ACCIDENT AND HEALTH 2025/2026 QUESTIONS AND
SOLUTION RATED A+
✔✔Recurrent Disability Provision - ✔✔A disabling condition which returns within a
specified period of time to be considered an extension of prior disability. The insured is
not required to undergo another elimination period.
✔✔waiver of premium provision - ✔✔If the insured is totally disabled for 90 days, future
premiums will be waived as long as the insured remains disabled
✔✔rehabilitation benefit provision - ✔✔pays for retraining to find a job in another line of
work
✔✔nondisabling injury provision - ✔✔will pay for minor injuries that does not affect work
✔✔Temporary Partial Disability - ✔✔ex: a broken arm
✔✔Permanent Partial Disability - ✔✔ex: loss of a limb
✔✔Temporary total disability - ✔✔ex: heart attack
✔✔Permanent total disability - ✔✔ex: complete paralysis
✔✔Business Overhead Expense - ✔✔Pays the business if the small business owner
gets disabled
- Its purpose is to pay overhead expenses to keep the business in business
- premiums are tax deductible with benefits being taxable
✔✔Key Employee policy - ✔✔Compensates business for loss due to death or disability
of key employee; premiums not deductible but benefits tax-free.
✔✔Disability Buy-Sell Policy - ✔✔Business disability insurance policy that establishes
how ownership in a business is transferred upon an owner's disability.
✔✔future income option rider (FIO) - ✔✔right to increase benefit (within limits) at certain
dates or ages in future
✔✔COLA rider - ✔✔adjusts monthly benefit
✔✔Return of Premium Rider - ✔✔partial return at contract intervals
✔✔Entire Contract Provision (R) - ✔✔the policy + the application
*changes can only be made by a designated officer of the company
, ✔✔Incontestable Clause (R) - ✔✔company has 2 years to contest validity
✔✔Grace Period Provision (R) - ✔✔7 days weekly premium
10 days monthly premium
31 days other premium
✔✔Reinstatement Provision (R) - ✔✔company NOT obligated
-New application
- Up to 60 days back premium
- starts on 45th day after application
✔✔Notice of Claim provision (R) - ✔✔must notify company of loss within 20 days
✔✔Claim Forms Provision (R) - ✔✔company must transmit claim forms to policy owner
within 15 days of claim notification
✔✔Proof of Loss Provision (R) - ✔✔complete + return claim forms within 90 days
✔✔Time of payment of claims provision (R) - ✔✔medical expense claims paid
immediately
disability income claims paid no less than monthly
✔✔Payment of Claims Provision (R) - ✔✔claims paid to policy owner
✔✔physical exam and autopsy provision (R) - ✔✔company has the right to conduct
physical exams to verify disability
✔✔Legal Action provision (R) - ✔✔owner may sue company for nonpayment of claim.
From 60 days after submitted claim forms until 3 years have passed.
✔✔Change of Beneficiary Provision (R) - ✔✔policy owner has all rights
✔✔Change of Occupation provision (O) - ✔✔must notify company of changed
occupation
✔✔Misstatement of age/gender (O) - ✔✔benefits adjusted
✔✔illegal occupation provision (O) - ✔✔claim denied if injured in commision of a felony
or engaged in illegal occupation
✔✔other insurance with this insurer provision (O) - ✔✔you get paid once
✔✔Medical Expense coverage with multiple companies provision (O) - ✔✔company
may coordinate benefits but only paid once
SOLUTION RATED A+
✔✔Recurrent Disability Provision - ✔✔A disabling condition which returns within a
specified period of time to be considered an extension of prior disability. The insured is
not required to undergo another elimination period.
✔✔waiver of premium provision - ✔✔If the insured is totally disabled for 90 days, future
premiums will be waived as long as the insured remains disabled
✔✔rehabilitation benefit provision - ✔✔pays for retraining to find a job in another line of
work
✔✔nondisabling injury provision - ✔✔will pay for minor injuries that does not affect work
✔✔Temporary Partial Disability - ✔✔ex: a broken arm
✔✔Permanent Partial Disability - ✔✔ex: loss of a limb
✔✔Temporary total disability - ✔✔ex: heart attack
✔✔Permanent total disability - ✔✔ex: complete paralysis
✔✔Business Overhead Expense - ✔✔Pays the business if the small business owner
gets disabled
- Its purpose is to pay overhead expenses to keep the business in business
- premiums are tax deductible with benefits being taxable
✔✔Key Employee policy - ✔✔Compensates business for loss due to death or disability
of key employee; premiums not deductible but benefits tax-free.
✔✔Disability Buy-Sell Policy - ✔✔Business disability insurance policy that establishes
how ownership in a business is transferred upon an owner's disability.
✔✔future income option rider (FIO) - ✔✔right to increase benefit (within limits) at certain
dates or ages in future
✔✔COLA rider - ✔✔adjusts monthly benefit
✔✔Return of Premium Rider - ✔✔partial return at contract intervals
✔✔Entire Contract Provision (R) - ✔✔the policy + the application
*changes can only be made by a designated officer of the company
, ✔✔Incontestable Clause (R) - ✔✔company has 2 years to contest validity
✔✔Grace Period Provision (R) - ✔✔7 days weekly premium
10 days monthly premium
31 days other premium
✔✔Reinstatement Provision (R) - ✔✔company NOT obligated
-New application
- Up to 60 days back premium
- starts on 45th day after application
✔✔Notice of Claim provision (R) - ✔✔must notify company of loss within 20 days
✔✔Claim Forms Provision (R) - ✔✔company must transmit claim forms to policy owner
within 15 days of claim notification
✔✔Proof of Loss Provision (R) - ✔✔complete + return claim forms within 90 days
✔✔Time of payment of claims provision (R) - ✔✔medical expense claims paid
immediately
disability income claims paid no less than monthly
✔✔Payment of Claims Provision (R) - ✔✔claims paid to policy owner
✔✔physical exam and autopsy provision (R) - ✔✔company has the right to conduct
physical exams to verify disability
✔✔Legal Action provision (R) - ✔✔owner may sue company for nonpayment of claim.
From 60 days after submitted claim forms until 3 years have passed.
✔✔Change of Beneficiary Provision (R) - ✔✔policy owner has all rights
✔✔Change of Occupation provision (O) - ✔✔must notify company of changed
occupation
✔✔Misstatement of age/gender (O) - ✔✔benefits adjusted
✔✔illegal occupation provision (O) - ✔✔claim denied if injured in commision of a felony
or engaged in illegal occupation
✔✔other insurance with this insurer provision (O) - ✔✔you get paid once
✔✔Medical Expense coverage with multiple companies provision (O) - ✔✔company
may coordinate benefits but only paid once
