AIC 300 Questions And Answers With Verified Updates
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Course
AIC 300
Institution
AIC 300
classification tree parts - root node: first node in a classification tree
leaf nodes: terminal node that is used to classify an instance
recursively: successfully applying a model
training data: used to train a predictive model, has known values
holdout data: existing data not used for trainin...
AIC 300
classification tree parts - root node: first node in a classification tree
leaf nodes: terminal node that is used to classify an instance
recursively: successfully applying a model
training data: used to train a predictive model, has known values
holdout data: existing data not used for training, tests the model
3 Quality Measures of a Claims Dept - - best practices
- claims audits
- customer satisfaction data
Diff types of claims investigations - - accident scene investigation
- property damage investigation
- medical investigation
- prior claim investigation
- subrogation investigation and recovery
3 types of legal approaches - mediation: neutral mediator to reach settlement
appraisal: professional appraiser evaluates dollar portions
litigation: court, creates a binding decision
5 Methods of Case Reserving - 1. Individual case method - based on claims circumstances and
claim reps experience/opinion
2. Roundtable method - consensus of 2+ claims personnel
3. Avg value method - establishes a predetermined amount of reserve for each claim
4. Formula method - using a mathematical formula
5. Expert system method - software application estimates losses and LAEs
, 7 Parts of Effective (sworn) Statements - 1. Permission and introduction (date/time of int, name of
person, etc)
2. Identification (info of person being int)
3. Setting (who was involved, where)
4. Incident (step by step of what occurred)
5. Post incident injuries/damages (property damage, bodily injury)
6. Miscellaneous
7. Conclusion (confirm statement taken w permission)
Activities in the claims handling process - 1. Acknowledge a claim and assigning it to a claims rep
2. Identifying the policy
3. Contacting the insured of the insured's representative
4. Investigating and documenting the claim
5. Determining the cause of loss and the loss amount
6. Concluding the claim
bad faith claims - CLAIMS PRACTICES CAN BE USED AS GROUNDS FOR BAD FAITH
- INAPPROPRIATE CLAIM DENIALS
- EVEN IF GOOD-FAITH IS FOLLOWED, COURT CAN FIND COVERAGE DOES APPLY
blockchain - a digital ledger that facilitates secure transactions without the need for a third party
(ex: 1 car has 6 diff insureds/policies on it --> must be stopped)
Claims Acknowledgement - claims process begins when an insurer receives a claim. this advises
that the claim was received
Claims denial - - denial letters are sent out, sometimes drafted by lawyers to ensure they comply
with requirements
- sent by certified mail, sometimes requested to be signed by addressee or marked confidential
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