CHAPTER 101

An Act to amend and reenact § 38.1-849, as amended, of the Code of
Virginia, relating to required provisions in policies of accident and
sickness tnsurance. 'S 82]

Approved March 5, 1966

Be it enacted by the General Assembly of Virginia:

L. That § 38.1-349, as amended, of the Code of Virginia, be amended
and reenacted as follows: ,

§ 38.1-349. Except as provided in § 38.1-351 of this article, 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; provided, however, that the insurer may,
at its option, substitute for one or more of such provisions corresponding
provisions of different wording approved by the Commission which are
™m each instance not less favorable in any respect to the insured or the
beneficiary. Such provisions shall be preceded individually by the caption
“REQUIRED PROVISIONS” or, at the option of the insurer, by such
appropriate individual or group captions or subcaptions as the Commission
may approve.
provision as follows:

ENTIRE CONTRACT; CHANGES: This policy, includ-
ing the endorsements and the attached papers, if any, con-
stitutes 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 at-
tached hereto. No agent has authority to change this policy
or to waive any of its provisions.
provision as follows:

TIME LIMIT ON CERTAIN DEFENSES: (a) After
* two years from the date of issue of this policy, no misstate-
ments, except fraudulent misstatements, made by the appli-
cant 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.
regoing policy provision shall not be so construed as to affect
juirement for avoidance of a policy or denial of a claim during
* two-year period, nor to limit the application of para-
(2), (3), (4) and (5) of § 88.1-350 in the event of misstatement
to age or occupation or other insurance.)
cy which the insured has the right to continue in force subject
by the timely payment of premium (1) until at least age 50
ne case of a policy issued after age 44, for at least five years
e of issue, may contain in lieu of the foregoing the following
‘rom which the clause in parentheses may be omitted at the
ion) 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 shall become
incontestable as to the statements contained in the ap-
plication).

(b) No claim for loss incurred or disability (as defined
in the policy) commencing after * two years from the date of
issue of this policy shall be reduced or denied on the ground
that a disease or physical condition not excluded from cover-
age by name or specific description effective on the date of
logs had existed prior to the effective date of coverage of this
policy. , | : oo
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 pre-
mium falling due after the first premium, during which grace
period the policy shall continue in force.
cy which contains a cancellation provision may add, at the
bove provision, subject to the right of the insurer to cancel
e with the cancellation provision hereof.

y In which the insurer reserves the right to refuse any re-
ave, at the beginning of the above provision,

Unless not less than five days prior to the premium due
date the insurer has delivered to the insured or has mailed
to his last address as shown by the records of the insurer
written notice of its intention not to renew this policy be-
yond the period for which the premium has been accepted,).
provision as follows:

REINSTATEMENT: If any renewal premium be not

Go ogle
paid within the time granted the insured for payment, a sub-
sequent 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; provided, however,
that if the insurer or such agent requires an application for
reinstatement and issues a conditional receipt for the pre-
mium 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 condi-
tional 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 i
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 reinstate-
ment. Any premium accepted in connection with a reinstate-
ment 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.

st sentence of the above provision may be omitted from any
1 the insured has the right to continue in force subject to its
e timely payment of premiums (1) until at least age 50, or,
case of a policy issued after age 44, for at least five years
» of issue.)

provision 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 in-
surer 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.
olicy providing a loss-of-time benefit which may be payable
two years, an insurer may at its option insert the following
first and second sentences of the above provision:

Subject to the qualifications set forth below, if the insured
suffers loss of time on account of disability for which in-
demnity may be payable for at least two years, he shall, at
least once in every six months after having given notice of
claim, give to the insurer notice of continuance of said dis-
ability, 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 in-
demnity which would otherwise have accrued during the
period of six months preceding the date on which such notice
is actually given.)
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 sub-
mitting, 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.

provision as follows: ,

PROOFS OF LOSS: Written proof of loss must be furn-
ished to the insurer at its said office in case of claim for loss
for which this policy provides any periodic payment con-
tingent 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, provided such proof is furnished as soon as reasonably
possible and in no event, except in the absence of legal ca-
pacity, later than one year from the time proof is otherwise
required.
provision as follows:

TIME OF PAYMENT OF CLAIMS: Indemnities pay-
able under this policy for any loss other than loss for which
this policy provides any periodic payment will be paid im-
mediately 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 re-
maining unpaid upon the termination of liability will be pai
immediately upon receipt of due written proof. |
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 in-
demnity 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.
lowing provisions, or either of them, may be included with
y provision 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 a valid release,
the insurer may pay such indemnity, up to an amount not
exceeding $....... (insert an amount which shall not
exceed $1,000), 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 ap-
plication or otherwise all or a portion of any indemnities pro-

Google
vided 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 re-
quired that the service be rendered by a particular hospital
or person.)

provision as follows:

PHYSICAL EXAMINATIONS AND AUTOPSY: The
insurer at its own expense shall have the right and oppor-
tunity 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.
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.
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.

‘st clause of this provision, relating to the irrevocable designa-
iclary, may be omitted at the insurer’s option.)
provision as follows:

REQUIRED COVERAGE ON CONNECTING OR RE-
TURNING PLANES: In every airtrip accident policy, is-
sued in this State through a mechanical vending machine
or otherwise, the coverage thereof, according to its terms
and provisions, shall extend to an accident on a connecting
or returning plane on which the insured’s initial airtrip ticket
entitles him to ride, if it be shown that the insured would
be entitled to recover under such policy had the accident
occurred while insured was riding on the initial plane desig-
nated on such ticket.