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1 



^ 



! Accident 

INSURANCE Manual 

1916 

^ TWENTY-THIRD ANNUAL EDITION 

A DIRECTORY 

Of 

PLANS AND CONTRACTS 



OF XHE LEADING 



Stock and mutual accident companies 



Ytau 



I. HINTS TO AGENTS • . " V' 

ii. FORMS OF POLICIES • ; 

III. CLASSIFICATION OF OCCUPATIONS 



Pricb, Flexible Leather Cover, $2.00 



THE SPECTATOR COMPANY 

Chicago Oppicc: 135 William Street 

insurance exchanoe new york. 



THE NEW YORK 
PUBLIC LIBRARY 

713338 

ASTOPI, LENOX AND 
T'lrPtN FOUNDATIONS 

B T9ia 



COPYKIGHT 1916 BY 

THE SPECTATOR COMPANY 
New York 



HINTS TO ACCIDENT INSURANCE AGENTS' 



THE GOODS. 

In selling a concrete commodity the salesman illustrates and 
demonstrates patently. Insurance ^lesmanship is the highest form 
of salesmanship. The seller cannot instantly, palpably demonstrate 
the need and the \^lue of his goods. ^ He sells a ''promise to pay." 

Insurance is a contract of indemnity; for an agreed consideration 
one party guarantees another against loss. 

Marine insurance is more than a thousand years old. Fire 
insurance several hundred years old. Life insurance nearly as old. 
Disability insurance is comparatively new. 

Our grandparents knew and desired fire and life insurance. Famil- 
iarity has made them' real essentials of life. Our parents could ob- 
tain guarantees of indemnity for pecuniary loss due to inability to 
attend to their livelihood because of accidental injuries. Only 
comparatively recently has disabilit)^ insurance become known to 
the prudent, thrifty, far-sighted American. 

^ The careful, sane, prudent man obtains life insurance to protect 
his estate and to obtain due credit for his enterprises. He obtains 
fire insurance to protect his properties. He must have accident and 
health insurance to protect nis livest asset — his ability to devote his 
brains, body, experience, influence to his daily business affairs. 

A man will die once — ^just once. He is liable to sustain many 
physical setbacks during an ordinary span of life. He may face the 
destruction of his [jropertY by fire or flood or tornado, and, even if he 
has no contract of indemnity, with his health, his strength, his credit, 
his influence, his experience, he can rebuild, replace his lost proper- 
ties. But no millionaire, no genius, no Hercules can replace a lost 
eye or shriveled limb. He can obtain large cash indemnities, how- 
ever, if he has had the prudence to "insure his income." 

No physical setback ever made a man richer. Every physical 
setback — any accident or illness — costs something besides pain. 
Disability insurance is "income insurance." It insures a man's 
income coming in when his outgo is increased because of some physi- 
cal setback. The doctor's, druggist's, hospital's, nurse's bills, the 
cost of a substitute to do his work, etc., all mean extra expense. 
A man's income may not be immediately cut off or even temporarily 
lessened; but it certainly is not increased by reason of any physical 
setback. 

His outgo, on the other hand, certainly is increased. To meet the 
increased pecuniary outgo, he must needs insure his income coming 
in. Accident and health insurance is the Paymaster in times of 
physical bankruptcy. 

The cost is dependent upon the hazard of a worker's occupation, 
and, as regards illness indemnities, upon his age, as well. Nearly 
7,000 occupations have been classified and rates deemed adequate 
for guaranteeing a certain weekly indemnity to each have been 
determined as well as indemnities for loss of life or limbs. 

Most companies issuing contracts of indemnity for such losses 

^Copyright, X916. by Tus Spbctator Company. New York. 



I 



HINTS TO AGENTS 



use the same, or approximately the same, manual of rates and class- 
ifications. 

There is a very wide latitude of choice between the various organ- 
izations' various policies (or contracts of indemnity), and under- 
writers vie with one another in devising policies including ^*^is, that 
and the other feature. 

It is a remarkable fact, however, that while the cost of practically 
all other necessaries of life, such as food, clothing, fuel, shelter, etc., 
has increased by leaps and bounds during the last forty years, the 
cost of protecting one's income through accident and health con- 
tracts of indemnity has remained almost stationary. 

As against the same low rate of premiums, or charges for health 
and accident "coverage," the contracts have been broadened year 
after year. Technicalities have been eliminated. Exclusions have 
been lessened. 

Moreover the development of transportation facilities, the pres- 
ence of the electrically propelled vehicles, high-speed "trolleys," 
electric, gasoline and steam-driven pleasure and commercial vehicles, 
have added a new and grievously potential hazard to daily perils. 
Indeed the losses due to automobiles alone ^and there are more than 
1.500,000 such vehicles darting about, this country today) con- 
stitute nearly 26 per cent, of the total losses sustained by the organi- 
zations issuing accident insurance contracts. 

Thus, with the cost practically the same as ever, the likelihood 
of corporeal disaster much greater than ever and the policies simpler, 
broader, fairer than ever, the necessity for this modern armor of 
indemnity is most palpable. 

THE SELLER. 

The opportunities, therefore, are ^eater than ever for the sales- 
man who knows his business, sees its possibilities and steadfa^tly. 
pursues his calling. 

Men will eagerly seek and pay for the things that satisfy or appeal 
to their five senses. They will obtain life insurance protection; 
fire insurance protection; marine insurance protection; windstorm 
and hail insurance protection; bank deposit insurance protection, 
etc. But they have to be persuaded to protect their incomes from 
losses due to physical impairments. 

"Health and accident insurance is not bought. It is sold." 
Nobody buys it over the counter. It must be explained, and the 
3ne who needs it must be interested and convinced of that which 
really is essentially a necessary of life. 

Salesmanship of the highest degree — ^that's what health and acci- 
dent soliciting is. Only men of earnest, insistent mould make the 
big successes. To them, though, the return is most glorious and 
satisfying. 

Relatively the commissions paid to the sellers of Income Insurance 
[and that is what health and accident indemnity really is) are higher 
than are paid to salesmen in any other legitimate calling. More- 
over, the renewal commissions, that is, the compensation paid to 
:hose who have originally sold this Twentieth Century necessary of 
ife and who have placed the annual or semi-annual renewal of the 
:ontract," are constant — not reduced, as in other forms of insurance. 

Today it is estimated that less than ten per centum of the avail- 
ible purchasers have been supplied with this necessary of life. More 
:han that, it is a fact that the readiest purchasers of this commodity — 
:he brainy, successful professional men and merchants — are the first 
)nes to increase the amount of health and accident insurance they 
»rry. 

Compensation insurance, as it is called, is becoming obligatory. 



HINtS TO AGENTS 



through statutory prods in all the great manufacturing, mining and 
commercial commonwealths. But this humane improvement over 
the unfair old liability laws does not protect any save the industrial 
classes, while farm laborers and domestic servants are not included 
in the scope of these so-called compensation laws. The merchants, 
the professional men and thousands of others do not come under the 
compulsory compensation laws. 

Even those workers whose employments are specifically or infer- 
entially included under ''compensation" laws are not compensated 
for mishaps occurring at other than their places of employment and 
only during the hours of employment and only if the injuries thus 
sustained continue longer than a week, or ten days or two weeks, as 
the local statutes specify. 

Statistics show that nearly 42 per cent, of all accidents compen- 
sated for by the health and accident companies to their commercial 
(not industrial) policyholders occur in and around the home. So 
that it is evident that so-called compulsory workmen's compensation 
laws do not reach the higher classes of workers and do not by any 
means fully "cover" the industrial classes. Moreover, thus far 
accidents, not ailments, are compensated for and the pecuniary losses 
due to illnesses alone are estimated at more than $800,000,000 
annually in this country. 

The opportunities therefore are illimitable for the wide-awake 
systematic, honorable seller of commercial health and accident 
contracts of indemnity. The field is not merely large; but it is 
fertile. The recompense is large. The sense of satisfaction in 
serving one's fellow-beings is alone a magnificent reward. 

Strict honesty and perseverance are the secrets of success in this 
work. "Misrepresentation will never result in upbuilding a success- 
ful agency" is a truism. Tell the "Prospect" precisely what the 
contract provides. Tell him it does not pay death indemnities for 
natural death losses. That is the province of life insurance. This 
is Live, not Life, Insurance. 

Statistics show that one out of every ten "Prospects" properly 
approached becomes a policyholder. The more men interviewed, 
the more policies sold, the greater the salesman's income. Most 
salesmen do not realize their own power. They fail to develop due 
and proper poise and confidence. The more a salesman believes in 
the value of his goods the more he sells. The more confidence he 
has in himself as a purveyor of good ^oods, needed goods, fairly sold 
goods, the more confidence he will inspire in his prospective pur- 
chasers. 

Selling a cake of soap is one thing, selling a piece of paper that 
makes a man glad and grateful subsequently in his hour of anguish 
and pecuniary distress . is another — a far greater, a far more satisfying 
thing. It is a fact that one out of every six policyholders presents 
at least one claim for compensation each year. 

Therefore, you are doing a noble as well as a needful work when 
you persuade a man to protect his income-producing hours by pur- 
chasing a disability contract of indemnity. 

You may not obtain one client in the first ten "Prospects" you 
solicit; nor in the second ten, and perhaps only one in the third ten; 
but out of 100 or 600 possible purchasers the average of "one in 
ten" will hold good. Of those to whom fair contracts, backed up by 
an organization of real integrity, solvency and reputed fair and 
prompt claim settlements, appeal, 90 per cent, will renew their 
policies at expiration — provicled the policies have been fairly and 
honestly sold; plainly described in the first instance. 

Consequently^ the cumulative value of steady, systematic soliciting 
is tremendous in this business. One man in New York City who 



6 HINTS TO AGENTS 

twice tried selling health and accident insurance and failed miserably 
is now receiving a renewal commission income of more than $12,000 
a year on his old, well -sold, carefully attended business. 

Haphazard soliciting may pay — a little systematic soliciting always 
has and always will succeed and is bound to pay the steady, consis- 
tent worker handsomiely. 

To those who will not accept accident indemnity contracts disabil- 
ity coverage may be offered and vice versa. But for real satisfac- 
tion the combined health and accident policy should always be 
offered, aye, insisted upon. No man is immune from accidents — 
none either is immune from ailments. The man, or woman (for 
women who earn a livelihood are eligible for Income Insurance), 
who is provided with Disability Insurance is really the one who feels 
safe — confidently relies upon prompt indemnity whenever any 
physical setback comes. 

