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Insurers usually send denial letters
Select one: B. By certified mail with a return receipt
A. By email to ensure prompt receipt by requested.
the insured.
B. By certified mail with a return receipt Some will also send a copy via regular
requested. mail in case the certified letter is not ac-
C. By overnight courier. cepted.
D. By registered mail.
As methods of communication evolve,
it's important for claims professionals to
remember that any written claims com-
D. Subpoenaed.
munication may be
Select one:
Any written claims communication may
A. Replaced with verbal communication.
be subpoenaed.
B. Misinterpreted.
C. Edited later.
D. Subpoenaed.
In which one of the following scenarios is
a public adjuster most likely to become
involved?
Select one: D. An insured's negotiations with the in-
A. An insurer finds it financially unfeasi- surer on a complex claim are not going
ble to hire its own claims staff in a given well.
state.
B. An insured is unable to afford legal If a claim is complex, or if settlement
representation to contest a claim. negotiations are not progressing with the
C. A catastrophic disaster strikes, involv- insurer, the insured may hire a public
ing damage to many properties. adjuster to protect his or her interests.
D. An insured's negotiations with the in-
surer on a complex claim are not going
well.
Which one of the following state-
ments regarding third-party administra-
tors (TPAs) is most accurate?
Select one:
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A. TPAs are typically used by businesses
that have chosen not to self-insure.
B. TPAs handle claims, keep claims
records, and perform statistical analy- B. TPAs handle claims, keep claims
ses. records, and perform statistical analy-
C. TPAs are generally found in an insur- ses.
er's claims department.
D. TPAs are employed only by indepen-
dent adjusting firms.
Hugo is conducting an audit of a branch
office claims operation. He is evalu-
ating timeliness of reports, number of
files opened, proper releases taken, and
accuracy of data entry. Which one of A. Proper releases taken
Hugo's metrics is a qualitative audit fac-
tor? Proper releases taken is a qualitative au-
Select one: dit factor; the others are quantitative.
A. Proper releases taken
B. Timeliness of reports
C. Number of files opened
D. Accuracy of data entry
D. Line underwriter.
Aaron works for a multi-line insurer. He Line underwriter. This describes the du-
works with insurance producers and ap- ties of a line underwriter, rather than a
plicants to evaluate new business sub- staff underwriter. There is not enough
missions and conduct renewal under- information to determine which line of
writing. Aaron is a business is being written. A public under-
Select one: writer does not exist. Line underwriters
A. Staff underwriter. evaluate new submissions and perform
B. Public underwriter. renewal underwriting, usually by working
C. Personal lines underwriter. directly with insurance producers and ap-
D. Line underwriter. plicants. Staff underwriters, meanwhile,
manage risk selection by working with
line underwriters and coordinating deci-
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sions about products, pricing and guide-
lines.
The first key to communicating empa-
thetically as a claims professional is
Select one: D. Listening.
A. A comprehensive understanding of
relevant insurance policies. Claims professionals should first listen
B. Speaking calmly and clearly. carefully to understand what the claimant
C. Being prepared with all documenta- is saying.
tion relating to the claim.
D. Listening.
Mia tracks loss adjustment expense
(LAE) as part of her management of the
C. Cost to investigate, defend, and settle
claims department for an insurer. Mia
claims.
considers LAE to be the
Select one:
Cost to investigate, defend, and settle
A. Total amount of loss reserves of all
claims. LAE is the expense that an insur-
claims.
er incurs to investigate, defend, and set-
B. Paid portion of claims.
tle claims according to the terms speci-
C. Cost to investigate, defend, and settle
fied in the insurance policy.
claims.
D. Total incurred amount of claims.
In her role with an insurer, Katarina has
opportunity to collaborate with not only
employees from her company, but also
external experts with particular exper- D. Claim representative.
tise. For example, as part of her investi-
gation, she hired an engineer to conduct Claim reps collaborate with more than
a review of a machine that was involved other insurer employees. Many insurers
in a personal injury. Katarina is a(n) employ a panel of experts that the claims
Select one: rep can select according to the investiga-
A. Medical provider. tion's needs.
B. Expert Witness.
C. Premium auditor.
D. Claim representative.
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When Mehmet interviews witnesses as
part of his claims investigation, he asks
different types of questions based on
need, such as open-ended, direct, indi-
rect, and leading. Which type of question
should Mehmet ask when he wants to set A. Open-ended
the interviewee at ease and he is looking
for explanation or elaboration of details Open-ended questions can be used to
in the interviewee's own words? clarify an interviewee's statements.
Select one:
A. Open-ended
B. Direct
C. Indirect
D. Leading
Charlotte is handling a new claim and
she has set the initial reserves at
$1,000,000. She has been asked to com-
plete an internal report summarizing all
the file status information for distribution D. Large loss report.
to management and updated as more
information is received. The report Char- Most insurers have guidelines outlining
lotte is completing is most likely a when and under what circumstances
Select one: large loss reports should be prepared.
A. Status report.
B. Summarized report.
C. Preliminary report.
D. Large loss report.
In which one of the following scenarios is
the right of subrogation most likely to be
employed by the insurer? D. A claims rep discovers that their in-
Select one: sured's car accident was caused by a
A. An insured files a homeowners claim road contractor who left equipment lying
for stolen jewelry. An investigation re- in the travel lanes of a highway.
veals that the jewelry is still in the in-
sured's possession.
B. An investigation reveals that an in-