17 Free Washington Life & Health Practice Questions: Individual Accident and Health and Disability Income (2026)
How to Use This Individual Accident and Health and Disability Income Set
This set sits behind two sections of the combined outline: Individual Accident and Health Insurance Policy Provisions, with 10 items, and Disability Income and Related Insurance, with 8. Together they are the heart of the Disability exam, whose own outline is 100 items.
The first theme is the definition of disability: own occupation, any occupation, partial, residual and presumptive. The second is the set of uniform provisions every individual policy carries, such as time limit on certain defenses, grace period, notice of claim and physical examination. When a question describes a clause, name the provision before you read the options.
Individual Accident and Health Insurance Policy Provisions has 10 items and Disability Income and Related Insurance has 8 items on the PSI combined Life and Disability outline.
Practice Questions 1-6: Disability Definitions and Required Provisions
Own-occupation total disability, which provisions are required, grace periods, any-occupation disability, the time limit on certain defenses and a change of occupation.
Question 1 (Chapter 7)
Under an individual disability income policy in Washington, the insured suffers a disability that prevents them from performing the material duties of their regular occupation but they are able to work in a different, gainful occupation. If the policy defines total disability as the inability to perform the material duties of one's own occupation, what benefit is payable?
- A) No benefit, because the insured can work in another occupation.
- B) Full total disability benefit, because they cannot perform their own occupation.
- C) Partial disability benefit only, as they retain some earning capacity.
- D) Residual disability benefit, proportional to the loss of income.
Show answer & explanation
Answer: B
Under an 'own occupation' definition of total disability, the insured is considered totally disabled if they cannot perform the material duties of their regular occupation, even if they can work in another job. Therefore, the full total disability benefit is payable. Options A, C, and D are incorrect: benefits are not denied, and partial or residual benefits apply only when the policy defines disability differently or when the insured suffers a loss of income but can still work in their own occupation.
Question 2 (Chapter 7)
Under Washington state law, which of the following is a uniform required provision that must be included in every individual accident and health insurance policy?
- A) Coinsurance provision requiring the insured to pay a percentage of medical expenses.
- B) Free look period allowing the insured to return the policy for a full refund within 10 days.
- C) Change of occupation provision that adjusts premiums if the insured switches to a riskier job.
- D) Time limit on certain defenses, which prevents the insurer from denying a claim based on a pre-existing condition after the policy has been in force for a specified period.
Show answer & explanation
Answer: D
The time limit on certain defenses is one of the twelve uniform required provisions mandated in every individual accident and health insurance policy. It prevents the insurer from denying a claim based on a pre-existing condition after the policy has been in force for a set period (typically two or three years). Options A, B, and C are incorrect: coinsurance and change of occupation are uniform optional provisions, and the free look period is a general provision, not a uniform required one.
Question 3 (Chapter 7)
Under Washington state insurance regulations, which of the following statements about the grace period in an individual accident and health policy is correct?
- A) The grace period allows the insured to delay premium payment indefinitely without losing coverage.
- B) The grace period applies only to the first premium payment on a new policy.
- C) If the premium is not paid during the grace period, the policy can be reinstated without evidence of insurability.
- D) The grace period is typically 7 to 31 days, during which coverage remains in force if the overdue premium is paid.
Show answer & explanation
Answer: D
The grace period in an individual accident and health policy is a uniform required provision that typically lasts 7 to 31 days. During this time, if the overdue premium is paid, coverage remains in force. It does not allow indefinite delay, is not limited to the first premium, and reinstatement after lapse requires evidence of insurability. Options A, B, and C are incorrect for these reasons.
Question 4 (Chapter 7)
A Washington resident becomes disabled and qualifies for benefits under their individual disability income policy. The disability is expected to last indefinitely and prevents them from performing any gainful occupation for which they are reasonably suited by education, training, or experience. How would this disability most likely be classified?
- A) Partial disability
- B) Total disability (any occupation)
- C) Residual disability
- D) Recurrent disability
Show answer & explanation
Answer: B
When a disability prevents the insured from performing any gainful occupation for which they are reasonably suited, it is classified as total disability under the 'any occupation' definition. This is distinct from 'own occupation' total disability, partial/residual disability (which involve some work capacity), or recurrent disability (which involves periodic episodes). Options A, C, and D are incorrect because the described scenario reflects a total inability to work in any suitable job.
