Unit 2
How many days does the Insurer have to accept or deny the claim after it has received the proof of loss from the Insured?
15 business days
The Insurer has how many days to acknowledge receipt of the claim from the Insured?
15 days
What makes up the NAIC?
State Insurance Commissioners
If an insurer is found guilty of violating the DTPA act, how much can an injured claimant collect for mental anguish and economic damages?
3 times the actual damages
A major hurricane has damaged many homes along the coast. If the storm caused damage and the Insured notified the Insurer of the damage, how long does the Insurer have to acknowledge receipt of the claim?
30 Days
If any insurance company suspects that the loss was caused by arson, how many days does the Insurer have to notify the Insured in writing of the acceptance or rejection of the claim?
30 Days
According to Texas law, how long after receiving claim documentation does the insurer have to notify the claimant of acceptance or rejection if arson is suspsected?
30 days
Once the Insurer has received all the needed information to settle a claim that it is liable for, how long does the Insurer have to send the payment to the Insured?
5 business days
A claim made by the Insured under an insurance policy or contract or by a beneficiary named in the policy or contract is considered
A 1st party claim
In the Texas Insurance Code, any day other than a Saturday, Sunday, or holiday recognized by this state is known as
A business day
All of the following are unfair claims practices except? A. After receiving the appraisal of damaged property, paying loss to the claimant. B. Attempting to settle the claim by underpaying what is actually due to the claimant. C. Responding to a claimant in 20 days after receiving notice of claim. D. Denying the claim before conducting proper investigation.
A. After receiving the appraisal of damaged property, paying loss to the claimant.
All of the following must be done within 15 days of receiving the notice of claim from the Insured except: A. Commence any investigation of the claim B. Pay the claim
B. Pay the claiim
All of the following must be present in the case of bad faith on behalf of the insurance company or the adjuster except: A. Unfavorable treatment by the adjuster B. Wrongful intent C. Breach of contract D. Inadequate explanation from the adjuster
B. Wrongful intent
If the insurance company does not settle the claim following the terms of the contract, and there is no explanation for the breach, it is considered
Bad faith
An agent can assist the adjuster with a claim by doing all of the following except: A. Resolving disputes B. Verifying effective dates of coverage C. Locating people D. Approving Payment
D. Approving Payment
All of the following would be considered a breach of the Statement of Principles EXCEPT. A. Advising claimants as to their legal rights B. Advising a claimant against seeking legal advice C. Communicating with a claimant who is represented by an attorney D. Explaining the policy provisions to a claimant
D. Explaining the policy provisions to a claimant
If an adjuster is found guilty of violating unfair claims settlement practices, the adjuster is most likely also guilty of violating what other act?
Deceptive Trade Practices Act
What level of fiduciary responsibility do adjusters have to adhere to?
Extraordinary
When can an insurance company require the claimant to produce tax or financial records?
Following a total loss by fire
According to contract law, a covenant of fair dealing and what other concepts is implied in every contract?
Good faith
When an adjuster is adjusting a loss for a 3rd party claimant, does the adjuster have contractual obligations to the claimant?
No, the adjuster has no contractual obligations to the claimant.
If the Insurer does not make payment on the claim after 60 days of receiving the proof of loss from the Insured, they are required to
Pay damage, including a 18% interest on the amount of the claim
When would a deceptive trade practice occur in any commercial transaction?
Seller causes provable mental anguish
Who must see that the contractual promises that have been made to policyholders are honored promptly, fairly, and accurately?
The Adjuster
All insurance contracts have several parties; the party known as the second party would be
The Insurance company
A person that markets and sells insurance policies to the public is known as
The agent
Who is responsible for submitting records, including claim records, to the state to verify proper handling?
The insurance company
What have states adopted to ensure that claims are handled promptly and fairly?
Unfair claims settlement practices
A contractual requirement for disclosure to all parties is called
Utmost good faith
