WebCE Continuing Education (CE) Practice Test

An insurance company would likely utilize estoppel in the situation where a claim is filed after premium payment without periodic notice. Estoppel is a legal principle that prevents someone from arguing something contrary to a claim based on previous actions or statements. In this context, if the insured had been making regular premium payments but the insurer did not provide periodic notice of any issues or changes regarding the policy, they may be estopped from denying the claim on the grounds that the policy was effectively lapsed or that the claim was submitted too late. This principle serves to protect the insured when they have acted under the assumption that their coverage was still valid due to the insurance company’s failure to communicate. In other situations: claim denials due to lack of evidence typically involve straightforward underwriting and claims assessments, while policy lapses due to nonpayment or termination of coverage without due cause would not usually engage principles of estoppel unless there had been misleading communications from the insurer that led the policyholder to believe they were still covered.