Only retired millionaires do not need Income Insurance — their 
incomes come in no matter whether they are ill or injured a day, a 
month or a year. Every other person, not mentally or physically 
impaired, is a fit subject for soliciting. 

Last year more than $12,000,000 was paid to holders of accident 
and health indemnity contracts in this country. More than 1,200,- 
000 workers have been paid indemnities by American health and 
accident organizations. They know; they realize the value of this 
Income Insurance. More than 20,000,000 are waiting to be ad- 
vised. For many, many of them who have scoffed at, put off ob- 
taining, or failed to retain this real, modern, reasonably priced 
necessary of life, the verdict will be, "Too bad; too late,'* when 
physical setbacks do come, as they always have come and always will 
come, to the stoutest, the most careful. 

THE METHODS. 

No two men are identical. No identical method of approach will 
do. Study your "Prospect." If he has others dependent upon him 
one line of thought is obvious. If he has no one dependent upon 
him another phase of the indemnity contract — the weekly indemni- 
ties — not the death or dismemberment indemnities — ^will appeal to 
him. 

If Mr. Prospect is a dentist or a surgeon his liability to toxic 
poisoning and the precious value of sound eyes and fingers form 
irresistible persuaders. If a merchant or banker, the very large 
returns to his estate for loss of life through accidental means — 
indemnities obtained at less than a tithe the cost of life insurance — 
appeal to his mind. 

Study your company's contracts. Learn the rates for each form 
of policy. Neither task is hard nor complicated. If ever in doubt 
upon any point consult the Home Office. All inquiries will be 
promptly and gladly answered. 

Make up a daily list of ten or fifteen calls. Your office work 
should always be done during the hours "Prospects" cannot be 
interviewed. Your "Back Calls" (third and fourth and nifith and 
tenth interviews with reluctant Prospects) should be sandwiched 
in daily between your interviews with "new" Prospects. 

Remember every one who you find has already provided himself 
0/ herself with "Income Insurance" was doubtless solicited, not 
once but several times, by not one but several solicitors like yourself. 

Aim high. Interview "Prospects" who might, could, should and 
will carry good-sized policies. It takes no more experience, brains, 
energy and tact to sell a hundred-dollar contract to a "big" man 
than a six-dollar contract to a mechanic or artisan. 



HINTS TO AGENTS 



Start high. If the Prospect does not feel that he can set aside 
enough money to provide an adequate weekly indemnity in time of 
need — say $50 or $40 or $25 — ^he can, if he will, take a policy costing 
only a few cents a day and guaranteeing an income of $15 or$12.50 
or $5 a week. 

Don't tell the Prospect he "can get a policy as low as $2 a year." 
He can, of course, but it will be a very limited contract. Tell him 
he can have a policy providing a fortv thousand or thirty thousand 
dollar estate for a trining sum, probably not as much as he spends 
for a couple of good cigars a day. 

Be most scrupulously careful in making out the application 
or schedule of warranties. Print the name of the applicant. Be 
sure to ask him each and every question called for. This is most 
important. You cannot waive anything in the contract, nor any- 
thing in the application or schedule of warranties. Remember that 
the greatest hazard of the applicant's vocation and avocation fixes 
the classification and the rate of premium charged. 

Wrong classifications and wrong rating always lead to dissatis- 
faction. ''One Knocker can do more harm than ten Boosters can 
overcome." Write your clients right and satisfaction is certain; 
renewals of present business will follow and increased income for the 
salesman is inevitable. 

Keep a card index of every "Prospect." Keep an exact copy of 
every application. Make every claim paid a business builder 
through mtroductions obtained from the satisfied policyholder. Try 
to illustrate the value of a policy such as you are about to sell by 
citing instances of claims paid to individuals in the same occupation 
as your present prospect — recent local claims, if possible. 

^ Be punctual — always a few moments ahead of time — ^for inter- 
views and for remittances to the company. Punctuality, like polite- 
ness, pays. Tact costs little; means much. Always leave your 
"Prospect" with a smile and express the wish that nothing may 
happen before he does protect his Income with Income Insurance. 
Then you can go back, and go back again until you, or some cleverer 
salesman, has sold him that which he needs, but puts off obtaining. 
Never let a "turn down" rob you of confidence. Many policy- 
holders turned down a dozen men once and one man a dozen times, 
until the right salesman sold him the policy he has today. Every 
man in the world is susceptible of having his mind changed. Since 
he turned you down cold, flat, hard last week Mr. Obstinate wit- 
nessed a thrilling accident, reali2»d how he might have been the 
sufferer and today his mind is putty, not stone. 

Represent a good company. Stick to it. You lose by swapping 
companies. A man's known by the company he keeps. 

Your income — your 8uccess--depends wholly upon yourself. You 
can't be fired, or locked out, or boycotted. You are your own em- 
ployer. If you are lazy you suffer. If you work hard, systemat- 
ically, you prosper. The agent's commission is usually ten or twelve 
times as much as the company's underwriting profit. Don't forget 
that. And the company carries the risk; sets aside necessary re- 
serves; pays the taxes and license fees, the printing, stationery and 
hundred and one other things. ^ j 

Your only investment is your time, your energy, your brains. 

What other occupation that pays as well as this can you enter 
with no pecuniary investment wfiatever? With no long period 
of study and diploma-striving^ before you can earn a living? 

Remember, the Producer is King. Every company wants him. 
If canvassing brings you success (and money) more canvassing will 
mean more money. 



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PLANS AND POLICIES 



OP 



Stock Actident Companies 



STANDARD PROVISIONS 11 

STANDARD PROVISIONS. 

(A): 1. This policy includes the endorsements and attached 
papers, if any, and contains the entire contract of insurance. No 
reduction shall be made in an^ indemnity herein provided by 
reason of change in the occupation of the insured or by reason of 
his doing any act or thing pertaining to any other occupation. 

(B): 1. This policy includes the endorsements and attached 
papers, if any, and contains the entire contract of insurance 
except as it may be modified by the insurer's classification of risks 
and premium rates in the event that the insured is injured after 
havine changed his occupation to one classified by the insurer as 
more hazardous than that stated in the policy, or while he is doing 
any act or thing pertaining to any occupation so clarified, except 
ordinary duties about his residence or while engaged in recreation, 
in which event the insurer will pay only such portion of the in- 
demnities provided in the policy as the i)remium paid would have 
purchased at the rate but within the limits so fixed by the insurer 
for such more hazardous occupation. 

If the law of the state in which the insured resides at the time 
this policy is issued requires that prior to its issue a statement of 
the premium rates and classification of risks pertaining to it shall 
be filed with the state official having supervision of insurance in 
such state, then the premium rates and classification of risks 
mentioned in this policy shall mean only such as have been last 
filed by the insurer in accordance with such law, but if such filing 
is not required by such^ law then they shall mean the insurer's 
premium rates and classification of risks last made effective by it 
m such state prior to the occurrence of the loss for which the 
insurer is liable. 

2. No statement made by the applicant for insurance not 
included herein shall avoid the policy or be used in any legal pro- 
ceeding hereunder. ^ No agent has authority to change this policy 
or to waive any of its provisions. No change in this policy shall 
be valid unless approved by an executive officer of the insurer and 
such approval be endorsed hereon. 

(A): 3. If default be made in the payment of the agreed 
premium for this policy, the subsequent acceptance of a premium 
by the insurer or by any of its duly authorized agents shall rein- 
state the policy but only to cover loss resulting from accidental 
injury thereafter sustained. 

(B): 3. If default be made in the payment of the agreed 
premium for this policy, the subsequent acceptance of a premium 
by the insurer or by any of its duly authorized agents shall reinstate 
the policy but only to cover such sickness as may begin more than 
ten days after the date of such acceptance. 

(C): 3. If default be made in the payment of the agreed 
premium for this policy, the subsequent acceptance of a premium 
by the insurer or by any of its duly authorized agents shall reinstate 
the policy but only to cover accidental injury thereafter sustained 
and such sickness as may begin more than ten days after the date 
of such acceptance. 

(A): 4. ^ Written notice of injury on which claim may be based 
must be given to the insurer within twenty days after the date of 
the accident causing such injury. 

(B): 4. Written notice of sickness on which claim may be 
based must be given to the insurer within ten days after the com- 
mencement of the disability from such sickness. 

(C): 4. Written notice of injury or of sickness on which claim 
^y be based must be given to the insurer within twenty days 



iim I 



12 STANDARD PROVISIONS 

after the date of the accident causing such injury or within ten 
days after the commencement of disability from such sickness. 

5. Such notice given by or in behalf of the insured or 

beneficiary, as the case may be, to the insurer at .or 

to any authorized agent of the insurer, with particulars sufficient 
to identify the insured, shall be deemed to be notice to the insurer. 
Failure to give notice within the time provided in this policy shall 
not invalidate anv claim if it shall be shown not to have been 
reasonably possible to give such notice and. that notice was given 
as soon as was reasonably possible. 

6. The insurer upon receipt of such notice, will furnish to 
the claimant such forms as are usually furnished by it for filing 
proofs of loss. If such forms are not so furnished within fifteen 
days after the receipt of such notice, the claimant shall be deemed 
to have complied with the requirements of this jjolicv as to proof 
of loss upon submitting within the time fixed in the policy for 
filing proofs of loss, written proof covering the occurrence^ character 
and extent of the loss for which claim is made. 

(A): 7. Affirmative proof of loss must be furnished to the 
insurer at its said office within ninety days after the date of the loss 
for which claim is made. 

(B) : 7. Affirmative proof of loss must be furnished to the in- 
surer at its said office within ninety days after the termination of 
the period of disability for which the company is liable. 

(C) : 7. Affirmative proof of loss must be furnished to the in- 
surer at its said office in case of claim for loss of time from dis- 
ability within ninety days after the termination of the period for 
which the insurer is liable, and in case of claim for any other loss 
within ninety days after the date of such loss. 

8. The insurer shall have the right and opportunity to 
examine the person of the insured when and so often as it may 
reasonably require during the pendency of claim hereunder, and 
also the right and opportunity to make ah autopsy in case of death 
where it is not forbidden by law. ^ 

(A): 9. All indemnities provided in this policy will be paid 
after receipt of due proof. 

(B) : 9. All indemnities provided in this policy for loss other 

than that of time on account of disability will De paid 

after receipt of due proof. 

