State RegulationsCO specificDifficulty 2/5
A Colorado health claim is denied after a reasonable investigation, and the denial letter explains the basis in detail; there is no pattern of similar conduct. Under C.R.S. § 10-3-1104(1)(h), the insurer most likely:
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
C.R.S. § 10-3-1104(1)(h) requires a willful violation or a frequency indicating a general business practice before enumerated conduct becomes an unfair claims practice. A denial supported by reasonable investigation and a detailed written explanation, standing alone with no pattern, satisfies neither branch — Colorado law does not treat good-faith claim denials as violations.
Why the other options are wrong
- B) The statute does not condemn denials as such; it condemns willful or systematic unfair handling of claims.
- C) Division involvement is not the trigger; the willfulness-or-frequency standard is.
- D) Written denial explanations are expected practice, not prohibited conduct.
Memory hook
Investigate, explain, deny in good faith — that's compliance, not misconduct.