AIC 300 CLAIMS IN AN EVOLVING WORLD
2026 EXAM REVIEW SOLVED QUESTIONS AND
CORRECT ANSWERS GRADED A+
◉ Third-party administrator (TPA).
Answer: An organization that provides administrative services
associated with risk financing and insurance.
◉ Claims representative.
Answer: A person responsible for investigating, evaluating, and
settling claims.
◉ Public adjuster.
Answer: An outside organization or person hired by an insured to
represent the insured in a claim in exchange for a fee.
◉ Premium audit.
Answer: Methodical examination of a policyholder's operations,
records, and books of account to determine the actual exposure
units and premium for insurance coverages already provided.
◉ Quantitative Audit Factors.
,Answer: Number of files open, timeliness of reports, reserving and
payments
◉ Qualitative Audit Factors.
Answer: Realistic reserving, accurate evaluation of insured's liability
and follow-up on subrogation opportunity, proper information
◉ Loss ratio.
Answer: A ratio that measures losses and loss adjustment expenses
against earned premiums and that reflects the percentage of
premiums being consumed by losses.
◉ Loss adjustment expense (LAE).
Answer: The expense that an insurer incurs to investigate, defend,
and settle claims according to the terms specified in the insurance
policy.
◉ Steps of Making an Initial Claims Assessment.
Answer: Acknowledging and Assigning the Claim
Identifying the Policy
Contacting the Insured or the Insured's Representative
◉ How do recorded statements and examinations under oath differ?.
,Answer: An examination under oath is more formal than a recorded
statement. Recorded statements are often taken by claims
representatives, typically by telephone. Examinations under oath are
usually performed by an attorney for the insurer at the insurer's
office or a court reporter's office.
◉ Effective statements exhibit these qualities:.
Answer: Coherence—The statement follows a logical sequence.
Completeness—The statement is thorough.
Objectivity—The statement contains facts relevant to the loss
expressed in the interviewee's own words.
◉ Seven-Part Method.
Answer: 1. Permission and introduction—date, time, and location of
the interview, names of the parties involved in the interview, and an
affirmation from the interviewee that the interview is given with
permission
2. Identification—identifying information about the person being
interviewed, such as name, address, phone number, and driver's
license number
3. Setting—answers to questions such as who was involved in the
loss, what was involved in the loss, when the loss occurred, where
the loss occurred, and why the loss occurred
, 4. Incident—a step-by-step description of how the loss occurred
5. Post incident injuries/damages—description of the property
damage and bodily injuries to individuals
6. Miscellaneous—any information the interviewee wants to add
7. Conclusion—reaffirmation that the statement was taken with
permission
◉ Reserve.
Answer: The amount the insurer estimates and sets aside to pay on
an existing claim.
◉ Individual case method.
Answer: a method of setting reserves based on the claim's
circumstances and the claim representative's experience in handling
similar claims
◉ Roundtable method.
Answer: A method of setting reserves by using the consensus of two
or more claim personnel who have independently evaluated the
claim file
2026 EXAM REVIEW SOLVED QUESTIONS AND
CORRECT ANSWERS GRADED A+
◉ Third-party administrator (TPA).
Answer: An organization that provides administrative services
associated with risk financing and insurance.
◉ Claims representative.
Answer: A person responsible for investigating, evaluating, and
settling claims.
◉ Public adjuster.
Answer: An outside organization or person hired by an insured to
represent the insured in a claim in exchange for a fee.
◉ Premium audit.
Answer: Methodical examination of a policyholder's operations,
records, and books of account to determine the actual exposure
units and premium for insurance coverages already provided.
◉ Quantitative Audit Factors.
,Answer: Number of files open, timeliness of reports, reserving and
payments
◉ Qualitative Audit Factors.
Answer: Realistic reserving, accurate evaluation of insured's liability
and follow-up on subrogation opportunity, proper information
◉ Loss ratio.
Answer: A ratio that measures losses and loss adjustment expenses
against earned premiums and that reflects the percentage of
premiums being consumed by losses.
◉ Loss adjustment expense (LAE).
Answer: The expense that an insurer incurs to investigate, defend,
and settle claims according to the terms specified in the insurance
policy.
◉ Steps of Making an Initial Claims Assessment.
Answer: Acknowledging and Assigning the Claim
Identifying the Policy
Contacting the Insured or the Insured's Representative
◉ How do recorded statements and examinations under oath differ?.
,Answer: An examination under oath is more formal than a recorded
statement. Recorded statements are often taken by claims
representatives, typically by telephone. Examinations under oath are
usually performed by an attorney for the insurer at the insurer's
office or a court reporter's office.
◉ Effective statements exhibit these qualities:.
Answer: Coherence—The statement follows a logical sequence.
Completeness—The statement is thorough.
Objectivity—The statement contains facts relevant to the loss
expressed in the interviewee's own words.
◉ Seven-Part Method.
Answer: 1. Permission and introduction—date, time, and location of
the interview, names of the parties involved in the interview, and an
affirmation from the interviewee that the interview is given with
permission
2. Identification—identifying information about the person being
interviewed, such as name, address, phone number, and driver's
license number
3. Setting—answers to questions such as who was involved in the
loss, what was involved in the loss, when the loss occurred, where
the loss occurred, and why the loss occurred
, 4. Incident—a step-by-step description of how the loss occurred
5. Post incident injuries/damages—description of the property
damage and bodily injuries to individuals
6. Miscellaneous—any information the interviewee wants to add
7. Conclusion—reaffirmation that the statement was taken with
permission
◉ Reserve.
Answer: The amount the insurer estimates and sets aside to pay on
an existing claim.
◉ Individual case method.
Answer: a method of setting reserves based on the claim's
circumstances and the claim representative's experience in handling
similar claims
◉ Roundtable method.
Answer: A method of setting reserves by using the consensus of two
or more claim personnel who have independently evaluated the
claim file
