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State RegulationsMA specificDifficulty 2/5

An individual accident and health policy was issued when the insured worked as an office administrator. She later becomes a logging worker, a more hazardous occupation, and is injured while logging. Under the optional change-of-occupation provision in M.G.L. c. 175, § 108(3)(b), what may the insurer do?

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Answer & full 3-part explanation (select an option above, or peek)

Why A is correct

The change-of-occupation provision of M.G.L. c. 175, § 108(3)(b) addresses the situation where a loss occurs while the insured is in a more hazardous occupation than the one on which the premium was based: the insurer may pay only the benefit that the premium paid would have purchased at the more hazardous occupational class. The claim is not denied outright — the insured retains coverage — but the payout is proportionally adjusted so the premium and the risk stay matched.

Why the other options are wrong

  • B) Total denial overreaches; the provision calls for proportional reduction to the higher-risk rate, not forfeiture of the claim.
  • C) Retroactive rescission and premium refund are not among the remedies M.G.L. c. 175, § 108(3)(b) gives the insurer for a later occupational change.
  • D) Paying unchanged benefits would let the insured carry high-hazard risk at office-worker rates, which the provision expressly prevents.

Memory hook

Riskier job, smaller check: the benefit drops to the hazardous-rate equivalent.

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