Montana State Life Insurance Practice Exam

An insurer or producer may not use pretext interviews to obtain personal information unless it is under what condition?

1. With the individual's consent

2. For marketing purposes

3. Suspecting criminal activity or fraud

4. Related to a denied claim

The correct answer is: Suspecting criminal activity or fraud

The correct condition under which an insurer or producer may use pretext interviews to obtain personal information is when there is suspicion of criminal activity or fraud. Pretext interviews, which involve obtaining information under false pretenses, are typically viewed with scrutiny due to ethical and legal considerations surrounding privacy and consent. In scenarios where there is a credible suspicion of criminal activities such as fraud, the use of pretext interviews may be justified as part of an investigation into unlawful behavior. Insurers have a legal obligation to combat insurance fraud, which can include gathering pertinent information to ensure the integrity of claims and policies. Therefore, in these specific situations, the use of such interviewing tactics is allowed to protect the interests of the insurer and preserve the insurance system from fraudulent claims. In contrast, using pretext interviews with an individual's consent offers a level of transparency that is typically preferred. Marketing purposes do not justify the use of deception, as this can lead to distrust and potential violations of privacy laws. Likewise, whether or not a claim has been denied does not inherently warrant the use of pretext interviews, as claims processing should adhere to ethical standards without resorting to deceptive practices unless justified by other factors.