§ 10295.5. — 10295.5. (Amended by Stats. 2018, Ch. 98, Sec. 8.)

California § 10295.5.

• Jurisdiction: California
• Code INS: Insurance Code - INS
• Div. 2.: DIVISION 2. CLASSES OF INSURANCE
• Part 2.: PART 2. LIFE AND DISABILITY INSURANCE
• Ch. 4.: CHAPTER 4. Standard Provisions in Disability Policies
• Art. 2.1.: ARTICLE 2.1. Accelerated Death Benefits

Text

(a)
Applications, if any, or forms supporting an application, if any, for accelerated death benefits shall contain clear, unambiguous, short, and simple questions designed to ascertain the health condition of the applicant. Each health-related question shall contain only one health status inquiry and shall require only a “yes” or “no” answer, except that the application may include a request for the name of any prescribed medication and the name of the prescribing physician. If the application requests the name of any prescribed medication or the prescribing physician, then any mistake or omission shall not be used as a basis for the denial of a claim or the rescission of the accelerated death benefit or life insurance policy or certificate.
(b)
The following
warning shall be printed conspicuously and in close conjunction with the applicant’s signature block:
“Caution: If your answers on this application are misstated or untrue, the insurer may have the right to deny benefits or rescind your accelerated death benefit coverage.”
(c)
If an insurer does not complete medical underwriting for the accelerated death benefit separate from underwriting for the life insurance policy and resolve all reasonable questions arising from information submitted on or with an application before issuing the accelerated death benefit, then the insurer may only rescind the accelerated death benefit or life insurance policy or certificate or deny an otherwise valid claim upon clear and convincing evidence of fraud or material misrepresentation of
the risk by the applicant. The evidence shall do all of the following:
(1)
Pertain to the condition for which benefits are sought.
(2)
Involve a chronic condition or involve dates of treatment before the date of application.
(3)
Be material to the acceptance for coverage.
(d)
An accelerated death benefit may not be field issued.
(e)
The contestability period for a life insurance policy or certificate that contains an accelerated death benefit shall comply with paragraph (3) of subdivision (c) of Section 10271.
(f)
A copy of the completed application shall be delivered to the insured at the time of delivery of the life
insurance policy or certificate that contains an accelerated death benefit.

Legislative History

Amended by Stats. 2018, Ch. 98, Sec. 8. (AB 2180) Effective January 1, 2019.