| |
Illinois Compiled Statutes
Information maintained by the Legislative Reference Bureau Updating the database of the Illinois Compiled Statutes (ILCS) is an ongoing process. Recent laws may not yet be included in the ILCS database, but they are found on this site as Public Acts soon after they become law. For information concerning the relationship between statutes and Public Acts, refer to the Guide. Because the statute database is maintained primarily for legislative drafting purposes, statutory changes are sometimes included in the statute database before they take effect. If the source note at the end of a Section of the statutes includes a Public Act that has not yet taken effect, the version of the law that is currently in effect may have already been removed from the database and you should refer to that Public Act to see the changes made to the current law.
INSURANCE (215 ILCS 5/) Illinois Insurance Code. 215 ILCS 5/357.5
(215 ILCS 5/357.5) (from Ch. 73, par. 969.5)
Sec. 357.5.
"REINSTATEMENT:
If any renewal premium be not paid within
the time granted the insured for payment, a subsequent acceptance of
premium by the company or by any agent duly authorized by the company to
accept such premium, without requiring in connection therewith an
application for reinstatement, shall reinstate the policy; provided,
however, that if the company or such agent requires an application for
reinstatement and issues a conditional receipt for the premium tendered,
the policy will be reinstated upon approval of such application by the
company or, lacking such approval, upon the 45th day following the date
of such conditional receipt unless the company has previously notified
the insured in writing of its disapproval of such application. The
reinstated policy shall cover only loss resulting from such accidental
injury as may be sustained after the date of reinstatement and loss due
to such sickness as may begin more than 10 days after such date. In all
other respects the insured and company shall have the same rights
thereunder as they had under the policy immediately before the due date
of the defaulted premium, subject to any provisions endorsed hereon or
attached hereto in connection with the reinstatement. Any premium
accepted in connection with a reinstatement shall be applied to a period
for which premium has not been previously paid, but not to any period
more than 60 days prior to the date of reinstatement."
The last sentence of the above provision may be omitted from any
policy which the insured has the right to continue in force subject to
its terms by the timely payment of premiums (1) until at least age 50
or, (2) in the case of a policy issued after age 44, for at least 5
years from its date of issue.
For the purpose of this Section, the phrase "loss resulting from such
accidental injury as may be sustained after the date of reinstatement and
loss due to such sickness as may begin more than 10 days
after such date" shall mean that the reinstated policy shall not cover a
loss resulting from accidental injury sustained after the date of lapse
of the policy and prior to the date of reinstatement or a loss resulting
from sickness which is first manifested after the date of lapse of the policy
but not after a date more than 10 days after the date of
reinstatement. An accidental injury and a sickness as described in this
Section shall be subject to the requirements of Section 357.3 with the
exception that references to date of issue and application shall mean date
of reinstatement and reinstatement application. All other accidental
injuries and sicknesses will be subject to the requirements of 357.3.
Provisions endorsed or attached to the policy in connection with the
reinstatement shall relate to a disease or physical condition of an insured
under the policy.
(Source: P.A. 84-1308.)
|
215 ILCS 5/357.6
(215 ILCS 5/357.6) (from Ch. 73, par. 969.6)
Sec. 357.6.
"NOTICE OF CLAIM:
Written notice of claim must be given to the
company within 20 days after the occurrence or commencement of any loss
covered by the policy, or as soon thereafter as is reasonably possible.
Notice given by or on behalf of the insured or the beneficiary to the
company at ....(insert the location of such office as the company may
designate for the purpose), or to any authorized agent of the company, with
information sufficient to identify the insured, shall be deemed notice to
the company."
In a policy providing a loss-of-time benefit which may be payable for at
least 2 years, a company may at its option insert the following between the
first and second sentences of the above provision:
"Subject to the qualifications set forth below, if the insured suffers
loss of time on account of disability for which indemnity may be payable
for at least 2 years, he shall, at least once in every 6 months after
having given notice of claim, give to the company notice of continuance of
said disability, except in the event of legal incapacity. The period of 6
months following any filing of proof by the insured or any payment by the
company on account of such claim or any denial of liability in whole or in
part by the company shall be excluded in applying this provision. Delay in
the giving of such notice shall not impair the insured's right to any
indemnity which would otherwise have accrued during the period of 6 months
preceding the date on which such notice is actually given."
