SOLUTION BLUEPRINT
◉ D. Subpoenaed.
Any written claims communication may be subpoenaed.
Answer: 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.
◉ 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.
,Answer: 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.
◉ B. TPAs handle claims, keep claims records, and perform
statistical analyses.
Answer: 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.
,◉ A. Proper releases taken
Proper releases taken is a qualitative audit factor; the others are
quantitative.
Answer: 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
◉ 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.
, Answer: 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.
◉ D. Listening.
Claims professionals should first listen carefully to understand what
the claimant is saying.
Answer: 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.
◉ C. Cost to investigate, defend, and settle claims.