Individual accident and health insurance policy provisions

What this document is

N.Y. Ins. Law s. 3216: Individual accident and health insurance policy provisions is a state statute published by New York State Senate (nysenate.gov). It is one of the New York documents that insurance license exam questions are written from, including new york life & health, new york property & casualty practice questions. This page summarizes it and points to the official version, which is the text to rely on.

Sections cited in practice questions

Each practice answer shows the exact passage it comes from. These are sections of this document that questions cite, with a short excerpt from the source text.

• N.Y. Ins. Law § 3216(d)(1)(A) (Entire Contract; Changes)

  “(A) ENTIRE CONTRACT; CHANGES: This policy, including the endorsements and the attached papers, if any, constitutes the entire contract of insurance. No change in this policy shall be valid until approved by an executive officer of the insurer and unless such approval be endorsed hereon or attached...”

• N.Y. Ins. Law § 3216(d)(1)(B) (Time Limit on Certain Defenses)

  “After two years from the date of issue of this policy no misstatements, except fraudulent misstatements, made by the applicant in the application for such policy shall be used to void the policy or to deny a claim for loss incurred or disability (as defined in the policy) commencing after the...”

• N.Y. Ins. Law § 3216(d)(1)(J) (Physical Examinations and Autopsy)

  “The insurer at its own expense shall have the right and opportunity to examine the person of the insured when and as often as it may reasonably require during the pendency of a claim hereunder and to make an autopsy in case of death where it is not forbidden by law.”

• N.Y. Ins. Law § 3216(d)(1)(H) (Time of Payment of Claims)

  “Indemnities payable under this policy for any loss other than loss for which this policy provides any periodic payment will be paid immediately upon receipt of due written proof of such loss.”

• N.Y. Ins. Law § 3216(d)(2)(A) (Change of Occupation)

  “If the insured changes his occupation to one classified by the insurer as less hazardous than that stated in this policy, the insurer, upon receipt of proof of such change of occupation, will reduce the premium rate accordingly, and will return the excess pro-rata unearned premium from the date of...”

• N.Y. Ins. Law § 3216(d)(1)(F) (Claim Forms)

  “The insurer, upon receipt of a notice of claim, will furnish to the claimant such forms as are usually furnished by it for filing proofs of loss. If such forms are not furnished within fifteen days after the giving of such notice the claimant shall be deemed to have complied with the requirements...”

• N.Y. Ins. Law § 3216(d)(2)(I) (Conformity With State Statutes)

  “CONFORMITY WITH STATE STATUTES: Any provision of this policy which, on its effective date, is in conflict with the statutes of the state in which the insured resides on such date is hereby amended to conform to the minimum requirements of such statutes.”

• N.Y. Ins. Law § 3216(d)(1)(C) (Grace Period)

  “A grace period of ........................ (insert a number not less than "7" for weekly premium policies, "10" for monthly premium policies and "31" for all other policies) days will be granted for the payment of each premium falling due after the first premium, during which grace period the...”

• N.Y. Ins. Law § 3216(d)(1)(K) (Legal Actions)

  “No action at law or in equity shall be brought to recover on this policy prior to the expiration of sixty days after written proof of loss has been furnished in accordance with the requirements of this policy. No such action shall be brought after the expiration of three years after the time...”

• N.Y. Ins. Law § 3216(d)(2)(B) (Misstatement of Age)

  “MISSTATEMENT OF AGE: If the insured's age has been misstated, all amounts payable under this policy shall be such as the premium paid would have purchased at the correct age.”

• N.Y. Ins. Law § 3216(d)(1)(E) (Notice of Claim)

  “Notice given by or on behalf of the insured or the beneficiary to the insurer at -------------- (insert the location of such office as the insurer may designate for the purpose), or to any authorized agent of the insurer or to any authorized broker, with information sufficient to identify the...”

• N.Y. Ins. Law § 3216(d)(2)(H) (Cancellation)

  “Within the first ninety days after the date of issue, the insurer may cancel this policy by written notice delivered to the insured, or sent by first class mail to his last address as shown by the records of the insurer, stating when, not less than ten days thereafter, such cancellation shall be...”

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Questions about this source

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