State RegulationsNY specificDifficulty 1/5
An individual accident and health policy is reinstated in New York after a lapse for nonpayment of premium. Under N.Y. Ins. Law §3216(d)(1)(D), which statement correctly describes the coverage provided by the reinstated policy?
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Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
Under N.Y. Ins. Law §3216(d)(1)(D), a reinstated accident and health policy covers only loss resulting from accidental injury sustained after the date of reinstatement and loss due to sickness that begins more than 10 days after that date. Accident coverage is therefore immediate, while sickness benefits carry a 10-day waiting period that discourages lapsing and reinstating just to capture an existing illness.
Why the other options are wrong
- A) Sickness coverage is not immediate after reinstatement; it applies only to sickness beginning more than 10 days after the reinstatement date.
- C) Accident coverage is immediate; only sickness benefits are subject to the 10-day waiting period.
- D) This reverses the rule: accidents are covered at once, and it is sickness that must begin more than 10 days after reinstatement.
Memory hook
Reinstated: accidents now, sickness after 10 days.