TOTAL DISABILITY FOR LIFE.-(c) If such sickness shall cause an immediate continuous and total disability as defined in clause (a) of this section for the full period of fifty-two consecutive weeks as covered by said clause (a), and shall not result in loss of sight or loss of use of limbs as defined in Section VI, the company will pay the insured one-fourth the weekly indemnity for each week of the period immediately and continuously following said fifty-two consecutive weeks, during which said disability, independently and exclusively of all other causes shall totally disable and prevent the insured from performing any and every kind of duty pertaining to any and all occupations. SECTION VI. SPECIFIC LOSSES. SICKNESS.-If any such sickness shall independently of all other causes continuously and wholly disable and prevent the insured from performing any and all duties pertaining to his business or occupation and shall during the period of such disability and within fifty-two weeks, independently of all other causes result in any one of the specific losses enumerated below, and the insured survives such loss for a period of one year, and at the end of such year such loss is declared by medical authority, satisfactory to the company, to be irrecoverable and for life, the company will pay the specific amount indicated opposite such respective loss: Loss of the entire sight of both eyes, the use of both arms, or both legs, or one arm and one leg, one-third principal sum. Loss of entire sight of one eye, or the use of one arm, or one leg, one-fifth principal sum, less such sums as have been paid by way of weekly indemnity. This policy under Sections V and VI does not cover disability resulting from any sickness commencing within fifteen days from noon of the day this policy is dated. SECTION VII. SURGEON'S FEES OR HOSPITAL EXPENSES. ACCIDENT or Sickness.(a) In addition to the indemnities to which the insured may be otherv. ise entitled, if, as the sole result of bodily injuires sustained or sickness contracted by insured, he shall, within ninety days from the date of the accident or commencement of the sickness, incur expense for a surgical operation named in the schedule of operations endorsed hereon, the company will pay the cost of an operation not exceeding the sum indicated opposite said operation in said schedule. (b) Or, at the option of insured, if said surgical operation is performed in an incorporated hospital, and requires continuous confinement therein, the company will pay, in lieu of said surgeon's fees, a weekly hospital expense of not exceeding one-half the amount of the weekly indemnity for the period of confinement in said hospital, not exceeding twelve consecutive weeks. (c) In no event shall said surgeon's fees or hospital expense be payable for more than one operation or hospital confinement as the result of any one accident or sickness, namely, in case of t: o or more operations specified in the schedule of operations, or hospital confinement, at different dates, payment shall be made for the first operation or hospital confinement; and in case of two or more such operations at one time, payment shall be made for one operation to be specified by the insured. No payment will be made for any operation resulting from any condition which existed prior to the issuance of this policy. SECTION VIII. IDENTIFICATION. -The company will furnish the insured with an identification card, wherein it is agreed that, if he shall by reason of accidental injury or sickness during the term of this policy or any renewal thereof, be physically unable to communicate with relatives or friends, the company will on receipt of a message giving the policy number, at once use all reasonable means and defray all expenses, not exceeding one hundred dollars, necessary for placing him in their care. FOR STANDARD PROVISIONS SEE PAGE 11 1. If the insured is entitled under this or any other policy to indemnity for loss resulting from sickness or disease, he shall not be entitled under this policy to indemnity for the same or a concurrent loss resulting from accidental bodily injury. 2. This policy does not cover disappearance, nor war risk, nor injuries intentionally inflicted by the insured upon himself, nor suicide, sane or insane, nor any attempt at suicide, sane or insane. 3. The insurance hereunder shall not cover any injury, fatal or non-fatal, sustained by the insured while participating in or in consequence of having participated in aeronautics. 