AIC 300 Claims in an Evolving World
As methods of communication evolve, it's important for claims professionals to
remember that any written claims communication may be
a. Replaced with verbal communication
b. Misinterpreted
c. Edited later
d. Subpoenaed - Answer-d. Subpoenaed
Soft fraud occurs when a claim is exaggerated and is also referred to as
a. Opportunity fraud
b. Financial fraud
c. Reimbursement fraud
d. Victimless fraud - Answer-a. Opportunity fraud
In which one of the following scenarios is the right of subrogation most likely to be
employed by the insurer?
a. An insured files a homeowners claim for stolen jewelry. An investigation reveals that
the jewelry is still in the insured's possession.
b. 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.
c. An investigation reveals that an insured set her own business on fire.
d. An insured files a claim for collision damage from a hit and run accident, when in fact
he backed into a utility pole. - Answer-b. 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.
In which one of the following scenarios is a public adjuster most likely to become
involved?
a. A catastrophic disaster strikes, involving damage to many properties.
b. An insurer finds it financially unfeasible to hire its own claims staff in a given state.
c. An insured is unable to afford legal representation to contest a claim.
, d. An insured's negotiations with the insurer on a complex claim are not going well. -
Answer-d. An insured's negotiations with the insurer on a complex claim are not
going well.
Carla is investigating a claim for a stolen car. The insured provided a copy of the police
report, but she notices that the account in the police report differs from the insured's
version of events. At this point, Carla should
a. Refer the case to the SIU.
b. Deny the claim.
c. Contact the police.
d. Continue with her investigation. - Answer-d. Continue with her investigation
Which one of the following methods of establishing case reserves is used most often
when there are small variations in loss size for a particular type of claim?
a. Individual case method.
b. Formula method.
c. Average value method.
d. Roundtable method. - Answer-c. Average value method
Chloe is an insurer defense attorney who is preparing a trial strategy. She has
researched a court decision that was made in a similar case and is basing the defense
on that precedent. Chloe is relying on the principle of stare decisis, which is that
a. Lower courts must follow precedents set by any other courts.
b. Lower courts must follow precedents set by higher courts.
c. Higher courts must follow precedents set by lower courts.
d. Higher courts must follow precedents set by any other counts. - Answer-b. Lower
courts must follow precedents set by higher courts
Which one of the following statements regarding state versions of the NAIC model act is
correct?
a. Only insureds may bring lawsuits against insurers.
b. Only claimants may bring lawsuits against insurers.
c. Some states allow insureds and claimants to bring lawsuits against insurers, while
others allow only insureds.
d. Both insureds and claimants may bring lawsuit against insurers. - Answer-c. Some
states allow insureds and claimants to bring lawsuits against insurers, while others
allow only insureds.
As methods of communication evolve, it's important for claims professionals to
remember that any written claims communication may be
a. Replaced with verbal communication
b. Misinterpreted
c. Edited later
d. Subpoenaed - Answer-d. Subpoenaed
Soft fraud occurs when a claim is exaggerated and is also referred to as
a. Opportunity fraud
b. Financial fraud
c. Reimbursement fraud
d. Victimless fraud - Answer-a. Opportunity fraud
In which one of the following scenarios is the right of subrogation most likely to be
employed by the insurer?
a. An insured files a homeowners claim for stolen jewelry. An investigation reveals that
the jewelry is still in the insured's possession.
b. 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.
c. An investigation reveals that an insured set her own business on fire.
d. An insured files a claim for collision damage from a hit and run accident, when in fact
he backed into a utility pole. - Answer-b. 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.
In which one of the following scenarios is a public adjuster most likely to become
involved?
a. A catastrophic disaster strikes, involving damage to many properties.
b. An insurer finds it financially unfeasible to hire its own claims staff in a given state.
c. An insured is unable to afford legal representation to contest a claim.
, d. An insured's negotiations with the insurer on a complex claim are not going well. -
Answer-d. An insured's negotiations with the insurer on a complex claim are not
going well.
Carla is investigating a claim for a stolen car. The insured provided a copy of the police
report, but she notices that the account in the police report differs from the insured's
version of events. At this point, Carla should
a. Refer the case to the SIU.
b. Deny the claim.
c. Contact the police.
d. Continue with her investigation. - Answer-d. Continue with her investigation
Which one of the following methods of establishing case reserves is used most often
when there are small variations in loss size for a particular type of claim?
a. Individual case method.
b. Formula method.
c. Average value method.
d. Roundtable method. - Answer-c. Average value method
Chloe is an insurer defense attorney who is preparing a trial strategy. She has
researched a court decision that was made in a similar case and is basing the defense
on that precedent. Chloe is relying on the principle of stare decisis, which is that
a. Lower courts must follow precedents set by any other courts.
b. Lower courts must follow precedents set by higher courts.
c. Higher courts must follow precedents set by lower courts.
d. Higher courts must follow precedents set by any other counts. - Answer-b. Lower
courts must follow precedents set by higher courts
Which one of the following statements regarding state versions of the NAIC model act is
correct?
a. Only insureds may bring lawsuits against insurers.
b. Only claimants may bring lawsuits against insurers.
c. Some states allow insureds and claimants to bring lawsuits against insurers, while
others allow only insureds.
d. Both insureds and claimants may bring lawsuit against insurers. - Answer-c. Some
states allow insureds and claimants to bring lawsuits against insurers, while others
allow only insureds.
