LLQP Accident & Sickness · Component 4.2 · 10% of the exam
The agent's role in the claims process is to:
- AStep back entirely, since the claim is a matter between the claimant and the insurer's claims department
- BDecide whether the claim meets the policy's definition, since the agent knows the contract best
- Explain the process, help with forms, follow up and advocate, without promising outcomes
- DGuarantee payment to the claimant, since the agent sold the policy on the strength of its benefits
Correct answer: C) Explain the process, help with forms, follow up and advocate, without promising outcomes
The curriculum's 'inform the claimant of the claims process' is a service duty. Agents do not adjudicate.
Why the other options are wrong
- AAbandoning the client at claim is a service failure.
- BInsurers adjudicate claims; the agent has no authority to decide them.
- DOutcomes cannot be guaranteed.
Exam tip
Agent at claim: explain, assist, follow up; never adjudicate or promise.
Common mistake
Telling the claimant the claim 'will definitely be paid'.
What this tests
CISRO competency component 4.2 — Provide customer service during the validity period of the coverage — which is weighted at 10% of the Accident & Sickness module. Written against the published curriculum.
More from component 4
- A client with a non-cancellable DI policy stops paying premiums after a dispute with the insurer about a claim. The agent should warn that:
- When a client moves to another province, the agent should:
- A client asks to reduce the waiting period on his in-force disability policy. The agent should explain that the change:
- A client's disability policy lapsed six weeks ago for non-payment. The agent should:
- A client on claim asks whether she must keep paying premiums. The accurate answer depends on:
- A client's non-cancellable disability policy reaches the expiry age stated in the contract. At that point:
Practice the whole Accident & Sickness module
Timed sets weighted like the exam, and review of every question you miss. Free to start.