10. Upon request of the insured and subject to due proof 

of loss accrued indemnity for loss of 

time on account of disability will be paid at the expiration of each 

during the continuance of the period for 

which the insurer is liable, and any balance remaining unpaid at 
the termination of such period will be paid immediately upon 
receipt of due proof.^ 

(A): 11. Indemnity for loss of life of the insured is payable 
to the beneficiary if surviving the insured, and otherwise to the 
estate of the insured. All other indemnities of this policy are 
payable to the insured. 

(B): 11. All the indemnities of this policy are payable to the 
insured. 

12. If the insured shall at any time change his occupation 
to one classified by the insurer as less hazardous than that stated 
in the policy, the insurer, upon written request of the insured and 
surrender of the policy, will cancel the same and will return to the 
insured the unearned premium. 

13. Consent of the beneficiary shall not be requisite to 
surrender or assignment of this policy, or to change of beneficiary, 
or to any other changes in the policy, . 



_^^ STANDARD PROVISIONS 13 

14. No action at law or in equity shall be brought to 
recover on this policy prior to the expiration of sixty days after 
proof of loss has been filed in accordance with the requirements of 
this policy, nor shall such action be brought at all unless brought 
within two years from the exi>iration of the time within which proof 
of loss is required by the policy. ^ 

15.^ If any time limitation of this policy with respect to 
giving notice of claim or Tumishing proof ot loss is less than that 
permitted by the law of the state m which the insured resides, 
at the time this policy is issued^ such limitation is hereby extended 
to agree with the minimum penod permitted by such law. 

OPTIONAL STANDARD PROVISIONS 

16. The insurer may cancel this policy at any time by 
Written nDtice delivered to the insured or mailed to his last address, 
as shov/n ty the records of the insurer, together with cash or the 
insurer's check for the unearned portion of the premiums actually 
paid by the insured,^ and such cancellation shall be without preju- 
dice to any claim ori^nating prior thereto. 

17. If the insured shall carry with another company, 
corporation, association or society other insurance covering the 
same loss without giving written notice to the insurer, then in that 
case the insurer shall be liable only for such portion of the indem- 
nity promised as the said indemnity bears to the total amount of 
like indemnity in all policies covering such loss, and for the return 
of such part of the premium paid as shall exceed the pro rata for 
the indemnity thus determined. 

C 18. Upon the payment of claim hereunder any premium 
then due and unpaid or covered by any note or written order may 
be deducted therefrom. 

(A): 19. If a like policy or policies, previously issued by the 
insurer to the insured be in force concurrently herewith, making 
the a2:gregate indemnity in excess of $ the excess in- 
surance shall be void and all premiums paid for such excess shall 
be returned to the insured. 

(B): 19. If a like policy or policies, previously issued by the 
insurer to the insured be in force concurrently herewith, making 
the aggregate indemnity for loss of time on account of disability in 

excess of $ weekly, the excess insurance shall be 

void and all premiums paid for such excess shall be returned to the 

insured. 

^ (C): 19. If a life policy or policies previously issued by the 

insurer to the insured be m force concurrently herewith making 

the aggregate indemnity for loss other than that of time on account 

of disability in excess of $ .or the aggregate indemnity 

for loss of time on account of disability in excess of $ 

weekly, the excess . insurance of either kind shall be void and all 
premiums paid for such excess shall be returned to the insured. 

20. The 'insurance under this policy shall not cover any 

person under thq ,age of years nor over the age of 

years. Any premiuni paid to the insurer for any period not 
covered by this policy will be returned upon request. 



14 iCTNA UP£ IKSUftAKcE COMPANY. 

fieti)a ^fe \T)BiiraT)Qe ^o(t\pagy. 

COMPANY'S BUILDING, HARTFORD, CONN. 



Commenced Business (accident and liability department), January 1, 1891. 
M. G. BuLKELEY, Pres. W. C. Faxon and J. S. Rowe, Vice-Pres. J. M. Parker, Jr.,, 
and Ernest C. Higgins, Sees. Edwin C. Bowen, John V. Adams and Cldford B. 
MoRCOM, Asst. Sees. 

ACCIDENT INSURANCE. 

The JEtnsi Life issues a variety of forms of policies, classifying 
risks as specified below: 

Select Class. — ^Annual rate $5 per $1000, with $5 weekly in- 
demnity; $2.50 per $1000 for "death only" insurance. 

Prbfbrrbd Class.— Annual rate $5 per $1000, with %5 weekly^ 
indemnity; $2.50 per $1000 for "death only" insurance. 

Extra Prbpbrrbd Class. — Annual rate $6 per $1000, with $5 
weekly indemnity; $3 per $1000 for "death only" insurance. 

Ordinary Class. — Annual rate $7.50 per $1000, with $5 weekly 
indemnity; $3.75 per $1000 for "death only" insurance. 

Mbdium Class. — Annual rate $10 per $1000, with $5 weekly 
indemnity; $6 per $1000 for "death only" insurance. 

SpBCIAL Class. — Annual rate $12.50 per $1000, with $5 weekly 
indemnity; $7.50 per $1000 for "death only" insurance. 

Hazardous Class. — Annual rate $15 per $1000, with $5 
weekly indemnity; $9 per $1000 for "death only" insurance. 

Extra Hazardous Class. — Annual rate $20 per $1000, with 
$5 weekly indemnity; $12 per $1000 for "death only" insurance. 

Special contracts for occupations of greater hazard than are 
included in above classes, such as freight brakemen, railroad 
yardmen, etc. 

Agb Limits. — Eighteen to sixty-five, and for "death only" 
insurance, eighteen to seventy. 

Maximum Indbmnity.— Death, $25,000; weekly, $125, doubling 
under "Combination" and increasing under "Accumulative" 
policies. 

"Rbgular" Policies in the above classes carry at the rates 
given for each $1000 instirance with weekly indemnity the follow- 
ing benefits: $1000 in event of accidental death, or the loss of 
both feet, both hands, one hand and one foot or the entire sight 
of both eyes; $500 for loss of one foot or one hand; $250 for loss 
of entire sight of one eye; $5 per week for total disability, limit 
104 weeks; $2 per week for partial disability, limit 26 weeks. 
Weekly indemnity is payable every four weeks during disability. 

Combination AccidbnT Policies are issued to "Select" and 
"Preferred" risks at an annual premium of $5 per $1000, to 
"Extra Preferred" risks (except passenger conductors) at $6 
per $1000, and to "Ordinary" risks at $8.50 per $1000. These 
policies provide for each $1000 principal sum, the following 
benefits for general accidents : $1000 in event of accidental death, 
loss of both hands, both feet, one hand and one foot, one eye and 



iETNA LIFE INSPRANCE COMPANY 16 

one limb, or entire sight oi both eyes; $500 for loss of either hand or 
fogt or entire sight of one eye; $5 per week indemnity durine the 
period of total disability; $2.50 weekly indemnity for partial dis- 
ability, limit twenty-six weeks. 

Thid policy also provides for the payment of weekly indemnity 
for continuous total disability from date of accident to date of loss 
of life, limb, limbs or sight, in addition to the specified amounts 
payable for such losses. 

If injuries are sustained while the insured is a passenger in or on 
a public conveyance provided by a common carrier for passenger 
service (including the platform, steps or running-board of railway 
or street railway cars), or while a passenger in a passenger elevator 
(excluding elevators in mines), or caused by a stroke of lightning, or 
by reason and in consequence of the burning of a building while the 
insur&l is therein, or caused by the collapse of the outer walls of a 
building, while the insured is therein, or caused by the explosion of a 
steam lx>iler, or caused by a cyclone or tornado, the amoiuits payable 
as above stated are doubled. Weekly indemnity is payable every 
four weeks during disability. In case of injury the insured has the 
privilege of receiving in lieu of weekly indemnity a specified amount 
as per the schedule of injuries shown in the policy. If a surgical 
operation named in the schedule of operations in the policy is per- 
formed by reason of an injury which creates other liability under 
the policy, the amount stated opposite such operation is payable to 
the insured in addition to other indemnity. If such iniuries do not 
result in disability, but do require surgical treatment by a surgeon 
within ninety days, the company ^rill pay the amount actually ex- 
pended for such treatment, but not exceeding the amoimt payable 
for one week of total disability, for general accidents. 

Claims for the principal sum or any specified portion thereof for 
loss of limbs, limb or sight are payable in cash, or in twenty-year 
four per cent gold bonds of the iEtna Life Insurance Company. 
These bonds will be registered or made payable to bearer, as desired, 
and interest thereon will be paid annually until maturity. 

Under the accumulative clause, if the premiums are paid an- 
nually, the principal sum will be increased ten per cent each year 
until such accumulations shall amount to fifty per cent of the 
amount originally insured. If the premituns are paid semi-an- 
nually or quarterly the principal sum will be increased five per cent 
each year until such accumulations shall amount to fifty per cent of 
the amount originally insured. 

POLICY FORM— "Accumulative Accident Policy." 
Principal Sum, $5000— ^$10000. Weekly Indemnity, $25— $50. 

In consideration of the premium of twenty-five dollars, and of 
the^ statements made in tne application for this policy (copy of 
which application is endorsed hereon and made a part hereof), the 
Mcna. Life Insurance Company, of Hartford, Connecticut, does 
hereby insure (subject to all conditions and limitations hereinafter 
contained) the person named and described in said application by 
occupation attorney for the term of twelve months from the first 
day of January, 1914, (commencing and ending at twelve o'clock 
noon, standard time), against loss resulting directly and inde- 
pendently of all other causes, from bodily injuries effected solely 
through external, violent and accidental means, suicide (sane or 
insane) not included, as herein defined. 

Part I. Single Indeunities.— If such injuries alone totally disable tbe insured, that 
is, from date of accident continuously and wholly prevent him from prosecuting any and 
every kind of business pertaining to his occupation, and during the period of such continu- 
ous total disability and within two hundred weeks from date of accident, result in any 



16 /ETNA' LIFJE INSPRAHCE COMPANY 

one 4>f the losses described below.' the oompany' will pay the sum fl^nccificd op|>oeite sjch 
loss and in addition will pay weekly indenmity for the period of such disabili^, fromue 
date of accident to the date of death or other specified loss, at the rate per week prov^led 
in Part II (a); or, if such injuries alone result within ninety days from date of acddeat in 
any one of the losses described below, vrithout such disabilitsr, the company will pay- the 
sum specified opposite such loss. Loss of: (a) life, the principal sum of $5000; (o) both 
hand? by removal at or. above the wrists, or (r) both feet by removal at or above the 
ankles, (dj one hand at or above the wrist and one foot at or above the ankle (by removal) 
or (e) entire sight of both eyes, if irrecoverably lost, oiiif) one hand by .removal at or above 
the wrist and entire sight of one eye, if irrecoverably lost, or (s) one foot by removal at or 
above the ankle and entire sight of one eye, if irrecoverably lost, the prinapal sum; or (A) 
one hand by removal at or above the wrist, or (0 one foot by removal at or aoove the ankle 
or (;). entire sight ot one eye, if irrecovejpably lost, onerh&lf of principal sum. 

