Group short-term disability insurance certification: This insurance only covers benefits for short-term disability as specified in the benefits schedule of this certificate. The benefits are paid to those with a short-term disability that is caused by sickness or off-the-job injury or illness. The certificate is not a guarantee of health benefits of any other sickness or condition.
If you are a victim of any other disability benefits that you can claim with the US only one disability Benefit is a benefit that can be paid.
Your Union (“the Policyholder”) was the applicant for insurance in the policy. Group short-term disability insurance the policy (the “Plan”). The plan is offered through the continental American Insurance Company (the “Company,” “we,” “us,” or “our”). For the Plan, “you” (including “your” and “yours”) is a reference to you.
Based on the Applicant’s information and based on the prompt payments of the premiums due, the company is willing to make the benefits provided on the next pages. The application will be kept in the database and form part of this certificate. (Please be aware that male pronouns such as you and you are used to refer to males as well as women unless the context indicates otherwise.)
There are certain phrases and words (including certain medical terms as well as the names of the Plan documents) that are included in the document documents are documents in this document are capitalized. They refer to terms that have extremely specific definitions.
This insurance plan applies to you take your time reading your Certificate this is not a Medicare supplements policy.
We verify that you are covered by the short-term disability policy of groups (the “Plan”). The plan was provided to you, the Union as well as the policyholder. This insurance covers losses resulting from short-term disability. This certificate will be subject to definitions, exclusions, as well as other conditions of the Plan.
Certain clauses that are part of the plan are listed in this certificate. All of the provisions of the Plan are included, regardless of whether the Certificate contains or not, to make an application to the insurance mentioned in the certificate.
The effective date of the certificate is stated in the schedule of the certificate. Schedule. The certificate will expire as included in the clause in the provision “Termination of A Member’s Insurance” in Section I” within Section 1. The certificate will remain in force for the duration of the time the premium was paid. This Certificate can be extended for future periods as set out within the Plan.
The Certificate, upon its effective date immediately replaces any certificate or certificate issued previously You will be notified of the Plan.
The insurance policy under which the certificate is issued is not a policy of worker’s insured compensation. You should consult your employer to determine if your employer is a subscriber to the worker’s compensation system.
Section I: Eligibility Effective Date, Date of Termination Section I – Eligibility, Effective Date, Termination
You are a Member eligible for this Program if have met the following conditions:
- You are a Member of the policyholder.
- You are working full-time employment.
- You belong to the group of members who are covered, according to the Application.
The effective date of the Plan can be found on the first page.
The Effective Date of your Certificate is the date that your insurance becomes effective. This date is one of two Following dates:
- The date is displayed in the Certificate Schedule if you are actively working at that time.
- The date that you are reinstated to the Actively-at Work status if you are not actively working at the time of your return.
is displayed in the Certificate Schedule.
The Plan can be terminated for one of these reasons
- The premium cannot be paid before the expiration of the Grace Period. Grace Period.
- The Company can cancel the Plan anytime after the expiration year one Policy year. To cancel the Plan you must notify the
The company has to give an advance written notice.
- The total number of participants members is less than the number set by the
The Policyholder and the Company in the completed Master Application.
The Policyholder holds sole responsibility for notifying you of the expiration of the Plan. If the Plan When the Plan expires when it does, the Plan will also mean that the Certificates and Riders that are issued under the Plan will cease when the date is stated.
termination date. The date of termination is midnight at the address of the policyholder.
If the Plan is terminated We will offer coverage for claims that arise from disabilities that were diagnosed at first during the time that it was in force. The plan was in effect.
Ending a Member’s Insurance
Your insurance policy will expire at the time of:
- The date on which the Company ceases to participate in the Plan.
- The 31st of the day following the date of payment for premiums If the premium is not paid.
- The date on which you are no longer in the Plan’s definition of a member.
- The date that you no longer are a member of an ineligible class.
When your coverage expires the coverage will continue for claims that result due to short-term disability.
First diagnosed while your coverage was in effect.
If you terminate your membership with the Policyholder, and your coverage is otherwise terminated you may lose coverage.
Choose to extend your coverage under the plan. You can continue to have the coverage you had before the date that your membership lapsed.
