AIC 300 - CLAIMS IN AN EVOLVING
WORLD 2025 LATEST UPDATE(GRADED
A+)
Soft fraud, also called opportunity fraud, occurs when... - ANSWER A legitimate claim is
exaggerated.
The first key to communicating empathetically as a claims professional is... - ANSWER
Listening.
Claims professionals should first listen carefully to understand what the claimant is
saying.
The Office of Foreign Assets Control requires claims payors to check payees against a
database of... - ANSWER Known terrorists & drug traffickers
Mia tracks loss adjustment expense (LAE) as part of her management of the claims
department for an insurer. Mia considers LAE to be the... - ANSWER Cost to
investigate, defend & settle claims
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.
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.
When Mehmet interviews witnesses as part of his claim 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? - ANSWER Open-Ended.
Open-Ended questions can be used to clarify an interviewee's statements.
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.
, Timely contact with all parties to a claim helps ensure that parties will be more likely to
remember details of the loss accurately.
In seeking to identify claims that will potentially develop into complex and more costly
claims, the data science team at Great Midsouthwest Insurance ranks a series of
attributes by their importance to the data model. Which one of the following terms best
describes the level of predictive power of each attribute? - ANSWER Information Gain.
Information gain is a measure of the predictive power of one or more attributes.
Not long after Valteri issued a denial and closed the claim, the insured sued for
coverage and alleged bad-faith claim handling against the insurer. Valteri was able to
demonstrate for his superiors that he had made a good-faith investigation and
determined that the claim was not covered by the policy. The insurer maintains that
Valteri had reasonable justification in fact for denying the claim. The insurer is
employing the... - ANSWER Debatable reasonable basis defense.
Debatable reasonable basis defense. The insurer may establish that defense that it has
a reasonable basis for questioning whether a claim was covered.
A recorded statement is taken by the claims rep over the phone or in person.
Benjamin is with the SIU department of an insurer. His company developed technology
to identify patterns related to fraudulent claims activity. He is using a program to analyze
claims data to identify similarities or connections that might indicate fraud. Benjamin is
utilizing... - ANSWER Data Mining.
This is using computers to analyze vast amounts of data to detect trends.
The claims litigation process begins with the receipt of.. - ANSWER A summons and
complain.
The claims litigation process begins with the receipt of a summons and complaint
announcing the initiation of a lawsuit.
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.
Claims-made forms are most often used for environmental, medical malpractice and
directors and officers' policies.
In the process of assigning a claim, an internal claims handler will often transfer
information to the insurer's standard form, called the... - ANSWER First Notice of Loss
(FNOL) Form
WORLD 2025 LATEST UPDATE(GRADED
A+)
Soft fraud, also called opportunity fraud, occurs when... - ANSWER A legitimate claim is
exaggerated.
The first key to communicating empathetically as a claims professional is... - ANSWER
Listening.
Claims professionals should first listen carefully to understand what the claimant is
saying.
The Office of Foreign Assets Control requires claims payors to check payees against a
database of... - ANSWER Known terrorists & drug traffickers
Mia tracks loss adjustment expense (LAE) as part of her management of the claims
department for an insurer. Mia considers LAE to be the... - ANSWER Cost to
investigate, defend & settle claims
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.
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.
When Mehmet interviews witnesses as part of his claim 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? - ANSWER Open-Ended.
Open-Ended questions can be used to clarify an interviewee's statements.
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.
, Timely contact with all parties to a claim helps ensure that parties will be more likely to
remember details of the loss accurately.
In seeking to identify claims that will potentially develop into complex and more costly
claims, the data science team at Great Midsouthwest Insurance ranks a series of
attributes by their importance to the data model. Which one of the following terms best
describes the level of predictive power of each attribute? - ANSWER Information Gain.
Information gain is a measure of the predictive power of one or more attributes.
Not long after Valteri issued a denial and closed the claim, the insured sued for
coverage and alleged bad-faith claim handling against the insurer. Valteri was able to
demonstrate for his superiors that he had made a good-faith investigation and
determined that the claim was not covered by the policy. The insurer maintains that
Valteri had reasonable justification in fact for denying the claim. The insurer is
employing the... - ANSWER Debatable reasonable basis defense.
Debatable reasonable basis defense. The insurer may establish that defense that it has
a reasonable basis for questioning whether a claim was covered.
A recorded statement is taken by the claims rep over the phone or in person.
Benjamin is with the SIU department of an insurer. His company developed technology
to identify patterns related to fraudulent claims activity. He is using a program to analyze
claims data to identify similarities or connections that might indicate fraud. Benjamin is
utilizing... - ANSWER Data Mining.
This is using computers to analyze vast amounts of data to detect trends.
The claims litigation process begins with the receipt of.. - ANSWER A summons and
complain.
The claims litigation process begins with the receipt of a summons and complaint
announcing the initiation of a lawsuit.
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.
Claims-made forms are most often used for environmental, medical malpractice and
directors and officers' policies.
In the process of assigning a claim, an internal claims handler will often transfer
information to the insurer's standard form, called the... - ANSWER First Notice of Loss
(FNOL) Form