Single Weekly iMDEUKiTy 

Part II. Total Disability.— (a) If such injuries do not result in any of the losses 
provided for in Part I, but alone totally disable the insured, that is, from date of aocidsnt 
continuously and wholly ivevent him from prosecuting any and every kind at business 
pertaining to his occupation, th^ company will pay the sum of twenty-five dollars per week 
so long as he shall live and su£Fer such disability. 

Partial Disability. — (6) /If such injuries do not totally disable the insuxed, as above, 
but alone partially disable nim, that is, from date of accident, or immediatdy following 
a period of total disability las above d^ned, oontinucnisly and whdly prevent him from 
pcnorming one or more important daily duties pertaining to his occupation, the company 
will pay one-half of the amount per week payable for: total disabihty for the period of 
such partial disability, but not for more than twenty-s^s consecutive weeks. 

Pakt III. Elective Indemnities. — ^If the insured shall sustain bodily injuries 
covered by this policy and named in the schedule of injuries below, the company will pay 
the largest amount provided in said schedule for any one of such mjuries. provided the 
insurednotifies the company vrithin twenty days from the date of acddmt of his election 
to accept such amount m beu of all other indemnity, except for such surgical operation 
fee as may become payable under Part V hereof. 

Schedule of Injuries. — ^The amounts stated in the following "Schedule of Injuries" 
are payable under this policy if the company's liability for single weekly indemnity for 
total disability is fifty dollus per week, proportionate amounts being payable if said 
liability is for a larger or smaller amount. lor loss by removal: Of one or more fingers 
(at least one entire phalaiuc), $300; of one or more entire toes, $400. For complete dis- 
locatbn, viz.: Of the shoulder, $120; of the elbow, $200: of the wrist, $250; of one or 
more fingers, $1(X); of the hip, $600; of the knee or ankle, $300; of one or m(M'e bones 
of foot (not toes), $300; of one or more toes, $100. For the complete fracture of bones, 
viz.: Of the skull, both Ubles. $650; of the lower jaw, $150; of the collar bone, $300; 
of the pelvis, $500; of the thigh, $600; of the leg or knee cap. $400i of the arm between 
elbow and shoulder, $600; of the forearm between wrist and dbow, $300; oi one or more 
ribs, $2(X); of one or more bones of the foot (not toes), $250; of one or more bones of 
the hand (not fingers), $250; of one or more toes, $200; of one or more fingers, $200. 

Part IV. Double iNDEMNmES.^The comramy will ^y double the sum other- 
wise payable under Parts I, II or III of this policy if the mjuries causing the loss are 
sustam»l by the insiu^ (1) while a passenger in or <m a' public conveyance provided 
by. a common carrier for passenger service (including the platform, steps or running 
board of railway or street railway cars), or (2) while a passenger in a passenger elevator 
(excluding elevators in mines); or by reason and in conseauence of (3) the burning of a 
building while the insured* is therein or (4) the collapse of the outer walls of a building 
while the insured is therein, or (5) the eqdosion.of a steam boiler, or (6) a cyclone or 
tornado, or (7) a stroke of lightning. 

Part V. Surgical Operations. — If the insured shall siistain bodily ihjuries covered 
by this policy solely by reason of which any operation oi operations named in the schedule 
of operations below are p^orined by a surgeon during a period of- total or partial dis- 
ability (aa herein defined) and vrithin ninety days from date of accident, the company 
will pay the largest amoimt provided. in said schedule for any one of the operations so 
performed in addition to other indemnity herein provided. 

•; , SfTHEDULE OF OPERATIONS.— Ther amounts Stated in the following ." Schedule of Opera- 
:tions" are payable imder this policy if the company's liability forsingle weekly indemnity 
for tbtdl disability is fifty dollars per week, proportionate amotults being payable if said 
lialbiliiy'is for a larger or smaller amounts ' AmpuUtion of foot, hand or forearm, $50; 
leg or arm, $100; thigh $250; thumb, finger or fingers, toe or toes, $20. , Dislocations, 
reduction of shoidder, elbow, hip, knee or ankle, $50; two or more bones in body of hand 
or foot (not thumb, finger or toe), $30; wrist or lower iaw, $30; thumb, finger or fingers, 
toe or toes, $20.5 • Excision of shoulder, hip or knee joint, $200; elbow, wrist or ankle 
joint, $100. Eye, car. noseor throat— Any cutting operation, $20. Fractures, reduction 
of nose, lower jaw, collar bone, shoulder blade or forearm (one or both bones), $50; breast 
bone, cocc3rx, two or more bones in body- of hand or foot' (not thumb, finger or toe), $30; 
-upper arm, $70; rib or Tibs, thumb, finger or fingers, toe or toes, $20; any of the bones of 
the pelvis, $100; thigh,4l50; knee cap or leg bones (one.ot both), $100. <;un8hot wounds 
— ^treatment not necessitating amputation -or laparotomy, $50. Lfipaiotomy(openuie 
of the abdominal bavity for an operation on any organ contained therein), $200. SkuD 
trephining, for fracture of both tabl^'- $200. Synovitis- (inflammation- of • thtf^linmg 
membrane of a joint), incision, $50. Tetanus-r-injection of anti-tetanic scarum ipto 
frontallobe of brain, $200.' Wounds -of.' scalp of t)thertoart»— Suturing;"$10, , ;'*' - .. 

If such injuries do not result in ;disability,t)ilt1fe<i^iW*surgital treatment by^U *ttlrgeoli 
"within ninety days from date of accident, thi*QDX^iiJ)' will pay the amount actuilliy^ 



■■ . iETNA LIFE INSURANCE COMPANY 17 

pended for Auch treatment, not exceeding the amount provided in Pait II (o) for single 
weekly indemnity fdr total disability for one week. 

Part VL Hospital Indemnities. — ^If the insured shall, solely !>y reason of bodily 
Injury for which weekly indemnity is payable, be confined in a hospital within nine^ 
days from date of acddent, and provided no claim is made under Part V for surgical open- 
tion fee, the company will pav, m addition to the weekly indemnity payable, the amount 
expended weekly by nim for hospital chaiges, but not in excess of cme-half of the single 
weekly indenmity provided in Part II (a) tor total disability, nor for a period of more than 
<m weeks. • 

Part VH Accumulations. — ^If all premiums are paid annually , the original principal 
sum hereby insured will be inOvased ten per cent, in the second and each subsequent >rear 
for fiye consecutive years, until such increases amoimt to fifty per cent, of the original 
sum insured, and thereafter, so long as this policy is maintainea in force by annual pre- 
mium payments the amount insured shall be the original principal sum plus the accumu- 
lations. 

If premiums are paid otherwise than annually, the original principal sum hereby in- 
sured will be increased five per cent' in the second and each sul»equent year for ten con- 
secutive years, tmtil such mcreases amoimt to fifty ^r cent of the original sum insured, 
and thereafter,^so long as this policy is maintamed m force the amount insured shall be 
the original principal sum plus the accumulations. 

Part VIII. Gold Bonds.— The principal sum insured under this policy shall be 
pavable at the option of the insured or beneficiary as the case may be, in United States 
f^old coin or its equivalent, or in twenty-year four per cent, gold bonds of the ^tna Life 
Insurance Company. These bonds w ill be reg istca^ or made payable to bearer as desired 
and-interest thereon will be paid annually imtil maturity. 

Part DC. Identification. — If the insured, by reason of injury or illness, shall be 
physically unable to communicate with friends, the company upon receipt of a telegram; 
or other message giving the number of this policy, will immediately transmit to his rel- 
atives or friends any information respecting him and will defray the expense necessary 
to put thte insured in the care of friends, witnin the sum of one hundred dollars. 

For Standard Provisions See Page 11 

Additional Provisions 

A. Upon the occurrence, of any one of the losses described in Part I (a) to 0) in- 
clusive of this policy, all insurance hereunder shall immediately cease and upon pay- 
ment of indemnity therefor, this policy shall be surrendered to the comi>any. Failure 
on the part of any claimant under this policy to furnish proofs of loss within ninety days 
after the date of loss or the termination of the period for which the company is liable, pro- 
vided the fumishnig of such proofs within that period was reasonably possible; or, re- 
fusal to permit such examination of the person of the insured or autopsy m case of death 
as is hereinbefore provided for, shall invalidate all claims under this policy. 

B. Tills insurance does not cover the result of injury received by the msured while 
participating in or in consequence of having participated in aeronautics. This insur- 
ance does not cover in event of accident or any lOss »>ecified in Part I or Part II of this 
policy, resulting wholly or partly, directly or mdirectly, from bodily or mental infirmity 
or disease in any form, or from ptomaines. 

C; No assignment of interest under this policy shall bind the company unless consent 
thereto is formally endorsed hereon by an executive officer of the company. The com- 
pany shall not be responsible for the validity of any assignment. The copy of the appli- 
cation endorsed hereon is hereby made a part of the contract of insurance between the com- 
pany and the insured. No provision of the charter, constitution or by-laws of this com- 
pany shall be used in defense of any claim arising imder the policy unless such provision 
is incorporated in full in this policy. This policy may be renewed with the consent of 
the company and by the pajrment of the premium in advance. 

Short Term Accident Insurance. 
Short Term policies in amounts not exceeding $6000 and $30 
weekly indemnity are issued to persons in the "Select," "Pre- 
ferred," "Extra Preferred," and "Ordinary" classes at the fol- 
lowing rates: 

$1000 Insurance with $5 Weekly 

Indemnity $1000 for death only 

One month $1.50 One month $ .75 

Twomonths 2.25 Two.months 1.13 

Three months 3.00 Three months 1.50 

Fourmonths , 3.75 Fourmonths 1.88 

Fivemonths 4.50 Five months 2.25 

Six months... 5.25 Six months 2.63 

Accident ticket? covering $2500 in event of accidental death and 
$12.50 weeklv indemnity for ordinary accidents, doubling to $5000 
and $25 weeklv indemnity for travel accidents are issued for from 
one to thirty days at the following rates: 

Twenty-Five Cents per Day for from One to Seven Days 

Ten days. .". $2.00 Thirty days $4.50 

Fifteen days 3.00 Women insured against death only. 