To ensure that your Certificate remains valid You must satisfy the following three conditions:
- You must make an application to the Company in writing within 31 days of the date on which your insurance will become effective.
Otherwise, the contract will end.
- You are required to pay the applicable premium the rate in force when you enter the port.
The Company must be in place no more than 31 days following the date on which the Certificate is otherwise terminated and at the time of
every premium due date after that.
• You have to be involved in full-time employment.
Coverage will cease:
- 31 days following the day you do not pay any premium or
- The date on which this Group Plan is terminated, the earlier it occurs.
If you are eligible for this Continuation Privilege it is expected that the Company will be able to apply the same Benefits and Plan The Premium Rate, as well as the Provisions that you can find in the previously issued Certificate.
The Section II, Premium Provisions
The Schedule of Premiums determines the amount of premium that must be paid on the date of any premium due.
The rates shown in this Schedule are subject to change each year after the guarantee period has expired.
expired. The Company will provide the policyholder a written notification 60 days before any rate change becomes effective.
The first premiums are due on the date of the plan’s effective. Then, premiums will be payable on the 1st day of each month the Plan is in force.
The total premiums for this Plan are due in cash to the Company at its Home Office in Columbia, South Carolina. The payment of any premium does not maintain the Plan in effect beyond the due date for the following premium, except what is defined within the Grace Period.
This Plan comes with the benefit of a grace period of 31 days. If the renewal fee is not paid by its due date, it will be charged the premium can be paid over the next thirty-one days. In the Grace Period, the Plan will remain in force until The Policyholder has provided the Company an email notification of its intention to end the Plan.
The Section III – Definitions
If the following terms are employed in this Plan the following definitions will be used:
Actively at Work is your capability to carry out your normal job duties in a normal workday. These activities can be performed at your workplace’s normal office or a location to which you might be required to travel to fulfill the duties that are part of your job.
Base Annual Pay refers to the total annual earnings from your Full-Time job at your company. It does not include Bonuses, overtime pay, or any other special pay.
The Benefit Period refers to the longest number of days that you can enjoy after the elimination period in the event of a benefit period, in which you may Be paid benefits during any period of disability. Every Benefit Period that is renewed will be subject to an elimination
Period. Refer to the Schedule of Benefits for the Benefit Schedule for the benefit period.
In this calculation to calculate this figure, “month” is defined as “month” and can be defined by a period of 30 days during which benefits will be paid.
The term “complications of pregnancy” refers to:
Certain conditions require medical treatment that is provided before or after the expiration of a pregnancy. The diagnostics for the Medical Treatment must be distinct from pregnancy, but they can be negatively affected by pregnancy or affected by the pregnancy. To be a complication of Pregnancy must be an identifiable pregnancy-related or a complication. Examples of the most common complications of pregnancy are:
- Acute nephritis
- Cardiac decompensation,
- Missed birth,
- Diseases of the hemopoietic, vascular or nervous systems and
- Similar surgical and medical conditions with similar degrees.
Additional complications of pregnancy are:
Hyperemesis gravidarum, pre-eclampsia, and hyper necessitating hospitalization
- An ectopic pregnancy that has been terminated and A spontaneous termination of pregnancy that happens during the gestation period during which there is an actual birth is not feasible.
The complications of pregnancy are not a part of these conditions
- Multiple gestation pregnancy.
- False labor.
- The occasional sighting.
- Morning sickness.
The complications of pregnancy are not a part of other issues that are a part of the management of A difficult pregnancy is not an identifiable complication based on pregnancy.
Elective cesarean delivery is not considered to be a complication of pregnancy.
A Daily Disability benefit is one-thirtieth of the Disability benefit for each month that is listed on the benefit schedule.
- Total Disability is you being under the supervision and care of a physician because of a
medical condition that renders you incapable to carry out the essential and essential tasks of the FullTime job. To be considered a Total Disability, you may not be employed in any occupation.
- Partial Disability is you being under the supervision and care of a physician because of a
medical condition that hinders your ability to perform the necessary obligations of the FullTime job. If you are deemed to be a Partial Disability it is possible to perform any job with a salary less than 80 percent.
percent of the annual income of your Full-Time Employment when you first were disabled.
