376.777. 1. Required provisions. Except as provided in subsection 3 ofthis section each such policy delivered or issued for delivery to any personin this state shall contain the provisions specified in this subsection in thewords in which the same appear in this section; provided, however, that theinsurer may, at its option, substitute for one or more of such provisionscorresponding provisions of different wording approved by the director of thedepartment of insurance, financial institutions and professional registrationwhich are in each instance not less favorable in any respect to the insured orthe beneficiary. Such provisions shall be preceded individually by thecaption appearing in this subsection or, at the option of the insurer, by suchappropriate individual or group captions or subcaptions as the director of thedepartment of insurance, financial institutions and professional registrationmay approve.
(1) A provision as follows:
"ENTIRE CONTRACT; CHANGES: This policy, including the endorsements and the attached papers, if any,constitutes the entire contract of insurance. No change in this policy shallbe valid until approved by an executive officer of the insurer and unless suchapproval be endorsed hereon or attached hereto. No agent has authority tochange this policy or to waive any of its provisions".
(When under the provisions of subdivision (2) of subsection 1 of section376.775 the effective and termination dates are stated in the premium receipt,the insurer shall insert in the first sentence of the foregoing policyprovision immediately following the comma after the word "any", the followingwords: "and the insurer's official premium receipt when executed").
(2) A provision as follows:
"TIME LIMIT ON CERTAIN DEFENSES:
(a) After two years from the date of issue of this policy nomisstatements, except fraudulent misstatements, made by the applicant in theapplication for such policy shall be used to void the policy or to deny aclaim for loss incurred or disability (as defined in the policy) commencingafter the expiration of such two-year period".
(The foregoing policy provision shall not be so construed as to affectany legal requirements for avoidance of a policy or denial of a claim duringsuch initial two-year period, nor to limit the application of subdivisions(1), (2), (3), (4) and (5) of subsection 2 of this section in the event ofmisstatement with respect to age or occupation or other insurance.)
(A policy which the insured has the right to continue in force subject toits terms by the timely payment of premium (1) until at least age fifty or,(2) in the case of a policy issued after age forty-four, for at least fiveyears from its date of issue, may contain in lieu of the foregoing thefollowing provision (from which the clause in parentheses may be omitted atthe insurer's option) under the caption "UNCONTESTABLE": "After this policy has been in force for a period of three years during thelifetime of the insured (excluding any period during which the insured isdisabled), it shall become uncontestable as to the statements contained in theapplication).
(b) No claim for loss incurred or disability (as defined in the policy)commencing after two years from the date of issue of this policy shall bereduced or denied on the ground that a disease or physical condition notexcluded from coverage by name or specific description effective on the dateof loss had existed prior to the effective date of coverage of this policy."
(3) A provision as follows: "GRACE PERIOD: A grace period of . . .(insert a number not less than "7" for weekly premium policies, "10" formonthly premium policies and "31" for all other policies) days will be grantedfor the payment of each premium falling due after the first premium, duringwhich grace period the policy shall continue in force."
(A policy which contains a cancellation provision may add, at the end ofthe above provision, subject to the right of the insurer to cancel inaccordance with the cancellation provision hereof. A policy in which theinsurer reserves the right to refuse any renewal shall have, at the beginningof the above provision, "Unless not less than five days prior to the premiumdue date the insurer has delivered to the insured or has mailed to his lastaddress as shown by the records of the insurer written notice of its intentionnot to renew this policy beyond the period for which the premium has beenaccepted").
(4) A provision as follows:
"REINSTATEMENT:
If any renewal premium be not paid within the time granted the insuredfor payment, a subsequent acceptance of premium by the insurer or by any agentduly authorized by the insurer to accept such premium, without requiring inconnection therewith an application for reinstatement, shall reinstate thepolicy; provided, however, that if the insurer or such agent requires anapplication for reinstatement and issues a conditional receipt for the premiumtendered, the policy will be reinstated upon approval of such application bythe insurer, or, lacking such approval, upon the forty-fifth day following thedate of such conditional receipt unless the insurer has previously notifiedthe insured in writing of its disapproval of such application. The reinstatedpolicy shall cover only loss resulting from such accidental injury as may besustained after the date of reinstatement and loss due to such sickness as maybegin more than ten days after such date. In all other respects the insuredand insurer shall have the same rights thereunder as they had under the policyimmediately before the due date of the defaulted premium, subject to anyprovisions endorsed hereon or attached hereto in connection with thereinstatement. Any premium accepted in connection with a reinstatement shallbe applied to a period for which premium has not been previously paid, but notto any period more than sixty days prior to the date of reinstatement".
(The last sentence of the above provision may be omitted from any policywhich the insured has the right to continue in force subject to its terms bythe timely payment of premiums (1) until at least age fifty or, (2) in thecase of a policy issued after age forty-four, for at least five years from itsdate of issue.)
(5) A provision as follows:
"NOTICE OF CLAIM:
Written notice of claim must be given to the insurer within twenty daysafter the occurrence or commencement of any loss covered by the policy, or assoon thereafter as is reasonably possible. Notice given by or on behalf ofthe insured or the beneficiary to the insured at .......... (insert thelocation of such office as the insurer may designate for the purpose), or toany authorized agent of the insurer, with information sufficient to identifythe insured, shall be deemed notice to the insurer".
(In a policy providing a loss-of-time benefit which may be payable for atleast two years, an insurer may at its option insert the following between thefirst and second sentences of the above provision: "Subject to thequalifications set forth below, if the insured suffers loss of time on accountof disability for which indemnity may be payable for at least two years, heshall, at least once in every six months after having given notice of claim,give to the insurer notice of continuance of said disability, except in theevent of legal incapacity. The period of six months following any filing ofproof by the insured or any payment by the insurer on account of such claim orany denial of liability in whole or in part by the insurer shall be excludedin applying this provision. Delay in the giving of such notice shall notimpair the insured's right to any indemnity which would otherwise have accruedduring the period of six months preceding the date on which such notice isactually given").
(6) A provision as follows:
"CLAIM FORMS:
The insurer upon receipt of a notice of claim, will furnish to theclaimant such forms as are usually furnished by it for filing proofs of loss.If such forms are not furnished within fifteen days after the giving of suchnotice the claimant shall be deemed to have complied with the requirements ofthis policy as to proof of loss upon submitting, within the time fixed in thepolicy for filing proofs of loss, written proof covering the occurrence, thecharacter and the extent of the loss for which claim is made".
(7) A provision as follows:
"PROOFS OF LOSS:
Written proof of loss must be furnished to the insurer at its said officein case of claim for loss for which this policy provides any periodic paymentcontingent upon continuing loss within ninety days after the termination ofthe period for which the insurer is liable and in case of claim for any otherloss within ninety days after the date of such loss. Failure to furnish suchproof within the time required shall not invalidate nor reduce any claim if itwas not reasonably possible to give proof within such time, provided suchproof is furnished as soon as reasonably possible and in no event, except inthe absence of legal capacity, later than one year from the time proof isotherwise required".
(8) A provision as follows:
"TIME OF PAYMENT OF CLAIMS:
Indemnities payable under this policy for any loss other than loss forwhich this policy provides any periodic payment will be paid immediately uponreceipt of due written proof of such loss. Subject to due written proof ofloss, all accrued indemnities for loss for which this policy provides periodicpayment will be paid .......... (insert period for payment which must not beless frequently than monthly) and any balance remaining unpaid upon thetermination of liability will be paid immediately upon receipt of due writtenproof".
(9) A provision as follows:
"PAYMENT OF CLAIMS:
Indemnity for loss of life will be payable in accordance with thebeneficiary designation and the provisions respecting such payment which maybe prescribed herein and effective at the time of payment. If no suchdesignation or provision is then effective, such indemnity shall be payable tothe estate of the insured. Any other accrued indemnities unpaid at theinsured's death may, at the option of the insurer, be paid either to suchbeneficiary or to such estate. All other indemnities will be payable to theinsured".
(The following provisions, or either of them, may be included with theforegoing provision at the option of the insurer: "If any indemnity of this policy shall be payable to the estate of theinsured, or to an insured or beneficiary who is a minor or otherwise notcompetent to give a valid release, the insurer may pay such indemnity, up toan amount not exceeding $...... (insert an amount which shall not exceed onethousand dollars), to any relative by blood or connection by marriage of theinsured or beneficiary who is deemed by the insurer to be equitably entitledthereto. Any payment made by the insurer in good faith pursuant to thisprovision shall fully discharge the insurer to the extent of such payment.Subject to any written direction of the insured in the application orotherwise all or a portion of any indemnities provided by this policy onaccount of hospital, nursing, medical, or surgical services may, at theinsurer's option and unless the insured requests otherwise in writing notlater than the time of filing proofs of such loss, be paid directly to thehospital or person rendering such services; but it is not required that theservice be rendered by a particular hospital or person").
