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Question

Difficulty: MediumInitial Premium and Premium Receipts

During a meeting on August 12, a prospective client fills out the paperwork for a life insurance policy, hands the producer a check for the first premium, and is given a conditional insurability receipt. The insurer requires a standard medical examination, which the client undergoes on August 16. Unfortunately, the client dies in an unforeseen accident on August 19. Three days later, the insurer's underwriters finish reviewing the file and conclude that the client was indeed insurable as a standard risk on the day of the exam. Based on these circumstances, what is the insurer's legal obligation regarding this claim?

  1. A
    Only a premium refund will be provided since the home office had not formally approved the risk prior to the client's death.
  2. B
    The death benefit is fully payable because the producer's acceptance of the check established an immediate binding contract on August 12.
  3. The death benefit is fully payable because the coverage took effect retroactively on the date of the medical exam.Answer
  4. D
    Only a premium refund will be provided because the policy was never delivered and a statement of good health was not collected.

Answer

The insurer must pay the full death benefit because the coverage took effect retroactively on August 16, the date the medical examination was completed.
The correct answer accurately reflects the function of a conditional insurability receipt. When a premium is paid with the application and a conditional receipt is issued, coverage becomes legally effective on the date of the application or the date of the required medical exam, whichever is later. Since the client completed the medical exam on August 16 and was later found to be insurable on that date, the coverage retroactively went into force on August 16. Therefore, the August 19 death is fully covered, and the insurer must pay the death benefit.

Step-by-Step Solution

1
Identify the type of receipt issued during the initial meeting.
A conditional insurability receipt was provided to the client after the initial premium was paid.
The specific type of receipt dictates the legal rules for when life insurance coverage becomes effective.
2
Determine the required conditions for the coverage to become active.
The client needed to complete a medical exam and be found insurable as a standard risk by the underwriting department.
Conditional receipts hinge entirely on the applicant proving insurability according to the insurer's guidelines.
3
Establish the exact effective date of the coverage.
Because the client was approved as a standard risk, coverage retroactively began on August 16, the date of the medical exam.
Under a conditional receipt, coverage starts on the date of the application or the date of the medical exam, whichever occurs later.
4
Compare the effective date of coverage to the date of loss.
The client died on August 19, which falls after the August 16 effective date.
Because the death occurred while the conditional coverage was legally active, the insurer is fully liable for the death benefit claim.

Key Concept

Conditional Insurability Receipts and Retroactive Effective Dates
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Topics

Initial Premium and Premium Receipts

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