Insurance Licensing New York Life, Accident and Health Insurance Agent/Broker Examination Series 17-55 NY-Life-Accident-and-Health Question # 3 Topic 1 Discussion
Insurance Licensing New York Life, Accident and Health Insurance Agent/Broker Examination Series 17-55 NY-Life-Accident-and-Health Question # 3 Topic 1 Discussion
Insurance agents have duties and responsibilities to the insured and the insurer. Which of the following responsibilities does an agent owe the insured during the policy year?
A.
Help the insured file and follow up on claims.
B.
Notify the insurance department when claims are paid.
C.
Work with rating bureaus to establish insurer ratings.
D.
Pay the insured ' s premiums if they are unable to do so.
During the policy year, an agent’s continuing responsibilities to the insured are commonly described as policyowner service duties. A key part of that service is assisting the insured with the claims process —helping the insured understand what is covered, how to complete claim forms, what documentation is needed, where and when to submit the claim, and following up when additional information is requested. This ongoing service obligation supports timely claim handling and helps the insured access benefits promised under the contract.
The other options do not represent responsibilities an agent owes the insured. Agents do not report paid claims to the Insurance Department as part of normal duties; claim reporting and market conduct oversight are handled through insurer compliance and regulatory processes. Agents also do not work with rating bureaus to establish insurer ratings—insurer ratings are produced by independent rating organizations and based on financial/claims performance, not agent activity. Finally, an agent is not obligated (and generally should not) pay an insured’s premiums; doing so can create improper financial arrangements and is outside normal agent duties. Therefore, helping the insured file and follow up on claims is the correct responsibility.
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