Question 5 (Chapter 7)
A Washington resident purchases an individual accident and health policy that includes a uniform required provision regarding the time limit on certain defenses. The insurer attempts to deny a claim for a disability that began 2 years and 1 month after the policy's effective date, based on a pre-existing condition not disclosed in the application. Assuming the policy's time limit on certain defenses is 2 years, what is the likely outcome?
- A) The insurer can deny the claim because the disability occurred after the application was signed.
- B) The insurer can deny the claim if the insured failed to provide proof of loss within 90 days.
- C) The insurer must pay the claim only if the insured was disabled at the time of application.
- D) The insurer cannot deny the claim based on the pre-existing condition because the time limit on certain defenses has been exceeded.
Show answer & explanation
Answer: D
The uniform required provision 'time limit on certain defenses' (often 2 or 3 years) prevents the insurer from denying a claim based on a pre-existing condition after the policy has been in force for the specified period. Since the disability began after the 2-year period had elapsed, the insurer is barred from using the non-disclosed pre-existing condition as a basis for denial. Options A, B, and C are incorrect: A ignores the time limit defense, B confuses it with the proof of loss provision, and C misstates the rule's application.
Question 6 (Chapter 7)
An individual disability income policy in Washington includes a change of occupation provision. The insured, who was employed in a clerical position when the policy was issued, later takes a job as a construction worker. The insured then becomes disabled due to a back injury. How does the change of occupation provision most likely affect the benefit payable?
- A) The benefit is increased because construction work is considered a higher-risk occupation.
- B) The benefit is denied because construction work is considered a hazardous occupation not covered under the policy.
- C) The benefit remains unchanged as long as the insured notifies the insurer within 30 days of the occupation change.
- D) The benefit is reduced to reflect the ratio of the premium that would have been charged for the construction occupation compared to the clerical occupation.
Show answer & explanation
Answer: D
The change of occupation provision in individual disability income policies adjusts the benefit amount when the insured moves to a more hazardous occupation. The benefit is typically reduced to the amount that the premium paid would have purchased at the rate for the new (construction) occupation. Options A, B, and C are incorrect: benefits are not increased for higher-risk jobs, denial is not automatic for hazardous occupations, and notification does not prevent benefit adjustment.
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Practice Questions 7-12: Naming Provisions, Riders and Exclusions
Claim forms, physical examinations, cost of living and future increase riders, an unlisted hazardous hobby and a refund of premium provision.
Question 7 (Chapter 7)
In Washington, an individual accident and health policy states that the insurer will provide claim forms to the insured within 15 days of receiving notice of a claim. This provision is an example of which of the following?
- A) A uniform optional provision
- B) A general provision
- C) A uniform required provision
- D) An exclusion
Show answer & explanation
Answer: C
The requirement that the insurer provide claim forms within 15 days of receiving notice of a claim is one of the twelve uniform required provisions that must be included in every individual accident and health policy sold in Washington. It is not optional, general, or an exclusion. Options A, B, and D are incorrect because this provision is specifically mandated as uniform required.
Question 8 (Chapter 7)
A Washington resident's individual accident and health policy includes a provision stating that the insurer has the right to examine the insured, at the insurer's expense, when a claim is made. This provision is an example of which of the following?
- A) Proof of loss
- B) Time of payment of claims
- C) Physical examinations and autopsy
- D) Reinstatement
Show answer & explanation
Answer: C
The provision allowing the insurer to examine the insured at their expense when a claim is made corresponds directly to the uniform required provision known as 'physical examinations and autopsy.' This provision grants the insurer the right to have the insured examined by a physician of its choice (and, in case of death, to have an autopsy performed unless prohibited by law). Options A, B, and D refer to other uniform required provisions that address different aspects of the claims process.
Question 9 (Chapter 7)
A Washington resident's individual disability income policy includes a cost of living (COL) rider tied to the Consumer Price Index (CPI). If the CPI increases by 3% over a year, how will the rider most likely affect the monthly disability benefit?
- A) The monthly benefit will decrease by 3% to account for inflation.
- B) The monthly benefit will remain unchanged unless the insured files a specific request.
- C) The monthly benefit will increase by 3% to help offset the effects of inflation.
- D) The monthly benefit will increase by 3% only if the insured's actual expenses have risen by 3%.
Show answer & explanation
Answer: C
A cost of living (COL) rider in an individual disability income policy is designed to periodically increase the monthly disability benefit by a percentage tied to an inflation measure such as the CPI, helping the benefit retain its purchasing power over time. If the CPI increases by 3%, the benefit will typically increase by 3% automatically, regardless of the insured's actual spending. Options A, B, and D are incorrect: the benefit does not decrease with inflation, it does not require a request to increase, and it is not contingent on the insured's personal expense increases.