Twenty-one days 4.00 



Id i£TNA LIFE INSURANCE COMPANY 

Disability Insurance. 

The Accumulative Disability policy combines accident and 
health insurance, and the annual premitmi rates are as follows: 

Ages 18 to 50 inclusive, "Select" and "Preferred" risks, $12 per 
$1000; "Extra Preferred" risks, $13 per $1000; "Ordinary" risks, 
$15.50 per $1000; ages 51 to 60, inclusive, "Select" and "Pre- 
ferred" risks, $14 per $1000; "Extra Preferred" risks, $15 per 
$1000. 

This policy provides payments in event of accidental death, loss 
of limbs, limb or sight, weekly indemnity, accumulations, elective 
indemnities, fees for surgical operations, identification of insured 
and payment of claims in Gold Bonds. Under the Health portion 
of the policy contract, the insured is covered for weekly indemnity, 
fees for surgical operations, and for payment of a substantial sum 
in event of permanent total disability resulting from blindness or 
paralysis. 

The policy contract follows: 

POLICY FORM— "Accumulative Disability." 
Principal Sum, $5000 — $10,000. Annual Premium, $60. 

This policy is similar to the Accumulative accident policy shown 
above, except where the phraseology conflicts with the health por- 
tions of the contract, and in the following paragraphs, whidi are 
taken from the disability policy in toto. 

Part VII. Illness. — If the insured shall, soldy by teason of any disease contracted 
during the term of this insurance and not herein excepted, be totaUy disabled, that is, 
for a period commencing during said term be wholly and continuously prevented from 
prosecuting any and every kind of business pertaining to his occupation, and be necessarily 
confined in the house, and be rec(ularly treated by a licensed physician, the company wu 
pay the same amount per week as is provided in Part II (a) for total disability and if, 
immediately following such a period of total disability and omfinement in the nouse he 
shall be totally disabled, that is, wholly and continvously prevented bom. prosecuting 
any and every kind of business pertaining to his occupation, but is not necessarily con- 
fined in the house, the company will pay one-half of said amount per week, but no pay- 
ment shall be made for disability in excess of fifty-two consecutive wedu' duration. 

Part VIII. Blindness Aifl> Paralysis. — ^If the insured shall, solely by reason of any 
disease contracted during the term of this insurance and not herein excepted, and mtlnm 
said term, suffer the irrecoverable loss of the entire sight of both eyes, or become perma- 
nently paralyzed whereby he shall entirely lose the use of both hands, or both feet, ot of 
one hand and one foot, and shall by reason of same be totally disabled, that is, wholly and 
continuously prevented from engaging in any work or occupation tax wages or profit, 
the company will pay the same amount of indemnity per wedc as is provided in Part 11 
(a) for the period of such total disability not in excess of one hundred consecutive weeks' 
duration. 

Part IX. Surgical Operations. — ^If the insured shall, during the term of this insur- 
ance, sustain bodily injuries covered by this policy or contract any disease not herein 
excepted, solely by reason of which any operation or operations named in the schedule 
of operations below are performed by a surgeon during a period of total or partial disabfl- 
ity^Cas herein defined) and vrithin nmety dajrs from date of accident, or contracting said 
disease, the company will pay the largest amount provided in said schedule for any one 
of the operations so performed in addition to other indemnitv herein provided. 

Schedule of Operations.— The amounts stated in the following "Schedule of Opera- 
tions" are pavable under this policy if the company's liability for single weekly indemnity 
for total disability is fifty dollars per week, proportionate amounts oeing payable if said 
liability is for a larger or smaller amount. Appendicitis — (see laparotomy). Aneurism 
(tumor of artery) — ^ligation, $100. Amputation of foot, hand or forearm, $50; leg or arm, 
$100; thigh, $200; thumb, &nger or fingers, $20; toe or toes, $20. Abscess or boil — incision 
$10. Bone — ^removal of diseased portion of bone, $50; curetting only, $50. Bronchot- 
omy, thyrotomy, laryngotomy, laryngotracheotomy or tracheotomy, $100. Carbuncle 
— mcision and treatment, $10. Dislocations, reduction of shoulder, elbow, hip, knee,or 
ankle, $50; two or more bones in body of hand or foot (not thumb, finger or toe), $30; 
wrist or lower jaw, $30; thumb, finder or fingers, $20; toe or toes, $20. Excision of shoulder, 
hip or knee jomt, $200; elbow, wnst or ankle jomt, $100. Eye, ear, nose or throat— any 
cutting operation, $20. Felon-Incision, $10. Fractures, reduction of nose, lower jaw, 
collar bone, shoulder blade or forearm (one or both bones), $50; breast bone, coccyx, two or 
more bones in body of hand or foot (not thumb, finger or toe). $50; upper arm, $70; rib 
or ribs, thumb, finger or fingers, toe or toes, $20; any of the bones of the pelvis, $100; 
thigh, $150; knee cap or leg bones (one or both), $100. Ganglion (cystic tumor of tendoD 
sheath)— incision and curetting, $30. Gunshot wounds — treatment not necessitating 
amputation or laparotomy, $50. Hydrocele — ^tapping — ^incision or exdsbn of sac, $50. 
Ingrowing toe nail— removal, $20. Intestinal obstruction — (see laparotomy). Kidney 



^ iCTNA UFE mStmANCE COMPANY W 

—fixation or removal, $200; laparotomy (opening of the abdominal cavity for an opera- 
tion on any organ contained therein, or for traxunatic peritonitis, or exploratory incision), 
1200. Lithotomy (operation for removal of stone in bladder), any cutting, $200. Mas- 
toiditis — operation for, $100. (Esophagotomy, for stricture or other causes, $200. Para- 
centesis — tapping of abdomen, chest, or bladder, $50; ear drum, $50. Peritonitis— (see 
laparotomy). Rectum, operation for hemorrhoids— excision, or li^tion, $50; prolapsed, 
$50; fistula in ano— incision, $50; polypus— extirpation, $50; malignant stricture — exci- 
sion or colostomy, $200. Skull trephuung, for fracture of both tables, $200. S^ovitis, 
(infiammation of the lining membrane of a joint), incision, $50. Tetanus— mjection 
of anti-tetanic serum into frontal lobe of brain, $200. Tumors — extirpation from any 
part of the body: Benign, $30; mali^knt, $100. Varicose veins— Ligation or excision, 
$50. Varicocele— acupressure— ligaUon or exdsion, $50. Wounds of scalp or other parts 
—suturing. $10. . . . , 

If such injuries do not result in disability, but require surgical treatment by a surgeon 
within ninety days from date of accident, tlie company will pay the amount actually ex- 
pended foe auch treatment, not exceeding the amount provided in Part II (a) for smgle 
weekly indemnity for total disability for one week. 

Part X. Hospual Indeunities. — If the insured shall, solely by reason of bodily 
injury or disease for which weekly indemnity is payable, be confined in a hospital within 
ninety days from the date of accident, or commencement of disability from disease, and 
provided no claim is made under Part IX for surgical operation fee, the company will 
pay, in addition to the weekly indemnity payable, the amount expended weekly by him 
tor hospiUl charges, but not m excess of one-half of the single weekly indemnity pro- 
vided in Part II (a) for total disability, nor for a period of more than ten weeks. 
For Standard Provisions See Page 11 
Additignal Provisions 

A. Upon the occurrence of any one of the losses described in Part I (a) to (j) inclusive 
of this policy, all insurance hereunder shall immediately cease and u^n payment of 
indemnity therefor, this policy shall be surrendered to the company. Failure on the part 
of any claimant under this policy to furnish proofs of loss within ninetv days after the date 
of toss or the termination of the period for which the company is liable, provided the fur- 
nishing of such proofs vrithin that period was reasonaUy possible; or, refusal to permit 
such examination of the person of the insured or autopsy in case of death as is hereizibefore 
provided for, shall invahdate all claims under this policy. 

B. This insurance does not cover the result of injury received by the insured while par- 
ticipating in or in consequence of having participated m aeronautics. This insurance does 
not cover in event of acadent or any loss specified in Part I or Part 11 of this polio^, result- 
ing wholly or partly, directly or indirectly, from bodily or mental infirmity or disease In 
any form or from ptomaines. 

This insurance does not cover disability resulting from any disease or illness contracted 
vhile the insured b engaged in military or naval service; nor anv disease or illness con- 
tracted within fifteen days from noon of the da^ this policy is dated. 

This insurance covers disease contracted and cusability sustained only within the limits 
of the United Sutes and Canada upon the North American Continent lying south of the 
fifty-fifth defTtee of north latitude and Europe. 

C. No assignment of intaest under this policy shall bind the company unless consent 
thereto is formally endorsed hereon by an executive officer of the company. The com- 
pany shall not be responsible for the validity of any assignment. The copy of the appli- 
cation endorsed hereon is hereby made a part of the contract of insurance between the 
company and the insured. No provision of the charter, constitution or by-laws of this 
company shall be used in defense of any claim arising under this policy unless such pro- 
vision is incorporated in full in this policy. This i>oIicy may be renewed with the consent 
of the company and by the payment of the premium in advance. 



20 AMEtaCAN CASUALTY COMPANY 

/)/T\eriGaQ Casualty ^ompaQy. 

READING, PA. 



CoamcBced BuiineM 1903. E. P. Van Rxb>. Prei. Hasvit H. Sbomo, Sec 

This company issues a variety of forms, principal among which 
is the "Progressive" accident policy, providine single indemnities, 
annual premium, $20; the "American Health policy, annual pre- 
mium, $35; "American Accident," annual premium, $25, prin- 
cipal sum, $7500; "Victor Disability" policy, which sells at $60 a 
year and is similar to the "Victor" accident contract, except for 
the health provisions. 

Age Limits. — ^^Eighteen to sixty years,, 

POLICY FORM— "ThS American." 

Principal Sum, $7,500--$15,000. Weekly Indeiinity, $25 — $50. 
Annual Premium, $25. 

In consideration of the premium of twenty-five dollars, and the 
statements contained in the Application, a copy of which is en- 
dorsed hereon and made a psirt hereof, the American Casualty 
Company, of Reading, Pennsylvania (hereinafter called "the 
Company"), 

Does hereby insure, subject to all the provisions, conditions, and limitations herdn- 
after contained John Doe (hereinafter called "the insured "), of Reading, State of Pennsyl- 
vania, by occupation a bodikeeper, for a term of twelve months, from the first day of 
January, 1914 (b^inning and ending at 12 o'clock noon, standard time at the place 
where this policy is countersigned) — against loss resulting directly, independently, and 
exclusively of any and all other causes from bodily injuries (herein caUed "such injuries "), 
effected uAdy throush accidental means (suicide or any attempt thereat, sane or insaat, 
not included)— as foUows: 

Schedule of SPEcmc Losses. 

