Cal. Code Regs. tit. 10 § 2232.17

Current through Register 2024 Notice Reg. No. 45, November 8, 2024

Section 2232.17 - Entire Contract; Changes

Form A.

This policy and the application of the employer constitute the entire contract between the parties, and any statement made by the employer shall, in the absence or fraud, be deemed a representation and not a warranty. No statement made by any employee whose eligibility has been accepted by the insurer shall (avoid the insurance or reduce the benefits under this policy or) be used in defense to a claim hereunder.

Form B.

This policy constitutes the entire contract between the parties, and no statement made by the employer or by any employee whose eligibility has been accepted by the insurer shall (avoid the insurance or reduce the benefits under this policy or) be used in defense to a claim hereunder.

No change in this policy shall be valid unless approved by an executive officer of the insurer and unless such approval be endorsed hereon or attached hereto. No agent has authority to change this policy or to waive any of its provisions.

Form C.

This policy (the application of the employer, if any, and the individual applications, if any, of the employees) constitute(s) the entire contract between the parties, and any statement made by the employer or by any employee shall, in the absence of fraud, be deemed a representation and not a warranty. No such statement shall (avoid the insurance or reduce the benefits under this policy or) be used in defense to a claim hereunder unless it is contained in a written application, nor shall any such statement of the employer, except a fraudulent misstatement, be used at all to void this policy after it has been in force for three years from the date of its issue, nor shall any such statement of any employee eligible for coverage under the policy, except a fraudulent misstatement, be used at all in defense to a claim for loss incurred or disability (as defined in the policy) commencing after the insurance coverage with respect to which claim is made has been in effect for three years from the date it became effective.

No change in this policy shall be valid unless approved by an executive officer of the insurer and unless such approval be endorsed herein or attached hereto. No agent has authority to change this policy or waive any of its provisions.

Instructions

1. The insurer may, at its option, use either Form A, Form B, or Form C.

2. If the insurer uses Form A, it shall use paragraph (a), or paragraph (b) of the "Time Limit on Certain Defenses" uniform provision as is required or permitted by the instructions for their use, but revised to eliminate all reference to the statements and applications of employees. Paragraph (c) of said uniform provision shall be used or omitted in accordance with the instructions for its use.

3. If the insurer uses Form B, it shall use neither paragraph (a) nor paragraph (b) of the "Time Limit on Certain Defenses" uniform provision, and it shall use or omit paragraph (c) of said uniform provision as required in accordance with the instructions for its use.

4. If the insurer uses Form C, it may, at its option, omit therefrom at the place indicated by parentheses in the first sentence reference to the applications of employees or the application of the employer, or both if it does not desire to make the application or applications, reference to which is omitted, a part of the policy. In such case proper connective words shall be used and the verb "constitute" made singular or plural to agree with the option selected by the insurer.

5. The insurer may, at its option, include or omit the words in parentheses in the first paragraph of Form A and Form B and in the second sentence of Form C reading, "avoid the insurance or reduce the benefits under this policy or."

6. The insurer may, at its option, substitute for the words "and unless such approval be endorsed hereon or attached hereto" at the end of the first sentence of the second paragraph of Form A, Form B, or Form C the words "and evidenced by endorsement hereon, or by amendment hereto signed by the employer and by an executive officer of the insurer."

7. The insurer may omit the portion of the first paragraph of Form C following the phrase "unless it is contained in a written application" if the insurer uses paragraph (a) or (b) of the uniform provision captioned "Time Limit on Certain Defenses" in accordance with the instructions for their use. (Ins. C. 10270.6 (a), 10350. 1.)

Cal. Code Regs. Tit. 10, § 2232.17

1. Amendment of Form A filed 5-6-77 as procedural and organizational; effective upon filing (Register 77, No. 19).

Note: Authority cited: Section 10270.94, Insurance Code. Reference: Sections 10350 and 10351, Insurance Code.

1. Amendment of Form A filed 5-6-77 as procedural and organizational; effective upon filing (Register 77, No. 19).