FLHC Fellow, Life and Health Claims Exam
Question 1: Which of the following best describes the primary function of a claims department in an insurance company?
- Marketing insurance policies
- Underwriting new policies
- Processing and paying claims
- Managing investment portfolios
Answer: C
Explanation: The claims department is responsible for processing submitted claims and ensuring proper payment to eligible policyholders or beneficiaries.
Question 2: What is the first step in processing a life insurance claim?
- Underwriting review
- Notification of death
- Policy reinstatement
- Payment of premium
Answer: B
Explanation: The initial step is to notify the insurer of the insured’s death so that the claims process can begin.
Question 3: Which element is critical when verifying a life insurance claim?
- Annual premium amount 1 / 4
FLHC Fellow, Life and Health Claims Exam
- Death certificate
- Age of the insurer
- Marketing strategy
Answer: B
Explanation: A valid death certificate is essential for confirming the claim and initiating benefit payment.
Question 4: In health insurance claims, what does “EOB” stand for?
- Electronic Office Billing
- Explanation of Benefits
- Estimation of Benefits
- Enrollment on Benefits
Answer: B
Explanation: EOB means Explanation of Benefits, which details the services provided and the corresponding payment decisions.
Question 5: Which document is usually required to support a health insurance claim?
- Investment statement
- Medical records
- Actuarial report 2 / 4
FLHC Fellow, Life and Health Claims Exam
- Marketing brochure
Answer: B
Explanation: Medical records provide proof of treatment, diagnosis, and service details, which are crucial for claim adjudication.
Question 6: What does “contestability period” mean in life insurance claims?
- The time during which a claim payment is delayed
- The period when the insurer can investigate and deny claims for misrepresentation
- The timeframe for beneficiaries to contest the death
- The review period for premium adjustments
Answer: B
Explanation: The contestability period is a set time (typically two years) during which the insurer can review the policy for misrepresentations and deny claims if necessary.
Question 7: Which of the following best describes a “rider” in a life insurance policy?
- A secondary beneficiary clause
- An additional option that modifies coverage
- A mandatory premium charge
- A form of claim appeal
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FLHC Fellow, Life and Health Claims Exam
Answer: B
Explanation: A rider is an add-on provision that modifies the original policy, allowing for additional benefits or restrictions.
Question 8: What is the primary purpose of claims processing in the insurance industry?
- Maximizing premium income
- Determining underwriting risks
- Evaluating and settling claims fairly
- Creating advertising campaigns
Answer: C
Explanation: Claims processing is focused on evaluating claim submissions and ensuring that benefits are paid out accurately and fairly.
Question 9: In life insurance claims, who is typically responsible for initiating the claim process?
- The policy issuer
- The beneficiary or their representative
- The underwriter
- The claims auditor
Answer: B
Explanation: The beneficiary or a designated representative notifies the insurer to begin processing the claim.
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