State RegulationsOH specificDifficulty 1/5
During the pendency of a claim under an Ohio individual sickness and accident policy, the insurer requires the insured to submit to a physical examination. Who bears the expense of that examination?
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Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
ORC 3923.04(J) gives the insurer the right, as part of the physical-examination-and-autopsy provision, to examine the insured as often as is reasonably required during the pendency of a claim — but expressly at the insurer's own expense. The cost can never be shifted to the insured or deducted from the claim.
Why the other options are wrong
- A) Wrong because ORC 3923.04(J) puts the cost on the insurer; no deduction from claim proceeds is permitted.
- C) Wrong because reimbursement is not conditioned on the claim's outcome; the insurer always pays for its own examination.
- D) Wrong because there is no cost-sharing arrangement in the statute — the expense belongs to the insurer alone.
Memory hook
Insurer wants the exam? Insurer pays for it.