631.81
631.81
Notice and proof of loss. 631.81(1)
(1)
Timeliness of notice. Provided notice or proof of loss is furnished as soon as reasonably possible and within one year after the time it was required by the policy, failure to furnish such notice or proof within the time required by the policy does not invalidate or reduce a claim unless the insurer is prejudiced thereby and it was reasonably possible to meet the time limit.
631.81(2)
(2) Method of giving notice. It is a sufficient service of notice or proof of loss if a 1st class postage prepaid envelope addressed to the insurer and containing the proper notice or proof is deposited in any U.S. post office within the time prescribed. The commissioner may expressly approve clauses requiring more expeditious methods of notice where that is reasonable.
631.81(3)
(3) Meaning of insurer's acts. The acknowledgment by the insurer of the receipt of notice, the furnishing of forms for filing proofs of loss, the acceptance of such proofs, or the investigation of any claim are not alone sufficient to waive any of the rights of the insurer in defense of any claim arising under the insurance contract.
631.81 History
History: 1975 c. 375.
631.81 Annotation
See note to 631.11, citing Dietz v. Hardware Dealers Mut. Fire Ins. Co. 88 W (2d) 496, 276 NW (2d) 808 (1979).
631.81 Annotation
Claimant failing to give notice under (1) within one year must prove lack of prejudice. Gerrard Realty Corp. v. American States Ins. Co. 89 W (2d) 130, 277 NW (2d) 863 (1979).
631.81 Annotation
The Federal Employee Retirement Income Security Act (ERISA) preempts state law related to any covered employe benefit plan, but does not preempt state regulation of insurance. This section regulates insurance and is not preempted. Bogusewski v. Life Insurance Co. of North America, 977 F Supp. 1357 (1997).
631.83
631.83
Limitation of actions. 631.83(1)
(1)
Statutory periods of limitation. 631.83(1)(a)(a)
Fire insurance. An action on a fire insurance policy must be commenced within 12 months after the inception of the loss. This rule also applies to riders or endorsements attached to a fire insurance policy covering loss or damage to property or to the use of or income from property from any cause, and to separate windstorm or hail insurance policies.
631.83(1)(b)
(b)
Disability insurance. An action on disability insurance coverage must be commenced within 3 years from the time written proof of loss is required to be furnished.
631.83(1)(c)
(c)
Life claims based on absence of insured. Sections 813.22 to
813.34 apply to life insurance actions based on death in which absence is relied upon as evidence of death.
631.83(1)(d)
(d)
Other. Except as provided in this subsection or elsewhere in
chs. 600 to
646 and
655,
s. 893.43 applies to actions on insurance policies.
631.83(2)
(2) General law applicable to limitation of actions. Except for the prescription of time periods under
sub. (1) or elsewhere in
chs. 600 to
646 and
655, the general law applicable to limitation of actions as modified by
ch. 893 applies to actions on insurance policies.
631.83(3)
(3) Prohibited clauses of policies. No insurance policy may:
631.83(3)(a)
(a)
Shorten periods of limitation. Limit the time for beginning an action on the policy to a time less than that authorized by the statutes;
631.83(3)(b)
(b)
Limit jurisdiction. Prescribe in what court action may be brought thereon; or
631.83(3)(c)
(c)
Proscribe action. Provide that no action may be brought.
631.83(4)
(4) Minimum waiting period for action. No action may be brought against the insurer on an insurance policy to compel payment thereunder until at least 60 days after proof of loss has been furnished as required by the policy or such proof of loss has been waived, or the insurer has denied full payment, whichever is earlier. This subsection does not apply in any case in which the verified complaint alleges facts that would establish prejudice to the complainant by reason of such delay, other than the delay itself.
631.83(5)
(5) Tolling of period of limitation. The period of limitation is tolled during the period in which the parties conducted an appraisal or arbitration procedure prescribed by the insurance policy or by law or agreed to by the parties.
631.83 Annotation
Term "fire insurance" covers indemnity insurance for losses to property caused by many other perils than fire. Villa Clement v. National Union Fire Ins. 120 W (2d) 140, 353 NW (2d) 369 (Ct. App. 1984).
631.83 Annotation
Action by mortgagees of insured property was not barred by (1) (a). Picus v. Citizens Sec. Mut. Ins. Co. 127 W (2d) 359, 379 NW (2d) 341 (Ct. App. 1985).
631.83 Annotation
Two-year statute of limitations, 893.57, governs intentional tort of bad faith by insurer. Warmka v. Hartland Cicero Mut. Ins., 136 W (2d) 31, 400 NW (2d) 923 (1987).
631.83 Annotation
"Inception of the loss" in sub. (1) (a) means the date on which the loss occurs not the discovery date. Borgen v. Economy Preferred Ins. Co. 176 W (2d) 498, 500 NW (2d) 176 (Ct. App. 1993).
631.83 Annotation
Failure of policyholders to give notice to an underinsurer of a settlement between the insured and the tortfeasor does not bar underinsured motorist coverage in the absence of prejudice to the insurer. There is a rebuttable presumption of prejudice where there is a lack of notice, with the burden on the insured to prove by the greater weight of the evidence that the insurer was not prejudiced. Ranes v. American Family Mutual Insurance Co. 219 W (2d) 49, 580 NW (2d) 197 (1998).