4. The company shall not be liable for more than one of the losses provided for in Sections I and VI and the occurence of any one of the specific losses shall terminate this policy; nor shall the liability of the company in respect of any one accident or sickness extend to more than one section of this policy, except as provided in Section VII. Any settlement with the assured or the beneficiary shall finally release the company from all further claims in respect of said accident. 5. This insurance shall cover only accidents occurring or disability from sickness contracted within the limits of the United States, Canada or Europe, or while traveling as a passenger by the regular passenger steamship lines between said countries, but not including any territory north of the sixtieth degree of north latitude, nor including Alaska or any territory of the United States acquired since 1897 (Philippine Islands, Hawaii, Porto Rico, Canal Zone and Guam.) 6. No assignment of interest under this policy shall bind the company unless consent thereto is formally endorsed hereon by the United States Manager of the company, Any failure to comply with the provisions of this policy shall render invalid any claim hereunder. A copy of any assignment shall be given, within thirty days, to the company, which shall not be responsible for its validity. 7. The copy of the application endorsed hereon is hereby made a part of this contract; no provision of the charter, constitution or by-laws of the company not included herein shall avoid the policy or be used in evidence in any legal proceeding hereunder. 8. Compliance on the part of the insured and beneficiary with all the provisions of the policy is a condition precedent to recovery hereunder, and any failure in this respect shall forfeit to the company all rights to any indemnity. In witness whereof, The Frankfort General Insurance Company, of Frankfort-on-theMain, Germany, has caused these presents to be signed by its United States manager and attorney, but the same shall not be binding upon the company until countersigned by a duly authorized and commissioned agent. SCHEDULE OF INJURIES. OPTIONAL INDEMNITIES. For each $5 of the weekly indemnity. For loss of certain members of one or more entire fingers, $30; one or more entire toes, $40. For complete hernia, $15. For complete dislocation of the shoulder, $20; elbow, $20; wrist, $25; hip, $60; knee, $30; any bones of foot (other than toes), $30; the ankle, $30; two or more toes, $12; two or more fingers, $12. For complete fracture of the skull, both tables, $65; lower jaw, $15; clavicle (collar bone), $30; scapula, $35; pelvis, $50; thigh, $60; leg (tibia and fibula), $40; patella (knee cap), $40; arm, between elbow and shoulder, $35; forearm, between the wrist and elbow, $30; two or more ribs, $20; two or more bones of the foot (not toes), $25; two or more bones of the hand (not fingers), $25; two or more toes, $20; two or more fingers, $20; Potts' fracture, $40; Colle's fracture, $30. SCHEDULE OF OPERATIONS.-Maximum amounts payable for surgeon's fees for each $5 of weekly indemnity. Appendicitis (see laparotomy), $20. Aneurism (tumor of artery)-ligation, $10. Amputation of hand, foot or forearm, $5; leg, $10; arm below elbow, $10; thigh, $20; one or more entire fingers, $2. Abscess or boil-incision, $1. Bone abscess-trephining, $5. Bronchotomy, thyrotomy, laryngotomy, laryngotracheotomy or tracheotomy, $10. Carbuncle-incision and treatment, $1. Caries (bone ulcer) curetting, $3. Dislocations, reduction of shoulder, elbow, hip, knee or ankle, $5; wrist or lower jaw, $3; thumb or fingers, $2. Excision of shoulder, hip or knee joint, $20; elbow, wrist or ankle joint, $10; toe or toes, $5. Eye, ear, nose, throat, any cutting operation, $2. Felon-incision, $1. Fractures, reduction of, nose, lower jaw, collar bone or shoulder blade, forearm (one or both bones), $5; breast bone, rib or ribs, fingers, coccyx, toes, $2; upper arm, $7; wrist or hand, bones of foot, $3; any of the bones of the pelvis or sacrum, $10; thigh, $15; knee cap or leg bones (one or both), $10. Ganglion (cystic tumor of tendon sheath)-incision and curetting, $3. Gunshot wounds-treatment not necessitating amputation or laparotomy, $5. Hernia (abdominal)—any cutting operation for the radical cure of the reducible, irreducible or strangulated form, $20. Hydrocele-tapping-incision or excision of sac, $5. Ingrowing toe nail removal, $2. Intestinal obstruction (see laparotomy). Kidneyfixation or removal. $20. Laparotomy (opening of the abdominal cavity for an operation on any organ contained therein), $20. Lithotomy any cutting (operation for removal of stone in bladder), $20. Mastoiditis-operation for, $10. Necrosis (death of bone)-sequestrotomy (removal of dead bone), $7. Esophogotomy for stricture or other cause, $20. Peritonitis (see