(Source: Laws 1967, p. 1735.)
|
215 ILCS 5/357.7
(215 ILCS 5/357.7) (from Ch. 73, par. 969.7)
Sec. 357.7.
"CLAIM FORMS:
The company, upon receipt of a notice of claim,
will furnish to the claimant such forms as are usually furnished by it for
filing proofs of loss. If such forms are not furnished within 15 days after
the giving of such notice the claimant shall be deemed to have complied
with the requirements of this policy as to proof of loss upon submitting,
within the time fixed in the policy for filing proofs of loss, written
proof covering the occurrence, the character and the extent of the loss for
which claim is made."
(Source: Laws 1967, p. 1735.)
|
215 ILCS 5/357.8
(215 ILCS 5/357.8) (from Ch. 73, par. 969.8)
Sec. 357.8.
"PROOFS OF LOSS:
Written proof of loss must be furnished to the
company at its said office in case of claim for loss for which this policy
provides any periodic payment contingent upon continuing loss within 90
days after the termination of the period for which the company is liable
and in case of claim for any other loss within 90 days after the date of
such loss. Failure to furnish such proof within the time required shall not
invalidate nor reduce any claim if it was not reasonably possible to give
proof within such time, provided such proof is furnished as soon as
reasonably possible and in no event, except in the absence of legal
capacity, later than one year from the time proof is otherwise required."
(Source: Laws 1967, p. 1735.)
|
215 ILCS 5/357.9
(215 ILCS 5/357.9) (from Ch. 73, par. 969.9)
Sec. 357.9.
"TIME OF PAYMENT OF CLAIMS:
Indemnities
payable under
this policy for any loss other than loss for which this policy provides
any periodic payment will be paid immediately upon receipt of due
written proof of such loss.
Subject
to due written proof of loss, all
accrued indemnities for loss for which this policy provides periodic
payment will be paid ....
(insert period for payment which must not be
less frequently than monthly) and any balance remaining unpaid upon the
termination of liability, will be paid immediately upon receipt of due
written proof."
All claims and indemnities payable under the terms of
a policy of accident and health insurance shall be paid within 30 days
following receipt by the insurer of due proof of loss.
Failure to pay
within such period shall entitle the insured
to interest at the rate of 9
per cent per annum from the 30th day after receipt of such proof of loss to
the date of late payment, provided that interest amounting to less than one
dollar need not be paid.
An insured or an insured's assignee shall be
notified by the insurer, health maintenance organization, managed care plan,
health care plan, preferred provider organization, or third party administrator
of any known failure to provide sufficient documentation for a
due proof of
loss within 30 days after receipt of the claim.
Any
required interest payments shall be made within 30 days after the payment.
The requirements of this Section shall apply to any policy of accident
and health insurance delivered, issued for delivery, renewed or amended on
or after 180 days following the effective date of this amendatory Act of 1985.
The requirements of this Section also shall specifically apply to
any group policy of dental insurance only, delivered, issued for
delivery, renewed or amended on or after 180 days following the effective
date of this amendatory Act of 1987.
(Source: P.A. 91-605, eff. 12-14-99.)
|
215 ILCS 5/357.9a
(215 ILCS 5/357.9a) (from Ch. 73, par. 969.9a)
Sec. 357.9a.
Delay in payment of claims.
Periodic payments
of accrued indemnities for loss-of-time coverage under accident
and health policies shall commence not later than 30 days after
the receipt by the company of the required written proofs of loss.
An insurer which violates this Section if liable under said policy, shall
pay to the insured, in addition to any other penalty provided for in this Code,
interest at the rate of 9% per annum from the 30th day after
receipt of such proofs of loss to the date of late payment of the
accrued indemnities, provided that interest amounting to less than
one dollar need not be paid.
(Source: P.A. 92-139, eff. 7-24-01.)
|
215 ILCS 5/357.10
(215 ILCS 5/357.10) (from Ch. 73, par. 969.10)
Sec. 357.10.
