AIC 300 CLAIMS IN AN EVOLVING WORLDMI
p p p p p p p
DTERM EXAM 2024 GRADED A+ p p p p
Some will also send a copy via regular mail in case the certified letter is nota
p p p p p p p p p p p p p p p p
ccepted. - ANSWER-Insurers usually send denial letters
p p p p p p
Select one: p
A. By email to ensure prompt receipt by the insured.
p p p p p p p p
B. By certified mail with a return receipt requested.
p p p p p p p
C. By overnight courier.p p
D. By registered mail. p p
D. Subpoenaed.
p
Any written claims communication may be subpoenaed. - ANSWER-
p p p p p p p p
As methodsof communication evolve, it's important for claims professionals to rem
p p p p p p p p p p p
ember thatany written claims communication may be
p p p p p p p
Select one: p
A. Replaced with verbal communication. p p p
B. Misinterpreted.
C. Edited later. p
D. Subpoenaed.
D. An insured's negotiations with the insurer on a complex claim are not goingw
p p p p p p p p p p p p p p
ell.
If a claim is complex, or if settlement negotiations are not progressing with the ins
p p p p p p p p p p p p p p
urer, the insured may hire a public adjuster to protect his or her interests. -
p p p p p p p p p p p p p p
pANSWER-
In which one of the following scenarios is a public adjuster most likelyto become i
p p p p p p p p p p p p p p p
nvolved?
Select one: p
A. An insurer finds it financially unfeasible to hire its own claims staff in a givenst
p p p p p p p p p p p p p p p
ate.
,B. An insured is unable to afford legal representation to contest a claim.
p p p p p p p p p p p
C. A catastrophic disaster strikes, involving damage to many properties.
p p p p p p p p
D. An insured's negotiations with the insurer on a complex claim are not goingw
p p p p p p p p p p p p p
ell.
B. TPAs handle claims, keep claims records, and perform statistical analyses. -
p p p p p p p p p p p
ANSWER-Which one of the following statements regarding third-
p p p p p p p p
party administrators (TPAs) is most accurate?
p p p p p
Select one: p
A. TPAs are typically used by businesses that have chosen not to self-insure.
p p p p p p p p p p p
B. TPAs handle claims, keep claims records, and perform statistical analyses.
p p p p p p p p p
C. TPAs are generally found in an insurer's claims department.
p p p p p p p p
D. TPAs are employed only by independent adjusting firms.
p p p p p p p
A. Proper releases taken
p p p
Proper releases taken is a qualitative audit factor; the others are quantitative. -
p p p p p p p p p p p p
ANSWER-
p
Hugo is conducting an audit of a branch office claims operation. He isevaluating ti
p p p p p p p p p p p p p p
meliness of reports, number of files opened, proper releases taken,and accuracy
p p p p p p p p p p p p
of data entry. Which one of Hugo's metrics is a qualitative audit factor?
p p p p p p p p p p p p
Select one: p
A. Proper releases taken p p
B. Timeliness of reports p p
C. Number of files opened p p p
D. Accuracy of data entry p p p
D. Line underwriter.
p p
Line underwriter. This describes the duties of a line underwriter, rather than a staff
p p p p p p p p p p p p p
punderwriter. There is not enough information to determine which line of business
p p p p p p p p p p p p
is being written. A public underwriter does not exist. Line underwriters evaluate ne
p p p p p p p p p p p p
w submissions and perform renewal underwriting, usually by workingdirectly with i
p p p p p p p p p p p
nsurance producers and applicants. Staff underwriters, meanwhile,manage risk s
p p p p p p p p p
election by working with line underwriters and coordinating decisions about produ
p p p p p p p p p p
cts, pricing and guidelines. - ANSWER-Aaron works for a
p p p p p p p p
,multi-
line insurer. He works with insurance producers and applicants to evaluatenew b
p p p p p p p p p p p p
usiness submissions and conduct renewal underwriting. Aaron is a Select one:
p p p p p p p p p p
A. Staff underwriter. p
B. Public underwriter. p
C. Personal lines underwriter. p p
D. Line underwriter. p
D. Listening.
p
Claims professionals should first listen carefully to understand what the claimanti
