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Web CE Ins Agent - Ethics and Law

Terms in this set (136)

Knowingly committing any of the following acts is a violation of the Unfair Claim Settlement Practices:
Misrepresenting to claimants pertinent facts or provisions in the insurance policy
Failing to acknowledge and act promptly on claims
Failing to use reasonable standards for the prompt investigation of claims
Failing to acknowledge claim coverage within a reasonable period of time after proof of loss requirements have been met by the insured
Failing to attempt to promptly and fairly settle claims in which liability is clear
Offering an insured substantially less than what a lawsuit would award, therefore forcing the insured to sue
Attempting to settle a claim for less than the amount to which the claimant believed he/she was entitled by reference to written or printed advertising material
Attempting to settle claims based on an application that was altered by the agent
Failing to inform the insured or beneficiary, upon request, of the coverage under which payment has been made
Failing to settle claims promptly under one portion of the policy in order to influence settlements under other portions of the policy
Failing to provide a reasonable explanation for the denial of a claim
Failing to settle claims promptly, where liability has become apparent, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy
Failing to provide a reasonable explanation for the denial of a claim
Directly advising a claimant not to obtain the services of an attorney
Misleading a claimant as to the applicable statute of limitations
Canceling or refusing to renew a policy based on religious affiliation
Is not properly qualified to perform the duties of a person holding the license applied for
Does not intend actively and in good faith to carry on as a business with the general public the transactions which would be permitted by the issuance of the license applied for
Is not of good business reputation
Is lacking in integrity
Has been refused a professional, occupational or vocational license or had such a license suspended or revoked by any licensing authority for reasons that should preclude the granting of the license applied for
Seeks the license for the purpose of avoiding or preventing the operation or enforcement of the insurance laws of this state
Has knowingly or willfully made a misstatement in an application to the Commissioner for a license, or in a document filed in support of such an application, or has made a false statement in testimony given under oath before the Commissioner or any other person acting in his stead
Has previously engaged in a fraudulent practice or act or has conducted any business in a dishonest manner
Has shown incompetency or untrustworthiness in the conduct of any business, or has by commission of a wrongful act or practice in the course of any business exposed the public or those dealing with him to the danger of loss
Has knowingly misrepresented the terms or effect of an insurance policy or contract
Has failed to perform a duty expressly enjoined upon him by a provision of this Code or has committed an act expressly forbidden by such a provision

Has been convicted of a:
Misdemeanor denounced by this Code or other laws regulating insurance
Public offense having as one of its necessary elements a fraudulent act or an act of dishonesty in acceptance, custody or payment of money or property
Has aided or abetted any person in an act or omission which would constitute grounds for the suspension, revocation or refusal of a license or certificate issued under this Code to the person aided or abetted
Has permitted any person in his employ to violate any provision of this Code
Has violated any provision of law relating to conduct of business which could lawfully be done only under authority conferred by such license
Has submitted to the Commissioner a false or fraudulent certificate of prelicensing or continuing education

The Commissioner also could deny a license application if the granting of the license would be against public interest.