Free LLQP Accident & Sickness Practice Questions: In-force Service

Use this focused LLQP Accident & Sickness page as a short practice test for In-force Service. The items are original Finance Prep sample exam questions built for LLQP-style scenario judgment, not trivia, puzzle questions, official LLQP questions, copied live-exam content, or exam dumps.

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Sample questions

These are original Finance Prep practice questions aligned to this LLQP competency area. They are not official LLQP questions, copied live-exam content, or exam dumps. Use them to preview question style and explanation depth before continuing with topic drills, mixed sets, and timed mock exams in Finance Prep.

Question 1

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

A client asks what it means when their disability insurance benefits are taxable. Which statement is most accurate from a client-service perspective?

• A. If benefits are taxable, it means the client can always deduct their disability insurance premiums on their tax return.
• B. If benefits are taxable, the insurer pays the income tax directly to CRA, so the client does not need to report the benefits on their tax return.
• C. Taxable disability benefits are generally included in the client’s income for the year and should be reported on their tax return using the tax information they receive (for example, a tax slip), so the client should be prepared for possible tax owing if not enough tax was withheld.
• D. Taxable disability benefits do not need to be reported by the client; only the employer reports them when the client returns to work.

Best answer: C

What this tests: In-force Service

Explanation: For ongoing service, a key advisor responsibility is setting realistic expectations about how benefits affect a client’s finances.

When disability benefits are taxable, they are treated as income to the client. Practically, this means the client will typically receive tax reporting information (often a tax slip) and must include the amount on their income tax return. Because tax may not be perfectly withheld during the year, the client should be aware they could owe tax at filing time and may want to budget accordingly.

This is conceptual guidance only: whether a disability benefit is taxable commonly depends on the plan design and who paid the premiums, but once you are told the benefit is taxable, the service focus is on the client’s reporting and cash-flow expectations.

If benefits are taxable, the key service message is that they are reportable income and the client should expect tax reporting (often via a slip) and potential tax payable depending on withholding and the client’s situation.

Question 2

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

Hassan submits a claim under his extended health plan for physiotherapy visits. The insurer replies that the claim is pending and asks for an itemized receipt showing the provider’s credentials and the dates of service. Hassan says, “They’re refusing to pay.” Which single factor most likely explains what is happening?

• A. A policy exclusion (or a pre-existing condition limitation) applies to physiotherapy claims.
• B. The insurer is waiting for required documentation to adjudicate the claim.
• C. Hassan made incomplete disclosure on his original application, so the insurer will deny the claim.
• D. The physiotherapy is an ineligible expense under the plan’s benefit category.

Best answer: B

What this tests: In-force Service

Explanation: This scenario tests the key service concept of the insurer’s role in claims adjudication: the insurer must verify that the expense is eligible under the contract and that the amount claimed is supported by acceptable evidence.

A very common reason a claim is delayed (shown here by “pending”) is missing or insufficient documentation—for example, an itemized receipt, dates of service, or provider information/credentials. Without this, the insurer cannot confirm that the service matches the plan’s covered benefits and reimbursement rules.

By contrast, claims are more commonly denied when the expense is not covered, the maximums/limits have been reached, an exclusion or limitation applies, or there is a material issue such as misrepresentation. In this case, the insurer’s specific request points to a documentation issue rather than a coverage decision.

A claim often remains pending when key documents (such as itemized receipts and provider details) are missing. The insurer needs this evidence to confirm eligibility and apply the contract terms.

Question 3

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

During a disability insurance claim, a client asks their advisor to contact the client’s doctor to discuss the diagnosis and send the client’s medical details directly to the insurer. What is the most appropriate response by the advisor?