(10) A provision as follows:
"PHYSICAL EXAMINATIONS AND AUTOPSY:
The insurer at its own expense shall have the right and opportunity toexamine the person of the insured when and as often as it may reasonablyrequire during the pendency of a claim hereunder and to make an autopsy incase of death where it is not forbidden by law".
(11) A provision as follows:
"LEGAL ACTIONS:
No action at law or in equity shall be brought to recover on this policyprior to the expiration of sixty days after written proof of loss has beenfurnished in accordance with the requirements of this policy. No such actionshall be brought after the expiration of three years after the time writtenproof of loss is required to be furnished".
(12) A provision as follows:
"CHANGE OF BENEFICIARY:
Unless the insured makes an irrevocable designation of beneficiary, theright to change of beneficiary is reserved to the insured and the consent ofthe beneficiary or beneficiaries shall not be requisite to surrender orassignment of this policy or to change of beneficiary or beneficiaries, or toany other changes in this policy".
(The first clause of this provision, relating to the irrevocabledesignation of beneficiary, may be omitted at the insurer's option).
2. Other provisions. Except as provided in subsection 3 of thissection, no such policy delivered or issued for delivery to any person in thisstate shall contain provisions respecting the matters set forth below unlesssuch provisions are in the words in which the same appear in this section;provided, however, that the insurer may, at its option, use in lieu of anysuch provision a corresponding provision of different wording approved by thedirector of the department of insurance, financial institutions andprofessional registration which is not less favorable in any respect to theinsured or the beneficiary. Any such provision contained in the policy shallbe preceded individually by the appropriate caption appearing in thissubsection or, at the option of the insurer, by such appropriate individual orgroup captions or subcaptions as the director of the department of insurance,financial institutions and professional registration may approve.
(1) A provision as follows:
"CHANGE OF OCCUPATION:
If the insured be injured or contract sickness after having changed hisoccupation to one classified by the insurer as more hazardous than that statedin this policy or while doing for compensation anything pertaining to anoccupation so classified, the insurer will pay only such portion of theindemnities provided in this policy as the premium paid would have purchasedat the rates and within the limits fixed by the insurer for such morehazardous occupation. If the insured changes his occupation to one classifiedby 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 premiumrate accordingly, and will return the excess pro rata unearned premium fromthe date of change of occupation or from the policy anniversary dateimmediately preceding receipt of such proof, whichever is the more recent. Inapplying this provision, the classification of occupational risk and thepremium rates shall be such as have been last filed by the insurer prior tothe occurrence of the loss for which the insurer is liable or prior to date ofproof of change in occupation with the state official having supervision ofinsurance in the state where the insured resided at the time this policy wasissued; but if such filing was not required, then the classification ofoccupational risk and the premium rates shall be those last made effective bythe insurer in such state prior to the occurrence of the loss or prior to thedate of proof of change in occupation".
(2) A provision as follows:
"MISSTATEMENT OF AGE:
If the age of the insured has been misstated, all amounts payable underthis policy shall be such as the premium paid would have purchased at thecorrect age".
(3) A provision as follows:
"OTHER INSURANCE IN THIS INSURER:
If an accident or sickness or accident and sickness policy or policiespreviously issued by the insurer to the insured be in force concurrentlyherewith, making the aggregate indemnity for .......... (insert type ofcoverage or coverages) in excess of $...... (insert maximum limit of indemnityor indemnities) the excess insurance shall be void and all premiums paid forsuch excess shall be returned to the insured or to his estate, or in lieuthereof. Insurance effective at any one time on the insured under a like policy orpolicies in this insurer is limited to the one such policy elected by theinsured, his beneficiary or his estate, as the case may be, and the insurerwill return all premiums paid for all other such policies".
(4) A provision as follows:
"INSURANCE WITH OTHER INSURERS:
If there be other valid coverage, not with this insurer, providingbenefits for the same loss on a provision of service basis or on an expenseincurred basis and of which this insurer has not been given written noticeprior to the occurrence or commencement of loss, the only liability under anyexpense incurred coverage of this policy shall be for such proportion of theloss as the amount which would otherwise have been payable hereunder plus thetotal of the like amounts under all such other valid coverages for the sameloss of which this insurer had notice bears to the total like amounts underall valid coverages for such loss, and for the return of such portion of thepremiums paid as shall exceed the pro rata portion for the amount sodetermined. For the purpose of applying this provision when other coverage ison a provision of service basis, the "like amount" of such other coverageshall be taken as the amount which the services rendered would have cost inthe absence of such coverage".
(If the foregoing policy provision is included in a policy which alsocontains the next following policy provision there shall be added to thecaption of the foregoing provision 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 director of the departmentof insurance, financial institutions and professional registration, whichdefinition shall be limited in subject matter to coverage provided byorganizations subject to regulation by insurance law or by insuranceauthorities of this or any other state of the United States or any province ofCanada, and by hospital or medical service organizations, and to any othercoverage the inclusion of which may be approved by the director of thedepartment of insurance, financial institutions and professional registration. In the absence of such definition such term shall not include groupinsurance, automobile medical payments insurance, or coverage provided byhospital or medical service organizations or by union welfare plans oremployer or employees benefit organizations. For the purpose of applying theforegoing policy provision with respect to any insured, any amount of benefitprovided for such insured pursuant to any compulsory benefit statute(including any workers' compensation or employer's liability statute whetherprovided by a governmental agency or otherwise shall in all cases be deemed tobe "other valid coverage" of which the insurer has had notice. In applyingthe foregoing policy provision no third party liability coverage shall beincluded as "other valid coverage").
(5) A provision as follows:
"INSURANCE WITH OTHER INSURERS:
If there be other valid coverage, not with this insurer, providingbenefits for the same loss on other than an expense incurred basis and ofwhich this insurer has not been given written notice prior to the occurrenceor commencement of loss, the only liability for such benefits under thispolicy shall be for such proportion of the indemnities otherwise providedhereunder for such loss as the like indemnities of which the insurer hadnotice (including the indemnities under this policy) bear to the total amountof all like indemnities for such loss, and for the return of such portion ofthe premium paid as shall exceed the pro rata portion for the indemnities thusdetermined".
(If the foregoing policy provision is included in a policy which alsocontains the next preceding policy provision there shall be added to thecaption of the foregoing provision the phrase--"OTHER BENEFITS". The insurermay, at its option, include in this provision a definition of "other validcoverage", approved as to form by the director of the department of insurance,financial institutions and professional registration which definition shall belimited in subject matter to coverage provided by organizations subject toregulation by insurance law or by insurance authorities of this or any otherstate of the United States or any province of Canada, and to any othercoverage the inclusion of which may be approved by the director of thedepartment of insurance, financial institutions and professional registration. In the absence of such definition such term shall not include groupinsurance, or benefits provided by union welfare plans or by employer oremployee benefit organizations. For the purpose of applying the foregoingpolicy provision with respect to any insured, any amount of benefit providedfor such insured pursuant to any compulsory benefit statute (including anyworkers' compensation or employer's liability statute) whether provided by agovernmental agency or otherwise shall in all cases be deemed to be "othervalid coverage", of which the insurer has had notice. In applying theforegoing policy provision no third party liability coverage shall be includedas "other valid coverage").
(6) A provision as follows:
"RELATION OF EARNINGS TO INSURANCE:
If the total monthly amount of loss of time benefits promised for thesame loss under all valid loss of time coverage upon the insured, whetherpayable on a weekly or monthly basis, shall exceed the monthly earnings of theinsured at the time disability commenced or his average monthly earnings forthe period of two years immediately preceding a disability for which claim ismade, whichever is the greater, the insurer will be liable only for suchproportionate amount of such benefits under this policy as the amount of suchmonthly earnings or such average monthly earnings of the insured bears to thetotal amount of monthly benefits for the same loss under all such coverageupon the insured at the time such disability commences and for the return ofsuch part of the premiums paid during such two years as shall exceed the prorata amount of the premiums for the benefits actually paid hereunder; but thisshall not operate to reduce the total monthly amount of benefits payable underall such coverage upon the insured below the sum of two hundred dollars or thesum of the monthly benefits specified in such coverages, whichever is thelesser, nor shall it operate to reduce benefits other than those payable forloss of time".
