LLQP Ethics & Professional Practice · Component 1.6 · 60% of the exam
A claimant is dissatisfied with the insurer's claim decision. The proper escalation is:
- AThe agent's manager only, since the agency is responsible for resolving disputes about its clients' claims
- The insurer's complaint process, then OLHI, with the regulator for conduct issues and court as the last avenue
- CThe police, since a wrongful claim decision by an insurer is a form of fraud against the beneficiary
- DStraight to court, since the insurer's internal process is designed to protect the insurer rather than the claimant
Correct answer: B) The insurer's complaint process, then OLHI, with the regulator for conduct issues and court as the last avenue
The escalation ladder is a core ethics-module fact; each step has its role.
Why the other options are wrong
- AThe agent cannot resolve claim disputes.
- CA claim decision is not a criminal matter.
- DCourt is the last step and time-limited.
Exam tip
Insurer → OLHI → (regulator for conduct) → court.
Common mistake
Going to OLHI before finishing the insurer's process.
What this tests
CISRO competency component 1.6 — Integrate into practice the legal aspects of insurance and annuity contracts — which is weighted at 60% of the Ethics & Professional Practice module. Written against the published curriculum.
More from component 1
- An 'assignee' of a life insurance policy is:
- A corporation as policyowner and beneficiary of a policy on a key employee:
- A 'trustee' named to receive proceeds on behalf of a beneficiary:
- The 'automatic premium loan' (APL) provision:
- A life insurance contract 'matures' when:
- The 'assignment' provision typically states that:
Practice the whole Ethics & Professional Practice module
Timed sets weighted like the exam, and review of every question you miss. Free to start.