California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 2a - Group Disability Policies › Subarticle 1 - General Instructions and Rules › Section 2232.8 - Short Form of Proof of Claim

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
As another alternative permissive order and wording for
						setting forth in a group disability policy certain of the uniform provisions,
						the insurer may, in lieu of using the promulgated order and wording of the
						uniform provisions captioned "Notice of Claim," "Claim Forms," and "Time of
						Payment of Claim," and at the option of the insurer, also in lieu of one or
						more or all of the uniform provisions captioned "Proof of Loss," "Physical
						Examination and Autopsy" and "Legal Actions," but subject to the instructions
						hereinafter set forth, use the following short form of proof of claim clause
						under one of the captions permitted by the instructions hereinafter set
						forth:
All ("benefits" or other descriptive phrase) provided in
						this policy shall be paid to the employee as they accrue or as stated
						(referring to the location in the policy of the uniform provision captioned
						"Payment of Claims") upon receipt of written proof on the insurer's forms or,
						if such forms are not furnished by the insurer within 15 days after demand
						therefor, then upon receipt of written proof covering the occurrence, character
						and extent of the event for which claim is made.
Instructions
1. The above provision shall be preceded by a
					 caption reading "Proof of Claim" or "Proof of Loss"; but if the uniform
					 provision captioned "Payment of Claims" has either been omitted in accordance
					 with Instruction 2, or if said uniform provision is set forth, in accordance
					 with the instructions for its use, immediately following this provision, then
					 such provision or provisions may be preceded by the caption "Payment of
					 Benefits" or "Payment of Claims."
2. The insurer shall omit the phrase "or as
					 stated__________" if the uniform provision captioned "Payment of Claims" is
					 entirely omitted from the Policy in accordance with the instructions for its
					 use. The insurer shall include said phrase in the policy even if it uses only
					 the second or third or the second and third paragraphs of the uniform provision
					 captioned "Payment of Claims" in the policy.
3. The insurer has the option of including or
					 omitting the language in the above provision concerning the forms for proof of
					 loss reading "on the insurer's forms or, if such forms are not furnished by the
					 insurer within 15 days after demand therefor, then upon receipt of written
					 proof."
4. The insurer has the
					 option of including in, or omitting from the policy the uniform provision
					 captioned "Proof of Loss," but if said provision is omitted the insurer shall
					 also omit the uniform provision captioned "Legal Actions." However, if said
					 Uniform Provision captioned "Proof of Loss" is included in the policy, the
					 Uniform Provision captioned "Legal Actions" may either be included or omitted
					 from the policy.
5. The insurer has
					 the option of including or omitting the uniform provision captioned "Physical
					 Examination and Autopsy." (Ins. C. 10270.94.)