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AICp 300 p–pCLAIMpINpANpEVOLVINGpWORLDpEXAMQp
UESTIONSpANDpCORRECTpANSWERSpWITHpRATIO
NALESp 2024 pUPDATEpGRADEDpA+
Larissapispanpautopclaimpadjuster.pTraditionally,pshephaspreliedponppolicepreportspandpwitnessptestimonypi npherpdecisionpmaking.pRecentptechnologicalpdevelopmentspgivepherpaccessptopthepdriver'spdrivingphabits, pincludingpacceleration,pspeed,pandpbraking.pThispdatapavailableptopLarissapispknownpas Selectpone: A. ArtificialpIntelligence. B. Telematics. C. Wearables. D. InternetpofpThings. B.pTelematics. Telematicsparepusedptopcollectpdataponppersonalpautos,pcommercialpvehicles,pproducts,pshipments ,pmachinery,psmartpdevices,pandpworkers. MartinpispinpSIUpandphelpsphispemployer,papmulti- linepinsurer,ptopdetectpfraudulentpclaims.pHepispusingpaptechnologypthatpenablespinsurersptopsharepfraud- relatedpinformation.pThispdistributedpdigitalpledgerpthatpfacilitatespsecureptransactionspwithoutpusingpapt hirdppartypispknownpas Selectpone: A. Blockchain. B. Appredictivepmodel. C. ThepInternetpofpThings. D. Telematics. Blockchain.
Byphavingpaptransparentpledgerpassociatedpwithpapcar,pforpexample,pinsurerspcanpdetectpfraudpthatpwoul dpbepdifficultptopdetectpotherwise. Jackpleadspthepclaimspdepartmentpforpaplargepinsurerpandphaspembracedptheprecentpdevelopmentspi npclaimspdatapcollectionpandpanalysis.pJackpknowspthat Selectpone: A. Peoplepmakeplittlepdifferencepinpanalyzingpdatapandpexplainingpitptopapcustomer. B. ClaimspdeterminationspandppaymentspwillpsoonpbepaccomplishedpentirelypbypAI. C. Hepwillpeventuallypnotpneedppeoplepbecausepinsurancepispnotpapcustomer-drivenpindustry. D. Hepstillpneedsppeoplepbecausepthepdatapneedptopbepanalyzedpinpcontextpbypaphuman. D.pHepstillpneedsppeoplepbecausepthepdatapneedptopbepanalyzedpinpcontextpbypaphuman. Aspapclaimsprepresentative,pBeatricepisponpthepfrontplinespforpprotectingpherpemployerpfrompinsuranc epfraud.pBeatricepshouldpunderstandpthatpinsurancepfraud Selectpone: A. Ispthepcostliestpwhite-collarpcrimepinpthepU.S. B. Accountspforp 25 ppercentpofpthepP&Cpindustrypincurredplosses. C. Costsproughlyp$40pbillionpperpyear,pexcludingphealthpinsurance. D. CostspeachpAmericanpfamilypbetweenp$2,000pandp$4,000pperpyear. C.pCostsproughlyp$40pbillionpperpyear,pexcludingphealthpinsurance. Ellapsuedpherpinsurerpandpallegedpbad- faithpclaimphandlingpafterpthepinsurerpsettledpapclaimpagainstpherpthatpEllapthoughtpshouldphavepbeenpden ied.pAspapresultpofpthepsettlement,pElla'sppremiumpincreased.pIn
OnepofpJulio'spexpectationspaspapclaimsprepresentativepispgood- faithpclaimsphandling.pHepkeepspinsuredspinformedpaboutpthepclaimpbecauseptheyphavepthatpexpectationp andpbecauseptheyparepmostplikelyptopmakepapcomplaintpaboutpbad- faithpclaimphandling.pHepalsopwishesptopparticipatepinpthepdefensepandpinpdiscussionspaboutptheppossibilit ypofpsettlement.pForpthesepreasons,pJulio Selectpone: A. Conductspfairpevaluations. B. Maintainspcompletepandpaccuratepdocumentation. C. Maintainspregularpandppromptpcommunication. D. Conductspgood-faithpnegotiation. C.pMaintainspregularpandppromptpcommunication. Communicatingpwithpallppartiesptopapclaimpispapcrucialpaspectpofpgood- faithpclaimsphandlingpandpresolution. WhichponepofpthepfollowingpstatementspregardingpstatepversionspofpthepNAICpmodelpactpispcorrect ?pSelectpone: A. Onlypinsuredspmaypbringplawsuitspagainstpinsurers. B. Onlypclaimantspmaypbringplawsuitspagainstpinsurers. C. Bothpinsuredspandpclaimantspmaypbringplawsuitspagainstpinsurers. D. Somepstatespallowpinsuredspandpclaimantsptopbringplawsuitspagainstpinsurers,pwhilepotherspallowponl ypinsureds. D.pSomepstatespallowpinsuredspandpclaimantsptopbringplawsuitspagainstpinsurers,pwhilepother spallowponlypinsureds. Tobiaspispapclaimsprepresentativepwhopunderstandspthepimportancepofpgood- faithpclaimsphandling,pincludingpfairpevaluation,pgood- faithpnegotiation,pcompletepandpaccuratepdocumentation,pandptimely
contactpwithpallppartiesptopapclaim.pWhichponepofpTobias'pgood- faithpclaimsphandlingppracticesphelpsphispemployerpbecauseptheppartiespwillpbepmoreplikelyptoprememberp detailspofptheplosspaccurately? Selectpone: A. Fairpevaluation B. Completepandpaccuratepdocumentation C. Timelypcontactpwithpallppartiesptopapclaim D. Good-faithpnegotiation C.pTimelypcontactpwithpallppartiesptopapclaim Timelypcontactpwithpallppartiesptopapclaimphelpspensurepthatppartiespwillpbepmoreplikelyptoprememberp detailspofptheplosspaccurately. Forpanpexcesspliabilitypclaimptopbepfiled,papfinalpjudgmentporpsettlementpmustphavepbeenpenteredpagains tpthepinsured,pand Selectpone: A. Thepinsuredpmustphaveppaidpthatpjudgment. B. Thepamountpofpthepjudgmentpmustpbepinpexcesspofpthepinsured'sppolicyplimit. C. Evidencepofpbadpfaithpmustpbepproduced. D. Thepinsurerpmustphavepdeterminedpthatpcoveragepdoespnotpapply. B.pThepamountpofpthepjudgmentpmustpbepinpexcesspofpthepinsured'sppolicyplimit. Forpanpexcesspliabilitypclaimptopbepfiled,papfinalpjudgmentporpsettlementpmustphavepbeenpenteredpagains tpthepinsured,pandpthepamountpofpthepjudgmentpmustpbepinpexcesspofpthepinsured'sppolicyplimit.pThepinsu redpispnotprequiredptophaveppaidpthepjudgmentpbeforepbringingpsuit. Whichponepofpthepfollowingpbestpdescribesptheptermp'professionalism'paspitprelatesptopclaimspprofessionals ?
C. Smartphones D. Telematics Drones Erikpwouldpmostplikelypusepdronesptoptakepphotosporpvideospofpthepdifficult-to- reachpareapandpassesspthepdamagepandpdanger.pBypusingpthepdrones,phepcanpassesspthepdangerpwithoutp riskingpthepsafetypofpthepclaimsprepresentatives. Lukeprunsphispbusinesspoutpofpapstorepfrontpinpapcommercialpbuilding.pAfterpapfirepdestroyedppartpofpth epbuilding,pLukepmadepapclaimpforpdamagespandpreceivedpapsettlementpcheckpfromptheppropertypinsur er.pThispnecessarilypmeanspthatpLuke Selectpone: A. Haspbusinesspinterruptionpcoverage. B. Ispnamedpinptheppolicypdeclarationsporpanpendorsement. C. Haspanpinsurablepinterestpinpthepdamagedpproperty. D. Ispthepownerpofpthepbuilding. B.pIspnamedpinptheppolicypdeclarationsporpanpendorsement. Anpindividualpmayphavepanpinsurablepinterestpinpapbuilding,pbutpnotpbepconsideredpanpinsuredpunderpth eppolicypbecausepthepperson'spnamepispnotplistedpinpthepdeclarationsporponpanpendorsement. Rodrigopmanagespapclaimspdepartmentpforpanpinsurerpandpusesplosspratiopaspapmeasurepofpth epdepartment'spperformance.pRodrigopcalculatesplosspratiopas Selectpone: A. Lossespdividedpbypwrittenppremium. B. LossespandpLAEpdividedpbypearnedppremium. C. LossespandpLAEpdividedpbypwrittenppremium.
