(1) Except as provided in section 10-16-204, each such policy delivered or issued for
delivery to any person in this state shall contain the provisions specified in this
section in the words in which the same appear in this section; except that the
insurer, at its option, may substitute for one or more of such provisions
corresponding provisions of different wording approved by the commissioner which
are in each instance not less favorable in any respect to the insured or the
beneficiary. Such provisions shall be preceded individually by the caption appearing
in this section or, at the option of the insurer, by such appropriate individual or
group captions or subcaptions as the commissioner may approve.
(2) 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 shall be valid until approved by an executive
officer of the insurer and unless such approval be endorsed hereon or attached
hereto. No agent has authority to change this policy or to waive any of its
provisions.
(3) Provisions as follows: Time limit on certain defenses: (a) Two years after
the date of issue of this policy no misstatements, except fraudulent misstatements,
made by the applicant in the application for such policy shall be used to void the
policy or to deny a claim for loss incurred or disability (as defined in the policy)
commencing after the expiration of such two-year period. The policy cannot be
retroactively terminated except for fraud or intentional misrepresentation. For any
termination other than for fraud or intentional misrepresentation, the carrier shall
provide notice thirty days in advance of the cancellation of the policy.
(The foregoing policy provision does not affect any legal requirement for
avoidance of a policy or denial of a claim during such initial two-year period, nor
limit the application of section 10-16-203 in the event of misstatement with respect
to age or occupation or other insurance.)
(A policy that the insured has the right to continue in force subject to its
terms by the timely payment of premium until at least age fifty, or in the case of a
policy issued after age forty-four, for at least five years after its date of issue, may
contain, in lieu of the foregoing, the following provision, from which the clause in
parentheses may be omitted at the insurer's option, under the caption
Incontestable:
After this policy has been in force for a period of two years during the
lifetime of the insured (excluding any period during which the insured is disabled), it
becomes incontestable as to the statements contained in the application.)
(b) Except for individual disability income insurance policies, no claim for
loss incurred or disability, as defined in the policy, commencing one year after the
date of issue of this policy shall be reduced or denied on the ground that a disease
or physical condition not excluded from coverage by name or a specific description
effective on the date of loss had existed prior to the effective date of coverage of
this policy.
(c) If this is an individual disability income insurance policy then no claim for
loss incurred or disability, as defined in this individual disability income insurance
policy, commencing two years after the date of issue of the policy shall be reduced
or denied on the ground that a disease or physical condition not excluded from
coverage by name or a specific description effective on the date of loss had existed
prior to the effective date of coverage of this policy.
(4) (a) Except as required by section 10-16-140, in a policy other than a health
benefit plan, a provision as follows: Grace period: A grace period of ........ (insert a
number not less than '7' for weekly premium policies, '10' for monthly premium
policies, and '31' for all other policies) days will be granted for the payment of each
premium falling due after the first premium, during which grace period the policy
shall continue in force.
(b) A policy in which the insurer reserves the right to refuse any renewal
shall have, at the beginning of the provision referred to in paragraph (a) of this
subsection (4), Unless not less than thirty days prior to the premium due date the
insurer has delivered to the insured or has mailed to the insured's last address as
shown by the records of the insurer written notice of its intention not to renew this
policy beyond the period for which the premium has been accepted.
(5) (a) A provision as follows: Reinstatement: If any renewal premium is not
paid within the time granted the insured for payment, a subsequent acceptance of
premium by the insurer or by any agent duly authorized by the insurer to accept
such premium, without requiring in connection therewith an application for
reinstatement, shall reinstate the policy. If the insurer or such agent requires an
application for reinstatement and issues a conditional receipt for the premium
tendered, the policy will be reinstated upon approval of such application by the
insurer or, lacking such approval, upon the forty-fifth day following the date of such
conditional receipt unless the insurer has previously notified the insured in writing
of its disapproval of such application. The reinstated policy shall cover only loss
resulting from such accidental injury as may be sustained after the date of
reinstatement and loss due to such sickness as may begin more than ten days after
such date. In all other respects the insured and insurer shall have the same rights
thereunder as they had under the policy immediately before the due date of the
defaulted premium, subject to any provisions endorsed hereon or attached hereto in
connection with the reinstatement. Any premium accepted in connection with a
reinstatement shall be applied to a period for which premium has not been
previously paid, but not to any period more than sixty days prior to the date of
reinstatement.
(b) The last sentence of the above provision may be omitted from any policy
which the insured has the right to continue in force subject to its terms by the
timely payment of premiums until at least age fifty or, in the case of a policy issued
after age forty-four, for at least five years from its date of issue.
(6) (a) Provisions as follows: Notice of claim: Written notice of claim must be
given to the insurer within twenty days after the occurrence or commencement of
any loss covered by the policy or as soon thereafter as is reasonably possible.