A doctor is a term used to describe a person who meets the criteria listed below:
- An individual who is legally authorized to practice medicine.
- A person licensed as a doctor in the state from which treatment is given.
The term “Doctor” does not apply to you or your family members.
The elimination period is the length of days that continue to be continuous that you have to endure from the start of your Disability Period for which there are not any benefits due. Refer to the Benefit Schedule for the period of elimination. Each new benefit period is subject to an additional elimination period.
A Member is someone who fulfills the eligibility requirements which are set out in Section I – Eligibility, and who This Plan covers you. The participant under this plan is you.
Family Member refers to anyone who is connected with you in the following way siblings, spouses, brothers, or sisters (includes stepbrothers, stepsisters, and stepbrothers) (includes stepbrothers and stepsisters); children (includes stepchildren) and Parents (includes stepparents); grandchildren, father or mother-in-law; as appropriate.
A full-Time Job is an occupation in which you are employed, carrying out the duties of your job for compensation or other benefits to working the required working hours per week. This is a requirement in the section on the eligibility of the Benefit Schedule.
Injuries refer to an off-the-job bodily injury that is not otherwise exempted. The term “injury” covers all of the criteria for an injury.
- It’s caused directly by an accident that is covered.
It is not caused by sickness or bodily illness or any other cause.
- It takes place on or following the Effective Date of coverage, as long as the coverage remains in effect.
Insured is the person who is covered under the Certificate effective.
Medically Necessary is the term used to describe treatment or services or items that are required and suitable for the treatment or diagnosis of a sickness or injury that is based on accepted medical practices.
Mental illness can be defined by total Disabilities resulting from psychiatric and mental disorders, regardless of the reason. Mental illness can be defined as but is not restricted to the following symptoms:
Bipolar affective disorder (manic-depressive syndrome) schizophrenia, delusional (paranoid) disorders psychotic disorders, psychotic disorders, somatoform disorder (psychosomatic illness) eating disorders, anxiety disorders, schizophrenia stress, depression post-partum depression, personality disorders, and adjustment disorders such as post-partum depression, personality disorders, and adjustment.
It also includes others The condition is typically managed by a doctor or mental health specialist or any other licensed professional using psychotherapy, psychotropic medications, or other similar methods that are used to treat the ailments As mentioned earlier.
Off-the-job injury refers to an injury that happens while you are not employed in any position that pays you or benefits.
On-the-job injury refers to any injury that happens while you are employed at any position that pays or provides benefits.
The term “period of disability” refers to the amount of time you are either totally disabled or partially disabled due to one or more causes. It begins on the first day of Total Disability or Partial Disability when you have ceased to be actively working for the policyholder. The policy expires on the earlier of the two dates:
- The date at which you are no longer totally disabled, or Partially Disabled.
- The date that you are reinstated to”Actively At Work” status with any employer.
Sickness refers to an illness or disease or any other physical medical condition.
Ailment must satisfy all the following requirements:
- It should not be caused by an injury.
- It first appeared and was treated shortly after the effective date of coverage.
- It is a problem that occurs when coverage is in effect.
Treatment or Medical Treatment refers to the consultation, care, or services offered by a doctor.
This could include taking diagnostic tests and also using prescribed medications and drugs.
The Section IV Benefit Dispositions
The benefits payable under this section fall under the section are included on the Benefit Schedule.
We will pay you the following benefits if they are appropriate in the event of your Disability being due to a covered illness or covered injury and when it happens while the covered Injury is being treated. The benefits will be subject to or covered Injury and if it occurs while the coverage is in force.
Exclusions and Limitations and Pre-existing Condition Limitations and other terms of the policy.
Benefits will be paid out for just one disability at any time, regardless of when the Disability is the result of more than one Sickness or more than one injury or a Sickness that is accompanied by an injury. We have the right to consult with you.
during the time a claim is pending or an independent expert and doctor’s declaration to establish whether you are qualified to be eligible to receive Disability benefits.
You have to be under the care and supervision of a physician for these benefits to be paid. Benefits The ceases to exist on the day on which you pass away.
Different periods of disability
A same or similar condition
Separate periods of disability resulting from the same or related condition are is considered to be a continuation of the previous Disability if they are not separated by more than 180 days.
