California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 6.9 - Standard Credit Life and Credit Disability Policy Forms › Section 2249.12 - Policy and Certificate Blocks

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
PA 1
POLICY
(INSTRUCTION: The following paragraph must be printed in at
					 least 14-point type.)
You can cancel this insurance at any time by telling the
					 creditor that you want to do so. You will get back ALL the premium you paid for
					 this insurance if you tell us or the creditor to cancel it within 30 days after
					 you receive this certificate. If you cancel this insurance after 30 days, you
					 will not get back all the premium that you paid.
(INSTRUCTION: The following paragraph must be printed in at
					 least 14-point bold face type.)
If you have a question, problem or complaint about
					 this insurance, please contact the Creditor Beneficiary at the address and
					 phone number shown in the Schedule or us at (insert address and telephone
					 number of insurer). If we do not resolve your question, problem or complaint to
					 your satisfaction, you may then contact the
California Department of Insurance
300 South Spring Street
Los Angeles, CA 90013
(800) 927-4357 or (213) 897-8921
WHAT YOU GET
If we have been paid the premium shown in the Schedule you
					 are insured for the coverage shown in the Schedule as provided in this
					 policy.
PA 2
CERTIFICATE OF INSURANCE
(INSTRUCTION: The following paragraph must be printed in at
					 least 14-point type.)
You can cancel this insurance at any time by telling the
					 creditor that you want to do so. You will get back ALL the premium you paid for
					 this insurance if you tell us or the creditor to cancel it within 30 days after
					 you receive this certificate. If you cancel this insurance after 30 days, you
					 will not get back all the premium that you paid.
(INSTRUCTION: The following paragraph must be printed out
					 in at least 14-point bold face type.)
If you have a question, problem or complaint about
					 this insurance, please contact the Creditor Beneficiary at the address and
					 phone number shown in the Schedule or us at (insert address and telephone
					 number of insurer). If we do not resolve your question, problem or complaint to
					 your satisfaction, you may then contact the
California Department of Insurance
300 South Spring Street
Los Angeles, CA 90013
(800) 927-4357 or (213) 897-8921
WHAT YOU GET
We certify that while we are paid the premiums for the
					 Group Policy by the Creditor as they become due each month you are insured for
					 the coverage marked in the Schedule, subject to the terms of the Group Policy
					 issued to the Creditor.
PA 3
CERTIFICATE OF INSURANCE
(INSTRUCTION: The following paragraph must be printed in at
					 least 14-point type.)
You can cancel this insurance at any time by telling the
					 creditor that you want to do so. You will get back ALL the premium you paid for
					 this insurance if you tell us or the creditor to cancel it within 30 days after
					 you receive this certificate. If you cancel this insurance after 30 days, you
					 will not get back all the premium that you paid.
(INSTRUCTION: The following paragraph must be printed in at
					 least 14-point bold face type.)
If you have a question, problem or complaint about
					 this insurance, please contact the Creditor Beneficiary at the address and
					 phone number shown in the Schedule or us at (insert address and telephone
					 number of insurer). If we do not resolve your question, problem or complaint to
					 your satisfaction, you may then contact the
California Department of Insurance
300 South Spring Street
Los Angeles, CA 90013
(800) 927-4357 or (213) 897-8921
WHAT YOU GET
We certify that if we have been paid the premium shown in
					 the Schedule you are insured for the coverage shown in the Schedule, subject to
					 the terms of the Group Policy issued to the Creditor.
PA 4
POLICY
(INSTRUCTION: The following paragraph must be printed in at
					 least 14-point type.)
You can cancel this insurance at any time by telling the
					 creditor that you want to do so. You will get back ALL the premium you paid for
					 this insurance if you tell us or the creditor to cancel it within 30 days after
					 you receive this certificate. If you cancel this insurance after 30 days, you
					 will not get back all the premium that you paid.
(INSTRUCTION: The following paragraph must be printed in at
					 least 14-point bold face type.)
If you have a question, problem or complaint about
					 this insurance, please contact the Creditor Beneficiary at the address and
					 phone number shown in the Schedule or us at (insert address and telephone
					 number of insurer). If we do not resolve your question, problem or complaint to
					 your satisfaction, you may then contact the
California Department of Insurance
300 South Spring Street
Los Angeles, CA 90013
(800) 927-4357 or (213) 897-8921
WHAT YOU GET
While we are paid the premiums shown in the Schedule as
					 they become due each month you are insured for the coverage marked in the
					 Schedule.
