AIC 300 - Claims in an Evolving World Questions With
Complete Solutions
A. A reservation of rights letter.
The insurer will issue a reservation of rights letter stating that it
will provide defense only until it can establish that there is no
coverage. Correct Answers Kira, a claims representative,
receives a summons and complaint from an insured. In
reviewing the facts, she has doubts that the insured's applicable
policy will provide coverage. She should work with counsel and
request a managerial review in order to issue
Select one:
A. A reservation of rights letter.
B. An excess letter.
C. A countersuit.
D. A claim denial.
A. Actuary.
Actuaries are critically important to this process because they
understand the business and the analytics. Correct Answers
Mustafa is a data scientist who is working with a team of
underwriting, IT, and actuary to develop a predictive analytics
model. The main goal of the project is to translate the insights
gained from the model they develop into business action. In
Mustafa's experience, the team member that can provide the
bridge between the analytics and the business is
Select one:
A. Actuary.
B. IT.
,C. Underwriting.
D. Data science.
A. Asking for referral
Asked for referral could indicate that the worker has knowledge
of the workers compensation system because he had been
through it before. Correct Answers Jose is handling a workers
compensation claim. The injured worker claims to have strained
his back when he lifted a box at work. He waited a day to report
the injury because he thought he would be okay. He asked Jose
when he would be referred to a back specialist and when he
could expect his first check. Which one of the injured worker's
actions would be the most pertinent fraud indicator to Jose?
Select one:
A. Asking for referral
B. Lifting a box
C. Waiting to report
D. Asking about check
A. Blockchain.
By having a transparent ledger associated with a car, for
example, insurers can detect fraud that would be difficult to
detect otherwise. Correct Answers Martin is in SIU and helps
his employer, a multi-line insurer, to detect fraudulent claims.
He is using a technology that enables insurers to share fraud-
related information. This distributed digital ledger that facilitates
secure transactions without using a third party is known as
Select one:
A. Blockchain.
,B. A predictive model.
C. The Internet of Things.
D. Telematics.
A. Consistent supervision, thorough training, and manageable
caseloads help ensure that claim representatives are able to
handle claims in good faith.
Consistent supervision, thorough training, and manageable
caseloads help ensure that claim representatives are able to
handle claims in good faith. Correct Answers Which one of the
following is correct with respect to the elements of good-faith
claim management?
Select one:
A. Consistent supervision, thorough training, and manageable
caseloads help ensure that claim representatives are able to
handle claims in good faith.
B. When resolving a coverage question, insurers should avoid
the appearance of bad faith by dealing only with those lawyers
hired to defend the insured.
C. If the insured has excess insurance, the claim representative
should merely notify the excess insurer of the claim.
D. Claim representatives should avoid using policy provisions,
such as arbitration clauses, to resolve disputes over the
settlement amount.
A. Data mining.
Data mining. This is using computers to analyze vast amounts of
data to detect trends. Correct Answers Benjamin is with the
SIU department of an insurer. His company developed
, technology to identify patterns related to fraudulent claims
activity. He is using a program to analyze claims data to identify
similarities or connections that might indicate fraud. Benjamin is
utilizing
Select one:
A. Data mining.
B. Telematics.
C. Claims audits.
D. Wearables.
A. Drones
Erik would most likely use drones to take photos or videos of
the difficult-to-reach area and assess the damage and danger. By
using the drones, he can assess the danger without risking the
safety of the claims representatives. Correct Answers Erik is a
claims manager for Taunton Insurance. He is leading a team of
property claims representatives responding to a recent tornado in
Kentucky. Before sending the representatives into the field, Erik
has decided to use Internet of Things (IoT) technology to assess
the damage and danger in the area. Which one of the following
IoT devices would Erik most likely use in this situation?
Select one:
A. Drones
B. Sensors
C. Smartphones
D. Telematics
A. Explain the rationale behind the decision to the claimant.
Complete Solutions
A. A reservation of rights letter.
The insurer will issue a reservation of rights letter stating that it
will provide defense only until it can establish that there is no
coverage. Correct Answers Kira, a claims representative,
receives a summons and complaint from an insured. In
reviewing the facts, she has doubts that the insured's applicable
policy will provide coverage. She should work with counsel and
request a managerial review in order to issue
Select one:
A. A reservation of rights letter.
B. An excess letter.
C. A countersuit.
D. A claim denial.
A. Actuary.
Actuaries are critically important to this process because they
understand the business and the analytics. Correct Answers
Mustafa is a data scientist who is working with a team of
underwriting, IT, and actuary to develop a predictive analytics
model. The main goal of the project is to translate the insights
gained from the model they develop into business action. In
Mustafa's experience, the team member that can provide the
bridge between the analytics and the business is
Select one:
A. Actuary.
B. IT.
,C. Underwriting.
D. Data science.
A. Asking for referral
Asked for referral could indicate that the worker has knowledge
of the workers compensation system because he had been
through it before. Correct Answers Jose is handling a workers
compensation claim. The injured worker claims to have strained
his back when he lifted a box at work. He waited a day to report
the injury because he thought he would be okay. He asked Jose
when he would be referred to a back specialist and when he
could expect his first check. Which one of the injured worker's
actions would be the most pertinent fraud indicator to Jose?
Select one:
A. Asking for referral
B. Lifting a box
C. Waiting to report
D. Asking about check
A. Blockchain.
By having a transparent ledger associated with a car, for
example, insurers can detect fraud that would be difficult to
detect otherwise. Correct Answers Martin is in SIU and helps
his employer, a multi-line insurer, to detect fraudulent claims.
He is using a technology that enables insurers to share fraud-
related information. This distributed digital ledger that facilitates
secure transactions without using a third party is known as
Select one:
A. Blockchain.
,B. A predictive model.
C. The Internet of Things.
D. Telematics.
A. Consistent supervision, thorough training, and manageable
caseloads help ensure that claim representatives are able to
handle claims in good faith.
Consistent supervision, thorough training, and manageable
caseloads help ensure that claim representatives are able to
handle claims in good faith. Correct Answers Which one of the
following is correct with respect to the elements of good-faith
claim management?
Select one:
A. Consistent supervision, thorough training, and manageable
caseloads help ensure that claim representatives are able to
handle claims in good faith.
B. When resolving a coverage question, insurers should avoid
the appearance of bad faith by dealing only with those lawyers
hired to defend the insured.
C. If the insured has excess insurance, the claim representative
should merely notify the excess insurer of the claim.
D. Claim representatives should avoid using policy provisions,
such as arbitration clauses, to resolve disputes over the
settlement amount.
A. Data mining.
Data mining. This is using computers to analyze vast amounts of
data to detect trends. Correct Answers Benjamin is with the
SIU department of an insurer. His company developed
, technology to identify patterns related to fraudulent claims
activity. He is using a program to analyze claims data to identify
similarities or connections that might indicate fraud. Benjamin is
utilizing
Select one:
A. Data mining.
B. Telematics.
C. Claims audits.
D. Wearables.
A. Drones
Erik would most likely use drones to take photos or videos of
the difficult-to-reach area and assess the damage and danger. By
using the drones, he can assess the danger without risking the
safety of the claims representatives. Correct Answers Erik is a
claims manager for Taunton Insurance. He is leading a team of
property claims representatives responding to a recent tornado in
Kentucky. Before sending the representatives into the field, Erik
has decided to use Internet of Things (IoT) technology to assess
the damage and danger in the area. Which one of the following
IoT devices would Erik most likely use in this situation?
Select one:
A. Drones
B. Sensors
C. Smartphones
D. Telematics
A. Explain the rationale behind the decision to the claimant.
