LLQP Accident & Sickness Cheatsheet — Decision Tables, Rules & Glossary

Use this as your last‑mile review. Pair it with the Syllabus for coverage and Practice for speed.

Accident & Sickness in one picture (identify the exposure)

    flowchart TD
	  A["Illness/injury scenario"] --> B["Exposure: income loss? expenses? long care?"]
	  B --> C["Existing coverage: public + group + savings"]
	  C --> D["Product fit: DI / CI / LTC / health+dental / travel / AD&D"]
	  D --> E["Contract mechanics: triggers + limits + exclusions"]
	  E --> F["Explain + document + service"]

Exam reflex: state (1) the exposure, (2) what’s missing, (3) what feature solves it.

Coverage map (what each product is “for”)

Competency 1 (35%) — Assess needs and situation

Fact-find checklist (high yield)

Best-answer elimination rule: if the stem is missing critical facts (income, group coverage, waiting period, travel), the best answer often focuses on gathering information before recommending.

Competency 2 (30%) — Analyze products that meet the need

Disability income (DI): the 5 levers

1. Definition of disability (own/regular/any; policy-specific)
2. Elimination period (how long before benefits start)
3. Benefit period (how long benefits can last)
4. Benefit amount (and how it integrates with other income sources)
5. Partial/residual disability features (return-to-work dynamics)

Quick matcher (concept):

• short elimination + longer benefit period = higher premium, more “protective”
• longer elimination = cheaper premium, assumes client has short-term resources

Coordination / integration (income replacement)

When multiple income sources exist, the question is often: how much net replacement does the client actually have? Common sources (concept):

• employer STD/LTD
• EI sickness (time-limited)
• CPP disability (long-term for severe and prolonged disability)
• workers’ compensation (work-related)

Critical illness (CI): what CI is (and isn’t)

• CI typically pays a lump sum if the insured is diagnosed with a covered condition and meets the policy’s requirements (e.g., survival period; policy-specific).
• It is not “income replacement by default” — it’s often recovery funding and flexibility.

Long-term care (LTC): trigger logic (high level)

LTC questions often test whether you recognize:

• ADL impairment and/or cognitive impairment triggers (policy-specific)
• long duration risk + inflation sensitivity for long claims (concept)

Extended health/dental: read limits carefully

• benefit schedules (drugs, dental, paramedical, vision)
• annual/lifetime maximums
• deductibles + coinsurance
• coordination of benefits (spouses) (concept)

Travel medical: emergency framing

Travel medical is generally about unexpected emergencies and assistance coordination. Common traps:

• pre-existing condition clauses/stability requirements (policy-specific)
• confusing elective care with emergency care

Competency 3 (25%) — Implement a recommendation

Implementation checklist (what exam answers reward)

• match coverage to the exposure (income vs expenses vs long care)
• choose elimination/benefit period consistent with client resources and horizon
• explain major limitations and exclusions clearly
• document why the recommendation is suitable given existing benefits

Competency 4 (10%) — Service and claims mindset

• review coverage after job/income changes, benefit changes, travel pattern changes, family changes
• keep disclosure accurate (material changes matter)
• for claims: expect documentation and timelines to matter (policy-specific)

Common exam traps

• Mixing up indemnity vs reimbursement benefits.
• Treating AD&D as a substitute for DI or CI.
• Ignoring elimination period / benefit period mechanics.
• Assuming “any sickness” is covered under CI or travel medical.
• Recommending without checking existing employer benefits and integration.

Glossary (high-yield)

• Accident & Sickness (A&S): category of insurance covering illness/injury-related financial risk (income loss and/or expenses).
• ADL (activities of daily living): basic self-care activities (policy-specific definitions; used in LTC triggers).
• AD&D: accidental death & dismemberment coverage; accident-only, indemnity benefit.
• Any‑occupation disability (concept): disability definition tied to inability to work in any gainful occupation (policy-specific).
• Benefit period: maximum time benefits can be payable for a claim (policy-specific).
• Coinsurance: percentage of eligible expenses paid by the insured (reimbursement coverage).
• Coordination of benefits: rules to prevent double payment when multiple plans cover the same expense (common in health/dental).
• Critical illness (CI): lump-sum benefit on specified diagnosis (covered conditions and requirements are policy-specific).
• Deductible: amount the insured pays before reimbursement begins (policy-specific).
• Elimination (waiting) period: time between disability/event and when benefits start (policy-specific).
• Indemnity benefit: fixed benefit payable on trigger (e.g., DI monthly benefit, CI lump sum).
• Integration of benefits: structuring benefits to account for other income sources (employer plans, government benefits).
• Own‑occupation disability (concept): disability definition tied to inability to perform the duties of the insured’s own occupation (policy-specific).
• Pre-existing condition clause: limits coverage for conditions that existed before coverage effective date (policy-specific).
• Reimbursement benefit: pays eligible expenses up to limits and plan rules.
• Residual/partial disability: partial work capacity loss with partial benefits (policy-specific).

✅ Next: use the Syllabus to pick a topic and run a short drill via Practice.