{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-3504.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-3504.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-3504.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-3504.html"}],"law_id":83509,"edition_id":1,"section_id":83509,"structure_id":13349,"section_number":"38.2-3504","catch_line":"Other provisions","history":"1952, c. 317, \u00a7 38.1-350; 1986, c. 562; 2000, c. 540; 2003, c. 377.","full_text":"Except as provided in \u00a7 38.2-3505, no individual accident and sickness insurance policy delivered or issued for delivery in this Commonwealth shall contain provisions respecting the matters set forth below unless such provisions use the same words which appear in this section. Provisions 1 through 7, 8 a, and 9 through 11 shall apply to all such policies that are issued for delivery or delivered in this Commonwealth prior to January 1, 2001. Provisions 1 through 7, 8 b, and 9 through 11 shall apply to all such policies that are issued for delivery, delivered, renewed, or extended in this Commonwealth on or after January 1, 2001. The insurer may use a corresponding provision of different wording approved by the Commission that is not less favorable in any respect to the Insured or the beneficiary. Any such provision shall be preceded individually by the appropriate caption OTHER PROVISIONS or by such appropriate individual or group captions or subcaptions as the Commission may approve.\n\n1\n\nProvision 1:\n\t\t\tCHANGE OF OCCUPATION: If the Insured is injured or contracts sickness after having changed his occupation to one classified by the Company as more hazardous than that stated in this policy or while doing for compensation anything pertaining to an occupation so classified, the Company will pay only the 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 Company for the more hazardous occupation. If the Insured changes his occupation to one classified by the Company as less hazardous than that stated in this policy, the Company, upon receipt of proof of the 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 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 Company prior to the occurrence of the loss for which the Company is liable or prior to the date of proof of change in occupation with the state insurance supervisory official in the state where the Insured resided at the time this policy was issued; but if the filing was not required, then the classification of occupational risk and the premium rates shall be those last made effective by the Company in the state prior to the occurrence of the loss or prior to the date of proof of change in occupation.2\n\nProvision 2:\n\t\t\tMISSTATEMENT OF AGE: If the Insured’s age has been misstated, the benefits will be those the premium paid would have purchased at the correct age.3\n\nProvision 3:\n\t\t\tOTHER INSURANCE IN THIS COMPANY: If an accident or sickness or accident and sickness policy or policies previously issued by the Company 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 such excess shall be returned to the Insured or to his estate.\n\t\t\tInstead of Provision 3, the following provision may be used:\n\t\t\tInsurance effective at any one time on the Insured under a like policy or policies in this Company is limited to the one such policy elected by the Insured, his beneficiary or his estate, as the case may be, and the Company will return all premiums paid for all other such policies.4\n\nProvision 4:\n\t\t\tINSURANCE WITH OTHER COMPANIES: If there is other valid coverage, not with this Company, providing benefits for the same loss on a provision of service basis or on an expense incurred basis and of which this Company has not been given written notice prior to the occurrence or commencement of loss, the only liability under any expense incurred coverage of this policy shall be for such proportion of the loss as the amount which would otherwise have been payable under this policy plus the total of the like amounts under all such other valid coverages for the same loss of which this Company had notice bears to the total like amounts under all valid coverages for such loss, and for the return of such portion of the premiums paid as shall exceed the pro rata portion for the amount so determined. For the purpose of applying this provision when other coverage is on a provision of service basis, the “like amount” of such other coverage shall be taken as the amount which the services rendered would have cost in the absence of such coverage.\n\t\t\tIf Provision 4 is included in a policy that also contains Provision 5, the phrase “EXPENSE INCURRED BENEFITS” shall be added to the caption of Provision 4. The insurer may include in this provision a definition of “other valid coverage,” approved by the Commission. The definition shall be limited in subject matter to coverage provided by organizations subject to regulation by insurance law or by insurance authorities of this Commonwealth or any other jurisdiction of the United States or Canada, and by hospital or medical service organizations, and to any other coverage the inclusion of which may be approved by the Commission. In the absence of such definition the term shall not include group insurance, automobile medical payments insurance, or coverage provided by hospital or medical service organizations, by union welfare plans, or employer or employee benefit organizations.\n\t\t\tFor the purpose of applying Provision 4, any amount of benefit provided for such insured pursuant to any compulsory benefit statute, including any workers’ compensation or employer’s liability statute, whether provided by a governmental agency or otherwise, shall in all cases be deemed to be “other valid coverage” of which the company has had notice. In applying Provision 4 no third party liability coverage shall be included as “other valid coverage.”5\n\nProvision 5:\n\t\t\tINSURANCE WITH OTHER COMPANIES: If there is other valid coverage, not with this Company, providing benefits for the same loss on other than an expense incurred basis and of which this Company has not been given written notice prior to the occurrence or commencement of loss, the only liability for such benefits under this policy shall be for such proportion of the indemnities otherwise provided under this policy for such loss as the like indemnities of which the Company had notice, including the indemnities under this policy, bear to the total amount of all like indemnities for such loss, and for the return of such portion of the premium paid as shall exceed the pro rata portion for the indemnities thus determined.