AIC 300 –
p p
pCLAIM IN AN EVOLVING WORLD EXAMQUESTION
p p p p p p
S AND CORRECT ANSWERS WITH RATIONALES 2
p p p p p p
024 UPDATE GRADED A+
p p p
Larissapispanpautopclaimpadjuster.pTraditionally,pshephaspreliedponppolicepreportspandpwitnessptestimonypi
npherpdecisionpmaking.pRecentptechnologicalpdevelopmentspgivepherpaccessptopthepdriver'spdrivingphabits,
pincludingpacceleration,pspeed,pandpbraking.pThispdatapavailableptopLarissapispknownpas
Selectpone:
A. ArtificialpIntelligence.
B. Telematics.
C. Wearables.
D. InternetpofpThings.
B.pTelematics.
Telematicsparepusedptopcollectpdataponppersonalpautos,pcommercialpvehicles,pproducts,pshipments
,pmachinery,psmartpdevices,pandpworkers.
MartinpispinpSIUpandphelpsphispemployer,papmulti-
linepinsurer,ptopdetectpfraudulentpclaims.pHepispusingpaptechnologypthatpenablespinsurersptopsharepfraud-
relatedpinformation.pThispdistributedpdigitalpledgerpthatpfacilitatespsecureptransactionspwithoutpusingpapt
hirdppartypispknownpas
Selectpone:
A. Blockchain.
B. Appredictivepmodel.
C. ThepInternetpofpThings.
D. Telematics.
Blockchain.
,Byphavingpaptransparentpledgerpassociatedpwithpapcar,pforpexample,pinsurerspcanpdetectpfraudpthatpwoul
dpbepdifficultptopdetectpotherwise.
Jackpleadspthepclaimspdepartmentpforpaplargepinsurerpandphaspembracedptheprecentpdevelopmentspi
npclaimspdatapcollectionpandpanalysis.pJackpknowspthat
Selectpone:
A. Peoplepmakeplittlepdifferencepinpanalyzingpdatapandpexplainingpitptopapcustomer.
B. ClaimspdeterminationspandppaymentspwillpsoonpbepaccomplishedpentirelypbypAI.
C. Hepwillpeventuallypnotpneedppeoplepbecausepinsurancepispnotpapcustomer-drivenpindustry.
D. Hepstillpneedsppeoplepbecausepthepdatapneedptopbepanalyzedpinpcontextpbypaphuman.
D.pHepstillpneedsppeoplepbecausepthepdatapneedptopbepanalyzedpinpcontextpbypaphuman.
Aspapclaimsprepresentative,pBeatricepisponpthepfrontplinespforpprotectingpherpemployerpfrompinsuranc
epfraud.pBeatricepshouldpunderstandpthatpinsurancepfraud
Selectpone:
A. Ispthepcostliestpwhite-collarpcrimepinpthepU.S.
B. Accountspforp25ppercentpofpthepP&Cpindustrypincurredplosses.
C. Costsproughlyp$40pbillionpperpyear,pexcludingphealthpinsurance.
D. CostspeachpAmericanpfamilypbetweenp$2,000pandp$4,000pperpyear.
C.pCostsproughlyp$40pbillionpperpyear,pexcludingphealthpinsurance.
Ellapsuedpherpinsurerpandpallegedpbad-
faithpclaimphandlingpafterpthepinsurerpsettledpapclaimpagainstpherpthatpEllapthoughtpshouldphavepbeenpden
ied.pAspapresultpofpthepsettlement,pElla'sppremiumpincreased.pIn
,herpsuit,pEllapclaimedpthatpthepinsurerprushedpthepinvestigationpandpdidpnotptakepallpofpherpfactspintopcons
iderationpinpherpdefense.pWhilepthepcourtpfoundpthatpElla'spargumentphadpmerit,pitpdidpnotpawardpherpthep
fullpvaluepbecausepitpfoundpthatpEllaphadpnotpprovidedpherpinformationptopthepinsurerpinpaptimelypmanner.
pThepinsurerpusedpthepdefensepof
Selectpone:
A. Contributorypnegligence.
B. Debatablepreasonablepbasis.
C. Comparativepnegligence.
D. Comparativepbadpfaith.
C.pComparativepnegligence.
Inpstatespthatppermitpnegligencepaspapbasispforpapbad-
faithpclaim,pmostpusepapcomparativepnegligencepapproach,preducingpthepamountpofpdamagespthatpm
aypbepawarded.
NotplongpafterpValteripissuedpapdenialpandpclosedpthepclaim,pthepinsuredpsuedpforpcoveragepandpallegedp
bad-
faithpclaimphandlingpagainstpthepinsurer.pValteripwaspableptopdemonstratepforphispsuperiorspthatphephadp
madepapgood-
faithpinvestigationpandpdeterminedpthatpthepclaimpwaspnotpcoveredpbyptheppolicy.pThepinsurerpmaintains
pthatpValteriphadpreasonablepjustificationpinpfactpforpdenyingpthepclaim.pThepinsurerpispemployingpthe
Selectpone:
A. Lackpofpstandingpdefense.
B. Advicepofpcounselpdefense.
C. Debatablepreasonablepbasispdefense.
D. Statutepofplimitationspdefense.
C.pDebatablepreasonablepbasispdefense.
