A house painter in Toledo takes a weekend job performing electrical work that Ohio law reserves to licensed electricians. He is injured in a fall while doing that work and files a claim under his individual A&H policy containing the optional illegal-occupation provision. What is the likely outcome?
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Answer & full 3-part explanation (select an option above, or peek)
Why D is correct
ORC 3923.05 authorizes the optional illegal-occupation provision, under which the insurer does not pay for a loss sustained while the insured was engaged in an occupation or activity that is illegal because it violates licensing or other occupational law. In this scenario the insured was working as an unlicensed electrician at the time of the injury, so the provision bars payment for that loss. Importantly, the provision excludes only that loss; the policy itself remains in force, and the Ohio Department of Insurance frames the clause as a permissive exclusion rather than a cancellation trigger.
Why the other options are wrong
- A) The cause of the injury does not matter under this provision; the disqualifying fact is that the loss was sustained while engaged in the illegal occupation.
- B) The provision provides no reduced-benefit middle ground; payment for the loss is simply excluded under ORC 3923.05.
- C) The policy is not canceled; only the loss connected to the illegal occupation is excluded, and coverage continues for lawful activities.
Memory hook
Illegal work, no coverage for that loss — but the policy survives.