\n\t\t\tIf Provision 5 is included in a policy that also contains Provision 4, the phrase “OTHER BENEFITS” shall be added to the caption of Provision 5. The insurer may include in this provision a definition of “other valid coverage,” approved by the Commission. The definition shall be limited in subject matter to coverage provided by organizations subject to regulation by insurance law or by insurance authorities of this Commonwealth or any other jurisdiction of the United States or Canada, and to any other coverage approved by the Commission. In the absence of such definition the term shall not include group insurance, or benefits provided by union welfare plans or by employer or employee benefit organizations. For the purpose of applying Provision 5, any amount of benefit provided for the insured pursuant to any compulsory benefit statute, including any workers’ compensation or employer’s liability statute, whether provided by a governmental agency or otherwise, shall in all cases be deemed to be “other valid coverage” of which the Company has had notice. In applying Provision 5 no third party liability coverage shall be included as “other valid coverage.”6\n\nProvision 6:\n\t\t\tRELATION OF EARNINGS TO INSURANCE: 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 a claim is made, whichever is greater, the Company will be liable only for the proportionate amount of the 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 the coverage upon the insured at the time the disability commences and for the return of the part of the premiums paid during such two years that 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 or the sum of the monthly benefits specified in the coverages, whichever is less, nor shall it operate to reduce benefits other than those payable for loss of time.\n\t\t\tProvision 6 may be inserted only in a policy that the insured has the right to continue in force subject to its terms by the timely payment of premiums (i) until at least age 50 or (ii) for a policy issued after age 44, for at least five years from its date of issue. The insurer may include in this provision a definition of “valid loss of time coverage” approved by the Commission. The 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 Commonwealth or any other jurisdiction of the United States or Canada, or to any other coverage the inclusion of which may be approved by the Commission or any combination of coverages. In the absence of such 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.7\n\nProvision 7:\n\t\t\tUNPAID PREMIUM: When a claim is paid, any premium due and unpaid may be deducted from the claim payment.8\n\nProvision 8 a:\n\t\t\tCANCELLATION BY COMPANY: 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, stating when, no less than __________ days thereafter, the cancellation shall be effective; and after the policy has been continued beyond its original term the Insured may cancel this policy at any time by written notice delivered or mailed to the Company effective upon receipt or on such later date as may be specified in the notice. In the event of cancellation, the Company will return promptly the unearned portion of any premium paid. If the Insured cancels, the earned premium shall be computed by the use of the short-rate table last filed with the state insurance supervisory official in the state where the Insured resided when the policy was issued. If the Company cancels, the earned premium shall be computed pro rata. Cancellation shall be without prejudice to any claim originating prior to the effective date of cancellation.\n\t\t\tProvision 8 b:\n\t\t\tCANCELLATION BY COMPANY: 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, stating when, no less than days thereafter, the cancellation shall be effective. In the event of cancellation, the Company will return promptly the unearned portion of any premium paid. The earned premium shall be computed pro rata. Cancellation shall be without prejudice to any claim originating prior to the effective date of cancellation.\n\t\t\tIn Provisions 8 a and 8 b, a number no less than “7″ for weekly premium policies, “10″ for monthly premium policies and “31″ for all other policies shall be inserted between the words “than” and “days.”9\n\nProvision 9:\n\t\t\tCONFORMITY WITH STATE STATUTES: Any provision of this policy that on its effective date is in conflict with the laws of the state in which the Insured resides on that date is hereby amended to conform to the minimum requirements of the laws.10\n\nProvision 10:\n\t\t\tILLEGAL OCCUPATION: The Company will not be liable for any loss that results from the Insured’s committing or attempting to commit a felony or from the Insured’s engaging in an illegal occupation.11\n\nProvision 11:\n\t\t\tINTOXICANTS AND NARCOTICS: The Company will not be liable for any loss resulting from the Insured’s being drunk, or under the influence of any narcotic unless taken on the advice of a physician.","order_by":null,"text":{"0":{"id":299235,"text":"Except as provided in \u00a7 38.2-3505, no individual accident and sickness insurance policy delivered or issued for delivery in this Commonwealth shall contain provisions respecting the matters set forth below unless such provisions use the same words which appear in this section. Provisions 1 through 7, 8 a, and 9 through 11 shall apply to all such policies that are issued for delivery or delivered in this Commonwealth prior to January 1, 2001. Provisions 1 through 7, 8 b, and 9 through 11 shall apply to all such policies that are issued for delivery, delivered, renewed, or extended in this Commonwealth on or after January 1, 2001. The insurer may use a corresponding provision of different wording approved by the Commission that is not less favorable in any respect to the Insured or the beneficiary. Any such provision shall be preceded individually by the appropriate caption OTHER PROVISIONS or by such appropriate individual or group captions or subcaptions as the Commission may approve.","type":"section","prefixes":[""],"prefix":"","entire_prefix":"","prefix_anchor":"","level":1,"next_prefix":"1"},"1":{"id":299236,"text":"Provision 1:\n\t\t\tCHANGE OF OCCUPATION: If the Insured is injured or contracts sickness after having changed his occupation to one classified by the Company as more hazardous than that stated in this policy or while doing for compensation anything pertaining to an occupation so classified, the Company will pay only the 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 Company for the more hazardous occupation. If the Insured changes his occupation to one classified by the Company as less hazardous than that stated in this policy, the Company, upon receipt of proof of the 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 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 Company prior to the occurrence of the loss for which the Company is liable or prior to the date of proof of change in occupation with the state insurance supervisory official in the state where the Insured resided at the time this policy was issued; but if the filing was not required, then the classification of occupational risk and the premium rates shall be those last made effective by the Company in the state prior to the occurrence of the loss or prior to the date of proof of change in occupation.","type":"section","prefixes":["1"],"prefix":"1","entire_prefix":"1","prefix_anchor":"1","level":1,"prior_prefix":"","next_prefix":"2"},"2":{"id":299237,"text":"Provision 2:\n\t\t\tMISSTATEMENT OF AGE: If the Insured’s age has been misstated, the benefits will be those the premium paid would have purchased at the correct age.","type":"section","prefixes":["2"],"prefix":"2","entire_prefix":"2","prefix_anchor":"2","level":1,"prior_prefix":"1","next_prefix":"3"},"3":{"id":299238,"text":"Provision 3:\n\t\t\tOTHER INSURANCE IN THIS COMPANY: If an accident or sickness or accident and sickness policy or policies previously issued by the Company 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 such excess shall be returned to the Insured or to his estate.