Gravelers Protective Association of America ST. LOUIS, MO. Commenced Business 1890. C. F. TOMLINSON, Pres. T. S. LOGAN, Sec. The certificate, copy of which appears below, is issued to traveling salesmen, credit men or buyers for wholesale or manufacturing concerns, house salesmen for wholesale or manufacturing concerns or men who employ same. A broker or commission merchant. Entrance fee, $2. Semi-annual dues, $5.50. COPY OF CERTIFICATE OF MEMBERSHIP. PRINCIPAL SUM, $5000. WEEKLY INDEMNITY, $25. The Travelers Protective Association of America, a fraternal benefit society, incorporated under the laws of the State of Missouri, by this certificate of membership certifies that John Doe is a member of the said Travelers Protective Association of America, and is entitled to such benefits as may be provided in and by the constitution, by-laws and articles of incorporation of said association, in force and effect at the time any accident occurs from which a claim for benefits arises. Benefits in case of death payable to Mary Doe, his wife. This certificate, the constitution, by-laws and articles of incorporation of said association, and application for membership signed by said member, and all amendments thereto shall constitute the agreement between said association and said member, and shall govern the payment of benefits and any changes, additions or amendments to said constitution, by-laws or articles of incorporation, hereafter duly made shall bind said member and his beneficiary or beneficiaries, and shall govern and control the contract in all respects the same as though such changes, additions or amendments had been made prior to, and were in force at the time of said member's application for membership. In witness whereof, this Association has caused this certificate to be signed by its president and secretary under the seal of the association at St. Louis, Mo., this first day of January, A. D. 1915. Any member meeting with an accident must notify the National Secretary in writing within thirty days of such accident, giving full particulars of same and name of attending physician. In case of death the beneficiary shall give such notice. In case of failure to notify except because of unconsciousness or physical inability the member or his beneficiaries shall forfeit all rights to insurance benefits. BENEFITS. The following benefits are paid subject to the conditions, exceptions and limitations of the constitution of the association and amendments thereto, whenever a member in good standing shall, independently of all other causes, through external violent and accidental means, receive bodily injuries which shall solely and exclusively cause death or disability: (1) $10,000 if killed by accident while riding as a passenger inside a passenger car on a passenger train, propelled by steam or electricity at terminals; (2) $5000 if killed by accident; (3) $5000 for the accidental loss of both legs or both arms by severance; (4) $2500 for the accidental loss of one hand or one foot by severance above wrist or ankle; (5) $1300 in case of accidental loss of four fingers of either hand by severance; (6) $5000 in case of accidental loss of both eyes; (7) $1250 in case of accidental loss of one eye; (8) $25 per week for total disability, from accident, not exceeding 104 weeks; (9) $12.50 per week for partial disability following total disability, from accident, not exceeding five weeks. The Woodmen Accident Company. (Division One), LINCOLN, NEB. Commenced Business 1890. A. O. FAULKNER, Pres. C. E. SPANGLER, Sec. The Company insures against accident under eight classifications of risks and accepts all members who are over 16 and under sixty years of age. When a member attains the age of sixty-five his membership may be continued at a rate increase of 100 per cent. Admission fee $5, certificate fee $1, and assessments $2 quarterly. TABLE OF BENEFITS-DIVISION ONE. hands, both feet, or $ 250.00 200.00 125.00 100.00 75.00 50.00 Loss of both eyes,both 650.00 500,00 400 375 250.00 187.00 156 hand and foot...... 3,000 2,000.00 1,500.00 1,250 1,000 800.00 600.00 400,00 Woodmen Accident Company of Lincoln, Nebraska, in consideration of the policy fee of $5 and the further quarterly payments of $2 on the last day of of each year, and the provisions herein contained, with his application, a copy of which is endorsed hereon, together with the classification of risks, which constitute the entire contract, the Woodmen Accident Company (hereinafter called the Company) of Lincoln, Nebraska, does hereby insure George Smith, whose address is given in the copy of his application herein (hereinafter called the Insured); as a bookkeeper, and agrees to pay said insured, subject to all conditions and limitations hereinafter contained, in case of loss of life, one or both eyes, one or both hands or one or both feet, or in case of total or partial disability, when such loss or disability is effected through violent, external and accidental