Except as provided in § 38.2-3505, no individual accident and sicknessinsurance policy delivered or issued for delivery in this Commonwealth shallcontain provisions respecting the matters set forth below unless suchprovisions use the same words which appear in this section. Provisions 1through 7, 8 a, and 9 through 11 shall apply to all such policies that areissued for delivery or delivered in this Commonwealth prior to January 1,2001. Provisions 1 through 7, 8 b, and 9 through 11 shall apply to all suchpolicies that are issued for delivery, delivered, renewed, or extended inthis Commonwealth on or after January 1, 2001. The insurer may use acorresponding provision of different wording approved by the Commission thatis not less favorable in any respect to the Insured or the beneficiary. Anysuch provision shall be preceded individually by the appropriate captionOTHER PROVISIONS or by such appropriate individual or group captions orsubcaptions as the Commission may approve.
1. Provision 1:
CHANGE OF OCCUPATION: If the Insured is injured or contracts sickness afterhaving changed his occupation to one classified by the Company as morehazardous than that stated in this policy or while doing for compensationanything pertaining to an occupation so classified, the Company will pay onlythe portion of the indemnities provided in this policy as the premium paidwould have purchased at the rates and within the limits fixed by the Companyfor the more hazardous occupation. If the Insured changes his occupation toone classified by the Company as less hazardous than that stated in thispolicy, the Company, upon receipt of proof of the change of occupation, willreduce the premium rate accordingly and will return the excess pro rataunearned premium from the date of change of occupation or from the policyanniversary date immediately preceding receipt of such proof, whichever ismore recent. In applying this provision, the classification of occupationalrisk and the premium rates shall be such as have been last filed by theCompany prior to the occurrence of the loss for which the Company is liableor prior to the date of proof of change in occupation with the stateinsurance supervisory official in the state where the Insured resided at thetime this policy was issued; but if the filing was not required, then theclassification of occupational risk and the premium rates shall be those lastmade effective by the Company in the state prior to the occurrence of theloss or prior to the date of proof of change in occupation.
2. Provision 2:
MISSTATEMENT OF AGE: If the Insured's age has been misstated, the benefitswill be those the premium paid would have purchased at the correct age.
3. Provision 3:
OTHER INSURANCE IN THIS COMPANY: If an accident or sickness or accident andsickness policy or policies previously issued by the Company to the Insuredis in force concurrently herewith, making the aggregate indemnity for ...................................(insert type of coverage or coverages) in excess of $........ (insert maximumlimit of indemnity or indemnities) the excess insurance shall be void and allpremiums paid for such excess shall be returned to the Insured or to hisestate.
Instead of Provision 3, the following provision may be used:
Insurance effective at any one time on the Insured under a like policy orpolicies in this Company is limited to the one such policy elected by theInsured, his beneficiary or his estate, as the case may be, and the Companywill return all premiums paid for all other such policies.
4. Provision 4:
INSURANCE WITH OTHER COMPANIES: If there is other valid coverage, not withthis Company, providing benefits for the same loss on a provision of servicebasis or on an expense incurred basis and of which this Company has not beengiven written notice prior to the occurrence or commencement of loss, theonly liability under any expense incurred coverage of this policy shall befor such proportion of the loss as the amount which would otherwise have beenpayable under this policy plus the total of the like amounts under all suchother valid coverages for the same loss of which this Company had noticebears to the total like amounts under all valid coverages for such loss, andfor the return of such portion of the premiums paid as shall exceed the prorata portion for the amount so determined. For the purpose of applying thisprovision when other coverage is on a provision of service basis, the "likeamount" of such other coverage shall be taken as the amount which theservices rendered would have cost in the absence of such coverage.
If Provision 4 is included in a policy that also contains Provision 5, thephrase "EXPENSE INCURRED BENEFITS" shall be added to the caption ofProvision 4. The insurer may include in this provision a definition of"other valid coverage," approved by the Commission. The definition shall belimited in subject matter to coverage provided by organizations subject toregulation by insurance law or by insurance authorities of this Commonwealthor any other jurisdiction of the United States or Canada, and by hospital ormedical service organizations, and to any other coverage the inclusion ofwhich may be approved by the Commission. In the absence of such definitionthe term shall not include group insurance, automobile medical paymentsinsurance, or coverage provided by hospital or medical service organizations,by union welfare plans, or employer or employee benefit organizations.