After the Maximum Total Disability Benefit Period or the maximum Part, Disability Benefit Once your period is paid, you will no longer be qualified for the Total Disability Benefit for a new Time or to obtain a new Partial Disability Benefit Period caused by the same condition
A related condition, for 180 days after all of the following conditions are satisfied:
- You were granted a medical release from the previous disability.
- You are no longer disabled.
- You are no longer qualified to be eligible for any disability benefits under this certificate.
After the Disability Benefit Period has ended, you can continue to receive your benefits when you fulfill the following conditions.
If the conditions are met
- You can return to work after 90 days when the Benefit Period has ended.
- The premium payments you receive for your insurance begin upon your return to your job.
- The Group Policy is in effect at the time of your back to work.
Causes not related
Disabilities that are a result of separate periods from non-related causes are regarded as an ongoing of the previous Disability, of the prior Disability from the prior Disability at a Full-Time Position of the prior Disability 30 consecutive days, in which you perform the principal and material tasks of the job.
When the Maximum Total Disability Benefit Period or maximum Disability Benefit Partial Once the benefit period has been paid you are not qualified for an additional Total Disability Benefit Period.
for a new Partially Disability Benefit Duration for Disability because of unrelated causes, and up to 30 consecutive days after the conditions are met:
- You have been granted release by a doctor from a previous Disability.
- You are no more disabled.
- You are no longer eligible to get any Disability benefits as defined by this Certificate.
After the Disability Benefit Period has ended, you can continue to receive your benefits if you meet the following conditions.
If the conditions are met
- You can return to work after 90 days after the Benefit Period has ended.
- Premiums for your insurance begin upon your back at work.
- The Group Policy is in force at the time of your returning to your job.
Periods of Disability that meet one of these requirements for separation will commence with a new Total Disability Benefit Period, or a new Partial Disability Benefit Time (a max of three months), The new elimination period.
The Partial Disability Benefit is a separate benefit from its Benefit Period and is not affected by any of the Total Disability Benefit Periods. You could be eligible to receive a Partially Disability Benefit. Partial Disability Benefit even if you have not received the Total Disability Benefit.
Total Disability Benefit: Illness or Off-Job Insurance
If you are employed in employment that is Full-Time when you suffer from your sickness or an Off-the-job Injury We will cover you in the same way as Follows when coverage is in effect:
If your covered illness or Off-the-job Injury that is covered results in your Total Disability within 90 days within 7 days of the last treatment to treat your Sickness that is covered or Off-the-job injury that is covered within the first 30 days of your last treatment, we will reimburse you.
You will receive the Daily Disability Benefit for each day that you are disabled for the totality of your disability. This benefit is payable for the duration of your disability.
The Total Disability to the Total Disability Benefit Period. The benefit is subject to the Period of Elimination Period as specified in the Benefit Schedule. Schedule. Total Disability Benefit Period begins after the Elimination Period has been completed and satisfied.
You will cease to be eligible for this benefit after the date of:
(1) being released your doctor has authorized you to fulfill the fundamental and essential tasks of your Full-Time Job (or
(2) Working at any job which pays at least 80 percent of your pre-disability annual income.
A Partial Disability Benefit: Illness or Off-Job Injury
If you are employed in a full-time job during the period of illness or an Off-the-Job Injury will provide you with insurance in the same way as continues when coverage is in effect:
If your covered sickness or Off-the-job injury that you are covered for creates your partial disability within 90 days within 7 days of the last treatment to treat your Sickness that is covered or Off-the-job Injury that you are covered for after which we will pay 50 % of your Daily Disability Allowance each day of your partial disability. This benefit is payable until the period of partial disability benefit (a maximum that is 3 months).
It is subject to a period of elimination. The Partially Disability Beneficial Period as well as the Elimination Period both The information is included on appearing in the Benefit Schedule. It is a part of the Benefit Schedule. The Partial Disability Benefit period begins following the Elimination Your period is complete and you can return to work, you earn lower than 80 percent of the Base Annual pay of your Full-Time job.
You will cease to be eligible for this benefit if you die before the time of:
(1) being released Your doctor has authorized you to fulfill the fundamental and essential obligations of your Full-Time job (or
(2) Working at any job which pays at least 80 percent of your annual income before the disability.
