Social Science Business Insurance
AIC 300 - Claims in an Evolving World
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B. By certified mail with a return receipt requested. Insurers usually send denial letters
Select one:
Some will also send a copy via regular mail in case the A. By email to ensure prompt receipt by the insured.
certified letter is not accepted. B. By certified mail with a return receipt requested.
C. By overnight courier.
D. By registered mail.
D. Subpoenaed. As methods of communication evolve, it's important for claims professionals to
remember that any written claims communication may be
Any written claims communication may be subpoenaed. Select one:
A. Replaced with verbal communication.
B. Misinterpreted.
C. Edited later.
D. Subpoenaed.
D. An insured's negotiations with the insurer on a complex In which one of the following scenarios is a public adjuster most likely to become
claim are not going well. involved?
Select one:
If a claim is complex, or if settlement negotiations are not A. An insurer finds it financially unfeasible to hire its own claims staff in a given
progressing with the insurer, the insured may hire a public state.
adjuster to protect his or her interests. 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.
,B. TPAs handle claims, keep claims records, and perform Which one of the following statements regarding third-party administrators (TPAs)
statistical analyses. 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.
A. Proper releases taken 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
Proper releases taken is a qualitative audit factor; the accuracy of data entry. Which one of Hugo's metrics is a qualitative audit factor?
others are quantitative. Select one:
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 works with insurance producers and
applicants to evaluate new business submissions and conduct renewal
Line underwriter. This describes the duties of a line underwriting. Aaron is a
underwriter, rather than a staff underwriter. There is not Select one:
enough information to determine which line of business is A. Staff underwriter.
being written. A public underwriter does not exist. Line B. Public underwriter.
underwriters evaluate new submissions and perform C. Personal lines underwriter.
renewal underwriting, usually by working directly with D. Line underwriter.
insurance producers and applicants. Staff underwriters,
meanwhile, manage risk selection by working with line
underwriters and coordinating decisions about products,
pricing and guidelines.
D. Listening. The first key to communicating empathetically as a claims professional is
Select one:
Claims professionals should first listen carefully to A. A comprehensive understanding of relevant insurance policies.
understand what the claimant is saying. B. Speaking calmly and clearly.
C. Being prepared with all documentation relating to the claim.
D. Listening.
C. Cost to investigate, defend, and settle claims. Mia tracks loss adjustment expense (LAE) as part of her management of the claims
department for an insurer. Mia considers LAE to be the
Cost to investigate, defend, and settle claims. LAE is the Select one:
expense that an insurer incurs to investigate, defend, and A. Total amount of loss reserves of all claims.
settle claims according to the terms specified in the B. Paid portion of claims.
insurance policy. C. Cost to investigate, defend, and settle claims.
D. Total incurred amount of claims.
, D. Claim representative. 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.
Claim reps collaborate with more than other insurer For example, as part of her investigation, she hired an engineer to conduct a
employees. Many insurers employ a panel of experts that review of a machine that was involved in a personal injury. Katarina is a(n)
the claims rep can select according to the investigation's Select one:
needs. A. Medical provider.
B. Expert Witness.
C. Premium auditor.
D. Claim representative.
A. Open-ended When Mehmet interviews witnesses as part of his claims investigation, he asks
different types of questions based on need, such as open-ended, direct, indirect,
Open-ended questions can be used to clarify an and leading. Which type of question should Mehmet ask when he wants to set the
interviewee's statements. 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
D. Large loss report. Charlotte is handling a new claim and she has set the initial reserves at $1,000,000.
She has been asked to complete an internal report summarizing all the file status
Most insurers have guidelines outlining when and under information for distribution to management and updated as more information is
what circumstances large loss reports should be received. The report Charlotte is completing is most likely a
prepared. Select one:
A. Status report.
B. Summarized report.
C. Preliminary report.
D. Large loss report.
D. A claims rep discovers that their insured's car accident In which one of the following scenarios is the right of subrogation most likely to
was caused by a road contractor who left equipment be employed by the insurer?
lying in the travel lanes of a highway. Select one:
A. An insured files a homeowners claim for stolen jewelry. An investigation reveals
The right of subrogation allows an insurer to recover that the jewelry is still in the insured's possession.
payment from a negligent third party. B. An investigation reveals that an insured set her own business on fire.
C. An insured files a claim for collision damage from a hit and run accident, when
in fact he backed into a utility pole.
D. A claims rep discovers that their insured's car accident was caused by a road
contractor who left equipment lying in the travel lanes of a highway.
