LLQP Accident & Sickness · Component 1.2 · 35% of the exam
A client's group plan has a non-evidence maximum for LTD below her salary-based entitlement, and she was declined for the excess. Her coverage is therefore:
- AZero, because a decline for the excess voids the automatic coverage too
- BHer full formula amount, because the non-evidence maximum applies only at enrolment
- CUnlimited, because the group plan must cover her salary once she is a member
- Capped at the non-evidence maximum, leaving a gap for individual DI to address
Correct answer: D) Capped at the non-evidence maximum, leaving a gap for individual DI to address
Declines above the non-evidence maximum leave the member with the automatic amount only. This is a common gap for higher earners with health issues.
Why the other options are wrong
- AShe retains coverage up to the maximum; the decline affects only the excess.
- BThe excess was underwritten and declined; the formula amount is not automatic.
- CGroup coverage is always capped.
Exam tip
Declined above the non-evidence maximum = coverage at the maximum only. Document the gap.
Common mistake
Assuming a group member has their full formula amount after a decline.
What this tests
CISRO competency component 1.2 — Assess the client's needs and situation — which is weighted at 35% of the Accident & Sickness module. Written against the published curriculum.
More from component 1
- The single most important fact for sizing a client's disability income need is:
- A client's beneficiaries for assets are listed in the fact-finding. Why does this matter for A&S planning?
- A client asks why the agent wants to know how assets are owned (jointly or individually). In the A&S context the answer is:
- A client mentions a back injury five years ago that fully resolved. The agent should:
- Which element of a client's situation most affects the definition of disability that should be recommended?
- Which of the following health facts is most relevant to a client's disability insurance situation?
Practice the whole Accident & Sickness module
Timed sets weighted like the exam, and review of every question you miss. Free to start.