[§431:10-211.5]  Premium waiver provisions;
restrictions.  (a)  Whenever an insurance policy contains a provision or a
rider for the waiver of premiums in the event of the total disability of the
named insured, the waiver of premiums shall be applicable throughout the period
of total disability or for the balance of the waiver period specified in the
policy 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 insured
which attests to the insured's medical condition and states the period that the
condition will last.  If the period that the condition will last cannot be
established with reasonable medical certainty, the physician shall state an
opinion of the period during which the condition is likely to persist.  If the
insurer does not accept the insured's physician's diagnosis or estimate of the
period that the condition will last, the insured will be examined by a second
physician selected by the insurer at the insurer's expense.  The insurer will
accept the second physician's diagnosis and estimate of the period that the
condition will last in order to determine total disability and waiver of
premium benefits to be provided.  The insured will be furnished with copies of
all physicians' reports.



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



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



(b)  When the insurer has determined there is
total disability and the probable period that it will last, the insurer shall
require further certification during the stated period of disability or
probable disability only at its expense and not more often than once in any
three calendar years, unless there is evidence of a change of circumstances
that indicate a change in the medical condition of the insured.



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



 



Note



 



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