AIC 300- CLAIMS IN AN EVOLVING
WORLD 2024\2025 GUARANTEED
SUCCESS
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. - 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. - 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. - 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. -
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 - 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. - 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.
WORLD 2024\2025 GUARANTEED
SUCCESS
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. - 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. - 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. - 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. -
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 - 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. - 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.
