Insurance Claims
Insurance Claims Handling & Adjusting – 100
Multiple Choice
Questions with
Answers
1. 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.: 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.
2. D. Subpoenaed.
Any written claims communication may be subpoenaed.: 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.
3. 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.: In which one of the following scenarios is a public adjuster most
likely to become involved?
Select one:
Insurance Claims Handling & Adjusting – 100 Multiple Choice Questions with
Answers
,Insurance Claims
A. An insurer finds it financially unfeasible to hire its own claims statt in a
given state.
B. An insured is unable to attord 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.
4. B. TPAs handle claims, keep claims records, and perform statistical analy-
ses.: 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.
5. A. Proper releases taken
Proper releases taken is a qualitative audit factor; the others are
quantitative.-
: Hugo is conducting an audit of a branch oflce 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
6. D. Line underwriter.
Insurance Claims Handling & Adjusting – 100 Multiple Choice Questions with
Answers
,Insurance Claims
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
underwrit- ers 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.: 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. Statt underwriter.
B. Public underwriter.
C. Personal lines underwriter.
D. Line underwriter.
7. D. Listening.
Claims professionals should first listen carefully to understand what the
claimant is saying.: 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.
8. 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.: Mia tracks loss adjustment expense
(LAE) as part of her manage- ment of the claims department for an insurer.
Mia considers LAE to be the Select one:
A. Total amount of loss reserves of all claims.
Insurance Claims Handling & Adjusting – 100 Multiple Choice Questions with
Answers
, Insurance Claims
B. Paid portion of claims.
C. Cost to investigate, defend, and settle claims.
D. Total incurred amount of claims.
9. D. Claim representative.
Claim reps collaborate with more than other insurer employees. Many insur-
ers employ a panel of experts that the claims rep can select according to
the investigation's needs.: 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.
10. A. Open-ended
Open-ended questions can be used to clarify an interviewee's statements.: -
When Mehmet interviews witnesses as part of his claims investigation, he
asks ditterent 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
Insurance Claims Handling & Adjusting – 100 Multiple Choice Questions with
Answers
Insurance Claims Handling & Adjusting – 100
Multiple Choice
Questions with
Answers
1. 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.: 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.
2. D. Subpoenaed.
Any written claims communication may be subpoenaed.: 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.
3. 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.: In which one of the following scenarios is a public adjuster most
likely to become involved?
Select one:
Insurance Claims Handling & Adjusting – 100 Multiple Choice Questions with
Answers
,Insurance Claims
A. An insurer finds it financially unfeasible to hire its own claims statt in a
given state.
B. An insured is unable to attord 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.
4. B. TPAs handle claims, keep claims records, and perform statistical analy-
ses.: 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.
5. A. Proper releases taken
Proper releases taken is a qualitative audit factor; the others are
quantitative.-
: Hugo is conducting an audit of a branch oflce 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
6. D. Line underwriter.
Insurance Claims Handling & Adjusting – 100 Multiple Choice Questions with
Answers
,Insurance Claims
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
underwrit- ers 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.: 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. Statt underwriter.
B. Public underwriter.
C. Personal lines underwriter.
D. Line underwriter.
7. D. Listening.
Claims professionals should first listen carefully to understand what the
claimant is saying.: 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.
8. 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.: Mia tracks loss adjustment expense
(LAE) as part of her manage- ment of the claims department for an insurer.
Mia considers LAE to be the Select one:
A. Total amount of loss reserves of all claims.
Insurance Claims Handling & Adjusting – 100 Multiple Choice Questions with
Answers
, Insurance Claims
B. Paid portion of claims.
C. Cost to investigate, defend, and settle claims.
D. Total incurred amount of claims.
9. D. Claim representative.
Claim reps collaborate with more than other insurer employees. Many insur-
ers employ a panel of experts that the claims rep can select according to
the investigation's needs.: 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.
10. A. Open-ended
Open-ended questions can be used to clarify an interviewee's statements.: -
When Mehmet interviews witnesses as part of his claims investigation, he
asks ditterent 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
Insurance Claims Handling & Adjusting – 100 Multiple Choice Questions with
Answers
