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. - ANSWER>>Any written claims communication may be subpoenaed.
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. - ANSWER>>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.
Some will also send a copy via regular mail in case the certified letter is not accepted. -
ANSWER>>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
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.
Proper releases taken is a qualitative audit factor; the others are quantitative. -
ANSWER>>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
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. -
ANSWER>>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.
Claims professionals should first listen carefully to understand what the claimant is saying. -
ANSWER>>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.
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. -
ANSWER>>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.
, 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. - ANSWER>>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.
Open-ended questions can be used to clarify an interviewee's statements. - ANSWER>>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.
any written claims communication may be
Select one:
A. Replaced with verbal communication.
B. Misinterpreted.
C. Edited later.
D. Subpoenaed. - ANSWER>>Any written claims communication may be subpoenaed.
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. - ANSWER>>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.
Some will also send a copy via regular mail in case the certified letter is not accepted. -
ANSWER>>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
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.
Proper releases taken is a qualitative audit factor; the others are quantitative. -
ANSWER>>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
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. -
ANSWER>>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.
Claims professionals should first listen carefully to understand what the claimant is saying. -
ANSWER>>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.
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. -
ANSWER>>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.
, 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. - ANSWER>>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.
Open-ended questions can be used to clarify an interviewee's statements. - ANSWER>>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.