\n\t\t\tInstead of Provision 3, the following provision may be used:\n\t\t\tInsurance effective at any one time on the Insured under a like policy or policies in this Company is limited to the one such policy elected by the Insured, his beneficiary or his estate, as the case may be, and the Company will return all premiums paid for all other such policies.","type":"section","prefixes":["3"],"prefix":"3","entire_prefix":"3","prefix_anchor":"3","level":1,"prior_prefix":"2","next_prefix":"4"},"4":{"id":299239,"text":"Provision 4:\n\t\t\tINSURANCE WITH OTHER COMPANIES: If there is other valid coverage, not with this Company, providing benefits for the same loss on a provision of service basis or on an expense incurred basis and of which this Company has not been given written notice prior to the occurrence or commencement of loss, the only liability under any expense incurred coverage of this policy shall be for such proportion of the loss as the amount which would otherwise have been payable under this policy plus the total of the like amounts under all such other valid coverages for the same loss of which this Company had notice bears to the total like amounts under all valid coverages for such loss, and for the return of such portion of the premiums paid as shall exceed the pro rata portion for the amount so determined. For the purpose of applying this provision when other coverage is on a provision of service basis, the “like amount” of such other coverage shall be taken as the amount which the services rendered would have cost in the absence of such coverage.\n\t\t\tIf Provision 4 is included in a policy that also contains Provision 5, the phrase “EXPENSE INCURRED BENEFITS” shall be added to the caption of Provision 4. The insurer may include in this provision a definition of “other valid coverage,” approved by the Commission. The definition shall be limited in subject matter to coverage provided by organizations subject to regulation by insurance law or by insurance authorities of this Commonwealth or any other jurisdiction of the United States or Canada, and by hospital or medical service organizations, and to any other coverage the inclusion of which may be approved by the Commission. In the absence of such definition the term shall not include group insurance, automobile medical payments insurance, or coverage provided by hospital or medical service organizations, by union welfare plans, or employer or employee benefit organizations.\n\t\t\tFor the purpose of applying Provision 4, any amount of benefit provided for such insured pursuant to any compulsory benefit statute, including any workers’ compensation or employer’s liability statute, whether provided by a governmental agency or otherwise, shall in all cases be deemed to be “other valid coverage” of which the company has had notice. In applying Provision 4 no third party liability coverage shall be included as “other valid coverage.”","type":"section","prefixes":["4"],"prefix":"4","entire_prefix":"4","prefix_anchor":"4","level":1,"prior_prefix":"3","next_prefix":"5"},"5":{"id":299240,"text":"Provision 5:\n\t\t\tINSURANCE WITH OTHER COMPANIES: If there is other valid coverage, not with this Company, providing benefits for the same loss on other than an expense incurred basis and of which this Company has not been given written notice prior to the occurrence or commencement of loss, the only liability for such benefits under this policy shall be for such proportion of the indemnities otherwise provided under this policy for such loss as the like indemnities of which the Company had notice, including the indemnities under this policy, bear to the total amount of all like indemnities for such loss, and for the return of such portion of the premium paid as shall exceed the pro rata portion for the indemnities thus determined.\n\t\t\tIf Provision 5 is included in a policy that also contains Provision 4, the phrase “OTHER BENEFITS” shall be added to the caption of Provision 5. The insurer may include in this provision a definition of “other valid coverage,” approved by the Commission. The definition shall be limited in subject matter to coverage provided by organizations subject to regulation by insurance law or by insurance authorities of this Commonwealth or any other jurisdiction of the United States or Canada, and to any other coverage approved by the Commission. In the absence of such definition the term shall not include group insurance, or benefits provided by union welfare plans or by employer or employee benefit organizations. For the purpose of applying Provision 5, any amount of benefit provided for the insured pursuant to any compulsory benefit statute, including any workers’ compensation or employer’s liability statute, whether provided by a governmental agency or otherwise, shall in all cases be deemed to be “other valid coverage” of which the Company has had notice. In applying Provision 5 no third party liability coverage shall be included as “other valid coverage.”","type":"section","prefixes":["5"],"prefix":"5","entire_prefix":"5","prefix_anchor":"5","level":1,"prior_prefix":"4","next_prefix":"6"},"6":{"id":299241,"text":"Provision 6:\n\t\t\tRELATION OF EARNINGS TO INSURANCE: 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 a claim is made, whichever is greater, the Company will be liable only for the proportionate amount of the 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 the coverage upon the insured at the time the disability commences and for the return of the part of the premiums paid during such two years that 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 or the sum of the monthly benefits specified in the coverages, whichever is less, nor shall it operate to reduce benefits other than those payable for loss of time.\n\t\t\tProvision 6 may be inserted only in a policy that the insured has the right to continue in force subject to its terms by the timely payment of premiums (i) until at least age 50 or (ii) for a policy issued after age 44, for at least five years from its date of issue. The insurer may include in this provision a definition of “valid loss of time coverage” approved by the Commission. The 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 Commonwealth or any other jurisdiction of the United States or Canada, or to any other coverage the inclusion of which may be approved by the Commission or any combination of coverages. In the absence of such 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.","type":"section","prefixes":["6"],"prefix":"6","entire_prefix":"6","prefix_anchor":"6","level":1,"prior_prefix":"5","next_prefix":"7"},"7":{"id":299242,"text":"Provision 7:\n\t\t\tUNPAID PREMIUM: When a claim is paid, any premium due and unpaid may be deducted from the claim payment.","type":"section","prefixes":["7"],"prefix":"7","entire_prefix":"7","prefix_anchor":"7","level":1,"prior_prefix":"6","next_prefix":"8"},"8":{"id":299243,"text":"Provision 8 a:\n\t\t\tCANCELLATION BY COMPANY: 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, stating when, no less than __________ days thereafter, the cancellation shall be effective; and after the policy has been continued beyond its original term the Insured may cancel this policy at any time by written notice delivered or mailed to the Company effective upon receipt or on such later date as may be specified in the notice. In the event of cancellation, the Company will return promptly the unearned portion of any premium paid. If the Insured cancels, the earned premium shall be computed by the use of the short-rate table last filed with the state insurance supervisory official in the state where the Insured resided when the policy was issued. If the Company cancels, the earned premium shall be computed pro rata. Cancellation shall be without prejudice to any claim originating prior to the effective date of cancellation.