632.76 Incontestability for disability insurance.
(1) Avoidance for misrepresentations. No statement made by an applicant in the application for individual disability insurance coverage and no statement made respecting the person's insurability by a person insured under a group policy, except fraudulent misrepresentation, is a basis for avoidance of the policy or denial of a claim for loss incurred or disability commencing after the coverage has been in effect for 2 years. The policy may provide for incontestability even with respect to fraudulent misstatements.
(2) Preexisting diseases.
(a) No claim for loss incurred or disability commencing after 2 years from the date of issue of the policy may be reduced or denied on the ground that a disease or physical condition existed prior to the effective date of coverage, unless the condition was excluded from coverage by name or specific description by a provision effective on the date of loss. This paragraph does not apply to a group health benefit plan, as defined in s. 632.745 (9), which is subject to s. 632.746.
(ac)
1. Notwithstanding par. (a), no claim or loss incurred or disability commencing after 12 months from the date of issue of an individual disability insurance policy, as defined in s. 632.895 (1) (a), may be reduced or denied on the ground that a disease or physical condition existed prior to the effective date of coverage, unless the condition was excluded from coverage by name or specific description by a provision effective on the date of the loss.
2. Except as provided in subd. 3., an individual disability insurance policy, as defined in s. 632.895 (1) (a), other than a short-term policy subject to s. 632.7495 (4) and (5), may not define a preexisting condition more restrictively than a condition, whether physical or mental, regardless of the cause of the condition, for which medical advice, diagnosis, care, or treatment was recommended or received within 12 months before the effective date of coverage.
3. Except as the commissioner provides by rule under s. 632.7495 (5), all of the following apply to an individual disability insurance policy that is a short-term policy subject to s. 632.7495 (4) and (5):
a. The policy may not define a preexisting condition more restrictively than a condition, whether physical or mental, regardless of the cause of the condition, for which medical advice, diagnosis, care, or treatment was recommended or received before the effective date of coverage.
b. The policy shall reduce the length of time during which a preexisting condition exclusion may be imposed by the aggregate of the insured's consecutive periods of coverage under the insurer's individual disability insurance policies that are short-term policies subject to s. 632.7495 (4) and (5). For purposes of this subd. 3. b., coverage periods are consecutive if there are no more than 63 days between the coverage periods.
(b) Notwithstanding par. (a), no claim for loss incurred or disability commencing after 6 months from the date of issue of a medicare supplement policy, medicare replacement policy or long-term care insurance policy may be reduced or denied on the ground that a disease or physical condition existed prior to the effective date of coverage. Notwithstanding par. (ac) 2., a medicare supplement policy, medicare replacement policy, or long-term care insurance policy may not define a preexisting condition more restrictively than a condition for which medical advice was given or treatment was recommended by or received from a physician within 6 months before the effective date of coverage. Notwithstanding par. (a), if on the basis of information contained in an application for insurance a medicare supplement policy, medicare replacement policy, or long-term care insurance policy excludes from coverage a condition by name or specific description, the exclusion must terminate no later than 6 months after the date of issue of the medicare supplement policy, medicare replacement policy, or long-term care insurance policy. The commissioner may by rule exempt from this paragraph certain classes of medicare supplement policies, medicare replacement policies, and long-term care insurance policies, if the commissioner finds the exemption is not adverse to the interests of policyholders and certificate holders.
History: 1975 c. 375, 421; 1981 c. 82; 1985 a. 29; 1989 a. 31; 1995 a. 289; 1997 a. 27; 2009 a. 28.
A generic exclusion of all diseases or conditions diagnosed or treated before issuance of the policy does not constitute exclusion by “name or specific description" under sub. (2). Peterson v. Equitable Life Assurance Society, 57 F. Supp. 2d 692 (1999).
Structure Wisconsin Statutes & Annotations
Wisconsin Statutes & Annotations
Chapter 632 - Insurance contracts in specific lines.
632.07 - Prohibiting requiring property insurance in excess of replacement value.
632.10 - Definitions applicable to property insurance escrow.
632.102 - Payment of final settlement.
632.103 - Procedure for payment of withheld funds.
632.104 - Funds released to mortgagee.
632.14 - Bonds need not be under seal.
632.17 - Validity of surety bonds.
632.18 - Rustproofing warranties insurance.
632.185 - Vehicle protection product warranty insurance policy.
632.22 - Required provisions of liability insurance policies.
632.23 - Prohibited exclusions in aircraft insurance policies.
632.24 - Direct action against insurer.
