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Question

Difficulty: HardInitial Premium and Premium Receipts

On October 5, Harrison completes an application for a permanent life insurance policy, pays the initial premium, and is issued a conditional insurability receipt. The insurer's underwriting guidelines require him to complete both a standard paramedical examination and a separate treadmill stress test. Harrison completes the paramedical exam on October 9 and the stress test on October 16. Tragically, he is killed in a structural collapse on October 20, before the home office completes the underwriting process. On October 25, underwriters review his file and determine he met all criteria for a standard risk classification. Based on these events, what is the effective date of coverage and what is the insurer's corresponding liability?

  1. A
    The effective date of coverage is October 5, as the applicant's payment of the initial premium establishes immediate, unconditional coverage until the policy is issued.
  2. B
    Coverage never became effective because the insurer did not grant final underwriting approval prior to the applicant's death, resulting in a premium refund.
  3. The effective date of coverage is October 16, and the insurer is obligated to pay the full death benefit to the beneficiary.Answer
  4. D
    The insurer will deny the claim because the policy could not be delivered to obtain a mandatory Statement of Good Health from the applicant.

Answer

The effective date of coverage is October 16 (the date of the final required medical exam), and the insurer must pay the full death benefit since the applicant was ultimately found insurable.
Under a conditional insurability receipt, coverage becomes effective on the date of the application or the date of the medical examination, whichever is later. When multiple exams are required by underwriting, the date of the last required exam (October 16) serves as the effective date. Because the applicant was ultimately determined to be an acceptable standard risk, coverage retroactively took effect on October 16. Since he died on October 20, the policy was fully in force at the time of his death, legally obligating the insurer to pay the death benefit.

Step-by-Step Solution

1
Identify the type of receipt issued and the premium payment status.
An initial premium was paid and a conditional insurability receipt was issued.
This determines the contractual rules for when coverage retroactively becomes effective.
2
Determine the effective date rules for a conditional receipt.
Coverage is effective on the date of the application or the date of the last required medical exam, whichever is later, provided the applicant is insurable.
Multiple medical exams were required in this scenario, meaning the later date applies.
3
Apply the chronological events to the effective date rule.
The stress test on October 16 was the last required exam, establishing October 16 as the retroactive effective date.
All medical underwriting requirements set by the insurer were fulfilled on this specific date.
4
Evaluate the insurer's liability upon the applicant's death.
Because the applicant died after October 16 and was found to be a standard risk by the underwriters, the coverage was fully in force at the time of death.
The insurer is legally liable for paying the full death benefit to the beneficiary.

Key Concept

Conditional Insurability Receipts and Multiple Medical Exams
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Topics

Initial Premium and Premium Receipts

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