For the purpose of applying Provision 4, any amount of benefit provided forsuch 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 company has had notice. In applying Provision 4no third party liability coverage shall be included as "other validcoverage."
5. Provision 5:
INSURANCE WITH OTHER COMPANIES: If there is other valid coverage, not withthis Company, providing benefits for the same loss on other than an expenseincurred basis and of which this Company has not been given written noticeprior to the occurrence or commencement of loss, the only liability for suchbenefits under this policy shall be for such proportion of the indemnitiesotherwise provided under this policy for such loss as the like indemnities ofwhich the Company had notice, including the indemnities under this policy,bear to the total amount of all like indemnities for such loss, and for thereturn of such portion of the premium paid as shall exceed the pro rataportion for the indemnities thus determined.
If Provision 5 is included in a policy that also contains Provision 4, thephrase "OTHER BENEFITS" shall be added to the caption of Provision 5. Theinsurer may include in this provision a definition of "other validcoverage," approved by the Commission. The definition shall be limited insubject matter to coverage provided by organizations subject to regulation byinsurance law or by insurance authorities of this Commonwealth or any otherjurisdiction of the United States or Canada, and to any other coverageapproved by the Commission. In the absence of such definition the term shallnot include group insurance, or benefits provided by union welfare plans orby employer or employee benefit organizations. For the purpose of applyingProvision 5, any amount of benefit provided for the insured pursuant to anycompulsory benefit statute, including any workers' compensation or employer'sliability statute, whether provided by a governmental agency or otherwise,shall in all cases be deemed to be "other valid coverage" of which theCompany has had notice. In applying Provision 5 no third party liabilitycoverage shall be included as "other valid coverage."
6. Provision 6:
RELATION OF EARNINGS TO INSURANCE: If the total monthly amount of loss oftime benefits promised for the same loss under all valid loss of timecoverage upon the Insured, whether payable on a weekly or monthly basis,shall exceed the monthly earnings of the Insured at the time disabilitycommenced or his average monthly earnings for the period of two yearsimmediately preceding a disability for which a claim is made, whichever isgreater, the Company will be liable only for the proportionate amount of thebenefits under this policy as the amount of the monthly earnings or theaverage monthly earnings of the Insured bears to the total amount of monthlybenefits for the same loss under all the coverage upon the insured at thetime the disability commences and for the return of the part of the premiumspaid during such two years that exceeds the pro rata amount of the premiumsfor the benefits actually paid hereunder; but this shall not operate toreduce the total monthly amount of benefits payable under all the coverageupon the Insured below the sum of $200 or the sum of the monthly benefitsspecified in the coverages, whichever is less, nor shall it operate to reducebenefits other than those payable for loss of time.
Provision 6 may be inserted only in a policy that the insured has the rightto continue in force subject to its terms by the timely payment of premiums(i) until at least age 50 or (ii) for a policy issued after age 44, for atleast five years from its date of issue. The insurer may include in thisprovision a definition of "valid loss of time coverage" approved by theCommission. The definition shall be limited in subject matter to coverageprovided by governmental agencies or by organizations subject to regulationby insurance law or by insurance authorities of this Commonwealth or anyother jurisdiction of the United States or Canada, or to any other coveragethe inclusion of which may be approved by the Commission or any combinationof coverages. In the absence of such definition the term shall not includeany coverage provided for the Insured pursuant to any compulsory benefitstatute, including any workers' compensation or employer's liability statute,or benefits provided by union welfare plans or by employer or employeebenefit organizations.
7. Provision 7:
UNPAID PREMIUM: When a claim is paid, any premium due and unpaid may bededucted from the claim payment.
8. Provision 8 a:
CANCELLATION BY COMPANY: The Company may cancel this policy at any time bywritten notice delivered to the Insured, or mailed to his last address asshown by the records of the Company, stating when, no less than ...... daysthereafter, the cancellation shall be effective; and after the policy hasbeen continued beyond its original term the Insured may cancel this policy atany time by written notice delivered or mailed to the Company effective uponreceipt or on such later date as may be specified in the notice. In the eventof cancellation, the Company 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 insurancesupervisory official in the state where the Insured resided when the policywas issued. If the Company cancels, the earned premium shall be computed prorata. Cancellation shall be without prejudice to any claim originating priorto the effective date of cancellation.
