054.00.52-9. UNDERWRITING GUIDELINES.
AR ADC 054.00.52-9Arkansas Administrative Code
Ark. Admin. Code 054.00.52-9
054.00.52-9. UNDERWRITING GUIDELINES.
A. No claim shall be reduced or denied on the ground that the disease or physical condition for which claim is made preexisted the effective date of the policy coverage and was not disclosed by the insured, unless the insurer has evidence that such disease or physical condition had manifested itself prior to the effective date of coverage for the disease or physical condition, and unless information on such disease or physical condition was requested on the application for insurance coverage. No claim shall be reduced or denied on such grounds unless the manifestation of the disease is established by proof of medical diagnosis or treatment of such disease or physical condition prior to the effective date of coverage for the disease or physical condition.
B. An insurer may rescind a minimum basic benefit policy within the first three years after the policy inception only upon receipt of information concerning the insured's state of health, and a finding thereon that the insured failed to disclose or misrepresented material information contained on the application. Material information is that information concerning the insured's physical condition or past treatment which would, if disclosed, resulted in refusal to accept that insured or others treated for the same condition or in substantially the same condition as the insured. The burden of proof in cases in controversy before the Department shall be on the insurer.
Current with amendments received through February 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 054.00.52-9, AR ADC 054.00.52-9
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