40-2210.Blanket sickness and accident insurance; payments, when blanketdisability income policy is integrated with social security benefits.(A) Blanket sickness and accident insurance is hereby declared to bethat form of sickness and accident insurance covering special groups ofpersons as enumerated in one of the following paragraphs (1) to (8)inclusive: (1) Under a policy or contract issued to any common carrier,or to any operator, owner or lessee of a means of transportation, who orwhich shall be deemed the policyholder, covering a group defined as allpersons who may become passengers on such common carrier or such meansof transportation.
(2) Under a policy or contract issued to a college, school or otherinstitutions of learning, a school district or districts, or schooljurisdictional unit, or to the head, or principal; or governing board ofany such educational unit, who or which shall be deemed thepolicyholder, covering students, teachers or other employees.
(3) Under a policy or contract issued to any volunteer firedepartment, first aid, civil defense, or other such volunteerorganization, which shall be deemed the policyholder, covering all themembers of such department or group, defined by reference to specifiedhazards incident to an activity or activities or operations sponsored orsupervised by such policyholder.
(4) Under a policy or contract issued to a sports team, camp orsponsor thereof, which shall be deemed the policyholder, covering ten(10) or more members, campers, employees, officials or supervisors.
(5) Under a policy or contract issued to an employer, who shall bedeemed the policyholder, covering any group of employees, dependents orguests, defined by reference to specified hazards incident to anactivity or activities or operations of the policyholder.
(6) Under a policy or contract issued to any religious, charitable,recreational, educational, or civic organization, or branch thereof,which shall be deemed the policyholder, covering any group of members orparticipants defined by reference to specified hazards incident to anactivity or activities or operations sponsored or supervised by suchpolicyholder.
(7) Under a policy or contract issued to a newspaper or otherpublisher, which shall be deemed the policyholder, covering itscarriers.
(8) Under a policy or contract issued to any other type of groupwhich the commissioner of insurance may find properly subject to theissuance of blanket sickness and accident policy or contract.
(B) Every such blanket policy shall contain provisions which in theopinion of the commissioner are not less favorable to the policyholderand the individual insured than the following:
(1) A provision that the policy, including endorsements and a copyof the application, if any, of the policyholder and the persons insuredshall constitute the entire contract between the parties, and that anystatement made by the policyholder or by a person insured shall inabsence of fraud, be deemed a representation and not a warranty, andthat no such statements shall be used in defense to a claim under thepolicy, unless contained in a written application. Such person, his or herbeneficiary, or assignee, shall have the right to make written requestto the insurer for a copy of such application and the insurer shall,within fifteen (15) days after the receipt of such request at its homeoffice or any branch office of the insurer, deliver or mail to theperson making such request a copy of such application. If such copyshall not be so delivered or mailed, the insurer shall be precluded fromintroducing such application as evidence in any action based upon orinvolving any statements contained therein.
(2) A provision that written notice of sickness or of injury must begiven to the insurer within twenty (20) days after the date when such asickness or injury occurred. Failure to give notice within such timeshall not invalidate nor reduce any claim if it shall be shown not tohave been reasonably possible to give such notice and that notice wasgiven as was reasonably possible.
(3) A provision that the insurer will furnish either to the claimantor to the policyholder for delivery to the claimant such forms as areusually furnished by it for filing proof of loss. If such forms are notfurnished before the expiration of fifteen (15) days after giving ofsuch notice, the claimant shall be deemed to have complied with therequirements of the policy as to proof of loss upon submitting, withinthe time fixed in the policy for filing proof of loss, written proofcovering the occurrence, the character and the extent of the loss forwhich claim is made.
(4) A provision that in the case of claim for loss of time fordisability, written proof of such loss must be furnished to the insurerwithin ninety (90) days after the commencement of the period for whichthe insurer is liable, and that subsequent written proofs of thecontinuance of such disability must be furnished to the insurer at suchintervals as the insurer may reasonably require, and that in the case ofclaim for any other loss, written proof of such loss must be furnishedto the insurer within ninety (90) days after the date of such loss.Failure to furnish such proof within such time shall not invalidate norreduce any claim if it shall be shown not to have been reasonablypossible to furnish such proof and that such proof was furnished as soonas was reasonably possible.
(5) A provision that all benefits payable under the policy otherthan benefits for loss of time will be payable immediately upon receiptof due written proof of such loss, and that, subject to due proof ofloss, all accrued benefits payable under the policy for loss of timewill be paid not less frequently than monthly during the continuance ofthe period for which the insurer is liable, and that any balanceremaining unpaid at the termination of such period will be paidimmediately upon receipt of such proof.
(6) A provision that the insurer at its own expense, shall have theright and opportunity to examine the person of the insured when and sooften as it may reasonably require during the pendency of claim underthe policy and also the right and opportunity to make an autopsy whereit is not prohibited by law.
