Accident and Sickness Insurance Flashcards

What is 'residual disability' coverage in a Canadian disability insurance policy?

Answer: Partial benefits when the insured can work but with reduced capacity

Residual disability coverage provides partial benefits when the insured can work in a reduced capacity and experiences a proportional loss of income.

In group accident and sickness insurance in Canada, what happens to an employee's coverage when they leave the employer?

Answer: The employee may have the right to convert to an individual policy

Most group policies include a conversion privilege that allows departing employees to convert their group coverage to an individual policy without evidence of insurability.

What is the 'relation back' doctrine as it applies to accident and sickness insurance claims in Canada?

Answer: The cause of loss is traced back to determine if it was accidental or from sickness

The relation back doctrine traces the chain of events to the original cause to determine whether a loss resulted from accident or sickness, which affects coverage and benefits.

Which provincial body typically regulates accident and sickness insurance products in Canada?

Answer: The provincial insurance regulator or superintendent of insurance

Insurance products in Canada are regulated at the provincial level by each province's insurance regulator or superintendent of insurance.

What is a 'cost of living adjustment' (COLA) rider in a disability insurance policy?

Answer: It increases disability benefits annually to keep pace with inflation

A COLA rider increases disability benefit payments annually, typically tied to the Consumer Price Index, to protect the purchasing power of benefits during a long-term claim.

In Canadian accident and sickness insurance, what does 'subrogation' refer to?

Answer: The insurer's right to recover benefits paid from a third party responsible for the loss

Subrogation is the insurer's right to recover claim payments from a negligent third party who caused the insured's injury or illness.