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
Under the Unfair Claims Settlement Practices Act (UCSPA), which action constitutes a prohibited practice?
Answer: Denying a claim without conducting a reasonable investigation
Denying claims without a reasonable investigation is a prohibited unfair claims settlement practice under the UCSPA.
The McCarran-Ferguson Act of 1945 primarily established that:
Answer: States have primary authority to regulate the insurance industry
McCarran-Ferguson reaffirmed state regulation of insurance by exempting insurers from federal antitrust laws as long as the state regulates the activity.
A claims adjuster fails to respond to a claimant's inquiry within the timeframe required by state law. This most likely violates:
Answer: Prompt Payment statutes
Prompt Payment statutes require insurers to acknowledge, investigate, and respond to claims within specified timeframes.
Which federal law imposes requirements on group health plan claims procedures, including specific timelines for benefit determinations?
Answer: ERISA
ERISA establishes minimum standards for benefit claims procedures in employer-sponsored group health plans, including mandatory timeframes.
When an insurer discovers evidence of insurance fraud during a claim investigation, most states require the insurer to:
Answer: Report the suspected fraud to the state's insurance fraud bureau
Most states mandate that insurers report suspected fraud to the state's insurance fraud bureau or department.
Under the Gramm-Leach-Bliley Act (GLBA), insurers must provide customers with a privacy notice:
Answer: At the time a policy is issued and annually thereafter
GLBA requires financial institutions, including insurers, to provide privacy notices at account opening and annually.
A claimant submits a claim under a policy subject to ERISA. The plan administrator denies the claim. Under ERISA, the claimant must first:
Answer: Exhaust the plan's internal appeal process
ERISA requires claimants to exhaust the plan's internal administrative appeals before pursuing litigation.