Unit 29: Required Uniform Policy Provisions Flashcards
Page 403
What do “required uniform policy provisions” do?
Handwritten note:
Protects the consumer
Is the Uniform Policy Provision Law in ALL states?
Yes, all have “adopted” it
How many total provisions are there?
How many are required?
How many are optional?
23
12 required
11 optional
Pages 404 – 411 (Required Provisions – 12 of them)
Required Provision 1: “Entire Contract; Changes” states what?
No agent has authority to change a policy or waive any of its provisions
What does the “entire contract’ mean? in regards to Provision 1
- the policy itself,
- any endorsements,
- any attached papers (application, riders) - nothing else
Required Provision 2: “Time Limit on Certain Defenses–Incontestability” states what?
- After 2 yrs from date of issues of policy, no misstatements, except fraudulent misstatements shall be used to void the policy or deny a claim for a loss
- Unless an insured’s misstatements are fraudulent, after 2 years from policy issue date, policy becomes incontestable
Handwritten notes say:
- Different from life insurance
- Can void if they have found out that you have lied on application
Required Provision 3: “Grace Period” states what? how many days of a “grace period”
Nothing highlighted, just handwritten notes. You might want to skim the page
- Insurers must allow the insured a grace period for premium payment - a specific time following the premium due date during which the company continues coverage in full force. No penalty for late premium payment, insur co accepts it as on time.
7 days for weekly things
10 days for monthly
31 days for all other policies
Required Provision 4: “Reinstatement” states what? Two parts…
Background: An insured (not insur co) may cancel a policy at time, or let it lapse and it’ll cancel.
Mumbo jumbo legal paragraph: I guess they are trying to say that a policy where premiums are delayed, policy lapsed can:
- be reinstated either after payment of premium (and a conditional receipt provided to insured) and an application for reinstatement is approved OR,
- lacking such approval, the 45th day following the date of of such conditional receipt (for payment of premium).
WORD VOMIT
Page 406 (you might want to read this page)
When is a lapsed policy reinstated (according to the reinstatement provision)?
when the insur co or an authorized agent accepts subsequent payments – they still may require an application for reinstatement and a insurer must accept premium payment
How much time does the insurer have to notify the insured who has submitted an reinstatement application and received a conditional receipt for the premium tendered?
Insur co will usually notify the applicant whether or not policy has been reinstated.
If insur co does NOT contact insured, policy automatically reinstates on the 45th day after the date of the receipt
Part 2 of Reinstatement provision:
What does the reinstate policy cover?
Reinstated policy shall cover only loss resulting from such accidental injury as may be sustained after the date of reinstatment and loss due to such sickness as may begin more than 10 DAYS after such date.
How is reinstatement premium applied?
To a period for which premium has not been previously paid, but not to any period more than 60 days prior to the date of reinstatement.
Page 407
Required Provision 5: “Notice of Claim” states what?
written notice of claim must be given to the insurer within 60 DAYS after occurrence or commencement of any loss covered by the policy, or as soon thereafter as is reasonably possible.
What is the essence of this provision? 5th provision (notice of claim)
(Last paragraph in this section should have been highlighted, makes more sense than the highlighted legal mumbo jumbo.
Key is 6 MONTHS)
if the policy provides disability income for an extended period, the insurer can require the insured to provide, EVERY 6 MONTHS, written notice that the claim is continuing.
Page 407-408
Required Provision 6: “Claim Forms” states what?
This paragraph should have been highlighted top of page 408
In essence, when an insurer receives notice of a claim, it should furnish insured with forms to provide proof of loss WITHIN 15 DAYS
Required Provision 7: “Proof of Loss” states what?
written proof of loss must be furnished to insurer within 90 DAYS after date of loss,
and in no event, except in the absence of legal capacity, no later than 1 YEAR from time proof is otherwise required
This is if a policy is paying out and in required to showing proof of a claim. so a next level of the 60 days
So they receive notice of cliam, company does form, and the insured must show proof of the lose.
Page 409
Required Provision 8: “Time of Payment of Claims” states what?
Insurer must make payment IMMEDIATELY after receiving proof of loss
Payment of periodic indemnities (compensation for loss) must be made monthly (i.e. for disability)
…Page 410
Required Provision 9: In the “Payment of Claims” provision, what 2 things does the “facility of payment clause” stipulate?
- if the insured or the beneficiary cannot legally release the company from further liability, as when the insured or beneficiary is a minor or is legally incapacitated, the company may pay the benefits to any relative by blood/marriage who is deemed to be entitled to the money
- The amount paid to this person can’t exceed $1,000
Page 411
Required Provision 10: “Physical Examination and Autopsy” states?
NOTHING highlighted…
- If insured is alive and receiving benefits, may require physical exams.
- if insured died (accidentally) insurer may have an autopsy done to determine cause of death. (state laws may prevent an autopsy from being done and these laws take precendence)
Required Provision 11: “Legal Actions” states?
(When written proof of loss has been submitted, the insur co needs time to investigate the claim to determine validity.)
-This provision prohibits insured from suing the insurer for at least 60 days after filing a written proof of loss
- Max time to file a suit is 3 yrs after written proof of loss is supplied
Required Provision 12: “Change of Beneficiary” states?
Policyowner (usually the insured) may name a beneficiary either:
- revocably - means the insured can change beneficiary later OR
- irrevocably - beneficiary designation can not be changed
Page 412
handwritten notes - Numbers to remember about REINSTATEMENT
45 days - automatic
10 days - sickness waiting period
60 days - back premium
handwritten notes - Numbers to remember about CLAIMS
60 days - written notice
15 days - forms supplied
90 days, 1 yr - written proof of loss
6 months - continuance of disability
