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Zorluk: KolayInitial Premium and Premium Receipts

Sarah meets with her insurance agent on Tuesday to finalize her life insurance application. She writes a check for the first premium and receives a conditional receipt. Sadly, Sarah suffers a fatal heart attack on Thursday before the insurer completes the final underwriting process. The home office underwriters later confirm that Sarah was a standard risk on the day she applied.

Based on these facts, how will the insurance company handle this claim?

  1. The company will pay the full death benefit because she was insurable as a standard risk on the application date.Cevap
  2. B
    The company will return the premium to her estate because the policy had not been formally approved and issued prior to her death.
  3. C
    The company will deny the claim because Sarah was not alive to sign a Statement of Good Health upon policy delivery.
  4. D
    The company will pay the death benefit only if the agent possessed the express authority to bind coverage immediately.

Cevap

The company will pay the full death benefit because she was insurable as a standard risk on the application date.
When a conditional receipt is issued after collecting the initial premium, coverage becomes effective on the date of the application (or medical exam, if required) provided the applicant is later found to be insurable as a standard risk. Because Sarah was determined to be insurable on the application date, the coverage was in force when she died two days later, and the insurer must pay the death benefit.

Adım Adım Çözüm

1
Analyze the conditions established on Tuesday.
Sarah submitted the application, paid the initial premium, and received a conditional receipt.
Paying the initial premium with the application is the necessary trigger for a conditional receipt to provide potential retroactive coverage.
2
Evaluate the underwriting determination.
The underwriters confirmed she was a standard risk on the date of application.
A conditional receipt requires the applicant to be insurable as applied for in order for coverage to take effect.
3
Determine the effective date of coverage.
Coverage became effective retroactively on Tuesday, prior to her death on Thursday.
Because she met the underwriting requirements, the conditional receipt made the policy effective on the application date, obligating the insurer to pay the claim.

Anahtar Kavram

Conditional Receipt Effective Date
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