Average size of converted policies, $3,346. Converted policies terminated by death and disability, 378,000 Ratio of death losses to American Experience Table, 40 per cent. XVI ACCIDENT AND HEALTH POLICY TEN DOLLAR ACCIDENT AND SICKNESS POLICY" Paying indemnity for Loss of Life by Accidental Means as provided by Part V and for loss MAXIMUM DEATH BENEFIT No.. MAXIMUM WEEKLY ACCIDENT INDEMNITY Under Part II WEEKLY SICKNESS INDEMNITY Casualty Company (HEREINAFTER CALLED THE COMPANY) In Consideration of the statements in the application, a copy of which is endorsed hereon and made part hereof, and OF TEN DOLLARS ($10.00) PREMIUM Gereby Insures subject to all the provisions and limitations herein contained, for the term of ONE YEAR from noon, standard time of the day and at the place this policy is dated, against the effects of BODILY INJURIES caused directly, solely and independently of all other causes by External, Violent and Accidental means, which bodily injuries or their effects shall not be caused wholly or in part, directly or indirectly, by any disease, defect or infirmity, and which shall from the date of the accident result in continuous disability and also against the effects of SICKNESS, as follows: Resulting within thirty days from date of accident solely from such injuries, but only when such injuries are sustained while actually riding as a passenger in a place regularly provided for the transportation of passengers only, within a railroad car, elevated subway or interurban railroad car, street car or steamboat, provided by a common carrier for passenger service by reason of the wrecking of any such car or steamboat; or PART II FOR LOSS OF TIME-FIFTY DOLLARS (50.00) PER WEEK Not exceeding ten consecutive weeks if injury sustained in the manner specified in Part I shall not cause any of the Losses in said Part I mentioned, but shall from the date of the accident continuously and wholly prevent the Insured from attending to any and every kind of business or labor PART IIL WEEKLY INDEMNITY FOR LOSS OF TIME-TWENTY-FIVE DOLLARS $(25.00) PER WEEK Not exceeding ten consecutive weeks, if such injuries shall from date of accident continuously and wholly prevent the Insured from attending to any and every kind of business or labor, but only when such injuries are sustained in the manner specified in Clauses 1 to 16 of this Part III. 1. WHILE ACTUALLY RIDING AS A PASSENGER IN A PLACE regularly provided for the transportation of passen. gers only, within a railroad car, elevated, subway or interurban rail road car, street car or steamboat, provided by a common carrier for passenger service; or 2. WHILE A PASSENGER WITHIN AN ELEVATOR provided for passenger service only; or 3. BY THE BURNING OF A DWELLING, HOTEL, OFFICE BUILDING, THEATRE, SCHOOL, CHURCH, LODGE ROOM, CLUB HOUSE, STORE OR BARN, in which the Insured may be burned by fire or suffocated by smoke, provided the Insured shall not be assisting or acting as a watchman, policeman, or a volunteer or paid fireman; or 4. WHILE WALKING ON A PUBLIC HIGHWAY, by being injured by actual contact with a bicycle or any moving conveyance or vehicle, provided the Insured is not or has not been employed or engaged on or about the conveyance or vehicle or is not stopping or attempting to stop a runaway; or 5. WHILE RIDING WITHIN A PRIVATE AUTOMOBILE, not being used for any business purpose or any work whatsoever and provided that the Insured shall not be a hired operator thereof (but this exception shall not apply to any physician or surgeon then employed in the practice of his profession or any commercial traveler or buyer selling or buying goods from sample for future delivery only, collectors of accounts, or regularly licensed real estate and insurance agents in their pursuit of business); and only in case of accident which shall materially injure the automovile; or 6. WHILE RIDING UPON A BICYCLE (not a motorcycle) and caused solely and directly by reason of a collision with another bicycle or any moving conveyance; or 7. WHILE RIDING UPON A MOTORCYCLE and caused solely and directly by reason of a collision with any moving conveyance, except another motorcycle, and not being used for any business purpose or any work whatsoever (but this exception shall not apply to any physician or surgeon then employed in the practice of his profession, or any commercial traveler or buyer selling or buying goods from sample for future delivery only, collectors of accounts, or regularly licensed real estate and insurance agents in their asual pursuit of business); or 8. AT THE HANDS OF ANY BURGLAR, HIGHWAYMAN OR ROBBER when robbing the Insured by force: or 9. BY THE EXplosion of a STEAM, STATIONARY, LOCOMOTIVE, OR MARINE BOILER, when such explosion causes destruction of such boiler; or 10. BY A REGULARLY LICENSED PHYSICIAN, SURGEON, DENTIST, UNDERTAKER OR NURSE accidentally cutting or wounding himself while holding an autopsy or performing a surgical operation and simultaneously therewith becoming inocu lated with poison; or XVI-Continued 11. WHILE RIDING WITHIN A CONVEYANCE drawn by horse power, provided that the Insured shall not then