(The foregoing policy provision may be inserted only in a policy whichthe insured has the right to continue in force subject to its terms by thetimely payment of premiums (1) until at least age fifty or, (2) in the case ofa policy issued after age forty-four, for at least five years from this dateof issue. The insurer may, at its option, include in this provision adefinition of "valid loss of time coverage", approved as to form by thedirector of the department of insurance, financial institutions andprofessional registration, which definition shall be limited in subject matterto coverage provided by governmental agencies or by organizations subject toregulation by insurance law or by insurance authorities of this or any otherstate of the United States or any province of Canada, or to any other coveragethe inclusion of which may be approved by the director of the department ofinsurance, financial institutions and professional registration or anycombination of such coverages. In the absence of such definition such termshall not include any coverage provided for such insured pursuant to anycompulsory benefit statute (including any workers' compensation or employer'sliability statute), or benefits provided by union welfare plans or by employeror employee benefit organizations).
(7) A provision as follows:
"UNPAID PREMIUM:
Upon the payment of a claim under this policy, any premium then due andunpaid or covered by any note or written order may be deducted therefrom".
(8) A provision as follows:
"CANCELLATION:
The insurer may cancel this policy at any time by written noticedelivered to the insured, or mailed to his last address as shown by therecords of the insurer, stating when, not less than five days thereafter, suchcancellation shall be effective; and after the policy has been continuedbeyond its original term the insured may cancel this policy at any time bywritten notice delivered or mailed to the insurer, effective upon receipt oron such later date as may be specified in such notice. In the event ofcancellation, the insurer will return promptly the unearned portion of anypremium paid. If the insured cancels, the earned premium shall be computed bythe use of the short-rate table last filed with the state official havingsupervision of insurance in the state where the insured resided when thepolicy was issued. If the insurer cancels, the earned premium shall becomputed pro rata. Cancellation shall be without prejudice to any claimoriginating prior to the effective date of cancellation".
(9) A provision as follows:
"CONFORMITY WITH STATE STATUTES:
Any provision of this policy which, on its effective date, is in conflictwith the statutes of the state in which the insured resides on such date ishereby amended to conform to the minimum requirements of such statutes".
(10) A provision as follows:
"ILLEGAL OCCUPATION:
The insurer shall not be liable for any loss to which a contributingcause was the insured's commission of or attempt to commit a felony or towhich a contributing cause was the insured's being engaged in an illegaloccupation".
(11) A provision as follows:
"INTOXICANTS AND NARCOTICS:
The insurer shall not be liable for any loss sustained or contracted inconsequence of the insured's being intoxicated or under the influence of anynarcotic unless administered on the advice of a physician".
3. Inapplicable or inconsistent provisions. If any provision of thissection is in whole or in part inapplicable to or inconsistent with thecoverage provided by a particular form of policy the insurer, with theapproval of the director of the department of insurance, financialinstitutions and professional registration, shall omit from such policy aninapplicable provision or part of a provision, and shall modify anyinconsistent provision or part of the provision, in such manner as to make theprovision as contained in the policy consistent with the coverage provided bythe policy.
4. Order of certain policy provisions. The provisions which are thesubject of subsections 1 and 2 of this section, or any correspondingprovisions which are used in lieu thereof in accordance with such subsections,shall be printed in the consecutive order of the provisions in suchsubsections or, at the option of the insurer, any such provision may appear asa unit in any part of the policy, with other provisions to which it may belogically related, provided the resulting policy shall not be in whole or inpart unintelligible, uncertain, ambiguous, abstruse, or likely to mislead aperson to whom the policy is offered, delivered or issued.
5. Third party ownership. The word "insured" as used in sections376.770 to 376.800, shall not be construed as preventing a person other thanthe insured with a proper insurable interest from making application for andowning a policy covering the insured or from being entitled under such apolicy to any indemnities, benefits and rights provided therein.
6. Requirements of other jurisdictions.
(1) Any policy of a foreign or alien insurer, when delivered or issuedfor delivery to any person in this state, may contain any provision which isnot less favorable to the insured or the beneficiary than the provisions ofsections 376.770 to 376.800 and which is prescribed or required by the law ofthe state under which the insurer is organized.
(2) Any policy of a domestic insurer may, when issued for delivery inany other state or country, contain any provision permitted or required by thelaws of such other state or country.
7. Approval of policies.
(1) No policy subject to sections 376.770 to 376.800 shall be deliveredor issued for delivery to any person in this state unless such policy,including any rider, endorsement or other provisions, supplementary thereto,shall have been approved by the director of the department of insurance,financial institutions and professional registration.
(2) The director of the department of insurance, financial institutionsand professional registration shall have authority to make such reasonablerules and regulations concerning the filing and submission of policies as arenecessary, proper or advisable. Such rules and regulations shall provide,among other things, that if a policy form is disapproved, the reasons thereforshall be stated in writing; that a hearing shall be granted upon suchdisapproval, if so requested; and that the failure of the director of thedepartment of insurance, financial institutions and professional registrationto take action approving or disapproving a submitted policy form within astipulated time, not to exceed sixty days from the date of filing, shall bedeemed an approval thereof until such time as the director of the departmentof insurance, financial institutions and professional registration shallnotify the submitting company, in writing, of his disapproval thereof.
(3) The director of the department of insurance, financial institutionsand professional registration shall approve only those policies which are incompliance with the insurance laws of this state and which contain such words,phraseology, conditions and provisions which are specific, certain andunambiguous and reasonably adequate to meet needed requirements for theprotection of those insured. The disapproval of any policy form shall bebased upon the requirements of the laws of this state or of any regulationlawfully promulgated thereunder.
(4) The director of the department of insurance, financial institutionsand professional registration may, by order or bulletin, exempt from theapproval requirements of this section for so long as he deems proper anyinsurance policy, document, or form or type thereof, as specified in suchorder or bulletin, to which, in his opinion, this section may not practicablybe applied, or the approval of which is, in his opinion, not desirable ornecessary for the protection of the public.
376.777. 1. Required provisions. Except as provided in subsection 3 ofthis section each such policy delivered or issued for delivery to any personin this state shall contain the provisions specified in this subsection in thewords in which the same appear in this section; provided, however, that theinsurer may, at its option, substitute for one or more of such provisionscorresponding provisions of different wording approved by the director of thedepartment of insurance, financial institutions and professional registrationwhich are in each instance not less favorable in any respect to the insured orthe beneficiary. Such provisions shall be preceded individually by thecaption appearing in this subsection or, at the option of the insurer, by suchappropriate individual or group captions or subcaptions as the director of thedepartment of insurance, financial institutions and professional registrationmay approve.
(1) A provision as follows:
"ENTIRE CONTRACT; CHANGES: This policy, including the endorsements and the attached papers, if any,constitutes the entire contract of insurance. No change in this policy shallbe valid until approved by an executive officer of the insurer and unless suchapproval be endorsed hereon or attached hereto. No agent has authority tochange this policy or to waive any of its provisions".
(When under the provisions of subdivision (2) of subsection 1 of section376.775 the effective and termination dates are stated in the premium receipt,the insurer shall insert in the first sentence of the foregoing policyprovision immediately following the comma after the word "any", the followingwords: "and the insurer's official premium receipt when executed").
(2) A provision as follows:
"TIME LIMIT ON CERTAIN DEFENSES:
(a) After two years from the date of issue of this policy nomisstatements, except fraudulent misstatements, made by the applicant in theapplication for such policy shall be used to void the policy or to deny aclaim for loss incurred or disability (as defined in the policy) commencingafter the expiration of such two-year period".
(The foregoing policy provision shall not be so construed as to affectany legal requirements for avoidance of a policy or denial of a claim duringsuch initial two-year period, nor to limit the application of subdivisions(1), (2), (3), (4) and (5) of subsection 2 of this section in the event ofmisstatement with respect to age or occupation or other insurance.)
(A policy which the insured has the right to continue in force subject toits terms by the timely payment of premium (1) until at least age fifty or,(2) in the case of a policy issued after age forty-four, for at least fiveyears from its date of issue, may contain in lieu of the foregoing thefollowing provision (from which the clause in parentheses may be omitted atthe insurer's option) under the caption "UNCONTESTABLE": "After this policy has been in force for a period of three years during thelifetime of the insured (excluding any period during which the insured isdisabled), it shall become uncontestable as to the statements contained in theapplication).
(b) No claim for loss incurred or disability (as defined in the policy)commencing after two years from the date of issue of this policy shall bereduced or denied on the ground that a disease or physical condition notexcluded from coverage by name or specific description effective on the dateof loss had existed prior to the effective date of coverage of this policy."
(3) A provision as follows: "GRACE PERIOD: A grace period of . . .(insert a number not less than "7" for weekly premium policies, "10" formonthly premium policies and "31" for all other policies) days will be grantedfor the payment of each premium falling due after the first premium, duringwhich grace period the policy shall continue in force."
