40-2203. Uniform policy provisions; rules and regulations for filing or submission of policies.
40-2203
40-2203. Uniform policy provisions; rules and regulations forfiling or submission of policies.(A) Required provisions. Except as provided in paragraph (C) ofthis section every such policy delivered or issued for delivery to anyperson in this state shall contain the provisions specified in thissubsection in the words in which the same appear in this section, but theinsurer, at its option, may substitutefor one or more of such provisions corresponding provisions of differentwording approved by the commissioner of insurance which are in eachinstance not less favorable in any respect to the insured or thebeneficiary. Such provisions shall be preceded individually by thecaption appearing in this subsection or at the option of the insurer, bysuch appropriate individual or group captions or subcaptions as thecommissioner of insurance may approve.
(1) A provision as follows: "Entire contract; changes: Thispolicy, including the endorsement and the attached papers, if any,constitutes the entire contract of insurance. No change in this policyshall be valid until approved by an executive officer of the insurer andunless such approval be endorsed hereon or attached hereto. No agent hasauthority to change this policy or to waive any of its provisions."
(2) A provision as follows: "Time limit on certain defenses:(a) After two years from the date of issue of this policy nomisstatements, except fraudulent misstatement, made by the applicant inthe application for such policy shall be used to void the policy or todeny a claim for loss incurred or disability (as defined in the policy)commencing after the expiration of such two-year period."
The foregoing policy provision shall not be so construed as to affectany legal requirement for avoidance of a policy or denial of a claimduring such initial two year period, nor to limit the application ofsubsections (B) (1), (2), (3), (4) and (5) in theevent of misstatementwith respect to age or occupation or other insurance.
A policy which the insured has the right to continue in force subjectto its terms by the timely payment of premium (1) until at least age 50, or (2)in the case of a policy issued after age 44, for at least five years from itsdateof issue, may contain inlieu of the foregoing the following provision (from which the clause inparentheses may be omitted at the insurer's option) under the caption"Incontestable": "After this policy has been in force for a periodof two years during the lifetime of the insured (excluding anyperiod during which the insured is disabled), it shall becomeincontestable as to the statements contained in the application.
(b) "No claim for loss incurred or disability (as defined in thepolicy) commencing after two years from the date of issue of thispolicy shall be reduced or denied on the ground that a disease orphysical condition not excluded from coverage by name or specificdescription effective on the date of loss has existed prior to theeffective date of coverage of this policy."
(3) A provision as follows: "Grace period: A grace period of__________" (insert a number not less than "7" for weekly premiumpolicies, "10" for monthly premium policies and "31" for all otherpolicies) "days will be granted for the payment of each premium fallingdue after the first premium, during which grace period the policy shallcontinue in force." A policy which contains a cancellation provision mayadd, at the end of the above provision, "subject to the right of theinsurer to cancel in accordance with the cancellation provision hereof."A policy in which the insurer reserves the right to refuse any renewalshall have, at the beginning of the above provision, "Unless not lessthan five days prior to the premium due date the insurer hasdelivered to the insured or has mailed to the last address as shownbythe records of the insurer written notice of its intention not to renewthis policy beyond the period for which the premium has been accepted."
(4) A provision as follows: "Reinstatement: If any renewalpremium be not paid within the time granted the insured for payment, asubsequent acceptance of premium by the insurer or by any agent dulyauthorized by the insurer to accept such premium without requiring inconnection therewith an application for reinstatement shall reinstatethe policy. If the insurer or suchagentrequires an application for reinstatement and issues a conditionalreceipt for the premium tendered, the policy will be reinstated uponapproval of such application by the insurer or, lacking such approval,upon the 45th day following the date suchconditionalreceipt unless the insurer has previously notified the insured inwriting of its disapproval of such application. The reinstated policyshall cover only loss resulting from such accidental injury as may besustained after the date of reinstatement and loss due to such sicknessas may begin more than ten days after such date. In all otherrespects the insured and insurer shall have the same rights thereunderas they had under the policy immediately before the due date of thedefaulted premium, subject to any provisions endorsed hereon or attachedhereto in connection with the reinstatement. Any premium accepted inconnection with a reinstatement shall be applied to a period for whichpremium has not been previously paid, but not to any period more than 60 daysprior to the date of reinstatement." The lastsentenceof the above provision may be omitted from any policy which the insuredhas the right to continue in force subject to its terms by the timelypayment of premiums (1) until at least age 50 or, (2) in thecase of a policy issued after age 44, for at leastfive years from its date of issue.
