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Difficulty: MediumInitial Premium and Premium Receipts

On August 5, an architect applies for a comprehensive life insurance policy, pays the initial premium, and receives a conditional insurability receipt from the producer. Due to the high face amount of the policy, the insurer requires a comprehensive medical examination, which the applicant completes on August 9. Unfortunately, the applicant dies in a commercial aviation accident on August 11 before the insurer has approved the application. The underwriting department subsequently reviews the file and determines the applicant was insurable at a standard risk classification on the date of the medical exam.

Based on these circumstances, which of the following statements regarding the insurer's obligations are correct? (Select all that apply)

  1. The insurer is legally obligated to pay the full death benefit to the designated beneficiary.Answer
  2. The effective date of the insurance coverage is retroactively established as August 9.Answer
  3. C
    The coverage became unconditionally binding on August 5, regardless of the medical examination results.
  4. D
    The insurer may deny the death claim because a Statement of Good Health could not be collected at policy delivery.

Answer

The insurer must pay the full death benefit, and the effective date of coverage is established retroactively to the date of the medical exam (August 9).
When a conditional insurability receipt is issued and a medical exam is required, the coverage becomes conditionally effective on the date of the medical exam. Because the underwriting department determined the applicant was insurable as a standard risk as of that date, the coverage retroactively took effect on August 9. Consequently, the policy was active when the applicant died on August 11, obligating the insurer to pay the full death benefit.

Step-by-Step Solution

1
Identify the type of receipt issued and whether a medical exam was required.
A conditional insurability receipt was issued on August 5, and a medical exam was required and completed on August 9.
The type of receipt and exam requirements determine the trigger for the effective date of coverage.
2
Determine the effective date of coverage under the conditional receipt rules.
Coverage becomes conditionally effective on the date of the application or the date of the medical exam, whichever is later. Here, the effective date is August 9.
Conditional receipts hinge coverage on the completion of all required medical requirements.
3
Evaluate the underwriting decision.
The applicant was found to be insurable as a standard risk as of the exam date.
The conditional coverage only becomes permanent and retroactive if the applicant meets the insurer's underwriting standards.
4
Apply the effective date to the time of loss.
Since coverage was retroactively active starting August 9 and the death occurred on August 11, the insurer is liable for the death claim.
The loss occurred while the retroactive coverage was in force.

Key Concept

Conditional receipts provide coverage that becomes effective on the date of application or the date of a required medical exam (whichever is later), provided the applicant is subsequently found to be insurable at the applied-for risk class.
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Topics

Initial Premium and Premium Receipts

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