Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

2021 NYS Life and Health > Chapter 18 - Insurance Regulations > Flashcards

Chapter 18 - Insurance Regulations Flashcards

1
Q

Define Coercion

A

Forceful act of threat aimed to influence a person to act against their will

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define Inducement

A

An offer that attempts to influence the other party

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define Moral Turpitude

A

Conduct that is contrary to community standards of justice, honesty, or good morals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Define Promulgate

A

To make public, to put into action

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Define Superintendent of Financial Services

A

The head of the NYS Department of Financial Services

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Define Insurance Producer

A

An insurance agent, title insurance agent, insurance broker, reinsurance intermediary, excess lines broker, or any other person required to be licensed under the laws of this state to sell, solicit or negotiate insurance.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Define Misrepresentation

A

Making false or misleading statements with the intent to defraud another

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

If a hearing is scheduled for a producer who has violated regulations regarding unfair trade practices, the Superintendent must send a prior notice within how many days of the hearing?

A

10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

In order for a nonresident licensee to become a resident producer in NY, the licensee must do what?

A

Apply within 90 days of becoming a resident.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

The Superintendent can examine an authorized fraternal benefit society and property/casualty insurance company how often?

A

Once every 3 years.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When must an agent submit their license renewal applications to the Superintendent?

A

At least 60 days before the license expires.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

To qualify for an insurance license, what are the requirements? (7)

A
  • An applicant must submit an application to the Superintendent and declare that all statements are true, accurate and complete to the best of the applicant’s knowledge and belief
  • Be a resident of NYS
  • Be at least 18 years old
  • Submit a standard application for licensing on a form approved by the Superintendent.
  • Pay the applicable fees
  • Pass the applicable examination for each line of authority
  • Fulfil the prelicensing education requirement or classroom work or equivalent in correspondence work or similar instruction (20 hours a single life of authority agent or broker, such as Life only agent or broker, 40 hours for a Lice, Accident and Health agent or broker, Personal Lines agent or broker and Public Adjuster, and 90 hours for Property/Casualty agent or broker).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

For who is a written examination not required when applying for an insurance agent’s license? (8)

A
  • Ticket-selling agent or rep (airline, bus, train, or sea) for one-time issuance of baggage or accident insurance
  • Any individual whose license has been revoked or suspended (at the discretion of the Superintendent)
  • In connection with any certificate of appointment for an additional insurer, as long as it is under the same line of authority already licensed.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the Department of Insurance Powers and Duties? (6)

A
  1. Control and supervise all insurance business in the state
  2. Enforce insurance laws
  3. Issue licenses and certificates of authority
  4. Approve policy forms
  5. Conduct examinations, investigations, and hearings
  6. Impose Penalties
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Why does the Department of Insurance not set premium rates or establish fines and penalties?

A

Those are defined by law

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the types of insurance licenses? (7) (not accident/life)

A
  • Producer (Agent) - Represents insurers, appointed to transact on behalf of the insurer
  • Insurance broker
  • Business Entity - Corporation/Association/Partnership - Must have a designated Agent
  • Consultant
  • Adjuster
  • Nonresident - Different home state, licensed to transact in resident and non-resident states.
  • Temporary - Issued for the continuation of existing business, a short period of time, approved by the department, not renewable
17
Q

Agents get appointed in two ways, what are they?

A
  • Appointed to each insurance company you will do business with so you can act as an agent
  • Appointed for each product you will be selling.
18
Q

When an insurer appoints an agent, what else do they have to do for the Department of Insurance?

A

They file a notice of agent appointment and pays appointment fees

19
Q

An insurance producer license is not required of any officer, director or employee of an insurer or organizations employed by insurers, provided they what? (2)

A
  • Are not directly or indirectly involved with the actual sale of an insurance contract
  • They do not receive any commission.
20
Q

Define Insurance Agent

A
  • A person authorized by an insurer, fraternal benefit society or HMO to solicit, negotiate and obtain insurance, HMO or annuity contracts
  • The agent represents the insurer
21
Q

Define Insurance Broker

A
  • Any person, firm, association or corporation who solicits, negotiates or obtains insurance for an insured (other than him/herself) in exchange for a commission.
    • -A broker represents the insured
  • Acts in the best interest of the insured
22
Q

Define Consultants

A

-Offer advice to the public about the benefits, advantages, and disadvantages or insurance policies for a fee.
-The Superintendent may issue an insurance consultant’s license to any person, firm, association, or corporation who has complied with the following requirements:
-Submit a written application and pay a fee of $50
per year
-Pass a written examination
-Must be trustworthy and competent
-Must not be an executive or an employee of or own
any shares in the insurer they represent.