(5) A provision as follows: "Notice of claim: Written notice ofclaim must be given to the insurer within 20 days after theoccurrence or commencement of any loss covered by the policy, or as soonthereafter as is reasonably possible. Notice given by or on behalf ofthe insured or the beneficiary to the insurer at ______________" (insertthe location of such office as the insurer may designate for thepurpose), "or to any authorized agent of the insurer, with informationsufficient to identify the insured, shall be deemed notice to theinsurer." In a policy providing a loss-of-time benefit which may bepayable for at least two years, an insurer may at its option insertthe following between the first and second sentences of the aboveprovisions: "Subject to the qualification set forth below, if theinsured suffers loss of time on account of disability for whichindemnity may be payable for at least two years, he shall, at leastonce in every six months after having given notice of claim, give tothe insurer notice of continuance of said disability, except in theevent of legal incapacity. The period of six months following anyfiling of proof by the insured or any payment by the insurer on accountof such claim or any denial of liability in whole or in part by theinsurer shall be excluded in applying this provision. Delay in thegiving of such notice shall not impair the insured's right to anyindemnity which would otherwise have accrued during the period of six monthspreceding the date on which such notice is actually given.
(6) A provision as follows: "Claim forms: The insurer, uponreceipt of a notice of claim, will furnish to the claimant such forms asare usually furnished by it for filing proofs of loss. If such forms arenot furnished within 15 days after the giving of suchnoticethe claimant shall be deemed to have complied with the requirements ofthis policy as to proof of loss upon submitting within the time fixed inthe policy for filing proofs of loss, written proof covering theoccurrence, the character and the extent of the loss for which claim ismade."
(7) A provision as follows: "Proofs of loss: Written proof ofloss must be furnished to the insurer at its said office in case ofclaim for loss for which this policy provides any periodic paymentcontingent upon continuing loss within 90 days after thetermination of the period for which the insurer is liable and in case ofclaim for any other loss within 90 days after the date ofsuchloss. Failure to furnish such proof within the time required shall notinvalidate nor reduce any claim if it was not reasonably possible togive proof within such time, provided such proof is furnished as soon asreasonably possible and in no event, except in the absence of legalcapacity, later than one year from the time proof is otherwiserequired."
(8) A provision as follows: "Time of payment of claims:Indemnities payable under this policy for any loss other than loss forwhich this policy provides any periodic payment will be paid immediatelyupon receipt of due written proof of such loss. Subject to due writtenproof of loss, all accrued indemnities for loss for which this policyprovides periodic payment will be paid ______" (insert period forpayment which must not be less frequently than monthly) "and any balanceremaining unpaid upon the termination of liability will be paidimmediately upon receipt of due written proof."
(9) A provision as follows: "Payment of claims: Indemnity forloss of life will be payable in accordance with the beneficiarydesignation and the provisions respecting such payment which may beprescribed herein and effective at the time of payment. If no suchdesignation or provision is then effective, such indemnity shall bepayable to the estate of the insured. Any other accrued indemnitiesunpaid at the insured's death, at the option of the insurer, may bepaid either to such beneficiary or to such estate. All other indemnities willbe payable to the insured." The following provisions, or either of them,may be included with the foregoing provision at the option of theinsurer: "If any indemnity of this policy shall be payable to the estateof the insured, or to an insured or beneficiary who is a minor orotherwise not competent to give a valid release, the insurer may paysuch indemnity, up to an amount not exceeding $______" (insert an amountwhich shall not exceed $1,000), "to any relative by blood or connectionby marriage of the insured or beneficiary who is deemed by the insurerto be equitably entitled thereto. Any payment made by the insurer ingood faith pursuant to this provision shall fully discharge the insurerto the extent of such payment. Subject to any written direction of theinsured in the application or otherwise all or a portion of anyindemnities provided by this policy on account of hospital, nursing,medical, or surgical services may, at the insurer's option and unlessthe insured requests otherwise in writing not later than the time offiling proofs of such loss, be paid directly to the hospital or personrendering such services; but it is not required that the service berendered by a particular hospital or person."
(10) A provision as follows: "Physical examinations and autopsy:The insurer at its own expense shall have the right and opportunity toexamine the person of the insured when and as often as it may reasonablyrequire during the pendency of a claim hereunder and to make an autopsyin case of death where it is not forbidden by law."