Provision 8 b:
CANCELLATION BY COMPANY: The Company may cancel this policy at any time bywritten notice delivered to the Insured, or mailed to his last address asshown by the records of the Company, stating when, no less than______________ days thereafter, the cancellation shall be effective. In theevent of cancellation, the Company will return promptly the unearned portionof any premium paid. The earned premium shall be computed pro rata.Cancellation shall be without prejudice to any claim originating prior to theeffective date of cancellation.
In Provisions 8 a and 8 b, a number no less than "7" for weekly premiumpolicies, "10" for monthly premium policies and "31" for all otherpolicies shall be inserted between the words "than" and "days."
9. Provision 9:
CONFORMITY WITH STATE STATUTES: Any provision of this policy that on itseffective date is in conflict with the laws of the state in which the Insuredresides on that date is hereby amended to conform to the minimum requirementsof the laws.
10. Provision 10:
ILLEGAL OCCUPATION: The Company will not be liable for any loss that resultsfrom the Insured's committing or attempting to commit a felony or from theInsured's engaging in an illegal occupation.
11. Provision 11:
INTOXICANTS AND NARCOTICS: The Company will not be liable for any lossresulting from the Insured's being drunk, or under the influence of anynarcotic unless taken on the advice of a physician.
(1952, c. 317, § 38.1-350; 1986, c. 562; 2000, c. 540; 2003, c. 377.)
Except as provided in § 38.2-3505, no individual accident and sicknessinsurance policy delivered or issued for delivery in this Commonwealth shallcontain provisions respecting the matters set forth below unless suchprovisions use the same words which appear in this section. Provisions 1through 7, 8 a, and 9 through 11 shall apply to all such policies that areissued for delivery or delivered in this Commonwealth prior to January 1,2001. Provisions 1 through 7, 8 b, and 9 through 11 shall apply to all suchpolicies that are issued for delivery, delivered, renewed, or extended inthis Commonwealth on or after January 1, 2001. The insurer may use acorresponding provision of different wording approved by the Commission thatis not less favorable in any respect to the Insured or the beneficiary. Anysuch provision shall be preceded individually by the appropriate captionOTHER PROVISIONS or by such appropriate individual or group captions orsubcaptions as the Commission may approve.
1. Provision 1:
CHANGE OF OCCUPATION: If the Insured is injured or contracts sickness afterhaving changed his occupation to one classified by the Company as morehazardous than that stated in this policy or while doing for compensationanything pertaining to an occupation so classified, the Company will pay onlythe portion of the indemnities provided in this policy as the premium paidwould have purchased at the rates and within the limits fixed by the Companyfor the more hazardous occupation. If the Insured changes his occupation toone classified by the Company as less hazardous than that stated in thispolicy, the Company, upon receipt of proof of the change of occupation, willreduce the premium rate accordingly and will return the excess pro rataunearned premium from the date of change of occupation or from the policyanniversary date immediately preceding receipt of such proof, whichever ismore recent. In applying this provision, the classification of occupationalrisk and the premium rates shall be such as have been last filed by theCompany prior to the occurrence of the loss for which the Company is liableor prior to the date of proof of change in occupation with the stateinsurance supervisory official in the state where the Insured resided at thetime this policy was issued; but if the filing was not required, then theclassification of occupational risk and the premium rates shall be those lastmade effective by the Company in the state prior to the occurrence of theloss or prior to the date of proof of change in occupation.
2. Provision 2:
MISSTATEMENT OF AGE: If the Insured's age has been misstated, the benefitswill be those the premium paid would have purchased at the correct age.
3. Provision 3:
OTHER INSURANCE IN THIS COMPANY: If an accident or sickness or accident andsickness policy or policies previously issued by the Company to the Insuredis in force concurrently herewith, making the aggregate indemnity for ...................................(insert type of coverage or coverages) in excess of $........ (insert maximumlimit of indemnity or indemnities) the excess insurance shall be void and allpremiums paid for such excess shall be returned to the Insured or to hisestate.
Instead of Provision 3, the following provision may be used:
Insurance effective at any one time on the Insured under a like policy orpolicies in this Company is limited to the one such policy elected by theInsured, his beneficiary or his estate, as the case may be, and the Companywill return all premiums paid for all other such policies.