D. A medical investigation. In claims investigation, all bodily injury claims require
Select one:
All bodily injury claims, including workers compensation A. Statements from all witnesses.
claims, require a medical investigation. B. Multiple claims payments
C. An attorney.
D. A medical investigation.
AIC 300 - Claims in an Evolving World
Save
Students also studied
AIC 300 AIC 300 AIC 300 - Simulated Exam AIC 30
194 terms 237 terms 50 terms 50 terms
dfaust22 Preview aagonzalez0717 Preview elemieux14 Preview owe
B. By certified mail with a return receipt requested. Insurers usually send denial letters
Select one:
Some will also send a copy via regular mail in case the A. By email to ensure prompt receipt by the insured.
certified letter is not accepted. B. By certified mail with a return receipt requested.
C. By overnight courier.
D. By registered mail.
D. Subpoenaed. As methods of communication evolve, it's important for claims professionals to
remember that any written claims communication may be
Any written claims communication may be subpoenaed. Select one:
A. Replaced with verbal communication.
B. Misinterpreted.
C. Edited later.
D. Subpoenaed.
D. An insured's negotiations with the insurer on a complex In which one of the following scenarios is a public adjuster most likely to become
claim are not going well. involved?
Select one:
If a claim is complex, or if settlement negotiations are not A. An insurer finds it financially unfeasible to hire its own claims staff in a given
progressing with the insurer, the insured may hire a public state.
adjuster to protect his or her interests. 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.
,B. TPAs handle claims, keep claims records, and perform Which one of the following statements regarding third-party administrators (TPAs)
statistical analyses. 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.
A. Proper releases taken 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
Proper releases taken is a qualitative audit factor; the accuracy of data entry. Which one of Hugo's metrics is a qualitative audit factor?
others are quantitative. Select one:
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 works with insurance producers and
applicants to evaluate new business submissions and conduct renewal
Line underwriter. This describes the duties of a line underwriting. Aaron is a
underwriter, rather than a staff underwriter. There is not Select one:
enough information to determine which line of business is A. Staff underwriter.
being written. A public underwriter does not exist. Line B. Public underwriter.
underwriters evaluate new submissions and perform C. Personal lines underwriter.
renewal underwriting, usually by working directly with D. Line underwriter.
insurance producers and applicants. Staff underwriters,
meanwhile, manage risk selection by working with line
underwriters and coordinating decisions about products,
pricing and guidelines.
D. Listening. The first key to communicating empathetically as a claims professional is
Select one:
Claims professionals should first listen carefully to A. A comprehensive understanding of relevant insurance policies.
understand what the claimant is saying. B. Speaking calmly and clearly.
C. Being prepared with all documentation relating to the claim.
D. Listening.
C. Cost to investigate, defend, and settle claims. Mia tracks loss adjustment expense (LAE) as part of her management of the claims
department for an insurer. Mia considers LAE to be the
Cost to investigate, defend, and settle claims. LAE is the Select one:
expense that an insurer incurs to investigate, defend, and A. Total amount of loss reserves of all claims.
settle claims according to the terms specified in the B. Paid portion of claims.
insurance policy. C. Cost to investigate, defend, and settle claims.
D. Total incurred amount of claims.
, D. Claim representative. 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.
Claim reps collaborate with more than other insurer For example, as part of her investigation, she hired an engineer to conduct a
employees. Many insurers employ a panel of experts that review of a machine that was involved in a personal injury. Katarina is a(n)
the claims rep can select according to the investigation's Select one:
needs. A. Medical provider.
B. Expert Witness.
C. Premium auditor.
D. Claim representative.
A. Open-ended When Mehmet interviews witnesses as part of his claims investigation, he asks
different types of questions based on need, such as open-ended, direct, indirect,
Open-ended questions can be used to clarify an and leading. Which type of question should Mehmet ask when he wants to set the
interviewee's statements. 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
D. Large loss report. Charlotte is handling a new claim and she has set the initial reserves at $1,000,000.
She has been asked to complete an internal report summarizing all the file status
Most insurers have guidelines outlining when and under information for distribution to management and updated as more information is
what circumstances large loss reports should be received. The report Charlotte is completing is most likely a
prepared. Select one:
A. Status report.
B. Summarized report.
C. Preliminary report.
D. Large loss report.
D. A claims rep discovers that their insured's car accident In which one of the following scenarios is the right of subrogation most likely to
was caused by a road contractor who left equipment be employed by the insurer?
lying in the travel lanes of a highway. Select one:
A. An insured files a homeowners claim for stolen jewelry. An investigation reveals
The right of subrogation allows an insurer to recover that the jewelry is still in the insured's possession.
payment from a negligent third party. B. An investigation reveals that an insured set her own business on fire.
C. An insured files a claim for collision damage from a hit and run accident, when
in fact he backed into a utility pole.
D. A claims rep discovers that their insured's car accident was caused by a road
contractor who left equipment lying in the travel lanes of a highway.
D. A medical investigation. In claims investigation, all bodily injury claims require
Select one:
All bodily injury claims, including workers compensation A. Statements from all witnesses.
claims, require a medical investigation. B. Multiple claims payments
C. An attorney.
D. A medical investigation.
