LLQP practice question 16 of 35

Germain is a life insurance agent. This morning, he receives a call from Jason, whose wife, Rosalie owned a $50,000 life insurance policy that she purchased from Germain seven years ago. Jason explains that Rosalie had a heart attack and died last week. Germain promises to help as much as he can.

Full set: 298 questions
Answer options
A: He can provide the claim form to Jason and help him fill it out. Correct answer
B: He can assure Jason that the payment will be made within 5 days after receipt of the claim.
C: He can inform Jason that the death benefit will be paid within 30 days of Rosalie’s death.
D: He can assure Jason that he will settle the death benefit as quickly as possible.
Correct Answer:
A. He can provide the claim form to Jason and help him fill it out.
Explanation

The primary and most appropriate role of a life insurance agent during the claims process is to facilitate communication and paperwork between the beneficiary and the insurer. Germain's duty is to provide the necessary claim forms and assist Jason in completing them accurately and thoroughly. This ensures the claim can be submitted promptly and processed efficiently by the insurer's claims department. The agent acts as a guide and a resource for the beneficiary but does not have the authority to adjudicate the claim or guarantee payment timelines.

Why Incorrect

B. The agent has no authority to guarantee a specific payment timeline; this is determined by the insurer's claims department after due diligence.
C. Payment is due within a set period after receiving proof of loss, not from the date of death, and the agent cannot guarantee this.
D. The agent does not settle claims; this is the exclusive responsibility of the insurance company's claims department.

References

1. IFSE Institute, Life Insurance (Common Law), (2023), Chapter 10: The Life Insurance Policy, Section 10.5 "Claims Process". This section outlines the agent's role, which includes providing the claimant with the appropriate forms and assisting in their completion to initiate the claims process with the insurer.

2. IFSE Institute, Ethics and Professional Practice (Common Law), (2023), Chapter 4: The Agent's Responsibilities and Duties, Section 4.2 "Duty to the Client". This chapter emphasizes that agents must act within the scope of their authority and avoid making promises or guarantees on behalf of the insurer, such as specific payment dates or claim approval.

3. Insurance Act, R.S.O. 1990, c. I.8, Part V — Life Insurance, Section 191(1). This statute (and similar legislation in other common law provinces) specifies that insurance money is payable "within thirty days after reasonably sufficient proof...has been furnished to the insurer." This contradicts the timelines and triggers mentioned in options B and C.

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