New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 4 - ACTUARIAL SERVICES
Subchapter 41 - STANDARDS FOR INDIVIDUAL LIFE INSURANCE POLICY FORMS
Section 11:4-41.7 - Standards for pre-existing conditions exclusions
Universal Citation: NJ Admin Code 11:4-41.7
Current through Register Vol. 56, No. 6, March 18, 2024
(a) Pre-existing condition exclusions shall only be permitted in the case of benefits for disability, as follows:
1. The
insurer shall not be liable for a disability resulting from any pre-existing
condition which is disclosed in the application and excluded by
rider.
2. The insurer shall be
liable from the effective date of the policy for a disability resulting from
any pre-existing condition which is in an application and not excluded by
rider.
3. The insurer shall not be
liable for any pre-existing condition which is not disclosed in the application
because the application did not include such a question and because of which
the insured becomes disabled during the first two years of the effective date
of the policy. The insurer shall be liable if the insured recovers from such
disability and becomes disabled again from the same pre-existing condition
after two years from the effective date of the policy.
4. The insurer shall be liable for any
pre-existing condition which is not disclosed in the application because the
application did not include such a question and because of which the insured
becomes disabled two or more years after the effective date of the
policy.
5. The insurer may contest
a material misrepresentation made by the insured in the application.
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