West Virginia Code § 33-15-4

Required policy provisions
Open in Lexace · Ask the AI about this section
Except as provided in section six of this article, each such policy delivered or issued for
delivery to any person in this state shall contain the provisions specified in this section in the
words in which the same appear in this section: Provided, That the insurer may, at its option,
substitute for one or more of such provisions corresponding provisions of different wording
approved by the commissioner which are in each instance not less favorablee in any respect
to the insured or the beneficiary. Such provisions shall be preceded individually by the
caption appearing in this section or, at the option of the insurer, by sucrh appropriate
individual or group captions or subcaptions as the commissioner may approve.
(a) A provision as follows:
"Entire Contract; Changes: This policy, including the endorsements and the attached papers,
if any, constitutes the entire contract of insurance. No change in this policy shall be valid
until approved by an executive officer of the insurer and unless such approval be endorsed
hereon or attached hereto. No agent has authority lto change this policy or to waive any of its
provisions." s
(b) A provision as follows: i
"Time Limit on Certain Defenses: (1) After two years from the date of issue of this policy no
misstatements, except fraudulent misstatements, made by the applicant in the application
for such policy shall be used to void the policy or to deny a claim for loss incurred or
disability (as defined in the policy) commencing after the expiration of such two-year
period."
The foregoing policy provision shall not be so construed as to affect any legal requirement
for avoidanceV of a policy or denial of a claim during such initial two-year period, nor to limit
the application of subdivisions (a), (b), (c), (d) and (e) of section five of this article in the
event of misstatement with respect to age or occupation or other insurance. A policy which
the insured has the right to continue in force subject to its terms by the timely payment of
premium (i) until at least age fifty, or (ii) in the case of a policy issued after age forty-four,
for at least five years from its date of issue, may contain in lieu of the foregoing the following
provision (from which the clause in parentheses may be omitted at the insurer's option)
under the caption "Incontestable":
"After this policy has been in force for a period of two years during the lifetime of the
insured (excluding any period during which the insured is disabled), it shall become
incontestable as to the statements contained in the application.
(2) No claim for loss incurred or disability (as defined in the policy) commencing after two
years from the date of issue of this policy shall be reduced or denied on the ground that a
disease or physical condition not excluded from coverage by name or specific description
effective on the date of loss had existed prior to the effective date of coverage of this policy."
(c) A provision as follows:
"Grace Period: A grace period of __________________ (insert a number not less than '7' for
weekly premium policies, '10' for monthly premium policies and '31' for all other policies)
days will be granted for the payment of each premium falling due after the first premium,
during which grace period the policy shall continue in force."
(d) A provision as follows:
"Reinstatement: If any renewal premium be not paid within the time granted the insured for
payment, as subsequent acceptance of premium by the insurer our by any agent duly
authorized by the insurer to accept such premium, without requiring in connection therewith
an application for reinstatement, shall reinstate the policy: Provided, That if the insurer or
such agent requires an application for reinstatement and issues a conditional receipt for the
premium tendered, the policy will be reinstated upon aapproval of such application by the
insurer, or lacking such approval, upon the forty-fifth day following the date of such
conditional receipt unless the insurer has previouslly notified the insured in writing of its
disapproval of such application. The reinstatesd policy shall cover only loss resulting from
such accidental injury as may be sustained after the date of reinstatement and loss due to
such sickness as may begin more than ten days after such date. In all other respects the
insured and insurer shall have the sgame rights thereunder as they had under the policy
immediately before the due date of the defaulted premium, subject to any provisions
endorsed hereon or attached heereto in connection with the reinstatement."
(e) A provision as follows:
"Notice of Claim: Written notice of claim must be given to the insurer within twenty days
after the occurrence or commencement of any loss covered by the policy, or as soon
thereafter as is reasonably possible. Notice given by or on behalf of the insured or the
beneficiary to the insurer at ____________________ (insert the location of such office as the
insuWrer may designate for the purpose), or to any authorized agent of the insurer, with
information sufficient to identify the insured, shall be deemed notice to the insurer."
In a policy providing a loss-of-time benefit which may be payable for at least two years, an
insurer may at its option insert the following between the first and second sentences of the
above provision:
"Subject to the qualifications set forth below, if the insured suffers loss of time on account of
disability for which indemnity may be payable for at least two years, he shall, at least once in
every six months after having given notice of claim give to the insurer notice of continuance
