AIC 30 (150 QUESTIONS) ANSWERED CORRECTLY TO SCORE A+

AIC 30 (150 QUESTIONS) ANSWERED CORRECTLY TO SCORE A+ Loss Reserve - Answer-an estimate of the amount of money the insurer expects to pay out on the claim. (includes IBNR claims) Loss Ratio - Answer-Losses and loss adjustment expenses against the earned premiums. this reflects the amount of premium that has not been consumed by loss Expense Ratio - Answer-the amount of operational expenses against the written premium. Shows how much of the premium for the year, is being consumed by cost of doing business Combined Ratio - Answer-by adding together the loss ratio and the expense ratio, you have a combined ratio. The combined ratio indicates if you have an underwriting gain or loss. Was the premium charged enough to cover the losses and expenses incurred by the company Sender - Answer-the person that is sending the message / initiating the communication process Receiver - Answer-the person that gets the message and interprets it. Verbal or non-verbal intentional or unintentional. Initial Credibility - Answer-the degree to which the person is believed before the conversation begins Derived Credibility - Answer-the perceived believability of the person during the conversation. Terminal Credibility - Answer-how believable were they after the end of the conversation Message - Answer-the words a sender uses in the communication process Encoding - Answer-the process of translating the message once sent Medium - Answer-the means a message was transmitted. written, oral, non-verbal, intentional, and unintentional Decoding - Answer-the interpretation of the message by the receiver Active Listening - Answer-listening with openness, both physical and mental, to determine the meaning. Non Verbal Communication - Answer-communication that is not written or oral..includes posture, eye movements, facial expressions, smells, and appearance Insurance Fraud - Answer-Any deliberate act of deception committed against an insurance producer or insurer for the purpose of unwarranted financial gain Motives for Insurance Fraud - Answer-financial gain, profit or savings. sense of entitlement. participation in organized crime Material Fact in Insurance - Answer-a fact that would have affected the insurer's decision to provide coverage or coverage at the cost of the premium, maintain a policy, or to pay a claim Staged Accident - Answer-and accident deliberately caused by a person who intends to fake injury and collect Hard Fraud (Moral Hazard) - Answer-Action undertaken to deliberately defraud. Soft Fraud (Morale Hazard) - Answer-fraud that occurs when a legitimate claim is exaggerated. Misrepresentation - Answer-a false statement of a material fact, knowingly made, with the intent to decieve Concealment - Answer-an intentional failure not to disclose a material fact Pre Inspection Laws - Answer-Vehicles (and homes in many cases) must be physically inspected for prior damage to insurance policies being issued Mandatory reporting - Answer-states require insurance companies to report claims that raise suspicions Immunity Laws - Answer-Designed to protect insurers, and claims representatives for reporting possible insurance fraud if the report is made without malice, fraud or criminal misconduct Civil and Criminal Penalties - Answer-Makes insurance fraud a crime Motor Vehicle Theft Law Enforcement Act of 1984 - Answer-Required VIN numbers on all vehicles for theft reporting and identification of stolen vehicles Anti Car Theft Act of 1992 - Answer-Dealing with stolen car parts and stolen vehicles is now a federal crime US Mail Fraud Statute - Answer-using the mail to commit insurance fraud is a federal crime False Representation Statute - Answer-Allows the post office to hold the mall anyone found by the postal inspectors to be committing fraud. CAIF - Coalition Against Insurance Fraud - Answer-a diverse group of commissioners, insurers, legislators, and regulators banding together to detect, prosecute and deter insurance fraud Win - Lose - Answer-we win, they lose. They committed fraud, they got caught Win - Win - Answer-Both sides of the negotiation walk away happy Lose - Win - Answer-We were at fault, we know we will pay the claim, but to earn a little good will we make an advanced payment for bills presented to make the injured parties life a little easier Lose - Lose - Answer-an agreement cant be reached, it goes into litigation. Neither party is concerned about a "good" outcome, it is an adversarial postion The 4 Steps of Negotiation - Answer-1. Prepare 2. Develop and evaluate alternative outcomes 3. identify and evaluate each parties interests 4. Make concessions to achieve an appropriate resolution. Crisis Phase - Answer-concerned about returning to normal Motivational Phase - Answer-recognition of the financial implication of the loss Bargaining Phase - Answer-each side evaluates and determines positions, disagreements may arise. The claim is in the process of being settled Principal of Yes - Answer-a sales technique by getting the person to agree, they have a tendency to continue to agree Choicing - Answer-offering a choice between one or the other Trading in dollars - Answer-often adjusters forget to look at the facts of the claim and begin to see "money" and fail to see other possible settlement options Summons - Answer-a notification to the defendant that the have been named to a law suit. Delivery by a specified means, ids the amount of the suit and amount of time limited to answer Complaint - Answer-the allegation made in the law suit