• A. Advise the client to avoid disclosing medical details because insurers cannot request medical information during a claim, and the advisor should negotiate approval based on the client’s description alone.
• B. Tell the client that once the claim forms are submitted, the insurer must pay benefits immediately and any missing medical information can be provided later if requested.
• C. Explain that the advisor can help the client with claim forms and follow up with the insurer, but medical information should be exchanged only with the client’s written consent and the advisor cannot promise the claim will be approved.
• D. Contact the doctor right away and request the complete chart so the advisor can decide whether the claim meets the policy definition of disability before sending it to the insurer.

Best answer: C

What this tests: In-force Service

Explanation: This tests the advisor’s role in claims support and ongoing service for Accident & Sickness insurance.

In an A&S claim, an advisor’s value is to:

• help the client understand and complete claim forms,
• explain what information is typically needed (employer, attending physician/medical evidence, income/occupation details when relevant),
• set realistic expectations about timelines and follow-ups, and
• act as a communication helper between the client and the insurer.

At the same time, the advisor must respect privacy and consent. Medical information is sensitive, and the advisor should ensure the client authorizes any exchange of information. The advisor should also avoid unauthorized practice, such as making medical judgments or promising that a claim will be approved.

A practical, compliant approach is to help the client submit what the insurer requests (with consent), follow up on outstanding items, and keep the client informed—without guaranteeing outcomes.

This reflects the advisor’s support role (forms, communication, expectations) while respecting privacy/consent and avoiding promising outcomes.

Question 4

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

Mina has an individual disability insurance policy with a 90-day elimination period. She was on claim for 5 months, then returned to full-time work. After 8 weeks back at work, the same medical condition flares up and she stops working again.

To determine whether Mina must satisfy a new elimination period or whether benefits can resume sooner, which policy attribute is the single most important factor to review?

• A. Whether the policy is non-cancellable or guaranteed renewable
• B. The policy’s definition of disability (own occupation vs any occupation)
• C. The policy’s benefit period (e.g., to age 65 vs 2 years)
• D. The policy’s recurrent (recurrence) disability provision

Best answer: D

What this tests: In-force Service

Explanation: This scenario tests the recurrent (recurrence) disability provision—a common contract feature that matters when a claimant returns to work and then relapses.

At a high level, a recurrence provision defines a time window after recovery/return-to-work during which a new period of disability (often from the same or related cause) may be treated as a continuation of the prior claim. When it is treated as a continuation, the claimant may not have to complete a full new elimination period before benefits resume. If the relapse occurs outside the recurrence window (or doesn’t meet the policy’s recurrence conditions), the disability is treated as a new claim, and the elimination period typically applies again.

Because Mina returned to work and relapsed only 8 weeks later, the deciding issue is not how long benefits could last overall or how the policy can be renewed—it’s whether the policy treats this relapse as a continuation of the prior disability.

A recurrence provision explains when a relapse is treated as a continuation of the prior disability (often allowing benefits to restart without a full new waiting period) versus a new claim that requires a new elimination period.

Question 5

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

Which sequence best describes the general steps to complete a critical illness (CI) insurance claim before a benefit is paid?

• A. Confirm the diagnosis and submit proof of claim, then return to work full-time to trigger payment.
• B. Confirm the diagnosis meets the policy definition, satisfy any survival period if applicable, then submit the required proof of claim to the insurer.
• C. Submit proof of claim first, then the insurer determines if the diagnosis qualifies, and finally the survival period begins after approval.
• D. Confirm the diagnosis and show an income loss for a set number of weeks, then submit proof of claim for reimbursement of lost earnings.

Best answer: B

What this tests: In-force Service

Explanation: A critical illness (CI) claim is generally driven by medical eligibility and timing under the contract, not by work capacity or income loss.

In broad terms, the claimant (often with help from the advisor) must:

• Confirm the diagnosis: a physician’s documentation must show the condition meets the policy’s definition.
• Satisfy any survival period (if the policy includes one): the insured must survive a specified number of days after the covered event/diagnosis before the benefit becomes payable.
• Provide proof of claim: completed claim forms and supporting medical evidence are submitted so the insurer can assess the claim and pay the benefit if the conditions are met.

