631.07(3)(a)3m.
3m. A person may obtain a disability insurance policy on a child placed for adoption, as defined in
s. 632.896 (1) (c), with the person.
631.07(3)(a)4.
4. A person may obtain a disability insurance policy on others that would merely indemnify against expenses the policyholder would be legally or morally obligated to pay; and
631.07(3)(a)5.
5. The commissioner may promulgate rules permitting issuance of insurance for a limited term on the life or health of a person serving outside the continental United States in the public service of the United States, provided the policyholder is closely related by blood or by marriage to the person whose life or health is insured.
631.07(3)(b)
(b)
Consent given by another. Consent may be given by another in the following cases:
631.07(3)(b)1.
1. A parent, a guardian of the person, or a person having legal custody as defined in
s. 48.02 (12) may consent to the issuance of a policy on a dependent child.
631.07(3)(b)2.
2. A grandparent may consent to the issuance of life or disability insurance on a grandchild.
631.07(3)(b)3.
3. A court of general jurisdiction may give consent on ex parte application on the showing of any facts the court considers sufficient to justify such insurance.
631.07(4)
(4) Effect of lack of insurable interest or consent. No insurance policy is invalid merely because the policyholder lacks insurable interest or because consent has not been given, but a court with appropriate jurisdiction may order the proceeds to be paid to someone other than the person to whom the policy is designated to be payable, who is equitably entitled thereto, or may create a constructive trust in the proceeds or a part thereof, subject to terms and conditions of the policy other than those relating to insurable interest or consent.
631.07 Annotation
Court, under (4), properly awarded proceeds of casualty insurance policy purchased by land contract vendee and naming vendor as mortgagee to vendor where following confirmation of strict foreclosure judgment against vendee, premises were destroyed by fire. Disrud v. Arnold, 167 W (2d) 177, 482 NW (2d) 114 (Ct. App. 1992).
631.07 Annotation
A stockholder may have an insurable interest in corporate property. Heyden v. Safeco Title Ins. Co. 175 W (2d) 508, 498 NW (2d) 905 (Ct. App. 1993).
631.08
631.08
Mistakes in contracts. 631.08(1)
(1)
General. Except as otherwise provided in
chs. 600 to
646 and
655, general contract law applies to mistakes in insurance contracts.
631.08(2)
(2) Person to whom proceeds payable in property insurance. Mistake in designating the person to whom the insurance is payable in a policy of property insurance does not void the policy nor constitute a defense for the insurer unless the mistake was due to misrepresentation or concealment by the owner of the property or someone representing the owner in procuring the policy, or unless the company would not have issued or continued the policy if it had known the truth.
631.09
631.09
Knowledge and acts of agents. 631.09(1)
(1)
Imputation of knowledge. An insurer is deemed to know any fact material to the risk or which breaches a condition of the policy, if the agent who bound the insurer or issued the policy or transmitted the application to the insurer knew it at the time the agent acted, or if thereafter any of the insurer's agents with whom the policyholder is then dealing as agent of the insurer learns it in the course of the agent's dealing with the policyholder, and knows that it pertains to a policy written by the insurer.
631.09(2)
(2) Acts of agent. A failure by any policyholder or insured to perform an act required to perfect his or her rights under the policy, or failure to perform the act in the time and manner prescribed, does not affect the insurer's obligations under the policy if the failure was caused by an act, statement or representation or omission to perform a duty by an agent of the insurer who has apparent authority, whether or not the agent was within the actual scope of the agent's authority.
631.09(3)
(3) Effect of notice to agent. Notice given by or on behalf of the policyholder or insured to any authorized agent of the insurer with particulars sufficient to identify the policy is notice to the insurer.
631.09(4)
(4) Collusion. Subsections (1) and
(2) do not apply if the agent and the policyholder or insured acted in collusion to deceive or defraud the insurer, or if the policyholder or insured knew the agent was acting beyond the scope of the agent's authority.