4. Provision 4:
INSURANCE WITH OTHER COMPANIES: If there is other valid coverage, not withthis Company, providing benefits for the same loss on a provision of servicebasis or on an expense incurred basis and of which this Company has not beengiven written notice prior to the occurrence or commencement of loss, theonly liability under any expense incurred coverage of this policy shall befor such proportion of the loss as the amount which would otherwise have beenpayable under this policy plus the total of the like amounts under all suchother valid coverages for the same loss of which this Company had noticebears to the total like amounts under all valid coverages for such loss, andfor the return of such portion of the premiums paid as shall exceed the prorata portion for the amount so determined. For the purpose of applying thisprovision when other coverage is on a provision of service basis, the "likeamount" of such other coverage shall be taken as the amount which theservices rendered would have cost in the absence of such coverage.
If Provision 4 is included in a policy that also contains Provision 5, thephrase "EXPENSE INCURRED BENEFITS" shall be added to the caption ofProvision 4. The insurer may include in this provision a definition of"other valid coverage," approved by the Commission. The definition shall belimited in subject matter to coverage provided by organizations subject toregulation by insurance law or by insurance authorities of this Commonwealthor any other jurisdiction of the United States or Canada, and by hospital ormedical service organizations, and to any other coverage the inclusion ofwhich may be approved by the Commission. In the absence of such definitionthe term shall not include group insurance, automobile medical paymentsinsurance, or coverage provided by hospital or medical service organizations,by union welfare plans, or employer or employee benefit organizations.
For the purpose of applying Provision 4, any amount of benefit provided forsuch 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 company has had notice. In applying Provision 4no third party liability coverage shall be included as "other validcoverage."
5. Provision 5:
INSURANCE WITH OTHER COMPANIES: If there is other valid coverage, not withthis Company, providing benefits for the same loss on other than an expenseincurred basis and of which this Company has not been given written noticeprior to the occurrence or commencement of loss, the only liability for suchbenefits under this policy shall be for such proportion of the indemnitiesotherwise provided under this policy for such loss as the like indemnities ofwhich the Company had notice, including the indemnities under this policy,bear to the total amount of all like indemnities for such loss, and for thereturn of such portion of the premium paid as shall exceed the pro rataportion for the indemnities thus determined.
If Provision 5 is included in a policy that also contains Provision 4, thephrase "OTHER BENEFITS" shall be added to the caption of Provision 5. Theinsurer may include in this provision a definition of "other validcoverage," approved by the Commission. The definition shall be limited insubject matter to coverage provided by organizations subject to regulation byinsurance law or by insurance authorities of this Commonwealth or any otherjurisdiction of the United States or Canada, and to any other coverageapproved by the Commission. In the absence of such definition the term shallnot include group insurance, or benefits provided by union welfare plans orby employer or employee benefit organizations. For the purpose of applyingProvision 5, any amount of benefit provided for the insured pursuant to anycompulsory benefit statute, including any workers' compensation or employer'sliability statute, whether provided by a governmental agency or otherwise,shall in all cases be deemed to be "other valid coverage" of which theCompany has had notice. In applying Provision 5 no third party liabilitycoverage shall be included as "other valid coverage."
6. Provision 6:
RELATION OF EARNINGS TO INSURANCE: If the total monthly amount of loss oftime benefits promised for the same loss under all valid loss of timecoverage upon the Insured, whether payable on a weekly or monthly basis,shall exceed the monthly earnings of the Insured at the time disabilitycommenced or his average monthly earnings for the period of two yearsimmediately preceding a disability for which a claim is made, whichever isgreater, the Company will be liable only for the proportionate amount of thebenefits under this policy as the amount of the monthly earnings or theaverage monthly earnings of the Insured bears to the total amount of monthlybenefits for the same loss under all the coverage upon the insured at thetime the disability commences and for the return of the part of the premiumspaid during such two years that exceeds the pro rata amount of the premiumsfor the benefits actually paid hereunder; but this shall not operate toreduce the total monthly amount of benefits payable under all the coverageupon the Insured below the sum of $200 or the sum of the monthly benefitsspecified in the coverages, whichever is less, nor shall it operate to reducebenefits other than those payable for loss of time.
