Chapter 6 Pt3 Flashcards
Injured while robbing convenience store. Payment of claim?
Claim paid in full
Claim denied if policy contains illegal occupation provision
If not convicted claim will be paid
Claim denied if policy contains illegal occupation provision
Excludes coverage for injuries incurred while performing an illegal act
Aleatory
Adhesion
Consideration
Illegal occupation provision
Illegal occupation provision
Purchased policy as window washer; changed to managing library. If insurer is notified insurer should
Adjust benefit with decreased risk
Increase premium
Replace policy with new one
Adjust benefit with decreased risk
Time limit of certain defenses provision prohibits insurers from denying claim due to misrepresentation as long as policy in force for
Six years
Six months
One year
Two years
Two years
Allows ins co to limit insured’s benefits to insured’s average income over the last 24 months if necessary benefits are reduced on a pro rata basis
Insuring clause
Aleatory
Adhesion
Relation of earnings to ins
Relation of earnings to ins
Total amount for single loss under all policies exceeds monthly earnings of insured or his avg monthly earnings for immedate prior two years, insurer will only be liable for
100 dollars
200 dollars
Proportionate amount of benefit
Disproportionate amount of benefit
Proportionate amount of benefit
In no event may benefit be reduced to less than
5 dollars
200 dollars
No minimum
Discretion of emp
200 dollars
Relation of earnings to ins provision allows ins co to limit benefits to his/her average income over last
24 months
36 months
24
Which does insuring clause not specify
Covered perils
Ins com
Name of ins
List of available doctors
List of available doctors
Lists the insured, ins co, what kind of losses and how much losses would be compensated
Covered perils
Ins company
Insuring clause
Consideration clause
Insuring clause
Right to examine provision allows insured a period of several days to look over policy. Commonly
1 day
2 days
10 days
10 days
They may return policy for full return based on
Consideration clause
Free look/right to examine provision
Aleatory contract
Free look/right to examine
Applicant failed to complete application properly. Before being able to complete application and pay initial premium, confined to hospital. This will not be covered by ins bc she has not met conditions specified in the
Eligibility clause
Insuring clause
Consideration clause
Consideration clause
Specifies that both parties to contract must give some valuable consideration
Consideration clause
Insuring clause of disability policy usually states all of following except
Identities of ins co and insured
Ins against loss is provided
Types of losses covered
Method of premium payment
Method of payment
General statement that defines ins agreement and identifies insured and ins co and states what kind of loss is covered
Type of losses covered
Executive contract
Buy loss contract
Insuring clause on first page of contract
Insuring clause on first page
States that period of time must lapse before coverage for specified conditions goes into effect
Elimination period
Waiver of premium
Probationary period
Probationary period
Type of deductible that is commonly found in disability income policies; period of days which must expire after the onset of illness or occurrence of accident before benefits will be payable
Waiver of premium
Probationary period
Elimination period
Elimination period
Provision most commonly found in disability income policies; applies to new employees who must wait certain period of time before they can enroll in group playin to avoid unecessary administrative expenses in employee turnover
Elimination period
Probationary period
Consideration period
Executive consideration period
Probationary period
Provision or rider is included with guaranteed renewable and noncancellable disability income policies; provides that in event of permanent and total disability premiums will be waived for duration of disability
Pre existing conditions clause
Waiver of premium
Probationary period
Elimination period
Waiver of premium
To qualify for this insured must be totally disabled for specified period of time usually three to six months
Waiver of premium
Pre existing clause
Coinsurance clause
Deductible clause
Waiver of premium
During this waiting period insured must continue to pay the policy premium but usually waiver is retroactive to date disability began and premiums paid during this waiting period will be refunded
Waiver of premium
Preexisting clause
Probationary period
Elimination period
Waiver of premium
Rider generally expires when insured attains age 65; however as long as insured becomes disabled prior to 65 premiums will continue to be waived for duration of disability
Probationary period
Deductible period
Waiver of premium
Waiver of premium
Hospitalized with back injury. Upon checking disability income policy learns he will not be eligible for benefits for at least thirty days. Indicates
Waiver of benefits period
Elimination period
Blackout period
Probationary period
Elimination period
Immediately following start of disability benefits are not payable; reduces cost of providing coverage and eliminates filing of many claims
Which of following would be considered consideration on part of applicant for ins
Payment of premium
Promise to renew the policy at the end of policy period
Providing warranties on application
Payment of premium
Two types of considerationon part of ins applicant are
Payment of premiums and representations on application
Payment of debts and policy cancellation
Providing warranties and promise to review
Payment of premiums and presentations on application
Purpose of coinsurance provisions
To have insured pay premiums to more than one company
To guarantee payment to doctors and hospitals
To share liability among different ins companies
To help ins company to prevent over utilization of policy
To help ins company to prevent over utilization of the policy
Waiver of premium provision may be included with which kind of health ins policy
Hospital indemnity
Dread disease
Disability income
Basic medical
Disability income
Endured multiple surgeries and hospitalizations for illness during last few months. Insurer no longer bills her for medical expenses. Which of the following allows for that
Waiver of premium
Grace period
Stop loss limit
Maximum loss
Stop loss limit
Specified dollar amount in which insured no longer shares expenses
Stop go limit
Stop help limit
Stop loss limit
Stop loss limit
Provides for sharing of expenses between insured and ins company
Coinsurance
Stop loss
Deductible
Divided cost
Coinsurance
With coinsurance the Larger percentage is paid by insured
Lower required premium will be
Higher required premium will be
Lower required premium will be