Sbctiom 1. If such injuries shall within ninety (90) days from the date of accident, 
result in any one of the losses enumerated in the following schedule of q>ecific losses, 
the company will pay the amount specified opposite such loss: (a) life, the principal 
sum of $7500; (b) both hands by removal at or above the wrists, or (c) both feet by removal 
at or above the ankles, or (d) one hand at or above the wrist and one foot at or above the 
ankle, or («) entire sight of both eyes, if irrecoverably lost, the principal stun; (/) either 
hand by removal at or above the wrist, or (g) either foot by removal at or above the ankle, 
or ih) entire sight of one eye, if irrecoverably lost, one-half of principal sum. 

SnrnoN 2. Total Lois or Time. — If such injuries shall not result in any of the losses 
enumerated in Section 1, but shall from the date of the accident continuously confine 
and totally disable the insured and prevent him from performing any and every duty 
pertaining to any business or occupation, the company will pay twenty-five dollars ($25) 
per week lor a period of such total disability. 

Section 3. Partial Loss of Time.— If such injuries shall not result in any of the losses 
enumerated in Section 1, 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 important duties pertaining to any business or occu- 
pation, the company will pay for the period of such disability and such partial loss of 
time, one-half of the weekly indemnity spo:ified in Section 2 for total loss of time, not 
exceeding, however, fifty-two (52) consecutive weeks. 

Section 4. Additional Benerts. — ^If such injuries shall result in any one of the losses 
designated in Section 1 , the C(Hnpany will pay in addition to the specific indemnity specified 
therein, such weekly indemnity (if any) as shall have accrued under Section 2, between 
the date of accident and the date of death or dismemberment. 

Section 5. Double Indemnity.— If such injuries result as above defined and are 
sustained, (1) while the insured is riding as a passenger and is in or on a public convey- 
ance provided by a common carrier for passenger service only (including the platform, 
steps, or running-board of railway or street railway cars); or (2) while a passenger within 
a passenger elevator (mine elevators excepted), provided for passenger service only; 
or (3) while a passenger on board a steam vessel hcensed for the re^lar transportation 
of passengers; or (4) in consequence of the burning of a building within which the insured 
shall be at the commencement of the fire— then the amounts payable shall be double the 
sums specified in Section 1, 2, 3, and 9. 



AMERICAN CASUALTY C01CPAN7 21 

- 

Sbctxom 6. HospiXAL iMDKiaiiTY.— If such iiyunes for which indenuuty is payable 
under thb policy are suffered by the insured, ana if on account of such injuries and 
within ninety (90) days from the date of the accident, the insured is removed to a re^- 
larly incorporated hospital, the company will pay the insured in addition to other in- 
demnity payable for such injui^f for a period not exceeding thirteen (13) consecutive 
weeks, during which the insured is necessarily confined in the said hospital, and provided 
that no claim is made under Sections 9 and 10, the amount expended bv him weekly 
on account of the hospital charges, not exceeding, however, one-half of the weekly in- 
demnity as specified in Section 2 of this policy. 

Section 7. Medical Atte^anck Indemnity. — If such ii^'uries shall not result in 
in any one of the losses enumerated herein, but shall require treatment by a physician, 
the company will reimburse the insured for the cost of such treatment^ not to exceed 
an amount equal to the indemnity payable for one week's total loss of tune as ^ecified 
in Section 2, provided the physician's receipt and statement on the company's form b 
furnished to the companv at its home ofike in Reading, Pennsylvania, within thirty 
(30) days from the date of accident. 

Section 8. Sunstroke, Freezino, Hydrophobia, etc. — ^If sunstroke, freeang. 
hydrophobia, septicemia, poisoning by gas or other poisonous vapor, due to external 
violent, and acadental means, shall result, independently of any and all other causes 
and within ninety (90) days from the date of exposure or infection, in the death of the 
insured, the company will pay the original principal sum as stated in Section 1. 

Section 9. Elective Indemnity. — If the insured shall be entitled to indemnity 
for an injury, and such injury shall result in a loss enumerated in the schedule of Elective 
Indemnities endorsed hereon, he may elect to receive in lieu of all other indemni^ the 
amount provided in said schedule for such loss, provided, he shall signify his choice in 
writing to the company at its home office in Reading. Pennsylvania, within twenty (20) 
days from the date of accident. Payment shall not be made for more than one of the 
losses enumerated in said schedule as the result of any one accident. 

Section 10. Surgeon's Fees.— If such injuries are sustained by the insured as 
described herein and shall within ninety (90) days from the date of the accident neces- 
sitate one of the surgical operations named in the "Schedule of Operations" hereinafter 
contained^ the companv will pay the insured in addition to all other indemnity the amount 
provided m said scheoule for such operation, but same will not be made for more than 
one operation as the result of injuries sustained in any one accident, or from anv condi- 
tion which existed prior to the issue of this policy. Operations not named in the ^'Sched- 
ule of Operations " .are not covered. 

Section 11. iDENTcncATiGN. — If such injuries shall render the insured physically 
unable to communicate with friends or relatives, the company will, upon receipt of a 
telegram or other messagejgiying the number of this pdicy> immediate^ transmit to the 
beneficiary all information m its possession req)ectiiig the insured , and wul pay in addit ioo 
to the indemnity otherwise provided herein, the expense necessary to place the insured 
in communication with and in care of relatives and friends, but such expense and the 
liability of the company under this section shall not exceed one hundred dollars ($100). 

Section 12. This policy shall be void for any of the foUowfaig causes: Fraud, mis- 
representation, or untrue statements concerning any claim hereunder, or should the in- 
sured suffer the loss of hearing, sight, reason, or become physicallv infirm. This insurance 
does not cover any accident received by the insured while engaged in military or naval serv- 
ice, disappearance, nor loss or injury resultmg or contributed to directly or indirecthr, 
wholly or in part, by disease, or from any means or act which if used or committed by the 
insured while in possession of all mental faculties would be deemed intentional or self- 
inflicted; nor does this insurqnce cover any injuries, either fatal or non-fatal, received 
while or resulting from riding or being in or on any aerial device or conveyance, or any 
injuries received while outside the limits of the United States, Canada, Europe, or Alaska, 
nor in Canada north of the sixtieth degree of north latitude. 

Section 13. Payment of indemnity under Section 1 shall immediately tenninate thb 
policy. 

For Standard Provisions See Page 11 

The amounts specified in the following "Schedule of Indemnities" are payable if the 
policy b issued for a seven thousand five hundred doUar ($7500) principal sum; propor- 
tionate amounts being payable if the policy is issued for a larger or smaller amount. 

Schedule or Elective Indemnities.— For loss of certain members by removal 
within ninety days after injury, vb.: Of one or more finders (at least one entire phaUnx), 
$1S0; of one or more entire toes, $200. For complete hernia, caused solely and direct^ 
by accidental injury, $70. For complete dislocation, viz.: of the shoulder, $100; of the 
elbow, $100; of the wrist, $125; of the hip, $300; of the knee, $150; of any bones of foot 
$150; of the ankle, $150; of two or more toes, $50: of two or more fingers, $50; For the 
complete fracture of bones, viz. : of the skull, both tables, $325; of the lower jaw, $75; 
of the collar bone. $150; of the pelvis, $250; of the thigh, $300: of the leg, $200; of the 
knee cap. $200; ot the arm between elbow and shoulder, $300; ot the forearm between the 
wrist and elbow, $150; of two or more ribs, $100; of the foot, $125; of the hand, $125; 
of two or more toes, $1(X); of two or more finsers, $100. 

The amounts specified in the following "Schedule of Operations" are payable if the 
policy b issued for a seven thousand five hundred doUar ($7500) principal sum; propor- 
tionate amounts being payable if the policy is issued for a larger or smaller amount. 

Schedule or Operations. — Amputation of foot, hand, or forearm, $25; les or arm, 
$50; thigh, $100; finger or fingers. $10. Dblocations, reduction of shoulder, elbow, hip, 
knee, of ankle, $25: wrist or lower jaw, $15; thumb or fingers, $10. Excbion of shoulder, 
hip, or knee joint, $100; elbow, wrist, or ankle joint, $50; toe or toes, $25. Fractures, 
reduction of nose, lower Jaw, collar bone, or shoulder blade, $35; breast bone, $10; rib 
or libs, $10; upper arm. $35; forearm (one or both bones), $25; wrist or hand, $1$; fingen. 



22 AMERICAN CASUALTY COMPANY. 

tlO; any of the bones of the pelvis or sacram, $50; coccyx. tlO; thigh, $75: knee cap or 
leg bones (one or both) $50; bones of foot, $15; toe or toes, $10. Gunuot woonds— 
Treatment not necessitating amputation or laparotomy, $25; skull trephining for frac- 
ture or other cause, $100. Synovitis (inflammation of the lining membrane m a joint\ 
incision, $25. Wounds of scalp or other parts — suturing. $5. 

Industrial Department. 

The "Golden Riile" policy is the form used in this department. 

Age Limits. — Eighteen to fifty-five for males; applicants over 
fifty years pay 60 per cent, advance. 

Policy Fee.— $2. 

Lapsed Policies. — Policies delinquent less than 30 days are 
reinstated upon payment of one monthly premium; over 30 days 
and less than 60 days, one monthly premium and a fee of 50 cents; 
over 60 days, one monthly premium and a fee of '$L 

Women. — Wage earners between ages of eighteen and forty-five 
are insured under the "Regular" form of $25 a month accident 
and illness indemnity, with $200 accident benefit, premium, $1 a 
month. Those desiring larger < indemnities must be classified ac- 
cording to occupation and pay 50 per cent, advance in rates. 

Benefits. — Under "Regular" bolicies accident indemnity is 
paid for 24 months and takes effect on date of policy. Illness 
Denefits take effect thirty days from date of policjr and are paid for 
disability after the first week of illness. "Special" policies pro- 
vide the same benefits except that the words "after the first week" 
in the health provision are eliminated. Benefits are increased ten 
per cent, (see policy form). 

Health Insurance. 
One form of health insurance is issued as follows: "American 
Health Policy," paying $25 weekly indemnity for fifty-two weeks, 
and provides for surgical operations. Smaller policies at propor- 
tionate rates. Issued to men only. Cost, ages IS to 49, $35; 
ages 50 to 60, $45 annually. 

POLICY FORM— "Simplex Accident." 