(A policy which contains a cancellation provision may add, at the end ofthe above provision, subject to the right of the insurer to cancel inaccordance with the cancellation provision hereof. A policy in which theinsurer reserves the right to refuse any renewal shall have, at the beginningof the above provision, "Unless not less than five days prior to the premiumdue date the insurer has delivered to the insured or has mailed to his lastaddress as shown by the records of the insurer written notice of its intentionnot to renew this policy beyond the period for which the premium has beenaccepted").
(4) A provision as follows:
"REINSTATEMENT:
If any renewal premium be not paid within the time granted the insuredfor payment, a subsequent acceptance of premium by the insurer or by any agentduly authorized by the insurer to accept such premium, without requiring inconnection therewith an application for reinstatement, shall reinstate thepolicy; provided, however, that if the insurer or such agent requires anapplication for reinstatement and issues a conditional receipt for the premiumtendered, the policy will be reinstated upon approval of such application bythe insurer, or, lacking such approval, upon the forty-fifth day following thedate of such conditional receipt unless the insurer has previously notifiedthe insured in writing of its disapproval of such application. The reinstatedpolicy shall cover only loss resulting from such accidental injury as may besustained after the date of reinstatement and loss due to such sickness as maybegin more than ten days after such date. In all other respects the insuredand insurer shall have the same rights thereunder as they had under the policyimmediately before the due date of the defaulted premium, subject to anyprovisions endorsed hereon or attached hereto in connection with thereinstatement. Any premium accepted in connection with a reinstatement shallbe applied to a period for which premium has not been previously paid, but notto any period more than sixty days prior to the date of reinstatement".
(The last sentence of the above provision may be omitted from any policywhich the insured has the right to continue in force subject to its terms bythe timely payment of premiums (1) until at least age fifty or, (2) in thecase of a policy issued after age forty-four, for at least five years from itsdate of issue.)
(5) A provision as follows:
"NOTICE OF CLAIM:
Written notice of claim must be given to the insurer within twenty daysafter the occurrence or commencement of any loss covered by the policy, or assoon thereafter as is reasonably possible. Notice given by or on behalf ofthe insured or the beneficiary to the insured at .......... (insert thelocation of such office as the insurer may designate for the purpose), or toany authorized agent of the insurer, with information sufficient to identifythe insured, shall be deemed notice to the insurer".
(In a policy providing a loss-of-time benefit which may be payable for atleast two years, an insurer may at its option insert the following between thefirst and second sentences of the above provision: "Subject to thequalifications set forth below, if the insured suffers loss of time on accountof disability for which indemnity may be payable for at least two years, heshall, at least once in every six months after having given notice of claim,give to the insurer notice of continuance of said disability, except in theevent of legal incapacity. The period of six months following any filing ofproof by the insured or any payment by the insurer on account of such claim orany denial of liability in whole or in part by the insurer shall be excludedin applying this provision. Delay in the giving of such notice shall notimpair the insured's right to any indemnity which would otherwise have accruedduring the period of six months preceding the date on which such notice isactually given").
(6) A provision as follows:
"CLAIM FORMS:
The insurer upon receipt of a notice of claim, will furnish to theclaimant such forms as are usually furnished by it for filing proofs of loss.If such forms are not furnished within fifteen days after the giving of suchnotice the claimant shall be deemed to have complied with the requirements ofthis policy as to proof of loss upon submitting, within the time fixed in thepolicy for filing proofs of loss, written proof covering the occurrence, thecharacter and the extent of the loss for which claim is made".
(7) A provision as follows:
"PROOFS OF LOSS:
Written proof of loss must be furnished to the insurer at its said officein case of claim for loss for which this policy provides any periodic paymentcontingent upon continuing loss within ninety days after the termination ofthe period for which the insurer is liable and in case of claim for any otherloss within ninety days after the date of such loss. Failure to furnish suchproof within the time required shall not invalidate nor reduce any claim if itwas not reasonably possible to give proof within such time, provided suchproof is furnished as soon as reasonably possible and in no event, except inthe absence of legal capacity, later than one year from the time proof isotherwise required".
(8) A provision as follows:
"TIME OF PAYMENT OF CLAIMS:
Indemnities payable under this policy for any loss other than loss forwhich this policy provides any periodic payment will be paid immediately uponreceipt of due written proof of such loss. Subject to due written proof ofloss, all accrued indemnities for loss for which this policy provides periodicpayment will be paid .......... (insert period for payment which must not beless frequently than monthly) and any balance remaining unpaid upon thetermination of liability will be paid immediately upon receipt of due writtenproof".
(9) A provision as follows:
"PAYMENT OF CLAIMS:
Indemnity for loss of life will be payable in accordance with thebeneficiary designation and the provisions respecting such payment which maybe prescribed herein and effective at the time of payment. If no suchdesignation or provision is then effective, such indemnity shall be payable tothe estate of the insured. Any other accrued indemnities unpaid at theinsured's death may, at the option of the insurer, be paid either to suchbeneficiary or to such estate. All other indemnities will be payable to theinsured".
(The following provisions, or either of them, may be included with theforegoing provision at the option of the insurer: "If any indemnity of this policy shall be payable to the estate of theinsured, or to an insured or beneficiary who is a minor or otherwise notcompetent to give a valid release, the insurer may pay such indemnity, up toan amount not exceeding $...... (insert an amount which shall not exceed onethousand dollars), to any relative by blood or connection by marriage of theinsured or beneficiary who is deemed by the insurer to be equitably entitledthereto. Any payment made by the insurer in good faith pursuant to thisprovision shall fully discharge the insurer to the extent of such payment.Subject to any written direction of the insured in the application orotherwise all or a portion of any indemnities provided by this policy onaccount of hospital, nursing, medical, or surgical services may, at theinsurer's option and unless the insured requests otherwise in writing notlater than the time of filing proofs of such loss, be paid directly to thehospital or person rendering such services; but it is not required that theservice be rendered by a particular hospital or person").
(10) A provision as follows:
"PHYSICAL EXAMINATIONS AND AUTOPSY:
The insurer at its own expense shall have the right and opportunity toexamine the person of the insured when and as often as it may reasonablyrequire during the pendency of a claim hereunder and to make an autopsy incase of death where it is not forbidden by law".
(11) A provision as follows:
"LEGAL ACTIONS:
No action at law or in equity shall be brought to recover on this policyprior to the expiration of sixty days after written proof of loss has beenfurnished in accordance with the requirements of this policy. No such actionshall be brought after the expiration of three years after the time writtenproof of loss is required to be furnished".
(12) A provision as follows:
"CHANGE OF BENEFICIARY:
Unless the insured makes an irrevocable designation of beneficiary, theright to change of beneficiary is reserved to the insured and the consent ofthe beneficiary or beneficiaries shall not be requisite to surrender orassignment of this policy or to change of beneficiary or beneficiaries, or toany other changes in this policy".
(The first clause of this provision, relating to the irrevocabledesignation of beneficiary, may be omitted at the insurer's option).
2. Other provisions. Except as provided in subsection 3 of thissection, no such policy delivered or issued for delivery to any person in thisstate shall contain provisions respecting the matters set forth below unlesssuch provisions are in the words in which the same appear in this section;provided, however, that the insurer may, at its option, use in lieu of anysuch provision a corresponding provision of different wording approved by thedirector of the department of insurance, financial institutions andprofessional registration which is not less favorable in any respect to theinsured or the beneficiary. Any such provision contained in the policy shallbe preceded individually by the appropriate caption appearing in thissubsection or, at the option of the insurer, by such appropriate individual orgroup captions or subcaptions as the director of the department of insurance,financial institutions and professional registration may approve.
(1) A provision as follows:
"CHANGE OF OCCUPATION:
If the insured be injured or contract sickness after having changed hisoccupation to one classified by the insurer as more hazardous than that statedin this policy or while doing for compensation anything pertaining to anoccupation so classified, the insurer will pay only such portion of theindemnities provided in this policy as the premium paid would have purchasedat the rates and within the limits fixed by the insurer for such morehazardous occupation. If the insured changes his occupation to one classifiedby 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 premiumrate accordingly, and will return the excess pro rata unearned premium fromthe date of change of occupation or from the policy anniversary dateimmediately preceding receipt of such proof, whichever is the more recent. Inapplying this provision, the classification of occupational risk and thepremium rates shall be such as have been last filed by the insurer prior tothe occurrence of the loss for which the insurer is liable or prior to date ofproof of change in occupation with the state official having supervision ofinsurance in the state where the insured resided at the time this policy wasissued; but if such filing was not required, then the classification ofoccupational risk and the premium rates shall be those last made effective bythe insurer in such state prior to the occurrence of the loss or prior to thedate of proof of change in occupation".
