ACCIDENT HEALTH LAWS TEST BANK
TESTED QUESTIONS AND ACCURATE
ANSWERS GRADED A+
●● Entire contract/changes
Answer: The policy, including the endorsements and the attached papers,
if any, constitutes the entire contract of insurance. No change in this
policy will be valid until approved by an executive officer of the insurer
and unless such approval be endorsed or attached. Producers have no
authority to change the policy or to waive any of its provisions.
●● Time limit on certain defenses
Answer: After 2 years from the date of issue of a policy, no
misstatements made by the applicant in the policy application (except in
the cases of fraud) can be used to void the policy or to deny a claim for
loss incurred or disability beginning after the expiration of a 2-year
period.
●● Incontestability
Answer: States that if policy has been in force for a period of 2 years
(excluding any period during which the insured is disabled), the
statements in the application will be incontestable. This provision may
be used in place of the Time Limit on Certain Defenses provision.
,●● Reinstatement
Answer: If a renewal premium is not paid on time, the policy can be
reinstated if the insurer accepts the premium without requiring an
application for reinstatement. If an application is required, and a
conditional receipt is issued, the policy will be reinstated upon approval
by the insurer or after 45 days from the conditional receipt if not
disapproved. The reinstated policy will only cover losses after the
reinstatement date, and any premium accepted will be applied to a
period up to 60 days before the reinstatement date.
●● Notice of claim
Answer: Written notice of claim must be given to the insurer within 20
days after the occurrence of any loss covered by the policy or as soon
thereafter as is reasonably possible. Notice given by or on behalf of the
insured or the beneficiary to any authorized producer of the insurer will
be deemed notice to the insurer.
●● Claim forms
Answer: Upon receipt of a notice of claim, the insurer must furnish to
the claimant such forms as are usually furnished by it for filing proofs of
loss. If such forms are not furnished within 15 days after the giving of
such notice, the claimant will be deemed to have complied with the
requirements of this policy as to proof of loss upon submitting, within
the time fixed in the policy for filing proofs of loss, written proof
covering the occurrence, the character, and the extent of the loss for
which claim is made.
, ●● Proofs of loss
Answer: Written proof of loss must be furnished to the insurer within 90
days after the date of such loss.
●● Time of payment of claims
Answer: Indemnities payable under this policy for any loss will be paid
immediately upon receipt of due written proof of such loss.
●● Payment of claims
Answer: Specifies to whom claim payments are to be made.
●● Legal actions
Answer: No action at law will be brought to recover on a policy prior to
the expiration of 60 days after written proof of loss has been furnished.
No such action will be brought after the expiration of 3 years after the
time written proof of loss is required to be furnished.
●● Free look
Answer: All accident and health policies must contain a notice stating
that the policyowner has the right to return the policy within 10 days of
its delivery for a full refund of premium.
●● When does coverage for a newborn child begin under a family health
insurance policy?
TESTED QUESTIONS AND ACCURATE
ANSWERS GRADED A+
●● Entire contract/changes
Answer: The policy, including the endorsements and the attached papers,
if any, constitutes the entire contract of insurance. No change in this
policy will be valid until approved by an executive officer of the insurer
and unless such approval be endorsed or attached. Producers have no
authority to change the policy or to waive any of its provisions.
●● Time limit on certain defenses
Answer: After 2 years from the date of issue of a policy, no
misstatements made by the applicant in the policy application (except in
the cases of fraud) can be used to void the policy or to deny a claim for
loss incurred or disability beginning after the expiration of a 2-year
period.
●● Incontestability
Answer: States that if policy has been in force for a period of 2 years
(excluding any period during which the insured is disabled), the
statements in the application will be incontestable. This provision may
be used in place of the Time Limit on Certain Defenses provision.
,●● Reinstatement
Answer: If a renewal premium is not paid on time, the policy can be
reinstated if the insurer accepts the premium without requiring an
application for reinstatement. If an application is required, and a
conditional receipt is issued, the policy will be reinstated upon approval
by the insurer or after 45 days from the conditional receipt if not
disapproved. The reinstated policy will only cover losses after the
reinstatement date, and any premium accepted will be applied to a
period up to 60 days before the reinstatement date.
●● Notice of claim
Answer: Written notice of claim must be given to the insurer within 20
days after the occurrence of any loss covered by the policy or as soon
thereafter as is reasonably possible. Notice given by or on behalf of the
insured or the beneficiary to any authorized producer of the insurer will
be deemed notice to the insurer.
●● Claim forms
Answer: Upon receipt of a notice of claim, the insurer must furnish to
the claimant such forms as are usually furnished by it for filing proofs of
loss. If such forms are not furnished within 15 days after the giving of
such notice, the claimant will be deemed to have complied with the
requirements of this policy as to proof of loss upon submitting, within
the time fixed in the policy for filing proofs of loss, written proof
covering the occurrence, the character, and the extent of the loss for
which claim is made.
, ●● Proofs of loss
Answer: Written proof of loss must be furnished to the insurer within 90
days after the date of such loss.
●● Time of payment of claims
Answer: Indemnities payable under this policy for any loss will be paid
immediately upon receipt of due written proof of such loss.
●● Payment of claims
Answer: Specifies to whom claim payments are to be made.
●● Legal actions
Answer: No action at law will be brought to recover on a policy prior to
the expiration of 60 days after written proof of loss has been furnished.
No such action will be brought after the expiration of 3 years after the
time written proof of loss is required to be furnished.
●● Free look
Answer: All accident and health policies must contain a notice stating
that the policyowner has the right to return the policy within 10 days of
its delivery for a full refund of premium.
●● When does coverage for a newborn child begin under a family health
insurance policy?
