Difficulty: Mixed
What is an insurance claim?
A Request for policy benefits
B Premium quotation
C Policy renewal
D Risk assessment
Answer: A. Request for policy benefits. A claim asks the insurer to pay or provide eligible benefits.
What should come first after an emergency loss?
A Complete every form
B Protect people and seek help
C Argue about fault
D Post policy details
Answer: B. Protect people and seek help. Prioritize safety and urgent assistance.
When should an insurer generally be notified?
A Only at renewal
B After selling property
C Promptly under policy instructions
D Never
Answer: C. Promptly under policy instructions. Follow the notification process and timing in the policy.
Where can claim-notice instructions be found?
A Social-media comments
B An old advertisement
C Another person’s policy
D Policy wording and insurer channel
Answer: D. Policy wording and insurer channel. The policy and official insurer guidance describe notification steps.
What is a claim intimation?
A Initial notice of a loss
B Final settlement payment
C Premium receipt
D Policy endorsement
Answer: A. Initial notice of a loss. Intimation alerts the insurer that a potential claim has occurred.
What is a claim form used for?
A Change traffic law
B Provide loss and policy details
C Set new premium
D Name an agent
Answer: B. Provide loss and policy details. A claim form records details needed for assessment.
Which item helps identify an insurance claim?
A Shopping receipt
B Hotel menu
C Policy or claim number
D Work badge
Answer: C. Policy or claim number. Policy and claim references help locate the case.
What can support a property claim?
A Unrelated grocery receipt
B A blank form
C Another policy
D Photos and repair estimates
Answer: D. Photos and repair estimates. Photos and estimates can document damage and repair needs.
Which record can support a medical claim?
A Itemized provider bill
B Restaurant receipt
C Travel playlist
D Home inventory
Answer: A. Itemized provider bill. An itemized bill helps show services and charges.
What may support a baggage-loss claim?
A Unrelated tax form
B Carrier report and receipts
C Home repair estimate
D Vehicle registration
Answer: B. Carrier report and receipts. Carrier records and purchase evidence can support a baggage claim.
What does cashless claim handling generally involve?
A All treatment becomes free
B No approval needed
C Eligible bills settled with provider
D Every provider participates
Answer: C. Eligible bills settled with provider. Cashless service may settle eligible approved costs directly.
What is reimbursement claim handling?
A Insurer skips review
B Provider pays premium
C Policy renews automatically
D Insured pays then submits documents
Answer: D. Insured pays then submits documents. The insured pays first and seeks reimbursement for eligible costs.
What is preauthorization in a health claim?
A Request before planned treatment
B Final claim settlement
C Premium payment notice
D Policy cancellation
Answer: A. Request before planned treatment. Preauthorization asks the insurer to review planned care.
Does preauthorization guarantee full payment?
A Yes, every bill
B No, policy terms still apply
C Only for emergencies
D Only in network
Answer: B. No, policy terms still apply. Limits, exclusions, and final claim review still apply.
What may a surveyor or assessor do?
A Set premium laws
B Choose the claimant
C Inspect loss evidence
D Guarantee settlement
Answer: C. Inspect loss evidence. A surveyor may inspect damage or evidence for claim assessment.
Why cooperate with a reasonable claim investigation?
A Guarantee approval
B Change policy limits
C Avoid all documents
D Support accurate assessment
Answer: D. Support accurate assessment. Providing requested accurate information helps the insurer assess the claim.
What should submitted claim information be?
A Truthful and complete
B Estimated from memory only
C Altered to raise payment
D Copied from another claim
Answer: A. Truthful and complete. Accurate details support fair claim review.
What can false claim documents cause?
A Automatic benefit increase
B Fraud and policy consequences
C Guaranteed approval
D Premium cancellation only
Answer: B. Fraud and policy consequences. False information can create serious claim and legal consequences.
What should be kept after claim submission?
A Only agent’s verbal promise
B Unrelated receipts
C Copies and acknowledgements
D Passwords
Answer: C. Copies and acknowledgements. Copies and dated acknowledgements help track the claim.
What can a claim reference number help with?
A Raise coverage automatically
B Change the insurer
C Remove a deductible
D Follow up on status
Answer: D. Follow up on status. A reference helps locate the claim during follow-up.
What may an insurer review during claim assessment?
A Cover, limits, and exclusions
B Claimant’s favorite color
C Unrelated employment reviews
D Social-media likes
Answer: A. Cover, limits, and exclusions. The insurer checks the loss against the policy terms.
Can an approved claim be less than the amount requested?
A No, always full
B Yes, terms may limit payment
C Only on life claims
D The request sets payment
Answer: B. Yes, terms may limit payment. Deductibles, limits, exclusions, and eligible losses affect settlement.
What is a partial settlement?
A Full premium refund
B Claim cancellation
C Payment for eligible portion
D Policy renewal
Answer: C. Payment for eligible portion. A partial settlement pays the amount assessed as eligible.
What should a denial explanation identify?
A Agent’s personal opinion
B Unrelated premium schedule
C Other claimants
D Policy reason and review options
Answer: D. Policy reason and review options. Request a written reason and the available review route.
What should a claimant do if settlement details seem incorrect?
A Ask for written clarification
B Ignore the notice
C Change the policy
D Pay an unknown caller
Answer: A. Ask for written clarification. A written explanation can clarify how the settlement was calculated.
Can every submitted claim be guaranteed?