Waiver of Premium Benefit
If your illness or Off-the-Job Injury is covered, it will cause your Total Disability or Partially Disability For more than 90 consecutive calendar days during the coverage is in effect during this period, we will offer a waiver from month to month.
the amount of the Certificate’s premium and the required rider(s) for the duration of time you are disabled, but not exceeding the applicable Benefit Periods are listed in the Schedule of Benefits. Schedule.
To waive the cost of premiums, We will need the declaration of an employer and the written statement of an individual.
A doctor certifying that you are incapable of performing your normal tasks or performing your usual. We could each month the next step is to obtain a doctor’s declaration that your inability to carry out these duties or tasks continues.
We could ask for and utilize an independent consultant to assess your Disability if the benefit is available to force.
All fees must be paid to maintain the certificate as well as the relevant rider(s) in effect until we can approve the claim you have made for this waiver of Benefits Premium. The premium payments you receive for your insurance will resume once you have completed them before you return to work or 90 days following the date of your return to work, or within 90 days after you have no longer be eligible for disability benefits.
The Premium Waiver is not offered with the three-month Total Disability Benefits Time.
Extension of Benefits
If your coverage is over the insurance company will cover claims arising out of the short-term disability that was the first time you were diagnosed while the coverage you had was still in place. If you were disabled on the date of your coverage When the time comes to end, we will offer benefits that are at the lesser of:
- 90 days * 90 days
- The length that the total disability lasts.
Section V. Limitations and Exclusions Section V – Limitations & Exclusions
Pre-Existing Condition Limitation
Pre-existing Condition refers to an illness or disease or disorder, pregnancy, or injury that occurred within the 12 months before the Effective Date. For a condition to be considered to have been pre-existing:
- A doctor should have been able to advise, diagnose, or treat you, It must be a condition that could normally cause a prudent individual to consult a physician for treatment.
We will not provide benefits for any disability resulting from or caused by a Pre-existing Condition if it is the Disability started within the 12-month period that followed your Effective Date.
This restriction does not apply to losses incurred or a Disability occurring after the completion of 12 consecutive months, starting at the Effective Date of Coverage, in which the insured has not received medical guidance or treatment that is in connection to the pre-existing condition.
In the initial nine-month period following the Effective Date of Coverage We do not pay any benefits for Disability caused by or occurring because of the pregnancy or birth of your child. Disability caused by Pregnancy complications is covered in the same way as a covered sickness.
After this coverage is in force for ninety-nine months starting from the Effective Date of the coverage Disability Benefits for childbirth are due. The maximum duration of disability is allowed in the case of disability caused by The average time for childbirth is six weeks for non-cesarean birth as well as eight weeks when it comes to cesarean deliveries and less Expiration Period, except if you provide evidence that your disability persists beyond these times due to complications that can arise from Pregnancy.
If this Plan is to replace the Short-Term Disability plan of another company’s policy, then we will offer insurance for individuals who had been covered by the previous plan provided that:
- They are part of a class that is eligible for insurance under this Plan.
- They meet the Program’s Actively At Work as well as Non-Confinement conditions; and
- They can choose to be covered by this Plan.
If an individual who could be covered by this Plan is not able to satisfy the Plan’s Actively at Non-confinement and work requirements This individual could be covered under this Plan if the plan is in place It meets the specifications.
If this Plan is to replace the Short-Term Disability plan of another carrier We will offer the less expensive of
- Extended benefit insurance that the previous carrier was required to offer under Texas law;
- Extended benefit insurance is required under Texas law.
The coverage of the extended benefit could be reduced by any benefits that are paid under the prior health benefit plan of the carrier.
Continuity of Coverage at The End Upon Replacement
When we take over an existing plan with another carrier we offer the following coverage for Continuity of Coverage. We Provide this protection for losses caused by a pre-existing condition for Members who are insured under the plan before the date of at the time of transfer.
Benefits can be payable in the event of losses resulting from an existing condition that is affecting the Member if any of the following conditions are met:
The insurance was provided by the previous insurer at the time of the transfer.
- He was employed and covered under the Plan at the Effective Date.
