State RegulationsFL specificDifficulty 2/5
A Florida insurer denies a health claim after only a cursory file review, without interviewing the treating provider or examining the medical records it had requested. Under Florida law, this is
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Why C is correct
Under Fla. Stat. 626.9541 (Chapter 626, Florida Statutes), it is an unfair claim settlement practice to refuse to pay claims without conducting a reasonable investigation based on all available information. Denying coverage after a cursory review, while relevant records sit unexamined, fails that standard and exposes the insurer to DFS penalties and interest on late-paid claims.
Why the other options are wrong
- A) The unfair trade practices law requires a reasonable, documented investigation before denial; insurer preference is not a defense.
- B) The wrong here is the failure to investigate before deciding, not a false statement about policy terms.
- D) No threats or intimidation were used against the insured; the defect is procedural, not coercive.
Memory hook
Investigate before you deny.