Provision 6 may be inserted only in a policy that the insured has the rightto continue in force subject to its terms by the timely payment of premiums(i) until at least age 50 or (ii) for a policy issued after age 44, for atleast five years from its date of issue. The insurer may include in thisprovision a definition of "valid loss of time coverage" approved by theCommission. The definition shall be limited in subject matter to coverageprovided by governmental agencies or by organizations subject to regulationby insurance law or by insurance authorities of this Commonwealth or anyother jurisdiction of the United States or Canada, or to any other coveragethe inclusion of which may be approved by the Commission or any combinationof coverages. In the absence of such definition the term shall not includeany coverage provided for the Insured pursuant to any compulsory benefitstatute, including any workers' compensation or employer's liability statute,or benefits provided by union welfare plans or by employer or employeebenefit organizations.
7. Provision 7:
UNPAID PREMIUM: When a claim is paid, any premium due and unpaid may bededucted from the claim payment.
8. Provision 8 a:
CANCELLATION BY COMPANY: The Company may cancel this policy at any time bywritten notice delivered to the Insured, or mailed to his last address asshown by the records of the Company, stating when, no less than ...... daysthereafter, the cancellation shall be effective; and after the policy hasbeen continued beyond its original term the Insured may cancel this policy atany time by written notice delivered or mailed to the Company effective uponreceipt or on such later date as may be specified in the notice. In the eventof cancellation, the Company 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 insurancesupervisory official in the state where the Insured resided when the policywas issued. If the Company cancels, the earned premium shall be computed prorata. Cancellation shall be without prejudice to any claim originating priorto the effective date of cancellation.
Provision 8 b:
CANCELLATION BY COMPANY: The Company may cancel this policy at any time bywritten notice delivered to the Insured, or mailed to his last address asshown by the records of the Company, stating when, no less than______________ days thereafter, the cancellation shall be effective. In theevent of cancellation, the Company will return promptly the unearned portionof any premium paid. The earned premium shall be computed pro rata.Cancellation shall be without prejudice to any claim originating prior to theeffective date of cancellation.
In Provisions 8 a and 8 b, a number no less than "7" for weekly premiumpolicies, "10" for monthly premium policies and "31" for all otherpolicies shall be inserted between the words "than" and "days."
9. Provision 9:
CONFORMITY WITH STATE STATUTES: Any provision of this policy that on itseffective date is in conflict with the laws of the state in which the Insuredresides on that date is hereby amended to conform to the minimum requirementsof the laws.
10. Provision 10:
ILLEGAL OCCUPATION: The Company will not be liable for any loss that resultsfrom the Insured's committing or attempting to commit a felony or from theInsured's engaging in an illegal occupation.
11. Provision 11:
INTOXICANTS AND NARCOTICS: The Company will not be liable for any lossresulting from the Insured's being drunk, or under the influence of anynarcotic unless taken on the advice of a physician.
(1952, c. 317, § 38.1-350; 1986, c. 562; 2000, c. 540; 2003, c. 377.)
Except as provided in § 38.2-3505, no individual accident and sicknessinsurance policy delivered or issued for delivery in this Commonwealth shallcontain provisions respecting the matters set forth below unless suchprovisions use the same words which appear in this section. Provisions 1through 7, 8 a, and 9 through 11 shall apply to all such policies that areissued for delivery or delivered in this Commonwealth prior to January 1,2001. Provisions 1 through 7, 8 b, and 9 through 11 shall apply to all suchpolicies that are issued for delivery, delivered, renewed, or extended inthis Commonwealth on or after January 1, 2001. The insurer may use acorresponding provision of different wording approved by the Commission thatis not less favorable in any respect to the Insured or the beneficiary. Anysuch provision shall be preceded individually by the appropriate captionOTHER PROVISIONS or by such appropriate individual or group captions orsubcaptions as the Commission may approve.
