Which one of the following is correct with respect to the elements of good-faith claim management? -
Consistent supervision, thorough training, and manageable caseloads help ensure that claim
representatives are able to handle claims in good faith.
Ciara is going to college with the goal of work...
Which one of the following is correct with respect to the elements of good-faith claim management? -
Consistent supervision, thorough training, and manageable caseloads help ensure that claim
representatives are able to handle claims in good faith.
Ciara is going to college with the goal of working as a data scientist for an insurer. She will need a strong
foundation in mathematics and statistics, computer programming, domain knowledge, and data science.
Which one of Ciara's skills will require her to understand the insurance profession to which the data is
being applied? - Domain knowledge.
Insurers and claim representatives must keep the promises specified in insurance policies, as well as
those created by the law. In insurance transactions, the insured pays a premium for the insurer's promise
to - Handle claims in good faith.
Maja handled a large liability claim that settled above the policy limits. The insured is now charging the
claim was handled in bad faith. During their investigation of the bad-faith claim, Maja and defense
counsel discovered that the claimant had received the payment from the insurer, but not the amount
above the policy limits that was to come from the insured's assets. Which one of the following defenses
would Maja's defense most likely invoke? - Insured's collusion with the claimant.
Bettina's apartment is burglarized and several items are stolen. In filing her claim, she tells her insurer
that her stolen television was both newer and larger than it actually was. This constitutes which one of
the following types of fraud? - Soft Fraud.
In liability claims, the claims rep will require an authorization from the injured party to - Obtain
medical records.
Antonia has a general liability policy with a self-insured retention of $50,000. The policy has an
occurrence limit of $250,000 and an aggregate limit of $500,000. She had submitted one prior claim this
policy term for which $100,000 was paid by the insurer. How much will Antonia's insurer pay on a
subsequent claim under the same policy period that is valued at $400,000? - $250,000
, Claims rep Miguel is conducting a settlement with a claimant. He constructs his first offer so that the
claimant will likely find it undesirable. This becomes the basis of comparison for the second offer that he
makes. Miguel understands that people - Feel empowered when given a choice.
Joy Insurance Company is interested in using data mining to solve a problem it is having with claims
fraud in one of its product lines. The first step it should take is - To understand what it wants to
achieve.
Thomas is an attorney who is defending an insurer in a litigated case. He has located documents that
show the insured was aware of the issue that cause the injury to the claimant before the accident.
Thomas is concerned that this evidence will hurt his case. He should - Preserve the evidence as
part of the record.
As a part of the first contact with an insured on a property damage claim, a claims representative may
provide a blank - Proof of loss form.
Rodrigo manages a claims department for an insurer and uses loss ratio as a measure of the
department's performance. Rodrigo calculates loss ratio as - Losses and LAE divided by earned
premium.
An insurer that finds it economically impractical to establish a claims office in a given state is likely to use
which one of the following to perform the claims handling function? - Independent Adjusters
Tonya is a claims representative tasked with determining whether coverage applies to a new claim. To
ensure that she considers all facets of the claim, she uses the DICE method, which stands for
declarations, insuring agreement, conditions and - Exclusions.
Which one of the following elements of a policy can include coverage that is otherwise excluded, exclude
coverage that is otherwise included, or add or delete insureds? - An endorsement.
As a claims representative, Joshua frequently requests proofs of loss and affidavits, and conducts
examinations under oath and recorded statements. Which one of Joshua's sworn statements is
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