“Physical Examinations and Autopsy” and “Legal Actions” Wording in Health Medical a Insurance Policy
Physical Examinations and Autopsy
(Typical wording*):
“Physical Examination and Autopsy: The insurance company at its own expense shall have the right and opportunity to examine the person of the insured when and as often as it may reasonably require during the pendency of a claim hereunder and to make an autopsy in case of death where it is not forbidden by law.” |
The standard here is one of reasonableness. An insurance company cannot use the provision as a hammer to discourage you from filing claims because you fear that every time you file a claim it is going to want to schedule you for a physical examination. By the same token, you must be willing to agree to reasonable requests. All such examinations are at the insurance company’s expense and at your convenience.
Legal Actions
| This provision is designed to protect the insurance company from unnecessary, frivolous or hard-to-prove lawsuits. The 60 days gives the insurance company time to resolve an outstanding matter without both parties incurring unnecessary legal expenses. The 3 years is not an unreasonable time limit for filing a suit. After 3 years (and possibly before), it becomes very difficult for both parties to provide a good, clear record of events relating to a claim. |
*Wording may vary from contract to contract and from state to state.
Related articles:
Overview
Time Limit on Certain Defenses Provision or the Incontestable Provision
Renewal and Reinstatement Provisions in a Health Insurance Policy
“Notice of Claim” and “Claim Forms” Provisions in a Health Medical Insurance Policy
“Proof of Loss” and “Time for Payment of Claims” Provisions in Health Medical Insurance Policy
“Change of Occupation”, “Misstatement of Age”, “Unpaid Premium”, “Illegal Occupation”, Provisions in Health Medical Insurance Policy
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