A Yes, automatically
B No, coverage rules apply
C Only online claims
D Only first claims
Answer: B. No, coverage rules apply. Claims depend on coverage, exclusions, limits, and evidence.
Why keep receipts for claim expenses?
A Guarantee reimbursement
B Replace policy terms
C Document amounts paid
D Change deductibles
Answer: C. Document amounts paid. Receipts help substantiate expenses submitted for review.
What should a claimant do with original documents?
A Discard them immediately
B Post publicly
C Send to unknown numbers
D Follow submission instructions
Answer: D. Follow submission instructions. Use insurer instructions and keep copies when possible.
How can a claimant check a claim’s status?
A Use official insurer channel
B Ask an unknown caller
C Scan a random QR code
D Post personal data
Answer: A. Use official insurer channel. Use the insurer’s verified service channel to track status.
What is a grievance?
A Premium payment
B Complaint about service or handling
C Policy limit
D Claim benefit
Answer: B. Complaint about service or handling. A grievance raises dissatisfaction with an insurer or intermediary.
Where should an insurance complaint usually start?
A Anonymous forum
B Unknown payment app
C Insurer’s grievance channel
D Random repair shop
Answer: C. Insurer’s grievance channel. Start with the insurer’s official complaint process and keep records.
What can an official regulator grievance portal do?
A Guarantee claim approval
B Replace the insurer
C Set benefit limits
D Record and track a complaint
Answer: D. Record and track a complaint. Regulator portals can route or track grievances, not promise outcomes.
Should a claimant pay a fee to an official regulator portal?
A Verify official regulator instructions
B Pay any caller
C Scan unknown QR codes
D Share banking OTP
Answer: A. Verify official regulator instructions. IRDAI warns that its Bima Bharosa portal does not demand payments from complainants.
What can an insurance ombudsman address?
A Every premium quote
B Eligible unresolved disputes
C Policy marketing
D Routine vehicle service
Answer: B. Eligible unresolved disputes. An ombudsman may hear eligible disputes under the applicable local process.
Why note dates and names during claim calls?
A Guarantee claim payout
B Change coverage
C Maintain a clear record
D Remove policy exclusions
Answer: C. Maintain a clear record. Notes can help reconstruct claim communications.
What should be done if requested documents are unavailable?
A Create false documents
B Ignore the request
C Submit another person’s records
D Tell insurer and ask alternatives
Answer: D. Tell insurer and ask alternatives. Ask the insurer what substitute evidence can be accepted.
Can a policy deadline be ignored?
A No, check notice requirements
B Yes, every time
C Only for online claims
D Deadlines never apply
Answer: A. No, check notice requirements. Policies may require prompt notice or documents; review the actual terms.
Why report a motor accident accurately?
A Guarantee payment
B Support claim and legal steps
C Change vehicle ownership
D Avoid policy review
Answer: B. Support claim and legal steps. Accurate incident details help the insurer assess the claim.
What is a useful step after receiving settlement?
A Delete all records
B Assume no limits
C Check calculation and deductions
D Share passwords
Answer: C. Check calculation and deductions. Review the settlement for covered amount, deductible, and other deductions.
What should happen if claim payment is received?
A Discard every notice
B Cancel unrelated cover
C Share bank login
D Keep settlement records
Answer: D. Keep settlement records. Keep the settlement statement with policy records.
Can a claimant withdraw a claim in every situation?
A Ask insurer about process
B Yes, without conditions
C No, never
D Only after renewal
Answer: A. Ask insurer about process. Withdrawal rules depend on the claim and policy process.
Why should claim updates go through secure channels?
A Guarantee approval
B Protect personal information
C Increase sum insured
D Remove claim review
Answer: B. Protect personal information. Secure channels reduce exposure of sensitive records.
What is a common cause of claim delay?
A Clear itemized documents
B Accurate policy details
C Missing required information
D Prompt notice
Answer: C. Missing required information. Missing documents can delay assessment.
What can help prevent avoidable claim delays?
A Wait until renewal
B Send incomplete forms
C Change contact details silently
D Submit requested records promptly
Answer: D. Submit requested records promptly. Prompt complete submissions can support efficient review.
What should a claimant do if circumstances change during review?
A Update insurer through official channel
B Ignore every request
C Alter old evidence
D Contact unknown agents
Answer: A. Update insurer through official channel. Keep the insurer informed through documented channels.
Does a claim assessor decide by premium paid alone?
A Yes, always
B No, terms and facts matter
C Only for health claims
D Premium fixes payment
Answer: B. No, terms and facts matter. The contract and facts of loss determine eligibility.
What does claim settlement mean?
A Initial policy quote
B Premium due date
C Insurer’s decision and payment
D Risk survey
Answer: C. Insurer’s decision and payment. Settlement is the insurer’s resolution of a claim.
What should the claimant verify before sharing bank details?
A Unknown caller identity
B A public social post
C Random email link
D Official insurer request
Answer: D. Official insurer request. Share sensitive details only through verified insurer channels.
Which statement about claims is accurate?
A Documentation supports policy review
B Documents guarantee approval
C Every loss is covered
D Claim requests set payout
Answer: A. Documentation supports policy review. Documents help the insurer assess a claim under the contract.
Who may coordinate a cashless health request?
A Hotel receptionist
B Insurer or appointed TPA
C Vehicle mechanic
D Travel agent
Answer: B. Insurer or appointed TPA. An insurer or its appointed administrator may coordinate eligible cashless services.