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AIC 300 - CLAIMS IN AN EVOLVING WORLD QUESTIONS
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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. 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. 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. 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
Select one: A. Staff underwriter. B. Public underwriter. C. Personal lines underwriter. D. Line underwriter. 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. C. Being prepared with all documentation relating to the
claim. D. Listening. D. Listening. Claims professionals should first listen carefully to understand what the claimant is saying. Mia tracks loss adjustment expense (LAE) as part of her management of the claims department for an insurer. Mia considers LAE to be the Select one: A. Total amount of loss reserves of all claims. B. Paid portion of claims. C. Cost to investigate, defend, and settle claims. D. Total incurred amount of claims. C. Cost to investigate, defend, and settle claims. Cost to investigate, defend, and settle claims. LAE is the expense that an insurer incurs to investigate, defend, and settle claims according to the terms specified in the insurance policy. 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. For example, as part of her investigation, she hired an engineer to conduct
A. Open-ended Open-ended questions can be used to clarify an interviewee's statements. 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 information for distribution to management and updated as more information is received. The report Charlotte is completing is most likely a Select one: A. Status report. B. Summarized report. C. Preliminary report. D. Large loss report. D. Large loss report. Most insurers have guidelines outlining when and under what circumstances large loss reports should be prepared. In which one of the following scenarios is the right of subrogation most likely to be employed by the insurer? Select one: A. An insured files a homeowners claim for stolen jewelry.
An investigation reveals that the jewelry is still in the insured's possession. 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 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. The right of subrogation allows an insurer to recover payment from a negligent third party. In claims investigation, all bodily injury claims require Select one: A. Statements from all witnesses. B. Multiple claims payments C. An attorney. D. A medical investigation. D. A medical investigation.
C. Recorded statement. D. Examination under oath. C. Recorded statement. A recorded statement is taken by the claims rep over the phone or in person. One of Juan's responsibilities as a claims representative is to prepare internal reports, such as preliminary, interim, large loss, and captioned. Which one of the reports Juan prepares is required for claims with reserves that exceed a specified threshold? Select one: A. Interim B. Large loss C. Preliminary D. Captioned B. Large loss Large loss reports are required by most insurers to summarize claims with reserves above a certain threshold. In the process of assigning a claim, an internal claims handler will often transfer information to the insurer's standard form, called the
Select one: A. Standard claims handling (SCH) form. B. Initial acknowledgment of notice (IAN) form. C. Claim intake (CI) form. D. First notice of loss (FNOL) form. D. First notice of loss (FNOL) form. An internal claims handler will often transfer information to the insurer's standard form, called the first notice of loss (FNOL) form. Which one of the following methods of establishing case reserves is used most often when there are small variations in loss size for a particular type of claim? Select one: A. Individual case method B. Average value method C. Formula method D. Roundtable method B. Average value method The average value method is used most often when their are small variations in loss size for a particular type of claim, and when claims can be concluded quickly.
D. Pain and suffering Pain and suffering, disfigurement, loss of body function, and emotional distress are all forms of general damages. Andrew is a claims representative investigating whether coverage applies to a new claim. To help ensure that he considers every facet of the policy before determining coverage, he might use Select one: A. The CARD method. B. The CARE method. C. The DICE method. D. The DARE method. C. The DICE method. Mitsuki was severely injured when the safety latch on an amusement park ride failed and she was thrown from the ride. In her lawsuit with the amusement park, Mitsuki was awarded payment for pain and suffering, emotional distress, disfigurement, and loss of earnings. Which one of Mitsuki's awards is considered special damages? Select one: A. Loss of earnings B. Emotional distress
C. Pain and suffering D. Disfigurement A. Loss of earnings Loss of earnings, medical bills, and lost property payments are all considered special damages. Although most policies are occurrence forms, covering claims that occur during the policy period, some are claims- made forms. Which one of the following types of loss is most likely to involve a claims-made form? Select one: A. An automotive collision claim. B. A homeowners liability claim due to a slip and fall. C. A homeowners claim due to storm damage. D. A medical malpractice claim. D. A medical malpractice claim. Claims-made forms are most often used for environmental, medical malpractice and directors and officers' policies. The Office of Foreign Assets Control requires claims payors to check payees against a database of Select one: A. Known perpetrators of insurance fraud.
negotiations as long as possible. Which negotiation technique is Riko using? Select one: A. Enticing a reasonable demand B. Timing settlements effectively C. Making concessions cautiously D. Leaning on the evaluation B. Timing settlements effectively Timing settlements effectively can impact how much money a claimant is willing to accept. Chloe is an insurer defense attorney who is preparing a trial strategy. She has researched a court decision that was made in a similar case and is basing the defense on that precedent. Chloe is relying on the principle of stare decisis, which is that Select one: A. Lower courts must follow precedents set by any other courts. B. Higher courts must follow precedents set by any other courts. C. Higher courts must follow precedents set by lower courts. D. Lower courts must follow precedents set by higher courts.
D. Lower courts must follow precedents set by higher courts. Lower courts must follow precedents set by higher courts. This is the principle of stare decisis. Kira, a claims representative, receives a summons and complaint from an insured. In reviewing the facts, she has doubts that the insured's applicable policy will provide coverage. She should work with counsel and request a managerial review in order to issue Select one: A. A reservation of rights letter. B. An excess letter. C. A countersuit. D. A claim denial. A. A reservation of rights letter. The insurer will issue a reservation of rights letter stating that it will provide defense only until it can establish that there is no coverage. The claims litigation process begins with the receipt of Select one: A. A notice of claim. B. A civil violation notice.
She is matching her demeanor, tone, and mannerisms to those of the claimant. Lily is using which one of the following negotiation techniques? Select one: A. Setting expectations B. Performing a needs analysis C. Using traditional sales techniques D. Collecting extraneous information C. Using traditional sales techniques A common sales technique is mirroring the behavior of the customer. Greatview Insurance wants to predict which auto liability claims will most likely go to litigation, so it can assign them to experienced adjusters early in the process. There are certain known indicators of litigation that Greatview wants to use in the data mining process. Which one of the following data mining techniques would Greatview's analyst most likely use? Select one: A. Regression analysis B. Association rule learning
C. Classification D. Cluster analysis C. Classification Because Greatview wants to use known characteristics, the analyst would most likely use classification to predict which auto liability claims will go to litigation. In seeking to identify claims that will potentially develop into complex and more costly claims, the data science team at Great Midsouthwest Insurance ranks a series of attributes by their importance to the data model. Which one of the following terms describes the level of predictive power of each attribute? Select one: A. Statistical relevance B. Information gain C. Lift D. Precision factor B. Information gain Information gain is a measure of the predictive power of one or more attributes.