631.09(5)
(5) Group policyholder not agent. No person is an agent of an insurer merely because the person is a policyholder of a group insurance policy.
631.09(6)
(6) Liability under common law. This section does not diminish any liability of the insurer that would exist under common law.
631.09 History
History: 1975 c. 375,
421.
631.09 Annotation
See note to 627.23, citing Master Plumbers Mut. Liab. v. Cormany & Bird, 79 W (2d) 308, 255 NW (2d) 533.
631.09 Annotation
Where insured elected to have open heart surgery after agent indicated insurer would probably pay bills, such action was sufficient reliance to estop insurer from denying coverage. Nolden v. Mutual Benefit Life Ins. Co. 80 W (2d) 353, 259 NW (2d) 75.
631.11
631.11
Representations, warranties and conditions. 631.11(1)(1)
Effect of negotiations for contract. 631.11(1)(a)(a)
Statement or warranty. No statement, representation or warranty made by a person other than the insurer or an agent of the insurer in the negotiation for an insurance contract affects the insurer's obligations under the policy unless it is stated in any of the following:
631.11(1)(a)2.
2. A written application signed by the person, provided that a copy of the written application is made a part of the policy by attachment or endorsement.
631.11(1)(a)3.
3. A written communication provided by the insurer to the insured within 60 days after the effective date of the policy.
631.11(1)(b)
(b)
Misrepresentation or breach of affirmative warranty. No misrepresentation, and no breach of an affirmative warranty, that is made by a person other than the insurer or an agent of the insurer in the negotiation for or procurement of an insurance contract constitutes grounds for rescission of, or affects the insurer's obligations under, the policy unless, if a misrepresentation, the person knew or should have known that the representation was false, and unless any of the following applies:
631.11(1)(b)1.
1. The insurer relies on the misrepresentation or affirmative warranty and the misrepresentation or affirmative warranty is either material or made with intent to deceive.
631.11(1)(b)2.
2. The fact misrepresented or falsely warranted contributes to the loss.
631.11(3)
(3) Effect of failure of condition or breach of promissory warranty. No failure of a condition prior to a loss and no breach of a promissory warranty constitutes grounds for rescission of, or affects an insurer's obligations under, an insurance policy unless it exists at the time of the loss and either increases the risk at the time of the loss or contributes to the loss. This subsection does not apply to failure to tender payment of premium.
631.11(4)(a)(a)
Knowledge when policy issued. No misrepresentation made by or on behalf of a policyholder and no breach of an affirmative warranty or failure of a condition constitutes grounds for rescission of, or affects an insurer's obligations under, an insurance policy if at the time the policy is issued the insurer has either constructive knowledge of the facts under
s. 631.09 (1) or actual knowledge. If the application is in the handwriting of the applicant, the insurer does not have constructive knowledge under
s. 631.09 (1) merely because of the agent's knowledge.
631.11(4)(b)
(b)
Knowledge acquired after policy issued. If after issuance of an insurance policy an insurer acquires knowledge of sufficient facts to constitute grounds for rescission of the policy under this section or a general defense to all claims under the policy, the insurer may not rescind the policy and the defense is not available unless the insurer notifies the insured within 60 days after acquiring such knowledge of its intention to either rescind the policy or defend against a claim if one should arise, or within 120 days if the insurer determines that it is necessary to secure additional medical information.
631.11(4m)(a)(a)
Copy of application to be made available. The policyholder under a life or disability insurance policy and any person whose life or health is insured under the policy may request in writing a copy of the application if he or she did not receive the policy or a copy of it, or if the policy has been reinstated or renewed without attachment of a copy of the original application. If the insurer does not deliver or mail a copy as requested within 15 working days after receipt of the request by the insurer or its agent or, in the case of a group policy certificate holder, does not inform such person within the same period how he or she may inspect the policy and application during normal business hours at a place reasonably convenient to the certificate holder, nothing in the application affects the insurer's obligations under the policy to the person making the request. A person whose life or health is insured under a group life or disability insurance policy has the same right to request a copy of any document specified in
par. (b), including the certificate.