Thepinsurerpmaypestablishpthatpdefensepthatpitphadpapreasonablepbasispforpquestioningpwhetherpapclai
mpwaspcovered.
, OnepofpJulio'spexpectationspaspapclaimsprepresentativepispgood-
faithpclaimsphandling.pHepkeepspinsuredspinformedpaboutpthepclaimpbecauseptheyphavepthatpexpectationp
andpbecauseptheyparepmostplikelyptopmakepapcomplaintpaboutpbad-
faithpclaimphandling.pHepalsopwishesptopparticipatepinpthepdefensepandpinpdiscussionspaboutptheppossibilit
ypofpsettlement.pForpthesepreasons,pJulio
Selectpone:
A. Conductspfairpevaluations.
B. Maintainspcompletepandpaccuratepdocumentation.
C. Maintainspregularpandppromptpcommunication.
D. Conductspgood-faithpnegotiation.
C.pMaintainspregularpandppromptpcommunication.
Communicatingpwithpallppartiesptopapclaimpispapcrucialpaspectpofpgood-
faithpclaimsphandlingpandpresolution.
WhichponepofpthepfollowingpstatementspregardingpstatepversionspofpthepNAICpmodelpactpispcorrect
?pSelectpone:
A. Onlypinsuredspmaypbringplawsuitspagainstpinsurers.
B. Onlypclaimantspmaypbringplawsuitspagainstpinsurers.
C. Bothpinsuredspandpclaimantspmaypbringplawsuitspagainstpinsurers.
D. Somepstatespallowpinsuredspandpclaimantsptopbringplawsuitspagainstpinsurers,pwhilepotherspallowponl
ypinsureds.
D.pSomepstatespallowpinsuredspandpclaimantsptopbringplawsuitspagainstpinsurers,pwhilepother
spallowponlypinsureds.
Tobiaspispapclaimsprepresentativepwhopunderstandspthepimportancepofpgood-
faithpclaimsphandling,pincludingpfairpevaluation,pgood-
faithpnegotiation,pcompletepandpaccuratepdocumentation,pandptimely
p p
pCLAIM IN AN EVOLVING WORLD EXAMQUESTION
p p p p p p
S AND CORRECT ANSWERS WITH RATIONALES 2
p p p p p p
024 UPDATE GRADED A+
p p p
Larissapispanpautopclaimpadjuster.pTraditionally,pshephaspreliedponppolicepreportspandpwitnessptestimonypi
npherpdecisionpmaking.pRecentptechnologicalpdevelopmentspgivepherpaccessptopthepdriver'spdrivingphabits,
pincludingpacceleration,pspeed,pandpbraking.pThispdatapavailableptopLarissapispknownpas
Selectpone:
A. ArtificialpIntelligence.
B. Telematics.
C. Wearables.
D. InternetpofpThings.
B.pTelematics.
Telematicsparepusedptopcollectpdataponppersonalpautos,pcommercialpvehicles,pproducts,pshipments
,pmachinery,psmartpdevices,pandpworkers.
MartinpispinpSIUpandphelpsphispemployer,papmulti-
linepinsurer,ptopdetectpfraudulentpclaims.pHepispusingpaptechnologypthatpenablespinsurersptopsharepfraud-
relatedpinformation.pThispdistributedpdigitalpledgerpthatpfacilitatespsecureptransactionspwithoutpusingpapt
hirdppartypispknownpas
Selectpone:
A. Blockchain.
B. Appredictivepmodel.
C. ThepInternetpofpThings.
D. Telematics.
Blockchain.
,Byphavingpaptransparentpledgerpassociatedpwithpapcar,pforpexample,pinsurerspcanpdetectpfraudpthatpwoul
dpbepdifficultptopdetectpotherwise.
Jackpleadspthepclaimspdepartmentpforpaplargepinsurerpandphaspembracedptheprecentpdevelopmentspi
npclaimspdatapcollectionpandpanalysis.pJackpknowspthat
Selectpone:
A. Peoplepmakeplittlepdifferencepinpanalyzingpdatapandpexplainingpitptopapcustomer.
B. ClaimspdeterminationspandppaymentspwillpsoonpbepaccomplishedpentirelypbypAI.
C. Hepwillpeventuallypnotpneedppeoplepbecausepinsurancepispnotpapcustomer-drivenpindustry.
D. Hepstillpneedsppeoplepbecausepthepdatapneedptopbepanalyzedpinpcontextpbypaphuman.
D.pHepstillpneedsppeoplepbecausepthepdatapneedptopbepanalyzedpinpcontextpbypaphuman.
