Exam (elaborations)
AIC 300 - Claims in an Evolving World With complete solution Newest
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AIC 300 - Claims in an Evolving World With complete solution Newest
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AIC 300 - Claims in an Evolving WorldWith complete solution Newest
B. By certified mail with a return receipt requested.
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Some will also send a copy via regular mail in case the certified letter is not accepted. -
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Insurers usually send denial letters
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Select one: II
A. By email to ensure prompt receipt by the insured.
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B. By certified mail with a return receipt requested.
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C. By overnight courier.
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D. By registered mail.
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II D. Subpoenaed.
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Any written claims communication may be subpoenaed. - As methods of communication
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evolve, it's important for claims professionals to remember that any written claims
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communication may be
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Select one: II
A. Replaced with verbal communication.
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B. Misinterpreted.
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C. Edited later.
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D. Subpoenaed.
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II D. An insured's negotiations with the insurer on a complex claim are not going well.
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If a claim is complex, or if settlement negotiations are not progressing with the insurer, the
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insured may hire a public adjuster to protect his or her interests. - In which one of the
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following scenarios is a public adjuster most likely to become involved?
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Select one: II
A. An insurer finds it financially unfeasible to hire its own claims staff in a given state.
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B. An insured is unable to afford legal representation to contest a claim.
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C. A catastrophic disaster strikes, involving damage to many properties.
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D. An insured's negotiations with the insurer on a complex claim are not going well.
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B. TPAs handle claims, keep claims records, and perform statistical analyses. - Which
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one of the following statements regarding third-party administrators (TPAs) is most
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accurate?
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Select one: II
A. TPAs are typically used by businesses that have chosen not to self-insure.
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B. TPAs handle claims, keep claims records, and perform statistical analyses.
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C. TPAs are generally found in an insurer's claims department.
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D. TPAs are employed only by independent adjusting firms.
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,II A. Proper releases taken
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Proper releases taken is a qualitative audit factor; the others are quantitative. - Hugo is
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conducting an audit of a branch office claims operation. He is evaluating timeliness of
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reports, number of files opened, proper releases taken, and accuracy of data entry. Which
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one of Hugo's metrics is a qualitative audit factor?
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Select one: II
A. Proper releases taken
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B. Timeliness of reports
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C. Number of files opened
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D. Accuracy of data entry
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II D. Line underwriter.
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Line underwriter. This describes the duties of a line underwriter, rather than a staff
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underwriter. There is not enough information to determine which line of business is being
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written. A public underwriter does not exist. Line underwriters evaluate new submissions
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and perform renewal underwriting, usually by working directly with insurance producers
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and applicants. Staff underwriters, meanwhile, manage risk selection by working with line
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underwriters and coordinating decisions about products, pricing and guidelines. - Aaron
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works for a multi-line insurer. He works with insurance producers and applicants to
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evaluate new business submissions and conduct renewal underwriting. Aaron is a
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Select one: II
A. Staff underwriter.
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B. Public underwriter.
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C. Personal lines underwriter.
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D. Line underwriter.
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II D. Listening.
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Claims professionals should first listen carefully to understand what the claimant is
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saying. - The first key to communicating empathetically as a claims professional is
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Select one: II
A. A comprehensive understanding of relevant insurance policies.
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B. Speaking calmly and clearly.
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C. Being prepared with all documentation relating to the claim.
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D. Listening.
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II C. Cost to investigate, defend, and settle claims.
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Cost to investigate, defend, and settle claims. LAE is the expense that an insurer incurs to
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investigate, defend, and settle claims according to the terms specified in the insurance
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policy. - Mia tracks loss adjustment expense (LAE) as part of her management of the
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claims department for an insurer. Mia considers LAE to be the
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Select one: II
A. Total amount of loss reserves of all claims.
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, B. Paid portion of claims.
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C. Cost to investigate, defend, and settle claims.
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D. Total incurred amount of claims.
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II D. Claim representative.
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Claim reps collaborate with more than other insurer employees. Many insurers employ a
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panel of experts that the claims rep can select according to the investigation's needs. - In
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her role with an insurer, Katarina has opportunity to collaborate with not only employees
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from her company, but also external experts with particular expertise. For example, as
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part of her investigation, she hired an engineer to conduct a review of a machine that was
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involved in a personal injury. Katarina is a(n)
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Select one: II
A. Medical provider.
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B. Expert Witness.
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C. Premium auditor.
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D. Claim representative.
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II A. Open-ended
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Open-ended questions can be used to clarify an interviewee's statements. - When II II II II II II II II II II II II II
Mehmet interviews witnesses as part of his claims investigation, he asks different types of
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questions based on need, such as open-ended, direct, indirect, and leading. Which type
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of question should Mehmet ask when he wants to set the interviewee at ease and he is
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looking for explanation or elaboration of details in the interviewee's own words?
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Select one: II
A. Open-ended
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B. Direct
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C. Indirect
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D. Leading
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II D. Large loss report.
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Most insurers have guidelines outlining when and under what circumstances large loss
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reports should be prepared. - Charlotte is handling a new claim and she has set the initial
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reserves at $1,000,000. She has been asked to complete an internal report summarizing
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all the file status information for distribution to management and updated as more
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information is received. The report Charlotte is completing is most likely a
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Select one: II
A. Status report.
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B. Summarized report.
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C. Preliminary report.
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D. Large loss report.
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D. A claims rep discovers that their insured's car accident was caused by a road
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contractor who left equipment lying in the travel lanes of a highway.
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