(2) A provision as follows:
"MISSTATEMENT OF AGE:
If the age of the insured has been misstated, all amounts payable underthis policy shall be such as the premium paid would have purchased at thecorrect age".
(3) A provision as follows:
"OTHER INSURANCE IN THIS INSURER:
If an accident or sickness or accident and sickness policy or policiespreviously issued by the insurer to the insured be in force concurrentlyherewith, making the aggregate indemnity for .......... (insert type ofcoverage or coverages) in excess of $...... (insert maximum limit of indemnityor indemnities) the excess insurance shall be void and all premiums paid forsuch excess shall be returned to the insured or to his estate, or in lieuthereof. Insurance effective at any one time on the insured under a like policy orpolicies in this insurer is limited to the one such policy elected by theinsured, his beneficiary or his estate, as the case may be, and the insurerwill return all premiums paid for all other such policies".
(4) A provision as follows:
"INSURANCE WITH OTHER INSURERS:
If there be other valid coverage, not with this insurer, providingbenefits for the same loss on a provision of service basis or on an expenseincurred basis and of which this insurer has not been given written noticeprior to the occurrence or commencement of loss, the only liability under anyexpense incurred coverage of this policy shall be for such proportion of theloss as the amount which would otherwise have been payable hereunder plus thetotal of the like amounts under all such other valid coverages for the sameloss of which this insurer had notice bears to the total like amounts underall valid coverages for such loss, and for the return of such portion of thepremiums paid as shall exceed the pro rata portion for the amount sodetermined. For the purpose of applying this provision when other coverage ison a provision of service basis, the "like amount" of such other coverageshall be taken as the amount which the services rendered would have cost inthe absence of such coverage".
(If the foregoing policy provision is included in a policy which alsocontains the next following policy provision there shall be added to thecaption of the foregoing provision 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 director of the departmentof insurance, financial institutions and professional registration, whichdefinition shall be limited in subject matter to coverage provided byorganizations subject to regulation by insurance law or by insuranceauthorities of this or any other state of the United States or any province ofCanada, and by hospital or medical service organizations, and to any othercoverage the inclusion of which may be approved by the director of thedepartment of insurance, financial institutions and professional registration. In the absence of such definition such term shall not include groupinsurance, automobile medical payments insurance, or coverage provided byhospital or medical service organizations or by union welfare plans oremployer or employees benefit organizations. For the purpose of applying theforegoing policy provision with respect to any insured, any amount of benefitprovided for such insured pursuant to any compulsory benefit statute(including any workers' compensation or employer's liability statute whetherprovided by a governmental agency or otherwise shall in all cases be deemed tobe "other valid coverage" of which the insurer has had notice. In applyingthe foregoing policy provision no third party liability coverage shall beincluded as "other valid coverage").
(5) A provision as follows:
"INSURANCE WITH OTHER INSURERS:
If there be other valid coverage, not with this insurer, providingbenefits for the same loss on other than an expense incurred basis and ofwhich this insurer has not been given written notice prior to the occurrenceor commencement of loss, the only liability for such benefits under thispolicy shall be for such proportion of the indemnities otherwise providedhereunder for such loss as the like indemnities of which the insurer hadnotice (including the indemnities under this policy) bear to the total amountof all like indemnities for such loss, and for the return of such portion ofthe premium paid as shall exceed the pro rata portion for the indemnities thusdetermined".
(If the foregoing policy provision is included in a policy which alsocontains the next preceding policy provision there shall be added to thecaption of the foregoing provision the phrase--"OTHER BENEFITS". The insurermay, at its option, include in this provision a definition of "other validcoverage", approved as to form by the director of the department of insurance,financial institutions and professional registration which definition shall belimited in subject matter to coverage provided by organizations subject toregulation by insurance law or by insurance authorities of this or any otherstate of the United States or any province of Canada, and to any othercoverage the inclusion of which may be approved by the director of thedepartment of insurance, financial institutions and professional registration. In the absence of such definition such term shall not include groupinsurance, or benefits provided by union welfare plans or by employer oremployee benefit organizations. For the purpose of applying the foregoingpolicy provision with respect to any insured, any amount of benefit providedfor such insured pursuant to any compulsory benefit statute (including anyworkers' compensation or employer's liability statute) whether provided by agovernmental agency or otherwise shall in all cases be deemed to be "othervalid coverage", of which the insurer has had notice. In applying theforegoing policy provision no third party liability coverage shall be includedas "other valid coverage").
(6) A provision as follows:
"RELATION OF EARNINGS TO INSURANCE:
If the total monthly amount of loss of time benefits promised for thesame loss under all valid loss of time coverage upon the insured, whetherpayable on a weekly or monthly basis, shall exceed the monthly earnings of theinsured at the time disability commenced or his average monthly earnings forthe period of two years immediately preceding a disability for which claim ismade, whichever is the greater, the insurer will be liable only for suchproportionate amount of such benefits under this policy as the amount of suchmonthly earnings or such average monthly earnings of the insured bears to thetotal amount of monthly benefits for the same loss under all such coverageupon the insured at the time such disability commences and for the return ofsuch part of the premiums paid during such two years as shall exceed the prorata amount of the premiums for the benefits actually paid hereunder; but thisshall not operate to reduce the total monthly amount of benefits payable underall such coverage upon the insured below the sum of two hundred dollars or thesum of the monthly benefits specified in such coverages, whichever is thelesser, nor shall it operate to reduce benefits other than those payable forloss of time".
(The foregoing policy provision may be inserted only in a policy whichthe insured has the right to continue in force subject to its terms by thetimely payment of premiums (1) until at least age fifty or, (2) in the case ofa policy issued after age forty-four, for at least five years from this dateof issue. The insurer may, at its option, include in this provision adefinition of "valid loss of time coverage", approved as to form by thedirector of the department of insurance, financial institutions andprofessional registration, which definition shall be limited in subject matterto coverage provided by governmental agencies or by organizations subject toregulation by insurance law or by insurance authorities of this or any otherstate of the United States or any province of Canada, or to any other coveragethe inclusion of which may be approved by the director of the department ofinsurance, financial institutions and professional registration or anycombination of such coverages. In the absence of such definition such termshall not include any coverage provided for such insured pursuant to anycompulsory benefit statute (including any workers' compensation or employer'sliability statute), or benefits provided by union welfare plans or by employeror employee benefit organizations).
(7) A provision as follows:
"UNPAID PREMIUM:
Upon the payment of a claim under this policy, any premium then due andunpaid or covered by any note or written order may be deducted therefrom".
(8) A provision as follows:
"CANCELLATION:
The insurer may cancel this policy at any time by written noticedelivered to the insured, or mailed to his last address as shown by therecords of the insurer, stating when, not less than five days thereafter, suchcancellation shall be effective; and after the policy has been continuedbeyond its original term the insured may cancel this policy at any time bywritten notice delivered or mailed to the insurer, effective upon receipt oron such later date as may be specified in such notice. In the event ofcancellation, the insurer will return promptly the unearned portion of anypremium paid. If the insured cancels, the earned premium shall be computed bythe use of the short-rate table last filed with the state official havingsupervision of insurance in the state where the insured resided when thepolicy was issued. If the insurer cancels, the earned premium shall becomputed pro rata. Cancellation shall be without prejudice to any claimoriginating prior to the effective date of cancellation".
(9) A provision as follows:
"CONFORMITY WITH STATE STATUTES:
Any provision of this policy which, on its effective date, is in conflictwith the statutes of the state in which the insured resides on such date ishereby amended to conform to the minimum requirements of such statutes".
(10) A provision as follows:
"ILLEGAL OCCUPATION:
The insurer shall not be liable for any loss to which a contributingcause was the insured's commission of or attempt to commit a felony or towhich a contributing cause was the insured's being engaged in an illegaloccupation".
(11) A provision as follows:
"INTOXICANTS AND NARCOTICS:
The insurer shall not be liable for any loss sustained or contracted inconsequence of the insured's being intoxicated or under the influence of anynarcotic unless administered on the advice of a physician".
3. Inapplicable or inconsistent provisions. If any provision of thissection is in whole or in part inapplicable to or inconsistent with thecoverage provided by a particular form of policy the insurer, with theapproval of the director of the department of insurance, financialinstitutions and professional registration, shall omit from such policy aninapplicable provision or part of a provision, and shall modify anyinconsistent provision or part of the provision, in such manner as to make theprovision as contained in the policy consistent with the coverage provided bythe policy.
