Legal Compliance & Regulatory Standards Flashcards
7 cards from real CCP practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Legal Compliance & Regulatory Standards flashcards as text
The National Association of Insurance Commissioners (NAIC) best serves which function in the U.S. regulatory framework?
Answer: Provides model laws and coordinates regulatory activities among state commissioners
The NAIC develops model laws and coordinates regulatory efforts among state insurance commissioners, but lacks direct enforcement authority.
Under HIPAA, a covered entity may disclose a claimant's protected health information (PHI) to an insurer's claims adjuster:
Answer: For treatment, payment, and healthcare operations without authorization
HIPAA permits disclosure of PHI for payment purposes, which includes processing insurance claims, without patient authorization.
Which concept describes an insurer's obligation to place the policyholder's interests above its own when handling claims?
Answer: Utmost good faith (uberrimae fidei)
The doctrine of utmost good faith requires both parties, but especially the insurer, to deal honestly and prioritize the insured's legitimate interests.
A state's Unfair Trade Practices Act typically applies to insurance claims when a violation occurs:
Answer: With such frequency as to indicate a general business practice
Unfair Trade Practices Acts typically require that violations occur with a frequency indicating a general business practice to trigger regulatory action.
The Americans with Disabilities Act (ADA) requires that insurance companies:
Answer: Not discriminate against individuals with disabilities in places of public accommodation
The ADA prohibits discrimination against individuals with disabilities in places of public accommodation, which can include insurance offices and services.
In a workers' compensation claim, the adjuster's obligation regarding benefit payments is primarily governed by:
Answer: State workers' compensation statutes
Workers' compensation is state-regulated, and each state's workers' compensation statute dictates benefit amounts, payment schedules, and adjuster obligations.
When an insurer uses a credit-based insurance score to investigate a claim, they must comply with requirements under:
Answer: The Fair Credit Reporting Act (FCRA)
The FCRA governs the use of consumer reports, including credit-based insurance scores, and requires adverse action notices when such information is used unfavorably.