AIC 300 - Simulated Exam Updated 2024/2025 Verified 100%

Which one of the following is correct with respect to the elements of good-faith claim management? - Consistent supervision, thorough training, and manageable caseloads help ensure that claim representatives are able to handle claims in good faith. Ciara is going to college with the goal of working as a data scientist for an insurer. She will need a strong foundation in mathematics and statistics, computer programming, domain knowledge, and data science. Which one of Ciara's skills will require her to understand the insurance profession to which the data is being applied? - Domain knowledge. Insurers and claim representatives must keep the promises specified in insurance policies, as well as those created by the law. In insurance transactions, the insured pays a premium for the insurer's promise to - Handle claims in good faith. Maja handled a large liability claim that settled above the policy limits. The insured is now charging the claim was handled in bad faith. During their investigation of the bad-faith claim, Maja and defense counsel discovered that the claimant had received the payment from the insurer, but not the amount above the policy limits that was to come from the insured's assets. Which one of the following defenses would Maja's defense most likely invoke? - Insured's collusion with the claimant. Bettina's apartment is burglarized and several items are stolen. In filing her claim, she tells her insurer that her stolen television was both newer and larger than it actually was. This constitutes which one of the following types of fraud? - Soft Fraud. In liability claims, the claims rep will require an authorization from the injured party to - Obtain medical records. Antonia has a general liability policy with a self-insured retention of $50,000. The policy has an occurrence limit of $250,000 and an aggregate limit of $500,000. She had submitted one prior claim this policy term for which $100,000 was paid by the insurer. How much will Antonia's insurer pay on a subsequent claim under the same policy period that is valued at $400,000? - $250,000Claims rep Miguel is conducting a settlement with a claimant. He constructs his first offer so that the claimant will likely find it undesirable. This becomes the basis of comparison for the second offer that he makes. Miguel understands that people - Feel empowered when given a choice. Joy Insurance Company is interested in using data mining to solve a problem it is having with claims fraud in one of its product lines. The first step it should take is - To understand what it wants to achieve. Thomas is an attorney who is defending an insurer in a litigated case. He has located documents that show the insured was aware of the issue that cause the injury to the claimant before the accident. Thomas is concerned that this evidence will hurt his case. He should - Preserve the evidence as part of the record. As a part of the first contact with an insured on a property damage claim, a claims representative may provide a blank - Proof of loss form. Rodrigo manages a claims department for an insurer and uses loss ratio as a measure of the department's performance. Rodrigo calculates loss ratio as - Losses and LAE divided by earned premium. An insurer that finds it economically impractical to establish a claims office in a given state is likely to use which one of the following to perform the claims handling function? - Independent Adjusters Tonya is a claims representative tasked with determining whether coverage applies to a new claim. To ensure that she considers all facets of the claim, she uses the DICE method, which stands for declarations, insuring agreement, conditions and - Exclusions. Which one of the following elements of a policy can include coverage that is otherwise excluded, exclude coverage that is otherwise included, or add or delete insureds? - An endorsement. As a claims representative, Joshua frequently requests proofs of loss and affidavits, and conducts examinations under oath and recorded statements. Which one of Joshua's sworn statements isadministered by the insurer's attorney at the office of the insurer, attorney, or court reporter? - Examination under oath. The allegations contained in a summons and complaint typically serve four purposes: To give notice, reveal facts, formulate legal causes of action and - State the damages sought. While staff claims representatives may have a variety of titles, the role is typically defined by two things: having a primary focus on claims and - Being an employee of the insurer. Millstone Insurance wanted to assign its most complex workers compensation claims to experienced claim adjusters as early as possible. The data science team used the classification tree technique to develop a predictive model. When holdout data was used to test the model's predictive accuracy, 45% of the complex claims were assigned to experienced adjusters. When claims were randomly assigned, only 15% of the complex claims were assigned to experienced adjusters. What is the lift provided by the predictive model? - 3 (45/15=3) James works for a multi-line insurer. He is responsible for investigating claims that raise suspicion of fraud. James is in the - Special Investigation Unit. Luke runs his business out of a store front in a commercial building. After a fire destroyed part of the building, Luke made a claim for damages and received a settlement check from the property insurer. This necessarily means that Luke - Is named in the policy declarations or an endorsement. Insurers usually send denial letters - By certified mail with a return receipt requested. Jose is handling a workers compensation claim. The injured worker claims to have strained his back when he lifted a box at work. He waited a day to report the injury because he thought he would be okay. He asked Jose when he would be referred to a back specialist and when he could expect his first check. Which one of the injured worker's actions would be the most pertinent fraud indicator to Jose? - Asking for referral Which one of the following terms encompasses types of fraud including false claims and intentional losses? - Hard Fraud.A claims representative should have the ability to persuade or influence - Claimants, insured's, supervisors and others. In her investigations into fraudulent claims, Laura uses information about the driver's history and driving habits to determine factors such as speed, acceleration, and location. Laura is using - Telematics Attorney Grace is representing an insurer in a case and is preparing a pretrial motion. Her argument is that the court has no jurisdiction for the cause of action brought by the claimant. Grace is preparing a - Motion to Dismiss. Among the methods used to pay claims are the issuance of checks and bank drafts. The main difference between the two is that - With a bank draft, the bank must verify that the insurer has authorized payment. The NAIC model act specifies that its provisions regarding bad-faith claims are to be enforced by - State Insurance Department. Which one of the following can be applied over time to refine a model to better predict results? - Machine Learning Because a full or partial denial of a claim may result in a bad-faith lawsuit, a claims representative should - Carefully document their reasoning for denial. Cristobal is negotiating a settlement with a claimant attorney in a workers compensation claim. The attorney has requested 200 weeks of benefits, which was more than Cristobal was hoping to pay. Cristobal countered with an offer to pay the 200 weeks if the worker would sign an agreement to resign his position and to never reopen the claim. Cristobal's negotiation strategy is an example of - Making concessions cautiously. Leila is conducting a claims investigation and is taking a recorded statement from the claimant. She wants a simple yes-or-no answer to prevent the interviewee from explaining the answer further. She asks, "You experienced back pain immediately when you lifted the box, didn't you?" Leila has asked a(n) - Leading questionIda was named in a bad-faith lawsuit as the claims representative who handled the file. The court dismissed the suit, however, because the statute of limitations had expired. This means that - Too much time had expired after the claim concluded. Olivia is careful to keep proper claim status notes when she handles a claim. For example, she makes sure to only include neutral, objective comments about the parties involved. This is because claim notes - Are potentially discoverable in a trial