LLQP Accident & Sickness Syllabus — Learning Objectives by Topic

Use this syllabus as your checklist for the LLQP Accident & Sickness module. The competency weightings below are published by CSI for its course assessments and reflect the standard LLQP competency structure; your provincial exam provider may present the blueprint in a different way.

Official sources:

• CSI LLQP curriculum: https://www.csi.ca/en/learning/courses/llqp/curriculum
• CSI LLQP exam credits/weightings: https://www.csi.ca/en/learning/courses/llqp/exam-credits

Official competency weightings (Accident & Sickness end-of-module test)

What’s covered

• Assess the client’s needs and situation (35%)
• Analyze the available products that meet the client’s needs (30%)
• Implement a recommendation adapted to the client’s needs and situation (25%)
• Provide customer service during the validity period of the coverage (10%)

Assess the client’s needs and situation (35%)

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Financial Protection Provided by Accident and Sickness Insurance

• Explain how accident and sickness (A&S) insurance fits into personal risk management and financial planning.
• Differentiate between the risks created by an accident versus a sickness and describe typical financial impacts of each.
• Identify the major categories of A&S coverage commonly used in Canada (e.g., disability income, critical illness, long-term care, medical/extended health, dental, travel medical, AD&D).
• Distinguish between indemnity benefits and reimbursement benefits in A&S products.
• Describe how Canada’s publicly funded health insurance and provincial/territorial plans interact with private supplementary health insurance.
• Identify common health-related expenses that may not be fully covered by public plans and that are often addressed by private insurance.
• Explain why out-of-province and out-of-country medical costs create a financial exposure and how travel medical insurance responds.
• Explain the concept of morbidity and why morbidity risk is central to the design and pricing of A&S insurance.
• Recognize the role of employer-sponsored group benefits in meeting A&S needs and identify common plan components.
• Define and apply common timing concepts in A&S contracts such as waiting/elimination period and benefit period.
• Explain the purpose of coordination/integration of benefits when multiple income replacement sources exist.
• Describe how insurable interest, eligibility, and consent relate to purchasing A&S coverage on another person.
• Identify typical benefit triggers in A&S products (e.g., disability definition, diagnosis/survival period for CI, ADL/cognitive impairment for LTC, eligible expense for health plans).
• Explain why pre-existing condition provisions exist and how they can affect coverage and claims.
• Identify common exclusions and limitations that may apply across A&S products.
• Compare the planning implications of an injury-based event versus an illness-based event for a client’s finances.
• Explain how inflation can affect long-duration A&S claims and why inflation protection options may be relevant.
• Identify key parties involved in A&S coverage in individual and group contexts (policyholder, insured, plan sponsor, administrator, claimant).
• Describe the agent/advisor’s role in A&S: fact-finding, suitability, product selection, disclosure, and ongoing service.
• Explain the consumer protection rationale for suitability, accurate disclosure, and clear explanation of limitations/exclusions in A&S sales.
• Differentiate between individual and group A&S coverage in terms of underwriting, customization, portability, and ownership.
• Describe the meaning of non-cancellable, guaranteed renewable, and annually renewable provisions (as applicable to disability coverage).
• Explain how riders and policy options can tailor A&S coverage to a client’s needs.
• Describe how occupation, income type, and lifestyle risks (e.g., hazardous hobbies) influence A&S risk assessment and pricing.
• Recognize that EI sickness benefits provide temporary income support for medical incapacity and are time-limited.
• Recognize that CPP disability benefits provide longer-term income support for eligible contributors with severe and prolonged disability.
• Recognize that Workers’ Compensation Boards provide benefits for workplace accidents and occupational illnesses and may interact with other benefits.
• Explain why multiple benefit sources can create offsets and why total income replacement is typically capped.
• Explain how a client’s emergency savings and budget constraints affect choices like elimination period and coverage layering.
• Summarize how A&S insurance supports financial resilience for individuals, families, and business owners when health events occur.