\n\t\t\tProvision 8 b:\n\t\t\tCANCELLATION BY COMPANY: 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, stating when, no less than days thereafter, the cancellation shall be effective. In the event of cancellation, the Company will return promptly the unearned portion of any premium paid. The earned premium shall be computed pro rata. Cancellation shall be without prejudice to any claim originating prior to the effective date of cancellation.\n\t\t\tIn Provisions 8 a and 8 b, a number no less than “7″ for weekly premium policies, “10″ for monthly premium policies and “31″ for all other policies shall be inserted between the words “than” and “days.”","type":"section","prefixes":["8"],"prefix":"8","entire_prefix":"8","prefix_anchor":"8","level":1,"prior_prefix":"7","next_prefix":"9"},"9":{"id":299244,"text":"Provision 9:\n\t\t\tCONFORMITY WITH STATE STATUTES: Any provision of this policy that on its effective date is in conflict with the laws of the state in which the Insured resides on that date is hereby amended to conform to the minimum requirements of the laws.","type":"section","prefixes":["9"],"prefix":"9","entire_prefix":"9","prefix_anchor":"9","level":1,"prior_prefix":"8","next_prefix":"10"},"10":{"id":299245,"text":"Provision 10:\n\t\t\tILLEGAL OCCUPATION: The Company will not be liable for any loss that results from the Insured’s committing or attempting to commit a felony or from the Insured’s engaging in an illegal occupation.","type":"section","prefixes":["10"],"prefix":"10","entire_prefix":"10","prefix_anchor":"10","level":1,"prior_prefix":"9","next_prefix":"11"},"11":{"id":299246,"text":"Provision 11:\n\t\t\tINTOXICANTS AND NARCOTICS: The Company will not be liable for any loss resulting from the Insured’s being drunk, or under the influence of any narcotic unless taken on the advice of a physician.","type":"section","prefixes":["11"],"prefix":"11","entire_prefix":"11","prefix_anchor":"11","level":1,"prior_prefix":"10"}},"ancestry":[{"id":13349,"edition_id":1,"name":"Individual Accident and Sickness Insurance Policies","identifier":"1","label":"article","depth":3,"order_by":1,"parent_id":13348,"metadata":{},"date_created":"2026-06-26 03:44:41","date_modified":"2026-06-26 03:44:41","permalink":{"id":215643,"object_type":"structure","relational_id":13349,"identifier":"1","token":"38.2\/35\/1","url":"\/38.2\/35\/1\/","edition_id":1,"permalink":0,"preferred":1}},{"id":13348,"edition_id":1,"name":"Accident and Sickness Insurance Policies","identifier":"35","label":"chapter","depth":2,"order_by":1,"parent_id":12698,"metadata":{},"date_created":"2026-06-26 03:44:41","date_modified":"2026-06-26 03:44:41","permalink":{"id":215641,"object_type":"structure","relational_id":13348,"identifier":"35","token":"38.2\/35","url":"\/38.2\/35\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12698,"edition_id":1,"name":"Insurance","identifier":"38.2","label":"title","depth":1,"order_by":1,"parent_id":null,"metadata":{},"date_created":"2026-06-26 03:43:49","date_modified":"2026-06-26 03:43:49","permalink":{"id":210661,"object_type":"structure","relational_id":12698,"identifier":"38.2","token":"38.2","url":"\/38.2\/","edition_id":1,"permalink":0,"preferred":1}}],"structure_contents":[{"id":81706,"structure_id":13349,"section_number":"38.2-3500","catch_line":"Form of policy","url":"\/38.2-3500\/","token":"38.2\/35\/1\/38.2-3500","metadata":false},{"id":54330,"structure_id":13349,"section_number":"38.2-3501","catch_line":"Policy forms; powers of Commission","url":"\/38.2-3501\/","token":"38.2\/35\/1\/38.2-3501","metadata":false},{"id":56141,"structure_id":13349,"section_number":"38.2-3502","catch_line":"Notice to be printed on policy; return of policy to insurer","url":"\/38.2-3502\/","token":"38.2\/35\/1\/38.2-3502","metadata":false},{"id":67765,"structure_id":13349,"section_number":"38.2-3503","catch_line":"Required accident and sickness policy provisions","url":"\/38.2-3503\/","token":"38.2\/35\/1\/38.2-3503","metadata":false},{"id":83509,"structure_id":13349,"section_number":"38.2-3504","catch_line":"Other provisions","url":"\/38.2-3504\/","token":"38.2\/35\/1\/38.2-3504","metadata":false},{"id":87251,"structure_id":13349,"section_number":"38.2-3505","catch_line":"Inapplicable or inconsistent provisions","url":"\/38.2-3505\/","token":"38.2\/35\/1\/38.2-3505","metadata":false},{"id":72012,"structure_id":13349,"section_number":"38.2-3506","catch_line":"Order of certain policy provisions","url":"\/38.2-3506\/","token":"38.2\/35\/1\/38.2-3506","metadata":false},{"id":62115,"structure_id":13349,"section_number":"38.2-3507","catch_line":"Third-party ownership","url":"\/38.2-3507\/","token":"38.2\/35\/1\/38.2-3507","metadata":false},{"id":67338,"structure_id":13349,"section_number":"38.2-3508","catch_line":"Requirements of other jurisdictions","url":"\/38.2-3508\/","token":"38.2\/35\/1\/38.2-3508","metadata":false},{"id":71696,"structure_id":13349,"section_number":"38.2-3509","catch_line":"Denial or reduction of benefits because of existence of other like insurance","url":"\/38.2-3509\/","token":"38.2\/35\/1\/38.2-3509","metadata":false},{"id":65637,"structure_id":13349,"section_number":"38.2-3510","catch_line":"Conforming to statute","url":"\/38.2-3510\/","token":"38.2\/35\/1\/38.2-3510","metadata":false},{"id":77787,"structure_id":13349,"section_number":"38.2-3511","catch_line":"Application","url":"\/38.2-3511\/","token":"38.2\/35\/1\/38.2-3511","metadata":false},{"id":78397,"structure_id":13349,"section_number":"38.2-3512","catch_line":"Notice; waiver","url":"\/38.2-3512\/","token":"38.2\/35\/1\/38.2-3512","metadata":false},{"id":65509,"structure_id":13349,"section_number":"38.2-3513","catch_line":"Age limit","url":"\/38.2-3513\/","token":"38.2\/35\/1\/38.2-3513","metadata":false},{"id":72827,"structure_id":13349,"section_number":"38.2-3514","catch_line":"When liability not to be denied because of preexisting disease, physical impairment or defect","url":"\/38.2-3514\/","token":"38.2\/35\/1\/38.2-3514","metadata":false},{"id":77154,"structure_id":13349,"section_number":"38.2-3514.1","catch_line":"Preexisting conditions provisions","url":"\/38.2-3514.1\/","token":"38.2\/35\/1\/38.2-3514.1","metadata":false},{"id":74263,"structure_id":13349,"section_number":"38.2-3514.2","catch_line":"Renewability of coverage","url":"\/38.2-3514.2\/","token":"38.2\/35\/1\/38.2-3514.2","metadata":false},{"id":71909,"structure_id":13349,"section_number":"38.2-3515","catch_line":"Repealed","url":"\/38.2-3515\/","token":"38.2\/35\/1\/38.2-3515","metadata":false}],"previous_section":{"id":67765,"structure_id":13349,"section_number":"38.2-3503","catch_line":"Required accident and sickness policy provisions","url":"\/38.2-3503\/","token":"38.2\/35\/1\/38.2-3503","metadata":false},"next_section":{"id":87251,"structure_id":13349,"section_number":"38.2-3505","catch_line":"Inapplicable or inconsistent provisions","url":"\/38.2-3505\/","token":"38.2\/35\/1\/38.2-3505","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-3504\/","history_text":"