(11) A provision as follows: "Legal actions: No action at lawor in equity shall be brought to recover on this policy prior to theexpiration of 60 days after written proof of loss has beenfurnishedin accordance with the requirements of this policy. No such action shallbe brought after the expiration of five years after the time writtenproof of loss is required to be furnished."
(12) A provision as follows: "Change of beneficiary: Unless theinsured makes an irrevocable designation of beneficiary, the right tochange of beneficiary is reserved to the insured and the consent of thebeneficiary or beneficiaries shall not be requisite to surrender orassignment of this policy or to any change of beneficiary orbeneficiaries, or to any other changes in this policy."
The first clause of this provision, relating to the irrevocabledesignation of beneficiary, may be omitted at the insurer's option.
(13) A provision as follows: "Cancellation by insured: Theinsured may cancel this policy at any time by written notice delivered ormailed to the insurer, effective upon receipt of such notice or on such later date as maybe specified in such notice. In the event of cancellation or death of theinsured, the insurer will promptly return the unearned portion of anypremium paid.The earned premium shall becomputed by the use of the short-rate table last filed with the stateofficial having supervision of insurance in the state where the insuredresided when the policy was issued. Cancellation shall be withoutprejudice to any claim originating prior to the effective date ofcancellation." When approved by the commissioner, the "cancellation"provision appearing in subsection (B)(8) may be substituted for the above.
(B) Other provisions: Except as provided in paragraph (C) ofthis section, no such policy delivered or issued for delivery to anyperson in this state shall contain provisions respecting the matters setforth below unless such provisions are in the words in which the sameappear in this section, but the insurer may, atits option, use in lieu of any such provision a corresponding provisionof different wording approved by the commissioner of insurance which isnot less favorable in any respect to the insured or the beneficiary. Anysuch provision contained in the policy shall be preceded individually bythe appropriate caption appearing in this subsection or, at the optionof the insurer, by such appropriate individual or group captions orsubcaptions as the commissioner of insurance may approve.
(1) A provision as follows: "Change of occupation: If theinsured be injured or contract sickness after having changed hisoccupation to one classified by the insurer as more hazardous than thatstated in this policy or while doing for compensation anythingpertaining to an occupation so classified, the insurer will pay onlysuch portion of the indemnities provided in this policy as the premiumpaid would have purchased at the rates and within the limits fixed bythe insurer for such more hazardous occupation. If the insured changeshis occupation to one classified by the insurer as less hazardous thanthat stated in this policy, the insurer, upon receipt of proof of suchchange of occupation, will reduce the premium rate accordingly, and willreturn the excess pro rata unearned premium from the date of change ofoccupation or from the policy anniversary date immediately precedingreceipt of such proof, whichever is the more recent. In applying thisprovision, the classification of occupational risk and the premium ratesshall be such as have been last filed by the insurer prior to theoccurrence of the loss for which the insurer is liable or prior to dateof proof of change in occupation with the state official havingsupervision of insurance in the state where the insured resided at thetime this policy was issued; but if such filing was not required, thenthe classification of occupational risk and the premium rates shall bethose last made effective by the insurer in such state prior to theoccurrence of the loss or prior to the date of proof of change inoccupation."
(2) A provision as follows: "Misstatement of age: If the age ofthe insured has been misstated, all amounts payable under this policyshall be such as the premium paid would have purchased at the correctage."
(3) A provision as follows: "Other insurance in this insurer:If an accident or sickness or accident and sickness policy or policiespreviously issued by the insurer to the insured be in force concurrentlyherewith, making the aggregate indemnity for __________" (insert type ofcoverage or coverages) "in excess of _______" (insert maximum limit ofindemnity or indemnities) "the excess insurance shall be void and allpremiums paid for such excess shall be returned to the insured or to hisestate"; or, in lieu thereof: "Insurance effective at any one time onthe insured under a like policy or policies in this insurer is limitedto one such policy elected by the insured, his beneficiary or hisestate, as the case may be, and the insurer will return all premiumspaid for all other such policies."