Client Profile

• Collect and organize the client’s personal information relevant to A&S planning (age, family status, dependents, lifestyle).
• Assess the client’s employment situation (employee vs self-employed), job stability, and duties as inputs to income protection needs.
• Identify all sources of earned and unearned income (salary, commission, dividends, rental, business income) and their stability.
• Analyze the client’s monthly cash-flow (fixed and variable expenses) to estimate the financial impact of disability or illness.
• Document the client’s current debt obligations (mortgage, loans, lines of credit) and the minimum required payments.
• Identify liquid assets and emergency savings available to cover short-term income interruptions.
• Determine the client’s existing insurance coverage (individual policies and group benefits) and summarize key features.
• Assess the adequacy of existing disability coverage relative to the client’s income and obligations.
• Assess the adequacy of existing medical/extended health coverage for the client and dependents.
• Assess the adequacy of existing critical illness and long-term care coverage (if any) relative to goals and risk profile.
• Explain how public programs (e.g., provincial health plans, EI sickness benefits, CPP/QPP disability, workers’ compensation) may form part of the client’s existing ‘coverage layer.’
• Identify whether the client may rely on employer sick leave or short-term disability plans before longer-term benefits begin.
• Analyze how the tax treatment of disability benefits can change the client’s net income replacement need.
• Determine the client’s short-term and long-term financial goals that could be disrupted by illness or injury.
• Identify the client’s tolerance for risk, debt, and variability in income as inputs to choosing A&S solutions.
• Identify health and lifestyle factors that could affect underwriting and claims risk (medical history, smoking, hazardous activities).
• Identify occupational hazards and classify the client’s work activities at a high level (sedentary, light, heavy, hazardous).
• Describe how family structure and dependency relationships influence income protection and care planning needs.
• Estimate the income replacement amount needed to maintain essential spending during disability.
• Explain how benefit offsets (CPP disability, workers’ compensation, group benefits) affect the amount of private disability benefit needed.
• Determine an appropriate elimination period based on the client’s resources and short-term coverage.
• Determine an appropriate disability benefit period based on the client’s age, retirement timeline, and risk tolerance.
• Identify when partial/residual disability benefits are especially valuable (e.g., variable income, professional practices).
• Identify when a future increase option or benefit indexing may be suitable (young professionals, growing income).
• Explain how coordination of benefits works for spouses/families with multiple health/dental plans.
• Assess the client’s need for travel medical coverage based on travel frequency, destinations, and existing coverage.
• Assess the client’s need for critical illness coverage based on goals for lump-sum use (debt payoff, treatment, time off).
• Assess the client’s need for long-term care planning based on age, family history, and desire for care choices.
• Identify business ownership structures and key roles to determine A&S exposures for business continuity.
• Assess whether the client requires business overhead expense coverage, key person coverage, or disability buyout funding.
• Identify legal/administrative requirements to sell A&S ethically (informed consent, clear disclosure, documentation).
• Document the needs analysis process and rationale for recommendations in a way that supports suitability and auditability.
• Prioritize recommended coverages when the client has a limited premium budget.
• Identify common red flags for unsuitable A&S recommendations (duplicate coverage, unaffordable premiums, unrealistic benefit assumptions).
• Identify special eligibility considerations that can apply to certain client situations (new residents, frequent travellers, students).
• Analyze how group plan maximums can create coverage gaps for high-income earners and when individual ‘top-up’ disability coverage may be needed.
• Assess how changes in occupation or income can affect the suitability of an existing disability policy.
• Prepare a concise written client profile summarizing exposures, existing coverage, gaps, and priorities for the recommendation stage.
• Identify how mental health conditions and policy limitations (where applicable) may affect disability planning discussions.
• Explain how the client’s benefit needs should be evaluated on an after-tax basis when benefits are taxable.

Analyze the available products that meet the client’s needs (30%)

