AIC 300 CERTIFICATION EXAM LATEST
2024 QUESTIONS WITH 100% SOLVED
SOLUTIONS!!
A doctor recommends that a patient receive physical therapy three times per week for
twelve weeks when three times per week for eight weeks would suffice. - Answer-This is
a padded claim, a type of soft fraud.
An insured buys multiple fire insurance policies on the same house, then intentionally
burns the house to the ground and collects the policy limits on several policies. -
Answer-This is an intentional loss, a type of hard fraud.
Material fact - Answer-A fact that is significant to a decision or matter at hand.
Hard fraud - Answer-Actions that are undertaken deliberately to defraud.
Misrepresentation - Answer-A false statement of a material fact on which a party relies.
Concealment - Answer-An intentional failure to disclose a material fact.
Staged accident - Answer-An accident deliberately caused by a person who intends to
feign injury and collect on the ensuing claim.
Soft fraud, or opportunity fraud - Answer-Fraud that occurs when a legitimate claim is
exaggerated.
What other steps should Maria take to conduct a balanced investigation based on her
suspicion? (Select all that apply.)
Have a physical examination conducted of the vehicle to determine whether the
allegedly stolen items would fit in the trunk
Schedule an examination under oath of Daniel, and require receipts documenting the
source of the cash used to purchase the items
Ask for a list of stores where the items were bought and contact those stores regarding
the purchases
Conduct interviews with Daniel's family members to find out whether they were aware of
the purchase of the gifts - Answer-Physical evidence and records from third parties can
confirm or refute the likelihood of fraud. Interviews with family members are not likely to
be helpful because they will probably state they did not know of the gifts or corroborate
the insured's story. After conducting a balanced investigation, Maria can refer the claim
to the SIU if appropriate.
,Larissa is an auto claim adjuster. Traditionally, she has relied on police reports and
witness testimony in her decision making. Recent technological developments give her
access to the driver's driving habits, including acceleration, speed, and braking. This
data available to Larissa is known as
A. Telematics.
B. Artificial Intelligence
C. Wearables.
D. Internet of Things. - Answer-A. Telematics.
How does professionalism relate to ethics? - Answer-Professionalism requires
individuals to act knowledgeably, courteously, and empathetically, behaviors that are
necessary to properly implement an ethical decision.
Role of Ethics and Professionalism in Good Faith - Answer-- By satisfying contractual
duties and other promises
- By maintaining insurers credibility
- By complying with legal duty
Explain why ethics and professionalism are of utmost importance to claims reps when
they are establishing good faith by satisfying contractual duties and other promises. -
Answer-Ethics and professionalism are of utmost importance to claims reps because
they are bound by the insurance contract to act in good faith, and they must act ethically
and professionally in keeping the promises specified in insurance policies, as well as
those created by law. In insurance transactions, the insured pays a premium in return
for the insurer's promise to handle claims in good faith, and the insurance policy states
the terms of that promise. In addition to fulfilling the promises outlined in the insurance
contract, claims reps must keep any promises made to insureds, claimants, vendors,
and their employers.
Ethics - Answer-The study of what constitutes good and bad behavior, dealing with
moral duty and obligation.
In investigating a recent liability claim against an insured, Amy, a claims representative,
suspected that the claimant was wealthier than his appearance and behavior indicated.
After interviewing him about what happened, she failed to add some information in her
report to the claim file because she judged it to be false. She also delayed responding
to his telephone inquiries. During settlement negotiations, based on her opinion of the
claimant's financial situation, Amy rejected his attorney's offer to settle at the policy
limits. What elements of good-faith claim handling did Amy violate? - Answer-Amy
violated the element of unbiased investigation by basing decisions about the
investigation and negotiation on her perception of the claimant's dishonesty, particularly
because the claimant's financial status was irrelevant to the claim. By omitting some of
the claimant's statement, she violated the elements of complete and accurate
documentation and fair evaluation. Her refusal to settle based on her perception of the
claimant's financial status violated the element of good-faith negotiation, and her delay
, in responding to the claimant's telephone inquiries may have violated the element of
regular and prompt communication.
Excess Liability Claims - Answer-- The insurer refuses the opportunity to settle within
policy limits
- The insurer refuses to pursue settlement
- The insurer is subject to strict liability
Ananya is a claims representative handling a homeowners claim for Chris, an insured.
After carefully reviewing the policy, Ananya finds that Chris does not have coverage for
his property damage. She lets him know promptly with a carefully worded claim denial
letter. A few days later, Chris calls Ananya to let her know he has hired an attorney.
Should Ananya worry that her actions will lead to a bad-faith claim against the insurer? -
Answer-While an attorney's involvement increases the possibility of a bad-faith claim,
Ananya should not be overly concerned as long as she has followed good-faith claims
handling practices. She fully documented the reason for the coverage denial, which may
be important in a lawsuit.
Stephanie is a claims representative. She handled a liability claim against an insured
small business and was careful to document all correspondence, evidence, estimates,
and bills. The claim eventually went to court, the claimant was awarded damages, and
the small business sued the insurer for bad faith. Describe how Stephanie's actions may
help the insurer defend itself against bad faith. - Answer-Stephanie's careful
documentation will demonstrate how she and the insurer handled the claim. Activity
logs, correspondence, and documentary evidence, such as police reports, damage
estimates, and medical bills, can indicate that claims reps, supervisors, and managers
are doing their jobs properly, which is part of a successful defense strategy for a bad-
faith claim.
Tort - Answer-A wrongful act or an omission, other than a crime or a breach of contract,
that invades a legally protected right.
Tortfeasor - Answer-A person or an organization that has committed a tort.
Contributory negligence - Answer-A common-law principle that prevents a person who
has been harmed from recovering damages if that person's own negligence contributed
in any way to the harm.
Comparative negligence - Answer-A common-law principle that requires both parties to
a loss to share the financial burden of the bodily injury or property damage according to
their respective degrees of fault.
As a claims representative, some of Sara's goals is to benefit her employer by ensuring
the parties to a loss remember details accurately, reassuring the parties that their claims
are important, and lessening the chance that the parties will retain attorneys. Sara
accomplishes these goals through
