State RegulationsOH specificDifficulty 1/5
An individual sickness and accident policy has been in force for more than 2 years. Under Ohio's time limit on certain defenses, on what basis may the insurer still contest the policy because of statements in the application?
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Answer & full 3-part explanation (select an option above, or peek)
Why D is correct
ORC 3923.04(B) imposes a time limit on certain defenses: after the policy has been in force for 2 years from its date of issue, only fraudulent misstatements in the application can be used to void the policy or deny a claim. Honest misstatements and innocent omissions can no longer be raised after that period.
Why the other options are wrong
- A) Wrong because after 2 years materiality alone is not enough under ORC 3923.04(B); the misstatement must have been fraudulent.
- B) Wrong because undisclosed treatment can be used only within the first 2 years unless the statement was fraudulent; a preexisting condition must instead have been excluded by name or specific description.
- C) Wrong because statements not in the application can never be used under ORC 3923.04(A), whether or not the agent failed to forward them.
Memory hook
Two years turn honest mistakes into fraud-only territory.