be a hired driver thereof nor be riding or driving in or upon any conveyance containing any merchandise or used for any business purpose or any work whatsoever (but this exception shall not apply to any physician or surgeon then employed in the practice of his profession or any commercial traveler or buyer selling or buying goods from sample for future delivery only) and only in case of an accident which shall materially injure the conveyance; or 12. By being KICKED BY A HORSE OR GORED BY A BULL OR COW; or 13. WHILE GETTING ON OR OFF OR BEING ON THE STEP OR PLATFORM OF ANY CONVEYANCE specified in Part I; or WHILE ACTIVELY ENGAGED IN FARMING, by actual contact with and while operating a THRESHING, MOWING, REÅPING 14. or BINDING MACHINE, HARROW or PLOW: or 15. BY BEING STRUCK BY LIGHTNING, CYCLONE, or TORNADO, as defined by the United States Weather Bureau; or 16. WHILE WALKING ON A PUBLIC STREET OR SIDEWALK, by being struck by a falling sign-board, awning, brick, stone, or other debris falling from a building (except buildings in process of construction, repairs or demolition PART IV FRACTURE OF BONES BY ANY ACCIDENT FOR LOSS THROUGH THE COMPLETE FRACTURE OF ANY BONE IN THIS PART MENTIONED BY ANY ACCIDENT IN OR OUT OF BUSINESS, except if covered under Parts I, II or III, as follows: But in case of more than one such fractures, payment shall only be made for one thereof, the Insured having the right to elect for which fracture payment shall be made. PART V. The Company will pay for loss of life of the Insured which results within thirty days from date of accident, solely from such injuries caused by an accident in or out of business if not otherwise covered by this policy, and which shall have caused continuous total disability from date of accident to date of loss, the sum of ONE HUNDRED DOLLARS ($100.00). PART VI. If the Insured shall in consequence of ANY ACCIDENT IN OR OUT OF BUSINESS not otherwise covered by the policy be continuously confined within the house and regularly visited therein by a Licensed Physician, not leaving it at any time for any purpose whatsoever and shall be wholly prevented from attending to any and every kind of work or business, for a period of not less than thirty (30) consecutive days from date of the accident, the Company will pay the sum of TWENTY-FIVE ($25.00). PART VII. HOSPITAL BENEFITS FOR LOSS FROM CONFINEMENT IN A PUBLIC OR PRIVATE HOSPITAL in his home town or in a hotel or hospital away from his home town, for not more than five consecutive weeks, resulting from such injuries caused by ANY ACCIDENT IN OR OUT OF BUSINESS for which no other indemnity is provided by this policy, and which causes continuous total disability from its date. TWENTY-FIVE DOLLARS ($25.00) PER WEEK PART VIII. SURGEON'S FEES-NON-DISABLING INJURIES If the Insured suffers injury in any manner described in Parts II or III hereof, and such injury shall not result in either disability or death, but shall require medical or surgical treatment by a legally qualified physician or surgeon, the Company will reimburse the Insured for the cost thereof in an amount not to exceed TEN DOLLARS ($10.00), the attending physician's or surgeon's receipt for services being deemed sufficient proof under this clause, but such receipt must be furnished the Company within 90 days from the date of accident. PART IX. SICKNESS BENEFITS If the Insured shall be continuously confined within the house, not leaving it at any time or for any purpose whatsoever, and regularly visited therein at least once in every seven days by a Licensed Physician and be wholly prevented from transacting any and every kind of business solely by not including their complications and consequences, provided that this insurance shaff have been in continuous force for thirty days from its date prior to the contraction of the disease, the Company will pay for such confinement alter the first seven days and not exceeding ten weeks a weekly indemnity of TWENTY-FIVE DOLLARS ($25.00). PART X. EMERGENCY BENEFIT-REGISTRATION, IDENTIFICATION AND FINANCIAL AID The Company will register the person insured hereunder and if he shall by reason of such injuries or sickness be physically unable to communicate with friends, will, upon receipt of a message giving this Policy Number, the number of the Key Tag, or the number on the card in the card case, which are furnished with this Policy, immediately transmit to such relatives or friends as may be known to it, any information respecting him, and will defray any expenses necessary to put him in communication with and in the care of friends, not exceeding ONE HUNDRED DOLLARS The loss of any member or members specified herein shall mean the loss by actual and complete severance at or above the wrist or ankle; loss of eye or eyes shall mean the irrecoverable loss of the entire sight thereof. This Policy may be renewed by the payment of annual premiums in advance, and a receipt signed by the Secretary and countersigned by a licensed agent of the Company shall be the only evidence binding upon the Company of the payment of a renewal premium. This insurance does not cover (1) an employee of a common carrier, news company or the Government, while on duty, excepting only employees whose duties call them solely in the office and away from track, train, yard, roundhouse and repair shop; (2) while in or on a balloon or other aerial machine or conveyance; (3) miners while at work; (4) suicide or an attempt thereat while sane or insane; (5) while intoxicated or under the influence of or affected by or resulting directly or indirectly from intoxicants or narcotics, anaesthetics, gas, corrosives, poison, infection, or poisonous substances except provided in Clause 10 of Part III; (6) while riding or driving in races or sustained by professional motorcycle or bicycle riders; (7) the result of the intentional act of the Insured or any other person, except as provided by Clause 8 of Part III; (8) any loss contributed to or caused by any mental or bodily infirmity or venereal disease, vertigo or exposure to unnecessary danger; (9) while violating law; (10) while walking over or on the roadbed or bridge of any railway, except while crossing at a public street or highway; (11) injuries, fatal or non-fatal, except drowning, of which there shall be no visible mark or contusion on exterior of the body at the place of injury, the body itself in case of death not to be deemed such. (12) while engaged in military or naval service; (13) while engaged in playing football or handling explosives or firearms; (14) sickness contracted prior to the date of this policy or from any disease or sickness not named in the policy, or complicated with a disease not specifically covered by this policy, or (15) unless sustained in the United States, Canada, Europe or Mexico. No recovery may be had under more than one of the provisions hereof and in no event shall the Company be liable under Part I for more than one of the specific losses named therein, and any payment hereunder, other than for weekly indemnity, or as provided by Parts IV, VI, VII, VIII, or X, shall terminate this policy. No assignment of this policy or change of beneficiary shall be valid unless approved by an executive officer of the Company and an endorsement shall be made hereon as provided by Standard Provision Number 2. Strict compliance on the part of Insured and Beneficiary with all provisions of this Policy is a condition precedent to recovery hereunder, and any failure in this respect shall forfeit to the Company all right to any indemnity. Between the ages of sixty and seventy all benefits hereunder shall be reduced one-third. No provision of the charter or by-laws of the Company not incorporated in full herein shall avoid the Policy or be used in evidence in any legal proceeding. The authority of the General Agents or Special Agents of this Company, including the Agent issuing or countersigning this Policy, is limited to securing applications for personal Accident and Health Insurance, and to the execution or countersigning of the same, where written authority is given therefore, and for the collection of premiums upon such executed policies. The authority of all attorneys in fact for this Company is limited to the acts to be performed as set forth in the Power of Attorney appointing such Attorney-in-Fact. This Section relates to and limits the authority and power of every Agent and other representative of this Company in the manner set forth in this paragraph. STANDARD PROVISIONS 1. This Policy includes the endorsements and attached papers, if any, and contains the entire contract of insurance. No reduction shall be made in any indemnity herein provided by reason of change in the occupation of the Insured or by reason of his doing any act or thing pertaining to any other occupation. 2. No statement made by the applicant for insurance not included herein shall avoid the Policy or be used in any legal proceeding hereunder. No agent has authority to change this Policy or to waive any of its provisions. No change in this Policy shall be valid unless approved by an executive officer of the Company and such approval be endorsed hereon. 3. If default be made in the payment of the agreed premium for this Policy, the subsequent acceptance of a premium by the Company or by any of its duly authorized agents shall reinstate the Policy, but only to cover accidental injury thereafter sustained and such sickness as may begin more than ten days after the date of such acceptance. 4. Written notice of injury or of sickness on which claim may be based must be given to the Company within twenty days after the date of the accident causing such injury or within ten days after the commencement of disability from such sickness. In event of accidental death immediate notice thereof must be given to the Company. 5. Such notice given by or in behalf of the Insured or beneficiary, as the case may be, to the Company at Philadelphia, Penna., or to any authorized agent of the Company, with particulars sufficient to identify the Insured, shall be deemed to be notice to the Company. Failure to give notice within the time provided in this policy shall not invalidate any claim if it shall be shown not to have been reasonably possible to give such potice and that notice was given as soon as was reasonably possible. 