PB 1
WHO GETS PAID
Claim payments are made to the irrevocable Creditor
					 Beneficiary named in the Schedule to pay off or reduce your debt. If claim
					 payments are more than the balance of your debt, the difference will be paid to
					 you or to the Secondary Beneficiary named in the Schedule, if any, or to your
					 estate.
PC 1
WHAT WE WILL PAY
Single Life Insurance Benefit. If you die while you are
					 insured for single life coverage we will pay the amount of insurance in force
					 at the time of your death after we receive proof of your death.
PC 2
WHAT WE WILL PAY
PC 3
Amount of Life Insurance. The amount of life insurance is
					 the outstanding principal balance of your loan on the date of your death plus
					 not more than 2 months unpaid loan interest. But we won't pay more than the
					 Maximum Amount of Life Insurance in the Schedule.
PD 1
Joint Life Insurance Benefit. If you or your co-borrower
					 die while insured for joint life coverage we will pay the amount of insurance
					 in force at the time you or your co-borrower dies after we receive proof of the
					 death. Only one death benefit is payable under this policy.
PE 2
Term of Insurance. The term of insurance coverage starts on
					 the Effective Date (as shown in the Schedule) and stops on the scheduled
					 maturity date of your loan with the Creditor; except that the coverage may stop
					 sooner as described below, under the caption "When Insurance
					 Stops-Refunds."
Amount of Life Insurance. The amount of life insurance is
					 the total amount due on the loan (excluding unearned finance charges),
					 outstanding on the date of the insured borrower's death.
PE 3
Amount of Life Insurance. The amount of life insurance is
					 the total amount due on the loan (excluding unearned finance charges),
					 outstanding on the date of the insured borrower's death. But we won't pay more
					 than the Maximum Amount of Life Insurance in the Schedule.
PE 4
Amount of Life Insurance. The amount of life insurance is
					 the scheduled unpaid balance due on the loan on the date of the insured
					 borrower's death. The amount of life insurance does not include any delinquent
					 payments or unearned interest.
PE 5
Amount of Life Insurance. The Amount of Level Life
					 Insurance shown in the Schedule stays the same while the policy is in
					 effect.
PE 6
Term of Insurance. The term of insurance coverage starts on
					 the Effective Date (as shown in the Schedule) and stops on the scheduled
					 maturity date of your loan with the Creditor; except that the coverage may stop
					 sooner as described below, under the caption "When Insurance
					 Stop--Refunds."
PF 1
Total Disability Insurance Benefit. If you are insured for
					 total disability insurance, we will pay a benefit if you file written proof
					 that you became totally disabled while insured and continue to be totally
					 disabled for more than 30 days. Payment will be calculated from the 31st day of
					 disability. The benefit will be equal to 1/30th of your Monthly Total
					 Disability Benefit in the Schedule for each day of disability to be
					 compensated. Payments will stop when you are not totally disabled any more or
					 when benefits are paid to the Scheduled Expiration Date, whichever comes
					 first.
PF 3
Total Disability Insurance Benefit. If you are insured for
					 total disability insurance, we will pay a benefit if you file written proof
					 that you became totally disabled while insured and continue to be totally
					 disabled for more than 30 days. Payment will be calculated from the 31st day of
					 disability. Payments will stop when you are not totally disabled anymore or
					 when your loan with the creditor is paid off, whichever comes first. The
					 benefit for each day of disability to be compensated will be 1/30th of your
					 required monthly loan payment or the Maximum Monthly Disability Benefit,
					 whichever is less.
PF 4
Total Disability Insurance Benefit. If you are insured for
					 total disability insurance, we will pay a benefit if you file written proof
					 that you became totally disabled while insured and continue to be totally
					 disabled for more than 30 days. Payment will be calculated from the 31st day of
					 disability. The benefit will be equal to 1/30th of your Monthly Total
					 Disability Benefit in the Schedule for each day of disability to be
					 compensated. Payments will stop:
1.
				  when you are not totally disabled any more,
2. when benefits are paid to the Scheduled
				  Expiration Date, or
3. when
				  benefits are paid for the Maximum Disability Benefit Period in the Schedule,
				  whichever comes first.
The amount of Monthly Total Disability Benefit is the same
					 even though your total disability may be due to more than one cause. The
					 Maximum Disability Benefit Period applies to each period of
					 disability.
If benefit payments have stopped and you have recovered and
					 then you become disabled again while still insured for total disability
					 insurance, we may consider it a new period of disability. We will do so only
					 if.