p p p p p p p p p p p
s saying. - ANSWER-
p p p
The first key to communicating empathetically as a claimsprofessional is
p p p p p p p p p p
Select one: p
A. A comprehensive understanding of relevant insurance policies.
p p p p p p
B. Speaking calmly and clearly. p p p
C. Being prepared with all documentation relating to the claim.
p p p p p p p p
D. Listening.
C. Cost to investigate, defend, and settle claims.
p p p p p p p
Cost to investigate, defend, and settle claims. LAE is the expense that an insurerin
p p p p p p p p p p p p p p
curs to investigate, defend, and settle claims according to the terms specified inthe
p p p p p p p p p p p p p p
insurance policy. - ANSWER- p p p
Mia tracks loss adjustment expense (LAE) as part of her management of the claim
p p p p p p p p p p p p p
s department for an insurer. Mia considers LAE to be the
p p p p p p p p p p
Select one: p
A. Total amount of loss reserves of all claims.
p p p p p p p
B. Paid portion of claims.
p p p
C. Cost to investigate, defend, and settle claims.
p p p p p p
D. Total incurred amount of claims.
p p p p
D. Claim representative.
p p
Claim reps collaborate with more than other insurer employees. Many insurerse
p p p p p p p p p p p
mploy a panel of experts that the claims rep can select according to the investig
p p p p p p p p p p p p p p
ation's needs. - ANSWER-In her role with an insurer, Katarina has
p p p p p p p p p p
, opportunity to collaborate with not only employees from her company, but alsoext
p p p p p p p p p p p p
ernal experts with particular expertise. For example, as part of her investigation, s
p p p p p p p p p p p p
he hired an engineer to conduct a review of a machine that wasinvolved in a perso
p p p p p p p p p p p p p p p p
nal injury. Katarina is a(n)
p p p p
Select one: p
A. Medical provider. p
B. Expert Witness. p
C. Premium auditor. p
D. Claim representative. p
A. Open-ended
p
Open-ended questions can be used to clarify an interviewee's statements. -
p p p p p p p p p p
ANSWER-
p
When Mehmet interviews witnesses as part of his claims investigation,he asks diff
p p p p p p p p p p p p
erent types of questions based on need, such as open-
p p p p p p p p p
ended, direct,indirect, and leading. Which type of question should Mehmet ask wh
p p p p p p p p p p p p
en he wantsto set the interviewee at ease and he is looking for explanation or elab
p p p p p p p p p p p p p p p p
oration of details in the interviewee's own words?
p p p p p p p
Select one: p
A. Open-ended
B. Direct
C. Indirect
D. Leading
D. Large loss report.
p p p
Most insurers have guidelines outlining when and under what circumstances larg
p p p p p p p p p p
e loss reports should be prepared. - ANSWER-
p p p p p p p
Charlotte is handling a new claim and she has set the initial reserves at $1,000,00
p p p p p p p p p p p p p p
0. She has been asked tocomplete an internal report summarizing all the file statu
p p p p p p p p p p p p p p
s information for distribution to management and updated as more information is r
p p p p p p p p p p p p
eceived. The report Charlotte is completing is most likely a
p p p p p p p p p
Select one: p
A. Status report. p
B. Summarized report. p
C. Preliminary report. p
D. Large loss report. p p
p p p p p p p
DTERM EXAM 2024 GRADED A+ p p p p
Some will also send a copy via regular mail in case the certified letter is nota
p p p p p p p p p p p p p p p p
ccepted. - ANSWER-Insurers usually send denial letters
p p p p p p
Select one: p
A. By email to ensure prompt receipt by the insured.
p p p p p p p p
B. By certified mail with a return receipt requested.
p p p p p p p
C. By overnight courier.p p
D. By registered mail. p p
D. Subpoenaed.
p
Any written claims communication may be subpoenaed. - ANSWER-
p p p p p p p p
As methodsof communication evolve, it's important for claims professionals to rem
p p p p p p p p p p p
ember thatany written claims communication may be
p p p p p p p
Select one: p
A. Replaced with verbal communication. p p p
B. Misinterpreted.
C. Edited later. p
D. Subpoenaed.
D. An insured's negotiations with the insurer on a complex claim are not goingw
p p p p p p p p p p p p p p
ell.
If a claim is complex, or if settlement negotiations are not progressing with the ins
p p p p p p p p p p p p p p
urer, the insured may hire a public adjuster to protect his or her interests. -
p p p p p p p p p p p p p p
pANSWER-
In which one of the following scenarios is a public adjuster most likelyto become i
p p p p p p p p p p p p p p p
nvolved?
Select one: p
A. An insurer finds it financially unfeasible to hire its own claims staff in a givenst
p p p p p p p p p p p p p p p
ate.
,B. An insured is unable to afford legal representation to contest a claim.
p p p p p p p p p p p
C. A catastrophic disaster strikes, involving damage to many properties.
p p p p p p p p
D. An insured's negotiations with the insurer on a complex claim are not goingw
p p p p p p p p p p p p p
ell.