This law was first created in 1952. The record of its establishment is cataloged in chapter 317 of that year\u2019s edition of \u201cActs of Assembly,\u201d the annual state publication listing all changes made to the Code of Virginia in that year. Unfortunately, the 1952 \u201cActs\u201d aren\u2019t available online. It has been modified 3 times. Those modifications are cataloged by \u201cThe Acts of Assembly,\u201d a state publication, by year and chapter. Those modifications that can be read on the General Assembly\u2019s website will be linked accordingly. Those modifications are as follows: in 1986, chapter 562; in 2000, chapter 540<\/a>; in 2003, chapter 377<\/a>.<\/p>","references":[{"id":67765,"section_number":"38.2-3503","catch_line":"Required accident and sickness policy provisions","order_by":null,"url":"\/38.2-3503\/"},{"id":72012,"section_number":"38.2-3506","catch_line":"Order of certain policy provisions","order_by":null,"url":"\/38.2-3506\/"},{"id":55347,"section_number":"38.2-4214","catch_line":"Application of certain provisions of law","order_by":null,"url":"\/38.2-4214\/"},{"id":67952,"section_number":"38.2-4319","catch_line":"Statutory construction and relationship to other laws","order_by":null,"url":"\/38.2-4319\/"}],"refers_to":[{"id":87251,"section_number":"38.2-3505","catch_line":"Inapplicable or inconsistent provisions","order_by":null,"url":"\/38.2-3505\/"}],"permalink":{"id":215661,"object_type":"law","relational_id":83509,"identifier":"38.2-3504","token":"38.2\/35\/1\/38.2-3504","url":"\/38.2-3504\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-3504\/","token":"38.2\/35\/1\/38.2-3504","dublin_core":{"Title":"Other provisions","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-3504","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

Except as provided in \u00a7 38.2-3505<\/a>, no individual accident and sickness insurance<\/span> policy delivered or issued for delivery in this Commonwealth shall contain provisions respecting the matters set forth below unless such provisions use the same words which appear in this section. Provisions 1 through 7, 8 a, and 9 through 11 shall apply to all such policies that are issued for delivery or delivered in this Commonwealth prior to January 1, 2001. Provisions 1 through 7, 8 b, and 9 through 11 shall apply to all such policies that are issued for delivery, delivered, renewed, or extended in this Commonwealth on or after January 1, 2001. The insurer<\/span> may use a corresponding provision of different wording approved by the Commission<\/span> that is not less favorable in any respect to the Insured or the beneficiary. Any such provision shall be preceded individually by the appropriate caption OTHER PROVISIONS or by such appropriate individual or group captions or subcaptions as the Commission<\/span> may approve.<\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> Provision 1:\n\t\t\tCHANGE OF OCCUPATION: If the Insured is injured or contracts<\/span> sickness after having changed his occupation to one classified by the Company<\/span> as more hazardous than that stated in this policy or while doing for compensation anything pertaining to an occupation so classified, the Company<\/span> will pay only the portion of the indemnities provided in this policy as the premium paid would have purchased at the rates<\/span><\/span> and within the limits fixed by the Company<\/span> for the more hazardous occupation. If the Insured changes his occupation to one classified by the Company<\/span> as less hazardous than that stated in this policy, the Company<\/span>, upon receipt of proof of the change of occupation, will reduce the premium rate<\/span> 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 more recent. In applying this provision, the classification of occupational risk and the premium rates<\/span><\/span> shall be such as have been last filed by the Company<\/span> prior to the occurrence of the loss for which the Company<\/span> is liable or prior to the date of proof of change in occupation with the state<\/span> insurance<\/span> supervisory official in the state<\/span> where the Insured resided at the time this policy was issued; but if the filing was not required, then the classification of occupational risk and the premium rates<\/span><\/span> shall be those last made effective by the Company<\/span> in the state<\/span> prior to the occurrence of the loss or prior to the date of proof of change in occupation. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> Provision 2:\n\t\t\tMISSTATEMENT OF AGE: If the Insured’s age has been misstated, the benefits will be those the premium paid would have purchased at the correct age. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> Provision 3:\n\t\t\tOTHER INSURANCE<\/span> IN THIS COMPANY<\/span>: If an accident or sickness or accident and sickness policy or policies previously issued by the Company<\/span> 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<\/span> shall be void and all premiums paid for such excess shall be returned to the Insured or to his estate.\n\t\t\tInstead of Provision 3, the following provision may be used:\n\t\t\tInsurance<\/span> effective at any one time on the Insured under a like policy or policies in this Company<\/span> is limited to the one such policy elected by the Insured, his beneficiary or his estate, as the case may be, and the Company<\/span> will return all premiums paid for all other such policies. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

4.<\/span> Provision 4:\n\t\t\tINSURANCE<\/span> WITH OTHER COMPANIES: If there is other valid coverage, not with this Company<\/span>, providing benefits for the same loss on a provision of service basis or on an expense incurred basis and of which this Company<\/span> has not been given written notice prior to the occurrence or commencement of loss, the only liability under any expense incurred coverage of this policy shall be for such proportion of the loss as the amount which would otherwise have been payable under this policy plus the total of the like amounts under all such other valid coverages for the same loss of which this Company<\/span> had notice bears to the total like amounts under all valid coverages for such loss, and for the return of such portion of the premiums paid as shall exceed the pro rata portion for the amount so determined. For the purpose of applying this provision when other coverage is on a provision of service basis, the “like amount” of such other coverage shall be taken as the amount which the services rendered would have cost in the absence of such coverage.