Ethical & Legal Compliance Flashcards
7 cards from real CA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Ethical & Legal Compliance flashcards as text
A claimant offers an adjuster a gift card after a favorable settlement. What is the ethical obligation of the adjuster?
Answer: Decline it to avoid any appearance of impropriety
Adjusters must decline gifts from claimants to avoid conflicts of interest and maintain impartiality.
Under the Unfair Claims Settlement Practices Act, which action is explicitly prohibited?
Answer: Delaying acknowledgment of a claim beyond 10 days
The UCSPA requires insurers to acknowledge claims promptly, typically within 10 days of receipt.
When handling a liability claim, an adjuster learns the insured was intoxicated during the incident. What must the adjuster do with this information?
Answer: Keep it confidential but include it in the claim file
Sensitive information must remain confidential within the claim file and shared only on a need-to-know basis per privacy laws.
Which principle requires adjusters to treat similarly situated claimants with the same degree of fairness?
Answer: Consistency in claims handling
Consistency in claims handling prevents discriminatory treatment and ensures all claimants receive equal consideration.
An adjuster discovers that a colleague submitted a falsified estimate. The adjuster's first step should be to:
Answer: Report the misconduct through appropriate internal channels
Fraud and misconduct must be reported through proper internal channels such as a supervisor or compliance department.
Under HIPAA, when can an adjuster legally obtain a claimant's medical records without a signed authorization?
Answer: Never; a signed authorization is always required
HIPAA requires a signed authorization from the individual before releasing protected health information for insurance claim purposes.
Which ethical standard requires an adjuster to disclose all relevant coverage information to a claimant, even if not asked?
Answer: Duty of good faith and fair dealing
The duty of good faith and fair dealing obligates adjusters to proactively inform claimants of all coverage that may apply to their loss.