AIC 300 FINAL COMPLETE QUESTIONS AND CORRECT ANSWERS
First party insurance: The policyholder (first party) receives payment
immediately from the ANSWER insurer for covered losses.
insurance for third parties The ANSWER insurance pays a claimant (third
party) on the policyholder's behalf.
Administrators of third parties (TPAs) An organization called ANSWER offers
administrative services related to risk financing and insurance, including
records, analysis, and claims.
Self-insured companies have the option of hiring a TPA or managing their own
claims.
P&C insurers have TPA-functioning subsidiaries.
Staff claims representatives are in charge of looking into, assessing, and
resolving claims (ex: adjusters).
Independent adjusters, some of whom work for adjusting businesses and others
for themselves, provide specialized claims and field work if insurers cannot
afford claims offices in every state.
Producers: ANSWER: any type of insurance professional who arranges
insurance and surety business with insurers and who act as an agent, broker, or
sales representative for either the insurers or the insureds.
Public adjusters are an outside company or individual that an insured party hires
to represent them in a claim in exchange for payment if the insured is unhappy
with the settlement or the claim is complicated.
sorts of staff claims representatives: ANSWER inside: just from the insurer's
office; field: outside, both in and out of office; they manage claims by
, conducting activities such as meeting with insureds and investigating the scene
of loss.
In order to assess new submissions and renewals, line underwriters at ANSWER
collaborate closely with insurance producers and applicants.
Staff underwriters—ANSWER collaborates with line underwriters to coordinate
choices for guidelines, pricing, and goods.
premium audit: ANSWER conducts systematic reviews of a policyholder's
books of accounts, records, and activities to ascertain the true exposure units
and premium for insurance coverages that have already been given.
Why should claim representatives exercise caution when communicating
claims? Any written claims communication may be subpoenaed, and ANSWER
claims investigation activities may then be used as evidence in court.
loss ratio: earned premium divided by answer losses and loss adjustment costs
evaluates the claims and uw departments' performance.
The cost an insurer bears to look into, defend, and resolve claims in accordance
with the provisions of the policy is known as loss adjustment costs (LAE).
Short-term option to lower LAE: ANSWER lowers costs by providing
settlement payments rather than funding legal defense and investigation.
ANSWER, best practices, claims audits, and customer satisfaction data are the
three quality indicators of a claims department.
Comparing quantitative and qualitative audit factors, the quantitative answer is
that they are all derived from data (e.g., the average claims settlement value, the
number of files opened each month, and the timeliness of reports).
Qualitative: based on judgment (appropriate releases, realistic reserving,
accurate coverage evaluation, and effective bargaining techniques)
First party insurance: The policyholder (first party) receives payment
immediately from the ANSWER insurer for covered losses.
insurance for third parties The ANSWER insurance pays a claimant (third
party) on the policyholder's behalf.
Administrators of third parties (TPAs) An organization called ANSWER offers
administrative services related to risk financing and insurance, including
records, analysis, and claims.
Self-insured companies have the option of hiring a TPA or managing their own
claims.
P&C insurers have TPA-functioning subsidiaries.
Staff claims representatives are in charge of looking into, assessing, and
resolving claims (ex: adjusters).
Independent adjusters, some of whom work for adjusting businesses and others
for themselves, provide specialized claims and field work if insurers cannot
afford claims offices in every state.
Producers: ANSWER: any type of insurance professional who arranges
insurance and surety business with insurers and who act as an agent, broker, or
sales representative for either the insurers or the insureds.
Public adjusters are an outside company or individual that an insured party hires
to represent them in a claim in exchange for payment if the insured is unhappy
with the settlement or the claim is complicated.
sorts of staff claims representatives: ANSWER inside: just from the insurer's
office; field: outside, both in and out of office; they manage claims by
, conducting activities such as meeting with insureds and investigating the scene
of loss.
In order to assess new submissions and renewals, line underwriters at ANSWER
collaborate closely with insurance producers and applicants.
Staff underwriters—ANSWER collaborates with line underwriters to coordinate
choices for guidelines, pricing, and goods.
premium audit: ANSWER conducts systematic reviews of a policyholder's
books of accounts, records, and activities to ascertain the true exposure units
and premium for insurance coverages that have already been given.
Why should claim representatives exercise caution when communicating
claims? Any written claims communication may be subpoenaed, and ANSWER
claims investigation activities may then be used as evidence in court.
loss ratio: earned premium divided by answer losses and loss adjustment costs
evaluates the claims and uw departments' performance.
The cost an insurer bears to look into, defend, and resolve claims in accordance
with the provisions of the policy is known as loss adjustment costs (LAE).
Short-term option to lower LAE: ANSWER lowers costs by providing
settlement payments rather than funding legal defense and investigation.
ANSWER, best practices, claims audits, and customer satisfaction data are the
three quality indicators of a claims department.
Comparing quantitative and qualitative audit factors, the quantitative answer is
that they are all derived from data (e.g., the average claims settlement value, the
number of files opened each month, and the timeliness of reports).
Qualitative: based on judgment (appropriate releases, realistic reserving,
accurate coverage evaluation, and effective bargaining techniques)
