10369.1. Except as provided in Section 10323, no disability policy
delivered or issued for delivery to any person in this State shall
contain provisions respecting the matters set forth in Sections
10369.2 to 10369.12, inclusive, unless such provisions are in the
words in which the same appear in such sections; provided, however,
that the insurer may, at its option, use in lieu of any such
provision a corresponding provision of different wording approved by
the commissioner, which is not less favorable in any respect to the
insured or the beneficiary. Any such provision contained in the
policy shall be preceded individually by the appropriate caption
appearing in each of such sections or, at the option of the insurer,
by such appropriate individual or group captions or subcaptions as
the commissioner may approve.
10369.2. A disability policy may contain a provision in the form
set forth herein.
Change of Occupation: If the insured be injured or contract
sickness after having changed his occupation to one classified by the
insurer as more hazardous than that stated in this policy or while
doing for compensation anything pertaining to an occupation so
classified, the insurer will pay only such portion of the indemnities
provided in this policy as the premium paid would have purchased at
the rates and within the limits fixed by the insurer for such more
hazardous occupation. If the insured changes his occupation to one
classified by the insurer as less hazardous than that stated in this
policy, the insurer, upon receipt of proof of such change of
occupation, will reduce the premium rate accordingly, and will return
the excess pro-rata unearned premium from the date of change of
occupation or from the policy anniversary date immediately preceding
receipt of such proof, whichever is the more recent. In applying this
provision, the classification of occupational risk and the premium
rates shall be such as have been last filed by the insurer prior to
the occurrence of the loss for which the insurer is liable or prior
to date of proof of change in occupation with the state official
having supervision of insurance in the state where the insured
resided at the time this policy was issued; but if such filing was
not required, then the classification of occupational risk and the
premium rates shall be those last made effective by the insurer in
such state prior to the occurrence of the loss or prior to the date
of proof of change in occupation.
10369.3. A disability policy may contain a provision in the form
set forth herein.
Misstatement of Age: If the age of the insured has been misstated,
all amounts payable under this policy shall be such as the premium
paid would have purchased at the correct age.
10369.4. A disability policy may contain a provision which shall,
at the option of the insurer, be in one of the two forms set forth
herein. If Form A is used, there shall be inserted in the first blank
the type of coverage or coverages and in the second blank the
maximum limit of indemnity or indemnities.
Form A.
Other Insurance in This Insurer: If an accident or sickness or
accident and sickness policy or policies previously issued by the
insurer to the insured be in force concurrently herewith, making the
aggregate indemnity for ____ in excess of $____, the excess insurance
shall be void and all premiums paid for such excess shall be
returned to the insured or to his estate.
Form B.
Other Insurance in This Insurer: Insurance effective at any one
time on the insured under a like policy or policies in this insurer
is limited to the one such policy elected by the insured, his
beneficiary or his estate, as the case may be, and the insurer will
return all premiums paid for all other such policies.
10369.5. A disability policy may contain a provision in the form
set forth in this section. If the provision also contains the
provision set forth in Section 10369.6, there shall be added to its
caption the phrase, "* * * expense incurred benefits." The insurer
may, at its option, include in this provision a definition of "other
valid coverage," approved as to form by the commissioner. The
definition shall be limited in subject matter to coverage provided by
organizations subject to regulation by insurance law or by insurance
authorities of this or any other state of the United States or any
province of Canada, or by hospital or medical service organizations,
and to any other coverage, the inclusion of which may be approved by
the commissioner. In the absence of that definition, the terms shall
not include group insurance, automobile medical payments insurance,
or coverage provided by hospital or medical service organizations or
by union welfare plans or employer or employee benefit organizations.
For the purpose of applying this policy provision with respect to
any insured, any amount of benefit provided for the insured pursuant
to any compulsory benefit statute, including any workers'
compensation or employers' liability statute, whether provided by a
governmental agency or otherwise, shall in all cases be deemed to be
"other valid coverage" of which the insurer has had notice. In
applying this provision, no third party liability coverage shall be
included as "other valid coverage."
