Health Final Exam - Preexisting Condition & Time Limit on Certain Defenses

Health Final Exam - Preexisting Condition & Time Limit on Certain Defenses

by Marie Tan -
Number of replies: 2

Can someone explain to me the correct answer on this question?

Study manual states: In the event the insured did not specifically cite the condition on the application and the insurer did not expressly exclude the condition from coverage, the preexisting condition provision would serve to exclude the condition nonetheless. However such exclusions are subject to the "time limit on certain defenses" provision.  The Time Limit Provision says the policy is "incontestable after it has been in force a certain period of time, usually two years... Under the provision, the insurance company cannot deny a claim on the basis of a preexisting condition after expiration of the stated contestable period."


The exam question below is clearly past the 2 year mark, hence wouldn't the time limit provision take effect and thus the insurer has to pay the claim?

EXAM QUESTION:

Maria is disabled thirty months after her disability income policy is issued. The disability is caused by a condition that existed prior to the policy issue date but was not specifically revealed on the application. In this situation, the insurance company will most likely:

Select one:
A. pay the full claim Incorrect
B. deny the claim on the basis of misrepresentation
C. pay the claim for a short term only
D. deny the claim because it involves a pre-existing condition

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In reply to Marie Tan

Re: Health Final Exam - Preexisting Condition & Time Limit on Certain Defenses

by Jerry Bateman - -

Hey Marie,

Please advise the page number of the study manual reference.  Thank you.

Jerry Bateman

In reply to Marie Tan

Re: Health Final Exam - Preexisting Condition & Time Limit on Certain Defenses

by Jerry Bateman - -

Hey Marie,

I found the answer on page 362 in the manual.  I am going to agree with you.  The answer to this question should be A.  Thank you for pointing this out.  I will change the question in the online material.

Jerry Bateman