D. Lossespdividedpbypearnedppremium. B.pLossespandpLAEpdividedpbypearnedppremium. LossespandpLAEpdividedpbypearnedppremium.pLosspratiopmeasuresplossespandplosspadjustmentpexpense spagainstpearnedppremiumpandpreflectsptheppercentagepofppremiumspbeingpconsumedpbyplosses. Inpliabilitypclaims,pthepclaimspreppwillprequirepanpauthorizationpfrompthepinjuredppartypt opSelectpone: A. Investigatepthepclaim. B. Obtainpmedicalprecords. C. Contactpthepinsured. D. Issuepappartialpclaimpsettlement. B.pObtainpmedicalprecords. Inpliabilitypclaims,pthepclaimspreppwillprequirepanpauthorizationpfrompthepinjuredppartyptopobtainpmedicalp records. Mustafapispapdatapscientistpwhopispworkingpwithpapteampofpunderwriting,pIT,pandpactuaryptopdeveloppapp redictivepanalyticspmodel.pThepmainpgoalpofpthepprojectpisptoptranslatepthepinsightspgainedpfrompthepmo delptheypdeveloppintopbusinesspaction.pInpMustafa'spexperience,pthepteampmemberpthatpcanpprovidepth epbridgepbetweenpthepanalyticspandpthepbusinesspis Selectpone: A. Actuary. B. IT. C. Underwriting. D. Datapscience.
Toopmuchptimephadpexpiredpafterpthepclaimpconcluded.pApstatutepofplimitationspispaplawpthatpstipulatespthepl engthpofptimepafterpanpeventpduringpwhichplegalpproceedingspmaypbepinitiated. DaJuan,papclaimsprepresentative,psetspaplowpcasepreservepforpapseeminglypsimplepclaim.pApfewpweeksplate rpitpbecomespapparentpthatpthepinitialpreservepwasptooplow,pandphepincreasespitpinporderptopissueppayment s.pMorepbillsprelatedptopthepclaimparrivepapfewpmonthsplater,pandphepincreasespthepreservepagain.pThisppro cesspispknownpas Selectpone: A. Stairstepping. B. Reopening. C. Readjusting. D. Incrementalpreserving. A.pStairstepping. Erinphelpspherpemployer,papmulti- linepinsurer,ptopdeterminepactualpexposurepandppremiumpforpcoverage.pShepdoespthispbypconductingpdet ailedpexaminationspofppolicyholderpoperations,precords,pandpaccounting.pErinpispa(n) Selectpone: A. Producer. B. Claimspadjuster. C. Premiumpauditor. D. Underwriter. C.pPremiumpauditor. Premiumpauditorspprovidepinventorypvalues,pcontractors'pequipmentplists,pandpotherpfactspthatpar epimportantptopthepclaimspfunction.
Thomaspispanpattorneypwhopispdefendingpanpinsurerpinpaplitigatedpcase.pHephasplocatedpdocumentsptha tpshowpthepinsuredpwaspawarepofpthepissuepthatpcausepthepinjuryptopthepclaimantpbeforepthepaccident. Thomaspispconcernedpthatpthispevidencepwillphurtphispcase.pHepshoul dpSelectpone: A. Preservepthepevidencepasppartpofptheprecord. B. Filepapmotionptopsuppresspthepevidence. C. Filepapmotionpinplimineptopexcludepthepevidence. D. Destroypthepevidenceptopmakepthepdefensepstronger. A.pPreservepthepevidencepasppartpofptheprecord. Anpinsurerpdefendingpapfirst- partypcoverageplawsuitpcouldpbepfoundpliablepifpevidencepispintentionallyporpnegligentlyplostporpdestroye d. Throughpdatapmining,pGoshenpMutualpdiscoverspthatpcustomerspwhopinsureptwoporpmorepvehiclesponp appersonalpautoppolicyparepveryplikelyptopbuypappersonalpumbrellappolicy.pAlgorithmsparepthenpusedptopi dentifyppotentialpcustomerspwhopmightpbepinterestedpinppurchasingpbothppersonalpautopandpumbrellap policies.pWhichponepofpthepfollowingpdatapminingptechniquespdidpGoshenpMutualpuse? Selectpone: A. Classification B. Associationpruleplearning C. Regressionpanalysis D. Clusterpanalysis B.pAssociationpruleplearning