4. Order of certain policy provisions. The provisions which are thesubject of subsections 1 and 2 of this section, or any correspondingprovisions which are used in lieu thereof in accordance with such subsections,shall be printed in the consecutive order of the provisions in suchsubsections or, at the option of the insurer, any such provision may appear asa unit in any part of the policy, with other provisions to which it may belogically related, provided the resulting policy shall not be in whole or inpart unintelligible, uncertain, ambiguous, abstruse, or likely to mislead aperson to whom the policy is offered, delivered or issued.
5. Third party ownership. The word "insured" as used in sections376.770 to 376.800, shall not be construed as preventing a person other thanthe insured with a proper insurable interest from making application for andowning a policy covering the insured or from being entitled under such apolicy to any indemnities, benefits and rights provided therein.
6. Requirements of other jurisdictions.
(1) Any policy of a foreign or alien insurer, when delivered or issuedfor delivery to any person in this state, may contain any provision which isnot less favorable to the insured or the beneficiary than the provisions ofsections 376.770 to 376.800 and which is prescribed or required by the law ofthe state under which the insurer is organized.
(2) Any policy of a domestic insurer may, when issued for delivery inany other state or country, contain any provision permitted or required by thelaws of such other state or country.
7. Approval of policies.
(1) No policy subject to sections 376.770 to 376.800 shall be deliveredor issued for delivery to any person in this state unless such policy,including any rider, endorsement or other provisions, supplementary thereto,shall have been approved by the director of the department of insurance,financial institutions and professional registration.
(2) The director of the department of insurance, financial institutionsand professional registration shall have authority to make such reasonablerules and regulations concerning the filing and submission of policies as arenecessary, proper or advisable. Such rules and regulations shall provide,among other things, that if a policy form is disapproved, the reasons thereforshall be stated in writing; that a hearing shall be granted upon suchdisapproval, if so requested; and that the failure of the director of thedepartment of insurance, financial institutions and professional registrationto take action approving or disapproving a submitted policy form within astipulated time, not to exceed sixty days from the date of filing, shall bedeemed an approval thereof until such time as the director of the departmentof insurance, financial institutions and professional registration shallnotify the submitting company, in writing, of his disapproval thereof.
(3) The director of the department of insurance, financial institutionsand professional registration shall approve only those policies which are incompliance with the insurance laws of this state and which contain such words,phraseology, conditions and provisions which are specific, certain andunambiguous and reasonably adequate to meet needed requirements for theprotection of those insured. The disapproval of any policy form shall bebased upon the requirements of the laws of this state or of any regulationlawfully promulgated thereunder.
(4) The director of the department of insurance, financial institutionsand professional registration may, by order or bulletin, exempt from theapproval requirements of this section for so long as he deems proper anyinsurance policy, document, or form or type thereof, as specified in suchorder or bulletin, to which, in his opinion, this section may not practicablybe applied, or the approval of which is, in his opinion, not desirable ornecessary for the protection of the public.
376.777. 1. Required provisions. Except as provided in subsection 3 ofthis section each such policy delivered or issued for delivery to any personin this state shall contain the provisions specified in this subsection in thewords in which the same appear in this section; provided, however, that theinsurer may, at its option, substitute for one or more of such provisionscorresponding provisions of different wording approved by the director of thedepartment of insurance, financial institutions and professional registrationwhich are in each instance not less favorable in any respect to the insured orthe beneficiary. Such provisions shall be preceded individually by thecaption appearing in this subsection or, at the option of the insurer, by suchappropriate individual or group captions or subcaptions as the director of thedepartment of insurance, financial institutions and professional registrationmay approve.
(1) A provision as follows:
"ENTIRE CONTRACT; CHANGES: This policy, including the endorsements and the attached papers, if any,constitutes the entire contract of insurance. No change in this policy shallbe valid until approved by an executive officer of the insurer and unless suchapproval be endorsed hereon or attached hereto. No agent has authority tochange this policy or to waive any of its provisions".
(When under the provisions of subdivision (2) of subsection 1 of section376.775 the effective and termination dates are stated in the premium receipt,the insurer shall insert in the first sentence of the foregoing policyprovision immediately following the comma after the word "any", the followingwords: "and the insurer's official premium receipt when executed").
(2) A provision as follows:
"TIME LIMIT ON CERTAIN DEFENSES:
(a) After two years from the date of issue of this policy nomisstatements, except fraudulent misstatements, made by the applicant in theapplication for such policy shall be used to void the policy or to deny aclaim for loss incurred or disability (as defined in the policy) commencingafter the expiration of such two-year period".
(The foregoing policy provision shall not be so construed as to affectany legal requirements for avoidance of a policy or denial of a claim duringsuch initial two-year period, nor to limit the application of subdivisions(1), (2), (3), (4) and (5) of subsection 2 of this section in the event ofmisstatement with respect to age or occupation or other insurance.)
(A policy which the insured has the right to continue in force subject toits terms by the timely payment of premium (1) until at least age fifty or,(2) in the case of a policy issued after age forty-four, for at least fiveyears from its date of issue, may contain in lieu of the foregoing thefollowing provision (from which the clause in parentheses may be omitted atthe insurer's option) under the caption "UNCONTESTABLE": "After this policy has been in force for a period of three years during thelifetime of the insured (excluding any period during which the insured isdisabled), it shall become uncontestable as to the statements contained in theapplication).
(b) No claim for loss incurred or disability (as defined in the policy)commencing after two years from the date of issue of this policy shall bereduced or denied on the ground that a disease or physical condition notexcluded from coverage by name or specific description effective on the dateof loss had existed prior to the effective date of coverage of this policy."
(3) A provision as follows: "GRACE PERIOD: A grace period of . . .(insert a number not less than "7" for weekly premium policies, "10" formonthly premium policies and "31" for all other policies) days will be grantedfor the payment of each premium falling due after the first premium, duringwhich grace period the policy shall continue in force."
(A policy which contains a cancellation provision may add, at the end ofthe above provision, subject to the right of the insurer to cancel inaccordance with the cancellation provision hereof. A policy in which theinsurer reserves the right to refuse any renewal shall have, at the beginningof the above provision, "Unless not less than five days prior to the premiumdue date the insurer has delivered to the insured or has mailed to his lastaddress as shown by the records of the insurer written notice of its intentionnot to renew this policy beyond the period for which the premium has beenaccepted").
(4) A provision as follows:
"REINSTATEMENT:
If any renewal premium be not paid within the time granted the insuredfor payment, a subsequent acceptance of premium by the insurer or by any agentduly authorized by the insurer to accept such premium, without requiring inconnection therewith an application for reinstatement, shall reinstate thepolicy; provided, however, that if the insurer or such agent requires anapplication for reinstatement and issues a conditional receipt for the premiumtendered, the policy will be reinstated upon approval of such application bythe insurer, or, lacking such approval, upon the forty-fifth day following thedate of such conditional receipt unless the insurer has previously notifiedthe insured in writing of its disapproval of such application. The reinstatedpolicy shall cover only loss resulting from such accidental injury as may besustained after the date of reinstatement and loss due to such sickness as maybegin more than ten days after such date. In all other respects the insuredand insurer shall have the same rights thereunder as they had under the policyimmediately before the due date of the defaulted premium, subject to anyprovisions endorsed hereon or attached hereto in connection with thereinstatement. Any premium accepted in connection with a reinstatement shallbe applied to a period for which premium has not been previously paid, but notto any period more than sixty days prior to the date of reinstatement".
(The last sentence of the above provision may be omitted from any policywhich the insured has the right to continue in force subject to its terms bythe timely payment of premiums (1) until at least age fifty or, (2) in thecase of a policy issued after age forty-four, for at least five years from itsdate of issue.)
(5) A provision as follows:
"NOTICE OF CLAIM:
Written notice of claim must be given to the insurer within twenty daysafter the occurrence or commencement of any loss covered by the policy, or assoon thereafter as is reasonably possible. Notice given by or on behalf ofthe insured or the beneficiary to the insured at .......... (insert thelocation of such office as the insurer may designate for the purpose), or toany authorized agent of the insurer, with information sufficient to identifythe insured, shall be deemed notice to the insurer".
(In a policy providing a loss-of-time benefit which may be payable for atleast two years, an insurer may at its option insert the following between thefirst and second sentences of the above provision: "Subject to thequalifications set forth below, if the insured suffers loss of time on accountof disability for which indemnity may be payable for at least two years, heshall, at least once in every six months after having given notice of claim,give to the insurer notice of continuance of said disability, except in theevent of legal incapacity. The period of six months following any filing ofproof by the insured or any payment by the insurer on account of such claim orany denial of liability in whole or in part by the insurer shall be excludedin applying this provision. Delay in the giving of such notice shall notimpair the insured's right to any indemnity which would otherwise have accruedduring the period of six months preceding the date on which such notice isactually given").