"PAYMENT OF CLAIMS:
Indemnity for loss of life will be payable
in accordance with the beneficiary designation and the provisions
respecting such payment which may be prescribed herein and effective at the
time of payment. If no such designation or provision is then effective,
such indemnity shall be payable to the estate of the insured. Any other
accrued indemnities unpaid at the insured's death may, at the option of the
company, be paid either to such beneficiary or to such estate. All other
indemnities will be payable to the insured."
The following provisions, or either of them, may be included with the
foregoing provision at the option of the company:
"If any indemnity of this policy shall be payable to the estate of the
insured, or to an insured or beneficiary who is a minor or otherwise not
competent to give a valid release, the company may pay such indemnity, up
to an amount not exceeding $....(insert an amount which shall not exceed
$1000), to any relative by blood or connection by marriage of the insured
or beneficiary who is deemed by the company to be equitably entitled
thereto. Any payment made by the company in good faith pursuant to this
provision shall fully discharge the company to the extent of such payment.
"Subject to any written direction of the insured in the application or
otherwise all or a portion of any indemnities provided by this policy on
account of hospital, nursing, medical, or surgical services may, at the
company's option and unless the insured requests otherwise in writing not
later than the time of filing proofs of such loss, be paid directly to the
hospital or person rendering such services; but it is not required that the
service be rendered by a particular hospital or person. Nothing in this
provision shall prohibit an insurer from providing incentives for insureds
to utilize the services of a particular hospital or person."
(Source: P.A. 84-618.)
|
215 ILCS 5/357.11
(215 ILCS 5/357.11) (from Ch. 73, par. 969.11)
Sec. 357.11.
"PHYSICAL EXAMINATIONS AND AUTOPSY:
The company at its own
expense shall have the right and opportunity to examine the person of the
insured when and as often as it may reasonably require during the pendency
of a claim hereunder and to make an autopsy in case of death where it is
not forbidden by law."
(Source: Laws 1967, p. 1735.)
|
215 ILCS 5/357.12
(215 ILCS 5/357.12) (from Ch. 73, par. 969.12)
Sec. 357.12.
"LEGAL ACTIONS:
No civil action shall be brought
to recover on this policy prior to the expiration of 60 days after written
proof of loss has been furnished in accordance with the requirements of
this policy. No such action shall be brought after the expiration of 3
years after the time written proof of loss is required to be furnished."
(Source: P.A. 79-1362.)
|
215 ILCS 5/357.13
(215 ILCS 5/357.13) (from Ch. 73, par. 969.13)
Sec. 357.13.
"CHANGE OF BENEFICIARY:
Unless the insured makes an
irrevocable designation of beneficiary, the right to change of beneficiary
is reserved to the insured and the consent of the beneficiary or
beneficiaries shall not be requisite to surrender or assignment of this
policy or to any change of beneficiary or beneficiaries, or to any other
changes in this policy."
(The first clause of this provision, relating to the irrevocable
designation of beneficiary, may be omitted at the company's option.)
(Source: Laws 1967, p. 1735.)
|
215 ILCS 5/357.14
(215 ILCS 5/357.14) (from Ch. 73, par. 969.14)
Sec. 357.14. Except as provided in section 357.26, no such policy delivered
or issued for delivery to any person in this State shall contain provisions
respecting the matters set forth in sections 357.15 through 357.24 unless
such provisions are in the words in which the same appear in this article;
provided, however, that the company may, at its option, use in lieu of any
such provision a corresponding provision of different wording approved by
the Director which is not less favorable in any respect to the insured or
the beneficiary. Any such provision contained in the policy shall be
preceded individually by the appropriate caption appearing in the following
sections or, at the option of the company, by such appropriate individual
or group captions or subcaptions as the Director may approve.
(Source: P.A. 95-230, eff. 1-1-08.)
|
215 ILCS 5/357.15
(215 ILCS 5/357.15) (from Ch. 73, par. 969.15)
Sec. 357.15.