laparotomy), $20. Paracentesis-tapping of abdomen, bladder, $5; ear drum, $3. Rectum, operation for hemorrhoids (external or internal) excision or ligation, prolapsed-operation for fistula in ano-incision, polypus extirpation, $5; malignant stricture, -excision or solostomy, $20. Skull trephining for fracture or other cause, $20. Synovitis (inflammation of the lining membrane of a joint)—incision, $5. Tetanus-injection of anti-tetanic serum into frontal lobe of brain, $20. Tumors extirpation from any part of the body, benign, $3; malignant, $10. Varicose veins-ligation or excision, $5. Varicocele-acupressure-ligation or excision, $5. Wounds of scalp or other parts-suturing, $1. APPLICATION FOR FULL PROTECTION DISABILITY POLICY.-I hereby apply to The Frankfort General Insurance Company of Frankfort-on-the-Main, Germany, for a policy to be based upon the following representation of facts. I understand and agree that the right to recovery under any policy which may be issued upon the basis of this application shall be barred in the event that any one of the following statements, material either to the acceptance of the risk or to the hazard assumed by the company, is false, or in the event that any one of the following statements is false and made with the intent to deceive. I agree that this application shall not be binding upon the company until accepted either by the home office or by an agent duly authorized to issue policies. POLICY FORM—“GOLDEN Jubilee DisabiLITY.” PRINCIPAL SUM, $1000. MONTHLY INDEMNITY, $100. The Frankfort General Insurance Company, in consideration of the statements in the application herefor, copy of which is endorsed hereon and made part hereof, and of the payment of the premium of six dollars (which is the premium covering the first period of Insurance), Does hereby insure Mr. John Doe of New York, age 25, occupation clerk, under classification AA, the person named and described in said application (herein called the Insured), for the term beginning on the first day of January, 1916, and expiring on the first day of February, 1916, at noon, standard time, at the place where this policy has been countersigned, and for further periods of insurance of one month each, upon payment of four dollars in advance on or before the first day of each calendar month thereafter, against disability or death resulting directly and independently of all other causes, from bodily injuries sustained through external, violent and accidental means, and against disability from sickness originating after this policy has been in continuous force for fifteen days from its date, subject to the limitations, statements, and provisions herein contained, which are to be considered as limitations, statements, and provisions precedent. The principal sum under this policy is one thousand dollars ($1,000). The monthly indemnity under this policy is one hundred dollars ($100). DIVISION I.-ACCIDENT INDEMNITIES SECTION 1. SPECIFIC LOSSES-DEATH, DISMEMBERMENT AND LOSS OF SIGHT.-If such injuries shall, within ninety days from date of accident, result in any one of the specific losses enumerated below, the Company will pay in lieu of all other indemnities under this policy (except as provided in Section VII) the specific amount indicated opposite such respective loss. Loss of life-payable to the beneficiary named in the application, or both hands by complete severance at or above the wrists, or both feet by complete severance at or above the ankles, or one hand and one foot by complete severance as defined above, or entire sight of both eyes if irrecoverably lost, or entire sight of one eye and severance of one foot as respectively defined above, or entire sight of one eye and severance of one hand as respectively defined above, the principal sum. Loss of one hand by complete severance at or above the wrist, or either foot by complete severance at or above the ankle, one-half principal sum. Loss of entire sight of one eye if irrecoverably lost, one-third principal sum. SECTION 2. DISABILITY BENEFITS AND DOCTOR'S BILLS.-Or, if none of the losses named in Section 1 shall occur the Company will pay the Insured for Disability as a result of said injuries as follows: FOR TOTAL DISABILITY. "A."-The Company will pay at the rate of the monthly indemnity per month for total disability, for a period not exceeding twenty-four consecutive months, during which such injuries shall, from the date of accident, wholly and continuously disable and prevent the Insured from performing every duty pertaining to any business or occupation, and he is attended by a legally qualified physician at least once a week.! ་ FOR PARTIAL DISABILITY. "B."