Notice given by or on behalf of the insured or the beneficiary to the insurer at ........
(insert the location of such office as the insurer may designate for the purpose), or
to any authorized agent of the insurer, with information sufficient to identify the
insured, shall be deemed notice to the insurer.
(b) In a policy providing a loss-of-time benefit which may be payable for at
least two years, an insurer may at its option insert the following between the first
and second sentences of the provision set forth in paragraph (a) of subsection (6) of
this section:
Subject to the qualifications set forth below, if the insured suffers loss of
time on account of disability for which indemnity may be payable for at least two
years, the insured shall, 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 the
event of legal incapacity. The period of six months following any filing of proof by
the insured or any payment by the insurer on account of such claim or any denial of
liability in whole or in part by the insurer shall be excluded in applying this
provision. Delay in the giving of such notice shall not impair the insured's right to
any indemnity which would otherwise have accrued during the period of six months
preceding the date on which such notice is actually given.
(7) A provision as follows: Claim forms: The insurer, upon receipt of a notice
of claim, will furnish to the claimant 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 such notice, the claimant shall be deemed to have complied with the
requirements of this policy as to proof of loss upon submitting, within the time fixed
in the policy for filing proofs of loss, written proof covering the occurrence, the
character, and the extent of the loss for which claim is made.
(8) A provision as follows: Proofs of loss: Written proof of loss must be
furnished to the insurer at its said office in case of claim for loss for which this
policy provides any periodic payment contingent upon continuing loss within ninety
days after the termination of the period for which the insurer is liable and in case of
claim for any other loss within ninety days after the date of such loss. Failure to
furnish such proof within the time required shall not invalidate nor reduce any claim
if it was not reasonably possible to give proof within such time, if such proof is
furnished as soon as reasonably possible and in no event, except in the absence of
legal capacity, later than one year from the time proof is otherwise required.
(9) A provision as follows: Time of payment of claims: Indemnities payable
under this policy for any loss other than loss for which this policy provides any
periodic payment will be paid immediately upon receipt of due written proof of such
loss. Subject to due written proof of loss, all accrued indemnities for loss for which
this policy provides periodic payment will be paid ........ (insert period for payment
which must not be less frequently than monthly) and any balance remaining unpaid
upon the termination of liability will be paid immediately upon receipt of due written
proof.
(10) (a) A provision as follows: Payment of claims: Indemnity for loss of life
will be payable in accordance with the beneficiary designation and the provisions
respecting such payment which may be prescribed herein and effective at the time
of payment. If no such designation or provision is then effective, such indemnity
shall be payable to the estate of the insured. Any other accrued indemnities unpaid
at the insured's death may, at the option of the insurer, be paid either to such
beneficiary or to such estate. All other indemnities will be payable to the insured.
(b) The following provisions, or either of them, may be included with the
provision set forth in paragraph (a) of this subsection (10) at the option of the
insurer:
If any indemnity of this policy shall be payable to the estate of the insured,
or to an insured or beneficiary who is a minor or otherwise not competent to give
valid release, the insurer may pay such indemnity, up to an amount not exceeding $
........ (insert an amount which shall not exceed $1000), to any relative by blood or
connection by marriage of the insured or beneficiary who is deemed by the insurer
to be equitably entitled thereto. Any payment made by the insurer in good faith
pursuant to this provision shall fully discharge the insurer to the extent of such
payment.
Subject to any written direction of the insured in the application or
otherwise, all or a portion of any indemnities provided by this policy on account of
hospital, nursing, medical, or surgical services may, at the insurer's option and
unless the insured requests otherwise in writing not later than the time of filing
proofs of such loss, be paid directly to the hospital or person rendering such
services; but it is not required that the service be rendered by a particular hospital
or person.
(11) A provision as follows: Physical examinations and autopsy: The insurer
at its own expense shall have the right and opportunity to examine the person of
the insured when and as often as it may reasonably require during the pendency of
a claim hereunder and to make an autopsy in case of death where it is not forbidden
by law.
(12) A provision as follows: Legal actions: No action at law or in equity shall
be brought to recover on this policy prior to the expiration of sixty days after
written proof of loss has been furnished in accordance with the requirements of this
policy. No such action shall be brought after the expiration of three years after the
time written proof of loss is required to be furnished.
(13) (a) A provision as follows: Change of beneficiary: Unless the insured
makes an irrevocable designation of beneficiary, the right to change of beneficiary
is reserved to the insured and the consent of the beneficiary or beneficiaries shall
not be requisite to surrender or assignment of this policy or to any change of
beneficiary or beneficiaries, or to any other changes in this policy.
(b) The first clause of this provision, relating to the irrevocable designation
of beneficiary, may be omitted at the insurer's option.