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Accident & Health: Ethical Practices and Consumer Protection

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Ethical Practices and Consumer Protection

Ethical Standards

Producers owe duties of honesty, integrity, and fair dealing to applicants, insureds, and insurers. Know the prohibited practices tested on exams: misrepresentation (false statements about policy terms or insurer), false advertising, twisting (misrepresentation to induce replacement), rebating (offering value not in the policy to induce a sale), coercion, intimidation, unfair discrimination (distinguishing among similar risks without actuarial basis), commingling, and fraudulent claims. Understand fiduciary responsibility for premiums and the duty to remit premiums promptly.

Know consumer protections: privacy rules limiting disclosure of nonpublic personal information, fraud reporting obligations, free look periods, replacement notice requirements, and suitability standards for annuity sales.

Traps in Questions

  • Rebating vs. discounting. Offering a gift or commission split to close a sale is rebating; a lawful premium discount filed with the state is not.
  • Twisting vs. replacement. Replacement is lawful when properly disclosed; twisting is unlawful misrepresentation during replacement.
  • Unfair discrimination. Distinguishing risks based on actuarially sound factors is permitted; arbitrary distinctions are not.
  • Privacy. Sharing nonpublic personal information requires notice and consent rules; questions often test whether consent is required.

Rule of Thumb

If a practice gives the buyer something of value not stated in the policy, or misleads the buyer about an existing policy, treat it as a prohibited practice unless a specific statute authorizes it.