-Or, if such injuries shall, from date of accident, or immediately following total disability, wholly and continuously disable and prevent the Insured from performing one or more important daily duties pertaining to his business or occupation, the Company will pay the Insured for the period of such partial disability between the first and last visits of or to the attending physician, not exceeding six consecutive months, at the rate of one-half the monthly indemnity, provided that the maximum period for which indemnity shall be paid under paragraphs A and B hereof for any one injury, shall not exceed twenty-four consecutive months. OPTIONAL INDEMNITIES. "C."-Or, at the option of the Insured, if he shall suffer any of the injuries named in the Schedule of Injuries endorsed hereon, the Company will pay the amount indicated opposite said injury in said schedule, in lieu of all indemnities for total or partial disability; provided, that the Insured shall give the Company notice of his said election within twenty days after said injuries are received, and that the Company shall not be liable for more than one of said injuries in consequence of any one accident. FOR DOCTOR'S BILLS IF NO DISABILITY. "D."-Or, if such injuries do not cause either total or partial disability, but shall require immediate medical or surgical treatment, the Company will reimburse the Insured for the amount actually expended for such treatment, upon presentation of the receipted bill of the doctor therefor; provided, such amount shall not exceed one-quarter of the monthly indemnity for one month. SECTION 3. DOUBLE INDEMNITIES.-TRAVEL, ELEVATOR, BURNING BUILDING, LIGHTNING. The Company will pay double the indemnities specified in Section 1 and in clauses A, B and C of Section 2 in case the said injuries shall be sustained by the Insured: (1) While travelling as a passenger in or on a public conveyance provided by a common carrier for passenger service (including the platform, steps or running board thereof); double indemnities shall not be payable for any injuries sustained while getting on or alighting from the step or steps of any public conveyance. (2) While a passenger in an elevator (excluding elevators in mines) provided for passenger service only; or, (3) In consequence of the burning of a building, while therein at the beginning of the fire; or, (4) Through being struck by lightning. SECTION 4. SPECIAL INDEMNITY.-SUNSTROKE, FREEZING, HYDROPHOBIA, INHALATION OF GAS, ETC.-Sunstroke, freezing, hydrophobia or blood-poisoning, due in either case to external, violent and accidental means, or the involuntary and unconscious inhalation of gas or other poisonous vapor shall be deemed a bodily injury within the meaning of this policy. DIVISION II.-SICKNESS INDEMNITIES. SECTION 5. MONTHLY INDEMNITY.-TOTAL DISABILITY WITH HOUSE CONFINEMENT.'A."-The Company will pay the Insured at the rate of the monthly indemnity per month, for the number of consecutive days, between the first and last visits of the attending physician, after the first week, that the Insured is necessarily and continuously confined within the house, and therein regularly visited by a legally qualified physician at least once in each seven days. TOTAL DISABILITY, NON-CONFINING. "B."-Or, if during convalescence immediately following said confinement, or by reason of any non-confining sickness, the Insured shall be wholly and continuously disabled from performing every duty pertaining to any business or occupation, though not confined within the house, and shall require the regular attendance of a legally qualified physician at least once in each seven days, the Company will pay the Insured indemnity at one-half the above rate for a period not exceeding six consecutive months. No indemnity for sickness shall be paid for the first seven days of disability, nor for a longer combined period under "A" and "B" than twelve consecutive months. SECTION 6. SPECIFIC LOSSES SICKNESS.-If any such sickness shall independently of all other causes continuously and wholly disable and prevent the Insured from performing any and all duties pertaining to his business or occupation and shall during the period of such disability and within twelve months, independently of all other causes result in any one of the specific losses enumerated below, and the Insured survives such loss for a period of one year, and at the end of such year such loss is declared by medical authority, satisfactory to the Company, to be irrecoverable and for life, the Company will pay the specific amount indicated opposite such respective loss: Loss of the entire sight of both eyes, the use of both arms, or both legs, or one arm and one leg, the principal sum. Loss of entire sight of one eye, or the use of one arm, or one leg, one-half principal sum (less such sums as have been paid by way of monthly indemnity). SECTION 7. SURGEON'S FEES OR HOSPITAL EXPENSES-ACCIDENT OR SICKNESS."A."