Examkin

Soru

Zorluk: OrtaUnfair Claims Settlement Practices

A beneficiary files a death benefit claim on an individual life insurance policy following the passing of the insured. As the insurer processes the file, the assigned claims representative takes various administrative actions. According to the NAIC Unfair Claims Settlement Practices Model Act, which of the following actions by the representative are considered statutory violations? (Select two)

  1. Demanding a formal proof of loss document that requests the exact same information already provided by the beneficiary in the preliminary claim reportCevap
  2. Informing the beneficiary that the insurer maintains a policy of appealing arbitration awards to pressure them into accepting a lower settlement offerCevap
  3. C
    Providing written notice to the beneficiary that the claim decision will be delayed for thirty days while awaiting the official medical examiner's report
  4. D
    Withholding the final death benefit payment until the beneficiary is able to supply a certified copy of the insured's official death certificate

Cevap

The statutory violations are demanding duplicate information across multiple claim forms and leveraging the threat of arbitration appeals to force a lower settlement.
Under the Unfair Claims Settlement Practices Act, insurers are strictly prohibited from utilizing procedural hurdles to delay payment, such as demanding a formal proof of loss form that duplicates information already provided in a preliminary report. Furthermore, threatening to appeal arbitration awards to coerce a claimant into accepting a lower settlement is an explicitly banned leveraging tactic.

Adım Adım Çözüm

1
Analyze the first action regarding proof of loss documentation.
The insurer is asking for duplicate information on a formal form after already receiving it on a preliminary report.
This evaluates whether the documentation request is a legitimate part of the investigation or a prohibited stalling tactic.
2
Evaluate the statement regarding arbitration appeals.
The insurer is using the threat of an appeal as leverage to reduce the payout.
This checks for prohibited coercive settlement tactics under the NAIC Model Act.
3
Review the written notice of delay.
The insurer communicated a specific, valid reason (medical examiner's report) for the timeline extension.
This confirms compliance with statutory communication and reasonable investigation requirements.
4
Assess the requirement for a certified death certificate.
This is a standard, non-duplicative requirement for life insurance claims.
This differentiates between legitimate proof of loss requirements and unfair procedural hurdles.

Anahtar Kavram

Unfair Claims Settlement Practices
Bu soruyu puanla

Konular

Unfair Claims Settlement Practices

Bu konudan daha fazla soru