LLQP Accident & Sickness: In-Force Service

Topic snapshot

Sample questions

These questions are original Securities Prep practice items aligned to this LLQP competency area. They are designed for self-assessment and are not official exam questions.

Question 1

Topic: Provide Customer Service During the Validity Period of the Coverage

Maya has an individual disability policy with a 31-day grace period. Her monthly premium was due May 1. The insurer confirms coverage continues during the grace period, but the policy lapses at the end of the grace period if the premium is still unpaid. Maya pays the overdue premium on June 10.

Using the policy rule above, for how many calendar days was Maya potentially without coverage (before any reinstatement is approved), and what is the key client impact to explain?

• A. 10 days; the policy may have lapsed, and reinstatement can require evidence of insurability, creating a coverage gap for new claims during that time
• B. 0 days; coverage continues as long as the premium is paid within the same calendar month
• C. 40 days; coverage is lost starting on the premium due date, and reinstatement is automatic once payment is made
• D. 31 days; the policy is automatically cancelled for the entire grace period, so no benefits are payable for anything that happens in May

Best answer: A

What this tests: In-force Service

Explanation: This question tests ongoing service: how missed premiums can create lapse risk, how a grace period works, and why reinstatement may require evidence of insurability.

• The premium is due May 1 and the grace period is 31 days.
• Coverage continues during the grace period, so Maya is covered through May 31.
• The policy lapses at the end of the grace period if unpaid, so the lapse begins June 1.
• Maya pays on June 10, which is 10 calendar days after June 1.

Client impact to explain: a late payment can create a period where coverage is not in force (a coverage gap). When a policy has lapsed, the insurer may require a reinstatement application and evidence of insurability before restoring coverage, so the client should not assume claims that start during the lapse will be covered.

Prevention: set up pre-authorized debit, calendar reminders, or an emergency payment plan; and encourage the client to contact the insurer/agent immediately if a payment will be missed to avoid a lapse.

Grace runs May 1 through May 31. Lapse starts June 1, and payment is June 10, so the potential gap is 10 calendar days. After lapse, reinstatement may require evidence of insurability and insurer approval, so coverage for new disabilities may not be in force during the gap.

Question 2

Topic: Provide Customer Service During the Validity Period of the Coverage

Why are periodic policy reviews important for accident & sickness (A&S) coverage as a client’s situation changes (for example, job change, major income change, new dependents, business changes, or increased travel)?

• A. To restart the elimination period so the client can qualify for disability benefits sooner on a future claim
• B. To confirm the coverage is still suitable and coordinated with other benefits, and to identify any gaps created by changes in income, occupation, family responsibilities, or travel exposure
• C. To avoid having to disclose changes in health or occupation later, since reviews replace the insurer’s right to ask questions
• D. To automatically increase benefits without any consideration of current income or occupation because A&S policies are guaranteed to adjust with life changes

Best answer: B

What this tests: In-force Service

Explanation: Periodic policy reviews are an essential part of customer service for A&S insurance because a client’s risk and financial needs evolve. Changes such as a new job (different duties), a major income change, new dependents, business growth, or more frequent travel can create a coverage gap or cause misalignment with existing employer group benefits.

A review helps the agent confirm whether key elements (like disability benefit amount, affordability, and any coordination with group plans) still fit the client’s current circumstances, and whether additional protection (for example, travel medical or higher benefit amounts) should be considered.

A&S needs can change quickly. Regular reviews help ensure disability income amounts, key definitions, and health/travel coverage still match the client’s current risks and any employer plan changes.

Question 3

Topic: Provide Customer Service During the Validity Period of the Coverage

Jordan, a self‑employed electrician, has an individual disability income policy in force. He calls you to say he injured his back and has been off work for 10 days. He asks what usually happens next to start a claim. Which guidance best reflects the general disability claim steps?

• A. Tell him only an employer statement is required to start the claim, since he is unable to work.
• B. Advise him to notify the insurer promptly and obtain the claim package, then complete claim forms and submit medical evidence from his treating physician, with ongoing proof if the disability continues.
• C. Tell him the first step is to determine his occupation class and hobbies to confirm whether the policy will remain in force before accepting any claim documents.
• D. Advise him to wait until the elimination period ends before contacting the insurer, because earlier notice is unnecessary.