Insurance With Other Insurers: If there is other valid coverage,
not with this insurer, providing benefits for the same loss on a
provision of service basis or on an expense incurred basis and of
which this insurer has not been given written notice prior to the
occurrence or commencement of loss, the only liability under any
expense incurred coverage of this policy shall be for the proportion
of the loss as the amount which would otherwise have been payable
under this policy plus the total of the like amounts under all the
other valid coverages for the same loss of which this insurer had
notice bears to the total like amounts under all valid coverages for
the loss, and for the return of the portion of the premiums paid as
shall exceed the pro-rata portion for the amount so determined. For
the purpose of applying this provision when other coverage is on a
provision of service basis, the "like amount" of the other coverage
shall be taken as the amount which the services rendered would have
cost in the absence of the coverage.
10369.6. A disability policy may contain a provision in the form
set forth in this section. If the provision is included in a policy
which also contains the provision set forth in Section 10369.5, there
shall be added to its caption the phrase, "* * * other benefits."
The insurer may, at its option, include in this provision a
definition of "other valid coverage," approved as to form by the
commissioner. The definition shall be limited in subject matter to
coverage provided by organizations subject to regulation by insurance
law or by insurance authorities of this or any other state of the
United States or any province of Canada, and to any other coverage
the inclusion of which may be approved by the commissioner. In the
absence of that definition the terms shall not include group
insurance, or benefits provided by union welfare plans or by employer
or employee benefit organizations. For the purpose of applying this
policy provision with respect to any insured, any amount of benefit
provided for the insured pursuant to any compulsory benefit statute,
including any workers' compensation or employers' liability statute,
whether provided by a governmental agency or otherwise, shall in all
cases be deemed to be "other valid coverage" of which the insurer has
had notice. In applying this provision, no third party liability
coverage shall be included as "other valid coverage."
Insurance With Other Insurers: If there is other valid coverage,
not with this insurer, providing benefits for the same loss on other
than an expense incurred basis and of which this insurer has not been
given written notice prior to the occurrence or commencement of
loss, the only liability for the benefits under this policy shall be
for the proportion of the indemnities otherwise provided under this
policy for the loss as the like indemnities of which the insurer had
notice, including the indemnities under this policy, bear to the
total amount of all like indemnities for the loss, and for the return
of the portion of the premium paid as shall exceed the pro rata
portion for the indemnities thus determined.
10369.7. A noncancellable disability policy may contain a provision
in the form set forth herein. The insurer may, at its option,
include in this provision a definition of "valid loss of time
coverage," approved as to form by the commissioner, which definition
shall be limited in subject matter to coverage provided by
governmental agencies or by organizations subject to regulation by
insurance law or by insurance authorities of this or any other state
of the United States or any province of Canada, or to any other
coverage the inclusion of which may be approved by the commissioner
or any combination of such coverages. In the absence of such
definition such term shall not include any coverage provided for such
insured pursuant to any compulsory benefit statute (including any
workmen's compensation or employers' liability statute), or benefits
provided by union welfare plans or by employer or employee benefit
organizations.
Relation of Earnings to Insurance: If the total monthly amount of
loss of time benefits promised for the same loss under all valid loss
of time coverage upon the insured, whether payable on a weekly or
monthly basis, shall exceed the monthly earnings of the insured at
the time disability commenced or his average monthly earnings for the
period of two years immediately preceding a disability for which
claim is made, whichever is the greater, the insurer will be liable
only for such proportionate amount of such benefits under this policy
as the amount of such monthly earnings or such average monthly
earnings of the insured bears to the total amount of monthly benefits
for the same loss under all such coverage upon the insured at the
time such disability commences and for the return of such part of the
premiums paid during such two years as shall exceed the pro-rata
amount of the premiums for the benefits actually paid hereunder; but
this shall not operate to reduce the total monthly amount of benefits
payable under all such coverage upon the insured below the sum of
two hundred dollars ($200) or the sum of the monthly benefits
specified in such coverages, whichever is the lesser, nor shall it
operate to reduce benefits other than those payable for loss of time.
10369.8. A disability policy may contain a provision in the form
set forth herein.
Unpaid Premium: Upon the payment of a claim under this policy, any
premium then due and unpaid or covered by any note or written order
may be deducted therefrom.
10369.9. A disability policy may contain a provision in the form
set forth herein.
