AIC 300 CLAIM IN AN EVOLVING WORLD
COMPREHENSIVE QUESTIONS AND CORRECT
VERIFIED ANSWERS 2024 NEWEST UPDATE
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. - (correct answer) 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 statistical
analyses.
C. TPAs are generally found in an insurer's claims department.
D. TPAs are employed only by independent adjusting firms. - (correct
answer) B. TPAs handle claims, keep claims records, and perform
statistical analyses.
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. - (correct answer) 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. - (correct answer) D. Subpoenaed.
Any written claims communication may be subpoenaed.
Hugo is conducting an audit of a branch office claims operation. He is
evaluating timeliness of reports, number of files opened, proper
releases taken, and accuracy of data entry. Which one of Hugo's
metrics is a qualitative audit factor?
Select one:
A. Proper releases taken
B. Timeliness of reports
C. Number of files opened
D. Accuracy of data entry - (correct answer) A. Proper releases taken
Proper releases taken is a qualitative audit factor; the others are
quantitative.
Aaron works for a multi-line insurer. He works with insurance
producers and applicants to evaluate new business submissions and
conduct renewal underwriting. Aaron is a
Select one:
A. Staff underwriter.
B. Public underwriter.
, C. Personal lines underwriter.
D. Line underwriter. - (correct answer) 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. - (correct answer) 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
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