Associate in Claims (AIC) 30 – Claim Handling Principles and Practices Practice Test

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• Which element of negligence ties the breach to the harm?
• An accident staged to claim insurance proceeds is an example of which broader wrongdoing?
• In civil cases, which standard of proof states the evidence supports the opinion that the person did it?
• What is the term for the delivery of a summons and complaint to the defendant by an alternative method, such as leaving with a receptionist?
• Which term describes a negotiation posture in which neither side seeks a favorable outcome and instead accepts an adversarial result?
• The words a sender uses in the communication process are referred to as what?
• Who is typically responsible for paying the claim to the insured?
• Quantitative measures in claims data can include which of the following?
• Which term refers to the location where a lawsuit is heard?
• Nonverbal communication in claims handling includes which elements?
• Which term best describes a deliberate act of deception against an insurance producer or insurer for unwarranted financial gain?
• How does strict liability relate to negligence?
• Which organization focuses on preventing insurance fraud?
• Which term describes insurers paying claims in proportion to their policy limits?
• Which term refers to the defendant's response to the complaint?
• What is the term for an organization that provides admin services for risk financing and insurance, handling claims for self-insured organizations?
• Reliance on lawyers' advice is commonly cited as a defense to bad-faith claims?
• Which term refers to actions taken on purpose to harm another, such as slander or false arrest?
• The federal crime of using the mail to commit insurance fraud is defined by which statute?
• Which term refers to the insurer's estimate of the total payout for a claim, including IBNR claims?
• Comparative Negligence refers to what?
• Which of the following is commonly cited as a defense to bad-faith claims?
• To set a reserve for losses that have been incurred but not reported, the insurer establishes a reserve based on the anticipated losses over a period of time for a certain type of insurance. This is known as which method?
• Which term refers to the pretrial exchange of information between the plaintiff and the defendant?
• Which term describes the amount of operational expenses against the written premium?
• What is the term for the plan that outlines whether to settle, fight, or negotiate during litigation?
• Which type of question is designed to trap the respondent by presupposing or assuming something?
• Which term describes fraud that occurs when a legitimate claim is exaggerated?
• Which sales concept involves getting a person to agree, with a tendency to continue agreeing?
• Which term describes a signed agreement that preserves the rights of both the insurer and the insured during the course of an investigation?
• Which term is the study of what constitutes good and bad behavior?
• Which factor is used to set reserves under the Individual Case Method?
• We were at fault, we know we will pay the claim, but to earn a little goodwill we make an advanced payment for bills presented to make the injured party's life a little easier. This is known as what?
• Which method uses an average expected payment amount to determine the reserve across claims?
• Under strict liability, what must the plaintiff prove?
• What does ISO stand for in the insurance industry?
• Which term describes the court's power to hear a case within a defined geographic area?
• Strict liability is most clearly applied in which situation?
• What term describes a negotiation stance where no agreement is reached and the dispute proceeds to litigation with an adversarial posture?
• Punitive damages are designed to do what?
• Which term describes the delivery of the summons and complaint to the defendant by an authorized person?
• What is a counterclaim?
• Which clause is associated with determining the amount of loss when the parties disagree on value?
• Which advertising requirement relates to providing elaboration or opinion about the circumstances under consideration?
• What term describes the failure to fulfill the contract as contracted without a legal excuse?
• Which ADR process is primarily designed to help determine settlement by presenting concise evidence and opinions before trial?
• NCCI is an organization associated with which area?
• What term describes an intentional misrepresentation that harms another person or organization?
• Which term refers to formal law enacted by legislative bodies such as Congress or state legislatures?
• The perceived believability of the person during the conversation is called what?
• Which term refers to a fixed fee charged by an attorney for handling a case?
• What is an Independent Medical Examination (IME) in an insurance context?
• Which term defines a fact that would have affected the insurer's decision to provide coverage or the cost of coverage?
• Which pretrial request asks the court to render a judgement when there are no material facts in dispute?
• What does the crisis phase imply in the context of claim handling?
• Code of Ethics describes what concept?
• Which method is used to set reserves for losses anticipated over a period for a specific line of insurance?
• What are Interrogatories?
• Which term describes the degree to which a person is believed before the conversation begins?
• Which term is the study of moral duty and obligation in professional conduct?