632.25 - Limited effect of conditions in employer's liability policies.
632.32 - Provisions of motor vehicle insurance policies.
632.34 - Defense of noncooperation.
632.35 - Prohibited rejection, cancellation and nonrenewal.
632.36 - Accident in the course of business or employment.
632.365 - Use of emission inspection data in setting rates.
632.37 - Motor vehicle glass repair practices; restriction on specifying vendor.
632.375 - Motor vehicle repair practices; restriction on specifying vendor.
632.38 - Nonoriginal manufacturer replacement parts.
632.41 - Prohibited provisions in life insurance.
632.42 - Trustee and deposit agreements in life insurance.
632.43 - Standard nonforfeiture law for life insurance.
632.435 - Standard nonforfeiture law for individual deferred annuities.
632.44 - Required provisions in life insurance.
632.45 - Contracts providing variable benefits.
632.46 - Incontestability and misstated age.
632.47 - Assignment of life insurance rights.
632.475 - Life insurance policy loans.
632.48 - Designation of beneficiary.
632.50 - Estoppel from medical examination.
632.56 - Required group life insurance provisions.
632.57 - Conversion option in group and franchise life insurance.
632.60 - Limitation on credit life insurance.
632.62 - Participating and nonparticipating policies.
632.63 - Unclaimed life insurance and annuities.
632.64 - Certification of disability.
632.65 - Annuities exempt from regulation.
632.66 - Annuity contracts without life contingencies.
632.67 - Effect of power of attorney for health care.
632.695 - Applicability of general transfers at death provisions.
632.697 - Benefits subject to department's right to recover.
632.71 - Estoppel from medical examination, assignability and change of beneficiary.
632.715 - Reports of action against health care provider.
632.72 - Medical benefits or assistance; assignment.
632.725 - Standardization of health care billing and insurance claim forms.
632.726 - Current procedural terminology code changes.
632.729 - Prohibiting discrimination based on COVID-19.
632.73 - Right to return policy.
632.74 - Reinstatement of individual or franchise disability insurance policies.
632.745 - Coverage requirements for group and individual health benefit plans; definitions.
632.746 - Preexisting condition; portability; restrictions; and special enrollment periods.
632.747 - Guaranteed acceptance.
632.748 - Prohibiting discrimination.
632.749 - Contract termination and renewability.
632.7495 - Guaranteed renewability of individual health insurance coverage.
632.7497 - Modifications at renewal.
632.75 - Prohibited provisions for disability insurance.
632.755 - Public assistance and early intervention services.
632.76 - Incontestability for disability insurance.
632.77 - Permitted provisions for disability insurance policies.
632.775 - Effect of power of attorney for health care.
632.78 - Required grace period for disability insurance policies.
632.793 - Notice of loss of primary insurance coverage due to age.
632.795 - Open enrollment upon liquidation.
632.797 - Disclosure of group health claims experience.
632.798 - Out-of-pocket costs.
632.80 - Restrictions on medical payments insurance.
632.81 - Minimum standards for certain disability policies.
632.82 - Renewability of long-term care insurance policies.
632.825 - Midterm termination of long-term care insurance policy by insured.
632.83 - Internal grievance procedure.
632.835 - Independent review of coverage denial determinations.
632.84 - Benefit appeals under certain policies.
632.845 - Prohibiting refusal to cover services because liability policy may cover.
632.85 - Coverage without prior authorization for treatment of an emergency medical condition.
632.853 - Coverage of drugs and devices.
632.855 - Requirements if experimental treatment limited.
632.857 - Explanation required for restriction or termination of coverage.
632.861 - Prescription drug charges.
632.865 - Pharmacy benefit managers.
632.866 - Step therapy protocols.
632.867 - Oral and injected chemotherapy.
632.87 - Restrictions on health care services.
632.873 - Restrictions relating to fees for dental services.
632.875 - Independent evaluations relating to chiropractic treatment.
632.88 - Policy extension for handicapped children.
632.885 - Coverage of dependents.
632.89 - Coverage of mental disorders, alcoholism, and other diseases.
632.896 - Mandatory coverage of adopted children.
632.897 - Hospital and medical coverage for persons insured under individual and group policies.
632.8985 - Prohibiting abortion coverage.
632.899 - Medical savings accounts study.
632.93 - The fraternal contract.
632.95 - Fraud in obtaining membership.
632.96 - Beneficiaries in fraternal contracts.
632.97 - Application of proceeds of credit insurance policy.
632.975 - Portable electronics insurance.