\n\t\t\tIf Provision 4 is included in a policy that also contains Provision 5, the phrase “EXPENSE INCURRED BENEFITS” shall be added to the caption of Provision 4. The insurer<\/span> may include in this provision a definition of “other valid coverage,” approved by the Commission<\/span>. The definition shall be limited in subject matter to coverage provided by organizations subject to regulation by insurance<\/span> law<\/span> or by insurance<\/span> authorities of this Commonwealth or any other jurisdiction<\/span> of the United States<\/span> or Canada, and by hospital or medical service organizations, and to any other coverage the inclusion of which may be approved by the Commission<\/span>. In the absence of such definition the term shall not include group insurance<\/span>, automobile medical payments insurance<\/span>, or coverage provided by hospital or medical service organizations, by union welfare plans, or employer or employee benefit organizations.\n\t\t\tFor the purpose of applying Provision 4, any amount of benefit provided for such insured pursuant to any compulsory benefit statute<\/span>, including any workers’ compensation or employer’s liability statute<\/span>, whether provided by a governmental agency or otherwise, shall in all cases be deemed to be “other valid coverage” of which the company<\/span> has had notice. In applying Provision 4 no third party<\/span> liability coverage shall be included as “other valid coverage.” <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

5.<\/span> Provision 5:\n\t\t\tINSURANCE<\/span> WITH OTHER COMPANIES: If there is other valid coverage, not with this Company<\/span>, providing benefits for the same loss on other than an expense incurred basis and of which this Company<\/span> has not been given written notice prior to the occurrence or commencement of loss, the only liability for such benefits under this policy shall be for such proportion of the indemnities otherwise provided under this policy for such loss as the like indemnities of which the Company<\/span> had notice, including the indemnities under this policy, bear to the total amount of all like indemnities for such loss, and for the return of such portion of the premium paid as shall exceed the pro rata portion for the indemnities thus determined.\n\t\t\tIf Provision 5 is included in a policy that also contains Provision 4, the phrase “OTHER BENEFITS” shall be added to the caption of Provision 5. The insurer<\/span> may include in this provision a definition of “other valid coverage,” approved by the Commission<\/span>. The definition shall be limited in subject matter to coverage provided by organizations subject to regulation by insurance<\/span> law<\/span> or by insurance<\/span> authorities of this Commonwealth or any other jurisdiction<\/span> of the United States<\/span> or Canada, and to any other coverage approved by the Commission<\/span>. In the absence of such definition the term shall not include group insurance<\/span>, or benefits provided by union welfare plans or by employer or employee benefit organizations. For the purpose of applying Provision 5, any amount of benefit provided for the insured pursuant to any compulsory benefit statute<\/span>, including any workers’ compensation or employer’s liability statute<\/span>, whether provided by a governmental agency or otherwise, shall in all cases be deemed to be “other valid coverage” of which the Company<\/span> has had notice. In applying Provision 5 no third party<\/span> liability coverage shall be included as “other valid coverage.” <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

6.<\/span> Provision 6:\n\t\t\tRELATION OF EARNINGS TO INSURANCE<\/span>: 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 a claim is made, whichever is greater, the Company<\/span> will be liable only for the proportionate amount of the 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 the coverage upon the insured at the time the disability commences and for the return of the part of the premiums paid during such two years that 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 or the sum of the monthly benefits specified in the coverages, whichever is less, nor shall it operate to reduce benefits other than those payable for loss of time.\n\t\t\tProvision 6 may be inserted only in a policy that the insured has the right to continue in force subject to its terms by the timely payment of premiums (i) until at least age 50 or (ii) for a policy issued after age 44, for at least five years from its date of issue<\/span>. The insurer<\/span> may include in this provision a definition of “valid loss of time coverage” approved by the Commission<\/span>. The definition shall be limited in subject matter to coverage provided by governmental agencies or by organizations subject to regulation by insurance<\/span> law<\/span> or by insurance<\/span> authorities of this Commonwealth or any other jurisdiction<\/span> of the United States<\/span> or Canada, or to any other coverage the inclusion of which may be approved by the Commission<\/span> or any combination of coverages. In the absence of such definition the term shall not include any coverage provided for the Insured pursuant to any compulsory benefit statute<\/span>, including any workers’ compensation or employer’s liability statute<\/span>, or benefits provided by union welfare plans or by employer or employee benefit organizations. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

7.<\/span> Provision 7:\n\t\t\tUNPAID PREMIUM: When a claim is paid, any premium due and unpaid may be deducted from the claim payment. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

8.<\/span> Provision 8 a:\n\t\t\tCANCELLATION BY COMPANY<\/span>: The Company<\/span> 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<\/span>, stating when, no less than __________ days thereafter, the cancellation shall be effective; and after the policy has been continued beyond its original term the Insured may cancel this policy at any time by written notice delivered or mailed to the Company<\/span> effective upon receipt or on such later date as may be specified in the notice. In the event of cancellation, the Company<\/span> will return promptly the unearned portion of any premium paid. If the Insured cancels, the earned premium shall be computed by the use of the short-rate<\/span> table last filed with the state<\/span> insurance<\/span> supervisory official in the state<\/span> where the Insured resided when the policy was issued. If the Company<\/span> cancels, the earned premium shall be computed pro rata. Cancellation shall be without prejudice to any claim originating prior to the effective date of cancellation.\n\t\t\tProvision 8 b:\n\t\t\tCANCELLATION BY COMPANY<\/span>: The Company<\/span> 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<\/span>, stating when, no less than days thereafter, the cancellation shall be effective. In the event of cancellation, the Company<\/span> will return promptly the unearned portion of any premium paid. The earned premium shall be computed pro rata. Cancellation shall be without prejudice to any claim originating prior to the effective date of cancellation.\n\t\t\tIn Provisions 8 a and 8 b, a number no less than “7″ for weekly premium policies, “10″ for monthly premium policies and “31″ for all other policies shall be inserted between the words “than” and “days.” <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

