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AIC 300 - Claims in an Evolving World Exam Questions and answers | Latest 2024/25 RATED A+
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AIC 300 - Claims in an Evolving World Exam Questions and answers | Latest 2024/25 RATED A+
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AIC 300 - Claims in an Evolving WorldExam Questions and answers | Latest
2024/25 RATED A+
A. A reservation of rights letter.
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The insurer will issue a reservation of rights letter stating that it will provide defense only
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until it can establish that there is no coverage. - Correct Answers Kira, a claims
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representative, receives a summons and complaint from an insured. In reviewing the facts,
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she has doubts that the insured's applicable policy will provide coverage. She should work
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with counsel and request a managerial review in order to issue
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Select one: ll
A. A reservation of rights letter.
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B. An excess letter.
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C. A countersuit.
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D. A claim denial.
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ll A. Actuary.
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Actuaries are critically important to this process because they understand the business
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and the analytics. - Correct Answers Mustafa is a data scientist who is working with a
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team of underwriting, IT, and actuary to develop a predictive analytics model. The main
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goal of the project is to translate the insights gained from the model they develop into
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business action. In Mustafa's experience, the team member that can provide the bridge
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between the analytics and the business is
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Select one: ll
A. Actuary.
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B. IT. ll
C. Underwriting.
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D. Data science.
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ll A. Asking for referral
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Asked for referral could indicate that the worker has knowledge of the workers
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compensation system because he had been through it before. - Correct Answers Jose is
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handling a workers compensation claim. The injured worker claims to have strained his
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back when he lifted a box at work. He waited a day to report the injury because he thought
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he would be okay. He asked Jose when he would be referred to a back specialist and when
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he could expect his first check. Which one of the injured worker's actions would be the
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most pertinent fraud indicator to Jose?
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Select one: ll
,A. Asking for referral
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B. Lifting a box
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C. Waiting to report
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D. Asking about check
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ll A. Blockchain.
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By having a transparent ledger associated with a car, for example, insurers can detect
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fraud that would be difficult to detect otherwise. - Correct Answers Martin is in SIU and
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helps his employer, a multi-line insurer, to detect fraudulent claims. He is using a
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technology that enables insurers to share fraud-related information. This distributed digital
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ledger that facilitates secure transactions without using a third party is known as
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Select one: ll
A. Blockchain.
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B. A predictive model.
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C. The Internet of Things.
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D. Telematics.
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A. Consistent supervision, thorough training, and manageable caseloads help ensure that
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claim representatives are able to handle claims in good faith.
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Consistent supervision, thorough training, and manageable caseloads help ensure that
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claim representatives are able to handle claims in good faith. - Correct Answers Which
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one of the following is correct with respect to the elements of good-faith claim
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management?
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Select one: ll
A. Consistent supervision, thorough training, and manageable caseloads help ensure that
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claim representatives are able to handle claims in good faith.
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B. When resolving a coverage question, insurers should avoid the appearance of bad faith
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by dealing only with those lawyers hired to defend the insured.
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C. If the insured has excess insurance, the claim representative should merely notify the
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excess insurer of the claim.
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D. Claim representatives should avoid using policy provisions, such as arbitration clauses,
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to resolve disputes over the settlement amount.
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ll A. Data mining.
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Data mining. This is using computers to analyze vast amounts of data to detect trends. -
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Correct Answers Benjamin is with the SIU department of an insurer. His company
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developed technology to identify patterns related to fraudulent claims activity. He is using a
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program to analyze claims data to identify similarities or connections that might indicate
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fraud. Benjamin is utilizing
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Select one: ll
A. Data mining.
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B. Telematics.
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C. Claims audits.
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, D. Wearables. ll
ll A. Drones ll
Erik would most likely use drones to take photos or videos of the difficult-to-reach area and
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assess the damage and danger. By using the drones, he can assess the danger without
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risking the safety of the claims representatives. - Correct Answers Erik is a claims
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manager for Taunton Insurance. He is leading a team of property claims representatives
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responding to a recent tornado in Kentucky. Before sending the representatives into the
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field, Erik has decided to use Internet of Things (IoT) technology to assess the damage
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and danger in the area. Which one of the following IoT devices would Erik most likely use in
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this situation?
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Select one: ll
A. Drones ll ll
B. Sensors ll
C. Smartphones ll
D. Telematics ll
ll A. Explain the rationale behind the decision to the claimant.
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If the decision on a claim settlement is negative, good-faith claims handling requires the
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claims rep to explain the rationale behind the decision. - Correct Answers If the decision
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on a claim settlement is negative, as in a denial, good-faith claims handling requires the
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claims rep to
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Select one: ll
A. Explain the rationale behind the decision to the claimant.
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B. Deliver the decision to the claimant in writing.
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C. Deliver a hard copy of the decision to the claimant by mail.
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D. Have a supervisor sign off on the communication to the claimant.
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A. Feel empowered when given a choice. - Correct Answers Claims rep Miguel is
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conducting a settlement with a claimant. He constructs his first offer so that the claimant
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will likely find it undesirable. This becomes the basis of comparison for the second offer
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that he makes. Miguel understands that people
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Select one: ll
A. Feel empowered when given a choice.
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B. Will typically accept a second offer.
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C. Are naturally suspicious of an initial offer.
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D. Are easier to manipulate with choices.
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ll A. Handle claims in good faith.
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In insurance transactions, the insured pays a premium for the insurer's promise to handle
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claims in good faith. - Correct Answers Insurers and claim representatives must keep the
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promises specified in insurance policies, as well as those created by the law. In insurance
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transactions, the insured pays a premium for the insurer's promise to
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