"CHANGE OF OCCUPATION:
If the insured be injured or contract
sickness after having changed his occupation to one classified by the
company as more hazardous than that stated in this policy or while doing
for compensation anything pertaining to an occupation so classified, the
company will pay only such portion of the indemnities provided in this
policy as the premium paid would have purchased at the rates and within the
limits fixed by the company for such more hazardous occupation. If the
insured changes his occupation to one classified by the company as less
hazardous than that stated in this policy, the company, upon receipt of
proof of such change of occupation, will reduce the premium rate
accordingly, and will return the excess pro-rata unearned premium from the
date of change of occupation or from the policy anniversary date
immediately preceding receipt of such proof, whichever is the more recent.
In applying this provision, the classification of occupational risk and the
premium rates shall be such as have been last filed by the company prior to
the occurrence of the loss for which the company is liable or prior to date
of proof of change in occupation with the state official having supervision
of insurance in the state where the insured resided at the time this policy
was issued; but if such filing was not required, then the classification of
occupational risk and the premium rates shall be those last made effective
by the company in such state prior to the occurrence of the loss or prior
to the date of proof of change in occupation."
(Source: Laws 1967, p. 1735.)
|
215 ILCS 5/357.16
(215 ILCS 5/357.16) (from Ch. 73, par. 969.16)
Sec. 357.16.
"MISSTATEMENT OF AGE:
If the age of the insured has been
misstated, all amounts payable under this policy shall be such as the
premium paid would have purchased at the correct age."
(Source: Laws 1967, p. 1735.)
|
215 ILCS 5/357.17
(215 ILCS 5/357.17) (from Ch. 73, par. 969.17)
Sec. 357.17.
"OTHER INSURANCE IN THIS COMPANY:
If an accident or health or
accident and health policy or policies previously issued by the company to
the insured be in force concurrently herewith, making the aggregate
indemnity for ....(insert type of coverage or coverages) in excess of
$....(insert maximum limit of indemnity or indemnities) the excess
insurance shall be void and all premiums paid for such excess shall be
returned to the insured or to his estate."
or, in lieu thereof:
"Insurance effective at any one time on the insured under a like policy
or policies in this company is limited to the one such policy elected by
the insured, his beneficiary or his estate, as the case may be, and the
company will return all premiums paid for all other such policies."
(Source: Laws 1967, p. 1735.)
|
215 ILCS 5/357.18
(215 ILCS 5/357.18) (from Ch. 73, par. 969.18)
Sec. 357.18.
"INSURANCE WITH OTHER COMPANIES:
If there be other valid
coverage, not with this company, providing benefits for the same loss on
a provision of service basis or on an expense incurred basis and of
which this company has not been given written notice prior to the
occurrence or commencement of loss, the only liability under any expense
incurred coverage of this policy shall be for such proportion of the
loss as the amount which would otherwise have been payable hereunder
plus the total of the like amounts under all such other valid coverages
for the same loss of which this company had notice bears to the total
like amounts under all valid coverages for such loss, and for the return
of such portion of the premiums paid as shall exceed the pro-rata
portion for the amount so determined. For the purpose of applying this
provision when other coverage is on a provision of service basis, the
"like amount" of such other coverage shall be taken as the amount which
the services rendered would have cost in the absence of such coverage."
(If the foregoing policy provision is included in a policy which also
contains the next following policy provision there shall be added to the
caption of the foregoing provision the phrase "--EXPENSE INCURRED
BENEFITS". The company may, at its option, include in this provision a
definition of "other valid coverage", approved as to form by the
Director, which definition shall be limited in subject matter to
coverage provided by organizations subject to regulation by insurance
law or by insurance authorities of this or any other state of the United
States or any province of Canada, and by hospital or medical service
organizations, and to any other coverage the inclusion of which may be
approved by the Director. In the absence of such definition such term
does not include group insurance, automobile medical payments insurance,
or coverage provided by hospital or medical service organizations or by
union welfare plans or employer or employee benefit organizations. For
the purpose of applying the foregoing policy provision with respect to
any insured, any amount of benefit provided for such insured pursuant to
any compulsory benefit statute (including any workers' compensation or
employer's liability statute) whether provided by a governmental agency
or otherwise is "other valid coverage" of which the company has had
notice. In applying the foregoing policy provision no third party
liability coverage shall be included as "other valid coverage".)