1. Provision 1:
CHANGE OF OCCUPATION: If the Insured is injured or contracts sickness afterhaving changed his occupation to one classified by the Company as morehazardous than that stated in this policy or while doing for compensationanything pertaining to an occupation so classified, the Company will pay onlythe portion of the indemnities provided in this policy as the premium paidwould have purchased at the rates and within the limits fixed by the Companyfor the more hazardous occupation. If the Insured changes his occupation toone classified by the Company as less hazardous than that stated in thispolicy, the Company, upon receipt of proof of the change of occupation, willreduce the premium rate accordingly and will return the excess pro rataunearned premium from the date of change of occupation or from the policyanniversary date immediately preceding receipt of such proof, whichever ismore recent. In applying this provision, the classification of occupationalrisk and the premium rates shall be such as have been last filed by theCompany prior to the occurrence of the loss for which the Company is liableor prior to the date of proof of change in occupation with the stateinsurance supervisory official in the state where the Insured resided at thetime this policy was issued; but if the filing was not required, then theclassification of occupational risk and the premium rates shall be those lastmade effective by the Company in the state prior to the occurrence of theloss or prior to the date of proof of change in occupation.
2. Provision 2:
MISSTATEMENT OF AGE: If the Insured's age has been misstated, the benefitswill be those the premium paid would have purchased at the correct age.
3. Provision 3:
OTHER INSURANCE IN THIS COMPANY: If an accident or sickness or accident andsickness policy or policies previously issued by the Company to the Insuredis in force concurrently herewith, making the aggregate indemnity for ...................................(insert type of coverage or coverages) in excess of $........ (insert maximumlimit of indemnity or indemnities) the excess insurance shall be void and allpremiums paid for such excess shall be returned to the Insured or to hisestate.
Instead of Provision 3, the following provision may be used:
Insurance effective at any one time on the Insured under a like policy orpolicies in this Company is limited to the one such policy elected by theInsured, his beneficiary or his estate, as the case may be, and the Companywill return all premiums paid for all other such policies.
4. Provision 4:
INSURANCE WITH OTHER COMPANIES: If there is other valid coverage, not withthis Company, providing benefits for the same loss on a provision of servicebasis or on an expense incurred basis and of which this Company has not beengiven written notice prior to the occurrence or commencement of loss, theonly liability under any expense incurred coverage of this policy shall befor such proportion of the loss as the amount which would otherwise have beenpayable under this policy plus the total of the like amounts under all suchother valid coverages for the same loss of which this Company had noticebears to the total like amounts under all valid coverages for such loss, andfor the return of such portion of the premiums paid as shall exceed the prorata portion for the amount so determined. For the purpose of applying thisprovision when other coverage is on a provision of service basis, the "likeamount" of such other coverage shall be taken as the amount which theservices rendered would have cost in the absence of such coverage.
If Provision 4 is included in a policy that also contains Provision 5, thephrase "EXPENSE INCURRED BENEFITS" shall be added to the caption ofProvision 4. The insurer may include in this provision a definition of"other valid coverage," approved by the Commission. The definition shall belimited in subject matter to coverage provided by organizations subject toregulation by insurance law or by insurance authorities of this Commonwealthor any other jurisdiction of the United States or Canada, and by hospital ormedical service organizations, and to any other coverage the inclusion ofwhich may be approved by the Commission. In the absence of such definitionthe term shall not include group insurance, automobile medical paymentsinsurance, or coverage provided by hospital or medical service organizations,by union welfare plans, or employer or employee benefit organizations.
For the purpose of applying Provision 4, any amount of benefit provided forsuch 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 company has had notice. In applying Provision 4no third party liability coverage shall be included as "other validcoverage."
5. Provision 5:
INSURANCE WITH OTHER COMPANIES: If there is other valid coverage, not withthis Company, providing benefits for the same loss on other than an expenseincurred basis and of which this Company has not been given written noticeprior to the occurrence or commencement of loss, the only liability for suchbenefits under this policy shall be for such proportion of the indemnitiesotherwise provided under this policy for such loss as the like indemnities ofwhich the Company had notice, including the indemnities under this policy,bear to the total amount of all like indemnities for such loss, and for thereturn of such portion of the premium paid as shall exceed the pro rataportion for the indemnities thus determined.
If Provision 5 is included in a policy that also contains Provision 4, thephrase "OTHER BENEFITS" shall be added to the caption of Provision 5. Theinsurer may include in this provision a definition of "other validcoverage," approved by the Commission. The definition shall be limited insubject matter to coverage provided by organizations subject to regulation byinsurance law or by insurance authorities of this Commonwealth or any otherjurisdiction of the United States or Canada, and to any other coverageapproved by the Commission. In the absence of such definition the term shallnot include group insurance, or benefits provided by union welfare plans orby employer or employee benefit organizations. For the purpose of applyingProvision 5, any amount of benefit provided for the insured pursuant to anycompulsory benefit statute, including any workers' compensation or employer'sliability statute, whether provided by a governmental agency or otherwise,shall in all cases be deemed to be "other valid coverage" of which theCompany has had notice. In applying Provision 5 no third party liabilitycoverage shall be included as "other valid coverage."