(7) A provision that no action at law or in equity shall be broughtto recover under the policy prior to the expiration of sixty (60) daysafter written proof of loss has been furnished in accordance with therequirements of the policy and that no action shall be brought after theexpiration of five (5) years after the time written proof of loss isrequired to be furnished.
(C) Each person insured under such blanket sickness and accidentpolicy or contract shall, except where authorization is otherwise givenby the commissioner of insurance, be furnished a memorandum approved bythe commissioner of insurance setting forth the essential coverages ofthe contract, including the conditions under which an individual'scoverage may be terminated under the policy and the age, if any, towhich the coverage shall be limited, reduced, or restricted; theprocedure to be followed in making claim under the policy; and, to whombenefits under the policy are payable. Such certificates shall alsocontain a summary of the provisions set forth in (B) of this subsection.
(D) All benefits under any blanket sickness and accident policyshall be payable to the person insured, or to his or her designated beneficiaryor beneficiaries, or to his or her estate, except that if the person insured bea minor, such benefits may be made payable to his or her parents, guardian, orother person actually supporting him or her.
(E) No blanket disability income policy which integrates benefits withsocial security benefits, shall provide that the amount of any disabilitybenefit actually being paid to the disabled person shall be reduced by changesin the level of social security benefits resulting either from changes inthe social security law or due to cost of living adjustments which becomeeffective after the first day for which disability benefits become payable.
History: L. 1951, ch. 296, § 10; L. 1965, ch. 306, § 2; L. 1977,ch. 162, § 2; July 1.
40-2210.Blanket sickness and accident insurance; payments, when blanketdisability income policy is integrated with social security benefits.(A) Blanket sickness and accident insurance is hereby declared to bethat form of sickness and accident insurance covering special groups ofpersons as enumerated in one of the following paragraphs (1) to (8)inclusive: (1) Under a policy or contract issued to any common carrier,or to any operator, owner or lessee of a means of transportation, who orwhich shall be deemed the policyholder, covering a group defined as allpersons who may become passengers on such common carrier or such meansof transportation.
(2) Under a policy or contract issued to a college, school or otherinstitutions of learning, a school district or districts, or schooljurisdictional unit, or to the head, or principal; or governing board ofany such educational unit, who or which shall be deemed thepolicyholder, covering students, teachers or other employees.
(3) Under a policy or contract issued to any volunteer firedepartment, first aid, civil defense, or other such volunteerorganization, which shall be deemed the policyholder, covering all themembers of such department or group, defined by reference to specifiedhazards incident to an activity or activities or operations sponsored orsupervised by such policyholder.
(4) Under a policy or contract issued to a sports team, camp orsponsor thereof, which shall be deemed the policyholder, covering ten(10) or more members, campers, employees, officials or supervisors.
(5) Under a policy or contract issued to an employer, who shall bedeemed the policyholder, covering any group of employees, dependents orguests, defined by reference to specified hazards incident to anactivity or activities or operations of the policyholder.
(6) Under a policy or contract issued to any religious, charitable,recreational, educational, or civic organization, or branch thereof,which shall be deemed the policyholder, covering any group of members orparticipants defined by reference to specified hazards incident to anactivity or activities or operations sponsored or supervised by suchpolicyholder.
(7) Under a policy or contract issued to a newspaper or otherpublisher, which shall be deemed the policyholder, covering itscarriers.
(8) Under a policy or contract issued to any other type of groupwhich the commissioner of insurance may find properly subject to theissuance of blanket sickness and accident policy or contract.
(B) Every such blanket policy shall contain provisions which in theopinion of the commissioner are not less favorable to the policyholderand the individual insured than the following:
(1) A provision that the policy, including endorsements and a copyof the application, if any, of the policyholder and the persons insuredshall constitute the entire contract between the parties, and that anystatement made by the policyholder or by a person insured shall inabsence of fraud, be deemed a representation and not a warranty, andthat no such statements shall be used in defense to a claim under thepolicy, unless contained in a written application. Such person, his or herbeneficiary, or assignee, shall have the right to make written requestto the insurer for a copy of such application and the insurer shall,within fifteen (15) days after the receipt of such request at its homeoffice or any branch office of the insurer, deliver or mail to theperson making such request a copy of such application. If such copyshall not be so delivered or mailed, the insurer shall be precluded fromintroducing such application as evidence in any action based upon orinvolving any statements contained therein.
(2) A provision that written notice of sickness or of injury must begiven to the insurer within twenty (20) days after the date when such asickness or injury occurred. Failure to give notice within such timeshall not invalidate nor reduce any claim if it shall be shown not tohave been reasonably possible to give such notice and that notice wasgiven as was reasonably possible.
(3) A provision that the insurer will furnish either to the claimantor to the policyholder for delivery to the claimant such forms as areusually furnished by it for filing proof of loss. If such forms are notfurnished before the expiration of fifteen (15) days after giving ofsuch notice, the claimant shall be deemed to have complied with therequirements of the policy as to proof of loss upon submitting, withinthe time fixed in the policy for filing proof of loss, written proofcovering the occurrence, the character and the extent of the loss forwhich claim is made.
(4) A provision that in the case of claim for loss of time fordisability, written proof of such loss must be furnished to the insurerwithin ninety (90) days after the commencement of the period for whichthe insurer is liable, and that subsequent written proofs of thecontinuance of such disability must be furnished to the insurer at suchintervals as the insurer may reasonably require, and that in the case ofclaim for any other loss, written proof of such loss must be furnishedto the insurer within ninety (90) days after the date of such loss.Failure to furnish such proof within such time shall not invalidate norreduce any claim if it shall be shown not to have been reasonablypossible to furnish such proof and that such proof was furnished as soonas was reasonably possible.
(5) A provision that all benefits payable under the policy otherthan benefits for loss of time will be payable immediately upon receiptof due written proof of such loss, and that, subject to due proof ofloss, all accrued benefits payable under the policy for loss of timewill be paid not less frequently than monthly during the continuance ofthe period for which the insurer is liable, and that any balanceremaining unpaid at the termination of such period will be paidimmediately upon receipt of such proof.
(6) A provision that the insurer at its own expense, shall have theright and opportunity to examine the person of the insured when and sooften as it may reasonably require during the pendency of claim underthe policy and also the right and opportunity to make an autopsy whereit is not prohibited by law.
(7) A provision that no action at law or in equity shall be broughtto recover under the policy prior to the expiration of sixty (60) daysafter written proof of loss has been furnished in accordance with therequirements of the policy and that no action shall be brought after theexpiration of five (5) years after the time written proof of loss isrequired to be furnished.
(C) Each person insured under such blanket sickness and accidentpolicy or contract shall, except where authorization is otherwise givenby the commissioner of insurance, be furnished a memorandum approved bythe commissioner of insurance setting forth the essential coverages ofthe contract, including the conditions under which an individual'scoverage may be terminated under the policy and the age, if any, towhich the coverage shall be limited, reduced, or restricted; theprocedure to be followed in making claim under the policy; and, to whombenefits under the policy are payable. Such certificates shall alsocontain a summary of the provisions set forth in (B) of this subsection.
(D) All benefits under any blanket sickness and accident policyshall be payable to the person insured, or to his or her designated beneficiaryor beneficiaries, or to his or her estate, except that if the person insured bea minor, such benefits may be made payable to his or her parents, guardian, orother person actually supporting him or her.
(E) No blanket disability income policy which integrates benefits withsocial security benefits, shall provide that the amount of any disabilitybenefit actually being paid to the disabled person shall be reduced by changesin the level of social security benefits resulting either from changes inthe social security law or due to cost of living adjustments which becomeeffective after the first day for which disability benefits become payable.
History: L. 1951, ch. 296, § 10; L. 1965, ch. 306, § 2; L. 1977,ch. 162, § 2; July 1.
40-2210.Blanket sickness and accident insurance; payments, when blanketdisability income policy is integrated with social security benefits.(A) Blanket sickness and accident insurance is hereby declared to bethat form of sickness and accident insurance covering special groups ofpersons as enumerated in one of the following paragraphs (1) to (8)inclusive: (1) Under a policy or contract issued to any common carrier,or to any operator, owner or lessee of a means of transportation, who orwhich shall be deemed the policyholder, covering a group defined as allpersons who may become passengers on such common carrier or such meansof transportation.
(2) Under a policy or contract issued to a college, school or otherinstitutions of learning, a school district or districts, or schooljurisdictional unit, or to the head, or principal; or governing board ofany such educational unit, who or which shall be deemed thepolicyholder, covering students, teachers or other employees.
(3) Under a policy or contract issued to any volunteer firedepartment, first aid, civil defense, or other such volunteerorganization, which shall be deemed the policyholder, covering all themembers of such department or group, defined by reference to specifiedhazards incident to an activity or activities or operations sponsored orsupervised by such policyholder.
(4) Under a policy or contract issued to a sports team, camp orsponsor thereof, which shall be deemed the policyholder, covering ten(10) or more members, campers, employees, officials or supervisors.
(5) Under a policy or contract issued to an employer, who shall bedeemed the policyholder, covering any group of employees, dependents orguests, defined by reference to specified hazards incident to anactivity or activities or operations of the policyholder.
(6) Under a policy or contract issued to any religious, charitable,recreational, educational, or civic organization, or branch thereof,which shall be deemed the policyholder, covering any group of members orparticipants defined by reference to specified hazards incident to anactivity or activities or operations sponsored or supervised by suchpolicyholder.
