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 Affordable Care Act (ACA), insurers offering individual and small group plans must cover which category of services without cost-sharing?
Answer: Preventive services rated A or B by the U.S. Preventive Services Task Force
The ACA requires coverage of USPSTF A/B-rated preventive services at no cost-sharing in non-grandfathered individual and small group plans.
An insurer's reservation of rights letter serves which primary legal purpose?
Answer: Notifying the insured that coverage is being investigated while preserving the insurer's right to deny later
A reservation of rights letter allows an insurer to investigate or defend a claim without waiving its right to deny coverage if a policy exclusion applies.
The principle of 'concurrent causation' in claims law is most relevant when:
Answer: A covered peril and an excluded peril both contribute to a single loss
Concurrent causation addresses how courts determine coverage when both a covered and an excluded cause contribute to a loss.
When an insurer settles a liability claim on behalf of an insured without the insured's consent, and the policy requires consent, the insurer may be liable for:
Answer: Breach of contract and potentially bad faith damages
Settling without the required consent violates the policy terms and can expose the insurer to breach of contract and bad faith claims.
Which federal act requires group health plans to offer continuation coverage to employees and dependents who lose coverage due to qualifying events?
Answer: COBRA
COBRA (Consolidated Omnibus Budget Reconciliation Act) mandates continuation coverage for qualified beneficiaries who lose group health coverage.
A claims adjuster who misrepresents the terms of a policy to discourage a claimant from filing a claim is most likely violating:
Answer: Unfair Claims Settlement Practices statutes
Misrepresenting policy provisions to prevent or discourage a claimant from filing is a classic unfair claims settlement practice prohibited by state statutes.
The 'notice-prejudice' rule in insurance law generally holds that:
Answer: An insurer may only deny coverage for late notice if it was actually prejudiced by the delay
Under the notice-prejudice rule, adopted in many states, an insurer cannot deny a claim solely for late notice unless the delay actually harmed the insurer's ability to investigate or defend.