-In addition to the indemnities to which Insured may be otherwise entitled if, as the sole result of bodily injuries sustained or sickness contracted by Insured, he shall, within ninety days from the date of accident or commencement of the sickness, incur expense for a surgical operation named in the Schedule of Operations endorsed hereon, the Company will pay the cost of an operation not exceeding the sum indicated opposite said operation in said schedule. "B."-Or, at the option of Insured, if said surgical operation is performed in an incorporated hospital, and requires continuous confinement therein, the Company will pay, in lieu of said surgeon's fees, a monthly hospital expense of not exceeding one-half the amount of the monthly indemnity for the period of confinement in said hospital, not exceeding three consecutive months. "C."-In no event shall said surgeon's fees or hospital expense be payable for more than one operation or hospital confinement as the result of any one accident or sickness, namely, in case of two or more operations specified in the Schedule of Operations, or hospital confinement, at different dates, payment shall be made for the first operation or hospital confinement; and in case of two or more such operations at one time, payment shall be made for one operation to be specified by the Insured. No payment will be made for any operation resulting from any condition which existed prior to the issuance of this policy. FOR STANDARD PROVISIONS SEE PAGE 11 GENERAL PROVISIONS 1. If the insured is entitled under this or any other policy in this or any other Company to indemnity for loss resulting from sickness or disease, he shall not be entitled under this policy to indemnity for the same or a concurrent loss resulting from accidental bodily injury. 2. This policy does not cover disappearance, nor war risk, nor injuries intentionally inflicted by the Insured upon himself, nor suicide, sane or insane, nor any attempt at suicide, sane or insane, nor any loss or disability caused by or from the use of intoxicants or narcotics. 3. The insurance hereunder shall not cover any injury, fatal or non-fatal, sustained by the Insured while participating in or in consequence of having participated in aeronautics. 4. The Company shall not be liable for more than one of the losses provided for in Sections 1 and 6 and the occurrence of any one of the specific losses shall terminate this policy; nor shall the liability of the Company in respect of any one accident or sickness extend to more than one section of this policy, except as provided in Section 7. settlement with the Insured or the beneficiary shall finally release the Company from all further claims in respect of said accident or sickness. Any 5. The acknowledgment by the Company of the receipt of notice given under this policy, or the furnishing of forms for filing proofs of loss, or the acceptance of such proofs, or the investigation of any claim thereunder, shall not operate as a waiver of any of the rights of the Company in defense of any claim arising under this policy. 6. If at the time of filing claim for sickness or accident indemnity under this policy the Insured is over fifty years of age and under sixty years of age, and is not paying the increased premium, as set forth in the statement of premium rates referred to in standard provision No. 1, then in all such cases the Company will pay only two-thirds of the amount for which it would otherwise be liable under this policy. 7. If the Insured be disabled by accident or sickness for more than one month, he or his representative shall furnish to the Company, every thirty days, or as near thereto as may be reasonably possible, with a written report from his attending physician or surgeon, fully stating his condition and probable duration of his disability. 8. The copy of application endorsed hereon is hereby made a part of this contract. No provision of the charter, constitution or by-laws of the Company not included herein shall avoid the policy or be used in evidence in any legal proceeding hereunder. Compliance on the part of the Insured and beneficiary with all the 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. 