B. TPAs handle claims, keep claims records, and perform statistical analyses. -
p p p p p p p p p p p
ANSWER-Which one of the following statements regarding third-
p p p p p p p p
party administrators (TPAs) is most accurate?
p p p p p
Select one: p
A. TPAs are typically used by businesses that have chosen not to self-insure.
p p p p p p p p p p p
B. TPAs handle claims, keep claims records, and perform statistical analyses.
p p p p p p p p p
C. TPAs are generally found in an insurer's claims department.
p p p p p p p p
D. TPAs are employed only by independent adjusting firms.
p p p p p p p
A. Proper releases taken
p p p
Proper releases taken is a qualitative audit factor; the others are quantitative. -
p p p p p p p p p p p p
ANSWER-
p
Hugo is conducting an audit of a branch office claims operation. He isevaluating ti
p p p p p p p p p p p p p p
meliness of reports, number of files opened, proper releases taken,and accuracy
p p p p p p p p p p p p
of data entry. Which one of Hugo's metrics is a qualitative audit factor?
p p p p p p p p p p p p
Select one: p
A. Proper releases taken p p
B. Timeliness of reports p p
C. Number of files opened p p p
D. Accuracy of data entry p p p
D. Line underwriter.
p p
Line underwriter. This describes the duties of a line underwriter, rather than a staff
p p p p p p p p p p p p p
punderwriter. There is not enough information to determine which line of business
p p p p p p p p p p p p
is being written. A public underwriter does not exist. Line underwriters evaluate ne
p p p p p p p p p p p p
w submissions and perform renewal underwriting, usually by workingdirectly with i
p p p p p p p p p p p
nsurance producers and applicants. Staff underwriters, meanwhile,manage risk s
p p p p p p p p p
election by working with line underwriters and coordinating decisions about produ
p p p p p p p p p p
cts, pricing and guidelines. - ANSWER-Aaron works for a
p p p p p p p p
,multi-
line insurer. He works with insurance producers and applicants to evaluatenew b
p p p p p p p p p p p p
usiness submissions and conduct renewal underwriting. Aaron is a Select one:
p p p p p p p p p p
A. Staff underwriter. p
B. Public underwriter. p
C. Personal lines underwriter. p p
D. Line underwriter. p
D. Listening.
p
Claims professionals should first listen carefully to understand what the claimanti
p p p p p p p p p p p
s saying. - ANSWER-
p p p
The first key to communicating empathetically as a claimsprofessional is
p p p p p p p p p p
Select one: p
A. A comprehensive understanding of relevant insurance policies.
p p p p p p
B. Speaking calmly and clearly. p p p
C. Being prepared with all documentation relating to the claim.
p p p p p p p p
D. Listening.
C. Cost to investigate, defend, and settle claims.
p p p p p p p
Cost to investigate, defend, and settle claims. LAE is the expense that an insurerin
p p p p p p p p p p p p p p
curs to investigate, defend, and settle claims according to the terms specified inthe
p p p p p p p p p p p p p p
insurance policy. - ANSWER- p p p
Mia tracks loss adjustment expense (LAE) as part of her management of the claim
p p p p p p p p p p p p p
s department for an insurer. Mia considers LAE to be the
p p p p p p p p p p
Select one: p
A. Total amount of loss reserves of all claims.
p p p p p p p
B. Paid portion of claims.
p p p
C. Cost to investigate, defend, and settle claims.
p p p p p p
D. Total incurred amount of claims.
p p p p
D. Claim representative.
p p
Claim reps collaborate with more than other insurer employees. Many insurerse
p p p p p p p p p p p
mploy a panel of experts that the claims rep can select according to the investig
p p p p p p p p p p p p p p
ation's needs. - ANSWER-In her role with an insurer, Katarina has
p p p p p p p p p p
, opportunity to collaborate with not only employees from her company, but alsoext
p p p p p p p p p p p p
ernal experts with particular expertise. For example, as part of her investigation, s
p p p p p p p p p p p p
he hired an engineer to conduct a review of a machine that wasinvolved in a perso
p p p p p p p p p p p p p p p p
nal injury. Katarina is a(n)
p p p p
Select one: p
A. Medical provider. p
B. Expert Witness. p
C. Premium auditor. p
D. Claim representative. p
A. Open-ended
p
Open-ended questions can be used to clarify an interviewee's statements. -
p p p p p p p p p p
ANSWER-
p
When Mehmet interviews witnesses as part of his claims investigation,he asks diff
p p p p p p p p p p p p
erent types of questions based on need, such as open-
p p p p p p p p p
ended, direct,indirect, and leading. Which type of question should Mehmet ask wh
p p p p p p p p p p p p
en he wantsto set the interviewee at ease and he is looking for explanation or elab
p p p p p p p p p p p p p p p p
oration of details in the interviewee's own words?
p p p p p p p
Select one: p
A. Open-ended
B. Direct
C. Indirect
D. Leading
D. Large loss report.
p p p
Most insurers have guidelines outlining when and under what circumstances larg
p p p p p p p p p p
e loss reports should be prepared. - ANSWER-
p p p p p p p
Charlotte is handling a new claim and she has set the initial reserves at $1,000,00
p p p p p p p p p p p p p p
0. She has been asked tocomplete an internal report summarizing all the file statu
p p p p p p p p p p p p p p
s information for distribution to management and updated as more information is r
p p p p p p p p p p p p
eceived. The report Charlotte is completing is most likely a
p p p p p p p p p
Select one: p
A. Status report. p
B. Summarized report. p
C. Preliminary report. p
D. Large loss report. p p