Principal Sum, $1500. Monthly Accident Indemnity, $35. 
Monthly Premium, $1.10. 

American Casualty Company of Reading, Pa. (hereinafter called 
the company), in consideration of the monthly premium of one 
and iVn dollars, ($1 jVt)) and the application, a copy of which is 
endorsed hereon and made a part hereof. 

Does hereby insure John Doe of Reading, a lawyer by occupation, subject to all coih 
ditions and limitations herein contained, Irom the day this contract is dated, twelve 
o'clock noon, standard time, of the place where the msured resides when this policy 
is issued, until twelve o'clock noon, such standard time, oi the first day of November, 
1914, and for such further periods as stated in the renewal receipts, and thepasrment of 
the premium specified, will maintain this poUcv in force, against the efifects resulting 
directly independently and extlusively of all other causes, from bodily injury sustained 
through external, violent and accidental means. 

Specific Losses.— (a) The principal sum of this policy is fifteen hundred doUan. 
If any one of the following specific losses shall result solely, independently and exclusively 
from injuries as described above, within ninety days from date of accident the company 
¥rill pay, in lieu of all other indemnity, for loss of ufe, or loss of both hands by complete 
severance at or above the wrists, or loss of botl) feet by complete severance at or aoove 
the ankles, or loss of entire sight of both eyes, if irrecoverably lost, or loss of one hand 
and one foot by complete severance as denned above, or loss of entire sight of one eye 
and severance of one foot as defined above or loss of entire sight of one eye and severance 
of one hand as defined above, the principal sum; or loss of right hand by complete sev 
erance at or above the wrist ot loss of either foot by complete severance at or above the 
ankle one- half the principal sum: or loss of left hand by complete severance at or above 
the wrist, or loss of entire sight of one eye, if irrecoverably lost, one-third the phocipal 
sum The payment of any one of the above losses shall terminate this policy. 

AccxD&NT Indemnity Total Loss of Tike.— <6) The company will pay at the rate 
qf tWrty-$v^ c)oU«n per iqqq^ fpr a pcriQ4 not ac^edin|{ thirty-^? QQq^^cixMv^ P»Potb$ 



AMERICAN CASUALTY COMPANY. 



. . total loM of time, resulting directly and independently of all otiier causesfron 
bodily injuries effected tliiough external, violent ana accidental means and which im- 
nediatcfy wholly and continuouslv from date of accident disable and prevent the insured 
from pefforming every duty pertaming to bis business or occupation. 

Pakiial Loss OF Tub.— (c) Or. if such injuries shall wholly or continuously from 
date of accident disable and prevent the insurea from performing one or more impwtant 
dutiespertaining to his occupation, or in the event of lil^e disability immediately following 
total disability* the company will pay the insured for the period of such disability not 
mrmting six consecutive months, fifty per cent, of the rate specified in paragraph (b); 
provided the maximum period for which indemnity shall be paid under paragraphs 
(b) and (c) hereof for any one injury shall not exceed thirty-six consecutive months, 
•nd further provided that mdemnity under these paragraphs (b) and (c) shall not be paid 
— >i — the insured is under the regular treatment of a legally qualified physician or sur- 



Tknmix iNDnanry. — (d) The amounts specified in paragraphs (a), (Jb) and (c) 
shall be doubled if the bodily injury be sustained (1) while a passenger in passenger 
elevator (excluding elevators m mines); (2) while riding as a passenger within the en* 
cksed part ci a railwav passenger car provided by a common carrier for the exclusive 
use of passengers; or (3) while riding as a passenger on board a steam vessel licensed 
for the regular transportation of passengers; or (4) in consequence of the burning of a 
boildiBg occupied by the insured as owner, guest or tenant, while the insured is therein 
sod is not acting as a volunteer or paid nreman; or (5) in consequence of a stroke of 
lightning. 

Inckbased iMDKMNiry— (e) All indemnities shall be increased ten per cent. (10%) on 
sny daim arising under pararraphs (jb) and (c) of this policy, provided the premiums 
are paid annually in advance, but such addition shall never exceed ten per cent. (10%) 
of the amount orijsinally mentioned in this policy and such increased benefits shall be 
effective only during the period for which said premiums are paid. Each consecutive 
full shear's renewal of this policy shall add ten per cent. (10%) to the benefit provided 
under paragraph (a) until such additions shall amount to fifty per cent. (50%) of the orig- 
inal principal sum, and thenceforth, so long as this policy is maintained in continuous 
force, the amount pasrable under paxagrai^ (a) will be the original principal sum plus the 
accumulations. 

Spbcial iNDnooTY. — (/) If sunstroke, freeaang or hydrophobia due to external, 
violent and accidental means shall result, independently of any and all other causes 
and within ninety days from the date of exposure, in the death of the insured, the com- 
pany will pay the original principal sum as stated in Section (a). 

SusoiCAL OPBRAnoN INDEMNITY. — (g) If "such injury" of the insured shall, within 
ninety davs from time of the accident necessitate one or more of the surgical operations 
named below, the company will pav, in addition to any indemnity otherwise provided 
the largest amount npid&ed for any one of the operations performed; provided that 
not more than one such indemnity shall be payable as the result of any one cause of 
disability. The amounts specified below are payable only in case the monthly accident 
indemnity is 950; if such indemnity is greater or less than S50, then the amount to be 
paid shaU be increased or reduced proportionately. 

Surgical Operations.— Amputation of forearm, entire foot or hand, $10; leg, $20; 
arm above elbow, $20; thigh, $40; one or more entire toes, $5. Excision of shoulder, 
hip or knee joint, $40; elbow, wrist or ankle joint, $20. Fractures, reduction of nose, 
lower jaw, collarbone or shoulder blade, $10; breast bone, $5; rib or ribs, $5; upper arm, 
$15; forearm (one or both bones), $10^ wrist or hand, $5; of two or more fingers, $5; 
any of the bones of the pelvis or sacrum, $20; cocc3rx, $5; thigh, $30; knee cap or leg 
bones (one or both), $20; two or more bones of foot (not toes), $5. Gunshot wounds — 
removal of shot or bullet not necessiuting ampuUtion or laparotomy, $10. Hernia (ab- 
dominal) — any cutting operation for the radical cure of the reducible, irreducible or strang- 
ulated form, $40. Laparotomy (opening of the abdominal cavity for an operation on 
any organ contained therein), $40. Skull trephining for fracture, $40. Tetanus — ^in- 
jeclioa of anti-tetanic serum into frontal lobe of brain, $40. 

Hospital Indemnity.— (A) If any surgical operation covered by paragraph (g) is 
performed in an incorporated hospital, the insured may elect to receive in lieu of the 
sum named herein for such surgical operation, an additional indemnity equal to one- 
fourth the monthly accident indemnity for the period of continuous connneme nt within 
said hospital, not exceeding three consecutive months; provided, that written notice 
of such election is given the company within nbety days from date of the accident. 

CBRTDncATE OP Identipication AMD REGISTRATION. — (t) The Company will place 
the insured's name on its registration Ust. and 1^ l^ reason of "such mjury" he shall 
be physicaUy unable to communicate witn friends, the company will, upon receipt of 
a telegram or other message giving this |>olicy number, immediately transmit to his rel- 
atives or friends any information respecting him and defray all expenses, not exceeding 
fif^ doUan, necessary for placing him in their care. 

MiscELLAMBoas PROVISIONS. — (J) If the insured is disabled by injury for more than 
thirty days, he or his representative must furnish the company every thirty days or as 
near thereto as may be reasonably possible, with a report in writing from his attending 
phjrsician or surgeon, fully stating the condition of the insured. This policy does not 
cover any loss caused bv or resulting from (1) any injury occurring outside of the United 
States (not including Alaska, Hawaii, Porto Rico, Philippines or the canal zone), Mexico 
or Canada; (2) injury received while engaged in aeronautics or received while engaged 
in military or naval service during time ofwar; or (3) fraud, misrepresentation, or untrue 
statements concerning any claim hereunder; and no indemnity is payable under this i>olicy 
for any such loss. Tbe copy of appUcat ion hereto attached or hereon endorsed is herdby 
made a part of this contract. The policy continues in efifect as long as the premium 
ihsU be paid a« agreed herein, unless it be sooner terminated in accordr-ice with it^ 



24 AMERICAN CASUALTY COMPANY 

teims. No aasignnient of this polior or of any claim arisiiig thereuiider, aad«no ursiver 
or change of any of its provisions, definitions or limits shall be valid unless appK«*ved m 
writing oy an executive officer of the company and such ^ppmvBl endorsed heieoife' The 
insured may at an^ time release the company from any and all liability then existing 
or thereafter accrumg to the benefidaiy. 

For Standasd Pkovisioits See Page 11. 



In wUmess whereof, the American Casoaltv CooqMuiy of Reading. Pa.,' has caused 
these i»esents to be s^ed by its president and secretary, at Reading. Pa.; but'this poUqr 
shall not be valid until countersipaed by a duly authorized agent ol toe compaiiy* . 



AMERICAN FIDELITY COMPANY 25 

/l/nerieaQ Fidelity Qompapy 

MONTPELIER, VERMONT. 



Commenced Business 19Q2. Chas. H. Dasuno, Pxes. Ralph B. Denny, Sec. 

The American Fidelity Company issues a series of ten Accident 
and Health Policies as follows: "Ideal Combination" Accident, 
"Ideal" Disability, "Ideal" Regular Accident, "Ideal" Death and 
Dismemberment, "Ideal" Beneficiary, "Ideal" Health, "American 
Leader" Accident, "American Leader" Disabilitjr, "Inter-Commer- 
cial" Accident and "Inter-Commercial" Disabihty. 

"Ideal Combination" Accident: Cost per $1500 principal sum 
and $5.00 weekly indemnity is as follows: Ages 18 to 65— <Jlass 1, 
$5.00; Class 2, $6.00; Class 2+, $7.00; Class 3, $8.50. 

"Ideal" Disability: Cost per $1500 principal sum and $5.00 
weekly indemnity is as follows: Ages 18 to 49 — Class 1, $12.00; 
Class 2, $12.00; Class 2+, $13.00; Class 3, $15.50; Ages 50 to 59— 
Class 1, $14.00; Class 2, $14.00; Class 2-h, $15.00; Class 3, $17.50. 

