A role defined by being an employee or an insurer and having a primary focus on handling claims -
ANSWER-Staff claims representative
Employees used when specialized skills are needed and when staff claim representatives are too busy to
handle all claims themselves. - ANSWER-Independent adjusters...
AIC 300 Exam Questions| Already
Answered| GRADED A+
A role defined by being an employee or an insurer and having a primary focus on handling claims -
ANSWER-Staff claims representative
Employees used when specialized skills are needed and when staff claim representatives are too busy to
handle all claims themselves. - ANSWER-Independent adjusters
Contractors who handle claims, keep claim records, and perform statistical analyses and are often
associated with large independent adjusting firms or with subsidiaries of insurers. - ANSWER-Third party
administrator (TPA)
Agents, brokers, sales representatives, and intermediaries who place insurance with insurers. -
ANSWER-Producer
A representative often hired by the insured to protect their interests if a claim is complex or if
settlement negotiations are not progressing with the insurer. - ANSWER-Public adjuster
Representatives who evaluate new submissions and perform renewal underwriting, usually by working
directly with insurance producers and applicants - ANSWER-Line underwriters
Representatives who manage risk selection by working with line underwriters and coordinating
decisions about products, pricing, and guidelines. - ANSWER-Staff underwriters
Representatives who collaborate with claims representatives to ensure fast, accurate communication of
claims related information. - ANSWER-Customer service representatives
Employees who insurers hire when needed to evaluate the cause or value of a loss, investigate the
possibility of fraud by an insured or a third-party claimant, or provide legal advice. - ANSWER-Experts
, If the decision is negative, good-faith claims handling requires the claims rep to
__________________________________________. - ANSWER-explain the rationale behind it.
Claims representatives could quickly reduce LAE in the short term by
___________________________________ rather than spending resources on investigating claims and
calculating and negotiating fair payments. - ANSWER-offering the settlement payments insureds and
claimants demand
3 frequently used tools provide quality measures of a Claims Department's performance - ANSWER-best
practices, claims audits, & customer satisfaction data
Identified by studying an insurer's own performance or the performance of successful insurers -
ANSWER-Best practices
Used by insurers to ensure compliance with best practices and gather statistical information on claims--
performed by evaluating information in open/closed claims. - ANSWER-Claims audits
Most policies require the insured, and sometimes third-party claimants, to provide
_______________________. - ANSWER-sworn statements
3 qualities of effective statements - ANSWER-coherence, completeness, objectivity
__________________________ help the claims representative determine whether accounts of the
accident are plausible. - ANSWER-Accident scene details
Claims representatives conduct ___________________________ on most incoming claims to avoid
paying for property damage or bodily injury that the claimant has already been compensated for
through prior claims. - ANSWER-prior claim investigations
Allows an insurer to recover payment from a negligent third party when the insurer has paid a claim for
a loss caused by the negligent third party. - ANSWER-Subrogation
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