Download AIC 300 - Claims World (Evolving) Question Answers 100% and more Exams Insurance Economics in PDF only on Docsity!
AIC 300 - Claims World (Evolving)
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? a. Individual case method. b. Formula method. c. Average value method. d. Roundtable method. - โโc. Average value method Chloe is an insurer defense attorney who is preparing a trial strategy. She has researched a court decision that was made in a similar case and is basing the defense on that precedent. Chloe is relying on the principle of stare decisis, which is that a. Lower courts must follow precedents set by any other courts. b. Lower courts must follow precedents set by higher courts. c. Higher courts must follow precedents set by lower courts. d. Higher courts must follow precedents set by any other counts. - โโb. Lower courts must follow precedents set by higher courts Which one of the following statements regarding state versions of the NAIC model act is correct?
a. Only insureds may bring lawsuits against insurers. b. Only claimants may bring lawsuits against insurers. c. Some states allow insureds and claimants to bring lawsuits against insurers, while others allow only insureds. d. Both insureds and claimants may bring lawsuit against insurers. - โโc. Some states allow insureds and claimants to bring lawsuits against insurers, while others allow only insureds. Carla is investigating a claim for a stolen car. The insured provided a copy of the police report, but she notices that the account in the police report differs from the insured's version of events. At this point, Carla should a. Refer the case to the SIU. b. Deny the claim. c. Contact the police. d. Continue with her investigation. - โโd. Continue with her investigation In the process of assigning a claim, an internal claims handler will often transfer information to the insurer's standard form, called the a. Standard claims handling (SCH) form. b. Claim intake (CI) form. c. Initial acknowledgment of notice (IAN) form.
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. Staff underwriter. b. Public underwriter. c. Personal lines underwriter. d. Line underwriter. - โโd. Line underwriter One of Julio's expectations as a claims representative is good-faith claims handling. He keeps insureds informed about the claim because they have that expectation and because they are most likely to make a complaint about bad-faith claim handling. He also wishes to participate in the defense and in discussions about the possibility of settlement. For these reasons, Julio a. Maintains complete and accurate documentation. b. Conducts fair evaluations. c. Maintains regular and prompt communication. d. Conducts good-faith negotiation. - โโc. Maintains regular and prompt communication In claims investigation, all bodily injury claims require a. An attorney.
b. Multiple claims payments. c. Statements from all witnesses. d. A medical investigation. - โโd. A medical investigation The first step in the data mining process is to a. Prepare the data that will be used. b. Understand what a business wants to achieve. c. Select a data mining technique. d. Collect the data that will be used. - โโb. Understand what a business wants to achieve For an excess liability claim to be filed, a final judgment or settlement must have been entered against the insured, and a. The insured must have paid that judgment. b. Evidence of bad faith must be produced. c. The insurer must have determined that coverage does not apply. d. The amount of the judgment must be n excess of the insured's policy limit. - โโd. The amount of the judgment must be in excess of the insured's policy limit 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
b. The DICE method. c. The CARD method. d. The CARE method. - โโb. The DICE method Hanna is in IT and works on data analytics projects for an insurer. These projects involve analyzing large amounts of data to help underwriting to select risks and price policies. Hanna knows that collaboration between data science, IT, underwriting, and actuary is critical to the success of these projects. In Hanna's experience, as soon as the need for a data project arises, the key to collaborating effectively is to engage which one of the following teams as soon as possible? a. Data science b. Actuary c. Underwriting d. IT - โโa. Data science Benjamin is with the SIU department of an insurer. His company developed technology to identify patterns related to fraudulent claims activity. He is using a program to analyze claims data to identify similarities or connections that might indicate fraud. Benjamin is utilizing a. Claims audits. b. Data minning. c. Telematics.
d. Wearables. - โโb. Data mining 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 a. Motion to strike. b. Motion to suppress. c. Motion to dismiss. d. Motion to limine. - โโd. Motion in limine Ella sued her insurer and alleged bad-faith claim handling after the insurer settled a claim against her that Ella thought should have been denied. As a result of the settlement, Ella's premium increased. In her suit, Ella claimed that the insurer rushed the investigation and did not take all of her facts into consideration in her defense. While the court found that Ella's argument had merit, it did not award her the full value because it found that Ella had not provided her information to the insurer in a timely manner. The insurer used the defense of a. Comparative negligence. b. Comparative bad faith. c. Contributory negligence. d. Debatable reasonable basis. - โโa. Comparative negligence
a. IT professional. b. Actuary. c. Data scientist. d. Ratemaker. - โโc. Data science Soft fraud, also called opportunity fraud, occurs when a. An application for insurance contains untrue information. b. A claim is filed for a loss that did not occur. c. A loss is triggered intentionally. d. A legitimate claim is exaggerated. - โโd. A legitimate claim is exaggerated Kira, a claims representative, receives a summons and complaint from an insured. In reviewing the facts, she has doubts that the insured's applicable policy will provide coverage. She should work with counsel and request a managerial review in order to issue a. A countersuit. b. A reservation of rights letter. c. A claim denial. d. An excess letter. - โโb. A reservation of rights letter
One of Juan's responsibilities as a claims representative is to prepare internal reports, such as preliminary, interim, large loss, and captioned. Which one of the reports Juan prepares is required for claims with reserves that exceed a specified threshold? a. Interim b. Preliminary c. Large loss d. Captioned - โโc. Large loss Hugo is conducting an audit of a branch office claims operation. He is evaluating timeliness of reports, number of files opened, proper releases taken, and accuracy of data entry. Which one of Hugo's metrics is a qualitative audit factor? a. Timeliness of reports b. Proper releases taken c. Accuracy of data entry d. Number of files opened - โโb. Proper releases taken Jack leads the claims department for a large insurer and has embraced the recent developments in claims data collection and analysis. Jack knows that a. He still needs people because the data need to be analyzed in context by a human.