23
Q

Define Independent Adjuster

A

Any person, firm, association, or corporation, who, for a commission, acts on behalf of an insurer in the work of investigating and adjusting claims. An independent adjuster may not include any of the following:

  • Officer, director, or regular salaried employee of an insurer
  • Adjustment bureau or association owned by the insurers
  • Licensed agent of the insurer, or
  • Attorney at law
24
Q

Define Public Adjuster

A

Any person, firm, association, or corporation, who, for a commission, acts on behalf of the insured in negotiating a settlement of a claim for loss or damage to property. The following are not considered public adjusters:

  • Employee, agent, broker, or other representative of any insurer who acts as an adjuster, or
  • Attorney at law
25
Q

What is required of all adjusters?

A

Must file a surety bond of $1,000 with the Superintendent before a license may be issued or renewed

26
Q

What is required of public adjusters but not independent adjusters?

A

They are required to complete 15 credit hours of continuing education every license renewal period (biennially)

27
Q

Broker and agent licenses must be renewed how often?

A

Every two years

28
Q

When do agent/broker licenses expire?

A
  • Born in an odd-numbered year - their birthday in odd-number years
  • Born in an even-numbered year - their birthday in even number years.
29
Q

The Department of Financial services must be notified within 30 days of any change of what? (3)

A
  • Home Address
  • Business Address
  • Email
30
Q

The Superintendent has the power and authority to recommend, withdraw, or amend regulations for what purposes? (3)

A
  • To regulate the internal affairs of the Department of Financial Services, including governing the procedures used in the practice of the Department
  • To prescribe forms and regulations, and
  • To interpret state insurance laws and provisions
31
Q

The Superintendent has the authority to take action deemed appropriate to ensure what? (6)

A
  • Economic development and financial industry growth in this state
  • Solvency, safety, and prudent conduct of the insurance and financial services providers
  • Fair and timely fulfillment of the financial obligations
  • High standards of honesty, transparency, and fair business practices
  • Elimination of financial fraud, criminal abuse, and unethical conduct in the industry
  • Education of product users to enable them to make informed decisions about financial products and services.
32
Q

When can the Superintendent levy an additional $50k civil penalty against someone?

A
  • When a person has been charged with 5 separate civil penalties within 5 years
  • An additional civil penalty of up to $50k may be levied if the person is charged for every 5 subsequent violations.
33
Q

What are the timeframes for the Superintendent to exam books and records? (3)

A
  • Every domestic fraternal benefit society and domestic property/casualty insurance company, at least once every 3 years. If the Superintendent determines that every 3 years is not necessary for property and casualty, it can be changed to every 5 years.
  • Every domestic life insurer must be examined at least once every 5 years
  • Every other authorized domestic insurer and every rate service organization which makes or files rates at least once in every 5 years.
34
Q

Unless otherwise required by law or regulation, an insurer must keep what for 6 years, or until the filing of a review of the record, whichever is longer? (6)

A
  1. A policy record for each insurance contract or policy (the time starts after the contract or policy is no longer in force)
  2. An application where no policy or contract was issued
  3. A claim file (the time starts after the claim is resolved and the file is closed)
  4. A licensing record for each licensee with which the insurer establishes a relationship,
  5. A complaint record (the time starts after the complaint is resolved and the file is closed)
  6. A financial record that is necessary to verify the financial condition of an insurer.
35
Q

What is a Guaranty Association? (6)

A
  • Formed to protect policyholders, insureds, beneficiaries, and anyone entitled to a payment under an insurance policy from the incompetence and insolvency of insurers.
  • The association will pay covered claims up to certain limits set by state law.
  • Funded by its members through assessment.
  • All authorized insurers, which are required to be the members of the Association, contribute to a fund to provide for the payment of claims for insolvent insurers.
  • It is an unfair trade practice to make any statement that an insurer’s policies are guaranteed by the existence of the Insurance Guaranty Association
  • Insurers cannot advertise protection by the Insurance Guaranty Association
36
Q

What are examples of Unfair Claim Settlement Practices? (6)

A
  1. Misrepresenting to insureds pertinent facts or policy provisions relating to coverages at issue
  2. Failing to acknowledge and act reasonably promptly upon communications with respect to an insurance claim.
  3. Failing to adopt and implement reasonable standards for prompt investigation and procession of insured’s claims
  4. Failing to affirm or deny coverage of claims within a reasonable time after proof of loss statements are completed and submitted by insureds
  5. Not attempting in good faith to effect prompt, fair, and equitable settlements of claims on which liability has become reasonably clear
  6. Compelling insureds to initiate suits to recover amounts due under an insurance policy by offering substantially less than the amount ultimately recovered in those suits.
37
Q

Define Controlled Business

A

Any coverage that is written on a producer’s own life, health, or property, and/or that of the producer’s immediate family or business associates.
-A licensee is not allowed to collect commissions on the controlled business above the state-specified limit.

38
Q

What is the Insurance Frauds Prevention Act?

A

Intended to permit the Superintendent and the department to
-utilize their expertise to investigate and discover insurance frauds,
-halt fraudulent activities more effectively, and
receive assistance from federal and state law enforcement agencies

39
Q

Who has a fiduciary relationship for all funds they receive in the course of their business? (3)

A
  1. Agents
  2. Brokers
  3. Reinsurance Intermediaries

2021 NYS Life and Health (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions