§ 27-8-5-15 — Blanket accident and sickness insurance; qualification of groups; policy provisions; payment of benefits

Indiana § 27-8-5-15

• Jurisdiction: Indiana
• Title 27: INSURANCE
• Art. 8: LIFE, ACCIDENT, AND HEALTH
• Ch. 5: Accident and Sickness Insurance─Policy Provisions

Text

(a) No policy of blanket accident and sickness
insurance shall be delivered or issued for delivery in this state unless
it conforms to the requirements of this section.
(1) A policy may be issued to any common carrier or to any
operator, owner or lessee of a means of transportation, who or
which shall be deemed the policyholder, covering a group of
persons who may become passengers defined by reference to their
travel status on such common carrier or such means of
transportation.
(2) A policy may be issued to an employer, who shall be deemed
the policyholder, covering any group of employees, dependents or
guests, defined by reference to specified hazards incident to an
activity or activities or operations of the policyholder.
(3) A policy may be issued to a college, school, or other
institution of learning, a school district or districts, or school
jurisdictional unit, or to the head, principal, or governing board of
any such educational unit, who or which shall be deemed the
policyholder, covering students, teachers, or employees.
(4) A policy may be issued to any religious, charitable,
recreational, educational, or civic organization, or branch of such
an organization, which shall be deemed the policyholder, covering
any group of members or participants defined by reference to
specified hazards incident to any activity or activities or
operations sponsored or supervised by such policyholder.
(5) A policy may be issued to a sports team, camp, or sponsor of
a sports team or camp, which shall be deemed the policyholder,
covering members, campers, employees, officials, or supervisors.
(6) A policy may be issued to any volunteer fire department, first
aid, emergency management, or other such volunteer
organization, which shall be deemed the policyholder, covering
any group of members or participants defined by reference to
specified hazards incident to an activity or activities or operations
sponsored or supervised by such policyholder.
(7) A policy may be issued to a newspaper or other publisher,
which shall be deemed the policyholder, covering its carriers.
(8) A policy may be issued to an association, including a labor
union, which shall have a constitution and bylaws and which has
been organized and is maintained in good faith for purposes other
than that of obtaining insurance, which shall be deemed the
policyholder, covering any group of members or participants
defined by reference to specified hazards incident to an activity
or activities or operations sponsored or supervised by such
policyholder.
(9) A policy may be issued to cover any other risk or class of risks
which, in the discretion of the commissioner, may be properly
eligible for blanket accident and sickness insurance. The
discretion of the commissioner may be exercised on an individual
risk basis or class of risks, or both.
(b) Each such policy shall contain in substance provisions which in
the opinion of the commissioner are not less favorable to the
policyholder and the individual insured than the following:
(1) A provision that the policy, including endorsements and a
copy of the application, if any, of the policyholder and the persons
insured shall constitute the entire contract between the parties,
and that any statement made by the policyholder or by a person
insured shall in absence of fraud, be deemed a misrepresentation
and not a warranty, and that no such statements shall be used in
defense to a claim under the policy, unless contained in a written
application. Such a person, the person's beneficiary, or the
person's assignee shall have the right to make written request to
the insurer for a copy of such application and the insurer shall,
within fifteen (15) days after the receipt of such request at its
home office or any branch office of the insurer, deliver or mail to
the person making such request a copy of such application. If such
copy shall not be so delivered or mailed, the insurer shall be
precluded from introducing such application as evidence in any
action based upon or involving any statements contained in the
application.
(2) A provision that written notice of sickness or of injury must be
given to the insurer within twenty (20) days after the date when
such sickness or injury occurred. Failure to give notice within
such time shall not invalidate nor reduce any claim if it is shown
not to have been reasonably possible to give such notice and that
notice was given as soon as was reasonably possible.
(3) A provision that the insurer will furnish either to the claimant
or to the policyholder for delivery to the claimant such forms as
are usually furnished by it for filing proof of loss. If such forms
are not furnished before the expiration of fifteen (15) days after
giving of such notice, the claimant shall be deemed to have
complied with the requirements of the policy as to proof of loss
upon submitting, within the time fixed in the policy for filing
proof of loss, written proof covering the occurrence, the character,
and the extent of the loss for which claim is made.
(4) A provision that in the case of claim for loss of time for
disability, written proof of such loss must be furnished to the
insurer within ninety (90) days after the commencement of the
period for which the insurer is liable and that subsequent written
proofs of the continuance of such disability must be furnished to
the insurer at intervals as the insurer may reasonably require, and
that in the case of claim for any other loss, written proof of such
loss must be furnished to the insurer within ninety (90) days after
the date of such loss. Failure to furnish such proof within such
time shall not invalidate nor reduce any claim if it shall be shown
not to have been reasonably possible to furnish such proof and
that such proof was furnished as soon as was reasonably possible.
(5) A provision that all benefits payable under the policy other
than benefits for loss of time will be payable:
(A) immediately upon receipt of due written proof of such loss;
or
(B) in accordance with IC 27-8-5.7;
whichever is more favorable to the policyholder, and that, subject
to due proof of loss, all accrued benefits payable under the policy
for loss of time will be paid not less frequently than monthly
during the continuance of the period for which the insurer is
liable, and that any balance remaining unpaid at the termination
of such period will be paid immediately upon receipt of such
proof.
(6) A provision that the insurer at its own expense, shall have the
right and opportunity to examine the person of the injured or sick
individual when and so often as it may reasonably require during
the pendency of claim under the policy and also the right and
opportunity to make an autopsy where it is not prohibited by law.
(7) A provision that no action at law or in equity shall be brought
to recover under the policy prior to the expiration of sixty (60)
days after written proof of loss has been furnished in accordance
with the requirements of the policy and that no such action shall
be brought after the expiration of three (3) years after the time
written proof of loss is required to be furnished.
The insurer may omit from a policy any portion of any of the above
provisions which is not applicable to that policy. An individual
application need not be required from a person covered under a blanket
accident and sickness policy, nor shall it be necessary for the insurer to
furnish each person a certificate.
(c) All benefits under any blanket accident and sickness policy shall
be payable to the person insured, or to the insured's designated
beneficiary or beneficiaries, or to the insured's estate, except that if the
person insured be a minor or otherwise not competent to give a valid
release, such benefits may be made payable to the insured's parent,
guardian, or other person actually supporting the insured. However, the
policy may provide in substance that all or any portion of any benefits
provided by any such policy on account of hospital, nursing, medical,
or surgical services may, at the option of the insurer and unless the
insured requests otherwise in writing not later than the time of filing
proofs of such loss, be paid directly to the hospital or person rendering
such services; but, the policy may not require that the service be
rendered by a particular hospital or person. Payment so made shall
discharge the insurer's obligations with respect to the amount of
insurance so paid.
(d) This section applies only to policies delivered or issued for
delivery in Indiana after August 19, 1975.
Formerly: Acts 1975, P.L.281, SEC.2. As amended by
P.L.5-1988, SEC.146; P.L.21-1991, SEC.24; P.L.162-2001, SEC.3;
P.L.136-2018, SEC.198.