QUESTIONS AND ANSWERS
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? -
answer-$250,000
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 - answer-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? - answer-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? -
answer-Soft Fraud.
In liability claims, the claims rep will require an
authorization from the injured party to - answer-
Obtain medical records.
, 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 - answer-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 - answer-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 -