These steps are common across CI policies, even though exact forms and evidence can vary by insurer and contract.

CI claims generally require medical confirmation that the condition meets the contract definition, completion of any stated survival period, and submission of claim forms/medical proof.

Question 6

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

Which statement best explains why reinstating an Accident & Sickness insurance policy after it has lapsed may require evidence of insurability?

• A. Because reinstatement guarantees payment of any claims that occurred during the lapse, so the insurer must confirm the claim details first.
• B. Because once coverage has lapsed, the insurer may need to re-assess the insured’s current health and risk before restoring coverage.
• C. Because the agent must pay the overdue premiums to reactivate the policy, and insurers require proof of the agent’s financial capacity.
• D. Because the grace period automatically extends coverage indefinitely as long as the client intends to pay.

Best answer: B

What this tests: In-force Service

Explanation: This question tests lapse risk, grace periods, and reinstatement in ongoing A&S policy service (customer service during coverage).

If premiums are missed, a policy typically enters a grace period—a limited window to pay overdue premiums and keep the contract in force. If the premium is still not paid by the end of the grace period, the policy can lapse (terminate), creating a potential coverage gap.

When a client later asks to reinstate a lapsed policy, the insurer may treat this as restoring coverage after it ended. Because the insured’s health or risk profile may have changed since the policy lapsed, the insurer may require evidence of insurability (such as updated health information) before agreeing to reinstate.

From a client-impact perspective, the key service message is to prevent gaps: set up reliable payment methods, watch for missed payments, act quickly within the grace period, and contact the insurer/agent immediately if payment trouble occurs.

A lapse can end the contract. Reinstatement is not always automatic, so the insurer may require updated information (evidence of insurability) to confirm the risk is still acceptable.

Question 7

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

In a typical employer-sponsored group extended health plan, what is the most likely outcome if an employee has a newborn but does not notify the plan administrator until several months later (after the plan’s enrolment window for family status changes has passed)?

• A. The newborn is covered automatically from birth, even without being reported, because the employee is already enrolled.
• B. The employee can add the newborn at any time with no restrictions, because dependents are not subject to enrolment rules.
• C. Only dental coverage can be added late; extended health must always be added within 24 hours of birth.
• D. The employee may have to wait until the next enrolment opportunity and/or provide evidence of insurability, and coverage is generally not retroactive for the unreported period.

Best answer: D

What this tests: In-force Service

Explanation: This question tests ongoing service for group A&S/health coverage: life events (like a birth) usually require prompt notification and timely enrolment to add a dependent.

Many group plans set an enrolment window (a limited time after the life event) to add or change dependent coverage. If the employee misses that window, the plan may treat the request as a late enrolment, which commonly results in one or more of the following conceptual outcomes:

• The dependent cannot be added until a future enrolment opportunity (for example, a plan anniversary or the next permitted change window).
• The plan may require evidence of insurability for the late addition (especially for certain benefits).
• Coverage is generally not retroactive for the period when the dependent was not properly enrolled.

From a customer-service perspective, the key lesson is to advise clients to notify the plan administrator promptly after life events and to confirm the plan’s specific window and paperwork requirements.

Missing the enrolment window often changes the outcome: the plan may treat the request as a late enrolment, which can mean delays, added requirements, and no automatic backdating.

Question 8

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

Mina owns an individual disability insurance policy with monthly premiums paid by pre-authorized debit. She calls you because her account had insufficient funds and she just noticed the last premium payment was missed. She is worried the policy has lapsed and says, “I don’t want a gap in coverage.”

What is the most appropriate next action for you to take?

• A. Submit a reinstatement request right away and reassure Mina that no evidence of insurability will be required because this is only one missed premium.
• B. Confirm whether the policy is still within its grace period with the insurer, and arrange for the missed premium to be paid immediately (and update billing details if needed).
• C. Tell Mina to wait until the insurer sends a lapse notice, because nothing can be done until the policy is officially cancelled.
• D. Advise Mina that coverage automatically ended on the missed payment date and she must submit a new application for disability insurance.

