AIC 300 ALL CLAIMS EXAM Latest Update 2025-
2026 Exam 245 Questions with 100% Verified
Correct Answers Guaranteed A+
A doctor recommends that a patient receive physical therapy three times per week for
twelve weeks when three times per week for eight weeks would suffice. - CORRECT
ANSWER: This is a padded claim, a type of soft fraud.
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. - CORRECT 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.
Accuracy - CORRECT ANSWER: In model performance evaluation, a model's correct
predictions divided by its total predictions.
Actuary - CORRECT ANSWER: A person who uses mathematical methods to analyze
insurance data for various purposes, such as to develop insurance rates or set claim
reserves.
,Adam manages a claims department for an insurer. He measures the department's
performance by best practices, claims audits, customer satisfaction data, and loss ratio.
Which one of Adam's measures refers to a system of identified internal practices that
claims representatives perform to produce superior performance?
A. Customer satisfaction data
B. Best practices
C. Loss ratio
D. Claims audits - CORRECT ANSWER: B. Best practices
Best practices generally refers to a system of identified internal practices that are
shared with claims reps and produce superior performance.
Algorithm - CORRECT ANSWER: An operational sequence used to solve mathematical
problems and to create computer programs.
Allegation - CORRECT ANSWER: A claim made in the complaint by the plaintiff,
specifying what the plaintiff expects to prove to obtain a judgment against the
defendant.
Although most policies are occurrence forms, covering claims that occur during the
policy period, some are claims-made forms. Which one of the following types of loss is
most likely to involve a claims-made form?
A. A homeowners claim due to storm damage.
B. An automotive collision claim.
C. A homeowners liability claim due to a slip and fall.
D. A medical malpractice claim. - CORRECT ANSWER: D. A medical malpractice claim.
,Alva works for an international, multi-line insurer. She helps her company to manage
risk selection by working with other underwriters and coordinating decisions about
products, pricing, and guidelines. Alva is a
A. Staff underwriter.
B. Master underwriter.
C. Chief Underwriting Officer
D. Line underwriter. - CORRECT ANSWER: A. Staff underwriter
Staff underwriter. This describes the duties of a staff 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.
Among the methods used to pay claims are the issuance of checks and bank drafts.
The main difference between the two is that - CORRECT ANSWER: A. With a bank
draft, the bank must verify that the insurer has authorized payment.
An insured borrows fine jewelry from her friends and family. She has it appraised and
covered by her homeowners policy. She returns the jewelry to the owners and reports it
stolen. She then collects on the insurance. - CORRECT ANSWER: This is a false claim,
a type of hard fraud.
An insured buys multiple fire insurance policies on the same house, then intentionally
burns the house to the ground and collects the policy limits on several policies. -
CORRECT ANSWER: This is an intentional loss, a type of hard fraud.
An insurer that finds it economically impractical to establish a claims office in a given
state is likely to use which one of the following to perform the claims handling function?
, A. Producers
B. Third-party administrators
C. Public adjusters
D. Independent adjusters - CORRECT ANSWER: D. Independent adjusters
An insurer wants to predict which claims to target for fraud investigation. It wishes to do
this based on the known fraud indicators: a claimant who threatens to hire an attorney
immediately after an accident and a claimant with a history of similar claims. Which data
mining technique would the analyst be likely to use? - CORRECT ANSWER: The
analyst would likely use classification because the insurer is predicting the category into
which a member of a dataset belongs—namely, the category that indicates the likely
existence of fraud. The insurer intends to use characteristics known beforehand:
threatening to hire an attorney immediately after the accident and having a history of
similar claims with the insurer.
Association rule learning and cluster analysis are exploratory techniques and do not rely
on categorizing members of a dataset based on known data characteristics. Regression
analysis is used to predict a numerical value based on known data characteristics rather
than a category.
Ananya is a claims representative handling a homeowners claim for Chris, an insured.
After carefully reviewing the policy, Ananya finds that Chris does not have coverage for
his property damage. She lets him know promptly with a carefully worded claim denial
letter. A few days later, Chris calls Ananya to let her know he has hired an attorney.
Should Ananya worry that her actions will lead to a bad-faith claim against the insurer? -
CORRECT ANSWER: While an attorney's involvement increases the possibility of a
bad-faith claim, Ananya should not be overly concerned as long as she has followed
good-faith claims handling practices. She fully documented the reason for the coverage
denial, which may be important in a lawsuit.
