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Exam (elaborations)

AIC 300 Exam Questions| Already Answered| GRADED A+

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  • Course
  • AIC 300
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  • AIC 300

first party insurance - ANSWER-insurer makes payment for covered losses directly to the policyholder (first party) third-party insurance - ANSWER-insurer makes payments on behalf of the policyholder to a claimant (third party) third party administrators (TPAs) - ANSWER-- an organization that pr...

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  • September 7, 2024
  • 10
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers
  • AIC 300
  • AIC 300
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lecturervince8
AIC 300 Exam Questions| Already
Answered| GRADED A+
first party insurance - ANSWER-insurer makes payment for covered losses directly to the policyholder
(first party)



third-party insurance - ANSWER-insurer makes payments on behalf of the policyholder to a claimant
(third party)



third party administrators (TPAs) - ANSWER-- an organization that provides administrative services
associated with risk financing and insurance (claims, records, analysis, etc)

- self insured businesses can handle their own claims or hire a TPA

- P&C insurers have subsidiaries that serve as a TPA



staff claims representatives - ANSWER-a person responsible for investigating, evaluating, and settling
claims (ex: adjusters)



independent adjusters - ANSWER-- specialized claims + field work

- if insurer cant afford claims offices in every state

- some are self employed, some work for adjusting firms



producers - ANSWER-- any kinds of insurance personnel who place insurance and surety business with
insurers and who represent either insurers, insureds, or both

- ex: agents, brokers, sales reps



public adjusters - ANSWER-- outside organization or person hired by an insured to represent the insured
in a claim in exchange for a fee

- if insured is not happy with settlement or it is a complex claim



types of staff claims representatives - ANSWER-inside: exclusively from insurer's office

, field: outside, both in and out of office, handle claims with tasks like investigating scene of loss, meeting
with insureds, etc



line underwriters - ANSWER-work directly with insurance producers and applicants to evaluate new
submissions & renewals



staff underwriters - ANSWER-work with line underwriters to coordinate decisions about products,
pricing, and guidelines



premium audit - ANSWER-methodical examinations of a policyholder's operations, records, and books of
account to determine the actual exposure units and premium for insurance coverages already provided



why should claim reps be careful with what they say on claims communication? - ANSWER-claims
investigation activities can later be used as evidence in legal proceedings, any written claims
communication can be subpoenaed



loss ratio - ANSWER-losses & los adjustment expenses / earned premium



measures the performance of claims & uw departments



loss adjustment expenses (LAE) - ANSWER-the expense that an insurer incurs to investigate, defend, and
settle claims according to the terms specified in the policy



short term solution to reduce LAE - ANSWER-reduce expenses by offering settlement payments instead
of paying for investigation and legal defense



3 Quality Measures of a Claims Dept - ANSWER-- best practices

- claims audits

- customer satisfaction data



Quantitative vs Qualitative Audit Factors - ANSWER-quantitative: all come from # data (ex: timeliness of
reports, number of files opened monthly, avg claims settlement value)

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