South Carolina Insurance Claims
Examiner Certification License Exam
Practice Questions And Correct Answers
(Verified Answers) Plus Rationale 2026
Q&A| Instant Download Pdf
1. An insurance claim examiner’s primary responsibility in South Carolina
is to:
A. Develop new insurance products
B. Evaluate and settle claims based on policy provisions and legal
guidelines
C. Sell insurance policies
D. Audit financial statements
The role of an insurance claims examiner is to analyze claims against
policy terms and applicable law and determine appropriate
settlement or denial.
2. Under South Carolina law, unfair claim settlement practices include:
A. Promptly paying claims within 10 days
B. Providing free policyholder consultations
C. Misrepresenting pertinent facts or policy provisions
D. Offering policy discounts
Misrepresentation of material facts or provisions in a policy to
claimants constitutes an unfair practice.
,3. A denial of a claim must be communicated in South Carolina within:
A. 30 business days
B. 15 days
C. A reasonable time with reasons for denial, usually within statutory
timelines
D. 90 days
Regulations require claim examiners to respond within reasonable
statutory timeframes and provide reasoned explanations for denials.
4. Which of the following actions is permitted for a claims examiner
regarding evidence?
A. Destroying evidence that supports a claim
B. Requesting additional evidence when necessary to evaluate a
claim
C. Delaying evidence review without cause
D. Ignoring claimant submissions
Examiners may request any additional evidence reasonably
necessary to make a proper determination.
5. “Bad faith” in claims handling refers to:
A. Settling claims too quickly
B. Failing to adopt good faith practices in evaluating and paying
claims
C. Charging high premiums
D. Offering policy rebates
Bad faith is the failure to act honestly and reasonably in claims
handling.
6. An insurance claim in South Carolina must be acknowledged within
how many days of receipt?
A. 5 days
B. 20 days
, C. A reasonable time, typically defined in regulations (often 15 days)
D. 60 days
Insurance regulations require timely acknowledgment of claims
within a period defined as reasonable by statute or rule.
7. When examining property damage claims, a claims examiner should:
A. Automatically approve full replacement cost
B. Verify the loss and apply the correct policy coverage and
depreciation
C. Ignore depreciation values
D. Only consult the claimant’s narrative
Examiners must verify losses, consider applicable coverage, and
account for depreciation when required.
8. If a claimant disputes a denial, the examiner should:
A. Ignore the dispute
B. Review the claim file and provide further explanation or correction
if appropriate
C. Forward the file to sales
D. Escalate immediately to litigation
Disputed denials should be reviewed internally and communicated
clearly to the claimant.
9. The principle of indemnity means:
A. A claimant receives more than their loss
B. A policy cannot be enforced
C. A claimant is restored to the approximate financial position before
loss
D. The insurer profits from a claim
Indemnity aims to put the insured back in the financial position held
before the loss, not to profit.
Examiner Certification License Exam
Practice Questions And Correct Answers
(Verified Answers) Plus Rationale 2026
Q&A| Instant Download Pdf
1. An insurance claim examiner’s primary responsibility in South Carolina
is to:
A. Develop new insurance products
B. Evaluate and settle claims based on policy provisions and legal
guidelines
C. Sell insurance policies
D. Audit financial statements
The role of an insurance claims examiner is to analyze claims against
policy terms and applicable law and determine appropriate
settlement or denial.
2. Under South Carolina law, unfair claim settlement practices include:
A. Promptly paying claims within 10 days
B. Providing free policyholder consultations
C. Misrepresenting pertinent facts or policy provisions
D. Offering policy discounts
Misrepresentation of material facts or provisions in a policy to
claimants constitutes an unfair practice.
,3. A denial of a claim must be communicated in South Carolina within:
A. 30 business days
B. 15 days
C. A reasonable time with reasons for denial, usually within statutory
timelines
D. 90 days
Regulations require claim examiners to respond within reasonable
statutory timeframes and provide reasoned explanations for denials.
4. Which of the following actions is permitted for a claims examiner
regarding evidence?
A. Destroying evidence that supports a claim
B. Requesting additional evidence when necessary to evaluate a
claim
C. Delaying evidence review without cause
D. Ignoring claimant submissions
Examiners may request any additional evidence reasonably
necessary to make a proper determination.
5. “Bad faith” in claims handling refers to:
A. Settling claims too quickly
B. Failing to adopt good faith practices in evaluating and paying
claims
C. Charging high premiums
D. Offering policy rebates
Bad faith is the failure to act honestly and reasonably in claims
handling.
6. An insurance claim in South Carolina must be acknowledged within
how many days of receipt?
A. 5 days
B. 20 days
, C. A reasonable time, typically defined in regulations (often 15 days)
D. 60 days
Insurance regulations require timely acknowledgment of claims
within a period defined as reasonable by statute or rule.
7. When examining property damage claims, a claims examiner should:
A. Automatically approve full replacement cost
B. Verify the loss and apply the correct policy coverage and
depreciation
C. Ignore depreciation values
D. Only consult the claimant’s narrative
Examiners must verify losses, consider applicable coverage, and
account for depreciation when required.
8. If a claimant disputes a denial, the examiner should:
A. Ignore the dispute
B. Review the claim file and provide further explanation or correction
if appropriate
C. Forward the file to sales
D. Escalate immediately to litigation
Disputed denials should be reviewed internally and communicated
clearly to the claimant.
9. The principle of indemnity means:
A. A claimant receives more than their loss
B. A policy cannot be enforced
C. A claimant is restored to the approximate financial position before
loss
D. The insurer profits from a claim
Indemnity aims to put the insured back in the financial position held
before the loss, not to profit.
