SLPC 25441 11/13 (exp. 11/15)

Accident insurance

The exclusions and limitations listed below may vary by state.

What exclusions apply to the benefits payable for both Accident Insurance and the Accident Disability benefits?

No benefits will be payable for any loss or Period of Disability that is a result of a Covered Accident that is due to or results from: war or an act of war, or any involvement in any period of any type of armed conflict (this does not include acts of terrorism); active military duty; riding in or driving any motor-driven vehicle in a race, stunt show, speed test or while Intoxicated; operating, learning to operate, serving as a crew member of, jumping or falling from any aircraft, including those which are not motor-driven (this does not include: 1) flying as a fare paying passenger in a scheduled or chartered flight operated by a commercial airline; or 2) flying as a passenger with no duties on board an aircraft operated by a private business to transport its personnel or guests); engaging in hang-gliding, bungee jumping, parachuting, sail gliding, parasailing, parakiting or any similar activities; participating in or practicing for any semi-professional or professional competitive athletic contest in which any compensation is received; committing of or attempting to commit an assault, felony or other criminal act; committing or attempting to commit suicide or injuring oneself intentionally; voluntary use of any controlled substance as defined in Title II of the Comprehensive Drug Abuse Prevention and Control Act of 1970, as now or hereafter amended, unless administered on the advice of a Physician and used as directed; improper or illegal use of inhalants or huffing; a Sickness or infection including physical or mental condition which is not caused solely by or as a direct result of a Covered Accident; an Injury arising out of or in the course of any work for pay or profit (if off-job coverage is elected); participation in a Riot, Rebellion or Insurrection (for Accident Disability Benefit only). Exclusions may vary depending on state requirements.

What limitations apply to the Accident Disability benefits payable?

Limitations include but are not limited to the following. No benefit is payable for any Period of Disability: while the insured is not under the Continuing Care of a Physician for the Injury causing the Disability, unless the insured has reached a maximum point of recovery and is still Disabled; for any period the insured does not submit to any medical examination or clinical assessment requested by us; for any Period of Disability during which the insured is incarcerated; for any period during which the insured would not receive regular pay from the Employer if the insured was not Disabled (any period during which benefits are suspended will not count towards the Maximum Benefit Duration).