• Which term describes questions designed to intimidate or entrap a person?
• Which ADR process uses an abbreviated trial with a panel of mock jurors and yields a non-binding result?
• Which statements, if not denied, bind the party to the trial?
• An estimate of the amount of money the insurer expects to pay on a claim, including IBNR claims, is known as what?
• What does a win-win negotiation aim for?
• Which term describes the deliberate withholding or destruction of evidence to influence the outcome of litigation?
• Which term defines the principle requiring courts to follow higher court rulings?
• Which of the following is listed as a defense to bad-faith claims?
• Loss ratio is calculated by dividing losses and loss adjustment expenses by which item?
• Which party handles claims for the insurer for a fee and works for the insurer?
• Which term describes a statement that presents information in a story form?
• Under strict liability, what must the plaintiff prove?
• In insurance terminology, which party is identified as the First Party?
• Which term is used to denote a sworn examination conducted to obtain facts during a claim investigation?
• Which term describes the monetary remedy sought in civil litigation?
• In the claims process, which phase involves both sides evaluating positions and potential disagreements as the claim is settled?
• Which term describes damages intended to punish wrongdoing and prevent recurrence?
• Which term describes compensatory damages that reimburse quantifiable bills?
• Which entity is typically required to report claims that raise suspicions?
• Which credibility assessment is made at the end of an interaction?
• Which term refers to the allegation made in a lawsuit?
• What term refers to a list of all past claims for an individual or organization, including amounts paid, amounts reserved, and current claim status?
• Which term describes offering a choice between one option or another?
• Which pretrial discovery tool involves the oral examination of a witness to produce a written verbatim record?
• When is strict liability typically applied?
• What term describes a method of setting a reserve by having two or more individuals review the file, discuss and develop a consensus for the reserve?
• Which term describes the duty to preserve evidence for possible pending litigation, with the loss or destruction typically being fault of the accused party?
• Which term describes an ownership stake in a property that would cause financial harm if damaged?
• Which scenario best illustrates a Conflict of Interest?
• What is an Allegation?
• Common defenses in strict liability cases include which of the following?
• Which term is a method of setting a reserve by two or more individuals who review the file and reach a consensus?
• Which term describes the attorney handles the case for one flat amount of money?
• In insurer-insured relationships, the Second Party refers to which entity?
• What is a facilitated, nonbinding negotiation used as an alternative to litigation?
• Which term describes a loss arising as a result of damage to property or injury to a person, other than the direct loss? Example: loss of salary for an injury, loss of use of the house causing you to rent another place to stay.
• Which term describes the act of converting a message into a form suitable for transmission?
• Which document describes a statement of facts related to the loss and is typically used to request payment under the policy?
• Which term describes the duty to prove the facts, to what extent - beyond a reasonable doubt for criminal, preponderance of evidence for civil actions?
• What term describes the legally enforceable obligation to pay damages?
• Which term is the amount the insurer estimates and sets aside to pay on a claim that has not been settled?
• Vehicles (and homes in many cases) must be physically inspected for prior damage to insurance policies being issued. This requirement is described by which law?
• Which term is the duty to prove the facts, varying between criminal and civil law?
• What does the combined ratio indicate for an insurer?
• What does 'First Party Focus' emphasize in claims handling?
• Which discovery tool captures sworn testimony in writing after an oral examination?
• Which ADR process involves an abbreviated version of a trial before a panel or advisor who poses questions and offers opinions on the outcome based on the evidence, with the goal of aiding settlement?
• In communication, what is the interpretation of the message by the receiver called?
• ADR stands for what in dispute resolution?
• What does IBNR stand for in claims reserving?
• Which term represents a monetary award to compensate a victim for 'qualitative' injuries such as pain and suffering, scar tissue, loss of consortium?
• In strict liability claims, the plaintiff does not need to prove what?
• Which term describes an action undertaken to deliberately defraud?
• Which metric compares losses and loss adjustment expenses to earned premiums?
• Which organization is commonly abbreviated ISO in the insurance industry and provides standardized forms and rating data?
• Which clause requires the insured to carry insurance equal to at least a specified percentage of the insured property value?
• The term Insured refers to which party in a standard policy context?
• NCCI is best known for providing information about which type of insurance?
• Which term refers to the plan that outlines how litigation should proceed, including whether to settle, fight, or negotiate?