Best answer: B

What this tests: In-force Service

Explanation: This question tests basic customer service and claims support for disability income (DI) insurance. At a high level, DI claims follow a predictable sequence:

• Notice of claim: the insured (or their advisor) contacts the insurer to report the disability and request instructions/forms.
• Claim forms: the claimant typically completes a statement describing the illness/injury, work duties, and how the condition prevents work; additional forms may be required depending on employment situation.
• Medical evidence: the insurer commonly requests medical confirmation (for example, a physician’s report) that supports the diagnosis, restrictions/limitations, and impairment.
• Ongoing proof: if the disability continues, the insurer may request periodic updates (medical status, return‑to‑work progress, and sometimes income information for self‑employed clients).

An agent should avoid promising approval and should focus on helping the client start the process promptly and gather the appropriate evidence.

A DI claim generally starts with notice, then claim forms and supporting medical evidence. Ongoing proof may be required while benefits are being considered or paid.

Question 4

Topic: Provide Customer Service During the Validity Period of the Coverage

Nora has been on her employer’s long-term disability (LTD) claim for 6 months. Her LTD booklet states that LTD benefits are reduced by other income benefits, including CPP Disability and workers’ compensation. Nora is approved for CPP Disability and then notices her monthly LTD payment drops.

Which single policy attribute best explains the reduction and why Nora should be prepared for it?

• A. An offset (integration/coordination of benefits) provision that reduces LTD by amounts received from CPP Disability or workers’ compensation
• B. A change in the definition of disability (for example, from own occupation to any occupation) that automatically reduces the monthly benefit
• C. The benefit period ending, because CPP Disability approval signals the LTD benefit period is over
• D. The elimination period, because it restarts when a new benefit source (CPP Disability) begins paying

Best answer: A

What this tests: In-force Service

Explanation: This scenario tests the offset (integration/coordination of benefits) provision during an ongoing LTD claim (customer service during coverage).

Many group LTD plans are designed to pay a target level of income replacement after accounting for other disability-related income (for example, CPP Disability, workers’ compensation, or other group disability benefits). When the claimant is approved for one of these other sources, the LTD carrier reduces its payment by the amount of that “other income,” so the client’s LTD cheque can drop even though the total income may stay closer to the plan’s intended level.

From a service perspective, clients should be prepared for this because:

• their monthly LTD amount can change when other benefits start, stop, or are adjusted;
• they may have to apply for other benefits and share approvals/amounts as part of claim administration; and
• budgeting should be based on the plan’s integrated benefit expectation, not the initial gross LTD payment alone.

Group LTD plans commonly include offsets so the combined income from multiple sources does not exceed the plan’s intended benefit level. When CPP Disability starts, the LTD insurer reduces its payment accordingly.

Question 5

Topic: Provide Customer Service During the Validity Period of the Coverage

Maya has an individual extended health policy and submitted a claim for chiropractic treatments. The insurer replied that the claim is “pending” and requested additional information, and warned it could be declined if the expense isn’t eligible under the contract. Maya is frustrated and asks you to “make them pay it today.” What is the best response that sets appropriate expectations and helps move the claim forward?

• A. Advise Maya to resubmit the claim but leave out any details that might lead to questions, since incomplete disclosure usually speeds up reimbursement.
• B. Explain that the insurer must adjudicate claims based on the policy terms, then help Maya confirm the service is eligible and submit the missing documents (for example, receipts and any required practitioner details/referral) so the insurer can complete its review.
• C. Recommend that Maya cancel her policy and reapply elsewhere, because a pending claim usually means her coverage has a pre-existing condition exclusion and will never pay for this type of expense.
• D. Tell Maya the insurer is required to reimburse any health expense her practitioner recommends, and you will demand immediate payment regardless of what information is missing.

Best answer: B

What this tests: In-force Service

Explanation: In accident & sickness insurance, the insurer’s role in a claim is to adjudicate—to review the claim and decide whether to pay it based on the contract, using the information provided.