1. since the last period of
				  disability, at least six straight months have passed during which you were not
				  disabled for any period of time or,
2. the new disability is due to an entirely
				  different cause than the previous disability.
PG 1
Definition of Total Disability. During the first 18
					 consecutive months of your total disability, total disability means that,
					 because of sickness or injury, you cannot perform with reasonable continuity,
					 the substantial and material duties that you must perform to work in your usual
					 occupation in the usual or customary way. Substantial and material duties are
					 duties that are normally required for the performance of your usual occupation
					 and that cannot be reasonably omitted or changed.
After the first 18 consecutive months of your total
					 disability, the definition of total disability changes. It requires that,
					 because of sickness or injury, you cannot work with reasonable continuity in
					 any occupation in which you might reasonably be expected to work satisfactorily
					 in light of your age, education, training, experience, station in life, and
					 physical and mental capacity.
You will be required to give us written proof of your
					 continuing total disability from time to time.
PH 1
WHAT WE WON'T PAY
Misstated Age. If you stated you are under 65, but you are
					 not, we will return your premium when we discover this and will not pay any
					 benefits. This also applies to your co-borrower, if you applied for joint life
					 coverage.
PH 2
WHAT WE WONT PAY
Misstated Age. If you stated you are under 65, but you are
					 not, we will return your premium when we discover this and will not pay any
					 benefits.
PH 3
Misstated Age. If you did not correctly state your age, we
					 will only pay for the amount of insurance that the premium you paid would have
					 bought if your age had been stated correctly. This also applies to your
					 coborrower, if you applied for joint life coverage.
PH 4
Misstated Age. If you did not correctly state your age, we
					 will only pay for the amount of insurance that the premium you paid would have
					 bought if your age had been stated correctly.
PI 1
Suicide. We won't pay any claim if you commit suicide
					 within 6 months of the Effective Date shown in the Schedule, but we will refund
					 the life insurance premium. This also applies to your co-borrower, if you
					 applied for joint life coverage.
PI 2
Suicide. We won't pay a claim for an advance on your loan
					 if you commit suicide within 6 months after the date of the advance, but we
					 will return the life insurance charge on that advance. This also applies to
					 your co-borrower, if you applied for joint life coverage. The time limit for
					 "Suicide" runs separately as to each advance, but a later advance does not
					 restart the time limit on prior advances.
PI 3
Suicide. We won't pay any claim if you commit suicide
					 within 6 months of the Effective Date shown in the Schedule, but we will refund
					 the life insurance premium.
PI 4
Suicide. We won't pay a claim for an advance on your loan
					 if you commit suicide within 6 months after the date of the advance but we will
					 return the life insurance charge on that advance. The time limit for "Suicide"
					 runs separately as to each advance, but a later advance does not re-start the
					 time limit on prior advances.
PJ 1
Total Disabilities Not Covered. We won't pay the claim or
					 refund the premium if your disability:
1. is a result of normal pregnancy or
				  childbirth or;
2. is a result of an
				  intentionally self-inflicted injury or;
3. begins within 2 years after the Effective
				  Date as a result of a pre-existing medical condition. A pre-existing medical
				  condition is one for which you saw or were under treatment by a physician or a
				  chiropractor both within the 6 months before
and
the 6 months
				  after the Effective Date shown in the Schedule.
PJ 2
Total Disabilities Not Covered. We won't pay a claim or
					 refund the disability insurance charge if your total disability:
1. is a result of normal pregnancy or
				  childbirth or
2. is a result of
				  intentionally self-inflicted injury or
3. as to each advance on your loan, begins
				  within 6 months after the date of the advance as a result of a pre-existing
				  medical condition. A pre-existing medical condition is one for which you saw or
				  were under treatment by a physician or a chiropractor both within the 6 months
				  before
and
the 6 months after the date of the advance.
PK 1
WHEN INSURANCE STOPS-REFUNDS
You can stop this insurance at any time. This insurance
					 stops on the Scheduled Expiration Date, or when your loan is paid off, renewed,
					 refinanced or otherwise stops, whichever happens first. If your insurance stops
					 before the Scheduled Expiration Date in the Schedule, you will be given a
					 refund or a credit on your account of unearned premium. This refund or credit
					 will be calculated using a formula approved by the Insurance Commissioner, but
					 refunds or credits of less than $5.00 won't be made.
PK 2
WHEN INSURANCE STOPS-REFUNDS
You have the right to stop this insurance at any time. This
					 insurance stops automatically on the Final Installment Due Date of your loan
					 with the Creditor, or when your loan is paid off, renewed, refinanced or
					 otherwise stops, whichever happens first. Any coverage under the disability
					 insurance will also stop in the event of your death.
