33-22-602. Required provisions of blanket policies. An insurer authorized to write disability insurance in this state has the power to issue blanket disability insurance. A blanket policy may not be issued or delivered in this state unless a copy of the policy form is filed in accordance with 33-1-501. A blanket policy must contain provisions that in the opinion of the commissioner are at least as favorable to the policyholder and the individual insured as the following provisions:

(1) the policy and the application constitute the entire contract between the parties, all statements made by the policyholder are, in absence of fraud, considered representations and not warranties, and statements may not be used in defense to a claim under the policy unless it is contained in a written application;

(2) written notice of sickness or of injury must be given to the insurer within 20 days after the date when the sickness or injury occurred. Failure to give notice within 20 days may not invalidate or reduce a claim if the insured shows that it was not reasonably possible to give the required notice and that notice was given as soon as was reasonably possible.

(3) the insurer will furnish to the policyholder forms for filing proof of loss. If forms are not furnished within 15 days after the insured provided notice of sickness or injury, the claimant is considered to have complied with the requirements of the policy as to proof of loss upon submitting, within the time established in the policy for filing proof of loss, written proof covering the occurrence, character, and extent of the loss for which claim is made.

(4) in the case of a claim for loss of time for disability, written proof of the loss must be furnished to the insurer within 30 days after the commencement of the period for which the insurer is liable and subsequent written proof of the continuance of the disability must be furnished to the insurer at intervals established by the insurer. In the case of a claim for any other loss, written proof of the loss must be furnished to the insurer within 90 days after the date of the loss. Failure to furnish proof within 90 days may not invalidate or reduce a claim if the insured shows it was not reasonably possible to furnish the required proof and that proof was furnished as soon as was reasonably possible.

(5) except as provided in 33-22-137, all benefits payable under the policy other than benefits for loss of time are payable immediately upon receipt of written proof of the loss. Subject to proof of loss, all accrued benefits payable under the policy for loss of time must be paid at least every 30 days during the period for which the insurer is liable. Any balance remaining unpaid at the termination of the period of liability must be paid immediately upon receipt of the proof of loss.

(6) the insurer at its own expense has the right and opportunity to examine the person of the insured when and as often as reasonably required during the pendency of a claim under the policy and also the right and opportunity to make an autopsy in case of death when it is not prohibited by law;

(7) an action at law or in equity may not be brought to recover a loss under the policy sooner than 60 days after written proof of loss has been furnished in accordance with the requirements of the policy and no later than 3 years after the time written proof of loss is required to be furnished.

History: En. Sec. 389, Ch. 286, L. 1959; R.C.M. 1947, 40-4105; amd. Sec. 29, Ch. 271, L. 2009.