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| Section | Weight | Objectives |
|---|---|---|
| Insurance Regulation and General Principles | 20% | - Insurance Concepts
|
| Accident and Health Insurance | 35% | - Government Health Programs
|
| Underwriting, Marketing and Sales Practices | 15% | - Application and Underwriting Procedures
|
| Life Insurance Products and Provisions | 30% | - Types of Life Insurance Policies
|
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NEW QUESTION # 12
The cause of a loss is called
Answer: B
Explanation:
In insurance terminology, the cause of a loss is known as a peril . A peril is the specific event or cause that results in damage, injury, or financial loss. Common examples of perils include fire, theft, accident, illness, disability, or death . In life and health insurance, the insured event-such as death in life insurance or sickness and accidental injury in health insurance-is considered the peril that triggers the insurer's obligation to pay benefits under the policy. Insurance policies are designed to provide financial protection against losses that result from covered perils.
It is important to distinguish a peril from other related insurance concepts. A hazard is a condition or situation that increases the likelihood or severity of a loss caused by a peril. Hazards are typically categorized as physical hazards (such as icy roads or faulty wiring), moral hazards (dishonesty or fraudulent behavior), and morale hazards (carelessness because of insurance coverage). An exposure refers to the possibility of loss, while risk refers to the uncertainty regarding the occurrence of a loss. Therefore, the term that specifically describes the direct cause of a loss is a peril .
NEW QUESTION # 13
What information must be included in the statement accompanying an insurance claim payment made by an insurer?
Answer: B
Explanation:
When an insurer issues a claim payment, New York claims-handling standards require that the payment be accompanied by an explanation that clearly identifies what the payment represents . A key required item is the coverage under which the payment is being made , so the claimant (or insured) can understand the basis for the payment and how it relates to the policy's benefits. This helps avoid confusion when a policy includes multiple coverages, benefit limits, deductibles, copayments/coinsurance, or when only part of a claim is payable. Stating the applicable coverage (for example, hospital confinement, major medical, disability income, accidental death, etc.) supports transparency and aligns with fair claims settlement practices by showing that the insurer is paying according to the policy provisions.
The other options are not required elements of the payment statement. Insurers are not required to list all claimants, disclose reinsurance arrangements (which are typically not visible to policyholders), or include the agent's name and address as part of the claim payment explanation. The essential requirement tested here is identifying the coverage supporting the payment.
NEW QUESTION # 14
Stranger originated life insurance violates which of the following statutory requirements?
Answer: C
Explanation:
Stranger-originated life insurance (STOLI) arrangements violate the fundamental legal requirement of insurable interest . In life insurance, the policyowner must have a legitimate interest in the continued life of the insured at the time the policy is issued. This usually exists when there is a close family relationship or a lawful economic interest, such as a business relationship where the death of the insured would cause financial loss. STOLI attempts to evade this rule by having a third party with no true insurable interest initiate or finance a policy for the purpose of benefiting from the insured's death.
That is why C. Insurable interest is the correct answer. The problem with STOLI is not trust ownership itself, since trusts may be used legally in life insurance planning when properly established. It is also not primarily about rescission rights or commission sharing. The key statutory violation is that the policy is effectively procured by or for someone who lacks a lawful interest in the insured's continued life. New York licensing materials treat this as contrary to public policy and inconsistent with lawful life insurance underwriting standards.
NEW QUESTION # 15
At the time of an insured ' s death, a per capita distribution of policy proceeds are paid to
Answer: D
Explanation:
The correct answer is the named living primary beneficiaries . In life insurance beneficiary designations, per capita means "by the head," or equally among the living members of the named class or group . When policy proceeds are distributed per capita, each living beneficiary at the same beneficiary level receives an equal share of the death benefit. If one of the named primary beneficiaries dies before the insured, that deceased beneficiary's share is not passed to that beneficiary's estate or descendants unless the policy specifically provides otherwise. Instead, the proceeds are divided equally among the remaining living primary beneficiaries .
This is what distinguishes per capita from per stirpes . Under per stirpes, the share of a deceased beneficiary would pass down to that beneficiary's descendants. But under per capita, only the surviving named beneficiaries in the class receive the proceeds.
The other options are incorrect because a deceased beneficiary's estate does not automatically receive the share, the children of a deceased primary beneficiary are not paid under per capita unless specifically named, and contingent beneficiaries are paid only if no primary beneficiaries survive. Therefore, D is correct.
NEW QUESTION # 16
The Group Life Underwriting risk selection process helps protect insurers from
Answer: D
Explanation:
The correct answer is adverse selection . In group life insurance, underwriting is generally based on the characteristics of the group as a whole rather than on extensive medical underwriting of each individual member. Because of this simplified underwriting approach, insurers must rely on certain group underwriting standards to protect themselves against the possibility that only those individuals who expect to need coverage most urgently will enroll. This danger is known as adverse selection .
Adverse selection occurs when people with a higher-than-average likelihood of loss are more motivated to obtain insurance than lower-risk individuals. In group life insurance, underwriting controls such as minimum participation requirements, employer contributions, eligibility rules, and actively-at-work provisions help ensure that the risk is spread across a broad base of insured persons rather than concentrated among poor risks. These requirements preserve the stability of the insurance pool and support fair premium pricing.
The other answer choices are incorrect because "risk selection" and "risk underwriting" are not the specific underwriting problem being tested, and "medical underwriting" is a process, not the danger the insurer is trying to avoid. Therefore, the correct answer is C. adverse selection .
NEW QUESTION # 17
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