Legal Definitions - evidence of insurability

Evidence of insurability refers to any information an insurance company requests to evaluate a person's health and risk factors, helping the insurer decide if they qualify for a particular insurance policy or for specific benefits within a policy.

This information allows the insurance company to determine the likelihood of a claim being made and to set appropriate premiums. It often includes details about a person's medical history, current health status, lifestyle, and sometimes financial situation.

• Example 1: Applying for a New Life Insurance Policy

  Sarah, a 45-year-old, applies for a new $1 million term life insurance policy. The insurance company asks her to undergo a medical examination, which includes blood and urine tests, and to provide access to her primary care physician's medical records for the past five years. This medical exam and her health records constitute the evidence of insurability that the insurer uses to assess her health risks and determine if she qualifies for the policy at the requested coverage amount and premium.

• Example 2: Increasing Coverage on an Existing Policy

  Mark has an existing life insurance policy from his employer, which he obtained without a medical exam when he started his job. Five years later, he gets married and wants to increase his coverage significantly to protect his new family. To approve this increase, the insurance company requires him to complete a health questionnaire and may ask for a paramedical exam. This new information serves as evidence of insurability, allowing the insurer to re-evaluate his health status before approving the higher coverage amount.

• Example 3: Applying for Long-Term Care Insurance

  Maria, aged 60, decides to purchase a long-term care insurance policy to cover potential future costs of nursing home care or in-home assistance. During the application process, the insurer requests a detailed health questionnaire, a cognitive assessment, and potentially an interview with a nurse to evaluate her current physical and mental health. This comprehensive health assessment is the evidence of insurability the company needs to determine if she meets their criteria for coverage and to calculate her premiums.