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AIC 300 - Claims Exam Final Latest Update 2024/2025, Exams of Insurance Economics

American International CollegeInsurance Economics

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) - ✔✔Recorded statement. Charlotte is handling a new claim and she has set the initial reserves at $1,000,000. She has been asked to complete an internal report summarizing all the file status information for distribution to management and updated as more information is received. The report Charlotte is completing is most likely a - ✔✔Large loss report. 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 - ✔✔Line underwriter.

Typology: Exams

2024/2025

Available from 09/11/2024

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AIC 30 REVIEW QUESTIONS
factor that can affect an insurance professional's competency? - ✔✔changes in
claim environment including consumer, social and political forces influence
insurance coverage, legal liability damages and techonology
If there is significant mismatch between the insured information on the loss
notice form and that contained in the application or policy that cannot be easily
resolved and verified what should be done to provide documentation of identity?
- ✔✔Examination under oath (EUO)
what is the public's attitude towards fraud? - ✔✔many are not certain about
fraud's effect on accessibility of insurance coverage.
what technique can smooth negotiations with unrepresented claimants? -
✔✔making the first offer to help the claimant understand the value of the claim
shifting eye movement - ✔✔lacks sincerity
claim rep who acknowledges receipt of claim should - ✔✔advise that the claim
was received and provide the name of the claim rep's number and the claim
number
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AIC 30 REVIEW QUESTIONS

factor that can affect an insurance professional's competency? - ✔✔changes in claim environment including consumer, social and political forces influence insurance coverage, legal liability damages and techonology If there is significant mismatch between the insured information on the loss notice form and that contained in the application or policy that cannot be easily resolved and verified what should be done to provide documentation of identity?

  • ✔✔Examination under oath (EUO) what is the public's attitude towards fraud? - ✔✔many are not certain about fraud's effect on accessibility of insurance coverage. what technique can smooth negotiations with unrepresented claimants? - ✔✔making the first offer to help the claimant understand the value of the claim shifting eye movement - ✔✔lacks sincerity claim rep who acknowledges receipt of claim should - ✔✔advise that the claim was received and provide the name of the claim rep's number and the claim number

receiver - ✔✔the policyholder interrogatories - ✔✔written answers off no opportunity for follow up questions padding - ✔✔a significant number of consumers believe it's acceptable conceding as deadline approaches - ✔✔offering high settlements before end of month excess liability claim - ✔✔can arise when the insurer has an opportunity to settle the claim within the policy limits but fails to do so this opportunity occurs when a claimant demands the policy limits or an amount within the policy limits to settle the claim Business rule engines - ✔✔used to analyze claims for fraud indicators or coverage issues in order to refer the claim actuary - ✔✔supply information required to calculate insurance rates, develop rating plans and estimate loss reserves factor that affects claim handling competency - ✔✔imperfections in the human memory that cause normal loss of knowledge over time

fraudulent - ✔✔deception with the intent to deprive the insurer of something of value claim negotiation - ✔✔different from other types of negotiation because primary focus is how much insurer will pay words - ✔✔may be the least significant aspect of communication states address organized crime rings by - ✔✔setting strict penalties to reduce the profit that results from insurance fraud diagram - ✔✔visual aid to communicate or clarify the events of a claim and is considered more succinct that a written report win-lose - ✔✔sees negotiation as a contest betweent wo parties derived credibility - ✔✔individual's perceived credibility during interpersonal communication statute of limitations - ✔✔the time limit for filing a lawsuit

proof of loss - ✔✔most claim reps prefer the insurer submit a sworn proof of loss before demanding EUO Complainant must show claim rep - ✔✔intended the misconduct and the consequences if no agency information is provided on the loss notice form the claim ep should review the policy to determine - ✔✔the producer who submitted the application photos taken with film - ✔✔for serious or complex claims medical reports - ✔✔assist in confirming information on the automobile loss notice generally, excess liability claims arise from either the insurer's refusal of an opportunity to settle within policy limits or - ✔✔the insurer's refusal to settle setting (in which claim negotiations are carried out) - ✔✔one of the most significant negotiation variables that can affect claim representatives consumer regulation - ✔✔creates legal duties for insurers reservation of rights letter - ✔✔used to avoid waiver and estoppel

punitive damages - ✔✔courts usually require insurer behavior that is worse than ordinary wrongdoing, such as malicious, fraudulent or oppressive behavior intentional losses - ✔✔are not accidental or fortuitous discovery - ✔✔many activities of the litigation plan concerning the management of litigation expenses and who should perform certain activities relate to element of good faith claim handling - ✔✔claimants are more likely to share information when contacted promptly by the claim representative Special reporting - ✔✔is beneficial it attempts to recover lost or stolen high-value property most states require licensing of - ✔✔public adjusters when a claim representative receives notice of a complaint he or she should? - ✔✔first review the defendants named to determine whether coverage exists under the applicable policy What should a claim rep be prepared to testify regarding a camera used to take photos? - ✔✔camera settings Gramm-Leach-Blilely Act - ✔✔protects the confidentiality and security of consumers of financial institutions

Additional state provisions (above NAIC) - ✔✔Requiring more than two competitive estimates in cases of property damage win-lose - ✔✔used when lawsuit is already filed large loss report - ✔✔death claim and high bodily injury reserve public's attitude toward insurance fraud - ✔✔many are not certain about fraud's effect on accessibility of insurance coverage recovery of lawyer fees - ✔✔may be allowed by statute or common law first step in confirming coverage - ✔✔matching the information on the loss notice form to the relevant policy leading question example - ✔✔did you see the Buick turn left in front of the ford? payment of interest in bad faith claims - ✔✔some courts have found that insureds that pay excess judgements have been deprived of the money, while insurer has had the use of the money to earn interests