(4) A provision as follows: "Insurance with other insurers: Ifthere be other valid coverage, not with this insurer, providing benefitsfor the same loss on a provision of service basis or on an expenseincurred basis and of which this insurer has not been given writtennotice prior to the occurrence or commencement of loss, the onlyliability under any expense incurred coverage of this policy shall befor such proportion of the loss as the amount which would otherwise havebeen payable hereunder plus the total of the like amounts under all suchother valid coverages for the same loss of which this insurer had noticebears to the total like amounts under all valid coverages for such loss,and for the return of such portion of the premiums paid as shall exceedthe pro rata portion for the amount so determined. For the purpose ofapplying this provision when other coverage is on a provision of servicebasis, the 'like amount' of such other coverage shall be taken as theamount which the services rendered would have cost in the absence ofsuch coverage." If the foregoing policy provision is included in apolicy which also contains the next following policy provision thereshall be added to the caption of the foregoing provision the phrase"__________ expense incurred benefits." The insurer, at its option,may include in this provision a definition of "other valid coverage,"approved as to form by the commissioner of insurance, which definitionshall be limited in subject matter to coverage provided by organizationssubject to regulation by insurance law or by insurance authorities ofthis or any other state of the United States or any province of Canada,and by hospital or medical service organizations, and to any othercoverage the inclusion of which may be approved by the commissioner ofinsurance. In the absence of such definition such term shall not includegroup insurance, automobile medical payments insurance, or coverageprovided by hospital or medical service organizations or by unionwelfare plans or employer or employee benefit organizations. For thepurpose of applying the foregoing policy provision with respect to anyinsured, any amount of benefit provided for such insured pursuant to anycompulsory benefit statute (including any workmen's compensation oremployer's liability statute) whether provided by a governmental agencyor otherwise shall in all cases be deemed to be "other valid coverage"of which the insurer has had notice. In applying the foregoing policyprovision no third party liability coverage shall be included as "othervalid coverage."
(5) A provision as follows: "Insurance with other insurers: Ifthere be other valid coverage, not with this insurer, providing benefitsfor the same loss on other than an expense incurred basis and of whichthis insurer has not been given written notice prior to the occurrenceor commencement of loss, the only liability for such benefits under thispolicy shall be for such proportion of the indemnities otherwiseprovided hereunder for such loss as the like indemnities of which theinsurer had notice (including the indemnities under this policy) bear tothe total amount of all like indemnities for such loss, and the returnof such portion of the premium paid as shall exceed the pro rata portionfor the indemnities thus determined." If the foregoing policy provisionis included in a policy which also contains the next preceding policyprovision there shall be added to the caption of the foregoing provisionthe phrase "__________ other benefits." The insurer, at its option,may include in this provision a definition of "other valid coverage,"approved as to form by the commissioner of insurance, which definitionshall be limited in subject matter to coverage provided by organizationssubject to regulation by insurance law or by insurance authorities ofthis or any other state of the United States or any province of Canada,and to any other coverage the inclusion of which may be approved by thecommissioner of insurance. In the absence of such definition such termshall not include group insurance, or benefits provided by union welfareplans or by employer or employee benefit organizations. For the purposeof applying the foregoing policy provision with respect to any insured,any amount of benefit provided for such insured pursuant to anycompulsory benefit statute (including any workers compensation oremployer's liability statute) whether provided by a governmental agencyor otherwise shall in all cases be deemed to be "other valid coverage"of which the insurer has had notice. In applying the foregoing policyprovision no third-party liability coverage shall be included as "othervalid coverage."
(6) A provision as follows: "Relation of earnings to insurance:If the total monthly amount of loss of time benefits promised for thesame loss under all valid loss of time coverage upon the insured,whether payable on a weekly or monthly basis, shall exceed the monthlyearnings of the insured at the time disability commenced or theaverage monthly earnings for the period of two years immediately preceding adisability for which claim is made, whichever is the greater, theinsurer will be liable only for such proportionate amount of suchbenefits under this policy as the amount of such monthly earnings orsuch average monthly earnings of the insured bears to the total amountof monthly benefits for the same loss under all such coverage upon theinsured at the time such disability commences and for the return of suchpart of the premiums paid during such two years as shall exceed thepro rata amount of the premiums for the benefits actually paidhereunder; but this shall not operate to reduce the total monthly amountof benefits payable under all such coverage upon the insured below thesum of $200 or the sum of the monthly benefitsspecified in such coverages, whichever is the lesser, nor shall itoperate to reduce benefits other than those payable for loss of time."The foregoing policy provision may be inserted only in a policy whichthe insured has the right to continue in force subject to its terms bythe timely payment of premiums (1) until at least age 50, or (2)in the case of a policy issued after age 44, for atleast five years from its date of issue. The insurer, at its option,may include in this provision a definition of "valid loss of time coverage,"approved as to form by the commissioner of insurance, which definitionshall be limited in subject matter to coverage provided by governmentalagencies or by organizations subject to regulation by insurance law orby insurance authorities of this or any other state of the United Statesor any province of Canada, or to any other coverage the inclusion ofwhich may be approved by the commissioner of insurance or anycombination of such coverages. In the absence of such definition suchterm shall not include any coverage provided for such insured pursuantto any compulsory benefit statute (including any workers compensationor employer's liability statute), or benefits provided by union welfareplans or by employer or employee benefit organizations.