631.11(4m)(b)
(b)
Statement or warranty. No statement, representation or warranty made by or on behalf of a particular certificate holder under a group life or disability insurance policy affects the insurer's obligations under the certificate unless it is stated in the certificate, or in a written document signed by the certificate holder, a copy of which is supplied to the certificate holder or the beneficiary whose rights would be affected.
631.11 History
History: 1975 c. 375,
421;
1977 c. 339 s.
44; Stats. 1977 s. 641.11;
1983 a. 189 s.
329 (25);
1995 a. 259.
631.11 Annotation
Where question on form calls for applicant's judgment or opinion as layman, any ambiguity should be construed against company. Nolden v. Mutual Benefit Life Ins. Co. 80 W (2d) 353, 259 NW (2d) 75.
631.11 Annotation
Insured's contradictory statements constituted a breach of contractual duties of notice and cooperation. Dietz v. Hardware Dealers Mut. Fire Ins. Co. 88 W (2d) 496, 276 NW (2d) 808 (1979).
631.11 Annotation
See note to 632.32, citing Rauch v. American Fam. Ins. Co. 115 W (2d) 257, 340 NW (2d) 478 (1983).
631.11 Annotation
Sub. (2) applies reliance test to misrepresentations made in negotiation or application for insurance, not in proofs of loss. Tempelis v. Aetna Casualty & Surety Co., 164 W (2d) 17, 473 NW (2d) 549 (Ct. App. 1991).
631.11 Annotation
In order to make a written application form a part of an insurance policy by endorsement, the insurer must specifically write across the application itself that is an endorsement an part of the policy. Smith v. Dodgeville Mutual Insurance Co. 212 W (2d) 226, 568 NW (2d) 31 (Ct. App. 1997).
631.13
631.13
Incorporation by reference. No insurance contract may contain any agreement or incorporate any provision not fully set forth in the policy or in an application or other document attached to and made a part of the policy at the time of its delivery except that:
631.13(1)
(1) Rates. Any policy may by reference incorporate rate schedules and classifications of risks and short-rate tables filed with the commissioner; and
631.13(2)
(2) Complex contracts. By rule or order or by approval of a form the commissioner may authorize for complex contracts incorporation by reference of provisions for administrative arrangements, premium schedules and payment procedures.
631.13 History
History: 1975 c. 375.
631.15
631.15
Contract rights under noncomplying policies. 631.15(1)(1)
Enforcement of policy terms. Except as otherwise specifically provided by statute, a policy is enforceable against the insurer according to its terms, even if it exceeds the authority of the insurer.
631.15(3m)
(3m) Enforcement of statute and rule requirements. A policy that violates a statute or rule is enforceable against the insurer as if it conformed to the statute or rule.
631.15(4)
(4) Reformation of contract. Upon written request of the policyholder or an insured whose rights under the policy are continuing and not transitory, an insurer shall reform and reissue its written policy to comply with the requirements of the law existing at the date of issue or last renewal of the policy.
631.15 History
History: 1975 c. 375;
1987 a. 247.
APPROVAL OF FORMS
631.20
631.20
Filing and approval of forms. 631.20(1)
(1)
Filing. No form subject to
s. 631.01 (1), except as exempted under
s. 631.01 (2) to
(5), may be used unless it has been filed with and approved by the commissioner and unless the insurer certifies that the form complies with
chs. 600 to
655 and rules promulgated under
chs. 600 to
655.It is deemed approved if it is not disapproved within 30 days after filing, or within a 30-day extension of that period ordered by the commissioner prior to the expiration of the first 30 days.