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Insurance to Protect Income

• Differentiate between employer sick leave, short-term disability (STD), EI sickness benefits, and long-term disability (LTD).
• Describe key types of individual disability insurance contracts (e.g., non-cancellable, guaranteed renewable) and why contract type matters.
• Define total disability, partial disability, and residual disability in the context of disability income insurance.
• Compare disability definitions based on occupation (own, regular, any) and explain how the definition affects claim eligibility.
• Explain how elimination periods (waiting periods) affect premiums and why they should be matched to the client’s short-term resources.
• Explain how benefit periods work and relate benefit period selection to the risk of long-duration disability.
• Describe how disability benefit amounts are determined (income-based maximums and replacement ratios) and why verification is required.
• Identify and explain common disability insurance riders and options (e.g., COLA/inflation, future increase, residual, waiver of premium, return of premium).
• Explain how the taxability of disability benefits depends on who pays the premiums and why this matters for net income replacement.
• Explain the concept of benefit integration/offsets (e.g., CPP disability, workers’ compensation, other group plans) in LTD policies.
• Describe key features of group disability plans (STD/LTD, non-evidence maximums, participation requirements, limitations).
• Identify common exclusions and limitations in disability insurance and their client impact.
• Explain rehabilitation and return-to-work provisions and how they can support claimants and reduce long-term disability duration.
• Differentiate disability income insurance from accidental death and dismemberment (AD&D) in terms of covered events and benefit structure.
• Apply income protection concepts to recommend an appropriate mix of STD/LTD/individual disability coverage for a client scenario.

Insurance to Protect Assets

• Explain the role of supplementary (extended) health insurance in covering gaps beyond publicly funded health care.
• Identify common extended health insurance benefit categories (prescription drugs, paramedical, vision, medical supplies, ambulance, home care).
• Explain how hospital insurance benefits can help cover costs not paid by public plans (e.g., room upgrades and ancillary charges).
• Differentiate dental insurance components (preventive/basic, major, orthodontic) and explain common plan limits and cost-sharing.
• Explain travel medical insurance and why out-of-country emergency medical expenses may require private coverage.
• Identify key travel medical policy considerations (trip length, stability/pre-existing conditions, exclusions, emergency definition).
• Explain how coordination of benefits works when a family has more than one health/dental plan.
• Describe common cost-sharing mechanisms in health insurance (deductible, co-pay/coinsurance) and how they affect out-of-pocket costs.
• Explain common prescription drug plan concepts (formulary, generic substitution, dispensing fees, prior authorization).
• Compare individual vs group health plans in underwriting, portability, and plan design flexibility.
• Identify common exclusions/limitations in medical expense and travel coverage and how to disclose them properly.
• Apply asset-protection coverage concepts to select suitable health/dental/travel coverage for a client scenario.

Insurance to Protect Savings

• Explain the purpose of critical illness (CI) insurance as a lump-sum benefit designed to protect savings and lifestyle after a serious diagnosis.
• Describe typical CI contract design elements such as covered conditions, definitions, diagnosis requirements, and survival periods.
• Differentiate between stand-alone CI insurance and CI riders attached to other policies (where applicable).
• Explain common CI policy options (e.g., return of premium on expiry/cancellation, partial benefits for early-stage conditions) and when they may be suitable.
• Explain how CI insurance can be used in a financial plan (debt payoff, income bridge, funding care) and why ‘use of proceeds’ should be discussed.
• Explain the purpose of long-term care (LTC) insurance and how it helps preserve retirement savings by funding ongoing care needs.
• Describe the common triggers for LTC benefits (ADL limitations and/or cognitive impairment) and the role of elimination periods.
• Differentiate between reimbursement-style and indemnity-style LTC benefits and the client implications of each.
• Explain how LTC benefits may be structured (daily/monthly maximums, benefit pools, benefit periods) and how choices affect premiums.
• Explain why inflation protection options may be important for LTC planning given the long time horizons involved.
• Identify basic underwriting considerations and common reasons for exclusions/declines in CI and LTC insurance.
• Apply savings-protection concepts to recommend an appropriate CI/LTC strategy for a client scenario.

Insurance to Protect Businesses

• Identify how the illness or disability of an owner, partner, or key employee can create financial risk for a business.
• Explain the purpose and basic structure of disability business overhead expense (BOE) insurance.
• Differentiate BOE insurance from personal disability insurance in terms of who is insured, what is paid, and how benefits are used.
• Identify typical expenses that may be covered under BOE insurance and common limitations.
• Explain key person disability coverage and how benefits can support recruitment, training, or revenue replacement strategies.
• Explain how disability buyout insurance can help fund a buy-sell agreement when an owner becomes disabled.
• Describe how creditor disability/loan protection can be used to help service business or personal debt during disability.
• Assess whether a small business should implement group benefits to address A&S needs for owners and employees.
• Identify underwriting and documentation requirements common in business A&S cases (financial statements, income verification, role description).
• Explain how exclusions, waiting periods, and benefit periods can materially affect business coverage outcomes during a claim.
• Apply business A&S concepts to recommend suitable solutions for a business owner scenario.