• Which statement best describes strict liability?
• What is a material fact in insurance?
• Which document warns the insured that coverage issues exist and that coverage may be denied later if facts warrant it?
• Which reserve method uses a mathematical formula that accounts for medical treatment, wage loss, and related factors to determine compensation?
• In claims handling, which phase focuses on recognizing the financial implications of the loss?
• Which pretrial request aims to exclude prejudicial or noncontroversial evidence from trial?
• Which term describes the process of selecting jurors for a trial?
• Which credibility measurement evaluates a party's believability at the end of the conversation?
• Immunity laws provide protection to insurers and claims representatives when reporting suspected fraud under what condition?
• Which scenario best illustrates strict liability in tort law?
• Qualitative Measures include which requirement related to vehicles?
• Which of the following is an example of an intentional tort?
• Which term refers to a request to provide all documents and other tangible evidence in possession related to the facts of the case?
• The combined ratio is composed of which two ratios?
• NAIC stands for which organization?
• What is a Counter Claim?
• Which term is the party who initiates the communication by sending the message?
• Which term describes penalties for insurance fraud?
• What term describes model laws developed by the NAIC for insurance and risk management?
• Which of the following is listed as a defense to bad-faith claims?
• During which phase is a Non Waiver Agreement typically executed?
• Which term describes the organization that provides admin services for risk financing and claims handling for self-insured organizations?
• Which concept describes the tendency to continue agreeing once initial agreement is reached, a common sales tactic?
• What does CAIF stand for?
• Using a software application to set a reserve based on information entered describes which concept?
• What is the term for an automatic judgment against a party who fails to appear in court?
• An award by the court that indemnifies an injured party for losses directly resulting from a breach or tort is called what?
• What term refers to a statement of facts related to the loss for which the insured is making a claim, as a condition of the policy?
• Which term is the formal delivery of legal papers to a defendant?
• Which term describes a situation where a decision maker's personal interests interfere to the extent that they make decisions adverse to the customer?
• Which method describes insurers paying losses in proportion to each insurer's share of total coverage?
• Which factor does NOT influence reserves under the Individual Case Method?
• The process by which a recipient interprets a message is known as what?
• Strict liability does not require proof of ordinary fault because it is based on?
• Which statement best distinguishes a first-party claim focus from a third-party focus?
• Which term is defined as a false statement of a material fact, knowingly made with the intent to deceive?
• Which term is a list of all past claims for an individual or organization, including amounts paid, amounts reserved, and current claim status?
• Which term describes a sworn examination used to obtain facts during a claim investigation?
• Which term refers to the court's power to hear and decide a lawsuit within a specific geographic territory?
• Which term describes a reduction in the value of property that results directly from damage or injury?
• Which term describes a legal principle that prohibits a party from asserting a claim once it has been waived and the other party relied upon that waiver to their detriment?
• The question "You were not speeding, were you?" is an example of which type of question used in investigations or claim handling?
• What is a statement in which the person attests that the information is true?
• Which term describes a statute requiring lawsuits to be filed within a specific timeframe after the action accrues?
• Which element of negligence is the failure to meet the standard of care?
• Which statement describes a common defense to strict liability?
• The practice of paying expenses in advance to help the claimant even when fault is acknowledged is called what?
• Which is a motive for insurance fraud?
• Which term would describe a question that requires a simple yes or no answer?
• What does NMVTIS stand for?
• Which term indicates the legal principle that lower courts follow higher court precedents?
• For underwriting, what requirement ensures physically inspecting vehicles or property prior to policy issuance?
• Which term is a formal written statement of facts and claims of each party to the lawsuit?
• The Motor Vehicle Theft Law Enforcement Act of 1984 is primarily associated with which concern in claims handling?
• In liability claims, which party is typically the claimant in a third-party scenario?
• Which term is most closely associated with intentional harm such as defamation or false imprisonment?
• Which of the following are examples of ADR techniques?
• Which term describes an intentional failure to disclose a material fact in an insurance claim?
• Which term denotes the notice to the defendant that they have been named in a lawsuit, delivered by a specified means, and sets the time to respond?
• Which outside organization hired by the insured to represent the insured in the claim for a fee?
• True or False: In strict liability, the defendant's degree of fault is irrelevant.
