Section 1: Lesson 5 "Unfair Claims Practices" Flashcards
Texas claims practices are regulated by what law
the Texas Unfair Claim Settlement Practices Act
Unfair trade practices would not include
Requesting additional information before settling a claim
Sally was in an auto accident. Her car sustained heavy damage and was told it was a total loss. They offer her $5700 for the car. She checked the call for her car with adjustments for condition and mileage, and the value given was $9500. She gave the adjuster her research and asked why the figure was so low. The adjuster told her it was the policy was to offer only 70% of the value, ad only pay 100% if an attorney was retained or suit filed. Sally was enraged and wants to complain. Who do she make an official complaint to?
The Texas Department of Insurance
Which of the following would not be a preferred claims practice or behavior under the Texas Unfair Claims Practices Act?
Not responding to an insured calls because you haven’t made up your mind.
Which of the following would be considered unfair claims practice under Texas law?
Refusing to settle a liability claim in which liability is clear in hopes that the claimant will give up and go away
Which of the following behaviors would qualify as an unfair trade or claims practice under either Florida or North Carolina law?
Sara is an adjuster but really doesn’t like her job. The minute an insured or claimant gets impatient with her , she simply denies their claim. “ Let them sue me”, she says.
Jason is assigned an automobile claim involving disputed liability.After conducting his investigation and having the damaged automobile appraised, Jason denied the claimants damages. Which of the following would not be an unfair claims practice?
Jason’s identified as witness who corroborated the insureds version, and the claimants version contained numerous inconsistencies. the police report was also consistent with the Insured’s version.
Which of he following practices would not be considered an unfair claims practice?
Refusing to pay the cos to repaint the entire car after an accident, when the body shop says it can adequately paint only the damaged front fender and match the paint on the entire car.
Before you leave a policyholder’s home , you are asked by the insured what constitutes “ unfair claims settlement practices”. which of the following would not be and example of an unfair claims settlement practice?
Refusing to pay the cost of replacing an insured entire roof, based on an inspection and appraisal of partial damage only, when the insured believes that they ought to be paid for an entire roof based on their discussions with a roofer and their neighbors.
Jason gets an auto claim involving disputed liability. Suppose Jason had denied the claimants damages because he had a personal relationship with the insured and was doing his friends a favor by denying the claimants damages. under Florida unfair insurance trade practices act, what could be a consequence of Jason’s actions?
the claimant could sue Jason personally
One of Sally’s insured policyholders has complained that Sally dosent return her calls. Here are her possible responses . Which one would qualify as an unfair claim practice?
Sally doesn’t like the insured because of his attitude, so she puts his calls on the bottom of her pile. She only speaks to him if his calls to her get through the phone system maze.
One of Sallys policyholders has complained that she won’t pay his claim for a 52 HD television set that was allegedly stolen. Which of the following reasons for delay in payment would be unfair claim practice?
While she doesn’t have any sporting evidence of the fact, Sally doesen’t believe the property was stolen, so she decide to to pay the claim.
A large tree limb fell on and damaged a policyholders roof. Sally dispatched an adjuster to appraise the damage. After receiving the appraisal, she advised the policyholder of how much she could pay for a partial roof repair. He rejected the offer and filed a compliant with the Department of Insurance for unfair claim practices. Which of the following would not be an unfair claim practice.
The adjuster provided photos showing that only 20% of the roof was damaged. Sally explained this when she made her offer.
Which of the following actions Sally took would not be a preferred claims practice or behavior under the Texas Unfair Claims Practice Act?
not responding to an insured calls because she had not yet made her mind
Sally became ill from food poisoning, so she called policy holder and explained she would not make their appointment. Sally was feeling ill for several days and was not able to make contact with policyholder until the following week. Later she was informed the policy holder secured an attorney and filed a complaint with the Department of Insurance for failure to respond in a timely manner. What wold be the most likely outcome of such complaint?
Nothing will happen. Sally’s action were not intentional, part of a trend or total or partial disregard for her adjusting responsibilities