(7) Under a policy or contract issued to a newspaper or otherpublisher, which shall be deemed the policyholder, covering itscarriers.
(8) Under a policy or contract issued to any other type of groupwhich the commissioner of insurance may find properly subject to theissuance of blanket sickness and accident policy or contract.
(B) Every such blanket policy shall contain provisions which in theopinion of the commissioner are not less favorable to the policyholderand the individual insured than the following:
(1) A provision that the policy, including endorsements and a copyof the application, if any, of the policyholder and the persons insuredshall constitute the entire contract between the parties, and that anystatement made by the policyholder or by a person insured shall inabsence of fraud, be deemed a representation and not a warranty, andthat no such statements shall be used in defense to a claim under thepolicy, unless contained in a written application. Such person, his or herbeneficiary, or assignee, shall have the right to make written requestto the insurer for a copy of such application and the insurer shall,within fifteen (15) days after the receipt of such request at its homeoffice or any branch office of the insurer, deliver or mail to theperson making such request a copy of such application. If such copyshall not be so delivered or mailed, the insurer shall be precluded fromintroducing such application as evidence in any action based upon orinvolving any statements contained therein.
(2) A provision that written notice of sickness or of injury must begiven to the insurer within twenty (20) days after the date when such asickness or injury occurred. Failure to give notice within such timeshall not invalidate nor reduce any claim if it shall be shown not tohave been reasonably possible to give such notice and that notice wasgiven as was reasonably possible.
(3) A provision that the insurer will furnish either to the claimantor to the policyholder for delivery to the claimant such forms as areusually furnished by it for filing proof of loss. If such forms are notfurnished before the expiration of fifteen (15) days after giving ofsuch notice, the claimant shall be deemed to have complied with therequirements of the policy as to proof of loss upon submitting, withinthe time fixed in the policy for filing proof of loss, written proofcovering the occurrence, the character and the extent of the loss forwhich claim is made.
(4) A provision that in the case of claim for loss of time fordisability, written proof of such loss must be furnished to the insurerwithin ninety (90) days after the commencement of the period for whichthe insurer is liable, and that subsequent written proofs of thecontinuance of such disability must be furnished to the insurer at suchintervals as the insurer may reasonably require, and that in the case ofclaim for any other loss, written proof of such loss must be furnishedto the insurer within ninety (90) days after the date of such loss.Failure to furnish such proof within such time shall not invalidate norreduce any claim if it shall be shown not to have been reasonablypossible to furnish such proof and that such proof was furnished as soonas was reasonably possible.
(5) A provision that all benefits payable under the policy otherthan benefits for loss of time will be payable immediately upon receiptof due written proof of such loss, and that, subject to due proof ofloss, all accrued benefits payable under the policy for loss of timewill be paid not less frequently than monthly during the continuance ofthe period for which the insurer is liable, and that any balanceremaining unpaid at the termination of such period will be paidimmediately upon receipt of such proof.
(6) A provision that the insurer at its own expense, shall have theright and opportunity to examine the person of the insured when and sooften as it may reasonably require during the pendency of claim underthe policy and also the right and opportunity to make an autopsy whereit is not prohibited by law.
(7) A provision that no action at law or in equity shall be broughtto recover under the policy prior to the expiration of sixty (60) daysafter written proof of loss has been furnished in accordance with therequirements of the policy and that no action shall be brought after theexpiration of five (5) years after the time written proof of loss isrequired to be furnished.
(C) Each person insured under such blanket sickness and accidentpolicy or contract shall, except where authorization is otherwise givenby the commissioner of insurance, be furnished a memorandum approved bythe commissioner of insurance setting forth the essential coverages ofthe contract, including the conditions under which an individual'scoverage may be terminated under the policy and the age, if any, towhich the coverage shall be limited, reduced, or restricted; theprocedure to be followed in making claim under the policy; and, to whombenefits under the policy are payable. Such certificates shall alsocontain a summary of the provisions set forth in (B) of this subsection.
(D) All benefits under any blanket sickness and accident policyshall be payable to the person insured, or to his or her designated beneficiaryor beneficiaries, or to his or her estate, except that if the person insured bea minor, such benefits may be made payable to his or her parents, guardian, orother person actually supporting him or her.
(E) No blanket disability income policy which integrates benefits withsocial security benefits, shall provide that the amount of any disabilitybenefit actually being paid to the disabled person shall be reduced by changesin the level of social security benefits resulting either from changes inthe social security law or due to cost of living adjustments which becomeeffective after the first day for which disability benefits become payable.
History: L. 1951, ch. 296, § 10; L. 1965, ch. 306, § 2; L. 1977,ch. 162, § 2; July 1.