9. This insurance shall cover only accidents occurring or disability from sickness contracted within the limits of the United States, Canada or Europe, or while travelling as a passenger by the regular passenger steamship lines between said countries, but not including any territory north of the 60th degree of north latitude, nor including Alaska or any territory of the United States acquired since 1897 (Philippine Islands, Hawaii, Porto Rico, Canal Zone and Guam). 10. No assignment of interest under this policy shall bind the Company unless consent thereto is formally endorsed hereon by the United States manager of the Company. Any failure to comply with the provisions of this policy shall render invalid any claim made hereunder. A copy of any assignment shall be given, within thirty days, to the Com pany, which shall not be responsible for its validity. General Accident, Fire & Life Assur. Corp., Ltd. Commenced Business 1885. PERTH, SCOTLAND. U. S. Office, 55 John St., New York. FREDERICK RICHARDSON, United States Manager. The General Accident issues the following policies in its Commercial Accident and Health Department: "Genaco Disability," $15 per $1500, and $5 weekly indemnity; "New Utopia Accident," $6 per $1500 and $5 weekly indemnity; "New Utopia Disability," $14 per $1500 and $5 weekly indemnity; "New Utopia Health," $9 for $5 weekly indemnity; "General Accident," $15 per $5000 and $25 weekly indemnity; "Complete Disability," $12 per $1500 and $5 weekly indemnity; "Gaflac Health," $7 for $5 weekly indemnity; "Straight Accident," $3.50 per $1000 and $5 weekly indemnity; "Death and Dismemberment," $3 per $1000; “Weekly Indemnity Only," $3 for $5 weekly indemnity. Weekly Indemnity on Genaco and Utopia forms accumulates 10% each year for five years. Double Indemnity Rider attached to Straight Accident policy for additional premium of $1.00 for each $5 weekly indemnity. For higher classifications on Straight Accident policy see next page. Double Indemnity Rider attached to Weekly Indemnity Only policy for additional premium of 75c. for each $5 weekly indemnity. POLICY FORM-"GENERAL ACCIDENT." PRINCIPAL SUM, $5000. WEEKLY INDEMNITY, $25. ANNUAL PREMIUM, $15. General Accident, Fire and Life Assurance Corporation, Ltd., (herein called the corporation) in consideration of the premium of fifteen dollars, and the statements in the application for this policy, a copy of which is endorsed hereon and made part hereof, and subject to the provisions and limitations hereinafter expressed, Does hereby insure John Doe, occupation, broker (herein called the insured), for the term of twelve months, beginning on the first day of November, 1914, at twelve o'clock noon, standard time, at the insured's place of residence, against bodily injuries, effected directly, independently and exclusively of all other causes through external, violent and accidental means (excluding suicide, sane or insane, or any attempt thereat, sane or insane), as specified in the following schedules. PART I. SPECIFIC TOTAL LOSSES.-If such injury shall, independently and exclusively of all other causes, immediately, wholly and continuously from date of accident, disable and prevent the insured from performing each and every duty pertaining to his business or occupation and shall, during the period of such disability and within ninety days from date of accident, result in any one of the following specific total losses, the corporation will pay: For loss of life, or both hands by severance at or above the wrist, or both feet by severance at or above the ankle, or one hand and one foot by severance at or above the wrist or ankle, or entire sight of both eyes, if irrecoverably lost, the principal sum. Either hand by severance at or above the wrist, or either foot by severance at or above the ankle, one-half of the principal sum. Entire sight of one eye. if irrecoverably lost, or thumb and index finger of either hand by severance at or above metacarpo-phalangeal joints, one-third of the principal sum. The payment of any one such loss shall end this policy. PART II. TOTAL LOSS OF TIME INDEMNITY. (a) If such injury shall not result in any of the losses enumerated in Part I, but shall from the date of accident directly and independently of all other causes, wholly and continuously disable and prevent the insured from performing each and every duty pertaining to his business or occupation, the corporation will pay for the period of such disability, not exceeding two hundred consecutive weeks, an indemnity per week of twent-five dollars. PARTIAL LOSS OF TIME INDEMNITY. (b) If such injury shall not result in any of the losses enumerated in Part I, but shall, from the date of accident, or immediately following a period of total loss of time as above defined, partially disable the insured and prevent him from performing one or more of the important daily duties pertaining to his business |