Cancellation: The insurer may cancel this policy at any time by
written notice delivered to the insured, or mailed to his last
address as shown by the records of the insurer, stating when, not
less than five days thereafter, such cancellation shall be effective;
and after the policy has been continued beyond its original term the
insured may cancel this policy at any time by written notice
delivered or mailed to the insurer, effective upon receipt or on such
later date as may be specified in such notice. In the event of
cancellation, the insurer will return promptly the unearned portion
of any premium paid. If the insured cancels, the earned premium shall
be computed by the use of the short-rate table last filed with the
state official having supervision of insurance in the state where the
insured resided when the policy was issued. If the insurer cancels,
the earned premium shall be computed pro rata. Cancellation shall be
without prejudice to any claim originating prior to the effective
date of cancellation.
10369.10. A disability policy may contain a provision in the form
set forth herein.
Conformity With State Statutes: Any provision of this policy
which, on its effective date, is in conflict with the statutes of the
state in which the insured resides on such date is hereby amended to
conform to the minimum requirements of such statutes.
10369.11. A disability policy may contain a provision in the form
set forth herein.
Illegal Occupation: The insurer shall not be liable for any loss
to which a contributing cause was the insured's commission of or
attempt to commit a felony or to which a contributing cause was the
insured's being engaged in an illegal occupation.
10369.12. (a) A disability policy may contain a provision in the
form set forth herein.
Intoxicants and controlled substances: The insurer shall not be
liable for any loss sustained or contracted in consequence of the
insured's being intoxicated or under the influence of any controlled
substance unless administered on the advice of a physician.
(b) Subdivision (a) shall not apply to a health insurance policy.
10369.1. Except as provided in Section 10323, no disability policy
delivered or issued for delivery to any person in this State shall
contain provisions respecting the matters set forth in Sections
10369.2 to 10369.12, inclusive, unless such provisions are in the
words in which the same appear in such sections; provided, however,
that the insurer may, at its option, use in lieu of any such
provision a corresponding provision of different wording approved by
the commissioner, which is not less favorable in any respect to the
insured or the beneficiary. Any such provision contained in the
policy shall be preceded individually by the appropriate caption
appearing in each of such sections or, at the option of the insurer,
by such appropriate individual or group captions or subcaptions as
the commissioner may approve.
10369.2. A disability policy may contain a provision in the form
set forth herein.
Change of Occupation: If the insured be injured or contract
sickness after having changed his occupation to one classified by the
insurer as more hazardous than that stated in this policy or while
doing for compensation anything pertaining to an occupation so
classified, the insurer will pay only such portion of the indemnities
provided in this policy as the premium paid would have purchased at
the rates and within the limits fixed by the insurer for such more
hazardous occupation. If the insured changes his occupation to one
classified by the insurer as less hazardous than that stated in this
policy, the insurer, upon receipt of proof of such change of
occupation, will reduce the premium rate accordingly, and will return
the excess pro-rata unearned premium from the date of change of
occupation or from the policy anniversary date immediately preceding
receipt of such proof, whichever is the more recent. In applying this
provision, the classification of occupational risk and the premium
rates shall be such as have been last filed by the insurer prior to
the occurrence of the loss for which the insurer is liable or prior
to date of proof of change in occupation with the state official
having supervision of insurance in the state where the insured
resided at the time this policy was issued; but if such filing was
not required, then the classification of occupational risk and the
premium rates shall be those last made effective by the insurer in
such state prior to the occurrence of the loss or prior to the date
of proof of change in occupation.
10369.3. A disability policy may contain a provision in the form
set forth herein.
Misstatement of Age: If the age of the insured has been misstated,
all amounts payable under this policy shall be such as the premium
paid would have purchased at the correct age.
10369.4. A disability policy may contain a provision which shall,
at the option of the insurer, be in one of the two forms set forth
herein. If Form A is used, there shall be inserted in the first blank
the type of coverage or coverages and in the second blank the
maximum limit of indemnity or indemnities.
Form A.
Other Insurance in This Insurer: If an accident or sickness or
accident and sickness policy or policies previously issued by the
insurer to the insured be in force concurrently herewith, making the
aggregate indemnity for ____ in excess of $____, the excess insurance
shall be void and all premiums paid for such excess shall be
returned to the insured or to his estate.
Form B.
Other Insurance in This Insurer: Insurance effective at any one
time on the insured under a like policy or policies in this insurer
is limited to the one such policy elected by the insured, his
beneficiary or his estate, as the case may be, and the insurer will
return all premiums paid for all other such policies.
