State RegulationsNY specificDifficulty 3/5
An insured accurately lists a lawful occupation on the application for a New York individual health policy but is later injured during an illegal side activity. He has never been convicted of a crime. Which statement is correct?
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Answer & full 3-part explanation (select an option above, or peek)
Why D is correct
Under N.Y. Ins. Law §3216(d)(2)(J), the illegal occupation exclusion focuses on the activity giving rise to the loss, not the occupation stated in the application, and it requires no criminal conviction: participation in the felony or illegal occupation is enough. A truthfully stated lawful occupation therefore does not save a claim for an injury sustained during criminal conduct.
Why the other options are wrong
- A) The exclusion is conduct-based, not application-based.
- B) It applies to loss arising from the illegal activity, whether the loss is from accident or sickness.
- C) Conviction is not a precondition to applying the exclusion.
Memory hook
It is what you were doing, not what you wrote or what a court decided.