Best answer: B

What this tests: In-force Service

Explanation: This situation tests ongoing policy service: managing missed premiums to prevent coverage gaps.

Key ideas:

• A missed premium can put a policy at risk, but many contracts include a grace period during which coverage can continue while the client catches up on payment.
• The most important immediate service action is to confirm the policy’s current status (in force vs. in grace vs. lapsed) and arrange payment as quickly as possible, including correcting the billing method so the problem does not repeat.
• If the policy has already lapsed, the client may need to apply for reinstatement. Reinstatement may require evidence of insurability (health/occupation/income information) because the insurer is being asked to put coverage back in force after a break, when the client’s risk profile may have changed.

From a client-impact perspective, the goal is to minimize the chance of an uncovered period and avoid making promises about coverage being “back on” until the insurer confirms the status and requirements.

This is the right service step: determine if coverage can be kept in force by paying within the grace period, and fix the payment issue to prevent a coverage gap.

Question 9

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

Mina has an individual disability insurance policy paid by monthly pre-authorized debit. She notices the payment did not come out this month because she changed bank accounts. She calls you and says, “If I get hurt this week, I’m still covered, right?”

Which statement to Mina is INCORRECT?

• A. “Let’s contact the insurer right away to confirm whether you are still within the policy’s grace period and arrange payment so the policy doesn’t lapse.”
• B. “If the policy lapses, you can usually apply to reinstate it, but reinstatement may require evidence of insurability and a loss during the lapse may not be covered.”
• C. “To prevent a gap, we can update your banking details and set up a reliable payment method, and you should notify me right away if a payment is ever missed again.”
• D. “Don’t worry—missing a premium doesn’t affect your coverage. You can just catch up later, and claims will be paid as long as you were insured when the policy was issued.”

Best answer: D

What this tests: In-force Service

Explanation: This question tests ongoing policy service for Accident & Sickness insurance: missed premiums create a lapse risk, policies typically include a grace period to allow time to pay, and if a policy lapses, the client may have to apply for reinstatement.

The key client impact is the potential for a coverage gap. If coverage has lapsed, a disability occurring during the lapse may not be covered. Even if reinstatement is available, it may require evidence of insurability (for example, updated health/occupation/income information) because the insurer is being asked to restore coverage after non-payment and must reassess risk.

Good service focuses on preventing gaps: act quickly when a payment is missed, confirm the policy’s current status, arrange payment, and update banking or payment methods to avoid a repeat.

This is incorrect because missed premiums can lead to lapse after any applicable grace period, creating a coverage gap. Reinstatement is not guaranteed and a claim during a lapse may be denied.

Question 10

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

Before Maya travels to the U.S., you review her travel medical coverage so she understands costs and avoids claim disputes. Her policy has a per-trip deductible of $200, then it reimburses 80% of remaining eligible expenses. If an eligible emergency room bill is $2,500, approximately how much should Maya expect to pay out of pocket? (Round to the nearest dollar.)

• A. $660
• B. $500
• C. $700
• D. $2,300

Best answer: A

What this tests: In-force Service

Explanation: This question tests proactive client education during coverage: helping a client understand how deductibles and coinsurance affect what they will personally pay if they submit a claim.

Calculation in plain words:

• First, apply the deductible: $2,500 − $200 = $2,300 remaining eligible expense.
• The policy reimburses 80%, so the client pays the other 20%: 20% × $2,300 = $460.
• Total out-of-pocket = deductible $200 + coinsurance $460 = $660.

Explaining this before travel reduces common claim issues and complaints because the client isn’t surprised by the deductible/coinsurance and is more likely to budget, keep receipts, and submit complete documentation.

Out-of-pocket equals the $200 deductible plus 20% of the remaining $2,300 ($460), for a total of $660.

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Related focused pages

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

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