State RegulationsPA specificDifficulty 2/5
An insured suffers a covered loss. The insurer wants to deny the claim based on oral statements the applicant made to the producer that appear nowhere in the policy or application. What is the effect of the entire contract provision?
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
Under 40 P.S. § 753(A)(1), the policy plus the attached application copy is the entire contract, and no statement made by the producer outside those documents can vary its terms. Oral representations the applicant relied on at the point of sale therefore cannot be used by the insurer to defeat a claim. The practical consequence is that any health statement the insurer wants to rely on later must appear in the attached application.
Why the other options are wrong
- A) The entire contract clause exists precisely to prevent verbal side agreements from changing or undermining the written policy terms.
- B) There is no such waiver mechanism; the statute fixes the contract documents themselves, not a supplementary waiver form.
- D) The rule operates automatically as a matter of contract construction under 40 P.S. § 753(A)(1); no departmental approval is involved.
Memory hook
If it isn't in the policy or the attached application, it isn't in the deal.