means and entirely independent of all other causes, and which shall leave some visible marks; provided, however, said injury shall cause death within ninety (90) days thereafter; or shall immediately sever one or both hands or one or both feet at or above the wrist or ankle, or amputation thereof, at or above the wrist or ankle, shall necessarily be made within ninety (90) days thereafter; or shall permanently and entirely destroy the sight of one or both eyes within ninety (90) days thereafter, the following sums, to wit: $3000 for loss of life, the same being payable to Mary Smith, beneficiary, if surviving, otherwise to the estate of said insured; $3000 for the loss or destruction of the sight of both eyes; $3000 for the loss of both hands or both feet, or one hand and one foot, at or above the wrist or ankle joint; $375 for the loss or destruction of the sight of one eye; $1500 for the loss of right hand, at or above the wrist; $1000 for the loss of left hand or either foot, at or above the wrist or ankle; $20 per week for not exceeding fifty-two (52) consecutive weeks for immediate, continuous and total disability; $5 per week for not exceeding ten (10) consecutive weeks for partial disability; $1500 for immediate, continuous and permanent total disability for life, when it is satisfactorily proved that the accidental injuries sustained will alone, independently of all other causes, permanently and entirely disable him during life, from any and all occupations. It being understood and agreed that this company shall not be liable for more than one indemnity specified herein for the same injury, nor for weekly indemnities where specific indemnities are herein provided, nor for a greater sum in any case than the largest amount mentioned herein. The insured failing to pay the premium when due, shall forfeit all rights to indemnities under this policy together with all moneys previously paid, and his insurance in the company shall become lapsed. This policy shall take effect at noon, standard time, at the place of residence of the insured on the date which it bears, and shall cover only loss arising out of accidental injury sustained by the insured thereafter. This policy and the rights hereby created shall automatically lapse and terminate at twelve o'clock midnight, standard time, at the place of the insured's residence on the last day of hereafter occurring, at such time the premium be unpaid. FOR STANDARD PROVISIONS SEE PAGE 11 MISCELLANEOUS PROVISIONS This policy shall cease to be in effect if the insured shall become blind in one or both eyes, deaf in one or both ears, or compelled to use a crutch or cane, or has lost one or both hands or feet, or has become insane, demented, or subject to fits, and no indemnities shall accrue to him or his beneficiary. Nothing herein shall, however, deprive the insured of the right to make claim for a prior accidental injury. No indemnity will be payable if the insured is injured fatally or otherwise while engaged temporarily or otherwise in any occupation, work, risk, or exposure, set forth in the company's classification of risks as not insurable. In the event the insured changes his occupation to one classified by the company as not insurable the company's liability is limited to the amount of premium paid by the insured since engaging in such not insurable occupation. DISABILITIES NOT PROVIDED FOR This company shall not be liable for disappearance, nor for disability or death resulting, wholly or partially, directly or indirectly from any of the following causes: Disease; suicide; the result of injury received by the insured while insane; injuries received while under the influence of intoxicants or narcotics; dueling or fighting; wrestling or boxing in exhibitions or contests; war or riot; over-lifting or over-exertion; disability directly or indirectly or partially due to immoralities, or venereal diseases however contracted, or to the results thereof; entering or trying to enter or leave a moving conveyance using steam or electricity as motive power (street cars excepted); riding or attempting to ride, or being upon, any conveyance or part of conveyance not intended or used for passengers; walking or being on a railway bridge, railway roadbed, or right-of-way, except at regular crossing (railroad employees, while engaged in performance of their duties, excepted); hernia from any cause; sunstroke; freezing; blood-poisoning, unless resulting from any injury which of itself would be disabling (except in the case of a physician or surgeon engaged in the regular practice of his profession); injuries by intentional acts of the insured or any other person; medical or surgical treatment unless necessitated wholly by an injury and within ninety days of the occurrence of the accident; violating laws of any State or government; fits, vertigo, sleep-walking; insanity from any cause; injuries not producing visible marks upon the body; or injuries while engaged in any of the following risks: blasting, playing basket ball or football; riding or driving in races; riding or being in or on any aerial device or conveyance. In witness whereof, the Woodmen Accident Company has caused to be attached to this policy, the signature of its president, and attested by its secretary, countersigned by its policy writer, and the seal of the company to be attached at the office of the company in the City of Lincoln, State of Nebraska, this first day of January, one thousand nine hundred and sixteen. General Instructions. POWERS OF AGENTS.