Q: Jacob is applying for life insurance.

He has forgotten that he applied for life insurance 13 years ago

and was declined because he was being treated for a medical condition at the time. He does not
disclose the fact that he was declined insurance. How will the insurance company be able to get this
information?
The Medical Information Bureau
When Jacob signs the life insurance application form, he will sign an authorization for the insurer to
contact the Medical Information Bureau for information on past insurance applications.
Q: Raphael is meeting with his client Elaine to deliver her just issued disability insurance policy. When
Raphael meets Elaine she tells him that she has had a very bad fall and hurt her back. She has been
off work for 10 days. Can Raphael have Elaine sign a policy delivery slip and deliver the policy?
No
Since Elaine has had a change in insurability Raphael must return the policy to the insurer and provide
full explanation of Elaine's change in insurability. The insurer will then determine if they will issue the
policy once investigating this change in insurability.
Q: Roger has applied for a disability insurance policy. While completing the application he discloses
that as a result of playing football as a teenager, he has some serious issues with his shoulder. His
agent has advised Roger that he should be prepared for the disability insurance company to decide
that they won't issue this policy on a standard basis.
What are the 3 options that the insurance company could use when underwriting this policy contract?
They could decline the application
The could rate the policy
They could put exclusion on the policy
The insurance company could decide that they won't underwrite the risk. They could also decide that
while there is a higher risk than normal, they would underwrite the risk with an additional premium.
Since it is a disability policy that is being applied for, the insurer could also decide to issue the policy
contract but exclude any disability arising from Roger's shoulder.
Q: What type of additional form may an insurance company require if an individual has used
marijuana in the past?
Drug Use Questionnaire
This additional form would be required if someone has used drugs such as marijuana, cocaine, heroin,
barbiturates, hallucinogens, amphetamines, etc.
Q: Reinsurance is commonly used by life insurance companies. Why would a life insurance company
choose to reinsure some risks?

This is not true of a disability insurance policy. The insurance company can change the policy if there is
a change in occupation.

Q: While completing an application for disability insurance you discover that the proposed insured has
had a history of severe arthritis. Should you complete the application ever if you suspect that the
policy will be declined?
Yes
The agent's job is to fully complete the application and submit it to the insurer for consideration. While
an agent does some field underwriting, it is the insurer who determines whether they want to insure a
risk.
Q: Under the Uniform Life Insurance Act what are the 4 provisions that must be met to deem a policy
contract to have been delivered?
The policy was issued as applied for
At least one month's premium has been paid
The life insurance agent has received the policy for delivery
The policy was issued for unconditional delivery to the policyowner

The term insurance becomes a rider on the whole life policy and thereby does not have a policy fee.
All life insurance policies have a policy fee that becomes part of the premium. By adding the term
insurance as a rider to the permanent policy, you eliminate the additional policy fee that would have to
be paid if you were to have a separate term insurance policy issued.
Business Overhead insurance is purchased to cover the costs of doing business if the business owner
is disabled.
Business overhead expenses continue even when the business owner is disabled. To keep the business
going during such as absence, the business itself can be protect by a business overhead policy. This
kind of policy is typically available to a very small business with a maximum of about ten employees,
where the business is completely dependent on the owner for revenues.

Q: Nahim is a Mechanical Engineer with a large international corporation. He travels extensively in

North America supervising large construction sites. Nahim owns an own occupation individual disability
insurance policy with a 90 day elimination period, to age 65 benefit period, a presumptive disability
clause and monthly benefit amount of $6,000 per month. While on a job site in Boston, he was
involved in a serious accident that left him paralyzed from the waist down. He was off work for 6
months. Nahim has filed a claim form with his insurance company.
How would the insurance company respond to this claim?
They would pay the $6,000 a month benefit to Nahim and would continue to pay the benefit until
Nahim reaches age 65.
This would be considered a presumptive disability because Nahim was paralyzed from the waist down.
Nahim could continue to work in some other occupation because his policy was issued as an own
occupation policy contract and he has met the presumptive disability test.

Future Income Option is a rider that can be added to an individual disability insurance policy.
Guaranteed Insurability Benefit is a rider than can be added to a life insurance policy.
The future purchase option (FPO), is also called the future income option (FIO), allows the policy
owner to increase the amount of monthly income benefit to keep pace with his or her growing income,
with no evidence of medical insurability. The premium will be increased in step with the increase in
coverage. Income will have to be proven when this option is used.
The guaranteed insurability benefit (GIB) provides exactly what its name says: guaranteed insurability.
It guarantees the policy owner the right to increase the amount of life insurance at certain times, over
periods of time, or if certain events occur. These dates, events, and the amounts by which the
insurance can be increased are established when the rider is purchased.
What is Presumptive Disability under an individual disability insurance policy?
Presumptive disability is when a disability claim will be honoured when the insured suffers the loss of
limbs, sight, hearing or speech, paraplegia or paralysis.
Full benefits are payable until the end of the benefit period or for life, regardless whether or not the
person can return to work.
In a UL policy the length of time the premium is paid by insured depends upon rate of return of
investment

Dima:
$ 50 single, $100 family B- day Jan
Lia: $75 single, $150 familiy B-day Aug
Both coordination Both co-insurance of 80%
!) Dima-$250-Mar
2) Lia-$300-Aug
3)Daughter-$430-Nov
How much will they receive from both plans for their third claim of $430 ?
First claim Dima $250
First Payor Dima's Plan
$250
-$50
$200
x 80%
$160
Out-of-pocket
$250
-$160
$90
Second Payor Lia's Plan

$250
-$75
$175
x80%
$140
So Lia's plan pays $90 (lesser of $140 and $90)
Deductibles used so far Dima's plan $50, Lia's plan $75

Second Claim
Lia $300
First Payor Lia's plan
$300
-$75
$225
x80%
$180
Out of pocket
$300
-$180
$120
Second Payor is Dima's Plan
$300
-$50
$250
x80%
$200
So Dima's plan pays $120 (lesser of $200 and $120)
Deductibles used so far Dima's plan $100, Lia's plan $150
So family deductibles have been used up in both the plans.
So no more deductibles for the rest of the year.
Claim 3 Daughter $430
First payor is Dima's plan 9earlier birthday)
$430
x80%
$344
out of pocket
$430
-$344

$86
Second payor is Lima's plan
$430
x80%
$344
Lima's plan pays $86 (lesser of $344 and $86)
Dental and prescription drug plan are reimbursement expenses and are tax free