(Source: P.A. 91-357, eff. 7-29-99.)
|
215 ILCS 5/357.19
(215 ILCS 5/357.19) (from Ch. 73, par. 969.19)
Sec. 357.19.
"INSURANCE WITH OTHER COMPANIES:
If there be other valid
coverage, not with this company, providing benefits for the same loss on
other than an expense incurred basis and of which this company has not
been given written notice prior to the occurrence or commencement of
loss, the only liability for such benefits under this policy shall be
for such proportion of the indemnities otherwise provided hereunder for
such loss as the like indemnities of which the company had notice
(including the indemnities under this policy) bear to the total amount
of all like indemnities for such loss, and for the return of such
portion of the premium paid as shall exceed the pro-rata portion for the
indemnities thus determined."
(If the foregoing policy provision is included in a policy which also
contains the next preceding policy provision there shall be added to the
caption of the foregoing provision the phrase "--OTHER BENEFITS". The
company may, at its option, include in this provision a definition of
"other valid coverage", approved as to form by the Director, which
definition shall be limited in subject matter to coverage provided by
organizations subject to regulation by insurance law or by insurance
authorities of this or any other state of the United States or any
province of Canada, and to any other coverage the inclusion of which may
be approved by the Director. In the absence of such definition such term
does not include group insurance, or benefits provided by union welfare
plans or by employer or employee benefit organizations. For the purpose
of applying the foregoing policy provision with respect to any insured,
any amount of benefit provided for such insured pursuant to any
compulsory benefit statute (including any workers' compensation or
employer's liability statute) whether provided by a governmental agency
or otherwise is "other valid coverage" of which the company has had
notice. In applying the foregoing policy provision no third party liability
coverage shall be included as "other valid coverage".)
(Source: P.A. 91-357, eff. 7-29-99.)
|
215 ILCS 5/357.20
(215 ILCS 5/357.20) (from Ch. 73, par. 969.20)
Sec. 357.20.
"RELATION OF EARNINGS TO INSURANCE:
If the total monthly
amount of loss of time benefits promised for the same loss under all
valid loss of time coverage upon the insured, whether payable on a
weekly or monthly basis, shall exceed the monthly earnings of the
insured at the time disability commenced or his average monthly earnings
for the period of 2 years immediately preceding a disability for which
claim is made, whichever is the greater, the company will be liable only
for such proportionate amount of such benefits under this policy as the
amount of such monthly earnings or such average monthly earnings of the
insured bears to the total amount of monthly benefits for the same loss
under all such coverage upon the insured at the time such disability
commences and for the return of such part of the premiums paid during
such 2 years as shall exceed the pro-rata amount of the premiums for the
benefits actually paid hereunder; but this shall not operate to reduce
the total monthly amount of benefits payable under all such coverage
upon the insured below the sum of $200.00 or the sum of the monthly
benefits specified in such coverages, whichever is the lesser, nor shall
it operate to reduce benefits other than those payable for loss of
time."
(The foregoing policy provision may be inserted only in a policy
which the insured has the right to continue in force subject to its
terms by the timely payment of premiums (1) until at least age 50 or,
(2) in the case of a policy issued after age 44, for at least 5 years
from its date of issue. The company may, at its option, include in this
provision a definition of "valid loss of time coverage", approved as to
form by the Director, which definition shall be limited in subject
matter to coverage provided by governmental agencies or by organizations
subject to regulation by insurance law or by insurance authorities of
this or any other state of the United States or any province of Canada,
or to any other coverage the inclusion of which may be approved by the
Director or any combination of such coverages. In the absence of such
definition such term does not include any coverage provided for such
insured pursuant to any compulsory benefit statute (including any
workers' compensation or employer's liability statute), or benefits
provided by union welfare plans or by employer or employee benefit
organizations.)
(Source: P.A. 91-357, eff. 7-29-99.)
|
|
|
|