AIC 300 - CLAIMS IN AN EVOLVING WORLD

• | Page

AIC 300 - CLAIMS IN AN EVOLVING WORLD

CORRECT SOLUTIONS.

• 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. - correct answer- Insurers usually send denial letters

Select one:

• By email to ensure prompt receipt by the insured.
• By certified mail with a return receipt requested.
• By overnight courier.
• By registered mail.

• Subpoenaed.

Any written claims communication may be subpoenaed. - correct answer- As methods of communication evolve, it's important for claims professionals to remember that any written claims communication may be

Select one:

• Replaced with verbal communication.
• Misinterpreted. 1 / 4

• | Page

• Edited later.
• Subpoenaed.

• 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. - correct answer- In which one of the following scenarios is a public adjuster most likely to become involved?

Select one:

• An insurer finds it financially unfeasible to hire its own claims

staff in a given state.

• An insured is unable to afford legal representation to contest

a claim.

• A catastrophic disaster strikes, involving damage to many

properties.

• An insured's negotiations with the insurer on a complex

claim are not going well.

• TPAs handle claims, keep claims records, and perform

statistical analyses. - correct answer- Which one of the following statements regarding third-party administrators (TPAs) is most accurate?

Select one: 2 / 4

• | Page

• TPAs are typically used by businesses that have chosen not

to self-insure.

• TPAs handle claims, keep claims records, and perform

statistical analyses.

• TPAs are generally found in an insurer's claims department.
• TPAs are employed only by independent adjusting firms.

• Proper releases taken

Proper releases taken is a qualitative audit factor; the others are quantitative. - correct answer- 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?

Select one:

• Proper releases taken
• Timeliness of reports
• Number of files opened
• Accuracy of data entry

• Line underwriter.

Line underwriter. This describes the duties of a line underwriter, rather than a staff underwriter. There is not enough information 3 / 4

• | Page

to determine which line of business is being written. A public underwriter does not exist. Line underwriters evaluate new submissions and perform renewal underwriting, usually by working directly with insurance producers and applicants. Staff underwriters, meanwhile, manage risk selection by working with line underwriters and coordinating decisions about products, pricing and guidelines. - correct answer- 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

Select one:

• Staff underwriter.
• Public underwriter.
• Personal lines underwriter.
• Line underwriter.

• Listening.

Claims professionals should first listen carefully to understand what the claimant is saying. - correct answer- The first key to communicating empathetically as a claims professional is

Select one:

• A comprehensive understanding of relevant insurance

policies.

• Speaking calmly and clearly.
• Being prepared with all documentation relating to the claim.
• Listening.
• / 4