AIC 300 - Claims in an Evolving World
exam with correct answers
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. |- |correct |answer |-B. |By |certified |mail |with |a |return |receipt |requested.
Some |will |also |send |a |copy |via |regular |mail |in |case |the |certified |letter |is |not |accepted.
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. |- |correct |answer |-D. |Subpoenaed.
Any |written |claims |communication |may |be |subpoenaed.
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. |- |correct
|answer |-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.
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. |- |correct |answer |-B. |TPAs |handle
|claims, |keep |claims |records, |and |perform |statistical |analyses.
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 |- |correct |answer |-A. |Proper |releases |taken
Proper |releases |taken |is |a |qualitative |audit |factor; |the |others |are |quantitative.
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. |- |correct |answer |-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.
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. |- |correct |answer |-D. |Listening.
Claims |professionals |should |first |listen |carefully |to |understand |what |the |claimant |is |saying.
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. |- |correct |answer |-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.
, 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. |- |correct |answer |-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.
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 |- |correct |answer |-A. |Open-ended
Open-ended |questions |can |be |used |to |clarify |an |interviewee's |statements.
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.
exam with correct answers
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. |- |correct |answer |-B. |By |certified |mail |with |a |return |receipt |requested.
Some |will |also |send |a |copy |via |regular |mail |in |case |the |certified |letter |is |not |accepted.
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. |- |correct |answer |-D. |Subpoenaed.
Any |written |claims |communication |may |be |subpoenaed.
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. |- |correct
|answer |-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.
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. |- |correct |answer |-B. |TPAs |handle
|claims, |keep |claims |records, |and |perform |statistical |analyses.
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 |- |correct |answer |-A. |Proper |releases |taken
Proper |releases |taken |is |a |qualitative |audit |factor; |the |others |are |quantitative.
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. |- |correct |answer |-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.
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. |- |correct |answer |-D. |Listening.
Claims |professionals |should |first |listen |carefully |to |understand |what |the |claimant |is |saying.
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. |- |correct |answer |-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.
, 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. |- |correct |answer |-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.
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 |- |correct |answer |-A. |Open-ended
Open-ended |questions |can |be |used |to |clarify |an |interviewee's |statements.
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.
