SDLAHP - South Dakota Life Accident and Health Producer

Question 1: A producer explains to a client that the cost of living adjustment rider on her disability policy will not raise her monthly benefit by a fixed dollar amount each year, but instead ties any increase to changes in a published measure of consumer prices. Which concept does this describe?

benefit increases fixed at a flat rate

benefit increases tied to insurer profits

benefit increases tied to a price index

benefit increases set by the insured's age

Question 2: A policy provision states that if the same disabling condition returns within six months of the insured's return to work, the new claim links back to the earlier one rather than starting fresh. Which practical benefit does this recurrent disability language give the insured during the second period of disability?

no new elimination period must be served

a doubled monthly benefit amount

an automatically extended benefit period cap

coverage for a previously excluded condition

Question 3: Under a funded buy-sell agreement between two business partners, the business itself applies for, owns, and pays premiums on a disability buyout policy covering each partner, with the business named as beneficiary. Which party is entitled to receive the buyout proceeds if one partner becomes disabled?

the disabled partner directly and personally

the disabled partner's surviving spouse

the business named as the policy's beneficiary

a bank holding the partnership's loan

Question 4: An insured receiving payments under a social insurance supplement rider is later approved for a monthly Social Security disability award, and the insurer immediately reduces the rider payment by roughly the same dollar amount now coming from Social Security. Which purpose does this offsetting reduction serve for the insurer?

increasing the insurer's total profit margin

penalizing the insured for applying late

complying with a hospital confinement limit

preventing duplicate payment for the same loss

Question 5: An insured is involved in an accident that causes total and irrecoverable loss of sight in both eyes, even though he could physically continue reporting to his workplace. Under a presumptive disability provision, which outcome follows regarding his eligibility for the full total disability benefit?

he is presumed totally disabled automatically

he must first prove he cannot work

he only qualifies for a partial benefit

he qualifies only after a lengthy delay

Question 6: An insured is injured while intoxicated and not under any physician's care or prescription at the time of the accident, under an accident and health policy. Which statement correctly describes the effect of the intoxicants and narcotics provision on the insurer's liability for that loss?

the insurer pays because it was accidental

coverage applies if the insured seeks treatment

the insurer bears no liability here

only prescription costs are excluded

Question 7: An insurer discovers, only after a claim is filed, that the insured's age was stated incorrectly on the original application for an accident and health policy issued several years earlier. Which statement correctly describes how the misstatement of age provision typically resolves that discrepancy?

the policy is automatically voided

the claim is paid in full regardless

the insured is charged a penalty fee

benefits adjust to the correct-age amount

Question 8: A producer compares two otherwise identical disability income policies for a client, one with a return of premium rider attached and one without, and finds the version with the rider carries a noticeably higher premium for the same base monthly benefit. Which tradeoff does this price difference best illustrate?

a refund guarantee costs more in premium

riders never change the base premium charged

the base benefit amount must be lower

the elimination period must be shortened

Question 9: An insured is injured on the job while actively engaged in an occupation that is illegal under the criminal law of the place where the activity occurred. Which statement correctly describes how the illegal occupation provision affects the insurer's liability for that resulting loss under the policy?

the insurer pays the claim as usual

only half the benefit is payable

the insurer owes no benefit at all

the loss is covered after a delay

Question 10: An insurer approves a claim for an insured whose account still shows an unpaid premium amount owed on the accident and health policy at the time of loss. Which statement correctly describes what the unpaid premium provision allows the insurer to do when paying that claim?

deny the claim until premium is paid

double the next premium as a penalty

require a co-signer before paying anything

deduct the unpaid premium from the benefit

Question 11: A newly issued accident and health policy takes effect, and the insured becomes ill from a common illness only a few days later, before any waiting period tied to sickness has elapsed. Which clause explains why that particular sickness claim may not yet be covered?

the probationary period

the elimination period

the incontestable clause

the coordination of benefits provision

Question 12: An insured receiving disability income benefits from several policies discovers the combined monthly benefit would exceed regular earned income before the disability began. Which statement correctly describes how the relation of earnings to insurance provision addresses that kind of overinsurance?

the newest policy alone is canceled

combined benefits reduce toward actual earnings

benefits increase to match cost of living

the insurer denies every pending claim

Question 13: A policyowner receives a letter from the insurer describing a new benefit that was never physically attached to the accident and health policy or the application. Under the entire contract provision, which statement best describes whether that letter can change the terms of coverage?

yes, any signed insurer letter binds

only if the insured verbally agrees

it cannot modify coverage unless attached

yes, once mailed to the policyowner

Question 14: An insurer finishes reviewing a completed proof of loss for a one-time accidental injury claim under an accident and health policy. Which statement correctly describes when the time of payment of claims provision requires the insurer to pay that benefit to the insured?

within one year of the injury

only at the insured's next renewal date

whenever the insurer's internal audit is done

immediately after receiving satisfactory proof of loss

Question 15: An accident and health policy has been continuously in force for longer than the contestable period stated in the incontestability provision when the insurer discovers an unintentional misstatement in the original application. Which outcome does the time limit on certain defenses provision require in this situation?

the insurer must pay the covered claim

the insurer may void the policy

the insurer may deny only that claim

the insurer may adjust future premiums only

Question 16: An insured who worked as a long-haul truck driver suffers an injury that prevents driving but leaves him able to perform a desk job that matches his prior training and experience. Under an any-occupation definition of total disability, which outcome most accurately describes how this claim would likely be resolved?

benefits are paid at the full rate

benefits are denied because other work fits

benefits are paid under a waiver rider

benefits are paid as a lump sum

Question 17: An insured with a disability income policy that includes an accidental death and dismemberment rider dies as a direct result of a covered accident within the period specified by the rider. Which amount does the beneficiary receive under this rider on account of the accidental death?

the insured's final monthly disability check

a refund of all premiums paid

the rider's principal sum

the rider's dismemberment schedule amount

Question 18: An insured is covered under two separate group health plans through different employers and submits the same medical expense claim to both insurers at once. Which provision correctly determines which plan pays first and prevents the insured from collecting more than the total actual expense?

the other insurance with this insurer provision

the relation of earnings to insurance provision

the time of payment of claims provision

coordination of benefits

Question 19: A policyowner asks her producer why her disability policy pays benefits easily during the claim's first two years but then requires proof she cannot work in any suitable occupation afterward. Which policy feature explains this shift in what the insured must prove as the claim continues?

the modified total disability definition

the elimination period provision

the recurrent disability provision

the waiver of premium provision

Question 20: An insured is found to be carrying several overlapping accident and health policies with the same insurer, exceeding the reasonable maximum amount the insurer normally issues to one person. Which statement correctly describes how the other insurance with this insurer provision addresses that situation?

the insurer keeps all premium, pays all

excess premium is refunded and liability capped

the oldest policy is canceled without refund

the insured chooses which policy stays active

SDLAHP South Dakota Life Accident and Health Producer - Set 4 - Part 1