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.
CORRECT ANSWER -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 professionals to
remember that any written claims communication may be Select one: A.
Replaced with verbal communication.
B. Misinterpreted.
C. Edited later.
D. Subpoenaed.
CORRECT ANSWER -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.
CORRECT ANSWER - 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 m ay 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. CORRECT ANSWER - 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 CORRECT ANSWER -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.
CORRECT ANSWER -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 claim’s 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.
CORRECT ANSWER -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.
B. Paid portion of claims.
C. Cost to investigate, defend, and settle claims.
D. Total incurred amount of claims. CORRECT ANSWER - C.
Cost to investigate, defend, and settle claims.
Cost to investigate, defend, and settle claims. LAE is the expense that an insurer incurs to
investigate, defend, and settle claims according to the terms specified in the insurance
policy.
9. 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. Katari na is a(n) Select one: A.
Medical provider.
B. Expert Witness.
C. Premium auditor.
D. Claim representative.
CORRECT ANSWER -D.
Claim representative.
, Claim reps collaborate with more than other insurer employees. Many insurers employ a panel
of experts that the claims rep can select according to the investigation's needs.
10. When Mehmet interviews witnesses as part of his claim’s investigation, he asks
different types of quest ions 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?
Select one:
A. Open-ended
B. Direct
C. Indirect
D. Leading
CORRECT ANSWER -A.
Open-ended
Open-ended questions can be used to clarify an interviewee's statements.
11. Charlotte is handling a new claim and she has set the initial reserves at
$1,000,000. She has been asked ed to complete an internal report summarizing all
the file status information for distribution to manage event and updated as more
information is received. The report Charlotte is completing is most likely a Select
one:
A. Status report.
B. Summarized report.
C. Preliminary report.
D. Large loss report.
CORRECT ANSWER -D.
Large loss report.
Most insurers have guidelines outlining when and under what circumstances large loss reports
should be prepared.
12. In which one of the following scenarios is the right of subrogation most likely to be
employed by the insurer?
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.
CORRECT ANSWER -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 professionals to
remember that any written claims communication may be Select one: A.
Replaced with verbal communication.
B. Misinterpreted.
C. Edited later.
D. Subpoenaed.
CORRECT ANSWER -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.
CORRECT ANSWER - 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 m ay 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. CORRECT ANSWER - 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 CORRECT ANSWER -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.
CORRECT ANSWER -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 claim’s 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.
CORRECT ANSWER -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.
B. Paid portion of claims.
C. Cost to investigate, defend, and settle claims.
D. Total incurred amount of claims. CORRECT ANSWER - C.
Cost to investigate, defend, and settle claims.
Cost to investigate, defend, and settle claims. LAE is the expense that an insurer incurs to
investigate, defend, and settle claims according to the terms specified in the insurance
policy.
9. 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. Katari na is a(n) Select one: A.
Medical provider.
B. Expert Witness.
C. Premium auditor.
D. Claim representative.
CORRECT ANSWER -D.
Claim representative.
, Claim reps collaborate with more than other insurer employees. Many insurers employ a panel
of experts that the claims rep can select according to the investigation's needs.
10. When Mehmet interviews witnesses as part of his claim’s investigation, he asks
different types of quest ions 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?
Select one:
A. Open-ended
B. Direct
C. Indirect
D. Leading
CORRECT ANSWER -A.
Open-ended
Open-ended questions can be used to clarify an interviewee's statements.
11. Charlotte is handling a new claim and she has set the initial reserves at
$1,000,000. She has been asked ed to complete an internal report summarizing all
the file status information for distribution to manage event and updated as more
information is received. The report Charlotte is completing is most likely a Select
one:
A. Status report.
B. Summarized report.
C. Preliminary report.
D. Large loss report.
CORRECT ANSWER -D.
Large loss report.
Most insurers have guidelines outlining when and under what circumstances large loss reports
should be prepared.
12. In which one of the following scenarios is the right of subrogation most likely to be
employed by the insurer?
