AIC 300 Claims in an Evolving World Exam rsion

AIC 300 Claims in an Evolving World Exam rsion with All Questions from Actual Past Exam, 100% Correct Answers Best Studying Materials

Luke runs his business out of a store front in a commercial building. After a fire destroyed part of the building, Luke made a claim for damages and received a settlement check from the property insurer. This necessarily means that Luke

Select one:

• Is named in the policy declarations or an endorsement.
• Is the owner of the building.
• Has business interruption coverage.
• Has an insurable interest in the damaged property. --------- Correct Answer --------- A.

Is named in the policy declarations or an endorsement.

Is named in the policy declarations or an endorsement. An individual may have an insurable interest in a building, but not be considered an insured under the policy because the person's name is not listed in the declarations or on an endorsement.

Part of the continuous cycle of data mining is preparing the data to eliminate missing or inaccurate information. This process is called

• Parsing.
• Machine learning.
• Cleaning.
• Predictive modeling. --------- Correct Answer --------- c. Cleaning

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?

• Enticing a reasonable demand
• Timing settlements effectively
• Leaning on the evaluation
• Making concessions cautiously --------- Correct Answer --------- B. 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?

• Loss of earnings 1 / 4

• Disgifurement
• Emotional distress
• Pain and suffering --------- Correct Answer --------- a. Loss of earnings

The Office of Foreign Assets Control requires claims payors to check payees against a database of

• Policyholders of other insurers.
• Those who have collected a payment for the same loss.
• Known terrorists and drug traffickers.
• Known perpetrators of insurance fraud. --------- Correct Answer --------- c. Known

terrorists and drug traffickers

If the decision on a claim settlement is negative, as in a denial, good-faith claims handling requires the claims rep to

Select one:

• Explain the rationale behind the decision to the claimant.
• Have a supervisor sign off on the communication to the claimant.
• Deliver the decision to the claimant in writing.
• Deliver a hard copy of the decision to the claimant by mail. --------- Correct Answer ---

------ A. Explain the rationale behind the decision to the claimant.

Correct. If the decision on a claim settlement is negative, good-faith claims handling requires the claims rep to explain the rationale behind the decision.

In a typical scenario, a summons and complaint initiating litigation is received by these parties in which one of the following sequences?

Select one:

• Defense counsel, insured, claims rep
• Defense counsel, claims rep, insured
• Claims rep, insured, defense counsel
• Insured, claims rep, defense counsel --------- Correct Answer --------- D. Insured,

claims rep, defense counsel

Incorrect. A summons and complaint is typically received by the insured, who then shares it with the claims rep, who in turn sends it to the insurer's defense counsel.

Which one of the following terms encompasses types of fraud including false claims and intentional losses?

Select one:

• Soft fraud
• Staged fraud
• Willful fraud
• Hard fraud --------- Correct Answer --------- Hard Fraud
• / 4

Through data mining, Goshen Mutual discovers that customers who insure two or more vehicles on a personal auto policy are very likely to buy a personal umbrella policy.Algorithms are then used to identify potential customers who might be interested in purchasing both personal auto and umbrella policies. Which one of the following data mining techniques did Goshen Mutual use?

Select one:

• Cluster analysis
• Association rule learning
• Classification
• Regression analysis --------- Correct Answer --------- B

Jose is handling a workers compensation claim. The injured worker claims to have strained his back when he lifted a box at work. He waited a day to report the injury because he thought he would be okay. He asked Jose when he would be referred to a back specialist and when he could expect his first check. Which one of the injured worker's actions would be the most pertinent fraud indicator to Jose?

Select one:

• Lifting a box
• Waiting to report
• Asking about check
• Asking for referral --------- Correct Answer --------- D. Asking for referral

...could indicate that the worker has knowledge of the workers compensation system because he had been through it before.

A claims representative should have the ability to persuade or influence

Select one:

• Claimants, insureds, supervisors and others.
• Claimants.
• Supervisors.
• Insureds. --------- Correct Answer --------- A. Claimants, insureds, supervisors and

others.

Correct. The impression that claims reps make on claimants, insureds, and others reflects either favorably or unfavorably on the insurer.

While staff claims representatives may have a variety of titles, the role is typically

defined by two things: having a primary focus on claims and

Select one:

• Being an employee of the insurer.
• Being an outsourced contractor of the insurer.
• A focus on inside claims.
• Having at least five years of claims experience. --------- Correct Answer --------- A.

Being an employee of the insurer.

• / 4

Correct. The role of staff claims representative is defined by being an employee of the insurer and having a primary focus on handling claims.

Alva works for an international, multi-line insurer. She helps her company to manage risk selection by working with other underwriters and coordinating decisions about products, pricing, and guidelines. Alva is a

Select one:

• Staff underwriter.
• Master underwriter.
• Chief Underwriting Officer.
• Line underwriter. --------- Correct Answer --------- A. Staff underwriter.

Correct. Staff underwriter. This describes the duties of a staff underwriter. Line underwriter. This describes the duties of a line underwriter, rather than a staff underwriter. There is not enough information 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.

Because a full or partial denial of a claim may result in a bad-faith lawsuit, a claims representative should

Select one:

• Carefully document their reasoning for denial.
• Check with the reinsurer before denying a claim.
• Seek a supervisor's approval before denying a claim.
• Make every effort to approve each claim. --------- Correct Answer --------- A. Carefully

document their reasoning for denial.

Claims reps should carefully document their reason(s) for fully or partially denying a claim.

hich one of the following statements regarding subrogation is most accurate?

Select one:

• The insured typically must cooperate with the insurer in recovering payment through

subrogation, but is not required to testify or appear in court.

• The insured is typically under no obligation to cooperate with the insurer in

recovering payment through subrogation.

• Most policies require the insured to cooperate with the insurer in recovering payment

through subrogation, to include testifying or appearing in court.

• All policies require the insured to cooperate with the insurer in recovering payment

through subrogation. --------- Correct Answer --------- C. Most policies require the insured to cooperate with the insurer in recovering payment through subrogation, to include testifying or appearing in court.

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