10369.5. A disability policy may contain a provision in the form
set forth in this section. If the provision also contains the
provision set forth in Section 10369.6, there shall be added to its
caption the phrase, "* * * expense incurred benefits." The insurer
may, at its option, include in this provision a definition of "other
valid coverage," approved as to form by the commissioner. The
definition shall be limited in subject matter to coverage provided by
organizations subject to regulation by insurance law or by insurance
authorities of this or any other state of the United States or any
province of Canada, or by hospital or medical service organizations,
and to any other coverage, the inclusion of which may be approved by
the commissioner. In the absence of that definition, the terms shall
not include group insurance, automobile medical payments insurance,
or coverage provided by hospital or medical service organizations or
by union welfare plans or employer or employee benefit organizations.
For the purpose of applying this policy provision with respect to
any insured, any amount of benefit provided for the insured pursuant
to any compulsory benefit statute, including any workers'
compensation or employers' liability statute, whether provided by a
governmental agency or otherwise, shall in all cases be deemed to be
"other valid coverage" of which the insurer has had notice. In
applying this provision, no third party liability coverage shall be
included as "other valid coverage."
Insurance With Other Insurers: If there is other valid coverage,
not with this insurer, providing benefits for the same loss on a
provision of service basis or on an expense incurred basis and of
which this insurer has not been given written notice prior to the
occurrence or commencement of loss, the only liability under any
expense incurred coverage of this policy shall be for the proportion
of the loss as the amount which would otherwise have been payable
under this policy plus the total of the like amounts under all the
other valid coverages for the same loss of which this insurer had
notice bears to the total like amounts under all valid coverages for
the loss, and for the return of the portion of the premiums paid as
shall exceed the pro-rata portion for the amount so determined. For
the purpose of applying this provision when other coverage is on a
provision of service basis, the "like amount" of the other coverage
shall be taken as the amount which the services rendered would have
cost in the absence of the coverage.
10369.6. A disability policy may contain a provision in the form
set forth in this section. If the provision is included in a policy
which also contains the provision set forth in Section 10369.5, there
shall be added to its caption the phrase, "* * * other benefits."
The insurer may, at its option, include in this provision a
definition of "other valid coverage," approved as to form by the
commissioner. The definition shall be limited in subject matter to
coverage provided by organizations subject to regulation by insurance
law or by insurance authorities of this or any other state of the
United States or any province of Canada, and to any other coverage
the inclusion of which may be approved by the commissioner. In the
absence of that definition the terms shall not include group
insurance, or benefits provided by union welfare plans or by employer
or employee benefit organizations. For the purpose of applying this
policy provision with respect to any insured, any amount of benefit
provided for the insured pursuant to any compulsory benefit statute,
including any workers' compensation or employers' liability statute,
whether provided by a governmental agency or otherwise, shall in all
cases be deemed to be "other valid coverage" of which the insurer has
had notice. In applying this provision, no third party liability
coverage shall be included as "other valid coverage."
Insurance With Other Insurers: If there is other valid coverage,
not with this insurer, providing benefits for the same loss on other
than an expense incurred basis and of which this insurer has not been
given written notice prior to the occurrence or commencement of
loss, the only liability for the benefits under this policy shall be
for the proportion of the indemnities otherwise provided under this
policy for the loss as the like indemnities of which the insurer had
notice, including the indemnities under this policy, bear to the
total amount of all like indemnities for the loss, and for the return
of the portion of the premium paid as shall exceed the pro rata
portion for the indemnities thus determined.
10369.7. A noncancellable disability policy may contain a provision
in the form set forth herein. The insurer may, at its option,
include in this provision a definition of "valid loss of time
coverage," approved as to form by the commissioner, which definition
shall be limited in subject matter to coverage provided by
governmental agencies or by organizations subject to regulation by
insurance law or by insurance authorities of this or any other state
of the United States or any province of Canada, or to any other
coverage the inclusion of which may be approved by the commissioner
or any combination of such coverages. In the absence of such
definition such term shall not include any coverage provided for such
insured pursuant to any compulsory benefit statute (including any
workmen's compensation or employers' liability statute), or benefits
provided by union welfare plans or by employer or employee benefit
organizations.
