LLQP Accident & Sickness · Component 4.2 · 10% of the exam
The claimant asks whether the agent will be told about her medical details during the claim. The agent should explain:
- AMedical details become public once a claim is filed, since insurers must justify every payment they make
- BThe agent sees everything the insurer sees, since the agent is the insurer's representative on the file
- Medical information goes to the insurer's claims department; the agent gets only what is needed, in confidence
- DThe agent has no role at claim, so no medical information reaches the agent under any circumstances
Correct answer: C) Medical information goes to the insurer's claims department; the agent gets only what is needed, in confidence
Privacy governs claims. The agent's assistance role does not entitle them to full medical records.
Why the other options are wrong
- AMedical information is confidential.
- BThe agent's access to medical details is limited to what is needed to assist.
- DThe agent assists with the process.
Exam tip
Claims privacy: insurer receives medical details; agent gets only what is needed.
Common mistake
Requesting a claimant's full medical file 'to help'.
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
- The agent's role in the claims process is to:
- 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:
Practice the whole Accident & Sickness module
Timed sets weighted like the exam, and review of every question you miss. Free to start.