Professional Standards & Ethics Flashcards

An adjuster discovers an error in a previous payment that underpaid the insured. What should the adjuster do?

Answer: Correct the error, issue the supplemental payment, and document the file

Honesty and fair dealing require correcting underpayments promptly once discovered.

Which is the best example of an adjuster acting with integrity during negotiations?

Answer: Making offers based on documented facts and a reasonable evaluation

Ethical negotiation relies on fact-based evaluations and truthful representations.

Threatening an insured with policy cancellation unless they accept a lower settlement is best characterized as:

Answer: Coercion and an unfair claims practice

Using threats to induce settlement is coercive and violates fair claims practice standards.

When using social media to investigate a claimant, which action crosses an ethical line?

Answer: Creating a fake profile to 'friend' a represented claimant and access private content

Deceptive pretexting to gain private access is unethical and may violate law and rules on contacting represented parties.

Which body primarily regulates claims handling practices in the United States?

Answer: State insurance departments

Under the McCarran-Ferguson Act, insurance is regulated primarily at the state level by insurance departments.

An adjuster requests the same proof-of-loss documents three separate times without explanation, delaying the claim. This risks being viewed as:

Answer: An unfair practice of unreasonable delay through duplicate information requests

Requiring repetitive, unnecessary documentation to delay payment can constitute an unfair claims practice.

A claimant speaks limited English. What is the most professional approach?

Answer: Arrange qualified interpretation or translated materials to ensure clear communication

Ensuring the claimant understands the process and documents supports fair treatment and accurate statements.