-No agent has authority to bind his company by the acceptance of any risk; nor to change rates; nor have agents authority to make any change in certificates, however slight. PROHIBITED RISKS.-Persons who are blind, deaf, compelled to use a crutch, insane, demented, subject to fits, intemperate, reckless or disreputable, or without visible means of support, are not insurable. OCCUPATIONS.-The business or occupation (if more than one) of each applicant should be stated definitely, for upon the nature of the business or occupation the classification depends. It is not sufficient to simply say, "Merchant," but it should be stated what kind of goods he handles; or in case of a carpenter, whether he uses a circular saw; of a manufacturer, whether working or not working, and also the kind of articles manufactured; of a contractor, state the nature of his work; of a common laborer, the kind of work, whether on a railroad, a farm, in a workshop, or a sawmill. When an applicant has more than one occupation, that of the greatest hazard will govern the classification. WHAT IS INSURED AGAINST.-Accident contracts provide against death, loss of one or more limbs, one or both eyes, permanent total disability, and bodily injuries-such as dislocations, fractures, broken bones, bruises, cuts, gunshot wounds, crushing or mangling, burns and scalds, bites of dogs or serpents, stroke of lightning, drowning, or injuries produced by falls, effected through external, violent and accidental means, within the intent and meaning of the contract, and its conditions as thereto annexed, whether such accidents happen while traveling, on the street or the farm, in the store, office, mill or workshop, or in any of the lawful and usual avocations of life. WHAT IS NOT INSURED AGAINST.-The insurance does not extend to any bodily injury of which there shall be no external or visible sign, nor to any bodily injury happening directly or indirectly in consequence of disease, or by any surgical operation, or medical or mechanical treatment, nor to hemorrhage, rheumatism, "crick," gout, hernia, felons, boils, nor to injuries caused by duelling, fighting, wrestling, lifting, or by over-exertion, or by suicide, sunstroke, freezing, poison, self-inflicted injuries, or in consequence of war, riot or invasion, or to disappearance, or in consequence of drunkenness, breach of the law, or voluntary exposure to unnecessary danger, hazard, or perilous adventure. Injuries caused by over-exertion, or paralysis, epilepsy, or natural decay of the system, are not "accidents" within the meaning of the contract. 1. 2. 2.66 3. 4.00 5.33 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17 18. 19 20. 21. 22. 23. 24. 25. 26. 27 28. 29. 30. 6.66 8.33 10.00 11.66 13.30 15.00 7.00 8.00 10.00 12.00 14.00 15.96 18.00 3.50 4.65 5.83 7.00 8.16 9.33 11.66 14.00 16.33 18.62 21.00 4.00 5.32 6.67 8.00 9.33 10.66 13.33 16.00 18.66 21.28 24.00 4.50 6.00 7.50 9.00 10.50 12.00 15.00 18.00 21.00 24.00 27.00 5.00 6.66 8.33 10.00 11.66 13.33 16.66 20.00 23.33 26.66 30.00 5.50 7.33 9.16 11.00 12.83 14.67 18.33 22.00 25.66 29.32 33.00 6.00 7.99 10.00 12.00 14.00 16.00 20.00 24.00 28.00 31.98 36.00 6.50 8.65 10.83 13.00 15.16 17.33 21.66 26.00 30.33 34.64 39.00 7.00 9.33 11.67 14.00 16.33 18.67 23.33 28.00 32.66 37.30 42.00 7.50 10.00 12.50 15.00 17.50 20.00 25.00 30.00 35.00 40.00 45.00 8.00 10.66 13.33 16.00 18.66 21.33 26.66 32.00 37.33 42.66 48.00 8.50 11.33 14.16 17.00 19.83 22.66 28.33 34.00 39.66 45.32 51.00 9.00 12.00 15.00 18.00 21.00 24.00 30.00 36.00 42.00 48.00 54.00 9.50 12.66 15.83 19.00 22.16 25.33 31.66 38.00 44.33 50.66 57.00 10.00 13.33 16.67 20.00 23.33 26.67 33.33 40.00 46.66 53.33 60.00 10.50 14.00 17.50 21.00 24.50 28.00 35.00 42.00 49.00 56.00 63.00 11.00 14.66 18.33 22.00 25.66 29.33 36.66 44.00 51.33 58.66 66.00 11.50 15.33 19.16 23.00 26.83 30.67 38.33 46.00 53.66 61.33 69.00 12.00 16.00 20.00 24.00 28.00 32.00 40.00 48.00 56.00 64.00 72.00 12.50 16.66 20.83 25.00 29.16 33.33 41.67 50.00 58.33 66.66 75.00 13.00 17.33 21.67 26.00 30.33 34.67 43.33 52.00 60.66 69.33 78.00 13.50 18.00 22.50 27.00 31.50 36.00 45.00 54.00 63.00 72.00 81.00 14.00 18.66 23.33 28.00 32.66 37.33 46.66 56.00 65.33 74.66 84.00 14.50 19.33 24.16 29.00 33.83 38.67 48.33 58.00 67.66 77.33 87.00 96.66 15.00 20.00 25.00 30.00 35.00 40.00 50.00 60.00 70.00 80.00 90.00 100.00 .50 66 .83 1.00 1.16 1.33 1.66 2.00 2.33 2.66 3.00 3.33 |