Aspapclaimsprepresentative,pBeatricepisponpthepfrontplinespforpprotectingpherpemployerpfrompinsuranc
epfraud.pBeatricepshouldpunderstandpthatpinsurancepfraud
Selectpone:
A. Ispthepcostliestpwhite-collarpcrimepinpthepU.S.
B. Accountspforp25ppercentpofpthepP&Cpindustrypincurredplosses.
C. Costsproughlyp$40pbillionpperpyear,pexcludingphealthpinsurance.
D. CostspeachpAmericanpfamilypbetweenp$2,000pandp$4,000pperpyear.
C.pCostsproughlyp$40pbillionpperpyear,pexcludingphealthpinsurance.
Ellapsuedpherpinsurerpandpallegedpbad-
faithpclaimphandlingpafterpthepinsurerpsettledpapclaimpagainstpherpthatpEllapthoughtpshouldphavepbeenpden
ied.pAspapresultpofpthepsettlement,pElla'sppremiumpincreased.pIn
,herpsuit,pEllapclaimedpthatpthepinsurerprushedpthepinvestigationpandpdidpnotptakepallpofpherpfactspintopcons
iderationpinpherpdefense.pWhilepthepcourtpfoundpthatpElla'spargumentphadpmerit,pitpdidpnotpawardpherpthep
fullpvaluepbecausepitpfoundpthatpEllaphadpnotpprovidedpherpinformationptopthepinsurerpinpaptimelypmanner.
pThepinsurerpusedpthepdefensepof
Selectpone:
A. Contributorypnegligence.
B. Debatablepreasonablepbasis.
C. Comparativepnegligence.
D. Comparativepbadpfaith.
C.pComparativepnegligence.
Inpstatespthatppermitpnegligencepaspapbasispforpapbad-
faithpclaim,pmostpusepapcomparativepnegligencepapproach,preducingpthepamountpofpdamagespthatpm
aypbepawarded.
NotplongpafterpValteripissuedpapdenialpandpclosedpthepclaim,pthepinsuredpsuedpforpcoveragepandpallegedp
bad-
faithpclaimphandlingpagainstpthepinsurer.pValteripwaspableptopdemonstratepforphispsuperiorspthatphephadp
madepapgood-
faithpinvestigationpandpdeterminedpthatpthepclaimpwaspnotpcoveredpbyptheppolicy.pThepinsurerpmaintains
pthatpValteriphadpreasonablepjustificationpinpfactpforpdenyingpthepclaim.pThepinsurerpispemployingpthe
Selectpone:
A. Lackpofpstandingpdefense.
B. Advicepofpcounselpdefense.
C. Debatablepreasonablepbasispdefense.
D. Statutepofplimitationspdefense.
C.pDebatablepreasonablepbasispdefense.
Thepinsurerpmaypestablishpthatpdefensepthatpitphadpapreasonablepbasispforpquestioningpwhetherpapclai
mpwaspcovered.
, OnepofpJulio'spexpectationspaspapclaimsprepresentativepispgood-
faithpclaimsphandling.pHepkeepspinsuredspinformedpaboutpthepclaimpbecauseptheyphavepthatpexpectationp
andpbecauseptheyparepmostplikelyptopmakepapcomplaintpaboutpbad-
faithpclaimphandling.pHepalsopwishesptopparticipatepinpthepdefensepandpinpdiscussionspaboutptheppossibilit
ypofpsettlement.pForpthesepreasons,pJulio
Selectpone:
A. Conductspfairpevaluations.
B. Maintainspcompletepandpaccuratepdocumentation.
C. Maintainspregularpandppromptpcommunication.
D. Conductspgood-faithpnegotiation.
C.pMaintainspregularpandppromptpcommunication.
Communicatingpwithpallppartiesptopapclaimpispapcrucialpaspectpofpgood-
faithpclaimsphandlingpandpresolution.
WhichponepofpthepfollowingpstatementspregardingpstatepversionspofpthepNAICpmodelpactpispcorrect
?pSelectpone:
A. Onlypinsuredspmaypbringplawsuitspagainstpinsurers.
B. Onlypclaimantspmaypbringplawsuitspagainstpinsurers.
C. Bothpinsuredspandpclaimantspmaypbringplawsuitspagainstpinsurers.
D. Somepstatespallowpinsuredspandpclaimantsptopbringplawsuitspagainstpinsurers,pwhilepotherspallowponl
ypinsureds.
D.pSomepstatespallowpinsuredspandpclaimantsptopbringplawsuitspagainstpinsurers,pwhilepother
spallowponlypinsureds.
Tobiaspispapclaimsprepresentativepwhopunderstandspthepimportancepofpgood-
faithpclaimsphandling,pincludingpfairpevaluation,pgood-
faithpnegotiation,pcompletepandpaccuratepdocumentation,pandptimely