Alvapworkspforpanpinternational,pmulti- linepinsurer.pShephelpspherpcompanyptopmanagepriskpselectionpbypworkingpwithpotherpunderwriterspandpc oordinatingpdecisionspaboutpproducts,ppricing,pandpguidelines.pAlvapispa Selectpone: A. Masterpunderwriter. B. Linepunderwriter. C. Staffpunderwriter. D. ChiefpUnderwritingpOfficer. C.pStaffpunderwriter. Thispdescribespthepdutiespofpapstaffpunderwriter.pLinepunderwriter.pThispdescribespthepdutiespofpaplinepund erwriter,pratherpthanpapstaffpunderwriter.pTherepispnotpenoughpinformationptopdeterminepwhichplinepofpbus inesspispbeingpwritten.pAppublicpunderwriterpdoespnotpexist.pLinepunderwriterspevaluatepnewpsubmissionsp andpperformprenewalpunderwriting,pusuallypbypworkingpdirectlypwithpinsurancepproducerspandpapplicants. pStaffpunderwriters,pmeanwhile,pmanagepriskpselectionpbypworkingpwithplinepunderwriterspandpcoordinati ngpdecisionspaboutpproducts,ppricingpandpguidelines. Majaphandledpaplargepliabilitypclaimpthatpsettledpaboveptheppolicyplimits.pThepinsuredpispnowpchargingpthe pclaimpwasphandledpinpbadpfaith.pDuringptheirpinvestigationpofpthepbad- faithpclaim,pMajapandpdefensepcounselpdiscoveredpthatpthepclaimantphadpreceivedptheppaymentpfrompthe pinsurer,pbutpnotpthepamountpaboveptheppolicyplimitspthatpwasptopcomepfrompthepinsured'spassets.pWhichp onepofpthepfollowingpdefensespwouldpMaja'spdefensepmostplikelypinvoke? Selectpone: A. Contributorypnegligence B. Advicepofpcounsel C. Debatablepreasonablepbasis D. Insured'spcollusionpwithpclaimant D.pInsured'spcollusionpwithpclaimant
Insured'spcollusionpwithpclaimant.pDiscoveringpcollusionpbetweenpthepinsuredpandpclaimant,psuchpaspap claimantpagreeingpnotptopcollectpapjudgmentpfrompthepinsured'spassets,pcanpleadptopdismissalpofpap bad-pfaithpclaim. Amongpthepmethodspusedptoppaypclaimsparepthepissuancepofpcheckspandpbankpdrafts.pThepmainpdifferenc epbetweenptheptwopispthat Selectpone: A. Onlypcheckspmaypbepusedpforpclaimppaymentspinpexcesspofp$10,000. B. Withpapcheck,pthepbankpmustpverifypthatpthepinsurerphaspauthorizedppayment. C. Onlypbankpdraftspmaypbepusedpforpclaimppaymentspinpexcesspofp$10,000. D. Withpapbankpdraft,pthepbankpmustpverifypthatpthepinsurerphaspauthorizedppayment. D.pWithpapbankpdraft,pthepbankpmustpverifypthatpthepinsurerphaspauthorizedppayment. Apclaimsprepresentativepshouldphavepthepabilityptoppersuadeporpinfluenc epSelectpone: A. Supervisors. B. Insureds. C. Claimants,pinsureds,psupervisorspandpothers. D. Claimants. C.pClaimants,pinsureds,psupervisorspandpothers. Thepimpressionpthatpclaimsprepspmakeponpclaimants,pinsureds,pandpotherspreflectspeitherpfavorablypo rpunfavorablyponpthepinsurer.
topapsystempofpidentifiedpinternalppracticespthatpclaimsprepresentativespperformptopproducepsuperiorpper formance? Selectpone: A. Customerpsatisfactionpdata B. Losspratio C. Bestppractices D. Claimspaudits C.pBestppractices Bestppracticespgenerallyprefersptopapsystempofpidentifiedpinternalppracticespthatparepsharedpwithpclaim sprepspandpproducepsuperiorpperformance. Whichponepofpthepfollowingpelementspofpappolicypcanpincludepcoveragepthatpispotherwisepexcluded ,pexcludepcoveragepthatpispotherwisepincluded,porpaddporpdeletepinsureds? Selectpone: A. Thepdeclarations. B. Thepconditions. C. Anpexclusion. D. Anpendorsement. D.pAnpendorsement. Anpendorsementpcanpincludepcoveragepthatpispotherwisepexcluded,pexcludepcoveragepthatpispotherwis epincluded,porpaddporpdeletepinsureds. Aspapclaimsprepresentative,pJoshuapfrequentlyprequestspproofspofplosspandpaffidavits,pandpconduct spexaminationspunderpoathpandprecordedpstatements.pWhichponepofpJoshua'spswornpstatementspisp administeredpbypthepinsurer'spattorneypatpthepofficepofpthepinsurer,pattorney,porpcourtpreporter?
