State RegulationsPA specificDifficulty 2/5
An accident and health insured is injured in an accident that occurs while he is committing a burglary, an act made illegal by law. Under the illegal-occupation provision of 40 P.S. § 753(B)(10), what happens to his claim?
Select an option to reveal the answer and the full 3-part explanation — free, no signup.
Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
The illegal-occupation provision of 40 P.S. § 753(B)(10) provides that the insurer need not pay benefits for a loss sustained while the insured is engaged in an occupation or activity that is illegal at the time. The loss here occurred during the commission of a felony, squarely within the exclusion, so no benefit is payable under the provision.
Why the other options are wrong
- A) Accident and health coverage is not a license to profit from illegal conduct; the provision expressly removes benefits for losses sustained in illegal activity.
- C) The remedy is forfeiture of the benefit, not a partial reduction; there is no statutory half-benefit rule.
- D) The claim is not suspended pending rehabilitation; the illegal-activity loss simply falls outside the coverage promise.
Memory hook
Crime doesn't pay a claim — illegal acts void the benefit.