N.J. Admin. Code § 11:4-41.7

Current through Register Vol. 56, No. 24, December 18, 2024

Section 11:4-41.7 - Standards for pre-existing conditions exclusions

(a) Pre-existing condition exclusions shall only be permitted in the case of benefits for disability, as follows:

1. The insurer shall not be liable for a disability resulting from any pre-existing condition which is disclosed in the application and excluded by rider.

2. The insurer shall be liable from the effective date of the policy for a disability resulting from any pre-existing condition which is in an application and not excluded by rider.

3. The insurer shall not be liable for any pre-existing condition which is not disclosed in the application because the application did not include such a question and because of which the insured becomes disabled during the first two years of the effective date of the policy. The insurer shall be liable if the insured recovers from such disability and becomes disabled again from the same pre-existing condition after two years from the effective date of the policy.

4. The insurer shall be liable for any pre-existing condition which is not disclosed in the application because the application did not include such a question and because of which the insured becomes disabled two or more years after the effective date of the policy.

5. The insurer may contest a material misrepresentation made by the insured in the application.

N.J. Admin. Code § 11:4-41.7