Group Plan Specifics

• Describe the structure of a group benefits plan, including the roles of plan sponsor, insurer/administrator, and plan members.
• Differentiate contributory and non-contributory group plans and explain how the design affects participation and underwriting.
• Explain common group underwriting approaches such as manual rating, experience rating, and administrative services only (ASO).
• Describe eligibility rules and plan classes (waiting periods, active-at-work requirements, dependent eligibility).
• Explain non-evidence maximums and evidence of insurability requirements in group plans.
• Explain coordination of benefits and how group plans prevent duplicate reimbursement of the same expense.
• Describe continuation, conversion, and portability concepts when an employee leaves the plan.
• Identify typical administrative processes in group plans (enrolment, premium billing, claims adjudication, member communications).
• Evaluate how plan amendments, renewals, or terminations should be communicated to members to reduce misunderstanding and complaints.
• Apply group plan concepts to analyze a plan scenario and identify key issues (eligibility, underwriting, cost drivers, sustainability).

Implement a recommendation adapted to the client’s needs and situation (25%)

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Insurance Recommendation, Contract, and Service Needs

• Summarize the client’s A&S risks, priorities, and constraints (budget, underwriting tolerance) into clear coverage objectives.
• Translate coverage objectives into specific product types and benefit structures (income replacement vs reimbursement vs lump-sum).
• Compare multiple product options and explain how key contract provisions affect suitability (definitions, exclusions, limits).
• Explain how to develop and present a quote that reflects the client’s needs and affordability.
• Explain how to communicate the recommendation in plain language and confirm client understanding.
• Explain common trade-offs in disability insurance design (elimination period, benefit period, occupation definition) and how to justify choices.
• Recommend appropriate riders and options based on client circumstances (e.g., COLA, future increase, residual, ROP).
• Explain how benefit integration/offsets should be discussed so the client understands potential net payable benefits.
• Discuss the tax implications of A&S premiums and benefits at a conceptual level and how taxation affects net outcomes.
• Explain the impact of pre-existing condition clauses, waiting periods, and exclusions on the client’s expectations.
• Explain key contract duration and renewability concepts for A&S coverage and how they affect long-term planning.
• Explain the purpose and structure of a group plan’s master contract and member certificate/benefit booklet.
• Recommend appropriate coverage for dependents (family health/dental, travel medical, CI) based on family structure.
• Evaluate when it may be appropriate to keep existing coverage, replace coverage, or add supplemental ‘top-up’ coverage.
• Prepare documentation that supports suitability: needs analysis summary, options considered, recommendation rationale.
• Obtain informed consent and necessary authorizations (e.g., to collect medical information) as part of implementing A&S coverage.
• Explain the typical steps and timeline in implementing A&S coverage, from application to underwriting to policy issue.
• Identify information and evidence commonly required in applications (income, occupation, health history) and why accuracy matters.
• Explain how underwriting decisions (standard, rated, exclusions, limitations, decline) affect the recommendation and next steps.
• Explain policy delivery best practices: review contract, confirm changes since application, verify effective date and premium details.
• Explain premium payment methods and the consequences of missed payments (grace periods, lapse, reinstatement).
• Explain client rights such as review/free-look periods (where applicable) and how to handle cancellations.
• Design an ongoing service plan (annual review triggers: income change, occupation change, life events, travel patterns).
• Explain how to support group plan sponsors with plan design, communications, and member education without providing legal advice.
• Handle common client objections (cost, ‘won’t happen to me’, complexity) using needs-based, ethical responses.