Relation of Earnings to Insurance: If the total monthly amount of
loss of time benefits promised for the same loss under all valid loss
of time coverage upon the insured, whether payable on a weekly or
monthly basis, shall exceed the monthly earnings of the insured at
the time disability commenced or his average monthly earnings for the
period of two years immediately preceding a disability for which
claim is made, whichever is the greater, the insurer will be liable
only for such proportionate amount of such benefits under this policy
as the amount of such monthly earnings or such average monthly
earnings of the insured bears to the total amount of monthly benefits
for the same loss under all such coverage upon the insured at the
time such disability commences and for the return of such part of the
premiums paid during such two years as shall exceed the pro-rata
amount of the premiums for the benefits actually paid hereunder; but
this shall not operate to reduce the total monthly amount of benefits
payable under all such coverage upon the insured below the sum of
two hundred dollars ($200) or the sum of the monthly benefits
specified in such coverages, whichever is the lesser, nor shall it
operate to reduce benefits other than those payable for loss of time.
10369.8. A disability policy may contain a provision in the form
set forth herein.
Unpaid Premium: Upon the payment of a claim under this policy, any
premium then due and unpaid or covered by any note or written order
may be deducted therefrom.
10369.9. A disability policy may contain a provision in the form
set forth herein.
Cancellation: The insurer may cancel this policy at any time by
written notice delivered to the insured, or mailed to his last
address as shown by the records of the insurer, stating when, not
less than five days thereafter, such cancellation shall be effective;
and after the policy has been continued beyond its original term the
insured may cancel this policy at any time by written notice
delivered or mailed to the insurer, effective upon receipt or on such
later date as may be specified in such notice. In the event of
cancellation, the insurer will return promptly the unearned portion
of any premium paid. If the insured cancels, the earned premium shall
be computed by the use of the short-rate table last filed with the
state official having supervision of insurance in the state where the
insured resided when the policy was issued. If the insurer cancels,
the earned premium shall be computed pro rata. Cancellation shall be
without prejudice to any claim originating prior to the effective
date of cancellation.
10369.10. A disability policy may contain a provision in the form
set forth herein.
Conformity With State Statutes: Any provision of this policy
which, on its effective date, is in conflict with the statutes of the
state in which the insured resides on such date is hereby amended to
conform to the minimum requirements of such statutes.
10369.11. A disability policy may contain a provision in the form
set forth herein.
Illegal Occupation: The insurer shall not be liable for any loss
to which a contributing cause was the insured's commission of or
attempt to commit a felony or to which a contributing cause was the
insured's being engaged in an illegal occupation.
10369.12. (a) A disability policy may contain a provision in the
form set forth herein.
Intoxicants and controlled substances: The insurer shall not be
liable for any loss sustained or contracted in consequence of the
insured's being intoxicated or under the influence of any controlled
substance unless administered on the advice of a physician.
(b) Subdivision (a) shall not apply to a health insurance policy.
10369.1. Except as provided in Section 10323, no disability policy
delivered or issued for delivery to any person in this State shall
contain provisions respecting the matters set forth in Sections
10369.2 to 10369.12, inclusive, unless such provisions are in the
words in which the same appear in such sections; provided, however,
that the insurer may, at its option, use in lieu of any such
provision a corresponding provision of different wording approved by
the commissioner, which is not less favorable in any respect to the
insured or the beneficiary. Any such provision contained in the
policy shall be preceded individually by the appropriate caption
appearing in each of such sections or, at the option of the insurer,
by such appropriate individual or group captions or subcaptions as
the commissioner may approve.
10369.2. A disability policy may contain a provision in the form
set forth herein.
Change of Occupation: If the insured be injured or contract
sickness after having changed his occupation to one classified by the
insurer as more hazardous than that stated in this policy or while
doing for compensation anything pertaining to an occupation so
classified, the insurer will pay only such portion of the indemnities
provided in this policy as the premium paid would have purchased at
the rates and within the limits fixed by the insurer for such more
hazardous occupation. If the insured changes his occupation to one
classified by the insurer as less hazardous than that stated in this
policy, the insurer, upon receipt of proof of such change of
occupation, will reduce the premium rate accordingly, and will return
the excess pro-rata unearned premium from the date of change of
occupation or from the policy anniversary date immediately preceding
receipt of such proof, whichever is the more recent. In applying this
provision, the classification of occupational risk and the premium
rates shall be such as have been last filed by the insurer prior to
the occurrence of the loss for which the insurer is liable or prior
to date of proof of change in occupation with the state official
having supervision of insurance in the state where the insured
resided at the time this policy was issued; but if such filing was
not required, then the classification of occupational risk and the
premium rates shall be those last made effective by the insurer in
such state prior to the occurrence of the loss or prior to the date
of proof of change in occupation.
