Home Table of Contents

§ 756.3. Blanket accident and sickness insurance

Purdon's Pennsylvania Statutes and Consolidated StatutesTitle 40 P.S. Insurance

Purdon's Pennsylvania Statutes and Consolidated Statutes
Title 40 P.S. Insurance (Refs & Annos)
Chapter 2. Insurance Companies (Refs & Annos)
Article VI. Casualty Insurance (Refs & Annos)
(b) Health and Accident Insurance (Refs & Annos)
40 P.S. § 756.3
§ 756.3. Blanket accident and sickness insurance
(a) Blanket accident and sickness insurance is hereby declared to be that form of accident and sickness insurance covering groups of persons in the following manner:
(1) Under a policy or contract issued to any common carrier or to any operator, owner or lessee of a means of transportation, who or which shall be deemed the policyholder covering all persons or all persons of a class who may become passengers on such common carrier or such means of transportation.
(2) Under a policy or contract issued to an employer who shall be deemed the policyholder, covering all employes, dependents or guests defined by reference to specified hazards, incident to the activities or operations of the employer or any class of employes, dependents or guests similarly defined.
(3) Under a policy or contract issued to a school or other institution of learning, camp or sponsor thereof, or to the head or principal thereof, who or which shall be deemed the policyholder, covering students or campers and which may cover supervisors and employes.
(4) Under a policy or contract issued in the name of any religious, charitable, recreational, educational or civic organization, which shall be deemed the policyholder, covering participants in activities sponsored by the organization.
(5) Under a policy or contract issued to a sports team or sponsors thereof, which shall be deemed the policyholder covering members, officials and supervisors.
(6) Under a policy or contract issued to cover any other risk or class of risks, which in the discretion of the Insurance Commissioner may be properly eligible for blanket accident and sickness insurance. The discretion of the Commissioner may be exercised on an1 individual risk basis or class of2 risks, or both.
(b) Every blanket accident and sickness insurance policy shall contain provisions which, in the opinion of the Insurance Commissioner, are at least as favorable to the policyholder and the individual insured as the following:
(1) A provision that the policy and the application shall constitute the entire contract between the parties and that all statements made by the policyholder shall, in absence of fraud, be deemed representations and not warranties, and that no such statements shall be used in defense to a claim under the policy, unless it is contained in a written application.
(2) A provision that written notice of sickness or of injury must be given to the insurer within twenty days after the date when such sickness or injury occurred. Failure to give notice within such time shall not invalidate nor reduce any claim, if it shall be shown not to have been reasonably possible to give such notice, and that notice was given as soon as was reasonably possible.
(3) A provision that the insurer will furnish to the policyholder such forms as are usually furnished by it for filing proof of loss. If such forms are not furnished before the expiration of fifteen days after the giving of such notice, the claimant shall be deemed to have complied with the requirements of the policy as to proof of loss upon submitting, within the time fixed 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) A provision that in the case of claim for loss of time for disability, written proof of such loss must be furnished to the insurer within thirty days after the commencement of the period for which the insurer is liable, and that subsequent written proofs of the continuance of such disability must be furnished to the insurer at such intervals as the insurer may reasonably require, and that in the case of claim for any other loss written proof of such loss must be furnished to the insurer within ninety days after the date of such loss. Failure to furnish such proof within such time shall not invalidate nor reduce any claim if it shall be shown not to have been reasonably possible to furnish such proof and that such proof was furnished as soon as was reasonably possible.
(5) A provision that all benefits payable under the policy, other than benefits for loss of time, will be payable immediately upon receipt of due written proof of such loss and that subject to due proof of loss all accrued benefits, payable under the policy for loss of time, will be paid not later than at the expiration of each period of thirty days during the continuance of the period for which the insurer is liable, and that any balance remaining unpaid at the termination of such period will be paid immediately upon receipt of such proof.
(6) A provision that the insurer, at its own expense, shall have the right and opportunity to examine the person of the insured, when and so often as it may reasonably require during the pendence of claim under the policy and also the right and opportunity to make an autopsy, in case of death, where it is not prohibited by law.
(7) A provision that no action at law or in equity shall be brought to recover under the policy prior to the expiration of sixty days after written proof of loss has been furnished in accordance with the requirements of the policy and that no such action shall be brought after the expiration of three years after the time written proof of loss is required to be furnished.
(c) An individual application shall not be required from a person covered under a blanket accident or sickness policy or contract, nor shall it be necessary for the insurer to furnish each person a certificate.
(d) Except as otherwise provided in this section, all benefits under any blanket accident and health policy shall be payable to the person insured or to his designated beneficiary or beneficiaries or to his estate. If the person insured be a minor or mental incompetent, such benefits may be made payable to his parent, guardian or other person actually supporting him, or if the entire cost of the insurance has been borne by the employer, such benefits may be made payable to the employer. The policy may provide that all or any portion of any indemnities provided by any such policy on account of hospital, nursing, medical or surgical services may, at the insurer's option, be paid directly to the hospital or person rendering such services, but the policy may not require that the service be rendered by a particular hospital or person. Payment so made shall discharge the insurer's obligation with respect to the amount of insurance so paid.

Credits

1921, May 17, P.L. 682, art. VI, § 621.3, added 1955, Dec. 9, P.L. 807, § 2.

Footnotes

Enrolled bill reads “any”.
Enrolled bill reads “of class or”.
40 P.S. § 756.3, PA ST 40 P.S. § 756.3
Current through 2022 Regular Session Act 121. Some statute sections may be more current, see credits for details.
End of Document