(6) A provision as follows:
"CLAIM FORMS:
The insurer upon receipt of a notice of claim, will furnish to theclaimant such forms as are usually furnished by it for filing proofs of loss.If such forms are not furnished within fifteen days after the giving of suchnotice the claimant shall be deemed to have complied with the requirements ofthis policy as to proof of loss upon submitting, within the time fixed in thepolicy for filing proofs of loss, written proof covering the occurrence, thecharacter and the extent of the loss for which claim is made".
(7) A provision as follows:
"PROOFS OF LOSS:
Written proof of loss must be furnished to the insurer at its said officein case of claim for loss for which this policy provides any periodic paymentcontingent upon continuing loss within ninety days after the termination ofthe period for which the insurer is liable and in case of claim for any otherloss within ninety days after the date of such loss. Failure to furnish suchproof within the time required shall not invalidate nor reduce any claim if itwas not reasonably possible to give proof within such time, provided suchproof is furnished as soon as reasonably possible and in no event, except inthe absence of legal capacity, later than one year from the time proof isotherwise required".
(8) A provision as follows:
"TIME OF PAYMENT OF CLAIMS:
Indemnities payable under this policy for any loss other than loss forwhich this policy provides any periodic payment will be paid immediately uponreceipt of due written proof of such loss. Subject to due written proof ofloss, all accrued indemnities for loss for which this policy provides periodicpayment will be paid .......... (insert period for payment which must not beless frequently than monthly) and any balance remaining unpaid upon thetermination of liability will be paid immediately upon receipt of due writtenproof".
(9) A provision as follows:
"PAYMENT OF CLAIMS:
Indemnity for loss of life will be payable in accordance with thebeneficiary designation and the provisions respecting such payment which maybe prescribed herein and effective at the time of payment. If no suchdesignation or provision is then effective, such indemnity shall be payable tothe estate of the insured. Any other accrued indemnities unpaid at theinsured's death may, at the option of the insurer, be paid either to suchbeneficiary or to such estate. All other indemnities will be payable to theinsured".
(The following provisions, or either of them, may be included with theforegoing provision at the option of the insurer: "If any indemnity of this policy shall be payable to the estate of theinsured, or to an insured or beneficiary who is a minor or otherwise notcompetent to give a valid release, the insurer may pay such indemnity, up toan amount not exceeding $...... (insert an amount which shall not exceed onethousand dollars), to any relative by blood or connection by marriage of theinsured or beneficiary who is deemed by the insurer to be equitably entitledthereto. Any payment made by the insurer in good faith pursuant to thisprovision shall fully discharge the insurer to the extent of such payment.Subject to any written direction of the insured in the application orotherwise all or a portion of any indemnities provided by this policy onaccount of hospital, nursing, medical, or surgical services may, at theinsurer's option and unless the insured requests otherwise in writing notlater than the time of filing proofs of such loss, be paid directly to thehospital or person rendering such services; but it is not required that theservice be rendered by a particular hospital or person").
(10) A provision as follows:
"PHYSICAL EXAMINATIONS AND AUTOPSY:
The insurer at its own expense shall have the right and opportunity toexamine the person of the insured when and as often as it may reasonablyrequire during the pendency of a claim hereunder and to make an autopsy incase of death where it is not forbidden by law".
(11) A provision as follows:
"LEGAL ACTIONS:
No action at law or in equity shall be brought to recover on this policyprior to the expiration of sixty days after written proof of loss has beenfurnished in accordance with the requirements of this policy. No such actionshall be brought after the expiration of three years after the time writtenproof of loss is required to be furnished".
(12) A provision as follows:
"CHANGE OF BENEFICIARY:
Unless the insured makes an irrevocable designation of beneficiary, theright to change of beneficiary is reserved to the insured and the consent ofthe beneficiary or beneficiaries shall not be requisite to surrender orassignment of this policy or to change of beneficiary or beneficiaries, or toany other changes in this policy".
(The first clause of this provision, relating to the irrevocabledesignation of beneficiary, may be omitted at the insurer's option).
2. Other provisions. Except as provided in subsection 3 of thissection, no such policy delivered or issued for delivery to any person in thisstate shall contain provisions respecting the matters set forth below unlesssuch provisions are in the words in which the same appear in this section;provided, however, that the insurer may, at its option, use in lieu of anysuch provision a corresponding provision of different wording approved by thedirector of the department of insurance, financial institutions andprofessional registration which is not less favorable in any respect to theinsured or the beneficiary. Any such provision contained in the policy shallbe preceded individually by the appropriate caption appearing in thissubsection or, at the option of the insurer, by such appropriate individual orgroup captions or subcaptions as the director of the department of insurance,financial institutions and professional registration may approve.
(1) A provision as follows:
"CHANGE OF OCCUPATION:
If the insured be injured or contract sickness after having changed hisoccupation to one classified by the insurer as more hazardous than that statedin this policy or while doing for compensation anything pertaining to anoccupation so classified, the insurer will pay only such portion of theindemnities provided in this policy as the premium paid would have purchasedat the rates and within the limits fixed by the insurer for such morehazardous occupation. If the insured changes his occupation to one classifiedby 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 premiumrate accordingly, and will return the excess pro rata unearned premium fromthe date of change of occupation or from the policy anniversary dateimmediately preceding receipt of such proof, whichever is the more recent. Inapplying this provision, the classification of occupational risk and thepremium rates shall be such as have been last filed by the insurer prior tothe occurrence of the loss for which the insurer is liable or prior to date ofproof of change in occupation with the state official having supervision ofinsurance in the state where the insured resided at the time this policy wasissued; but if such filing was not required, then the classification ofoccupational risk and the premium rates shall be those last made effective bythe insurer in such state prior to the occurrence of the loss or prior to thedate of proof of change in occupation".
(2) A provision as follows:
"MISSTATEMENT OF AGE:
If the age of the insured has been misstated, all amounts payable underthis policy shall be such as the premium paid would have purchased at thecorrect age".
(3) A provision as follows:
"OTHER INSURANCE IN THIS INSURER:
If an accident or sickness or accident and sickness policy or policiespreviously issued by the insurer to the insured be in force concurrentlyherewith, making the aggregate indemnity for .......... (insert type ofcoverage or coverages) in excess of $...... (insert maximum limit of indemnityor indemnities) the excess insurance shall be void and all premiums paid forsuch excess shall be returned to the insured or to his estate, or in lieuthereof. Insurance effective at any one time on the insured under a like policy orpolicies in this insurer is limited to the one such policy elected by theinsured, his beneficiary or his estate, as the case may be, and the insurerwill return all premiums paid for all other such policies".
(4) A provision as follows:
"INSURANCE WITH OTHER INSURERS:
If there be other valid coverage, not with this insurer, providingbenefits for the same loss on a provision of service basis or on an expenseincurred basis and of which this insurer has not been given written noticeprior to the occurrence or commencement of loss, the only liability under anyexpense incurred coverage of this policy shall be for such proportion of theloss as the amount which would otherwise have been payable hereunder plus thetotal of the like amounts under all such other valid coverages for the sameloss of which this insurer had notice bears to the total like amounts underall valid coverages for such loss, and for the return of such portion of thepremiums paid as shall exceed the pro rata portion for the amount sodetermined. For the purpose of applying this provision when other coverage ison a provision of service basis, the "like amount" of such other coverageshall be taken as the amount which the services rendered would have cost inthe absence of such coverage".
(If the foregoing policy provision is included in a policy which alsocontains the next following policy provision there shall be added to thecaption of the foregoing provision 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 director of the departmentof insurance, financial institutions and professional registration, whichdefinition shall be limited in subject matter to coverage provided byorganizations subject to regulation by insurance law or by insuranceauthorities of this or any other state of the United States or any province ofCanada, and by hospital or medical service organizations, and to any othercoverage the inclusion of which may be approved by the director of thedepartment of insurance, financial institutions and professional registration. In the absence of such definition such term shall not include groupinsurance, automobile medical payments insurance, or coverage provided byhospital or medical service organizations or by union welfare plans oremployer or employees benefit organizations. For the purpose of applying theforegoing policy provision with respect to any insured, any amount of benefitprovided for such insured pursuant to any compulsory benefit statute(including any workers' compensation or employer's liability statute whetherprovided by a governmental agency or otherwise shall in all cases be deemed tobe "other valid coverage" of which the insurer has had notice. In applyingthe foregoing policy provision no third party liability coverage shall beincluded as "other valid coverage").
