Commissioner Of Insurance - New Guidelines

Author:Ms Tammy Greenberg
Profession:Levitan, Sharon & Co
 
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During July - August 2013, the Israeli Commissioner of Insurance issued three new guidelines:

Regarding a policy for serious illnesses In respect of the limitation period in an insurance contract which includes coverage for disability Guidelines for drafting an insurance programme . Please find herewith details regarding the said guidelines:

Policy for Serious Illnesses:

Insurance programme against serious illnesses which is intended to provide insureds with an agreed amount if it is found that they suffer from a serious illness:

During 2003 the Commissioner issued guidelines regarding the illnesses/medical procedures which should be included in the above mentioned insurance. As medical science has progressed since said date resulting in new medications, the Commissioner finds it necessary to periodically update the list of illnesses/medical procedures within the current guidelines.

Based on the new guidelines, insurance for serious illnesses/medical procedures will cover discovery of at least the following: cancer, stroke, multiple sclerosis, myocardial infraction, heart valve surgery, heart bypass surgery, aortic surgery, and cardiomyopathy.

An insurer is obliged to check the list of illnesses/medical procedures at least once every 3 years and update same taking into account the common severe events resulting from the above mentioned illnesses.

Limitation period in life and disability policies:

According to Section 31 of the Insurance Contract Law, 1981 the limitation period in respect of claims for insurance benefits is three years from the date of the insured event. Many judgments discussed the question "what is the insured event?" in case of a claim for insurance benefits due to the insured's permanent disability, i.e. what is the inception date of the limitation period.

In C.A. 1806/05 Harel Insurance Co. v. the Estate of the late Mr. Amitay, the Court determined that the inception date is the date of the accident.

According to the Commissioner, determining the date of the accident as the inception date might be problematic since the insured's medical condition is usually unstable for a lengthy period or alternatively, the discussion regarding the quantum of disability is ongoing for a long time. In these events, the three year limitation period may be insufficient. The Commissioner therefore wishes to set guidelines for a proper disclosure by the Insurer in respect of the limitation period and for handling requests for an extension of the limitation...

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