LLQP Accident & Sickness Cheat Sheet — Decision Tables, Rules, and Product Fit

Use this as your fast recall layer for LLQP Accident and Sickness. Pair it with the guide home, the Study Plan, the FAQ, the official resources, and companion practice on MasteryExamPrep.

Quick facts

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.

Pressure checklist

• What exact financial or medical-expense loss is the client exposed to?
• Is this an income-replacement, lump-sum, reimbursement, or care-planning problem?
• What existing coverage or group benefit changes the answer?
• What exclusion, waiting period, or service issue could still weaken the recommendation?

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).

Better use of this page

• use this page after you already understand the product families from the guide home
• if you keep missing needs-analysis questions, go back to the Study Plan and rebuild your fact-find sequence
• if you keep missing format or module-fit questions, use the FAQ