AIC 300: Claims in an Evolving World
Questions and Answers
1. Insurers usually send denial letters Select one:
A. By email to ensure prompt receipt by the insured.
B. By certified mail with a return receipt requested.
C. By overnight courier.
D. By registered mail.: B. By certified mail with a return receipt
requested.
Some will also send a copy via regular mail in case the certified
letter is not accepted. 2. As methods of communication evolve,
it's important for claims profession-
als to remember that any written claims communication may
be Select one:
A. Replaced with verbal communication.
B. Misinterpreted.
C. Edited later.
D. Subpoenaed.: D. Subpoenaed.
Any written claims communication may be subpoenaed.
3. 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.: 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.
4. 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.: B.
TPAs handle claims, keep claims records, and perform statistical
analyses.
, 5. 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: A. Proper releases taken
Proper releases taken is a qualitative audit factor; the others are
quantitative.
6. 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. 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.
7. 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.: D. Listening.
Claims professionals should first listen carefully to understand what
the claimant is saying.
8. Mia tracks loss adjustment expense (LAE) as part of her
management of the
claims department for an insurer. Mia considers LAE to be the
Select one:
A. Total amount of loss reserves of all claims.
B. Paid portion of claims.
C. Cost to investigate, defend, and settle claims.
Questions and Answers
1. Insurers usually send denial letters Select one:
A. By email to ensure prompt receipt by the insured.
B. By certified mail with a return receipt requested.
C. By overnight courier.
D. By registered mail.: B. By certified mail with a return receipt
requested.
Some will also send a copy via regular mail in case the certified
letter is not accepted. 2. As methods of communication evolve,
it's important for claims profession-
als to remember that any written claims communication may
be Select one:
A. Replaced with verbal communication.
B. Misinterpreted.
C. Edited later.
D. Subpoenaed.: D. Subpoenaed.
Any written claims communication may be subpoenaed.
3. 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.: 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.
4. 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.: B.
TPAs handle claims, keep claims records, and perform statistical
analyses.
, 5. 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: A. Proper releases taken
Proper releases taken is a qualitative audit factor; the others are
quantitative.
6. 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. 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.
7. 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.: D. Listening.
Claims professionals should first listen carefully to understand what
the claimant is saying.
8. Mia tracks loss adjustment expense (LAE) as part of her
management of the
claims department for an insurer. Mia considers LAE to be the
Select one:
A. Total amount of loss reserves of all claims.
B. Paid portion of claims.
C. Cost to investigate, defend, and settle claims.
