State RegulationsNY specificDifficulty 1/5
Under the illegal occupation provision available in New York individual accident and health policies, the insurer may deny a claim for a loss that results from the insured's
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Answer & full 3-part explanation (select an option above, or peek)
Why D is correct
Under N.Y. Ins. Law §3216(d)(2)(J), the illegal occupation exclusion permits the insurer to deny benefits for loss incurred while the insured is engaged in an illegal occupation or is committing or attempting a felony. Public policy bars indemnifying the consequences of criminal activity. Lawful but dangerous work, by contrast, is an underwriting and rating matter, not a ground for denying claims.
Why the other options are wrong
- A) A hazardous but lawful occupation affects premiums, not claim payment.
- B) Misstatement of occupation is handled by a separate provision about misstatement.
- C) The insured's refusal to change occupations is not a ground for denial.
Memory hook
Crime does not pay claims.