Rescission of policy and denial of claims
(1) For a policy or certificate that has been in force for less than six months, an insurer may rescind a long term care insurance policy or certificate or deny an otherwise valid long term care insurance claim upon a showing of a misrepresentation that is material to the acceptance for coverage.
(2) For a policy or certificate that has been in force for at least six months but less than two years, an insurer may rescind a long term care insurance policy or certificate or deny an otherwise valid long term care insurance claim upon a showing of a misrepresentation that is material to the acceptance for coverage and also pertains to the condition for which benefits are sought.
(3) After a policy or certificate has been in force for two years, the policy or certificate is not contestable upon the ground of misrepresentation alone. The policy or certificate may be contested only upon a showing that the insured knowingly and intentionally misrepresented relevant facts relating to the insured’s health.
(4) A long term care insurance policy or certificate may not be field issued based on medical or health status. A policy or certificate is field issued for the purposes of this subsection if the policy or certificate is issued by an insurance producer or a third party administrator pursuant to underwriting authority granted to the insurance producer or third party administrator by an insurer.
(5) If an insurer has paid benefits under the long term care insurance policy or certificate, the insurer may not recover the benefit payments in the event that the policy or certificate is rescinded.
(6) This section does not apply to the remaining death benefit of a life insurance policy in the event of the death of the insured if the policy accelerates benefits for long term care, but this section otherwise applies to a life insurance policy that accelerates benefits for long term care. In the event of the death of an insured, the remaining death benefits under the life insurance policy are governed by ORS 743.168 (Incontestability).
(7) This section is exempt from ORS 743A.001 (Automatic repeal of certain statutes on individual and group health insurance). [2007 c.486 §6]
Note: Section 18, chapter 486, Oregon Laws 2007, provides:
Sec. 18. Sections 6 [743.662 (Rescission of policy and denial of claims)] and 7 [743.664 (Offer of nonforfeiture benefit)] of this 2007 Act and the amendments to ORS 743.650 (Long Term Care Insurance Act), 743.652 (Definitions for ORS 743.650 to 743.664), 743.653 (Prohibition on certain policies) and 743.655 (Rules) by sections 1 to 4 of this 2007 Act apply to policies and certificates delivered or issued for delivery on or after January 1, 2008. [2007 c.486 §18]
3 OregonLaws.org assembles these lists by analyzing references between Sections. Each listed item refers back to the current Section in its own text. The result reveals relationships in the code that may not have otherwise been apparent. Currency Information