Question 10 (Chapter 7)
In Washington, an individual disability income policy includes a future increase option (FIO) rider. The insured wishes to exercise this rider to increase their benefit. Which of the following is typically required to exercise the FIO rider?
- A) Proof of a change in occupation to a higher-risk class.
- B) Proof that the insured has been continuously disabled for at least 6 months.
- C) Evidence of increased income; no proof of good health is required.
- D) Proof that the policy has been in force for at least 5 years.
Show answer & explanation
Answer: C
C is correct. The future increase option rider guarantees the right to increase the benefit without evidence of insurability; the insurer only requires financial proof that the higher benefit is justified by current income. A, B and D describe conditions the rider does not impose.
Question 11 (Chapter 7)
A Washington resident purchases an individual accident and health policy. The insurer denies a claim, stating the policy does not cover the loss because it falls under an exclusion for injuries sustained while participating in a hazardous hobby. The insured was injured while rock climbing, which is not listed as a covered activity in the policy but also not explicitly excluded. How should the insurer's denial be evaluated under Washington state law?
- A) The denial is valid because any activity not listed as covered is automatically excluded.
- B) The denial is valid only if the insured failed to disclose the hobby in the application.
- C) The denial is invalid because hazardous hobbies are never excludable under individual A&H policies in Washington.
- D) The denial is invalid because the exclusion must be explicitly stated in the policy to be enforceable.
Show answer & explanation
Answer: D
Under Washington state law, which adopts NAIC model provisions, exclusions in individual accident and health policies must be explicitly stated to be enforceable. An activity not listed as covered does not trigger an exclusion unless the policy specifically excludes it. The insurer cannot deny a claim based on an unstated exclusion, even if the activity is hazardous. Option A is incorrect because silence does not equal exclusion. Option B introduces an unrelated application disclosure issue. Option C is incorrect because hazardous activities can be excluded if explicitly stated.
Question 12 (Chapter 7)
A Washington resident buys an individual disability income policy that includes a refund of premium provision. The insured survives to the end of the 20-year refund period without having received any disability benefits. How is the refund typically calculated under this provision?
- A) The insured receives a refund equal to 100% of the total premiums paid, without interest.
- B) The insured receives a refund equal to 50% of the total premiums paid, plus interest at a guaranteed rate.
- C) The insured receives a refund of the premiums paid during the last 5 years of the refund period.
- D) The insured receives no refund because the provision only applies if the insured dies before the end of the period.
Show answer & explanation
Answer: A
A refund of premium provision in an individual disability income policy typically returns the premiums paid if the insured survives to the end of the specified period (e.g., 20 years) and has not received any disability benefits. The refund is usually 100% of the premiums paid, without interest, unless the policy specifies otherwise. Option A is correct. Option B incorrectly specifies 50% and adds interest, which is not standard. Option C describes a different structure (like a return of premium term life insurance feature). Option D is incorrect; the provision applies upon survival without benefits, not death (which would typically trigger a death benefit, not a premium refund).
Practice Questions 13-17: Presumptive Disability, Payment of Claims and Late Notice
The presumptive disability benefit, who receives benefits, the entire contract provision, the incontestable-style time limit again and late notice of claim.
Question 13 (Chapter 7)
Under an individual disability income policy in Washington, the insured suffers a disability that results in the permanent loss of use of both hands. The policy includes a presumptive disability benefit. How is the insured's eligibility for benefits determined under this provision?
- A) The insured qualifies for the full monthly benefit immediately, without needing to satisfy the elimination period.
- B) The insured must be unable to perform the material duties of their own occupation to qualify.
- C) The insured must first exhaust any sick leave or short-term disability benefits before qualifying.
- D) The insured receives a lump-sum payment equal to twice the monthly benefit.
Show answer & explanation
Answer: A
Presumptive disability benefits in individual disability income policies are triggered by specific, severe losses (such as the loss of sight in both eyes, hearing in both ears, speech, or the use of both hands or both feet). Upon such a loss, the insured is presumed to be totally disabled and is eligible to receive the full monthly benefit immediately, without having to satisfy the elimination period. Option A correctly describes this. Option B describes the standard total disability definition, not presumptive disability. Option C is incorrect; there is no requirement to exhaust other benefits first. Option D is incorrect; presumptive disability provides ongoing monthly benefits, not a lump sum (unless combined with other riders like AD&D, but the presumptive disability benefit itself is periodic).