9.<\/span> Provision 9:\n\t\t\tCONFORMITY WITH STATE<\/span> STATUTES<\/span>: Any provision of this policy that on its effective date is in conflict with the laws<\/span> of the state<\/span> in which the Insured resides on that date is hereby amended to conform to the minimum requirements of the laws<\/span>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

10.<\/span> Provision 10:\n\t\t\tILLEGAL OCCUPATION: The Company<\/span> will not be liable for any loss that results from the Insured’s committing or attempting to commit a felony<\/span> or from the Insured’s engaging in an illegal occupation. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

11.<\/span> Provision 11:\n\t\t\tINTOXICANTS AND NARCOTICS: The Company<\/span> will not be liable for any loss resulting from the Insured’s being drunk, or under the influence of any narcotic unless taken on the advice of a physician. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nOTHER PROVISIONS (\u00a7 38.2-3504)\n\nExcept as provided in \u00a7 38.2-3505, no individual accident and sickness\ninsurance policy delivered or issued for delivery in this Commonwealth shall\ncontain provisions respecting the matters set forth below unless such provisions\nuse the same words which appear in this section. Provisions 1 through 7, 8 a,\nand 9 through 11 shall apply to all such policies that are issued for delivery\nor delivered in this Commonwealth prior to January 1, 2001. Provisions 1 through\n7, 8 b, and 9 through 11 shall apply to all such policies that are issued for\ndelivery, delivered, renewed, or extended in this Commonwealth on or after\nJanuary 1, 2001. The insurer may use a corresponding provision of different\nwording approved by the Commission that is not less favorable in any respect to\nthe Insured or the beneficiary. Any such provision shall be preceded\nindividually by the appropriate caption OTHER PROVISIONS or by such appropriate\nindividual or group captions or subcaptions as the Commission may approve.\n\n1. Provision 1:\n\t\t\tCHANGE OF OCCUPATION: If the Insured is injured or contracts sickness after\nhaving changed his occupation to one classified by the Company as more hazardous\nthan that stated in this policy or while doing for compensation anything\npertaining to an occupation so classified, the Company will pay only the portion\nof the indemnities provided in this policy as the premium paid would have\npurchased at the rates and within the limits fixed by the Company for the more\nhazardous occupation. If the Insured changes his occupation to one classified by\nthe Company as less hazardous than that stated in this policy, the Company, upon\nreceipt of proof of the change of occupation, will reduce the premium rate\naccordingly and will return the excess pro rata unearned premium from the date\nof change of occupation or from the policy anniversary date immediately\npreceding receipt of such proof, whichever is more recent. In applying this\nprovision, the classification of occupational risk and the premium rates shall\nbe such as have been last filed by the Company prior to the occurrence of the\nloss for which the Company is liable or prior to the date of proof of change in\noccupation with the state insurance supervisory official in the state where the\nInsured resided at the time this policy was issued; but if the filing was not\nrequired, then the classification of occupational risk and the premium rates\nshall be those last made effective by the Company in the state prior to the\noccurrence of the loss or prior to the date of proof of change in occupation.\n\n2. Provision 2:\n\t\t\tMISSTATEMENT OF AGE: If the Insured’s age has been misstated, the\nbenefits will be those the premium paid would have purchased at the correct age.\n\n3. Provision 3:\n\t\t\tOTHER INSURANCE IN THIS COMPANY: If an accident or sickness or accident and\nsickness policy or policies previously issued by the Company to the Insured is\nin force concurrently herewith, making the aggregate indemnity for\n____________________ (insert type of coverage or coverages) in excess of\n$_________ (insert maximum limit of indemnity or indemnities) the excess\ninsurance shall be void and all premiums paid for such excess shall be returned\nto the Insured or to his estate.\n\t\t\tInstead of Provision 3, the following provision may be used:\n\t\t\tInsurance effective at any one time on the Insured under a like policy or\npolicies in this Company is limited to the one such policy elected by the\nInsured, his beneficiary or his estate, as the case may be, and the Company will\nreturn all premiums paid for all other such policies.\n\n4. Provision 4:\n\t\t\tINSURANCE WITH OTHER COMPANIES: If there is other valid coverage, not with\nthis Company, providing benefits for the same loss on a provision of service\nbasis or on an expense incurred basis and of which this Company has not been\ngiven written notice prior to the occurrence or commencement of loss, the only\nliability under any expense incurred coverage of this policy shall be for such\nproportion of the loss as the amount which would otherwise have been payable\nunder this policy plus the total of the like amounts under all such other valid\ncoverages for the same loss of which this Company had notice bears to the total\nlike amounts under all valid coverages for such loss, and for the return of such\nportion of the premiums paid as shall exceed the pro rata portion for the amount\nso determined. For the purpose of applying this provision when other coverage is\non a provision of service basis, the “like amount” of such other\ncoverage shall be taken as the amount which the services rendered would have\ncost in the absence of such coverage.\n\t\t\tIf Provision 4 is included in a policy that also contains Provision 5, the\nphrase “EXPENSE INCURRED BENEFITS” shall be added to the caption of\nProvision 4. The insurer may include in this provision a definition of\n“other valid coverage,” approved by the Commission. The definition\nshall be limited in subject matter to coverage provided by organizations subject\nto regulation by insurance law or by insurance authorities of this Commonwealth\nor any other jurisdiction of the United States or Canada, and by hospital or\nmedical service organizations, and to any other coverage the inclusion of which\nmay be approved by the Commission. In the absence of such definition the term\nshall not include group insurance, automobile medical payments insurance, or\ncoverage provided by hospital or medical service organizations, by union welfare\nplans, or employer or employee benefit organizations.\n\t\t\tFor the purpose of applying Provision 4, any amount of benefit provided for\nsuch insured pursuant to any compulsory benefit statute, including any\nworkers’ compensation or employer’s liability statute, whether\nprovided by a governmental agency or otherwise, shall in all cases be deemed to\nbe “other valid coverage” of which the company has had notice. In\napplying Provision 4 no third party liability coverage shall be included as\n“other valid coverage.”