AIC 302 STUDY EXAMS GUIDE ANSWERS AND
QUESTIONS SET A+
✔✔When liens/subrogation is presented: - ✔✔Acknowledge as presented
Check for automatic Medicare/Medicaid
Investigate the mechanism of the injury
Investigate medical history
✔✔Determine whether loss of earnings is being claimed: - ✔✔Obtain wage
authorization
Identify employer and address
Determine occupation, employment status, job title, job description, and job history
Obtain verification of wages—documents such as pay stubs and tax records
Obtain medical verification of the inability to work due to injuries
✔✔Statutes of Limitations - ✔✔A law that stipulates the length of time after an event
during which legal proceedings (such as a lawsuit or criminal charges) may be initiated.
✔✔A bodily injury investigation plan allows the claims representative to keep track of
the various healthcare providers, their contact information, the requested documents,
and the documents' due dates. Additionally, it helps - ✔✔the claims rep to conduct
timely follow-ups for documents not received and to identify damages being claimed.
✔✔Claimants are entitled to be compensated for the costs of treatment for injuries and -
✔✔conditions caused by an insured event, but for no more than is reasonable and
necessary.
✔✔Because of the prevalence of preexisting medical problems, claims reps should
always determine the nature of a - ✔✔patient's complaint and the physician's treatment
before paying bills for office visits. Similarly, claims reps should understand the purpose
of diagnostic and laboratory tests to know whether they are related to injuries suffered in
an insured accident.
, ✔✔Claims reps investigate any condition described as or known to be chronic. In a
medical context, chronic means ongoing or frequently recurring. Joint problems,
especially in the - ✔✔spine, knees, or hips; osteoporosis; arteriosclerosis; diabetes; and
arthritis are all chronic problems. Chronic problems that may or may not be related to
the accident can be initially involved in a claim until further investigation confirms
whether a causal relationship exists.
✔✔It's often alleged that a chronic condition has been aggravated by an accident. An
exacerbation of a preexisting problem is compensable, but with certain limitations. Once
the condition has returned to its - ✔✔pre-injury status, it is no longer compensable.
Likewise, an exacerbated chronic problem is no longer compensable if the natural
course of that preexisting condition would have made it just as bad.
✔✔Some injured claimants begin to recover and then reinjure themselves. Such
subsequent occurrences are known as - ✔✔intervening problems or injuries. The
insurer responsible for the original claim should not pay for the intervening injury unless
it was an unavoidable consequence of the first injury.
✔✔A correct diagnosis is crucial for determining the cause of a claimant's injury. Claims
reps should not accept as a diagnosis a statement that refers only to symptoms, such
as - ✔✔headache or back pain. Innumerable medical conditions can cause the same
symptoms.
Any physician who appears to avoid making a diagnosis should be required to provide a
working, or presumptive, diagnosis, which is a condition believed by the healthcare
provider to be the most likely cause of the patient's symptoms.
✔✔X-rays - ✔✔are widely available and generate inexpensive images, although they're
no longer routinely used because of the exposure to radiation they involve.
✔✔Computerized tomography scans (CT scans) - ✔✔can provide high-resolution
images without the visual interference found in standard x-rays.
✔✔Myelograms' - ✔✔invasive process of using contrast agents and the unpleasant side
effects that can result are the major disadvantages of this type of test.
✔✔Electromyograms (EMG) - ✔✔can help identify nerve damage by monitoring the
electrical activity in muscles.
✔✔Magnetic resonance imaging (MRI) - ✔✔does not use radiation, is not stopped by
dense bone, and can create images on any plane—vertically, horizontally, and
diagonally.
✔✔Thermography test results are - ✔✔not widely accepted in the medical community.
QUESTIONS SET A+
✔✔When liens/subrogation is presented: - ✔✔Acknowledge as presented
Check for automatic Medicare/Medicaid
Investigate the mechanism of the injury
Investigate medical history
✔✔Determine whether loss of earnings is being claimed: - ✔✔Obtain wage
authorization
Identify employer and address
Determine occupation, employment status, job title, job description, and job history
Obtain verification of wages—documents such as pay stubs and tax records
Obtain medical verification of the inability to work due to injuries
✔✔Statutes of Limitations - ✔✔A law that stipulates the length of time after an event
during which legal proceedings (such as a lawsuit or criminal charges) may be initiated.
✔✔A bodily injury investigation plan allows the claims representative to keep track of
the various healthcare providers, their contact information, the requested documents,
and the documents' due dates. Additionally, it helps - ✔✔the claims rep to conduct
timely follow-ups for documents not received and to identify damages being claimed.
✔✔Claimants are entitled to be compensated for the costs of treatment for injuries and -
✔✔conditions caused by an insured event, but for no more than is reasonable and
necessary.
✔✔Because of the prevalence of preexisting medical problems, claims reps should
always determine the nature of a - ✔✔patient's complaint and the physician's treatment
before paying bills for office visits. Similarly, claims reps should understand the purpose
of diagnostic and laboratory tests to know whether they are related to injuries suffered in
an insured accident.
, ✔✔Claims reps investigate any condition described as or known to be chronic. In a
medical context, chronic means ongoing or frequently recurring. Joint problems,
especially in the - ✔✔spine, knees, or hips; osteoporosis; arteriosclerosis; diabetes; and
arthritis are all chronic problems. Chronic problems that may or may not be related to
the accident can be initially involved in a claim until further investigation confirms
whether a causal relationship exists.
✔✔It's often alleged that a chronic condition has been aggravated by an accident. An
exacerbation of a preexisting problem is compensable, but with certain limitations. Once
the condition has returned to its - ✔✔pre-injury status, it is no longer compensable.
Likewise, an exacerbated chronic problem is no longer compensable if the natural
course of that preexisting condition would have made it just as bad.
✔✔Some injured claimants begin to recover and then reinjure themselves. Such
subsequent occurrences are known as - ✔✔intervening problems or injuries. The
insurer responsible for the original claim should not pay for the intervening injury unless
it was an unavoidable consequence of the first injury.
✔✔A correct diagnosis is crucial for determining the cause of a claimant's injury. Claims
reps should not accept as a diagnosis a statement that refers only to symptoms, such
as - ✔✔headache or back pain. Innumerable medical conditions can cause the same
symptoms.
Any physician who appears to avoid making a diagnosis should be required to provide a
working, or presumptive, diagnosis, which is a condition believed by the healthcare
provider to be the most likely cause of the patient's symptoms.
✔✔X-rays - ✔✔are widely available and generate inexpensive images, although they're
no longer routinely used because of the exposure to radiation they involve.
✔✔Computerized tomography scans (CT scans) - ✔✔can provide high-resolution
images without the visual interference found in standard x-rays.
✔✔Myelograms' - ✔✔invasive process of using contrast agents and the unpleasant side
effects that can result are the major disadvantages of this type of test.
✔✔Electromyograms (EMG) - ✔✔can help identify nerve damage by monitoring the
electrical activity in muscles.
✔✔Magnetic resonance imaging (MRI) - ✔✔does not use radiation, is not stopped by
dense bone, and can create images on any plane—vertically, horizontally, and
diagonally.
✔✔Thermography test results are - ✔✔not widely accepted in the medical community.
