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AIC 300 - CLAIMS IN AN EVOLVING WORLD
EXAM 2025|ACTUAL 105Qs&As WITH
RATIONALES|A+GRADE
B. By certified mail with a return receipt requested. Some will also send a copy via regular mail in case the certified letter is not accepted. Insurers usually send denial letters Select one: A. By email to ensure prompt receipt by the insured. B. By certified mail with a return receipt requested. C. By overnight courier. D. By registered mail. D. Subpoenaed. Any written claims communication may be subpoenaed. As methods of communication evolve, it's important for claims professionals to remember that any written claims communication may be Select one: A. Replaced with verbal communication. B. Misinterpreted. C. Edited later.
D. Subpoenaed. D. An insured's negotiations with the insurer on a complex claim are not going well. If a claim is complex, or if settlement negotiations are not progressing with the insurer, the insured may hire a public adjuster to protect his or her interests. In which one of the following scenarios is a public adjuster most likely to become involved? Select one: A. An insurer finds it financially unfeasible to hire its own claims staff in a given state. B. An insured is unable to afford legal representation to contest a claim. C. A catastrophic disaster strikes, involving damage to many properties. D. An insured's negotiations with the insurer on a complex claim are not going well. B. TPAs handle claims, keep claims records, and perform statistical analyses. Which one of the following statements regarding third-party administrators (TPAs) is most accurate? Select one: A. TPAs are typically used by businesses that have chosen not to self-insure. B. TPAs handle claims, keep claims records, and perform statistical analyses.
Select one: A. Staff underwriter. B. Public underwriter. C. Personal lines underwriter. D. Line underwriter. D. Listening. Claims professionals should first listen carefully to understand what the claimant is saying. The first key to communicating empathetically as a claims professional is Select one: A. A comprehensive understanding of relevant insurance policies. B. Speaking calmly and clearly. C. Being prepared with all documentation relating to the claim. D. Listening. C. Cost to investigate, defend, and settle claims. Cost to investigate, defend, and settle claims. LAE is the expense that an insurer incurs to investigate, defend, and settle claims according to the terms specified in the insurance policy. Mia tracks loss adjustment expense (LAE) as part of her management of the claims department for an insurer. Mia considers LAE to be the Select one:
A. Total amount of loss reserves of all claims. B. Paid portion of claims. C. Cost to investigate, defend, and settle claims. D. Total incurred amount of claims. D. Claim representative. Claim reps collaborate with more than other insurer employees. Many insurers employ a panel of experts that the claims rep can select according to the investigation's needs. In her role with an insurer, Katarina has opportunity to collaborate with not only employees from her company, but also external experts with particular expertise. For example, as part of her investigation, she hired an engineer to conduct a review of a machine that was involved in a personal injury. Katarina is a(n) Select one: A. Medical provider. B. Expert Witness. C. Premium auditor. D. Claim representative. A. Open-ended Open-ended questions can be used to clarify an interviewee's statements. When Mehmet interviews witnesses as part of his claims investigation, he asks different types of questions based on need, such as open-ended, direct, indirect, and leading. Which type of question should Mehmet ask when he wants to set the
The right of subrogation allows an insurer to recover payment from a negligent third party. In which one of the following scenarios is the right of subrogation most likely to be employed by the insurer? Select one: A. An insured files a homeowners claim for stolen jewelry. An investigation reveals that the jewelry is still in the insured's possession. B. An investigation reveals that an insured set her own business on fire. C. An insured files a claim for collision damage from a hit and run accident, when in fact he backed into a utility pole. D. A claims rep discovers that their insured's car accident was caused by a road contractor who left equipment lying in the travel lanes of a highway. D. A medical investigation. All bodily injury claims, including workers compensation claims, require a medical investigation. In claims investigation, all bodily injury claims require Select one: A. Statements from all witnesses. B. Multiple claims payments C. An attorney. D. A medical investigation.
D. Prepare a list of questions for the insured. Before making initial contact with an insured or claimant, a claims representative should prepare a list of questions for the insured, along with information on how the claim will be handled. Before making initial contact with an insured or claimant, a claims representative should Select one: A. Research similar losses in the same geographical area. B. Contact company counsel for a reservation of rights letter. C. Prepare an approximate estimate based on similar losses. D. Prepare a list of questions for the insured. C. Recorded statement. A recorded statement is taken by the claims rep over the phone or in person. 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) Select one: A. Affidavit. B. Deposition.