Underwriting and Policy Implementation (Accident & Sickness)

• Explain the purpose of underwriting in A&S insurance and how it supports risk classification and fair pricing.
• Identify the main underwriting factors in A&S (income, occupation, health, lifestyle, medical history, family history).
• Explain financial underwriting for disability income insurance and why income verification is required to set benefit limits.
• Describe how occupation classes and job duties can affect eligibility, premium rates, and available disability definitions.
• Identify common evidence requirements in individual A&S underwriting (application questions, medical exams, APS, lab tests).
• Explain how third-party information sources (e.g., medical reports, inspections) may be used to assess risk and prevent fraud.
• Explain the importance of accurate and complete disclosure on applications and the potential consequences of misrepresentation.
• Differentiate between a premium rating, an exclusion rider, and a benefit limitation as underwriting outcomes.
• Explain how underwriting outcomes should be communicated to clients and how recommendations may need to be adjusted.
• Identify underwriting considerations that are particularly relevant for CI insurance (health history, family history, lifestyle).
• Identify underwriting considerations that are particularly relevant for LTC insurance (functional ability, cognitive impairment, age).
• Describe group plan underwriting at a high level (participation levels, plan design, experience, late entrants, evidence rules).
• Explain the concept of non-evidence maximums and how late entrants or optional benefits may trigger evidence requirements.
• Explain how pre-existing condition clauses and late entrant rules can apply in group disability and health plans.
• Explain how effective dates are determined and why coverage is not in force until required conditions are met.
• Describe best practices when collecting application information (clarifying answers, documenting notes, avoiding assumptions).
• Explain how conditional receipts or temporary coverage arrangements (where offered) may work and why conditions matter.
• Identify common underwriting ‘red flags’ (inconsistent financials, hazardous activities, incomplete medical history) and how to address them.
• Explain how lifestyle factors (smoking, high-risk sports) can affect premiums, exclusions, and eligibility.
• Explain underwriting considerations for travel medical coverage (age, trip length, stability of pre-existing conditions).
• Explain privacy and consent principles when collecting and sharing client medical and financial information.
• Describe how riders and options are selected and documented at application and how errors can affect issued coverage.
• Explain how amendments (rated/excluded offers) are accepted by the client and why the client must understand the changes.
• Identify common application errors that cause delays (missing signatures, incomplete health answers, unclear occupation details).
• Apply underwriting process knowledge to anticipate likely evidence needs and possible outcomes for a client scenario.

Provide customer service during the validity period of the coverage (10%)

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Ongoing Service and Claims for Accident & Sickness Insurance

• Explain why periodic policy reviews are important for A&S coverage as the client’s situation changes (income, occupation, family status).
• Identify when contract amendments may be appropriate (benefit increases, rider additions/removals, coverage adjustments).
• Explain renewal and termination provisions at a high level for individual and group A&S coverage.
• Explain lapse risk, grace periods, and reinstatement concepts and why reinstatement may require evidence of insurability.
• For group plans, explain how life events and employment changes can affect coverage (adding dependents, class changes, leaves of absence).
• Describe the general steps in a disability income claim (notice, claim forms, medical evidence, ongoing proof).
• Explain how the elimination period affects the timing of disability benefit payments and what the claimant must do during the waiting period.
• Explain recurrent disability provisions at a high level and why they matter for claimants returning to work and relapsing.
• Describe the general steps in a critical illness claim (diagnosis confirmation, survival period if applicable, proof of claim).
• Describe the general steps in a long-term care claim (functional assessment, care plan, elimination period, ongoing eligibility checks).
• Describe the basics of extended health/dental claim submission (receipts, provider information) and coordination of benefits.
• Explain the insurer’s role in claims adjudication and common reasons claims may be delayed or denied.
• Explain the advisor’s role in supporting clients through the claims process while respecting privacy and avoiding unauthorized practice.
• Explain how offsets from other benefit sources can reduce LTD payments during an ongoing claim and why clients should be prepared for this.
• Explain the tax reporting implications of taxable disability benefits and the importance of client awareness.
• Describe how rehabilitation and return-to-work programs can affect benefit payments and claimant obligations.
• Explain how to handle client complaints and service issues (escalation within insurer/administrator, ombudsman or regulator as appropriate).
• Document ongoing service activities and client communications to support compliance and continuity of service.
• Identify proactive client education steps that reduce claim issues (reporting changes, understanding exclusions, timely submissions).
• For group sponsors, explain ongoing service activities such as monitoring plan experience, discussing renewals, and communicating plan changes.

Tip: Treat each learning objective as a “can I answer a scenario question about this in 60–90 seconds?” test. If not, add it to your miss log and drill it again in 48–72 hours.