(5) A provision as follows:
"INSURANCE WITH OTHER INSURERS:
If there be other valid coverage, not with this insurer, providingbenefits for the same loss on other than an expense incurred basis and ofwhich this insurer has not been given written notice prior to the occurrenceor commencement of loss, the only liability for such benefits under thispolicy shall be for such proportion of the indemnities otherwise providedhereunder for such loss as the like indemnities of which the insurer hadnotice (including the indemnities under this policy) bear to the total amountof all like indemnities for such loss, and for the return of such portion ofthe premium paid as shall exceed the pro rata portion for the indemnities thusdetermined".
(If the foregoing policy provision is included in a policy which alsocontains the next preceding policy provision there shall be added to thecaption of the foregoing provision the phrase--"OTHER BENEFITS". The insurermay, at its option, include in this provision a definition of "other validcoverage", approved as to form by the director of the department of insurance,financial institutions and professional registration which definition shall belimited in subject matter to coverage provided by organizations subject toregulation by insurance law or by insurance authorities of this or any otherstate of the United States or any province of Canada, and to any othercoverage the inclusion of which may be approved by the director of thedepartment of insurance, financial institutions and professional registration. In the absence of such definition such term shall not include groupinsurance, or benefits provided by union welfare plans or by employer oremployee benefit organizations. For the purpose of applying the foregoingpolicy provision with respect to any insured, any amount of benefit providedfor such insured pursuant to any compulsory benefit statute (including anyworkers' compensation or employer's liability statute) whether provided by agovernmental agency or otherwise shall in all cases be deemed to be "othervalid coverage", of which the insurer has had notice. In applying theforegoing policy provision no third party liability coverage shall be includedas "other valid coverage").
(6) A provision as follows:
"RELATION OF EARNINGS TO INSURANCE:
If the total monthly amount of loss of time benefits promised for thesame loss under all valid loss of time coverage upon the insured, whetherpayable on a weekly or monthly basis, shall exceed the monthly earnings of theinsured at the time disability commenced or his average monthly earnings forthe period of two years immediately preceding a disability for which claim ismade, whichever is the greater, the insurer will be liable only for suchproportionate amount of such benefits under this policy as the amount of suchmonthly earnings or such average monthly earnings of the insured bears to thetotal amount of monthly benefits for the same loss under all such coverageupon the insured at the time such disability commences and for the return ofsuch part of the premiums paid during such two years as shall exceed the prorata amount of the premiums for the benefits actually paid hereunder; but thisshall not operate to reduce the total monthly amount of benefits payable underall such coverage upon the insured below the sum of two hundred dollars or thesum of the monthly benefits specified in such coverages, whichever is thelesser, nor shall it operate to reduce benefits other than those payable forloss of time".
(The foregoing policy provision may be inserted only in a policy whichthe insured has the right to continue in force subject to its terms by thetimely payment of premiums (1) until at least age fifty or, (2) in the case ofa policy issued after age forty-four, for at least five years from this dateof issue. The insurer may, at its option, include in this provision adefinition of "valid loss of time coverage", approved as to form by thedirector of the department of insurance, financial institutions andprofessional registration, which definition shall be limited in subject matterto coverage provided by governmental agencies or by organizations subject toregulation by insurance law or by insurance authorities of this or any otherstate of the United States or any province of Canada, or to any other coveragethe inclusion of which may be approved by the director of the department ofinsurance, financial institutions and professional registration or anycombination of such coverages. In the absence of such definition such termshall not include any coverage provided for such insured pursuant to anycompulsory benefit statute (including any workers' compensation or employer'sliability statute), or benefits provided by union welfare plans or by employeror employee benefit organizations).
(7) A provision as follows:
"UNPAID PREMIUM:
Upon the payment of a claim under this policy, any premium then due andunpaid or covered by any note or written order may be deducted therefrom".
(8) A provision as follows:
"CANCELLATION:
The insurer may cancel this policy at any time by written noticedelivered to the insured, or mailed to his last address as shown by therecords of the insurer, stating when, not less than five days thereafter, suchcancellation shall be effective; and after the policy has been continuedbeyond its original term the insured may cancel this policy at any time bywritten notice delivered or mailed to the insurer, effective upon receipt oron such later date as may be specified in such notice. In the event ofcancellation, the insurer will return promptly the unearned portion of anypremium paid. If the insured cancels, the earned premium shall be computed bythe use of the short-rate table last filed with the state official havingsupervision of insurance in the state where the insured resided when thepolicy was issued. If the insurer cancels, the earned premium shall becomputed pro rata. Cancellation shall be without prejudice to any claimoriginating prior to the effective date of cancellation".
(9) A provision as follows:
"CONFORMITY WITH STATE STATUTES:
Any provision of this policy which, on its effective date, is in conflictwith the statutes of the state in which the insured resides on such date ishereby amended to conform to the minimum requirements of such statutes".
(10) A provision as follows:
"ILLEGAL OCCUPATION:
The insurer shall not be liable for any loss to which a contributingcause was the insured's commission of or attempt to commit a felony or towhich a contributing cause was the insured's being engaged in an illegaloccupation".
(11) A provision as follows:
"INTOXICANTS AND NARCOTICS:
The insurer shall not be liable for any loss sustained or contracted inconsequence of the insured's being intoxicated or under the influence of anynarcotic unless administered on the advice of a physician".
3. Inapplicable or inconsistent provisions. If any provision of thissection is in whole or in part inapplicable to or inconsistent with thecoverage provided by a particular form of policy the insurer, with theapproval of the director of the department of insurance, financialinstitutions and professional registration, shall omit from such policy aninapplicable provision or part of a provision, and shall modify anyinconsistent provision or part of the provision, in such manner as to make theprovision as contained in the policy consistent with the coverage provided bythe policy.
4. Order of certain policy provisions. The provisions which are thesubject of subsections 1 and 2 of this section, or any correspondingprovisions which are used in lieu thereof in accordance with such subsections,shall be printed in the consecutive order of the provisions in suchsubsections or, at the option of the insurer, any such provision may appear asa unit in any part of the policy, with other provisions to which it may belogically related, provided the resulting policy shall not be in whole or inpart unintelligible, uncertain, ambiguous, abstruse, or likely to mislead aperson to whom the policy is offered, delivered or issued.
5. Third party ownership. The word "insured" as used in sections376.770 to 376.800, shall not be construed as preventing a person other thanthe insured with a proper insurable interest from making application for andowning a policy covering the insured or from being entitled under such apolicy to any indemnities, benefits and rights provided therein.
6. Requirements of other jurisdictions.
(1) Any policy of a foreign or alien insurer, when delivered or issuedfor delivery to any person in this state, may contain any provision which isnot less favorable to the insured or the beneficiary than the provisions ofsections 376.770 to 376.800 and which is prescribed or required by the law ofthe state under which the insurer is organized.
(2) Any policy of a domestic insurer may, when issued for delivery inany other state or country, contain any provision permitted or required by thelaws of such other state or country.
7. Approval of policies.
(1) No policy subject to sections 376.770 to 376.800 shall be deliveredor issued for delivery to any person in this state unless such policy,including any rider, endorsement or other provisions, supplementary thereto,shall have been approved by the director of the department of insurance,financial institutions and professional registration.
(2) The director of the department of insurance, financial institutionsand professional registration shall have authority to make such reasonablerules and regulations concerning the filing and submission of policies as arenecessary, proper or advisable. Such rules and regulations shall provide,among other things, that if a policy form is disapproved, the reasons thereforshall be stated in writing; that a hearing shall be granted upon suchdisapproval, if so requested; and that the failure of the director of thedepartment of insurance, financial institutions and professional registrationto take action approving or disapproving a submitted policy form within astipulated time, not to exceed sixty days from the date of filing, shall bedeemed an approval thereof until such time as the director of the departmentof insurance, financial institutions and professional registration shallnotify the submitting company, in writing, of his disapproval thereof.
(3) The director of the department of insurance, financial institutionsand professional registration shall approve only those policies which are incompliance with the insurance laws of this state and which contain such words,phraseology, conditions and provisions which are specific, certain andunambiguous and reasonably adequate to meet needed requirements for theprotection of those insured. The disapproval of any policy form shall bebased upon the requirements of the laws of this state or of any regulationlawfully promulgated thereunder.
(4) The director of the department of insurance, financial institutionsand professional registration may, by order or bulletin, exempt from theapproval requirements of this section for so long as he deems proper anyinsurance policy, document, or form or type thereof, as specified in suchorder or bulletin, to which, in his opinion, this section may not practicablybe applied, or the approval of which is, in his opinion, not desirable ornecessary for the protection of the public.