631.20(2)
(2) Grounds for disapproval. The commissioner may disapprove a form upon a finding:
631.20(2)(a)
(a) That it is inequitable, unfairly discriminatory, misleading, deceptive, obscure or encourages misrepresentation, including cases where the form:
631.20(2)(a)1.
1. Is misleading because its benefits are too restricted to achieve the purposes for which the policy is sold;
631.20(2)(a)2.
2. Contains provisions whose natural consequence is to obscure or lessen competition;
631.20(2)(a)4.
4. Is misleading, deceptive or obscure because of such physical aspects as format, typography, style, color, material or organization;
631.20(2)(b)
(b) That it provides benefits or contains other provisions that endanger the solidity of the insurer;
631.20(2)(c)
(c) That in the case of the policy, though not of riders and endorsements, it fails to provide the exact name of the insurer and the full address of its home office; or
631.20(2)(d)
(d) That it violates a statute or a rule promulgated by the commissioner, or is otherwise contrary to law.
631.20(3)
(3) Subsequent disapproval. Whenever the commissioner finds, after a hearing, that a form approved or deemed to be approved under
sub. (1) would be disapproved under
sub. (2) if newly filed, the commissioner may order that on or before a date not less than 30 nor more than 90 days after the order the use of the form shall be discontinued or appropriate changes shall be made.
631.20(4)
(4) Contents of order of disapproval. The commissioner's disapproval must be in writing and constitutes an order. It must state the reasons for disapproval sufficiently explicitly that the insurer is provided reasonable guidance in reformulating its proposals.
631.20(5)
(5) Explicit approval of certain clauses. General approval of a form under this section, or failure to disapprove, does not constitute approval of clauses specified in
s. 631.21.
631.20(6)
(6) Approved form which violates statute or rule. 631.20(6)(a)(a) The penalties under
s. 601.64 (3) to
(5) may not be imposed against an insurer for using a form that does not comply with a statute or rule if the statute or rule was in effect on the date the form was approved or deemed to be approved under
sub. (1).
631.20(6)(b)
(b) Use of a form that does not comply with a statute or rule which takes effect after the date the form was approved or deemed to be approved under
sub. (1) is a violation of the statute or rule, and the penalties under
s. 601.64 may be imposed against the insurer using the form.
631.21
631.21
Explicit approval required. 631.21(1)
(1)
Required approval. Despite the general approval of a form under
s. 631.20, the following clauses are not approved even if contained in the form unless the commissioner gives explicit approval to them:
631.21(1)(a)
(a)
Expeditious notice. Clauses requiring more expeditious notice than 1st class mail, as provided in
s. 631.81 (2).
631.21(1)(c)
(c)
Reinstatement fees. A schedule of reinstatement fees under
s. 632.74, if made a part of the policy. Such a schedule need not be included in the contract but may be given approval as a separate document specifically made applicable to particular classes of policies.
631.21(2)
(2) Effect of failure to obtain explicit approval. If an insurer fails to obtain explicit approval from the commissioner for the clauses under
sub. (1), the clauses shall be null and void.
631.21 History
History: 1975 c. 375;
1985 a. 280.
631.22
631.22
Consumer insurance policy readability. 631.22(1)
(1) In this section "consumer insurance policy" means a life, disability, property or casualty insurance policy, or a certificate or a substitute for a certificate for group life, disability, property or casualty insurance coverage, which is issued to a person for a personal, family or household purpose and a copy of which is customarily, in the insurance industry, delivered or is required by law, rule or agreement to be delivered to the person obtaining insurance coverage.
631.22(2)
(2) An insurer may provide a consumer insurance policy which is delivered to a person obtaining insurance coverage and is not exempt under
sub. (5) only if the consumer insurance policy is coherent, written in commonly understood language, legible, appropriately divided and captioned by its various sections and presented in a meaningful sequence. The commissioner shall promulgate rules establishing standards for the determination of compliance with this subsection.
631.22(3)
(3) This section does not apply to specific language or format required by state or federal law, rule or regulation.
