Unfair Claims Settlement Practices Quiz
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Questions and Answers

Which of the following is considered an unfair claims settlement practice according to the provided text?

  • Making claims payments to insureds or beneficiaries without a statement setting forth the coverage
  • Failing to adopt and implement reasonable standards for the prompt investigation of claims (correct)
  • Misrepresenting pertinent facts or insurance policy provisions
  • Attempting to settle a claim for less than the amount to which a reasonable man would have believed he was entitled
  • What is the consequence of committing unfair claims settlement practices with such frequency as to indicate a general business practice?

  • License suspension
  • Civil penalties (correct)
  • Criminal charges
  • Mandatory training
  • Which of the following is NOT an unfair claims settlement practice mentioned in the text?

  • Failing to affirm or deny coverage of claims within a reasonable time
  • Denying claims based on pre-existing conditions (correct)
  • Refusing to pay claims without conducting a reasonable investigation
  • Compelling insureds to institute litigation to recover amounts due under an insurance policy
  • Which practice involves delaying the investigation or payment of claims by requiring an insured, claimant, or physician to submit a preliminary claim report and then requiring the subsequent submission of formal proof of loss forms, both of which submissions contain substantially the same information?

    <p>Practice (l)</p> Signup and view all the answers

    Which practice involves failing to promptly settle claims, where liability has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage?

    <p>Practice (m)</p> Signup and view all the answers

    Which practice involves failing to provide forms necessary to present claims within fifteen calendar days of a request with reasonable explanations regarding their use, if the insurer maintains the forms for that purpose?

    <p>Practice (o)</p> Signup and view all the answers

    Which practice involves making known to insureds or claimants a policy of appealing from arbitration awards in favor of insureds or claimants for the purpose of compelling them to accept settlements or compromises less than the amount awarded in arbitration?

    <p>Practice (k)</p> Signup and view all the answers

    Which practice involves delaying the investigation or payment of claims by requiring an insured, claimant, or the physician of either to submit a preliminary claim report and then requiring the subsequent submission of formal proof of loss forms, both of which submissions contain substantially the same information?

    <p>Practice (l)</p> Signup and view all the answers

    Which practice involves failing to promptly settle claims, where liability has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage?

    <p>Practice (m)</p> Signup and view all the answers

    Which practice involves refusing to pay claims without conducting a reasonable investigation based upon all available information?

    <p>Refusing to pay claims without conducting a reasonable investigation based upon all available information</p> Signup and view all the answers

    Which practice involves attempting to settle claims on the basis of an application which was altered without notice to, or knowledge or consent of, the insured?

    <p>Attempting to settle claims on the basis of an application which was altered without notice to, or knowledge or consent of, the insured</p> Signup and view all the answers

    Which practice involves compelling insureds to institute litigation to recover amounts due under an insurance policy by offering substantially less than the amounts ultimately recovered in actions brought by such insureds?

    <p>Compelling insureds to institute litigation to recover amounts due under an insurance policy by offering substantially less than the amounts ultimately recovered in actions brought by such insureds</p> Signup and view all the answers

    Which practice involves delaying the investigation or payment of claims by requiring an insured, claimant, or the physician of either to submit a preliminary claim report and then requiring the subsequent submission of formal proof of loss forms, both of which submissions contain substantially the same information?

    <p>Practice (l)</p> Signup and view all the answers

    Which practice involves making known to insureds or claimants a policy of appealing from arbitration awards in favor of insureds or claimants for the purpose of compelling them to accept settlements or compromises less than the amount awarded in arbitration?

    <p>Practice (k)</p> Signup and view all the answers

    Which practice involves failing to promptly provide a reasonable explanation of the basis in the insurance policy in relation to the facts or applicable law for denial of a claim or for the offer of a compromise settlement?

    <p>Practice (n)</p> Signup and view all the answers

    Which practice involves attempting to settle claims on the basis of an application which was altered without notice to, or knowledge or consent of, the insured?

    <p>Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.</p> Signup and view all the answers

    Which practice involves delaying the investigation or payment of claims by requiring an insured, claimant, or physician to submit a preliminary claim report and then requiring the subsequent submission of formal proof of loss forms, both of which submissions contain substantially the same information?

    <p>Failing to adopt and implement reasonable standards for the prompt investigation of claims arising under insurance policies.</p> Signup and view all the answers

    What is the consequence of committing unfair claims settlement practices with such frequency as to indicate a general business practice?

    <p>The insurer may be fined for each violation of unfair claims settlement practices.</p> Signup and view all the answers

    Study Notes

    Unfair Claims Settlement Practices

    • Failing to settle claims promptly, where liability has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage, is an unfair claims settlement practice.
    • Delaying the investigation or payment of claims by requiring an insured, claimant, or physician to submit a preliminary claim report and then requiring the subsequent submission of formal proof of loss forms, both of which submissions contain substantially the same information, is an unfair claims settlement practice.
    • Failing to provide forms necessary to present claims within fifteen calendar days of a request with reasonable explanations regarding their use is an unfair claims settlement practice.
    • Making known to insureds or claimants a policy of appealing from arbitration awards in favor of insureds or claimants for the purpose of compelling them to accept settlements or compromises less than the amount awarded in arbitration is an unfair claims settlement practice.
    • Refusing to pay claims without conducting a reasonable investigation based upon all available information is an unfair claims settlement practice.
    • Attempting to settle claims on the basis of an application which was altered without notice to, or knowledge or consent of, the insured is an unfair claims settlement practice.
    • Compelling insureds to institute litigation to recover amounts due under an insurance policy by offering substantially less than the amounts ultimately recovered in actions brought by such insureds is an unfair claims settlement practice.
    • Failing to promptly provide a reasonable explanation of the basis in the insurance policy in relation to the facts or applicable law for denial of a claim or for the offer of a compromise settlement is an unfair claims settlement practice.

    Consequences of Unfair Claims Settlement Practices

    • Committing unfair claims settlement practices with such frequency as to indicate a general business practice may result in penalties and other consequences.

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    Description

    Test your knowledge on unfair claims settlement practices with this quiz! Learn about the methods, acts, and practices defined as unfair or deceptive under Tit. 22, § 1964. Challenge yourself to identify misrepresentation of facts or insurance policy provisions and understand the importance of prompt action in claims resolution.

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