(7) A provision as follows: "Unpaid premium: Upon the paymentof a claim under this policy, any premium then due and unpaid or coveredby any note or written order may be deducted therefrom."
(8) A provision as follows: "Cancellation: The insurer maycancel this policy at any time by written notice delivered to theinsured, or mailed to his last address as shown by the records of theinsurer, stating when, not less than five days thereafter, suchcancellation shall be effective; and after the policy has been continuedbeyond its original term the insured may cancel this policy at any timeby written notice delivered or mailed to the insurer, effective uponreceipt or on such later date as may be specified in such notice. In theevent of cancellation, the insurer will return promptly the unearnedportion of any premium paid. If the insured cancels, the earned premiumshall be computed by the use of the short-rate table last filed with thestate official having supervision of insurance in the state where theinsured resided when the policy was issued. If the insurer cancels, theearned premium shall be computed pro rata. Cancellation shall be withoutprejudice to any claim originating prior to the effective date ofcancellation."
(9) A provision as follows: "Conformity with state statutes:Any provision of this policy which, on its effective date, is inconflict with the statutes of the state in which the insured resides onsuch date is hereby amended to conform to the minimum requirements ofsuch statutes."
(10) A provision as follows: "Illegal occupation: The insurershall not be liable for any loss to which a contributing cause was theinsured's commission of or attempt to commit a felony or to which acontributing cause was the insured's being engaged in an illegaloccupation."
(11) A provision as follows: "Intoxicants and narcotics: Theinsurer shall not be liable for any loss sustained or contracted inconsequence of the insured's being intoxicated or under the influence ofany narcotic unless administered on the advice of a physician."
(C) Inapplicable or inconsistent provisions: If any provisionof this section is in whole or in part inapplicable to or inconsistentwith the coverage provided by a particular form of policy the insurer,with the approval of the commissioner of insurance, shall omit from suchpolicy any inapplicable provision or part of a provision, and shallmodify any inconsistent provision or part of the provision in suchmanner as to make the provision as contained in the policy consistentwith the coverage provided by the policy.
(D) Order of certain policy provisions: The provisions whichare the subject of subsection (A) and (B) of this section, or anycorresponding provisions which are used in lieu thereof in accordancewith such subsections, shall be printed in the consecutive order of theprovisions in such subsections or, at the option of the insurer, anysuch provision may appear as a unit in any part of the policy, withother provisions to which it may be logically related, provided theresulting policy, shall not be in whole or in part unintelligible,uncertain, ambiguous, abstruse, or likely to mislead a person to whomthe policy is offered, delivered or issued.
(E) Third-party ownership: The word "insured," as used in thisact, shall not be construed as preventing a person other than theinsured with a proper insurable interest from making application for andowning a policy covering the insured or from being entitled under such apolicy to any indemnities, benefits and rights provided therein.
(F) Requirements of other jurisdictions: (1) Any policy of aforeign or alien insurer, when delivered or issued for delivery to anyperson in this state, may contain any provision which is not lessfavorable to the insured or the beneficiary than the provisions of thisact and which is prescribed or required by the law of the state underwhich the insurer is organized.
(2) Any policy of a domestic insurer, when issued for delivery in any otherstate or country, may contain any provision permitted or required by the lawsof such other state or country.
(G) Filing procedure: The commissioner of insurance may makesuch reasonable rules and regulations concerning the procedure for thefiling or submission of policies subject to this act as are necessary,proper or advisable to the administration of this act. This provisionshall not abridge any other authority granted the commissioner ofinsurance by law.
(H) (1) No policy issued by an insurer to which this section applies shallcontain a provision which excludes, limits or otherwise restricts coveragebecause medicaid benefits as permitted by title XIX of the social security actof 1965 are or may be available for the same accident or illness.
(2) Violation of this subsection shall be subject to the penaltiesprescribed by K.S.A. 40-2407 and 40-2411, and amendments thereto.
History: L. 1951, ch. 296, § 3; L. 1965, ch. 304, § 1;L. 1989, ch. 138, § 1;L. 1993, ch. 132, § 6; July 1.