ch.3- life ins, a&s ins, anuity claims pmt of proceeds

Question 1

claimant

Answer 1

• may be insured, or insureds estate, or beneficiary, or assignee

Question 2

insurers records

Answer 2

• insurers pay beneifts based on most recent beneficiary designation on file or estate if n o ben.

Question 3

notice of claim

Answer 3

• insurer usually receives notice of eth from agent, estate executor, beneficiary or emplyer
• once NOD recd, no more premiums, and insurer waits to reeive claim
• insurer not req to notify bens.

Question 4

proof of claim: docs req

Answer 4

• beneficiary completed claim form

- -> oncde recd insurer will assess if claim payale, and pay of entitled

Question 5

proof of claim: claimant needs to proove (4)

Answer 5

• insured person died
• insured persons age
• claimant has right to benefit
• claimant name and identity

may req more evidence

Question 6

proof of claim: probate

Answer 6

must receive sufficient evidence of parties right to pmt

Question 7

proof of claim: proof of age

Answer 7

• if aent properly verified age at time of app, insurer will use age on file w/o proof

Question 8

proof of claim: proof of identity

Answer 8

• person who changed nam (i.e marriage) needs additional proof, ppl w common name (?)
• bens describe in terms: children, court app trustee, executor, guardian, etc….. have to establish qualification w additional proof

Question 9

proof of claim: accidental vs natural causes (loimitations, accidental deth)

Answer 9

• if limitations on casue of death, insurer may investigate further
• may req more proof if policy has esclusions
• accidental death policies: only pay if death is accident–> need proof deth was accident

-

Question 10

disappearance + presumptions of death

Answer 10

• if insured missing more than 7 yrs –> court can declare dead
• if policy lapsed due to non pmt— need to proove policy was in force while alive

Question 11

death of 2 or more ppl

Answer 11

• time and seq of deth importan t to estab lish who entitled to benefits
• jpit policy— may state who is presumed to have died 1st

Question 12

payment in to court

Answer 12

• if insurer cant determine beneiciary or if a minor, prov+ terr ins legislation allows payment to coursts, releases insurer from liability

Question 13

proceeds on deposit

Answer 13

• policy settlement options; insurer mayb provide options for pmt of DB
• most common: lump sum pmt to ben. or executor

Question 14

time to pay claim

Answer 14

• insurer must pay claim w/in 30 days os proper evidence

- seg fund/IVIC: DB must be calculated

Question 15

Denial of claim (3+1)

Answer 15

• fraud
• pmt of db against public order (i.e ben. killed insured)
• lapse– pmt default

4th: limitation period- claim not made in timely mannerr

Question 16

pmt contrary to public order

Answer 16

beneficiary caused death of life insured

Question 17

accidental death and dismemberment (AD&D)

Answer 17

• PH can name ben.
• if accident cause loss of i.e limbs: pmt to PH/insured
• if accident = loss of line–> pmt to ben.

Question 18

accident and sickness claims (AADC)

Answer 18

diff benefits payable

• accidental injury/ dismemberment
• accidental death
• disability
• critical illness

Question 19

A&S claims: accident death + dismemberment claims

Answer 19

• PH can name ben.
• if accident cause loss of i.e limbs: pmt to PH/insured
• if accident = loss of life–> pmt to ben.

Question 20

A&s: disability claims

Answer 20

• unable to work, work F/T, continue same job
• caused by accident, illness, mental/psychological conditions (depression, anxiety)
• requires doctor to provide attending physician stmt (APS)
  SEE PG 91

Question 21

A&s diability claims: Critical illness (CI)

Answer 21

cRITICAL ILLNESS— lump sum pmt, once paid CI policy finished
if insured dies for reason not it CI policy— premiums refunded to ben.

Question 22

SEG FUNDS + ANNUITIES

Answer 22

• When dead: ben or estate gets DB –> unless if immediate annuity if pmts started—>???

Question 23

immediate or payout annuity

Answer 23

• can be purchased w guarantee period—> if death before guaraneed # pmts, insurer still has to make pmts (to annuity grantee)

Question 24

amts accrued in annuity for retirement

Answer 24

• locked in

- may only be trfd to a: LIRA, another pension plan, purch immediate life ann. or deferred life ann. , LIF

Question 25

seg funds/ann.: Death before retirement

Answer 25

• spouse becomes eligible to receive pmts
• no spouse—> paid to ben
• no Ben. —-> paid to estate

Question 26

seg funds/ann: Death after retirement

Answer 26

• spouse may be eligible or survivors DB –> reduced amt of pension paid to pensioner
• if no spouse—> commuted lump sum of rest of pmts to ben
• if no Ben.—> to estate