Select one: A. Standard claims handling (SCH) form. B. Initial acknowledgment of notice (IAN) form. C. Claim intake (CI) form. D. First notice of loss (FNOL) form. B. Average value method The average value method is used most often when their are small variations in loss size for a particular type of claim, and when claims can be concluded quickly. 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? Select one: A. Individual case method B. Average value method C. Formula method D. Roundtable method A. The insurer's case reserves. To determine whether an insurer typically underreserves or overreserves claims, actuaries compare the insurer's paid losses to the insurer's case reserves.
To determine whether an insurer typically underreserves or overreserves claims, actuaries compare the insurer's paid losses to Select one: A. The insurer's case reserves. B. The insurer's profits. C. NAIC model regulations. D. National averages. D. Pain and suffering Pain and suffering, disfigurement, loss of body function, and emotional distress are all forms of general damages. Samuel was seriously injured in a car accident caused by a drunk driver. His settlement included payments for repairs to his vehicle, medical bills, pain and suffering, and lost wages. Which one of the payments in Samuel's settlement is considered general damages? Select one: A. Medical bills B. Lost wages C. Repairs to his vehicle D. Pain and suffering C. The DICE method.
D. A medical malpractice claim. Claims-made forms are most often used for environmental, medical malpractice and directors and officers' policies. 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? Select one: A. An automotive collision claim. B. A homeowners liability claim due to a slip and fall. C. A homeowners claim due to storm damage. D. A medical malpractice claim. D. Known terrorists and drug traffickers. Failure to check a master list of known terrorists and drug traffickers may result in substantial penalties. The Office of Foreign Assets Control requires claims payors to check payees against a database of Select one: A. Known perpetrators of insurance fraud. B. Policyholders of other insurers. C. Those who have collected a payment for the same loss. D. Known terrorists and drug traffickers.
B. By electronic funds transfer. Claims may be paid in any of three ways: by check, by bank transfer or Select one: A. In a direct transfer of goods or services, as with a contractor performing repairs. B. By electronic funds transfer. C. By the issuance of a credit on the premium for the next policy period. D. In cash. B. Timing settlements effectively Timing settlements effectively can impact how much money a claimant is willing to accept. Riko is an experienced settlement negotiator. When negotiating with claimant representatives, she uses techniques such as timing settlements effectively, enticing a reasonable demand, making concessions cautiously, and leaning on the evaluation. She understands that her current claimant is eager to receive money, so she is delaying the negotiations as long as possible. Which negotiation technique is Riko using? Select one: A. Enticing a reasonable demand B. Timing settlements effectively C. Making concessions cautiously
Select one: A. A reservation of rights letter. B. An excess letter. C. A countersuit. D. A claim denial. C. A summons and complaint. The claims litigation process begins with the receipt of a summons and complaint announcing the initiation of a lawsuit. The claims litigation process begins with the receipt of Select one: A. A notice of claim. B. A civil violation notice. C. A summons and complaint. D. A settlement offer. C. Motion in limine. This is a pretrial request that certain evidence be excluded from the trial because it is irrelevant or prejudicial.
Linnea is an attorney who is preparing to defend an insurer in a workers compensation case. Discovery produced several documents that are being presented as witnesses statements, but the witnesses admit in the statements to not actually seeing the accident. Linnea would like to omit these statements from the proceedings, so she is filing a Select one: A. Motion to dismiss. B. Motion to strike. C. Motion in limine. D. Motion to suppress. C. Using traditional sales techniques A common sales technique is mirroring the behavior of the customer. Claims rep Lily is negotiating a claim settlement with an unrepresented claimant and wishes to smooth the process. She is matching her demeanor, tone, and mannerisms to those of the claimant. Lily is using which one of the following negotiation techniques? Select one: A. Setting expectations B. Performing a needs analysis C. Using traditional sales techniques D. Collecting extraneous information
C. Lift D. Precision factor B. Data scientist. Data science involves experimenting with data using rapidly evolving methods to learn and provide solutions to complex problems. Rin works for an insurer designing and using techniques to process large amounts of data from various sources and providing knowledge based on the analysis of that data. Rin is a(n) Select one: A. Actuary. B. Data scientist. C. IT professional. D. Ratemaker. D. Classification Classification is a data mining technique an insurer applies when it knows what information it wants to predict. Which one of the following is a data mining technique an insurer applies when it knows what information it wants to predict? Select one:
A. Machine learning B. Association rule learning C. Cluster analysis D. Classification C. Understand what a business wants to achieve. The first step in the data mining process is to Select one: A. Collect the data that will be used. B. Select a data mining technique. C. Understand what a business wants to achieve. D. Prepare the data that will be used. A. Risk selection. Generally speaking, the most common application of predictive modeling in insurance occurs in Select one: A. Risk selection. B. Marketing. C. Reinsurance. D. Claims handling.
