Indiana State Life and Health Insurance Practice Exam

What is an example of an Unfair Claims Settlement Practice?

1. Making it mandatory that the proof of loss be provided for each claim

2. Requiring a time for submitting a claim

3. Paying a claim in a timely matter

4. Turning down a claim without providing the basis of denial

The correct answer is: Turning down a claim without providing the basis of denial

Turning down a claim without providing the basis of denial is an example of an Unfair Claims Settlement Practice because it does not adhere to the principle of transparency and communication that is expected in the insurance industry. Under fair claims practices, insurers are required to provide policyholders with clear reasons when a claim is denied. This ensures that claimants understand why their claim was not approved and have the opportunity to address any issues or appeal the decision. In the context of insurance regulation, failing to communicate the rationale behind a denial can lead to confusion and frustration for the policyholder, undermining trust and potentially leading to complaints or disputes. This practice also violates the obligation of insurers to act in good faith and treat policyholders fairly. The other options listed involve standard procedures in the claims process. For example, requiring proof of loss and setting a timeframe for claim submission are commonly accepted practices that help ensure the integrity of the claims process. Paying claims promptly is also a fundamental expectation of insurers. However, denying a claim without explanation clearly falls outside the bounds of fair treatment and industry standards.