- The benefit period and elimination time under his previous coverage are the same or less and, if applicable, the benefits and elimination periods under the plan.
These benefits are determined in the following manner:
- This Plan will be governed by the Pre-existing Condition Limitation. If the member is eligible for benefits, he will be paid according to the certificate’s benefit schedule.
- If the member is unable to comply with this Plan’s Pre-existing Conditions Limitation, they must use the prior carrier’s
Pre-existing condition limitation is in effect:
- If the Member meets the pre-existing condition of the previous carrier’s limitation, granting In consideration of the continuous time insurance under both policies the insured will be compensated as per the prior benefit schedule of the carrier (including the benefit period, and elimination time, and the maximum month’s benefit).
- If he is unable to satisfy the Limitation on Pre-existing Conditions in this policy, or if the previous carrier was not a good one, and there is no benefit to be provided.
Exclusions and Limitations
A. We will not provide benefits if coverage under the Policy is in contravention of the law of any U.S. trade or economic sanctions. If the coverage violates U.S. economic or trade sanctions, the coverage will be deemed to be illegal is null and null.
B. We will not provide benefits for fraud that is committed when the process of submitting a claim for this policy.
C. We do not provide benefits to anyone suffering from an impairment that is caused by or is the result of:
- Any declaration of war or unproclaimed; insurrection or rebellious act or participating in the unrest.
- Actively working as a member of any forces of the military, or units that are auxiliary to them that including the National Guard or Reserve or Guard.
- A self-inflicted injury that is intentionally caused.
- In the commission of a crime that the insured is convicted of, we do not provide an indemnity for any time that the insured is in a prison.
- The ability to travel in, jump or descend from an aircraft, unless when you are a fare-paying customer in the course of certified passenger planes.
- Mental illness is defined in Section III of Definitions.
- Addiction to alcohol or drugs.
- A traumatic injury that is a result of any job.
- Sickness or Injury that is covered under Worker’s Compensation.
Benefits will be paid out for the Disability only at one time, regardless of cases where the Disability was caused by more than one illness More than one Injury, or a Sickness with an Injury.
Section VI – Claims Section VI – Claim
Notice of Claim
You must send the following notice in writing:
- not after the 20th day following a disability diagnosis or When it is reasonable.
Notice should include your name as well as your Certificate number. Notices can be sent directly to Company at: P.O. BOX 427 Columbia, South Carolina 29202.
If the Company receives notice of a claim, we will provide forms to you to help you provide proof of Loss. (Details are provided inside the Proof of Loss section below.)
If the company fails to send the forms before the 16th day following the date that we received the notice of claim, You can satisfy Proof of Loss requirements by giving a written explanation of the nature and severity of the loss. It is also necessary to present a medical report to the treating doctor. It is required to provide this information within the timeframe stipulated by the Proof of Loss section.
The Evidence of the loss
The term “proof of loss” refers to any documentation supporting the validity of a claim (this document is typically located in Standardized medical documents standard medical documents, such as hospital bills or operative reports). You will need to present proof of
A loss for the Company at: P.O. BOX 427 Columbia, South Carolina 29202.
You are required to provide Proof of Loss documentation not after the 90th day following commencement of the time for which the insurer is responsible. But the Company cannot make any claim invalid or less when it’s within the time it was not feasible to supply this information within the specified time.
You must submit the proof in the shortest time feasible. The Company will not accept any proof at any time.
not more than three months after the diagnosis of the disability beyond one year and three months after diagnosis of the Disability, unless in the absence of your legal mental capacity.
Rapid Settlement of Benefits
For other benefits, besides loss of time For benefits other than loss of time, the Company will, when we have received the necessary Proof of Loss either pay, deny, or settle any claim submitted within 60 days after the day that proof of loss has been received.
In the event of written proof of Loss, all benefits that are due under the policy for the loss of time are paid.
at least once a month throughout the time during which the insurance company is responsible. Unpaid balances at the conclusion The amount due at this time of the time as is possible after receipt of the proof of loss.
Settlement of claims
We will be able to pay all benefits you receive unless we have a different arrangement. If benefits remain not paid at the time of payment in the event of your death, we’ll pay these benefits in the order listed below:
- To the beneficiary named by the insured or the beneficiary’s designated assignee.
