15;

1. Acknowledge receipt of the new claim;
2. Begin the investigation;
3. Request all of the items needed to evaluate and investigate the claim

15 Business Days;

1. Review and evaluate the claim;
2. Process the claim;
3. Accept or reject the claim.

Accepts; Rejects

The insurer has 5 Business Days to:

1. pay the claim or
2. issue full or partial denial of the claim

Not attempting in ____ ____ to bring about ______, ___ and _____ settlements when liabillity has become reasonably clear.

Not attempting in ____ ____ to bring about ______, ___ and _____ settlements when liabillity has become reasonably clear.

_______ to settle claims ______, where liability has become reasonably clear, under one portion of the insurance policy coverage in order to infulence settlements under other portions of the insurance policy coverage.

1. Misrepresent a policy's terms, benefits, or advantages;
2. Misrepresent the dividends or share of the surplus to be received or previously paid on a policy
3. Misrepresent the financial condition of a person in the insurance business
4. Use a title of a policy or class of policies that misrepresent the true nature of the policy
5. Misrepresent the legal reserve system on which any life insurer operates
6. Make a misrepresentation to induce a policyholder to lapse, forfeit, exchange, convert, or surrender a policy.

1. Committed while engaging in the business of insurance;
2. Committed as part of or in support of an insurance transaction
3. Part of an attempt to defraud an insurer

1. File a false statement of financial condition of an insurer
2. Make or distribute a false statement of financial condition of an insurer
3. Make a false entry in an insurer's statement or willfully omit a true material fact with intent to deceive

• An agent or examiner lawfully appointed to examine the insurer's condition or affairs
• A public official who has authority to examine the insurer's condition or affairs

1. An authorized governmental agency or the department;
2. A law enforcement officier or an agent or employee of the officier
3. The National Association of Insurance Commissioners or an employee of the assosication;
4. A state or federal governmental agency established to detect and prevent fraudulent insurance acts or to regulate the business of insurance or an employee of the agency
5. A special investigative unit of an insurer

1. Fraud in obtaining coverage
2. Failure to pay premiums when due
3. On an increase in hazard within the control of the insured that would produce an increase in rate
4. Loss of the insurer's reinsurance coverage all or part of the risk covered by the policy
5. On an insurer being placed in supervision, conservatorship, or receivership, if the cancellation or nonrenewal is approved or directed by the supervisor conservator, or receiver.

1. An insurer may not decline to renew a policy solely because of the insured's age
2. An insurer must renew a policy that was written for less than one year, though an insurer may decline to renew the policy on any 12-month anniversary of the original effective date of the the policy

1. Fully explain any decision that adversly affects an applicant for insurance or a policyholder by denying the applicant or policyholder insurance coverage or continued coverage.
2. State the precise incident, circumstance, or risk factors applicable to the applicant for insurance or the policyholder that violates any applicable guidelines
3. State the source of information on which the insurer relied regarding the incident, circumstance, or risk factors
4. Specify any other relevant information

1. Not later than the 10th day before the date on which the cancellation of a liability insurance policy takes effect, an insurer must deliver written notice of the cancellation to the first-named insured under the policy at the address shown on the policy.
2. An insurer may refuse to renew a liabiliy insurance policy if it delivers written notice of the nonrenewal to the first-named insured under the policy at the address shown on the policy.
3. The notice must be delivered or mailed not later than the 60th day before the date on which the policy expires. If the notice is delivered or mailed later than the 60th day before the date on which the policy expires, the coverage remains in effect until the 61st day after the date on which the notice is delivered or mailed.
4. Earned premium for any period of coverage that extends beyond the expiration date of the policy shall be computed pro rata based on the previous year's rate.

1. An insurer may assess a premium surcharge at the time an insurance policy is renewed if the insured has filed two or more claims in the preceding three policy years. The amount of the surcharge must be based on sound actuarial principles.
2. An insurer may refuse to renew an insurance policy if the insured has filed three or more claims under the policy in any three-year period.
3. An insurer may notify an insured who has filed two claims in a period of less than three years that the insurer may refuse to renew the policy if the insured files a third claim duriing the three-year period. If the insurer does not notify the insured in accordance with this subsection, the insurer may not refuse to renew the policy because of claims.

1. An insurer must maintain information regarding cancellation or nonrenewal of insurance policies in accordance with the insurer's ordinary practices for maintaining records of expired policies.
2. The insurer must make the information available to the department on request.

1. Known to be false
2. Made with malice or willful intent to injure any person
3. Declination prohibited; consideration of certain claims