Free West Virginia Accident & Health practice questions

Answer: B. It is excluded, because it was issued in the state when the insurer lacked authority to issue it

The Act lists, among the policies it does not cover, a policy issued in West Virginia by a member insurer at a time when that insurer was unlicensed or lacked a certificate of authority to issue it. The test looks at the insurer's status when the policy was issued, so a license obtained later does not bring the policy within coverage. The exclusion contains no reduced-benefit alternative and no claim-filing deadline that would restore coverage.

Answer: D. Payment is barred, because Jordan solicited insurance without a required license

An insurer or a producer may not pay a commission, service fee, brokerage or other valuable consideration to someone for selling, soliciting or negotiating insurance in West Virginia if that person must be licensed and is not. Jordan solicited insurance without a required license, so the producer may not share the commission. The prohibition reaches producers as well as insurers, covers any valuable consideration rather than only payments labeled commissions, and sets no percentage below which a share is allowed.

Answer: D. Unless it shows that, in providing the coverage, it is regulated by a federal agency

W. Va. Code Ann. Sec. 33-44-11(a) provides that any person who transacts insurance or provides coverage in West Virginia for the cost of listed services, which include chiropractic, dental care and ophthalmic care along with medical, surgical, hospital and other care, is subject to regulation by the commissioner and to the code unless the person shows that, while doing so, it is subject to regulation by a federal agency. The section applies whether the coverage pays directly, reimburses, or uses any other payment method, so the payment method does not matter. The services are listed in the alternative, so hospital or surgical coverage is not required. Chiropractic, dental and ophthalmic care are among the listed services, so they are within the section.

Answer: C. It is within liability insurance if incidental to the liability coverage

Sec. 33-1-10(e)(2) defines liability insurance as insurance against legal liability for the death, injury or disability of a person or for property damage. It then brings within that definition medical, hospital, surgical and disability benefits to injured persons, regardless of the insured's legal liability, when the benefits are written as incidental to, or supplemental to, the liability coverage. So the medical payments feature is liability insurance, and it does not wait for a finding that the store was at fault. Because the definition itself includes these benefits within liability insurance, the feature does not have to be split off into a separate accident and sickness policy, and its presence does not change what the policy is.

Answer: A. A partnership in which only one partner is a licensed producer

The definition of insurance agency reaches an individual or legal entity, other than an insurer or an adjuster, that employs licensed persons or whose members carry out work only a licensed individual producer or solicitor may perform. The definition then expressly leaves out a sole proprietor and a partnership that has just one licensed insurance producer, so the one-licensee partnership is the arrangement outside it. The corporation employing several licensed producers, the limited liability company whose members do licensed work, and the association employing licensed solicitors each fit the general definition and are not within the stated exclusion.

Answer: A. The debtor is let go in a mass layoff at the employer's plant

Sec. 33-1-10(b) explains that involuntary loss of employment means the debtor loses wage or salary income through unemployment caused by an individual or mass layoff, a general strike, a labor dispute, a lockout, or a termination by the employer for reasons other than willful or criminal misconduct. A mass layoff is one of the listed causes, so it qualifies. Theft from the employer is criminal misconduct, so a firing for it falls outside the definition. Resigning for a better job and retiring to care for a relative are the debtor's own choices and are not among the listed causes.

Answer: C. When it is done often enough to indicate a general business practice

The statute prohibits the listed acts when they are committed or performed with such frequency as to indicate a general business practice. The test is frequency, so an isolated act on one claim is not what the statute describes. It does not make a prior written complaint or a court finding of liability a condition of the prohibition.

Answer: B. It is an unfair practice, because the section reaches untrue insurance statements put before the public in any way.

The section defines as an unfair and deceptive practice putting before the public an advertisement or statement about the business of insurance that is untrue, deceptive, or misleading. The section names familiar media and then adds a catchall for any other way of reaching the public, so a social media video is covered and the list is not a closed set of media. The section attaches to whoever makes the statement or causes it to be made, directly or indirectly, and its text says nothing about the insurer authorizing it. Its text also contains no requirement that a consumer rely on the statement or buy a policy.

Answer: A. When that department was NAIC accredited at the time the examination took place

West Virginia law lets the commissioner accept a report prepared by the insurance department of a foreign or alien insurer's state of domicile or port-of-entry state in place of a West Virginia examination, but for reports after January 1, 1994 only on stated conditions. One condition is that the reporting department was accredited under the NAIC Financial Regulation Standards and Accreditation Program at the time of the examination. Accreditation gained later does not meet that condition, because the statute ties it to the time of the examination. An outside auditor's certification is not one of the conditions, and the age of the report is not the test.

Answer: A. The Commissioner of Insurance of this state, meaning West Virginia

The definitions subsection of West Virginia's examination section defines commissioner as the Commissioner of Insurance of this state, which is West Virginia. An individual or firm authorized to conduct an examination is covered by the separate definition of examiners, the domiciliary state's regulator is not the defined commissioner, and the National Association of Insurance Commissioners appears in the section for its accreditation program and examiners' handbook, not as the commissioner.