of said disability, except in the event of legal incapacity. The period of six months following
any filing of proof by the insured or any payment by the insurer on account of such claim or
any denial of liability, in whole or in part, by the insurer shall be excluded in applying this
provision. Delay in the giving of such notice shall not impair the insured's right to any
indemnity which would otherwise have accrued during the period of six months preceding
the date on which such notice is actually given."
(f) A provision as follows:
"Claim Forms: The insurer, upon receipt of a notice of claim, will furnish to the claimant
such forms as are usually furnished by it for filing proofs of loss. If such forms are not
furnished within fifteen days after the giving of such notice the claimant shall be deemed to
have complied with the requirements of this policy as to proof of loss upon submitting,
within the time fixed in the policy for filing proofs of loss, written proof covering the
occurrence, the character and the extent of the loss for which claim is made."
(g) A provision as follows:
"Proof of Loss: Written proof of loss must be furnished to the insurer at its said office in case
of claim for loss for which this policy provides any periaodic payment contingent upon
continuing loss within ninety days after the termination of the period for which the insurer is
liable and in case of claim for any other loss withinl ninety days after the date of such loss.
Failure to furnish such proof within the time rsequired shall not invalidate nor reduce any
claim if it was not reasonably possible to give proof within such time, provided such proof is
furnished as soon as reasonably possible aind in no event, except in the absence of legal
capacity, later than one year from thge time proof is otherwise required."
(h) A provision as follows:
"Time of Payment of Claims: Indemnities payable under this policy for any loss other than
loss for which this policy provides any periodic payment will be paid immediately upon
receipt of due written proof of such loss. Subject to due written proof of loss, all accrued
indemnities for loss f or which this policy provides periodic payment will be paid _____________
(insert periodV for payment which must not be less frequently than monthly) and any balance
remaining unpaid upon the termination of liability will be paid immediately upon receipt of
due written proof."
(i) A provision as follows: "Payment of Claims: Indemnity for loss of life will be payable in
accordance with the beneficiary designation and the provisions respecting such payment
which may be prescribed herein and effective at the time of payment. If no such designation
or provision is then effective, such indemnity shall be payable to the estate of the insured.
Any other accrued indemnities unpaid at the insured's death may, at the option of the
insurer, be paid either to such beneficiary or to such estate. All other indemnities will be
payable to the insured."
The following provisions, or either of them, may be included with the foregoing provisions at
the option of the insurer:
"If any indemnity of this policy shall be payable to the estate of the insured, or to an insured
or beneficiary who is a minor or otherwise not competent to give a valid release, the insurer
may pay such indemnity, up to an amount not exceeding $_________ (insert an amount which
shall not exceed $1,000), to any relative by blood or connection by marriage of the insured
or beneficiary who is deemed by the insurer to be equitably entitled thereto. Any payment
made by the insurer in good faith pursuant to this provision shall fully discharge the insurer
to the extent of such payment."
"Subject to any written direction of the insured in the application or otherweise all or a
portion of any indemnities provided by this policy on account of hospital nursing, medical, or
surgical services may, at the insurer's option and unless the insured rerquests otherwise in
writing not later than the time of filing proofs of such loss, be paid directly to the hospital or
person rendering such services; but it is not required that the service be rendered by a
particular hospital or person."
(j) A provision as follows:
"Physical Examinations and Autopsy: The insurer at its own expense shall have the right and
opportunity to examine the person of the insured wlhen and as often as it may reasonably
require during the pendency of a claim hereunsder and to make an autopsy in case of death
where it is not forbidden by law."
(k) A provision as follows: g
"Legal Actions: No action at law or in equity shall be brought to recover on this policy prior
to the expiration of sixty days after written proof of loss has been furnished in accordance
with the requirements of this policy. No such action shall be brought after the expiration of
three years after the time written proof of loss is required to be furnished."
(l) A provision as foll ows:
"Change of Beneficiary: Unless the insured makes an irrevocable designation of beneficiary,
the right to change of beneficiary is reserved to the insured and the consent of the
beneficiary or beneficiaries shall not be requisite to surrender or assignment of this policy or
to any change of beneficiary or beneficiaries, or to any other changes in this policy."
The first clause of this provision, relating to the irrevocable designation of beneficiary, may
be omitted at the insurer's option.

‹ Prev All West Virginia sections Next ›


Lexace provides legal information, not legal advice, and no attorney–client relationship is created. Statute text is provided for general information and may not reflect the most recent amendments; verify against the official state code.