10369.3. A disability policy may contain a provision in the form
set forth herein.
Misstatement of Age: If the age of the insured has been misstated,
all amounts payable under this policy shall be such as the premium
paid would have purchased at the correct age.
10369.4. A disability policy may contain a provision which shall,
at the option of the insurer, be in one of the two forms set forth
herein. If Form A is used, there shall be inserted in the first blank
the type of coverage or coverages and in the second blank the
maximum limit of indemnity or indemnities.
Form A.
Other Insurance in This Insurer: If an accident or sickness or
accident and sickness policy or policies previously issued by the
insurer to the insured be in force concurrently herewith, making the
aggregate indemnity for ____ in excess of $____, the excess insurance
shall be void and all premiums paid for such excess shall be
returned to the insured or to his estate.
Form B.
Other Insurance in This Insurer: Insurance effective at any one
time on the insured under a like policy or policies in this insurer
is limited to the one such policy elected by the insured, his
beneficiary or his estate, as the case may be, and the insurer will
return all premiums paid for all other such policies.
10369.5. A disability policy may contain a provision in the form
set forth in this section. If the provision also contains the
provision set forth in Section 10369.6, there shall be added to its
caption the phrase, "* * * expense incurred benefits." The insurer
may, at its option, include in this provision a definition of "other
valid coverage," approved as to form by the commissioner. The
definition shall be limited in subject matter to coverage provided by
organizations subject to regulation by insurance law or by insurance
authorities of this or any other state of the United States or any
province of Canada, or by hospital or medical service organizations,
and to any other coverage, the inclusion of which may be approved by
the commissioner. In the absence of that definition, the terms shall
not include group insurance, automobile medical payments insurance,
or coverage provided by hospital or medical service organizations or
by union welfare plans or employer or employee benefit organizations.
For the purpose of applying this policy provision with respect to
any insured, any amount of benefit provided for the insured pursuant
to any compulsory benefit statute, including any workers'
compensation or employers' liability statute, whether provided by a
governmental agency or otherwise, shall in all cases be deemed to be
"other valid coverage" of which the insurer has had notice. In
applying this provision, no third party liability coverage shall be
included as "other valid coverage."
Insurance With Other Insurers: If there is other valid coverage,
not with this insurer, providing benefits for the same loss on a
provision of service basis or on an expense incurred basis and of
which this insurer has not been given written notice prior to the
occurrence or commencement of loss, the only liability under any
expense incurred coverage of this policy shall be for the proportion
of the loss as the amount which would otherwise have been payable
under this policy plus the total of the like amounts under all the
other valid coverages for the same loss of which this insurer had
notice bears to the total like amounts under all valid coverages for
the loss, and for the return of the portion of the premiums paid as
shall exceed the pro-rata portion for the amount so determined. For
the purpose of applying this provision when other coverage is on a
provision of service basis, the "like amount" of the other coverage
shall be taken as the amount which the services rendered would have
cost in the absence of the coverage.
10369.6. A disability policy may contain a provision in the form
set forth in this section. If the provision is included in a policy
which also contains the provision set forth in Section 10369.5, there
shall be added to its caption the phrase, "* * * other benefits."
The insurer may, at its option, include in this provision a
definition of "other valid coverage," approved as to form by the
commissioner. The definition shall be limited in subject matter to
coverage provided by organizations subject to regulation by insurance
law or by insurance authorities of this or any other state of the
United States or any province of Canada, and to any other coverage
the inclusion of which may be approved by the commissioner. In the
absence of that definition the terms shall not include group
insurance, or benefits provided by union welfare plans or by employer
or employee benefit organizations. For the purpose of applying this
policy provision with respect to any insured, any amount of benefit
provided for the insured pursuant to any compulsory benefit statute,
including any workers' compensation or employers' liability statute,
whether provided by a governmental agency or otherwise, shall in all
cases be deemed to be "other valid coverage" of which the insurer has
had notice. In applying this provision, no third party liability
coverage shall be included as "other valid coverage."