\n\n5. Provision 5:\n\t\t\tINSURANCE WITH OTHER COMPANIES: If there is other valid coverage, not with\nthis Company, providing benefits for the same loss on other than an expense\nincurred basis and of which this Company has not been given written notice prior\nto the occurrence or commencement of loss, the only liability for such benefits\nunder this policy shall be for such proportion of the indemnities otherwise\nprovided under this policy for such loss as the like indemnities of which the\nCompany had notice, including the indemnities under this policy, bear to the\ntotal amount of all like indemnities for such loss, and for the return of such\nportion of the premium paid as shall exceed the pro rata portion for the\nindemnities thus determined.\n\t\t\tIf Provision 5 is included in a policy that also contains Provision 4, the\nphrase “OTHER BENEFITS” shall be added to the caption of Provision\n5. The insurer may include in this provision a definition of “other valid\ncoverage,” approved by the Commission. The definition shall be limited in\nsubject matter to coverage provided by organizations subject to regulation by\ninsurance law or by insurance authorities of this Commonwealth or any other\njurisdiction of the United States or Canada, and to any other coverage approved\nby the Commission. In the absence of such definition the term shall not include\ngroup insurance, or benefits provided by union welfare plans or by employer or\nemployee benefit organizations. For the purpose of applying Provision 5, any\namount of benefit provided for the insured pursuant to any compulsory benefit\nstatute, including any workers’ compensation or employer’s liability\nstatute, whether provided by a governmental agency or otherwise, shall in all\ncases be deemed to be “other valid coverage” of which the Company\nhas had notice. In applying Provision 5 no third party liability coverage shall\nbe included as “other valid coverage.”\n\n6. Provision 6:\n\t\t\tRELATION OF EARNINGS TO INSURANCE: If the total monthly amount of loss of\ntime benefits promised for the same loss under all valid loss of time coverage\nupon the Insured, whether payable on a weekly or monthly basis, shall exceed the\nmonthly earnings of the Insured at the time disability commenced or his average\nmonthly earnings for the period of two years immediately preceding a disability\nfor which a claim is made, whichever is greater, the Company will be liable only\nfor the proportionate amount of the benefits under this policy as the amount of\nthe monthly earnings or the average monthly earnings of the Insured bears to the\ntotal amount of monthly benefits for the same loss under all the coverage upon\nthe insured at the time the disability commences and for the return of the part\nof the premiums paid during such two years that exceeds the pro rata amount of\nthe premiums for the benefits actually paid hereunder; but this shall not\noperate to reduce the total monthly amount of benefits payable under all the\ncoverage upon the Insured below the sum of $200 or the sum of the monthly\nbenefits specified in the coverages, whichever is less, nor shall it operate to\nreduce benefits other than those payable for loss of time.\n\t\t\tProvision 6 may be inserted only in a policy that the insured has the right\nto continue in force subject to its terms by the timely payment of premiums (i)\nuntil at least age 50 or (ii) for a policy issued after age 44, for at least\nfive years from its date of issue. The insurer may include in this provision a\ndefinition of “valid loss of time coverage” approved by the\nCommission. The definition shall be limited in subject matter to coverage\nprovided by governmental agencies or by organizations subject to regulation by\ninsurance law or by insurance authorities of this Commonwealth or any other\njurisdiction of the United States or Canada, or to any other coverage the\ninclusion of which may be approved by the Commission or any combination of\ncoverages. In the absence of such definition the term shall not include any\ncoverage provided for the Insured pursuant to any compulsory benefit statute,\nincluding any workers’ compensation or employer’s liability statute,\nor benefits provided by union welfare plans or by employer or employee benefit\norganizations.\n\n7. Provision 7:\n\t\t\tUNPAID PREMIUM: When a claim is paid, any premium due and unpaid may be\ndeducted from the claim payment.\n\n8. Provision 8 a:\n\t\t\tCANCELLATION BY COMPANY: The Company may cancel this policy at any time by\nwritten notice delivered to the Insured, or mailed to his last address as shown\nby the records of the Company, stating when, no less than __________ days\nthereafter, the cancellation shall be effective; and after the policy has been\ncontinued beyond its original term the Insured may cancel this policy at any\ntime by written notice delivered or mailed to the Company effective upon receipt\nor on such later date as may be specified in the notice. In the event of\ncancellation, the Company will return promptly the unearned portion of any\npremium paid. If the Insured cancels, the earned premium shall be computed by\nthe use of the short-rate table last filed with the state insurance supervisory\nofficial in the state where the Insured resided when the policy was issued. If\nthe Company cancels, the earned premium shall be computed pro rata. Cancellation\nshall be without prejudice to any claim originating prior to the effective date\nof cancellation.\n\t\t\tProvision 8 b:\n\t\t\tCANCELLATION BY COMPANY: The Company may cancel this policy at any time by\nwritten notice delivered to the Insured, or mailed to his last address as shown\nby the records of the Company, stating when, no less than days thereafter, the\ncancellation shall be effective. In the event of cancellation, the Company will\nreturn promptly the unearned portion of any premium paid. The earned premium\nshall be computed pro rata. Cancellation shall be without prejudice to any claim\noriginating prior to the effective date of cancellation.\n\t\t\tIn Provisions 8 a and 8 b, a number no less than “7″ for weekly\npremium policies, “10″ for monthly premium policies and\n“31″ for all other policies shall be inserted between the words\n“than” and “days.”\n\n9. Provision 9:\n\t\t\tCONFORMITY WITH STATE STATUTES: Any provision of this policy that on its\neffective date is in conflict with the laws of the state in which the Insured\nresides on that date is hereby amended to conform to the minimum requirements of\nthe laws.\n\n10. Provision 10:\n\t\t\tILLEGAL OCCUPATION: The Company will not be liable for any loss that results\nfrom the Insured’s committing or attempting to commit a felony or from the\nInsured’s engaging in an illegal occupation.\n\n11. Provision 11:\n\t\t\tINTOXICANTS AND NARCOTICS: The Company will not be liable for any loss\nresulting from the Insured’s being drunk, or under the influence of any\nnarcotic unless taken on the advice of a physician.\n\nHISTORY: 1952, c. 317, \u00a7 38.1-350; 1986, c. 562; 2000, c. 540; 2003, c. 377.","edition":{"id":1,"name":"2025","slug":"2025","date_created":"2026-06-21 22:39:22","date_modified":"2026-06-21 22:39:22","current":1,"order_by":1,"last_import":null}}