California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 2a - Group Disability Policies › Subarticle 2 - Compulsory Uniform Provisions › Section 2232.18 - Time Limit on Certain Defenses

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) After this policy has been in force for a
					 period of three years, no statements of the employer contained in the
					 application, and no statement relating to insurability made by any employee
					 eligible for coverage under the policy shall be used to deny a claim or in
					 contesting the validity of the insurance with respect to which such statement
					 was made after the insurance has been in force prior to the contest for a
					 period of three years during the lifetime of the person with respect to whom
					 any such statement was made.
(b)
					 After three years from the date of issue of this policy, no misstatement of the
					 employer, except a fraudulent misstatement, made in the employer's application
					 shall be used to void the policy; and after three years from the effective date
					 of the coverage with respect to which any claim is made no misstatement of any
					 employee eligible for coverage under the policy, except a fraudulent
					 misstatement, made in an application under the policy shall be used to deny a
					 claim for loss incurred or disability (as defined in the policy) commencing
					 after expiration of such three years.
(c) No claim for loss incurred or disability
					 (as defined in the policy) commencing after three years from the effective date
					 of the insurance coverage with respect to which the claim is made shall be
					 reduced or denied on the ground that a disease or physical condition, not
					 excluded from coverage by name or specific description effective on the date of
					 loss, had existed prior to the effective date of the coverage with respect to
					 which the claim is made:
Instructions
1. If the insurer uses Form A or Form B of
					 the "Entire Contract; Changes" uniform provision, it may, at its option,
					 include paragraph (a) in the policy (eliminating, if Form A is used, references
					 to statements of employees), and the insurer shall use such paragraph, with the
					 language appropriately adjusted, as aforesaid, in any policy which is
					 noncancellable and guaranteed renewable for five years or more and for which
					 the premium rate is guaranteed for five years or more. If said paragraph (a) is
					 used, the insurer shall not use paragraph (b), and shall omit the portion of
					 the first paragraph of Form C, if used, of the "Entire Contract; Changes"
					 uniform provision following the phrase "unless it is contained in a written
					 application."
2. In case the
					 insurer uses Form A or Form C of the "Entire Contract; Changes" uniform
					 provision, and unless paragraph (a) of this uniform provision is included in
					 the policy in accordance with Instruction 1, the insurer shall include
					 paragraph (b) therein, except that if the alternative language at the end of
					 the first paragraph of Form C of the "Entire Contract; Changes" uniform
					 provision is used and not omitted therefrom in accordance with Instruction 7
					 for the use of that form of such uniform provision, then the insurer may omit
					 both paragraph (a) and (b) hereof. If Form A of the "Entire Contract; Changes"
					 uniform provision is used, there shall be omitted from paragraph (a) or (b)
					 hereof, whichever is used in the policy, all portions referring to statements
					 of the employees.
3. The insurer
					 shall omit paragraph (c) from any policy which does not exclude coverage for
					 pre-existing diseases or conditions. The insurer shall use said paragraph (c)
					 in any policy which contains any exclusion of pre-existing diseases or
					 conditions. The term "pre-existing disease or conditions, means any diseases or
					 conditions" means any disease or condition, other than pregnancy, of any
					 employee or other person covered by the policy which existed on, or had its
					 inception before the effective date of the insurance coverage of such person
					 under the policy. (Ins. C. 10350.2 Cf. Ins. C. 10206 and
					 10270.6.)