Andrew is a claims representative investigating whether coverage applies to a new
claim. To help ensure that he considers every facet of the policy before determining
coverage, he might use
2026 Exam 245 Questions with 100% Verified
Correct Answers Guaranteed A+
A doctor recommends that a patient receive physical therapy three times per week for
twelve weeks when three times per week for eight weeks would suffice. - CORRECT
ANSWER: This is a padded claim, a type of soft fraud.
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. - CORRECT 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.
Accuracy - CORRECT ANSWER: In model performance evaluation, a model's correct
predictions divided by its total predictions.
Actuary - CORRECT ANSWER: A person who uses mathematical methods to analyze
insurance data for various purposes, such as to develop insurance rates or set claim
reserves.
,Adam manages a claims department for an insurer. He measures the department's
performance by best practices, claims audits, customer satisfaction data, and loss ratio.
Which one of Adam's measures refers to a system of identified internal practices that
claims representatives perform to produce superior performance?
A. Customer satisfaction data
B. Best practices
C. Loss ratio
D. Claims audits - CORRECT ANSWER: B. Best practices
Best practices generally refers to a system of identified internal practices that are
shared with claims reps and produce superior performance.
Algorithm - CORRECT ANSWER: An operational sequence used to solve mathematical
problems and to create computer programs.
Allegation - CORRECT ANSWER: A claim made in the complaint by the plaintiff,
specifying what the plaintiff expects to prove to obtain a judgment against the
defendant.
Although most policies are occurrence forms, covering claims that occur during the
policy period, some are claims-made forms. Which one of the following types of loss is
most likely to involve a claims-made form?
A. A homeowners claim due to storm damage.
B. An automotive collision claim.
C. A homeowners liability claim due to a slip and fall.
D. A medical malpractice claim. - CORRECT ANSWER: D. A medical malpractice claim.
,Alva works for an international, multi-line insurer. She helps her company to manage
risk selection by working with other underwriters and coordinating decisions about
products, pricing, and guidelines. Alva is a
A. Staff underwriter.
B. Master underwriter.
C. Chief Underwriting Officer
D. Line underwriter. - CORRECT ANSWER: A. Staff underwriter
Staff underwriter. This describes the duties of a staff 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.
Among the methods used to pay claims are the issuance of checks and bank drafts.
The main difference between the two is that - CORRECT ANSWER: A. With a bank
draft, the bank must verify that the insurer has authorized payment.
An insured borrows fine jewelry from her friends and family. She has it appraised and
covered by her homeowners policy. She returns the jewelry to the owners and reports it
stolen. She then collects on the insurance. - CORRECT ANSWER: This is a false claim,
a type of hard fraud.
An insured buys multiple fire insurance policies on the same house, then intentionally
burns the house to the ground and collects the policy limits on several policies. -
CORRECT ANSWER: This is an intentional loss, a type of hard fraud.
An insurer that finds it economically impractical to establish a claims office in a given
state is likely to use which one of the following to perform the claims handling function?
, A. Producers
B. Third-party administrators
C. Public adjusters
D. Independent adjusters - CORRECT ANSWER: D. Independent adjusters
An insurer wants to predict which claims to target for fraud investigation. It wishes to do
this based on the known fraud indicators: a claimant who threatens to hire an attorney
immediately after an accident and a claimant with a history of similar claims. Which data
mining technique would the analyst be likely to use? - CORRECT ANSWER: The
analyst would likely use classification because the insurer is predicting the category into
which a member of a dataset belongs—namely, the category that indicates the likely
existence of fraud. The insurer intends to use characteristics known beforehand:
threatening to hire an attorney immediately after the accident and having a history of
similar claims with the insurer.
Association rule learning and cluster analysis are exploratory techniques and do not rely
on categorizing members of a dataset based on known data characteristics. Regression
analysis is used to predict a numerical value based on known data characteristics rather
than a category.
Ananya is a claims representative handling a homeowners claim for Chris, an insured.
After carefully reviewing the policy, Ananya finds that Chris does not have coverage for
his property damage. She lets him know promptly with a carefully worded claim denial
letter. A few days later, Chris calls Ananya to let her know he has hired an attorney.
Should Ananya worry that her actions will lead to a bad-faith claim against the insurer? -
CORRECT ANSWER: While an attorney's involvement increases the possibility of a
bad-faith claim, Ananya should not be overly concerned as long as she has followed
good-faith claims handling practices. She fully documented the reason for the coverage
denial, which may be important in a lawsuit.
Andrew is a claims representative investigating whether coverage applies to a new
claim. To help ensure that he considers every facet of the policy before determining
coverage, he might use
