AIC 300 CLAIMS IN AN EVOLVING WORLD 2024
NEWEST COMPLETE 250 QUESTIONS WITH DETAILED
VERIFIED ANSWERS AND RATIONALES (100% CORRECT)
/ALREADY GRADED A+
Indemnify - ANSWER: To restore a party who has sustained a loss to the same
financial position that party held before the loss occurred.
Third-party administrator (TPA) - ANSWER: An organization that provides
administrative services associated with risk financing and insurance.
Claims representative - ANSWER: A person responsible for investigating, evaluating,
and settling claims.
Public adjuster - ANSWER: An outside organization or person hired by an insured to
represent the insured in a claim in exchange for a fee.
Premium audit - ANSWER: Methodical examination of a policyholder's operations,
records, and books of account to determine the actual exposure units and premium
for insurance coverages already provided.
Quantitative Audit Factors - ANSWER: Timeliness of reports, reserving and payments
Qualitative Audit Factors - ANSWER: Realistic reserving, accurate evaluation of
insured's liability and follow-up on subrogation opportunity
Loss ratio - ANSWER: A ratio that measures losses and loss adjustment expenses
against earned premiums and that reflects the percentage of premiums being
consumed by losses.
Loss adjustment expense (LAE) - ANSWER: The expense that an insurer incurs to
investigate, defend, and settle claims according to the terms specified in the
insurance policy.
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
A. Personal lines underwriter.
B. Line underwriter.
C. Staff underwriter.
D. Public underwriter. - ANSWER: B. 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.
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?
A. Number of files opened
B. Timeliness of reports
C. Accuracy of data entry
D. Proper releases taken - ANSWER: D. Proper releases taken
Which one of the following statements regarding third-party administrators (TPAs) is
most accurate?
A. TPAs handle claims, keep claims records, and perform statistical analyses.
B. TPAs are generally found in an insurer's claims department.
C. TPAs are typically used by businesses that have chosen not to self-insure.
D. TPAs are employed only by independent adjusting firms. - ANSWER: A. TPAs
handle claims, keep claims records, and perform statistical analyses.
Steps of Making an Initial Claims Assessment - ANSWER: Acknowledging and
Assigning the Claim
Identifying the Policy
Contacting the Insured or the Insured's Representative
How do recorded statements and examinations under oath differ? - ANSWER: An
examination under oath is more formal than a recorded statement. Recorded
statements are often taken by claims representatives, typically by telephone.
Examinations under oath are usually performed by an attorney for the insurer at the
insurer's office or a court reporter's office.
Effective statements exhibit these qualities: - ANSWER: Coherence—The statement
follows a logical sequence.
Completeness—The statement is thorough.
Objectivity—The statement contains facts relevant to the loss expressed in the
interviewee's own words.
Seven-Part Method - ANSWER: 1. Permission and introduction—date, time, and
location of the interview, names of the parties involved in the interview, and an
affirmation from the interviewee that the interview is given with permission
2. Identification—identifying information about the person being interviewed, such
as name, address, phone number, and driver's license number
, 3. Setting—answers to questions such as who was involved in the loss, what was
involved in the loss, when the loss occurred, where the loss occurred, and why the
loss occurred
4. Incident—a step-by-step description of how the loss occurred
5. Post incident injuries/damages—description of the property damage and bodily
injuries to individuals
6. Miscellaneous—any information the interviewee wants to add
7. Conclusion—reaffirmation that the statement was taken with permission
Reserve - ANSWER: The amount the insurer estimates and sets aside to pay on an
existing claim.
Individual case method - ANSWER: a method of setting reserves based on the claim's
circumstances and the claim representative's experience in handling similar claims
Roundtable method - ANSWER: A method of setting reserves by using the consensus
of two or more claim personnel who have independently evaluated the claim file
Average value method - ANSWER: A case reserving method that establishes a
predetermined dollar amount of reserve for each claim as it is reported.
Formula method - ANSWER: A method of setting claim reserves by using a
mathematical formula.
Expert system method - ANSWER: A method of setting reserves with a software
application that estimates losses and loss adjustment expenses.
Carolina is a claim representative handling a liability claim. She is speaking to the
claimant over the phone and has informed him that his statements must be true
under penalty of perjury. When completed, she sent a transcription of the
conversation to the claimant for him to sign before a notary. Carolina has taken a(n)
- ANSWER: Recorded statement
Which one of the following methods of establishing case reserves is used most often
when there are small variations in loss size for a particular type of claim?