631.85
631.85
Appraisal or arbitration. An insurance policy may contain provision for independent appraisal and compulsory arbitration, subject to the provisions of
s. 631.20. If an approved policy provides for application to a court of record for the appointment of a disinterested appraiser, arbitrator or umpire, any court of record of this state except the court of appeals or the supreme court may be requested to make an appointment. Upon appropriate request, the court shall make the appointment promptly.
631.85 History
History: 1975 c. 375;
1977 c. 187.
631.89
631.89
Restrictions on use of genetic test results. 631.89(1)(1) In this section, "genetic test" means a test using deoxyribonucleic acid extracted from an individual's cells in order to determine the presence of a genetic disease or disorder or the individual's predisposition for a particular genetic disease or disorder.
631.89(2)
(2) An insurer, the state with respect to a self-insured health plan, or a county, city, village or school board that provides health care services for individuals on a self-insured basis, may not do any of the following:
631.89(2)(a)
(a) Require or request directly or indirectly any individual or a member of the individual's family to obtain a genetic test.
631.89(2)(b)
(b) Require or request directly or indirectly any individual to reveal whether the individual or a member of the individual's family has obtained a genetic test or what the results of the test, if obtained by the individual or a member of the individual's family, were.
631.89(2)(bm)
(bm) Require or request directly or indirectly a health care provider, as defined in
s. 146.81 (1), who is or may be providing or who has or may have provided health care services to an individual to reveal whether the individual or a member of the individual's family has obtained a genetic test or what the results of the test, if obtained by the individual or a member of the individual's family, were.
631.89(2)(c)
(c) Condition the provision of insurance coverage or health care benefits on whether an individual or a member of the individual's family has obtained a genetic test or what the results of the test, if obtained by the individual or a member of the individual's family, were.
631.89(2)(d)
(d) Consider in the determination of rates or any other aspect of insurance coverage or health care benefits provided to an individual whether an individual or a member of the individual's family has obtained a genetic test or what the results of the test, if obtained by the individual or a member of the individual's family, were.
631.89(3)(a)(a) Subsection (2) does not apply to an insurer writing life insurance coverage or income continuation insurance coverage.
631.89(3)(b)
(b) An insurer writing life insurance coverage or income continuation insurance coverage that obtains information under
sub. (2) (a) or
(b) may not do any of the following:
631.89(3)(b)1.
1. Use the information contrary to
sub. (2) (c) or
(d) in writing a type of insurance coverage other than life or income continuation for the individual or a member of the individual's family.
631.89(3)(b)2.
2. Provide for rates or any other aspect of coverage that is not reasonably related to the risk involved.
631.89 History
History: 1991 a. 269;
1997 a. 74.
631.90
631.90
Restrictions on use of tests for HIV. 631.90(1)
(1) In this section, "HIV" means any strain of human immunodeficiency virus, which causes acquired immunodeficiency syndrome.
631.90(2)
(2) With regard to policies issued or renewed on and after July 20, 1985, an insurer may not do any of the following:
631.90(2)(a)
(a) Require or request directly or indirectly any individual to reveal whether the individual has obtained a test for the presence of HIV, antigen or nonantigenic products of HIV or an antibody to HIV or what the results of this test, if obtained by the individual, were.
631.90(2)(b)
(b) Condition the provision of insurance coverage on whether an individual has obtained a test for the presence of HIV, antigen or nonantigenic products of HIV or an antibody to HIV or what the results of this test, if obtained by the individual, were.
631.90(2)(c)
(c) Consider in the determination of rates or any other aspect of insurance coverage provided to an individual whether an individual has obtained a test for the presence of HIV, antigen or nonantigenic products of HIV or an antibody to HIV or what the results of this test, if obtained by the individual, were.
631.90(3)(a)(a) Subsection (2) does not apply with regard to any test or series of tests for use in the underwriting of individual life, accident and health insurance policies that the person designated by the secretary of health and family services as the state epidemiologist finds medically significant and sufficiently reliable for the presence of HIV, antigen or nonantigenic products of HIV or an antibody to HIV and that the commissioner finds and designates by rule as sufficiently reliable for use in the underwriting of individual life, accident and health insurance policies.
631.90(3)(b)
(b) Paragraph (a) does not authorize the use of any test or series of tests for the presence of HIV, antigen or nonantigenic products of HIV or an antibody to HIV to discriminate in violation of
s. 628.34 (3).
631.93
631.93
Prohibited provisions concerning HIV infection. 631.93(1)(1)
Definitions. In this section, "HIV infection" means the pathological state produced by a human body in response to the presence of HIV, as defined in
s. 631.90 (1).
631.93(2)
(2) Accident and health insurance. An accident or health insurance policy may not contain exclusions or limitations, including deductibles or copayments, for coverage of the treatment of HIV infection or any illness or medical condition arising from or related to HIV infection, unless the exclusions or limitations apply generally to other illnesses or medical conditions covered by the policy.
631.93(3)
(3) Life insurance. A life insurance policy may not deny or limit benefits solely because the insured's death is caused, directly or indirectly, by HIV infection or any illness or medical condition arising from or related to HIV infection.
631.93 History
History: 1989 a. 201.
