[§431:10-211.5]  Premium waiver provisions;restrictions.  (a)  Whenever an insurance policy contains a provision or arider for the waiver of premiums in the event of the total disability of thenamed insured, the waiver of premiums shall be applicable throughout the periodof total disability or for the balance of the waiver period specified in thepolicy or the rider, whichever is shorter.  To qualify for the premium waiver,the insured shall submit a certificate from a physician who is selected by the insuredwhich attests to the insured's medical condition and states the period that thecondition will last.  If the period that the condition will last cannot beestablished with reasonable medical certainty, the physician shall state anopinion of the period during which the condition is likely to persist.  If theinsurer does not accept the insured's physician's diagnosis or estimate of theperiod that the condition will last, the insured will be examined by a secondphysician selected by the insurer at the insurer's expense.  The insurer willaccept the second physician's diagnosis and estimate of the period that thecondition will last in order to determine total disability and waiver ofpremium benefits to be provided.  The insured will be furnished with copies ofall physicians' reports.

The insurer will also furnish the insured withan explanation of the insurer's decision regarding the total disability underthe terms of the contract and the expected period it will last.

If the insured does not agree with theinsurer's decision, the insured may appeal to the insurance commissioner withinthirty days following receipt of the written notice of insurer's decision.

(b)  When the insurer has determined there istotal disability and the probable period that it will last, the insurer shallrequire further certification during the stated period of disability orprobable disability only at its expense and not more often than once in anythree calendar years, unless there is evidence of a change of circumstancesthat indicate a change in the medical condition of the insured.

(c)  If a claim for premium waiver has beenfiled after expiration of the grace period specified in the insurance policy,and the qualifying disability has been proved, and the policy owner hasdemonstrated good faith and honest error justifying the late filing for premiumwaiver, the insurer shall refund premiums paid after the date the premiumwaiver would have been effective if the claim had been filed within the periodspecified in the policy for filing claims. [L 1989, c 336, §1]

 

Note

 

  Derivation.  L 1987, c 250, §1 and L 1989, c 276, §2.