LLQP Accident & Sickness · Component 4.2 · 10% of the exam
A claimant's DI benefit is being reduced under the relation-of-earnings provision because his income fell before disability. The agent should explain:
- AThe claim has been denied, since a fall in income means the claimant no longer qualifies for benefits
- BThe insurer is acting illegally, since a non-cancellable policy guarantees the benefit stated in the contract
- CThe claimant should sue, since the benefit was set at issue and cannot be reduced without consent
- The provision limits benefits to a share of pre-disability earnings and refunds the excess premium
Correct answer: D) The provision limits benefits to a share of pre-disability earnings and refunds the excess premium
Relation-of-earnings adjusts, it does not deny. Prior review could have adjusted the benefit and premium earlier.
Why the other options are wrong
- AThe benefit is reduced, not denied.
- BThe provision is contractual.
- CLitigation is unwarranted for a valid provision.
Exam tip
Relation-of-earnings: reduced benefit + premium refund.
Common mistake
Failing to review benefits when a client's income drops.
What this tests
CISRO competency component 4.2 — Provide customer service during the validity period of the coverage — which is weighted at 10% of the Accident & Sickness module. Written against the published curriculum.
More from component 4
- The agent's role in the claims process is to:
- A client with a non-cancellable DI policy stops paying premiums after a dispute with the insurer about a claim. The agent should warn that:
- When a client moves to another province, the agent should:
- A client asks to reduce the waiting period on his in-force disability policy. The agent should explain that the change:
- A client's disability policy lapsed six weeks ago for non-payment. The agent should:
- A client on claim asks whether she must keep paying premiums. The accurate answer depends on:
Practice the whole Accident & Sickness module
Timed sets weighted like the exam, and review of every question you miss. Free to start.