Question 14 (Chapter 7)
A Washington resident purchases an individual accident and health policy that includes a provision stating that benefits are payable to the insured unless a beneficiary designation has been made. This provision is an example of which of the following?
- A) Change of beneficiary
- B) Payment of claims
- C) Entire contract
- D) Notice of claim
Show answer & explanation
Answer: B
The provision describing to whom benefits are payable (e.g., to the insured unless a beneficiary is designated) is the payment of claims uniform required provision. It specifies the recipient of benefits, which may be the insured, a beneficiary, or a healthcare provider. Change of beneficiary allows the policyowner to update the beneficiary designation. Entire contract refers to the policy being the full agreement. Notice of claim requires the insured to notify the insurer of a loss within a specified time.
Question 15 (Chapter 7)
An individual disability income policy in Washington includes a cost of living (COL) rider. Which of the following best describes how this rider functions?
- A) It allows the insured to purchase additional coverage at a later date without evidence of insurability.
- B) It waives premiums if the insured becomes totally disabled.
- C) It provides a lump-sum payment if the disability is deemed permanent and total.
- D) It increases the monthly benefit amount annually based on changes in the Consumer Price Index to offset inflation.
Show answer & explanation
Answer: D
A cost of living (COL) rider on an individual disability income policy increases the monthly benefit amount periodically (usually annually) based on an index such as the Consumer Price Index to help the benefit keep pace with inflation. Option A describes a future increase option (FIO) rider, Option B describes a waiver of premium rider, and Option C describes a feature more typical of life insurance or accidental death and dismemberment (AD&D) benefits.
Question 16 (Chapter 7)
A Washington resident purchases an individual accident and health policy with a uniform required provision regarding the time limit on certain defenses set at two years. The insured files a claim for disability benefits 25 months after the policy's effective date, alleging the disability stems from an undisclosed pre-existing heart condition. How will the insurer likely handle this claim under Washington state law and the policy provision?
- A) Deny the claim because the pre-existing condition was not disclosed in the application.
- B) Deny the claim only if the insured misrepresented their health status fraudulently.
- C) Pay the claim because the time limit on certain defenses has expired, barring the insurer from denying based on the pre-existing condition.
- D) Pay 50% of the claim due to the late filing, as the condition was pre-existing.
Show answer & explanation
Answer: C
The uniform required provision for time limit on certain defenses prevents the insurer from denying a claim based on a pre-existing condition after the policy has been in force for the specified period (here, two years). Since the claim was filed at 25 months, which is beyond the two-year limit, the insurer is barred from denying the claim on that basis, regardless of non-disclosure in the application, absent fraud. Option A is incorrect because non-disclosure alone does not permit denial after the time limit expires. Option B introduces a fraud exception not triggered by the scenario. Option D misstates the provision's effect; it does not reduce benefits but bars denial entirely after the period.
Question 17 (Chapter 7)
A Washington resident's individual accident and health policy states that notice of claim must be given to the insurer within 20 days after a loss occurs. The insured provides notice 25 days after the loss. The delay was due to the insured being hospitalized and unable to act sooner. What is the likely outcome regarding the claim, assuming the insurer was not prejudiced by the delay?
- A) The claim is denied because notice was not given within the contractual 20-day period.
- B) The claim is not denied solely due to the delay if the delay was reasonable and the insurer was not prejudiced.
- C) The claim is denied because any delay beyond 20 days voids coverage.
- D) The insurer may reduce the benefit payment by 25% due to the late notice.
Show answer & explanation
Answer: B
Under Washington state law and standard insurance provisions, failure to give notice of claim within the specified time does not invalidate the claim if it is shown that the delay was reasonable and the insurer was not prejudiced. The insured's hospitalization made the delay reasonable, and without prejudice to the insurer, the claim should not be denied. Options A and C are incorrect because they ignore the reasonableness and prejudice exceptions, and D is incorrect as late notice does not automatically reduce benefits by a fixed percentage.
The Mistakes That Cost Marks
Reading own occupation as any occupation. With an own-occupation definition, inability to do your regular job can mean full benefits even if you could work elsewhere.
Naming the wrong provision. A clause about who receives benefits is payment of claims, a clause about examining the insured is physical examinations and autopsy, and a clause that bars later challenges is the time limit on certain defenses.
Counting time from the wrong date. Several questions give a policy period and a date of loss. Work out whether the defense period had expired before the claim was filed.
Assuming a rider needs proof of health. A future increase option rider needs evidence of income, not of insurability.
Treating late notice as automatic denial. A reasonable delay without prejudice to the insurer does not by itself defeat the claim.
Your Next Step
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