State RegulationsMA specificDifficulty 2/5
An individual accident and health policy includes the optional 'illegal occupation' provision. The insured is injured while committing a burglary. What is the consequence under M.G.L. c. 175, § 108(3)(b)?
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Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
The illegal-occupation provision in M.G.L. c. 175, § 108(3)(b) permits the insurer to exclude benefits for any loss sustained while the insured was engaged in an occupation or activity that is illegal. Committing a burglary at the time of the injury brings the loss squarely within the exclusion, so no benefits are payable for it. The provision exists to keep the policy from underwriting criminal activity — it protects law-abiding claimants, not injuries sustained in the course of a crime.
Why the other options are wrong
- A) The provision keys the exclusion to the illegal activity at the time of the loss; payment is not required merely because the injury itself is real.
- C) A half-benefit compromise has no basis in M.G.L. c. 175, § 108(3)(b); the provision excludes the loss, it does not discount it.
- D) Pay now, recover later is not a mechanism the provision creates; losses from illegal occupations are simply not covered.
Memory hook
Crime on the clock, coverage off: no benefits for losses in illegal occupations.