CCP Legal Compliance & Regulatory Standards 2

Question 1

Under the Unfair Claims Settlement Practices Act (UCSPA), which action constitutes a prohibited practice?

Accepted Answer

Denying a claim without conducting a reasonable investigation

Answer

Denying claims without a reasonable investigation is a prohibited unfair claims settlement practice under the UCSPA.

Question 2

The McCarran-Ferguson Act of 1945 primarily established that:

Accepted Answer

States have primary authority to regulate the insurance industry

Answer

McCarran-Ferguson reaffirmed state regulation of insurance by exempting insurers from federal antitrust laws as long as the state regulates the activity.

Question 3

A claims adjuster fails to respond to a claimant's inquiry within the timeframe required by state law. This most likely violates:

Accepted Answer

Prompt Payment statutes

Answer

Prompt Payment statutes require insurers to acknowledge, investigate, and respond to claims within specified timeframes.

Question 4

Which federal law imposes requirements on group health plan claims procedures, including specific timelines for benefit determinations?

Accepted Answer

ERISA

Answer

ERISA establishes minimum standards for benefit claims procedures in employer-sponsored group health plans, including mandatory timeframes.

Question 5

When an insurer discovers evidence of insurance fraud during a claim investigation, most states require the insurer to:

Accepted Answer

Report the suspected fraud to the state's insurance fraud bureau

Answer

Most states mandate that insurers report suspected fraud to the state's insurance fraud bureau or department.

(CCP) Certified Claims Professional Practice Test

(CCP) Certified Claims Professional Practice Test

CCP Legal Compliance & Regulatory Standards 2