Which one of the following best describes the term 'professionalism' as it relates to claims professionals? a. Fulfilling the terms of an insurance contract b. The behaviors necessary to implement an ethical decision c. Remaining silent when a competitor is disparaged publicly d. A set of principles and values - โโb. The behaviors necessary to implement an ethical decision Part of the continuous cycle of data mining is preparing the data to eliminate missing or inaccurate information. This process is called a. Parsing. b. Machine learning. c. Cleaning. d. Predictive modeling. - โโc. Cleaning The Office of Foreign Assets Control requires claims payors to check payees against a database of a. Policyholders of other insurers. b. Those who have collected a payment for the same loss.
c. Known terrorists and drug traffickers. d. Known perpetrators of insurance fraud. - โโc. Known terrorists and drug traffickers Which one of the following is a data mining technique an insurer applies when it knows what information it wants to predict? a. Association rule learning b. Classification c. Machine learning d. Cluster analysis - โโb. Classification Claims may be paid in any of three ways: by check, by bank transfer or a. By the issuance of a credit on the premium for the next policy period. b. By electronic funds transfer. c. In a direct transfer of goods or services, as with a contractor performing repairs. d. In cash. - โโb. By electronic funds transfer 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
a. An insured files a homeowners claim for stolen jewelry. An investigation reveals that the jewelry is still in the insured's possession. b. 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. c. An investigation reveals that an insured set her own business on fire. d. An insured files a claim for collision damage from a hit and run accident, when in fact he backed into a utility pole. - โโb. 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. In which one of the following scenarios is a public adjuster most likely to become involved? a. A catastrophic disaster strikes, involving damage to many properties. b. An insurer finds it financially unfeasible to hire its own claims staff in a given state. c. An insured is unable to afford legal representation to contest a claim. d. An insured's negotiations with the insurer on a complex claim are not going well. - โโd. An insured's negotiations with the insurer on a complex claim are not going well. Tobias is a claims representative who understands the importance of good-faith claims handling, including fair evaluation, good-faith negotiation, complete and accurate documentation, and timely contact with all parties to a claim. Which one
of Tobias' good-faith claims handling practices helps his employer because the parties will be more likely to remember details of the loss accurately? a. A Good-faith negotiation b. Timely contract with all parties to a claim c. Fair evaluation d. Complete and accurate documentation - โโb. Timely contact with all parties to a claim Not long after Valteri issued a denial and closed the claim, the insured sued for coverage and alleged bad-faith claim handling against the insurer. Valteri was able to demonstrate for his superiors that he had made a good-faith investigation and determined that the claim was not covered by the policy. The insurer maintains that Valteri had reasonable justification in fact for denying the claim. The insurer is employing the a. Debatable reasonable basis defense. b. Statute of limitations defense. c. Advice of counsel defense. d. Lack of standing defense. - โโa. Debatable reasonable basis defense To determine whether an insurer typically underreserves or overreserves claims, actuaries compare the insurer's paid losses to
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? a. Enticing a reasonable demand b. Timing settlements effectively c. Learning on the evaluation d. Making concessions cautiously - โโb. Timing settlements effectively Mitsuki was severely injured when the safety latch on an amusement park ride failed and she was thrown from the ride. In her lawsuit with the amusement park, Mitsuki was awarded payment for pain and suffering, emotional distress, disfigurement, and loss of earnings. Which one of Mitsuki's awards is considered special damages? a. Loss of earnings b. Disfigurement c. Emotional distress d. Pain and suffering - โโa. Loss of earnings Which one of the following explains why a computer recursively applies a model?
a. To determine the probability of a target variable b. To analyze different splits in the values of attributes c. To identify attributes that can be used d. To analyze claims data from previous years - โโb. To analyze different splits in the values of attributes Which one of the following explains why a computer recursively applies a model? 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. c. TPAs are employed only by independent adjusting firms. d. TPAs are generally found in an insurer's claims department. - โโb. TPAs handle claims, keep claims records, and perform statistical analyses 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) a. Claim representative. b. Medical provider. c. Expert Witness.