- To your spouse who is still living.
- To your estate.
Transfer of Beneficiary
You may ask us to alter your beneficiary anytime. The request should be made written in writing and will be entered into the change will take effect on the day that you make the decision. The change will take effect on the day you sign the request. any impact on any payments made before when the date we Approved the request.
Once a claim has been paid we can subtract any premiums due and not paid from the amount of the claim.
Physical Exam and Autopsy
The Company could request that you be assessed as often as required when a claim is in the process of being filed. In the event of a claim, In the event of death should someone dies, the event of a death, Company will also conduct an autopsy unless required by the law. If a person dies, the Company will pay for all expenses associated with exams or an autopsy.
You are not allowed to pursue any legal actions against us to claim benefits under this Plan
• Within sixty days of the time you have sent us a letter of Proof of Loss or
- Not more than 3 years after the date a written document must be provided.
Notice of Acceptance or Refusal of Claim
CAIC will inform the insured by writing about the denial or acceptance of a claim not earlier than the fifteenth business day following the day that we receive all the items including statements, documents, and forms we must obtain the last evidence of loss. However, if we are in a position to deny or accept the claim within that duration, then we will consider the claim within the same time frame, and inform the insured of the reasons you require more time. CAIC will either accept or deny the request.
The claim must be filed no later than the 45th day from the date on which we inform the insured of the need for an extension in time.
If CAIC refuses to accept a claim the reason behind the denial will be listed in the denial announcement.
The Section VII – General Provisions
We do not take responsibility for determining the legitimacy of the transfer of your benefits to the recipient of your benefits.
Provider of services. The benefits you are assigned will be acknowledged until we are notified that you have been specifically designated the advantages to the benefits of Group the Short-Term Disability Insurance certificate.
Other insurance through continental American insurance company if you are covered by several Continental American Insurance Certificates with Disability Benefits Only one Disability benefit you select or your estate or your estate, as the case may be, will be effective.
We will reimburse all premiums paid to the canceled benefits as of when the duplication was made less any benefits The policy is paid out starting on the date.
Entire Contract Changes
The Entire Contract of Insurance is composed of:
- This Policy
- The Master Application
- Benefit agreements,
- Riders (if there are any).
Any assertions (excluding false ones) that you or the policyholder have made in the application will be considered to be true.
are considered to be representations, not warranties. The statements made by you or the Policyholder should not be considered in any contest that is conducted that is held under the Plan that is not accompanied by the written instrument that contains the declaration is
The information has been given to:
- The person who makes the statement, or
- If the declaration was signed by you and you have died or become incapacitated, you are your beneficiary or Personal Representative.
The goal is to ensure that the Policyholders and Insureds will have the opportunity to examine the information they have received.
that are included in their Application. The company will not deny insurance coverage or reduce benefits (as as a consequence of statements that are made in the Application) and not statements made on the Application) without Application copies, as stated above.
Modifications to the Plan:
- is not valid until it is approved in writing by one of the executive officers in the Company.
- must be written on the Contract.
- is not used by any agent (nor is an agent able to abstain from any Plan clauses).
A Rider or Endorsement or application that alters the limits or exclusions of the coverage of this Plan must be signed by you to be legally valid.
Limitation on the Time of Certain Defenses
Two years after the date of the effective date of your insurance, there will be no misstatements other than fraudulent False statements, which you make in the Application will be used to cancel your coverage, or to refuse a claim. A disability that begins at the end of these two years.
There is no claim for losses that are incurred or disability that begins within 12 months after the date of effective the coverage is admissible.
be reduced on the basis that it is a physical or mental disease that is not excluded from coverage in any way, particular description, was in existence before the effective date of the coverage. Protection for pre-existing conditions The conditions will not be changed or withdrawn after your coverage has been in effect for twelve months.
Incorrect stating of age
If your age is incorrectly stated on the application your benefits will be the same as the premium that you pay the insurance was purchased on the correct date and at the right. We will refund any premiums not earned in addition to any benefits received when the age you listed at the date of application was not within the limit of age for your insurance.
The incorrect statement of income or occupation if your job is incorrectly stated, your benefits will be the same as the premiums you pay would have been.
