State RegulationsTN specificDifficulty 2/5
A Tennessee individual accident and health policy is reinstated on March 1. The insured suffers an accidental injury on March 3 and a sickness on March 5. How does the reinstated coverage apply to these two losses?
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Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
T.C.A. § 56-26-108(4) provides that after reinstatement, coverage for accident losses takes effect immediately, but loss caused by sickness is covered only from 10 days after the reinstatement date. The March 3 injury falls within the immediate accident coverage, while the March 5 sickness is only two days after reinstatement and falls inside the 10-day sickness waiting window.
Why the other options are wrong
- A) 45 days is the reinstatement backstop when the insurer neither approves nor disapproves under T.C.A. § 56-26-108(4); it is not a waiting period that blocks reinstated coverage.
- C) T.C.A. § 56-26-108(4) expressly subjects sickness losses to a 10-day waiting period after reinstatement, so both losses are not covered immediately.
- D) The two treatment rules are reversed: accident coverage is immediate and sickness waits 10 days under T.C.A. § 56-26-108(4).
Memory hook
Accidents now, sickness in 10.