Mandatory Provisions Flashcards
What is required from a policyholder under the notice of claim provision?
The policyholder must notify the insurer within 20 days of the incident, or as soon as possible. Notification to an agent is considered as notification to the insurer
What is the insurer’s responsibility regarding claims forms after receiving a notice of claim?
The insurer must provide the necessary claims forms to the policyholder within 15 days of receiving the notice of claim
What are the requirements and time frame for submitting a proof of loss?
The policyholder must submit a proof of loss within 90 days, which can extend up to one year if the claimant is not legally competent.
What is the insurer’s obligation once they receive the proof of loss?
The insurer must pay the claims immediately unless otherwise specified in the policy. In Florida, the typical period to settle claims is within 45 days.
What rights does the “Physical Examination and Autopsy” provision grant to the insurer?
It allows the insurer to request physical examinations of the insured at reasonable intervals during the claims process and to require an autopsy where permissible by law, to verify the cause of death.
What are the timing limitations imposed by the “Legal Actions” provision on lawsuits against an insurer?
The insured must wait 60 days after submitting proof of loss before initiating legal action and must file any lawsuit within the statute of limitations, which is 5 years in Florida.
How does a change to a more hazardous occupation affect the insurance benefits under the “Change of Occupation” provision?
If the insured changes to a more hazardous occupation, the insurer may reduce the benefits to match the risk level covered by the original premium.
What is the impact of the “Illegal Occupation” provision on the policy coverage?
The provision voids coverage if the insured engages in an illegal occupation or commits an illegal act that leads to a claim.
How does the “Relation of Earnings to Insurance” provision affect the benefit amount in a disability insurance policy?
It limits the benefits to a percentage of the insured’s pre-disability earnings, typically around 60% to 70%, to provide financial support while encouraging the insured to return to work when able.