6. The Company upon receipt of such notice will furnish to the claimant such forms as are usually furnished by it for filing proofs of loss. If Buch forms are not so furnished within fifteen days after the receipt of such notice, the claimant shall be deemed to have complied with the require ments 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, character and extent of the loss for which claim is made. 7. Affirmative proof of loss must be furnished to the Company at its said office in case of claim for loss of time from disability within ninety days after the termination of the period for which the Company is liable, and in case of claim for any other loss, within ninety days after the date of such loss. 8. The Company shall have the right and opportunity to examine the person of the Insured when and so often as it may reasonably require during the pendency of claim hereunder, and also the right and opportunity to make an autopsy in case of death where it is not forbidden by law. 9. All indemnities provided in this policy for loss other than that of time on account of disability will be paid immediately after receipt of. due proof. 10. Upon request of the Insured and subject to due proof of loss all accrued indemnity for loss of time on account of disability will be paid at the expiration of each thirty days during the continuance of the period for which the Company is liable, and any balance remaining unpaid at the termination of such period will be paid immediately upon receipt of due proof. 11. Indemnity for loss of life of the Insured is payable to the beneficiary if surviving the Insured, and otherwise to the estate of the Insured. All other indemnities of this Policy are payable to the Insured. 12. If the Insured shall at any time change his occupation to one classified by the Company as less hazardous than that stated in the Policy, the Company, upon written request of the Insured and surrender of the Policy, will cancel the same and will return to the Insured the unearned premium. 13. Consent of the beneficiary shall not be requisite to surrender or assignment of this policy, or to change of beneficiary, or to any other changes in the Policy. 14. No action at law or in equity shall be brought to recover on this Policy prior to the expiration of sixty days after proof of loss has been filed in accordance with the requirements of this Policy, nor shall such action be brought at all unless brought within two years from the expiration of the time within which proof of loss is required by the Policy. 15. If any time limitation of this policy with respect to giving notice of claim or furnishing proof of loss is less than that permitted by the law of the state in which the insured resides at the time this policy is issued, such limitation is hereby extended to agree with the minimum period permitted by such law. 16. The Company may cancel this policy at any time by written notice delivered to the insured or mailed to his last address, as shown by the records of the Company, together with cash or the Company's check for the unearned portion of the premiums actually paid by the insured, and such cancellation shall be without prejudice to any claim originating prior thereto. 17. If the Insured shall carry with another company, corporation, association or society other insurance covering the same loss without giving written notice to the Company, then in that case the Company shall be liable only for such portion of the indemnity promised as the said indemnity bears to the total amount of like indemnity in all policies covering such loss, and for the return of such part of the premium paid as shall exceed the pro rata for the indemnity thus determined. 20. The insurance under this policy shall not cover any person under the age of sixteen years nor over the age of seventy years. Any premium paid to this Company for any period not covered by this policy will be returned upon request. In Bitness Whereof the tary in the City of CASUALTY COMPANY has caused this policy to be signed by its President and SecrePenna, but the same shall not be binding on the Company until signed by its authorized Agent. XVI-Continued COPY OF APPLICATION I hereby apply for Limited Accident and Sickness Insurance in the Company to be based upon the following representation of facts: Casualty Have you ever had fits, diabetes, kidney disease, syphilis, heart disease, hernia or any disease of the nervous system? Have you lost a hand, foot or eye or the use of either? Are you in whole and sound condition? Have you had medical attendance within the past twelve months? Have you any insurance in this Company? Are you now carrying or have you applied for any other Accident or Health Insurance? Has any application ever made by you been declined, or has any policy issued to you been cancelled or renewal refused by any Life, Accident or Health Insurance Association, Company or Society? Dated at.. ..this.... Signed........ .......19...... In the event of any accident or any sickness full particulars |