State RegulationsCO specificDifficulty 1/5
A Colorado insurer receives a claim and suspects the claimant has submitted fraudulent documentation. Under C.R.S. § 10-1-128, the insurer:
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Answer & full 3-part explanation (select an option above, or peek)
Why D is correct
C.R.S. § 10-1-128 requires every licensed insurer to maintain an anti-fraud plan, but an allegation of fraud does not excuse the insurer's duty to promptly investigate the claim. The anti-fraud framework and the duty to investigate claims operate side by side.
Why the other options are wrong
- A) The insurer may not park the claim until law enforcement finishes; prompt investigation remains its own duty.
- B) An allegation of fraud is not a substitute for investigation, and denial without investigation is not authorized.
- C) Pending status does not suspend the anti-fraud plan; the plan's procedures apply while the claim is investigated.
Memory hook
Suspect fraud all you want — you still have to investigate the claim.