If insurance stops before the Final Installment Due Date of
					 your loan, you will be given a refund or credit on your account of unearned
					 premium. This refund or credit will be calculated using a formula approved by
					 the Insurance Commissioner, but refunds or credits of less than $5.00 won't be
					 made.
PK 3
WHEN INSURANCE STOPS-REFUNDS
You can stop this insurance at any time. This insurance
					 stops on the Scheduled Expiration Date, or when your loan is paid off, renewed,
					 refinanced or otherwise stops, whichever happens first. If your insurance stops
					 before the Scheduled Expiration Date in the Schedule, you will be given a
					 refund or credit on your account of unearned premium. This refund or credit
					 will be calculated on a pro-rata basis, but refunds or credits of less than
					 $5.00 won't be made.
PK 4
WHEN INSURANCE STOPS
This insurance stops:
1. on the first billing date after the
				  Creditor receives your written request to stop the insurance, or
2. on the first billing date after you
				  withdraw your authorization for the addition of charges for the insurance to
				  your loan, or
3. on the first
				  billing date after you reach your 65th birthday, or
4. on the date your loan stops, or
5. on the billing date upon which you are 3
				  months delinquent in making a minimum monthly payment on your loan,
				  or
6. on the date the Group Policy
				  stops.
PK 5
WHEN INSURANCE STOPS
This insurance stops:
1. on the first billing date after the
				  Creditor receives your written request to stop the insurance, or
2. on the first billing date after you
				  withdraw your authorization for the addition of charges for the insurance to
				  your loan, or
3. on the first
				  billing date after you reach your 65th birthday, or
4. on the date your loan stops, or
5. on the billing date upon which you are 3
				  months delinquent in making a minimum monthly payment on your loan,
				  or
6. on the date specified in our
				  written notice of cancellation to you.
PK 6
WHEN INSURANCE STOPS
This insurance stops:
1. on the first billing date after the
				  Creditor receives your written request to stop the insurance, or
2. on the Scheduled Expiration Date,
				  or
3. on the date when your loan is
				  paid off, renewed, refinanced or otherwise stops, or
4. on the date when you are 3 months
				  delinquent in payment of a monthly premium for this insurance, or
5. on the date the Group Policy stops.
PK 7
WHEN INSURANCE STOPS
This insurance stops:
1. on the first billing date after the
				  Creditor receives your written request to stop the insurance, or
2. on the Scheduled Expiration Date,
				  or
3. on the date when your loan is
				  paid off, renewed, refinanced or otherwise stops, or
4. on the date when you are 3 months
				  delinquent in the payment of a monthly premium for this insurance, or
5. on the date specified in our written
				  notice of cancellation to you.
PK 8
WHEN INSURANCE STOPS-REFUNDS
You can stop this insurance at any time. This insurance
					 stops on the Scheduled Expiration Date, or when your loan is renewed or
					 refinanced if new insurance is written on the new loan. If your insurance stops
					 before the Scheduled Expiration Date in the Schedule, you will be given a
					 refund or credit on your account of unearned premium. This refund or credit
					 will be calculated using a formula approved by the Insurance Commissioner, but
					 refunds or credits of less than $5.00 won't be made.
PL
					 1
WHAT THE CONTRACT IS AND HOW YOUR STATEMENTS AFFECT
					 IT
This Policy and the attached Application are the complete
					 contract of insurance. All statements made by you in the Application are
					 considered to have been made to the best of your knowledge and belief. No
					 statement can be used to void this Policy or deny a claim unless that statement
					 is in your signed Application. After 2 years during your lifetime from the
					 Effective Date, no statement made by you in your Application can be used to
					 void this Policy or deny a claim. This does not apply to your disability
					 coverage (if any) if that statement was made fraudulently. If you stated in
					 your Application that you are age 65 or older and we do not return your premium
					 within 75 days of the Effective Date, you are insured.
PL
					 2
WHAT THE CONTRACT IS AND HOW YOUR STATEMENTS AFFECT
					 IT
The Group Policy, the Application for the Group Policy, and
					 the attached Application of Borrower are the complete contract of insurance.
					 All statements made by you in your Application are considered to have been made
					 to the best of your knowledge and belief No statement can be used to void this
					 insurance or deny a claim unless that statement is in your signed Application.
