New Jersey Accident & Health Policy
Provisions, Clauses & Riders Questions
and Complete Solutions Graded A+
Entire Contract - Answer: states that the policy, riders, and endorsements form the contract between
the insurance company and the policyowner; agreements beyond the contract are not part of it
Time Limit on Certain Defenses (Incontestibility) - Answer: limits the time an insurer can void a policy or
deny a claim for material misrepresentations on the application - two years
Grace Period - Answer: gives the policyowner some time after the due date to pay the premium
- 7 days for weekly premiums
- 10 days for monthly premiums
- 31 days for all other payment modes
Reinstatement - Answer: lets a policyowner reinstate a lapsed policy within a certain period; normally
three years from the date of lapse
apply for policy, pay past-due premiums with interest, and provide proof of insurability
insurer has 45 days to reject the app; if they do not respond, automatically reinstated
Notice of Claim - Answer: requires the insured to notify the insurer within 20 days of loss; or as soon as
reasonably possible
tells the insurer that the insured intends to file a claim
Claim Forms - Answer: requires the insurer to give claim forms to the insured within 15 days; otherwise,
the insured can instead submit a written statement describing how the loss occurred, the nature of the
loss, and the medical expenses
Proof of Loss - Answer: must give the insurer proof of loss within 90 days; can be extended under certain
circumstances
, Time of Payment of Claims - Answer: compels the insurer to pay claims immediately after receiving
proof of loss
Payment of Claims - Answer: states how claims are paid - beneficiary/estate
Physical Examination and Autopsy - Answer: gives the insurer the right to examine the insured as often
as necessary while a claim is pending
Legal Actions - Answer: sets the period during which the insured can take legal action against the insurer
to dispute its decision on a claim
60 day window until legal action can be taken
cannot be taken more than 3 years later
Change of Beneficiary - Answer: gives the policyowner the right to change the beneficiary IF the
designation is revocable
Mandatory Provisions - Answer: - Entire Contract
- Time Limit on Certain Defenses
- Grace Period
- Reinstatement
- Notice of Claims
- Claims Forms
- Proof of Loss
- Time of Payment of Claims
- Payment of Claims
- Physical Exams and Autopsy
- Legal Actions
- Change of Beneficiary
Provisions, Clauses & Riders Questions
and Complete Solutions Graded A+
Entire Contract - Answer: states that the policy, riders, and endorsements form the contract between
the insurance company and the policyowner; agreements beyond the contract are not part of it
Time Limit on Certain Defenses (Incontestibility) - Answer: limits the time an insurer can void a policy or
deny a claim for material misrepresentations on the application - two years
Grace Period - Answer: gives the policyowner some time after the due date to pay the premium
- 7 days for weekly premiums
- 10 days for monthly premiums
- 31 days for all other payment modes
Reinstatement - Answer: lets a policyowner reinstate a lapsed policy within a certain period; normally
three years from the date of lapse
apply for policy, pay past-due premiums with interest, and provide proof of insurability
insurer has 45 days to reject the app; if they do not respond, automatically reinstated
Notice of Claim - Answer: requires the insured to notify the insurer within 20 days of loss; or as soon as
reasonably possible
tells the insurer that the insured intends to file a claim
Claim Forms - Answer: requires the insurer to give claim forms to the insured within 15 days; otherwise,
the insured can instead submit a written statement describing how the loss occurred, the nature of the
loss, and the medical expenses
Proof of Loss - Answer: must give the insurer proof of loss within 90 days; can be extended under certain
circumstances
, Time of Payment of Claims - Answer: compels the insurer to pay claims immediately after receiving
proof of loss
Payment of Claims - Answer: states how claims are paid - beneficiary/estate
Physical Examination and Autopsy - Answer: gives the insurer the right to examine the insured as often
as necessary while a claim is pending
Legal Actions - Answer: sets the period during which the insured can take legal action against the insurer
to dispute its decision on a claim
60 day window until legal action can be taken
cannot be taken more than 3 years later
Change of Beneficiary - Answer: gives the policyowner the right to change the beneficiary IF the
designation is revocable
Mandatory Provisions - Answer: - Entire Contract
- Time Limit on Certain Defenses
- Grace Period
- Reinstatement
- Notice of Claims
- Claims Forms
- Proof of Loss
- Time of Payment of Claims
- Payment of Claims
- Physical Exams and Autopsy
- Legal Actions
- Change of Beneficiary