Insurance With Other Insurers: If there is other valid coverage,
not with this insurer, providing benefits for the same loss on other
than an expense incurred basis and of which this insurer has not been
given written notice prior to the occurrence or commencement of
loss, the only liability for the benefits under this policy shall be
for the proportion of the indemnities otherwise provided under this
policy for the loss as the like indemnities of which the insurer had
notice, including the indemnities under this policy, bear to the
total amount of all like indemnities for the loss, and for the return
of the portion of the premium paid as shall exceed the pro rata
portion for the indemnities thus determined.
10369.7. A noncancellable disability policy may contain a provision
in the form set forth herein. The insurer may, at its option,
include in this provision a definition of "valid loss of time
coverage," approved as to form by the commissioner, which definition
shall be limited in subject matter to coverage provided by
governmental agencies or by organizations subject to regulation by
insurance law or by insurance authorities of this or any other state
of the United States or any province of Canada, or to any other
coverage the inclusion of which may be approved by the commissioner
or any combination of such coverages. In the absence of such
definition such term shall not include any coverage provided for such
insured pursuant to any compulsory benefit statute (including any
workmen's compensation or employers' liability statute), or benefits
provided by union welfare plans or by employer or employee benefit
organizations.
Relation of Earnings to Insurance: If the total monthly amount of
loss of time benefits promised for the same loss under all valid loss
of time coverage upon the insured, whether payable on a weekly or
monthly basis, shall exceed the monthly earnings of the insured at
the time disability commenced or his average monthly earnings for the
period of two years immediately preceding a disability for which
claim is made, whichever is the greater, the insurer will be liable
only for such proportionate amount of such benefits under this policy
as the amount of such monthly earnings or such average monthly
earnings of the insured bears to the total amount of monthly benefits
for the same loss under all such coverage upon the insured at the
time such disability commences and for the return of such part of the
premiums paid during such two years as shall exceed the pro-rata
amount of the premiums for the benefits actually paid hereunder; but
this shall not operate to reduce the total monthly amount of benefits
payable under all such coverage upon the insured below the sum of
two hundred dollars ($200) or the sum of the monthly benefits
specified in such coverages, whichever is the lesser, nor shall it
operate to reduce benefits other than those payable for loss of time.
10369.8. A disability policy may contain a provision in the form
set forth herein.
Unpaid Premium: Upon the payment of a claim under this policy, any
premium then due and unpaid or covered by any note or written order
may be deducted therefrom.
10369.9. A disability policy may contain a provision in the form
set forth herein.
Cancellation: The insurer may cancel this policy at any time by
written notice delivered to the insured, or mailed to his last
address as shown by the records of the insurer, stating when, not
less than five days thereafter, such cancellation shall be effective;
and after the policy has been continued beyond its original term the
insured may cancel this policy at any time by written notice
delivered or mailed to the insurer, effective upon receipt or on such
later date as may be specified in such notice. In the event of
cancellation, the insurer will return promptly the unearned portion
of any premium paid. If the insured cancels, the earned premium shall
be computed by the use of the short-rate table last filed with the
state official having supervision of insurance in the state where the
insured resided when the policy was issued. If the insurer cancels,
the earned premium shall be computed pro rata. Cancellation shall be
without prejudice to any claim originating prior to the effective
date of cancellation.
10369.10. A disability policy may contain a provision in the form
set forth herein.
Conformity With State Statutes: Any provision of this policy
which, on its effective date, is in conflict with the statutes of the
state in which the insured resides on such date is hereby amended to
conform to the minimum requirements of such statutes.
10369.11. A disability policy may contain a provision in the form
set forth herein.
Illegal Occupation: The insurer shall not be liable for any loss
to which a contributing cause was the insured's commission of or
attempt to commit a felony or to which a contributing cause was the
insured's being engaged in an illegal occupation.
10369.12. (a) A disability policy may contain a provision in the
form set forth herein.
Intoxicants and controlled substances: The insurer shall not be
liable for any loss sustained or contracted in consequence of the
insured's being intoxicated or under the influence of any controlled
substance unless administered on the advice of a physician.
(b) Subdivision (a) shall not apply to a health insurance policy.
