P.R. Laws tit. 26, § 10257
(a) For a policy or certificate that has been in force for less than six (6) months, an issuer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that is material to the acceptance for coverage or to the risk assumed by the issuer.
(b) For a policy or certificate that has been in force for at least six (6) months but less than two (2) years, an issuer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that is both material to the acceptance for coverage and which pertains to the condition for which benefits are sought.
(c) After a policy or certificate has been in force for two (2) years, it is not contestable upon the grounds of misrepresentation alone; such policy or certificate may be contested only upon a showing that the enrollee knowingly and intentionally misrepresented relevant facts relating to his/her health status.
(d) Long-term care insurance policies or certificates may be field issued by third-party administrators if the compensation to the producer or third party administrator is not based on the number of policies or certificates issued. For purposes of this section, “field issued” means a policy or certificate issued by a producer or a third-party administrator pursuant to the underwriting authority granted to the producer or third-party administrator by an issuer and using the issuer’s underwriting guidelines.
(e) If an issuer has paid benefits under the long-term care insurance policy or certificate, the benefit payments may not be recovered by the insurer in the event that the policy or certificate is rescinded.
(f) In the event of the death of the enrollee, this section shall not apply to the remaining death benefit of a life insurance policy that accelerates benefits for long-term care. In this situation, the remaining death benefits under these policies shall be governed by the provisions of law applicable to life insurance. In all other situations, this section shall apply to life insurance policies that accelerate benefits for long-term care.
History —Aug. 29, 2011, No. 194, § 66.070, eff. 180 days after Aug. 29, 2011.