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
An adjuster in a state with a mandatory 15-day acknowledgment requirement receives a claim on March 1. The latest acceptable acknowledgment date is:
Answer: March 16
A 15-day requirement from March 1 means the deadline is March 16 (day 1 is March 1, so the 15th day is March 15, but the 15th day counted from March 1 is March 16 inclusive — deadline is the 15th calendar day after receipt, i.e., March 16).
The doctrine of 'bad faith' in insurance claims handling refers to:
Answer: An insurer's unreasonable denial or delay of a valid claim without proper cause
Bad faith occurs when an insurer unreasonably denies or delays payment of a valid claim or fails to properly investigate without a reasonable basis.
Under the Mental Health Parity and Addiction Equity Act (MHPAEA), health insurers must:
Answer: Ensure mental health and substance use disorder benefits are no more restrictive than medical/surgical benefits
MHPAEA requires that financial requirements and treatment limitations for mental health and substance use disorders be no more restrictive than those for medical and surgical benefits.
A claimant's attorney sends a letter of representation to an insurer. The adjuster's most appropriate immediate response is to:
Answer: Direct all future communications to the claimant's attorney
Once an attorney represents a claimant, the adjuster must communicate through the attorney to comply with ethical rules and avoid claims of improper contact.
The statute of limitations for an insurance claim lawsuit is most commonly triggered by:
Answer: The date the insurer formally denies the claim
In most jurisdictions, the statute of limitations for a coverage lawsuit begins to run from the date of the insurer's formal denial of the claim.
Which regulatory requirement mandates that insurers maintain claims files for a minimum period after claim closure?
Answer: State record retention statutes
State record retention statutes specify minimum periods — often 5 to 10 years — during which closed claims files must be maintained.
When a claim involves a potential subrogation recovery against a negligent third party, the adjuster's compliance obligation includes:
Answer: Preserving and documenting evidence of the third party's liability
Preserving and documenting evidence of third-party liability is essential to protect the insurer's subrogation rights after paying the claim.