A. Roundtable method
B. Average value method
C. Formula method
D. Individual case method - ANSWER: B. Average value method
NEWEST COMPLETE 250 QUESTIONS WITH DETAILED
VERIFIED ANSWERS AND RATIONALES (100% CORRECT)
/ALREADY GRADED A+
Indemnify - ANSWER: To restore a party who has sustained a loss to the same
financial position that party held before the loss occurred.
Third-party administrator (TPA) - ANSWER: An organization that provides
administrative services associated with risk financing and insurance.
Claims representative - ANSWER: A person responsible for investigating, evaluating,
and settling claims.
Public adjuster - ANSWER: An outside organization or person hired by an insured to
represent the insured in a claim in exchange for a fee.
Premium audit - ANSWER: Methodical examination of a policyholder's operations,
records, and books of account to determine the actual exposure units and premium
for insurance coverages already provided.
Quantitative Audit Factors - ANSWER: Timeliness of reports, reserving and payments
Qualitative Audit Factors - ANSWER: Realistic reserving, accurate evaluation of
insured's liability and follow-up on subrogation opportunity
Loss ratio - ANSWER: A ratio that measures losses and loss adjustment expenses
against earned premiums and that reflects the percentage of premiums being
consumed by losses.
Loss adjustment expense (LAE) - ANSWER: The expense that an insurer incurs to
investigate, defend, and settle claims according to the terms specified in the
insurance policy.
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
A. Personal lines underwriter.
B. Line underwriter.
C. Staff underwriter.
D. Public underwriter. - ANSWER: B. 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.
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?
A. Number of files opened
B. Timeliness of reports
C. Accuracy of data entry
D. Proper releases taken - ANSWER: D. Proper releases taken
Which one of the following statements regarding third-party administrators (TPAs) is
most accurate?
A. TPAs handle claims, keep claims records, and perform statistical analyses.
B. TPAs are generally found in an insurer's claims department.
C. TPAs are typically used by businesses that have chosen not to self-insure.
D. TPAs are employed only by independent adjusting firms. - ANSWER: A. TPAs
handle claims, keep claims records, and perform statistical analyses.
Steps of Making an Initial Claims Assessment - ANSWER: Acknowledging and
Assigning the Claim
Identifying the Policy
Contacting the Insured or the Insured's Representative
How do recorded statements and examinations under oath differ? - ANSWER: An
examination under oath is more formal than a recorded statement. Recorded
statements are often taken by claims representatives, typically by telephone.
Examinations under oath are usually performed by an attorney for the insurer at the
insurer's office or a court reporter's office.
Effective statements exhibit these qualities: - ANSWER: Coherence—The statement
follows a logical sequence.
Completeness—The statement is thorough.
Objectivity—The statement contains facts relevant to the loss expressed in the
interviewee's own words.
Seven-Part Method - ANSWER: 1. Permission and introduction—date, time, and
location of the interview, names of the parties involved in the interview, and an
affirmation from the interviewee that the interview is given with permission
2. Identification—identifying information about the person being interviewed, such
as name, address, phone number, and driver's license number
, 3. Setting—answers to questions such as who was involved in the loss, what was
involved in the loss, when the loss occurred, where the loss occurred, and why the
loss occurred
4. Incident—a step-by-step description of how the loss occurred
5. Post incident injuries/damages—description of the property damage and bodily
injuries to individuals
6. Miscellaneous—any information the interviewee wants to add
7. Conclusion—reaffirmation that the statement was taken with permission
Reserve - ANSWER: The amount the insurer estimates and sets aside to pay on an
existing claim.
Individual case method - ANSWER: a method of setting reserves based on the claim's
circumstances and the claim representative's experience in handling similar claims
Roundtable method - ANSWER: A method of setting reserves by using the consensus
of two or more claim personnel who have independently evaluated the claim file
Average value method - ANSWER: A case reserving method that establishes a
predetermined dollar amount of reserve for each claim as it is reported.
Formula method - ANSWER: A method of setting claim reserves by using a
mathematical formula.
Expert system method - ANSWER: A method of setting reserves with a software
application that estimates losses and loss adjustment expenses.
Carolina is a claim representative handling a liability claim. She is speaking to the
claimant over the phone and has informed him that his statements must be true
under penalty of perjury. When completed, she sent a transcription of the
conversation to the claimant for him to sign before a notary. Carolina has taken a(n)
- ANSWER: Recorded statement
Which one of the following methods of establishing case reserves is used most often
when there are small variations in loss size for a particular type of claim?
A. Roundtable method
B. Average value method
C. Formula method
D. Individual case method - ANSWER: B. Average value method
