California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 6.5 - Unemployment Compensation Disability Policies › Subarticle 2 - Filing and Approval › Section 2243.5 - Policies to Contain Required Provisions and May Contain Optional Provisions; Uniform Provisions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Every U. C. D. policy issued or delivered by any insurer
						shall contain the required provisions hereinafter set forth and many contain
						the optional provisions hereinafter set forth either in the exact language so
						set forth or in the substance thereof, or in the substance thereof but more
						favorable to the employees insured or not less favorable to such employees and
						more favorable to the employer; provided it shall be presumed, subject to the
						approval of the commissioner, that the policy contains the substance of the
						required and optional provisions herein set forth if it contains therein in
						accordance with the rules and regulations for their use those uniform
						provisions promulgated for use in group disability policies which cover the
						same subject matter as the required and optional provisions herein set forth,
						with such changes in the language of such uniform provisions as are necessary
						to make them fit the coverage provided in the U. C. D. policy, and meet in
						substance the corresponding applicable requirements for such provisions as
						herein set forth; provided further that:
(a) The uniform provisions captioned "Entire
					 Contract; Changes," "Notice of Claim," "Claims Forms," "Proofs of Loss" and
					 "Time of Payment of Claim" are the uniform provisions which incorporate the
					 substance of the corresponding required provisions for U.C.D. policies herein
					 set forth.
(b) The uniform
					 provisions captioned "Physical Examination and Autopsy," "Legal Actions,"
					 "Cancellation" and "Payment of Claims" are the uniform provisions which
					 incorporate the substance of the corresponding optional provisions herein set
					 forth for use in U.C.D. policies.
(c) In case the uniform provision captioned
					 "Entire Contract; Changes" is used in a U.C.D. policy, there shall be added to
					 the language thereof promulgated for use in group disability policies a phrase
					 reading in substance, "and the provisions of the California Unemployment
					 Insurance Code and the regulations of the Director of the Department of
					 Employment Development which are incorporated by reference in this policy."
					 This phrase shall be added to the enumeration of the writings which constitute
					 the entire contract between the parties, and shall be used in accordance with
					 the requirements set forth in Section
					 2244.1 hereof.
(d) In the blank in the uniform provision
					 captioned "Time of Payment of Claim" there shall be entered either a period of
					 time not greater than one week, or a period of time greater than one week,
					 together with the phrase "or each week if the claimant so requests."
(e) To the uniform provision captioned
					 "Physical Examination and Autopsy" there shall be added the phrase "except
					 where such right is limited by the California Unemployment Insurance
					 Code."
(f) To the uniform provision
					 captioned "Legal Actions" there shall be added a sentence reading "This
					 provision does not affect in any way any employee's rights to appeal under the
					 California Unemployment Insurance Code."
(g) The uniform provisions captioned "Other
					 Insurance in This Insurer," "Time Limits on Certain Defenses," "Change of
					 Beneficiary," "Insurance With Other Insurers," "Illegal Occupations" and
					 "Intoxicants and Narcotics" may not be used in a U. C. D. policy; but this
					 prohibition is without prejudice to the right of the insurer to include in a U.
					 C. D. policy any provision expressly permitted by these rules and regulations,
					 by the regulations of the director or by the C. U. I. Code.
(h) The other uniform provisions which
					 neither cover subject matter of required or optional provisions set forth
					 herein nor are forbidden to be used in U. C. D. policies by the immediately
					 preceding paragraph hereof may, subject to the approval of the commissioner and
					 insofar as consistent with the C. U. I. Code, be used in substance in a U. C.
					 D. policy at the option of the insurer.
1.
						Amendment filed 5-6-77 as procedural and organizational; effective upon filing
						(Register 77, No. 19).
Note: Authority cited: Section
						  10270.2,
						  Insurance Code. Reference: Section
						  10270.2
						  (f), Insurance
						  Code.