State RegulationsCO specificDifficulty 2/5
The Colorado Division of Insurance reviews a health insurer's files and finds repeated failures to acknowledge policyholder communications promptly and claim denials made without any investigation. Under C.R.S. § 10-3-1104(1)(h), these enumerated acts are actionable when:
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Answer & full 3-part explanation (select an option above, or peek)
Why D is correct
C.R.S. § 10-3-1104(1)(h) enumerates unfair claim practices — including failing to acknowledge communications promptly, applying no reasonable investigation standards, and refusing to pay claims without investigation — and makes them actionable when committed willfully or with such frequency as to indicate a general business practice. This two-part standard, applied by the Colorado Division of Insurance, reaches both deliberate misconduct and persistent sloppiness.
Why the other options are wrong
- A) A single inadvertent lapse does not satisfy the statute; willfulness or frequency is required.
- B) A lawsuit by the claimant is not a prerequisite; the Division can act on the insurer's own conduct pattern.
- C) Liability rests with the insurer's business practices, not merely with an individual adjuster.
Memory hook
Willful once, or sloppy all the time — either way, it's an unfair claim practice.