AIC 300 - Claims in an Evolving World
Q&A
Some will also send a copy via regular mail in case the certified letter is not
accepted. - ✔✔ 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.
D. Subpoenaed.
Any written claims communication may be subpoenaed. - ✔✔ 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.
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 may hire a public adjuster to protect his or her interests. - ✔✔ 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.
B. TPAs handle claims, keep claims records, and perform statistical analyses. - ✔✔
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.
A. Proper releases taken
,Proper releases taken is a qualitative audit factor; the others are quantitative. - ✔✔
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
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. - ✔✔ 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.
D. Listening.
Claims professionals should first listen carefully to understand what the claimant is
saying. - ✔✔ The first key to communicating empathetically as a claims 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.
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. - ✔✔ 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.
, 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. - ✔✔ 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.
Katarina is a(n)
Select one:
A. Medical provider.
B. Expert Witness.
C. Premium auditor.
D. Claim representative.
A. Open-ended
Open-ended questions can be used to clarify an interviewee's statements. - ✔✔
When Mehmet interviews witnesses as part of his claims 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?
Select one:
A. Open-ended
B. Direct
C. Indirect
D. Leading
D. Large loss report.
Most insurers have guidelines outlining when and under what circumstances large
loss reports should be prepared. - ✔✔ Charlotte is handling a new claim and she has
set the initial reserves at $1,000,000. She has been asked to complete an internal
report summarizing all the file status information for distribution to management 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.
D. A claims rep discovers that their insured's car accident was caused by a road
contractor who left equipment lying in the travel lanes of a highway.
The right of subrogation allows an insurer to recover payment from a negligent third
party. - ✔✔ In which one of the following scenarios is the right of subrogation most
likely to be employed by the insurer?
Select one:
Q&A
Some will also send a copy via regular mail in case the certified letter is not
accepted. - ✔✔ 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.
D. Subpoenaed.
Any written claims communication may be subpoenaed. - ✔✔ 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.
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 may hire a public adjuster to protect his or her interests. - ✔✔ 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.
B. TPAs handle claims, keep claims records, and perform statistical analyses. - ✔✔
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.
A. Proper releases taken
,Proper releases taken is a qualitative audit factor; the others are quantitative. - ✔✔
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
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. - ✔✔ 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.
D. Listening.
Claims professionals should first listen carefully to understand what the claimant is
saying. - ✔✔ The first key to communicating empathetically as a claims 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.
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. - ✔✔ 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.
, 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. - ✔✔ 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.
Katarina is a(n)
Select one:
A. Medical provider.
B. Expert Witness.
C. Premium auditor.
D. Claim representative.
A. Open-ended
Open-ended questions can be used to clarify an interviewee's statements. - ✔✔
When Mehmet interviews witnesses as part of his claims 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?
Select one:
A. Open-ended
B. Direct
C. Indirect
D. Leading
D. Large loss report.
Most insurers have guidelines outlining when and under what circumstances large
loss reports should be prepared. - ✔✔ Charlotte is handling a new claim and she has
set the initial reserves at $1,000,000. She has been asked to complete an internal
report summarizing all the file status information for distribution to management 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.
D. A claims rep discovers that their insured's car accident was caused by a road
contractor who left equipment lying in the travel lanes of a highway.
The right of subrogation allows an insurer to recover payment from a negligent third
party. - ✔✔ In which one of the following scenarios is the right of subrogation most
likely to be employed by the insurer?
Select one:
