Free Oregon Accident & Health practice questions

Answer: A. A prompt and truthful reply, sent by email as the director requested

The director may direct proper inquiries to an insurer or licensee about its activities, condition or transactions, and the person addressed must reply promptly and truthfully, using the form of communication the director asks for. The director chose email, so the reply goes by email. The statute does not let the producer pick the format or set a 30-day window, does not wait for an order or subpoena, and is not limited to matters connected with a complaint.

Answer: B. Within 30 business days, notify her of the refusal, its reasons and her right to file a statement

Oregon gives the insurer a choice, but a deadline on both branches. Within 30 business days of receiving a written request to correct, amend or delete recorded personal information, the insurer must either make the change to the disputed portion or notify the individual that it refuses, with the reasons for refusing and her right to file a statement. Because this insurer believes the entry is accurate, it may refuse, so it is not bound to delete simply because she asked. A refusal notice that omits the reasons falls short, because the reasons are part of what the notice must contain. A period of 90 business days is the window the adverse underwriting provision gives an individual to request reasons, not the insurer's time to answer a correction request. If she then disagrees, she may file a concise statement of what she thinks is correct and why.

Answer: A. No later than the 30th day after the termination takes effect

When the producer ends the appointment, Oregon law requires written notice of the termination and its date to reach the director within 30 days after the effective date, and notice also goes to the insurer. The 90-day advance notice runs in the other direction: it is what an insurer generally owes the producer when the insurer ends the appointment. The statute sets no 30-day advance deadline and no 60-day deadline for the producer's notice.

Answer: B. Only when it is clearly supported by sound actuarial principles or by actual or reasonably anticipated experience

ORS 746.015(3) prohibits an insurer from discriminating in its underwriting standards or rates based solely on an applicant's or insured's reaching or passing age 65, unless the insurer's distinction clearly rests on sound actuarial principles or relates to actual or reasonably anticipated experience. Because the statute itself supplies that actuarial or experience exception, a blanket ban on every age distinction misstates it. The provision describes no prior-approval route through the director and no disclosure route through the producer, so neither approval nor a written explanation to the applicant is what makes an age-based standard lawful under it.

Answer: C. Restitution on the consumer's behalf for the actual damages the consumer suffered

In an action against an insurer, the director may seek restitution for a consumer's actual damages that result from the insurer's violation of the Insurance Code or applicable federal law, or from its breach of the consumer's insurance contract, along with other equitable relief the director considers appropriate. A breach of the policy is therefore enough, so restitution is not limited to federal-law violations. Where a violation warrants criminal prosecution, the director passes the information to the Attorney General or the district attorney with jurisdiction, who brings the case; the director does not prosecute it. The director's action is an exercise of regulatory authority and, apart from that criminal referral, creates no cause of action for anyone else.

Answer: C. Any person making such a statement, whether that person is the applicant, the producer or someone else

ORS 746.100 is written to reach any person. It forbids anyone from making a false or fraudulent statement or representation on or relating to an insurance application, and it also forbids such statements made to obtain a fee, commission, money or benefit from an insurer or producer. Because the statute is not limited by role, confining it to producers, to applicants or to insurers misreads it.

Answer: C. 20 days after the order is mailed to the producer

The copy of a cease and desist order sent to the person must state the specific charges and tell the person that a hearing may be requested within 20 days of mailing. If no written hearing request reaches the director within that window, the order becomes final 20 days after mailing. Thirty days is the period within which the director must hold a hearing once one is requested, and seven days is the minimum advance written notice of the hearing date, so neither governs an unchallenged order. The order is not final on mailing, because the statute first gives the person the 20-day period to ask for a hearing.

Answer: D. $3,000

Oregon caps the civil penalty at $10,000 per offense for a person generally, but for an individual insurance producer, adjuster or insurance consultant the cap is $1,000 for each offense, and every violation counts as its own offense. Three violations by an individual producer therefore support up to $3,000. A $1,000 total treats the three violations as a single offense, while $10,000 and $30,000 apply the general cap instead of the individual producer cap.

Answer: B. She must become licensed as an insurance producer for that additional class of insurance

Oregon law bars a person from selling, soliciting or negotiating a class of insurance in the state unless the person is licensed as an insurance producer for that class. Dana's license covers one class, so she must be licensed for the additional class before she solicits it. Under the statute an appointment is not an alternative to the license, a license does not reach a class it does not include, and no applicant-consent route is offered.

Answer: A. 30 days

Once a properly executed proof of loss is in hand, the insurer must tell the claimant whether the claim is accepted or denied within 30 days. The period runs from receipt of the proof of loss, not from a lawsuit or from the date of the loss, and the provision does not leave the timing to the insurer's discretion.