Chapter 6 Part 2 Flashcards
Linda broke her hip and notified agent in writing within 12 days of loss. Agent did not notify ins company until 60 days after loss. Which statement explains how handled
Insurer may deny claim since was not notified within 20 day time frame
Insurer is considered to be notified since notification to agent equals notification to insurer
The contract is going to be void
Insurer is considered to be notified since notification to agent equals notification to insurer
In event of loss …after notice of claim submitted to insurer… who is responsible for providing claim forms and to which party?
Agent to insurer
Insurer to insurer
Insurer to insured
Insurer to insured
Which of following is mandatory for health ins policies
Unpaid premiums
Intoxicants and narcotics
Rocks and blunts
Physical exam and autopsy
Physical exam and autopsy
Payment of claims provision states that claims must be paid to policyowner unless
Paid to dependent
Paid to estate
Paid to beneficiary
Proceeds need to be paid to beneficiary
While claim is pending ins company may require
Insured to be examined
only within first 30 days
Only once annually
Independent exam as often as reasonably required
Independent exam as often as reasonably required
Under uniform required provisions proof of loss under health ins policy normally should be filed within
20 days of loss
30 days of loss
90 days of loss
90 days of loss
Under physical aexam and autopsy provision how many times can insurer have insured examined at its own expense while claim pending
1 exam per week of claim processing
2 exams per week of claim processing
Unlimited
Unlimited
On following occurrence of covered loss must insured submit written proof of such loss to ins company
As soon as possible
Within 20 days
Within 60 days
Within 90 days or as soon as reasonable possible but not to exceed 1 year
90 days but not to exceed 1 year
Re insured’s duty to provide insurer with reasonable notice in event of loss
Loss of notification
Claims initiation
Notice of claim
Notice of claim
Time limit of certain defenses provision prohibits insurers from denying claim due to misrepresentation as long as policy has been in force for at least
1 year
6 months
Five years
2 years
2 years
Insured submitted notice of claim to insurer but never recd claims forms. Later submits proof of loss and explains nature and extent in hand written letter. Which would be true
Insured was in compliance with policy requirements re claims
Claim will be denied
Claim will be buried in mud
Insurer will be fined for not providing claim forms
Insured was in compliance with policy requirements re claims
Misstated her age on app for individual health ins policy. Insurance co found mistake after conteetsable period had expired. Ins company will
Deny paying claim
Pay full amount
Adjust claim to reflect insured’s true age
Adjust claim to reflect insured’s true age
Misstatement of age provision says that if client misstates her age, intentional or unintentional, they will adjust benefit and
Send a message in a bottle
Invite to dinner
Doesnt matter when mistake was found
Everything is canceled
Doesnt matter when the mistake was found
Max period of time insurer may contest fraudulent misstatements made in health ins application
90 days after effective policy date
As long as policy is in force
Until minor move out
As long as policy is in force
Under disability income ins policy changes to more hazardous occupation after policy has been issued and claim is filed ins company should
Increase premium
Exclude coverage for on the job injury
Adjust the benefit in accordance with increase risk
Adjust benefit in accordance with the increased risk
