Rule 20:06:13:02.01 Requirements for definition of "accident" and similar words in policies.
20:06:13:02.01. Requirements for definition of
"accident" and similar words in policies. "Accidental
injury" or "accidental means" shall be defined in a Medicare
supplement policy by employing results language and may not include words which
establish an accidental means test or use words such as "external,"
"violent," or "visible wounds" or similar words of
description or characterization.
The definition may not be more
restrictive than the following "Injury or injuries for which benefits are
provided" means accidental bodily injury sustained by the insured person
which is the direct result of an accident, which is independent of disease or
bodily infirmity or any other cause, and which occurs while insurance coverage
is in force.
The definition may provide that
injuries do not include injuries for which benefits are provided or available
under any workers' compensation, employer's liability, or similar law or any
motor vehicle no-fault plan, unless prohibited by law.
18 SDR 225, effective July 17, 1992.
Authority: SDCL 58-17A-2.
Implemented: SDCL 58-17A-2.
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