Common reasons a claim may be delayed include:

• Missing or unclear documentation (for example, receipts, dates of service, practitioner credentials, required forms)
• Needing additional information to confirm the expense meets the policy’s eligibility rules

Common reasons a claim may be denied include:

• The expense is not eligible under the plan (an ineligible service/product, or a limit has been reached)
• An applicable exclusion or limitation applies (for example, a pre-existing condition limitation when relevant and stated in the contract)
• Materially incomplete or inaccurate disclosure related to the claim

As the agent, your best service is to set realistic expectations (you cannot force payment) and help the client provide complete, accurate information so the insurer can make a decision.

This correctly describes the insurer’s role (adjudication against contract terms) and addresses common delay/denial causes (missing documentation, ineligible expense) by focusing on completing the claim file.

Question 6

Topic: Provide Customer Service During the Validity Period of the Coverage

A client is covered under an employer group extended health and dental plan and is about to change jobs. You want to reduce the risk of a coverage gap and future claim issues. Which policy element should you remind the client to ask about so they may be able to continue coverage when the group plan ends?

• A. Disability elimination period
• B. Coordination of benefits provision
• C. Annual deductible amount
• D. A conversion or portability option (continuation privilege)

Best answer: D

What this tests: In-force Service

Explanation: This question tests proactive client education during the coverage period (customer service). When a client is about to change jobs, a key claim-risk is an unintended lapse in coverage—especially for prescription drugs, dental work already underway, or ongoing paramedical treatments. A practical service step is to remind the client to confirm whether their group plan offers a conversion or portability/continuation option and what deadlines apply, so they can maintain coverage or arrange replacement coverage without interruption.

Other common plan elements (deductibles, coordination of benefits, disability elimination periods) affect how benefits are calculated or when they start, but they do not solve the “coverage ends when employment ends” problem.

This feature is specifically meant to help an insured continue coverage when group benefits terminate due to employment ending, helping avoid a gap that can create claim issues.

Question 7

Topic: Provide Customer Service During the Validity Period of the Coverage

In ongoing service for an in‑force individual disability insurance (DI) policy, which client change most directly suggests that a contract amendment may be appropriate to keep coverage suitable?

• A. Changing banks and updating the pre‑authorized debit information
• B. A sustained increase in earned income since the policy was issued
• C. Moving to a new rental apartment in the same city
• D. A new medical diagnosis that occurs after the policy is already in force

Best answer: B

What this tests: In-force Service

Explanation: This tests ongoing service under Accident & Sickness insurance: recognizing when a policy review and possible amendment is appropriate.

For individual disability insurance, suitability is closely linked to the client’s earned income and how much of that income needs to be replaced if illness or injury prevents working. When income changes meaningfully and persistently (for example, promotions, a new role, or a growing business), the client may be underinsured and may want a benefit increase or other coverage adjustments. Any increase is typically subject to the insurer’s administrative rules and, often, evidence of insurability.

By contrast, many day-to-day administrative changes (address, banking) require updates for service but do not usually change coverage suitability. A new medical diagnosis after issue may affect the client’s ability to buy new coverage, but it does not automatically mean the current policy should be amended.

DI benefit amounts are generally tied to earned income. If income has increased and the client wants to better protect their cash flow, a benefit increase (policy amendment) may be appropriate, subject to the insurer’s rules and underwriting.

Question 8

Topic: Provide Customer Service During the Validity Period of the Coverage

Nadia has an individual disability income policy. She was on claim for back pain, returned to full-time work, and worked for 8 weeks. Her doctor has now taken her off work again for the same back condition. Her policy states that if disability from the same or related cause returns within 6 months of returning to work, it is treated as a continuation of the prior claim (a recurrent disability).

As her agent, what is the most appropriate next action?

• A. Advise Nadia to wait until she has been off work for several more weeks before contacting the insurer, to see if it resolves
• B. Start a brand-new disability claim and explain that she must satisfy a new elimination period because she returned to work
• C. Recommend cancelling the policy now that she has had repeated back issues, and rely on her emergency fund instead
• D. Help Nadia notify the insurer that this is a recurrence and submit updated medical and work-status information referencing the prior claim

Best answer: D

What this tests: In-force Service

Explanation: This scenario tests customer service during coverage (claims support) and the recurrent disability (recurrence) concept.