					 After 2 years during your lifetime from the Date in the Application, no
					 statement made by you in your Application can be used to void this insurance or
					 deny a. claim. This does not apply to your disability coverage (if any) if that
					 statement was made fraudulently. If you stated in your Application that you are
					 age 65 or older and we do not return your premium within 75 days of the
					 Effective Date, you are insured.
PL
					 3
WHAT THE CONTRACT IS AND HOW YOUR STATEMENTS AFFECT
					 IT
This Policy and the attached Application are the complete
					 contract of insurance. All statements made by you in the Application are
					 considered to have been made to the best of your knowledge and belief No
					 statement can be used to void this Policy or deny a claim unless that statement
					 is in your signed Application. After 2 years during your lifetime from the
					 Effective Date, no statement made by you in your Application can be used to
					 void this Policy or deny a claim. This does not apply to your disability
					 coverage (if any) if that statement was made fraudulently.
PL
					 4
WHAT THE CONTRACT IS AND HOW YOUR STATEMENTS AFFECT
					 IT
The Group Policy, the Application for the Group Policy, and
					 the attached Application of Borrower are the complete contract of
					 insurance.
All statements made by you in your Application are
					 considered to have been made to the best of your knowledge and belief. No
					 statement can be used to void this insurance or deny a claim unless that
					 statement is in your signed Application. After 2 years during your lifetime
					 from the Date in the Application, no statement made by you in your Application
					 can be used to void this insurance or deny a claim. This does not apply to your
					 disability coverage (if any) if that statement was made fraudulently.
PM 1
RULES FOR FILING A TOTAL DISABILITY
					 CLAIM
You must write us or our agent about your total disability
					 claim within 30 days after the beginning of your total disability or as soon
					 after that as you can. We will send you claims forms within 15 days after you
					 tell us about the claim. If we don't send the forms in 15 days, you can simply
					 send us written proof of your disability. The proof must show the date and the
					 cause of the total disability and how serious it is, and it must be signed by a
					 physician or a chiropractor. The proof of total disability must be sent to us
					 no later than 90 days after the end of each period for which a total disability
					 benefit is payable. If it is impossible to file within 90 days, you must file
					 as soon as you can. Unless you have been legally incapable of filing the proof
					 of total disability, we won't accept if it is filed after one year from the
					 time it should have been filed. You can't start any legal action until 60 days
					 after you send us the proof of your total disability, and you can't start any
					 legal action more than 3 years after the proof is filed.
PN 1
RULES FOR FILING A LIFE CLAIM
We must be given a certified copy of the death certificate
					 as proof of a life claim.
PO 1
CONFORMITY WITH STATE STATUTES
Any part of this policy which, on the Effective Date of
					 this Policy, conflicts with the statutes of the state where the policy was
					 delivered to you is changed to conform to the minimum standards of those
					 statutes.
PP 1
PHYSICAL EXAMINATION AND AUTOPSY
We at our own expense have the right, and you must allow us
					 the opportunity, to examine your person as often as is reasonably required
					 while a claim is pending and to make an autopsy in case of death, if it is not
					 forbidden by law.
PQ 1
______________________
______________________
Secretary
President
1. Amendment
					 of paragraphs PK 1-PK 8 filed 12-29-78; designated effective 4-1-79 and for
					 technical reasons, printed in Register 79, No. 2.
2. Amendment filed
					 7-25-83; effective thirtieth day thereafter (Register 83, No. 31). 3. Amendment
					 filed 5-23-85; effective thirtieth day thereafter (Register 85, No.
					 21).
3. Amendment of section and NOTE filed 10-2-2006; operative
					 11-1-2006 (Register 2006, No. 40).
4. Repealer and new paragraph PG
					 1 and amendment of NOTE filed 5-27-2008; operative 6-26-2008 (Register 2008,
					 No. 22).
Note: Authority cited: Sections
						779.21 and
						779.27,
						Insurance Code. Reference: Sections
						510,
						779.2,
						779.3,
						779.4,
						779.6,
						779.14,
						779.27,
						779.28,
						779.30,
						779.31,
						10113,
						10113.5,
						10203.5,
						10203.55,
						10207,
						10208,
						10209,
						10270.94,
						10320,
						10350-10350.3, 10350.5-10350.7,
						10350.10, 10350.11, 10369.1 and 10369. 10, Insurance Code; Sections
						18290-
						18292,
						22314,
						22315 and
						22455,
						Financial Code; Erreca v. Western States Life Insurance Co. (1942) 19 Cal.2d
						388; and Moore v. American United Life Insurance Co. (1984), 150 Cal. App.3d
						610.