You have to purchase the right equipment for your job. If your earnings have been not correctly calculated, the amount payable will be the amount that would have been allowed by your income. Any premium that is not paid is a charge refunded.
An error in the policyholder’s record is not a cause for the cancellation of coverage. continue to terminate coverage. If there is a clerical error, it will not end coverage.
When an error occurs, we will adjust the price.
We will provide the policyholder with an individual Certificate for each member. The Certificate will state:
- The coverage
- Who will benefit be made and
These rights and benefits are granted provided under the Plan.
The Policyholder must provide all the information and evidence that could be reasonably required by us regarding the plan.
Conformity to State Statutes
The Plan was published at the time of its effective date in the state specified as Master Application. Any Plan the provision that conflicts with the state’s laws is modified to be consistent with the minimal standards of the laws.
Important information regarding coverage under the texas life and health insurance guaranty association
(For insurance companies declared bankrupt, impaired, or insolvent on or on or after September 1, 2011.)
Texas law provides a mechanism to safeguard Texas Policyholders if their health or life insurance company is unable to meet its obligations. Texas Life and Health Insurance Guaranty Association (the “Association”) manages this insurance system.
Only the policyholders of insurance companies who belong to the Association are protected by this insurance policy and are subject to the restrictions, terms and the terms, limitations, and the Association to the terms, limitations, and conditions of the Association’s law.
(The law is inside Chapter XVII of the Texas Insurance Code, Chapter 463.)
It could be that the Association could not be able to protect the entirety or a portion of your policy due to the limitations of the law.
Protection eligibility by the Association
If a member insurance firm is discovered to be insolvent and put under liquidation orders by the court or classified as being insolvent as impaired by designated as impaired by the Texas Commissioner of Insurance, the Association offers insurance to policyholders They are:
- Residents from Texas (regardless of the location where the policyholder resided at the time of issue)
- Residents of states other than the United States only when these conditions are fulfilled:
- The policyholder is insured by a firm based in Texas;
- The policyholder’s home state is a comparable guaranty state and
- The policyholder is not covered by the guaranty organization of the state that which the policyholder is in residence.
Continental American Insurance Company Columbia, South Carolina
Limits to Protection of the Association
Accidents, Health as well as Health Insurance
- For every person that is covered under one or more insurance policies over $500,000 for medical-surgical, hospital, major medical insurance, and major medical insurance $300,000 for long-term care insurance, and $200,000 for all other kinds of health insurance.
- Net cash surrender value or net withdrawal value that is up to a maximum of $ 100,000 in one of the policies based on Single life; or A death benefit amounting to up to a maximum of $300,000. This is under any of the policies for one life.
- Benefits up to $5,000,000 for any owner of multiple life insurance policies that are not a group.
- The value of benefits at present exceeds $250,000 in the terms of one contract or more under one life.
- Actual value allotted benefits to a maximum of $250,000 in any one lifetime; or
- The actual value of unallocated benefits is more than $5,000,000 per contract holder, regardless of the number of contracts.
- $300,000 for any single life, except an insurance policy that is $500,000, and the $5,000,000 multi-owner life insurance policy. Insurance limits, and the unallocated $5,000,000 limit for group annuities.
- Health Insurance and Its Types
- What Is Life Insurance? – Types of Life Insurance
- Auto Insurance and Different Types of Auto Insurance
- What is Home Insurance – Types of Home Insurance Policy
- What Is Business Insurance & Its Types
- What is Pet Insurance and How Does It Work?
The limits apply to any insolvent insurance company.
Agents and insurance companies are forbidden by law from using the name of Association for the purpose behind sales the purpose of sales, solicitation, or intention to purchase any kind of insurance. When you choose Insurance companies, do not be relying on Association insurance coverage. For more information on Association or general information on the insurance company, you can make use of the contact details below.
Texas Life and Health Insurance Guaranty Association Texas Department of Insurance
515 Congress Avenue Post Office Box 515 Congress Avenue Post Office Box
Suite 1875 Austin, Texas 78714-9104
Austin, TX 78701 (800)-252-3439 or www.tdi.texas.gov
(800)-982-6362 or www.txlifega.org