A recurrent disability provision explains what happens when a claimant returns to work and then becomes disabled again shortly afterward from the same or a related cause. When the recurrence happens within the time window stated in the policy, it is typically treated as a continuation of the prior claim rather than a completely new claim. Why it matters: treating it as a continuation can affect administrative handling and often helps the claimant avoid restarting the claim process as if nothing had happened (for example, not being treated as a new period of disability).

Given Nadia’s relapse occurred after only 8 weeks back at work and the policy’s recurrence window is 6 months, the agent’s role is to help her report the recurrence promptly and provide updated medical/work-status documentation so the insurer can connect it to the prior claim appropriately.

A recurrent disability provision is meant to link a relapse back to the prior claim when it happens within the stated window, typically avoiding a new waiting period. The next step is to report it promptly and provide updated medical/work details tied to the earlier claim.

Question 9

Topic: Provide Customer Service During the Validity Period of the Coverage

During an annual review, Nadia tells her insurance advisor she has an individual disability insurance policy. She has had no claims and her health is unchanged. Since the policy started, her income increased from $60,000 to $85,000, she had a new baby, she now travels to the U.S. for work 6–8 times per year, and she changed jobs from office administrator to working full-time as a roofing labourer.

If Nadia applies to increase her disability benefit, which change is most likely to affect underwriting (risk classification) and the terms or price offered?

• A. Having a new baby
• B. Travelling to the U.S. 6–8 times per year for work
• C. Changing from office administrator to roofing labourer
• D. Income increasing from $60,000 to $85,000

Best answer: C

What this tests: In-force Service

Explanation: Periodic policy reviews matter because a client’s need for coverage and the insurer’s view of risk can change over time. In disability insurance, the two big underwriting lenses are:

• Occupational risk (what the client does day-to-day): more hazardous duties often mean higher claim risk.
• Financial justification (income stability/amount): higher income may support a higher benefit amount, but it does not automatically change risk class.

In this scenario, the client’s move from office work to roofing is the clearest underwriting-sensitive change. If she requests a benefit increase, the insurer will typically reassess her occupation class and may offer different pricing/terms than would apply to an office role.

A move to a more physically hazardous occupation commonly affects disability risk classification and can lead to different pricing or availability when applying for more coverage.

Question 10

Topic: Provide Customer Service During the Validity Period of the Coverage

A group sponsor asks what will likely happen at the next renewal if their extended health plan’s claims have been consistently higher than the premiums collected over the past year. At a conceptual level, what outcome should the agent explain?

• A. The insurer will pay any shortfall indefinitely, so claims experience does not affect renewals.
• B. The plan will automatically terminate immediately once claims exceed premiums, and members lose coverage without notice.
• C. The insurer may propose a renewal with a higher premium and/or plan design changes to improve sustainability, and the sponsor should be prepared to communicate any changes to members.
• D. The insurer must keep premiums and benefits unchanged because group benefits are guaranteed once the plan is in place.

Best answer: C

What this tests: In-force Service

Explanation: This question tests ongoing service to a group sponsor and the expected renewal outcome when plan experience is poor.

In group A&S (for example, extended health and dental), part of servicing the sponsor is to monitor plan experience, discuss renewal terms, and support plan sustainability. If the plan’s claims are consistently higher than the premiums collected, the insurer commonly responds at renewal by proposing changes such as a premium increase and/or adjustments to plan design (for example, changing deductibles, coinsurance, or limits). The agent should also help the sponsor understand the changes and communicate them clearly to members.

Ongoing service includes reviewing plan experience, discussing renewal terms, and helping the sponsor understand and communicate changes needed to keep the plan sustainable.

Continue with full practice

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Related focused pages

• Free LLQP Accident & Sickness Full-Length Practice Exam
• LLQP Accident & Sickness: Needs Analysis
• LLQP Accident & Sickness: Product Analysis
• LLQP Accident & Sickness: Recommendation Implementation

Free review resource

Read the LLQP Accident & Sickness Study Guide on SecuritiesMastery.com, then return to Securities Prep for timed practice.