Title 33, Chapter 29, Section 4
( 33-29-4)
(a) No accident and sickness policy delivered or issued for delivery
in this state shall contain provisions respecting the matters set
forth in this Code section unless such provisions are in the words
in which the same appear in subsection (b) of this Code section,
except that the insurer may, at its option, use in lieu of any such
provision a corresponding provision of different wording approved by
the Commissioner which is not less favorable in any respect to the
insured or the beneficiary. Any such provision contained in the
policy shall be preceded individually by the appropriate caption
appearing in this Code section or, at the option of the insurer, by
such appropriate individual or group captions or subcaptions as the
Commissioner may approve. If any such provision is in whole or in
part inapplicable to or inconsistent with the coverage provided by a
particular form of policy, the insurer, with the approval of the
Commissioner, shall omit from the policy any inapplicable provision
or part of a provision and shall modify any inconsistent provision
or part of a provision in such a manner as to make the provision as
contained in the policy consistent with the coverage provided by the
policy. (b)(1) Change of occupation. If the insured is injured or
contracts sickness after having changed his occupation to one
classified by the insurer as more hazardous than that stated in
this policy or while doing for compensation anything pertaining to
an occupation so classified, the insurer will pay only such
portion of the indemnities provided in this policy as the premium
paid would have purchased at the rates and within the limits fixed
by the insurer for such more hazardous occupation. If the insured
changes his occupation to one classified by the insurer as less
hazardous than that stated in this policy, the insurer, upon
receipt of proof of such change of occupation, will reduce the
premium rate accordingly and will return the excess pro rata
unearned premium from the date of change of occupation or from the
policy anniversary date immediately preceding receipt of such
proof, whichever is the more recent. In applying this provision,
the classification of occupational risk and the premium rates
shall be such as have been last filed by the insurer, prior to the
occurrence of the loss for which the insured is liable or prior to
date of proof of change in occupation, with the state official
having supervision of insurance in the state where the insured
resided at the time this policy was issued; but, if such filing
was not required, then the classification of occupational risk and
the premium rates shall be those last made effective by the
insurer in the state prior to the occurrence of the loss or prior
to the date of proof of change in occupation. (2) Misstatement of age. If the age of the insured has been
misstated, all amounts payable under this policy shall be such as
the premium paid would have purchased at the correct age. (3) Other insurance with this insurer. (A) If an accident or sickness or accident and sickness policy
or policies previously issued by the insurer to the insured is
in force concurrently herewith, making the aggregate indemnity
for ________ (insert type of coverage or coverages) in excess of
$________ (insert maximum limit of indemnity or indemnities),
the excess insurance shall be void and all premiums paid for the
excess shall be returned to the insured or to his estate; or, in lieu thereof: (B) Insurance effective at any one time on the insured under a
like policy or policies with this insurer is limited to the one
such policy elected by the insured, his beneficiary, or his
estate, as the case may be, and the insurer will return all
premiums paid for all other policies. (4) Relation of earnings to insurance. (A) If the total monthly amount of loss of time benefits
promised for the same loss under all valid loss of time coverage
upon the insured, whether payable on a weekly or monthly basis,
shall exceed the monthly earnings of the insured at the time
disability commenced or his average monthly earnings for the
period of two years immediately preceding a disability for which
claim is made, whichever is the greater, the insurer will be
liable only for such proportionate amount of such benefits under
this policy as the amount of the monthly earnings or the average
monthly earnings of the insured bears to the total amount of
monthly benefits for the same loss under all such coverage upon
the insured at the time such disability commences and for the
return of that part of the premiums paid during such two years
which exceeds the pro rata amount of the premiums for the
benefits actually paid hereunder; but this shall not operate to
reduce the total monthly amount of benefits payable under all
the coverage upon the insured below the sum of $200.00 or the
sum of the monthly benefits specified in the coverages,
whichever is the lesser, nor shall it operate to reduce benefits
other than those payable for loss of time. (B) The policy provision of subparagraph (A) of this paragraph
may be inserted only in a 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 60 or, in the case of a policy
issued after age 54, for at least five years from its date of
issue. The insurer may, at its option, include in this
provision a definition of "valid loss of time coverage,"
approved as to form by the Commissioner, which definition shall
be limited in subject matter to coverage provided by
governmental agencies or by organizations subject to regulation
by insurance law or by insurance authorities of this or any
other state of the United States or any province of Canada, or
to any other coverage the inclusion of which may be approved by
the Commissioner or any combination of such coverages. In the
absence of that definition the term shall not include any
coverage provided for the insured pursuant to any compulsory
benefit statute, including any workers' compensation or
employer's liability statute, or benefits provided by union
welfare plans or by employer or employee benefit organizations. (5) Unpaid premium. Upon the payment of a claim under this policy,
any premiums then due and unpaid or covered by any note or written
order may be deducted therefrom. (6) Return of premium on cancellation. If the insured cancels this
policy, the earned premium shall be computed by the use of the
short-rate table last filed with the state official having
supervision of insurance in the state where the insured resided
when the policy was issued. Cancellation shall be without
prejudice to any claim originating prior to the effective date of
cancellation. (7) Conformity with state statutes. Any provision of this policy
which, on its effective date, is in conflict with the statutes of
the state, District of Columbia, or territory in which the insured
resides on such date is amended to conform to the minimum
requirements of such statutes. (8) Illegal occupation. The insurer shall not be liable for any
loss to which a contributing cause was the insured's commission of
or attempt to commit a felony or to which a contributing cause was
the insured's being engaged in an illegal occupation. (9) Intoxicants and narcotics. The insurer shall not be liable for
any loss sustained or contracted in consequence of the insured
being intoxicated or under the influence of any narcotic unless
administered on the advice of a physician. (10) Cancellation of travel accident policies. With respect only
to travel accident insurance policies, the following optional
provisions may be inserted in the policy: "The insurer reserves the right to cancel this policy under the provisions set forth in Code Section 33-24-44." |