Selectpone: A. Affidavit B. Examinationpunderpoath C. Recordedpstatement D. Proofpofploss B.pExaminationpunderpoath Examinationpunderpoathpispadministeredpbypthepattorneypforpthepinsurerpafterpnoticepispissuedptopappea rpatpthepofficepofpthepinsurer,pattorney,porpcourtpreporter. Becausepapfullporppartialpdenialpofpapclaimpmaypresultpinpapbad- faithplawsuit,papclaimsprepresentativepshouldpSelectpone: A. Seekpapsupervisor'spapprovalpbeforepdenyingpapclaim. B. Makepeverypeffortptopapprovepeachpclaim. C. Carefullypdocumentptheirpreasoningpforpdenial. D. Checkpwithpthepreinsurerpbeforepdenyingpapclaim. C.pCarefullypdocumentptheirpreasoningpforpdenial. Thepactivitiespthatpmakepuppthepclaimsphandlingpproces spSelectpone: A. Arepalwayspsequentialpbutpmaypoverlap. B. Arepalwayspsequentialpandpdopnotpoverlap. C. Arepnotpalwayspsequential,pandpmaypoverlap. D. Arepnotpalwayspsequential,pbutpdopnotpoverlap. C.pArepnotpalwayspsequential,pandpmaypoverlap.
Cristobalpispnegotiatingpapsettlementpwithpapclaimantpattorneypinpapworkerspcompensationpclaim.pThepatt orneyphasprequestedp 200 pweekspofpbenefits,pwhichpwaspmorepthanpCristobalpwasphopingptoppay. Cristobalpcounteredpwithpanpofferptoppaypthep 200 pweekspifpthepworkerpwouldpsignpanpagreementptopresig nphisppositionpandptopneverpreopenpthepclaim.pCristobal'spnegotiationpstrategypispanpexamplepof Selectpone: A. Timingpsettlementspeffectively. B. Leaningponpthepevaluation. C. Makingpconcessionspcautiously. D. Enticingpapreasonablepdemand. C.pMakingpconcessionspcautiously. Claimsprepspshouldponlypmakepconcessionspforpspecificpreasons,pthepotherppartyphaspmadepapconcession,p orpapconcessionpwouldpallowpthepclaimptopbepsettledpmorepquickly Whichponepofpthepfollowingpispcorrectpwithprespectptopthepelementspofpgood- faithpclaimpmanagement?pSelectpone: A. Consistentpsupervision,pthoroughptraining,pandpmanageablepcaseloadsphelppensurepthatpclai mprepresentativesparepableptophandlepclaimspinpgoodpfaith. B. Whenpresolvingpapcoveragepquestion,pinsurerspshouldpavoidpthepappearancepofpbadpfaithpbypdealin gponlypwithpthoseplawyersphiredptopdefendpthepinsured. C. Ifpthepinsuredphaspexcesspinsurance,pthepclaimprepresentativepshouldpmerelypnotifypthepexcesspinsure rpofpthepclaim. D. Claimprepresentativespshouldpavoidpusingppolicypprovisions,psuchpasparbitrationpclauses,ptopresolve pdisputespoverpthepsettlementpamount. A.pConsistentpsupervision,pthoroughptraining,pandpmanageablepcaseloadsphelppensurepthatpclai mprepresentativesparepableptophandlepclaimspinpgoodpfaith. Consistentpsupervision,pthoroughptraining,pandpmanageablepcaseloadsphelppensurepthatpclai mprepresentativesparepableptophandlepclaimspinpgoodpfaith.
Antoniaphaspapgeneralpliabilityppolicypwithpapself- insuredpretentionpofp$50,000.pTheppolicyphaspanpoccurrenceplimitpofp$250,000pandpanpaggregateplimitpofp$ 500,000.pShephadpsubmittedponeppriorpclaimpthisppolicyptermpforpwhichp$100,000pwasppaidpbypthepinsurer. pHowpmuchpwillpAntonia'spinsurerppayponpapsubsequentpclaimpunderpthepsameppolicypperiodpthatpispvalue dpatp$400,000? Selectpone: A.p$200, B.p$250, C.p$400, D.p$500,000p B.p$250, AfterpthepSIRplimitphadpbeenpreached,pthepinsurerpwaspobligatedptoppaypupptopthepoccurrenceplimit. Ifpthepdecisionponpapclaimpsettlementpispnegative,paspinpapdenial,pgood- faithpclaimsphandlingprequirespthepclaimspreppto Selectpone: A. Explainptheprationalepbehindpthepdecisionptopthepclaimant. B. Deliverpthepdecisionptopthepclaimantpinpwriting. C. Deliverpaphardpcopypofpthepdecisionptopthepclaimantpbypmail. D. Havepapsupervisorpsignpoffponpthepcommunicationptopthepclaimant. A.pExplainptheprationalepbehindpthepdecisionptopthepclaimant. Ifpthepdecisionponpapclaimpsettlementpispnegative,pgood- faithpclaimsphandlingprequirespthepclaimsprepptopexplainptheprationalepbehindpthepdecision.