• What term refers to the method of delivering legal documents to the defendant by handing them to a receptionist or other office personnel?
• Which pretrial request seeks to exclude certain information from trial because of prejudice, it was cumulative, or not in controversy?
• Which term refers to the process of presenting a formal complaint to the court initiating litigation?
• What is a typical defense to strict liability?
• Which term refers to the belief that the insured's interests must be given at least as much consideration as the insurer's?
• Which element of negligence refers to the harm or loss suffered?
• In a claim involving an inherently dangerous activity, what is necessary?
• What damages are designed to reimburse for actual harm suffered?
• Which term refers to the person or entity that files a lawsuit?
• In a civil action, who defends against the plaintiff's claims?
• Which statement best describes the purpose of the combined ratio?
• Which term describes the intentional or unintentional relinquishing (giving up) of a known right?
• Which term describes the failure to exercise due care that a reasonable person would do in a similar situation to avoid harming others?
• What term refers to a formal request for an action to be taken?
• Which term refers to the location where a lawsuit is filed?
• Which term means a false statement of a material fact knowingly made with the intent to deceive?
• Which federal act addresses stolen car parts and stolen vehicles as federal crimes?
• Which concept describes listening with openness to determine the meaning of what others say, especially in third-party contexts?
• Which term describes ownership in property that would cause financial harm if damaged?
• Which statement best defines breach of contract?
• In negligence, what term describes the obligation to protect another party from harm?
• Which term describes the purpose of standardizing insurance laws across jurisdictions?
• The objective of standardizing insurance laws to address issues related to insurance is described by which term?
• We win, they lose. They committed fraud, they got caught. This outcome is described as which?
• Was not relevant to the case, can be reconstructed, a reasonable opportunity to examine the evidence was made before it was destroyed. This is described as which defense?
• Which term describes claims that have occurred but not yet been reported?
• Which term is the amount payable under the terms of the contract?
• In negotiation, which step comes second?
• An insurer's letter that specifies coverage issues and informs the insured that the insurer is handling a claim with the understanding that the insurer may later deny coverage should the facts warrant it is called what?
• Which term describes the initial filing of a civil case by the plaintiff presenting claims?
• Which term refers to an accident deliberately caused to fake injury and collect on an insurance policy?
• In a lawsuit, who is the party in a law suit against whom the complaint is filed?
• Which ADR option results in a binding and final decision administered by a neutral arbitrator?
• What is the term for hand delivery of a summons and complaint to a defendant?
• Ex Parte contracts in claim discussions occur when which situation exists?
• Which term describes attorney charges allocated for each phase or task of litigation?
• NMVTIS is a system designed to prevent what?
• Which ADR option results in a binding and final ruling by a neutral selected to adjudicate the dispute?
• What term is a notification to the defendant that they have been named to a lawsuit, with details of the suit and the time to respond?
• Which term is the party who receives and interprets messages?
• Which term refers to the pretrial exchange of information between plaintiff and defendant?
• Which concept is described as preventing insurance companies from taking unfair advantage of the insured/claimants?
• Which term designates the insured's own perspective in a claim, as opposed to the insurer's perspective?
• What term describes the means by which a message is transmitted?
• Which phrase describes adjusters who focus on money and overlook other settlement options?
• Using the mail to commit insurance fraud is a federal crime. This is governed by which statute?
• Which term covers any deliberate deception against an insurer or producer for the purpose of unwarranted financial gain?
• What term refers to a set of model laws developed by the NAIC for use by states?
• Which group is described as banding together to detect, prosecute and deter insurance fraud?
• Which method establishes a reserve for each claim based on the average expected payment?
• In a third-party claim, who is typically the claimant?
• Which term is defined as the process of translating the message after it is sent?
• Which term describes the monetary award for qualitative injuries such as pain and suffering, scar tissue, or loss of consortium?
• Contributory Negligence refers to what?
• Which of the following is a hallmark of strict liability?
• Which term is a formal written statement of facts and claims by a party to the lawsuit?
• Which body coordinates the regulation of insurance at the state level in the United States and is abbreviated NAIC?
• Which phase addresses intangible measures such as negotiation skills and overall performance?
• Which term describes the process of selecting jurors and assessing biases?
• Which ADR process involves presenting evidence to a panel for a non-binding advisory verdict?