6. Provision 6:
RELATION OF EARNINGS TO INSURANCE: If the total monthly amount of loss oftime benefits promised for the same loss under all valid loss of timecoverage upon the Insured, whether payable on a weekly or monthly basis,shall exceed the monthly earnings of the Insured at the time disabilitycommenced or his average monthly earnings for the period of two yearsimmediately preceding a disability for which a claim is made, whichever isgreater, the Company will be liable only for the proportionate amount of thebenefits under this policy as the amount of the monthly earnings or theaverage monthly earnings of the Insured bears to the total amount of monthlybenefits for the same loss under all the coverage upon the insured at thetime the disability commences and for the return of the part of the premiumspaid during such two years that exceeds the pro rata amount of the premiumsfor the benefits actually paid hereunder; but this shall not operate toreduce the total monthly amount of benefits payable under all the coverageupon the Insured below the sum of $200 or the sum of the monthly benefitsspecified in the coverages, whichever is less, nor shall it operate to reducebenefits other than those payable for loss of time.
Provision 6 may be inserted only in a policy that the insured has the rightto continue in force subject to its terms by the timely payment of premiums(i) until at least age 50 or (ii) for a policy issued after age 44, for atleast five years from its date of issue. The insurer may include in thisprovision a definition of "valid loss of time coverage" approved by theCommission. The definition shall be limited in subject matter to coverageprovided by governmental agencies or by organizations subject to regulationby insurance law or by insurance authorities of this Commonwealth or anyother jurisdiction of the United States or Canada, or to any other coveragethe inclusion of which may be approved by the Commission or any combinationof coverages. In the absence of such definition the term shall not includeany coverage provided for the Insured pursuant to any compulsory benefitstatute, including any workers' compensation or employer's liability statute,or benefits provided by union welfare plans or by employer or employeebenefit organizations.
7. Provision 7:
UNPAID PREMIUM: When a claim is paid, any premium due and unpaid may bededucted from the claim payment.
8. Provision 8 a:
CANCELLATION BY COMPANY: The Company may cancel this policy at any time bywritten notice delivered to the Insured, or mailed to his last address asshown by the records of the Company, stating when, no less than ...... daysthereafter, the cancellation shall be effective; and after the policy hasbeen continued beyond its original term the Insured may cancel this policy atany time by written notice delivered or mailed to the Company effective uponreceipt or on such later date as may be specified in the notice. In the eventof cancellation, the Company 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 insurancesupervisory official in the state where the Insured resided when the policywas issued. If the Company cancels, the earned premium shall be computed prorata. Cancellation shall be without prejudice to any claim originating priorto the effective date of cancellation.
Provision 8 b:
CANCELLATION BY COMPANY: The Company may cancel this policy at any time bywritten notice delivered to the Insured, or mailed to his last address asshown by the records of the Company, stating when, no less than______________ days thereafter, the cancellation shall be effective. In theevent of cancellation, the Company will return promptly the unearned portionof any premium paid. The earned premium shall be computed pro rata.Cancellation shall be without prejudice to any claim originating prior to theeffective date of cancellation.
In Provisions 8 a and 8 b, a number no less than "7" for weekly premiumpolicies, "10" for monthly premium policies and "31" for all otherpolicies shall be inserted between the words "than" and "days."
9. Provision 9:
CONFORMITY WITH STATE STATUTES: Any provision of this policy that on itseffective date is in conflict with the laws of the state in which the Insuredresides on that date is hereby amended to conform to the minimum requirementsof the laws.
10. Provision 10:
ILLEGAL OCCUPATION: The Company will not be liable for any loss that resultsfrom the Insured's committing or attempting to commit a felony or from theInsured's engaging in an illegal occupation.
11. Provision 11:
INTOXICANTS AND NARCOTICS: The Company will not be liable for any lossresulting from the Insured's being drunk, or under the influence of anynarcotic unless taken on the advice of a physician.
(1952, c. 317, § 38.1-350; 1986, c. 562; 2000, c. 540; 2003, c. 377.)
