Free New Hampshire Accident & Health practice questions

Answer: B. It must be written and detailed enough for the member to reasonably understand the benefits in the payment.

Ins 1001.03(b) requires that a statement describing the benefits contained in a claim payment be written and be detailed enough for the insured, claimant, or their representative to reasonably understand what the payment covers. An oral account from a claims representative does not meet the writing requirement, even if a figure is mailed later. The paragraph does not call for a list of every exclusion in the policy, and it does not make the statement depend on a request from the member.

Answer: A. The insurer may not refuse the advance on the ground that the claimant hired an attorney to help with recovery.

Ins 1001.06 bars an insurer from refusing advance payments on a claim because the claimant, insured, or their representative has hired a lawyer to help obtain recovery. The rule removes that reason for refusing; it does not itself say an advance is owed on every claim. The wrong choices each make the attorney's involvement a basis for refusing or holding back the advance, whether by routing payment through counsel, waiting for a written confirmation to the department, or demanding that the attorney be let go, and the rule contains no such conditions.

Answer: B. Within 5 working days after June 10, when the claimant met the agreement's condition

Ins 1001.02(h) requires an insurer to pay an amount finally agreed upon in settlement no later than 5 working days from the date of the agreement or from the date the claimant performs all the conditions the agreement sets. Because this agreement set a condition, the claimant's return of the signed release on June 10 is the performance from which the 5 working days are counted. Ten working days is longer than the paragraph allows, 30 days is the period for a complete decision on a health claim under Ins 1001.02(a) rather than for paying an agreed settlement, and the date of first notice is not a starting point the paragraph names.

Answer: C. The insurer may not require a new physician report to prove a disability that a prior report established.

Ins 1001.07 provides that, unless another law says otherwise, once an insurer has accepted a disability benefits claim under an individual or group accident and health policy, it may not require further reports from the insured's or beneficiary's physician to substantiate a disability that an earlier report already established. The examiner's request is exactly that. The rule contains no exception for the insured's written consent, and it does not let the insurer demand such a report at any time while benefits are being paid. It covers individual policies and group policies alike, so limiting it to group coverage misstates it.

Answer: B. 24 months

RSA 402-J:7(III) allows an individual producer whose license has lapsed to reinstate that same license, without passing the written examination again, if it is done within 24 months of the date renewal was due. A window of 6 or 12 months is shorter than the statute allows, and 36 months is longer than the statute allows.

Answer: D. A waiver of the 30 day delay letter provision, in a writing the beneficiary signs

Ins 1001.02(i) bars an insurer from asking a claimant or insured to waive any of its obligations under Ins 1000, with one exception: the insurer may ask for a waiver of the 30 day delay letter provision. That waiver must be in writing, signed by the insured or claimant, and kept in the claim file. The reply period, the payment period for agreed settlements, and the duty to state the reason for a denial are all obligations under Ins 1000, so the insurer may not ask the beneficiary to give them up.

Answer: D. Notify the beneficiary that it needs more time and state the reasons for the delay

Ins 1001.02(c) gives the insurer 10 working days after acknowledging a notice of claim to tell the claimant in writing whether the claim is accepted or rejected. If the insurer needs more time to decide, it must say so within those same 10 working days and give the reasons for the delay. Paragraph (c) does not call for a report to the department or a partial payment, and a status letter sent at 30 days would miss the 10 working day deadline.

Answer: C. Forcing claimants into court by offering substantially less than they later recover in their suits

RSA 417:4(XV)(a)(5) names as an unfair claim settlement practice compelling claimants to litigate for amounts due by making offers substantially below what they ultimately recover in their actions, when the insurer acts without just cause and not merely by inadvertence or accident. That matches an insurer whose low offer pushed the insured into a suit that recovered much more. The other choices describe different practices on the same list (delay after proof of loss, a payment without a benefits statement, and duplicate claim reports), and nothing in these facts shows any of them.

Answer: B. Reapply for the examination and complete the application again before a new date is set

RSA 402-J:5(IV) treats a candidate who misses a scheduled examination the same way as one who fails it: the individual must reapply for the examination, supplying everything the application requires, before being rescheduled. The paragraph provides no automatic rescheduling and no waiting period, and it does not make a commissioner's excuse or additional coursework the way back to the examination.

Answer: A. At least 3 hours of ethics, but never more than 10 hours

RSA 402-J:7-a requires a producer to complete 24 hours of continuing education every 2 years and sets both a floor and a ceiling on ethics: no fewer than 3 and no more than 10 of those hours must be approved ethics courses. Treating 3 hours as an exact figure ignores the ceiling of 10, treating 10 hours as a minimum turns the ceiling into the floor, and allowing all 24 hours to be ethics would exceed the 10-hour cap.