comparison for the second offer that he makes. Miguel understands that people -
ANSWER Feel empowered when given a choice.
Joy Insurance Company is interested in using data mining to solve a problem it is
having with claims fraud in one of its product lines. The first step it should take is -
ANSWER To understand what it wants to achieve.
Thomas is an attorney who is defending an insurer in a litigated case. He has located
documents that show the insured was aware of the issue that cause the injury to the
claimant before the accident. Thomas is concerned that this evidence will hurt his case.
He should - ANSWER Preserve the evidence as part of the record.
As a part of the first contact with an insured on a property damage claim, a claims
representative may provide a blank - ANSWER Proof of loss form.
, Ciara is going to college with the goal of working as a data scientist for an insurer. She
will need a strong foundation in mathematics and statistics, computer programming,
domain knowledge, and data science. Which one of Ciara's skills will require her to
understand the insurance profession to which the data is being applied? - ANSWER
Domain knowledge.
Rodrigo manages a claims department for an insurer and uses loss ratio as a measure
of the department's performance. Rodrigo calculates loss ratio as - ANSWER Losses
and LAE divided by earned premium.
Insurers usually send denial letters - ANSWER By certified mail with a return receipt
requested.
Jose is handling a workers compensation claim. The injured worker claims to have
strained his back when he lifted a box at work. He waited a day to report the injury
because he thought he would be okay. He asked Jose when he would be referred to a
back specialist and when he could expect his first check. Which one of the injured
worker's actions would be the most pertinent fraud indicator to Jose? - ANSWER Asking
for referral
Which one of the following terms encompasses types of fraud including false claims and
intentional losses? - ANSWER Hard Fraud.
A claims representative should have the ability to persuade or influence - ANSWER
Claimants, insured's, supervisors and others.
In her investigations into fraudulent claims, Laura uses information about the driver's
history and driving habits to determine factors such as speed, acceleration, and
location. Laura is using - ANSWER Telematics
Attorney Grace is representing an insurer in a case and is preparing a pretrial motion.
Her argument is that the court has no jurisdiction for the cause of action brought by the
claimant. Grace is preparing a - ANSWER Motion to Dismiss.
Among the methods used to pay claims are the issuance of checks and bank drafts.
The main difference between the two is that - ANSWER With a bank draft, the bank
must verify that the insurer has authorized payment.
The NAIC model act specifies that its provisions regarding bad-faith claims are to be
enforced by - ANSWER State Insurance Department.
Which one of the following can be applied over time to refine a model to better predict
results? - ANSWER Machine Learning
QUESTIONS & SOLUTIONS
Insurers and claim representatives must keep the promises specified in insurance
policies, as well as those created by the law. In insurance transactions, the insured pays
a premium for the insurer's promise to - ANSWER Handle claims in good faith.
Maja handled a large liability claim that settled above the policy limits. The insured is
now charging the claim was handled in bad faith. During their investigation of the bad-
faith claim, Maja and defense counsel discovered that the claimant had received the
payment from the insurer, but not the amount above the policy limits that was to come
from the insured's assets. Which one of the following defenses would Maja's defense
most likely invoke? - ANSWER Insured's collusion with the claimant.
Bettina's apartment is burglarized and several items are stolen. In filing her claim, she
tells her insurer that her stolen television was both newer and larger than it actually was.
This constitutes which one of the following types of fraud? - ANSWER Soft Fraud.
In liability claims, the claims rep will require an authorization from the injured party to -
ANSWER Obtain medical records.
Antonia has a general liability policy with a self-insured retention of $50,000. The policy
has an occurrence limit of $250,000 and an aggregate limit of $500,000. She had
submitted one prior claim this policy term for which $100,000 was paid by the insurer.
How much will Antonia's insurer pay on a subsequent claim under the same policy
period that is valued at $400,000? - ANSWER $250,000
Claims rep Miguel is conducting a settlement with a claimant. He constructs his first
offer so that the claimant will likely find it undesirable. This becomes the basis of
comparison for the second offer that he makes. Miguel understands that people -
ANSWER Feel empowered when given a choice.
Joy Insurance Company is interested in using data mining to solve a problem it is
having with claims fraud in one of its product lines. The first step it should take is -
ANSWER To understand what it wants to achieve.
Thomas is an attorney who is defending an insurer in a litigated case. He has located
documents that show the insured was aware of the issue that cause the injury to the
claimant before the accident. Thomas is concerned that this evidence will hurt his case.
He should - ANSWER Preserve the evidence as part of the record.
As a part of the first contact with an insured on a property damage claim, a claims
representative may provide a blank - ANSWER Proof of loss form.
, Ciara is going to college with the goal of working as a data scientist for an insurer. She
will need a strong foundation in mathematics and statistics, computer programming,
domain knowledge, and data science. Which one of Ciara's skills will require her to
understand the insurance profession to which the data is being applied? - ANSWER
Domain knowledge.
Rodrigo manages a claims department for an insurer and uses loss ratio as a measure
of the department's performance. Rodrigo calculates loss ratio as - ANSWER Losses
and LAE divided by earned premium.
Insurers usually send denial letters - ANSWER By certified mail with a return receipt
requested.
Jose is handling a workers compensation claim. The injured worker claims to have
strained his back when he lifted a box at work. He waited a day to report the injury
because he thought he would be okay. He asked Jose when he would be referred to a
back specialist and when he could expect his first check. Which one of the injured
worker's actions would be the most pertinent fraud indicator to Jose? - ANSWER Asking
for referral
Which one of the following terms encompasses types of fraud including false claims and
intentional losses? - ANSWER Hard Fraud.
A claims representative should have the ability to persuade or influence - ANSWER
Claimants, insured's, supervisors and others.
In her investigations into fraudulent claims, Laura uses information about the driver's
history and driving habits to determine factors such as speed, acceleration, and
location. Laura is using - ANSWER Telematics
Attorney Grace is representing an insurer in a case and is preparing a pretrial motion.
Her argument is that the court has no jurisdiction for the cause of action brought by the
claimant. Grace is preparing a - ANSWER Motion to Dismiss.
Among the methods used to pay claims are the issuance of checks and bank drafts.
The main difference between the two is that - ANSWER With a bank draft, the bank
must verify that the insurer has authorized payment.
The NAIC model act specifies that its provisions regarding bad-faith claims are to be
enforced by - ANSWER State Insurance Department.
Which one of the following can be applied over time to refine a model to better predict
results? - ANSWER Machine Learning
