CCP Legal Compliance & Regulatory Standards 3

Question 1

The National Association of Insurance Commissioners (NAIC) best serves which function in the U.S. regulatory framework?

Accepted Answer

Provides model laws and coordinates regulatory activities among state commissioners

Answer

The NAIC develops model laws and coordinates regulatory efforts among state insurance commissioners, but lacks direct enforcement authority.

Question 2

Under HIPAA, a covered entity may disclose a claimant's protected health information (PHI) to an insurer's claims adjuster:

Accepted Answer

For treatment, payment, and healthcare operations without authorization

Answer

HIPAA permits disclosure of PHI for payment purposes, which includes processing insurance claims, without patient authorization.

Question 3

Which concept describes an insurer's obligation to place the policyholder's interests above its own when handling claims?

Accepted Answer

Utmost good faith (uberrimae fidei)

Answer

The doctrine of utmost good faith requires both parties, but especially the insurer, to deal honestly and prioritize the insured's legitimate interests.

Question 4

A state's Unfair Trade Practices Act typically applies to insurance claims when a violation occurs:

Accepted Answer

With such frequency as to indicate a general business practice

Answer

Unfair Trade Practices Acts typically require that violations occur with a frequency indicating a general business practice to trigger regulatory action.

Question 5

The Americans with Disabilities Act (ADA) requires that insurance companies:

Accepted Answer

Not discriminate against individuals with disabilities in places of public accommodation

Answer

The ADA prohibits discrimination against individuals with disabilities in places of public accommodation, which can include insurance offices and services.

(CCP) Certified Claims Professional Practice Test

(CCP) Certified Claims Professional Practice Test

CCP Legal Compliance & Regulatory Standards 3