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This Certificate, the application of the Certificateholder (if any, a copy of which is attached), endorsements, riders <br />and attached papers constitute the entire contract between the parties. If an application of a Covered Person is <br />required, the application of any Insured, at our option, may also be made a part of this contract. <br />All statements made by the Certificateholder or by a Covered Person are deemed representations and not <br />warranties. No such statement will cause us to deny or reduce benefits or be used as a defense to a claim unless <br />a copy of the instrument containing the statement is or has been furnished to such person; or, in the event of his <br />death or incapacity, his beneficiary or representative. After 2-years from the Covered Person's effective date of <br />coverage, no such statement, except in the case of fraud or with respect to eligibility for coverage, will cause such <br />coverage to be contested. <br />No change in this Certificate will be valid until approved by one of our executive officers. This approval must be <br />endorsed on or attached to this Certificate. No agent may change this Certificate or waive any of its provisions. <br />WORKERS' COMPENSATION INSURANCE: <br />This Certificate is not in lieu of and does not affect any requirement for coverage under any Workers' <br />Compensation Insurance. <br />CERTIFICATES OF INSURANCE: <br />A -certificate of insurance will be delivered to the Certifiicateholder for delivery to a Covered Person, Each <br />certificate will list the benefits, conditions and limits of the Certificate. It will state to whom the benefits will be <br />paid. <br />CONFORMITY WITH STATE STATUTES: <br />Any provision of this Certificate in conflict, on the Effective Date of this Certificate, with the laws of the state where <br />It is delivered, is amended to conform to the minimum requirements of such laws. <br />CLAIM PROVISIONS <br />NOTICE OF CLAIM: <br />Written notice must be given to us within 30 days after a covered loss occurs or begins or as soon as reasonably <br />possible. Notice can be given at our administrative office as shown on the cover page or to our agent. Notice <br />should include the Certificateholder's name and number and a Covered Person's name and address, <br />CLAIM FORMS: <br />When we receive the notice of claim, we will send forms for filing proof of loss. If claim forms are not sent within <br />15 days after notice is given, the proof requirements will be met by submitting, within the time required under <br />PROOF OF LOSS, written proof of the nature and extent of the loss. <br />PROOF OF LOSS: <br />Written proof of loss must be furnished to us in the case of a claim for loss for which this Certificate provides <br />periodic payment contingent upon continuing loss within 90 days after the end of the period for which we are <br />liable. Written proof that the loss continues must be furnished to us at intervals required by us. <br />In case of claim for any other loss, proof must be furnished within 90 days after the date of such loss. <br />If that is not reasonably possible, we will not deny or reduce any claim if proof is furnished as soon as reasonably <br />possible. Proof must, in any case, be furnished not more than a year later, except for lack of legal capacity. <br />TIME OF PAYMENT OF CLAIMS: <br />Benefits due under this Certificate for a loss, other than a loss for which this Certificate provides installments, will <br />be paid immediately upon receipt of due written proof of such loss. <br />Subject to written proof of loss, all accrued benefits for loss for which this Certificate provides installments will be <br />paid Monthly; any balance remaining unpaid upon the termination of liability will be paid immediately upon receipt <br />of a written proof of loss, unless otherwise stated in the Description of Benefits. <br />PAYMENT OF CLAIMS: <br />GAC26932 <br />