The "Ideal"' Regular Accident is issued at the following rates: 
$1000 principal sum and $5.00 weekly indemnity; Class 1, $4.00; 
Class 2, $5.00;-Class 2-f-, $6.00; Class 3, $7.50; Class 4, $10.00; 
Class 5, $12.50; Class 6, $15.00; Class 7, $20.00. This policy pro- 
vides for ten per cent accumulation; for loss of life, limb and sight; 
weekly indemnity - for 200 weeks; optional indemnity for specific 
injuries; sunstroke, freezing, hydrophobia, asphyxiation deemed 
bodily injuries; identification. 

The "Ideal" Death and Dismemberment issued at $3.00 per 
$1000 for Class 1 and $3.75 for Class 2. This policy provides ten 
per cent accumulation; loss of life, limb and sight; double indem- 
nity for travel accidents; surgical operation fee; sunstroke, freezing, 
hydrophobia, . asphyxiation and blood poisoning deemed bodily 
injuries; identification. 

The "Ideal" Beneficiary is issued only to a person between the 
ages of 18 and 60 named as beneficiary under either an "Ideal" 
Disability or an "Ideal" Accident policy. Rate: 20c for each 
$1000 of principal sum. This policy provides for loss of life, limb 
and sight; fixed indenmity for specific injuries; surgical operation 
fees. 

The "Ideal" Health policy is issued at the following rates: Ages 
18 to 40, weekly indemnity, $5.00; Classes 1, 2, 2+ and 3, $7.00; 
Classes 4, 5, 6 and 7, $8.75; Ages 41 to 50, Classes 1, 2, 2-f and 3, 
$8.00; Classes 4, 5, 6 and 7, $10.00; Ages 51 to 60, Classes 1, 2, 
2-1- and 3, $10.00; Classes 4, 5, 6 and 7, $12.50. This policy is 
issued only to male risks; covers all diseases; period of indemnity 
fifty-two weeks. 

The "American Leader" Accident: Cost per $1000 principal sum 
and $5.00 weekly indemnity: Ages 18 to 65 — Classes 1 and 2, $4.00; 
Class 2+, $5.00; Class 3, $7.00. Policy provides for loss of life, 
limb and sight, and 50% additional indemnities for travel accidents; 
identification. 

The "American Leader" Disability: Cost per $1000 principal sum 
and $5.00 weekly indemnity: Ages 18 to 49 — Classes 1 and 2, $10.00; 
Class 2-h, $11.00; Class 3, $13.00; Ages 50 to 59— Classes 1 and 2, 
$12.00; Class 2-|-', $13.00; Class 3, $15.00. Issued only to male 
risks; covers any accidents and all diseases; period of sickness in- 
demnity 52 weeks; identification. 

The "Inter-Commercial" Accident is issued on a c[uarterly basis 
in all classes;, various combinations of small principal sums and 



^ AmSdCAii FlDBLltY COMPANY 

monthly indemnity; provides ten per cent accumtdations; loss of 
life, limb or sight; double indemnity for travel accidents; fixed in- 
demnity for specific injuries and ho^ital fees. Rates: principal 
sum $1000, monthly indemnity $100, Class 1, $3.95; Class 2, $4.70; 
Class 2+, $5.50. 

The "Inter-Commerdal" Disability is issued on quarterly basis ' 
(males only) in all classes; various combinations; provides ten per 
cent accumulations; loss of life, limb and sight; double indemnity 
for travel accidents; fixed indemnity for specific injuries; hospital 
fees and all diseases; sidmess indemnity payable for disability not i 
more than twenty-six weeks or less than seven days. Rates: prin- 
cipal sum $1000, monthly indemnity $100, Class 1, $10.35; Class 2, 
$12.50; Class 2 +,$13.50. 

POLICY FORM— "Ideal Combination Accident." 

Principal Sum, $7,500-$15,000. Weekly Indemnity, $25-$50 
Annual Premium, $25. 
This policy provides indemnity for loss of Ufe, limb, sight, hear- 
ing and time by accident, as herein limited and provided Sie Amer- . 
ican Fidelity Company of Montpelier, Vt., m consideration of 
twenty-five dollars premium, and subject to all the conditions 
and lmiitati6ns hereinafter contained, hereby insures John Doe, | 
hereinafter called the insured, of Montpelier, State of Vermont, i 
by occupation a cashier, from November 1, 1914, to November j 
1, 1915; in the principal sum of $7,500 and for a weekly indemnity 
of $25 commencing and ending at noon, standard time, at the 
place where this policy is countersigned, against loss resulting 
Jrorn bodily injtuy effected directly and independently of all other 
causes through accidental means, excluding suicide or any attempt 
thereat, sane or insane, as follows: i 

If such injury alone shall totally and continuously diaable the insured from the date 
of the accident from performing any and all business duties, and during the period of 
such continuous disability and within five years shall result in any one of the looses enu- 
merated m the following Schedule A; or, if within one year from Uie date of the accident 
and irrespective of total disability, such injuiy alone shall result in any one of the said 
losses, the company will pav the sum spedned, and in addition we^y mdemnity as pro- 
vided herein to the date of said loss: 

Schedule A— Death, Dismembesment and Loss of Sight or Heasing Indemnities 
— For loss of life or both eyes or both hands or both feet or one hand and one foot or either 
hand and eye or either foot and one eye, principal sum; one arm or one leg. two-thirds 
principal sum; one eye or one hand or one foot, one-half principal sum; thumb and index 
finger or hearing of both ears, one-third principal sum. 

Definitions.— The loss of an eye or eyes shall mean that the sight of the eye or ^es 
shall be entirely and irrecoverably lost. The loss of a hand, foot, arm, kg or thumb 
and index finger shall mean the actual severance thereof at or above the wnst, ankle, 
elbow, knee or metacarpo-phalangeal joints, respectively. The loss of houring shall 
mean total and permanent deafness of both ears. Payment shall not be made for more 
than one of the mdemnities specified in Schedule A. 

Weekly Indemnity Total Disability. — (a) If such injury shall result m a loss not 
enumerated in Schedule A, but shall, from the date of the acadent. totally and continu- 
ously disable and prevent the insured from performing any and all business duties, the 
company will pay the weekly indemnity specified above, so long as be lives and suffers 
such continuous total disability. . 

Weekly Indemnity Partial Disability.— (6) If such injury shall result m a loss 
not enumerated in Schedule A, but shall, either from the date of the accident, or imme- 
diately following a total disability, continuously disable and prevent the insured from per- 
forming one or more of his important business duties, the company will pay for such 
partial disability one-half the weekly indemnity specified above, for a period not exceeding 
fifty-two consecutive weeks. 

Double Principal Sum $15,000. Double Indemmribs, Public Conveyance El- 
evator, Burning or Collapsing Buhding, Explosion, Tornado, Cyclone, Lightning 
Accidents. — If such injury shall result in a loss enumerated in Schedule A, and is sus- 
tained by the insured whfle in or on a public conveyance provided by a common carrier 
for passenger service, includmg the platforms, steps and running bouds thereof; or in a 
passenger elevator, mine elevators excepted; or in consequence of the burning of a building 
while the insured is therein; or is caused by the collapse of an outer wall of a building 
while the insured is therein; or by the explosion of a steam boiler; or by a cyclone or tornado 
or by a stroke of lightning, the company will pay double the sum specified in Schedule A 



AMfiRtCAl^ FIbELltY COU^AJ^ ^ 

for such loss, and in addition thereto doable the we^ly indemnity specified in paragraphs 
(a) and (6) for such total or partial disability. 

Double Weekly iNDEHNiry $50. — If such injunr shall result in total or partial dis- 
ability as provided in para^phs (a) and (6) and does not result in a loss enumerated 
in Schedule A and is sustamed in the manner provided in the preceding paragraph en- 
titled double indemnities, the compan^r will pay double the weekly indemnity specified 
above for such total or partial disabiUty. 

Optional Indemnities. — ^If such injury shall within ninety da^ from the date of the 
accident result in any one of the losses enumerated in the following schedule of specific 
injuries, the insured may elect to receive in lieu of all other indemmtv (except such sur- 
gical operation-indemnity as may be due under the schedule of sureical operations herein) 
the indenmity^ specified for such injury, provided he signifies his choice m writing to the 
comi>any at its home office within twenty days from the date of such loss. If any one 
of such losses is sustained in the manner set forth in the paragraph of this policy entitled 
double indemnities, the optional indemnity pavable hereunder shall be doubled. Payment 
shall not be made for more than one of the indemnities specified in this schedule as a result 
of any one accident. The amounts in this schedule are payable if the single weekly 
indemnity for total disability in this policy is twenty-five dollars. If such weekly indem- 
nitv b greater or less than twenty-five dollars the amount to be paid will be increased or 
reoucedf proportionately. 

" * ..... . ^rjf^^ 

or toes, 
. 1200; 

patella with serious knee joint complications. $250; Pott's fracture, $200; scapula, $175; 
scapula with complications, $225; skull, both tables, $300; thigh, $325; thigh involving 
hip joint, $350; two or more ribs, $75. For complete dislocation, viz.: Any bone of 
foot or toe. $150: ankle, $150; elbow, $100; hip, $300; knee, $160; shoulder, $100; wrist, 
$125. For loss, oy severance, of one or more fini^ers — at least one entire phalanx, $150; 
one or more entire toes, $150; for complete hernia, $75. 

Sunstroke, Freezing, Hydrophobia, Asphyxiation. — Sunstroke, freezing, hydro- 
phobia or asphyxiation, suffered through accidental means, shall be deemed a bodily 
injury within the meaning of this policy. 

Blood Poisoning. — Blood poisoning resulting directly from an accidental bodily 
injury shall be deemed a bodily injury within the meaning of this policy. 

Non-Disabling Minor Injury Indemnity. — If such injury does not result m any 
disability but shall require immediate treatment of the insured by a physician, surgeon, 
oculist or dentist, the companv will reimburse the insured for the cost thereof to an amount 
not exceeding one wedi's indemnity as provided in paragraph (a) herein for total dis- 
ability, a receipted bill for such services to be filed oy the insured with the company 
within ninety days after the date of such treatment. 

Hospital Indemnity. — ^If such injury results in disability for which weeklv indemnity 
is payable under this policy and shall, within ninety days from the date of the accident, 
necessitate the removu of the insured to a hospital, ana requires continuous confinement 
therein, the company will pay the double weekly indenuity specified in this policy for 
a period not exceeding ten consecutive weeks; provided the insured shall not make claim 
for any surgical operatbn indemnity imder the schedule of sur^^l operations con- 
tained herein. If the insured is entitled to double weekly indemmty as provided in the 
paragraph of this policy entitled double indemnities, he shall not be entitled to the double 
weekly mdemnity pavable for hospital confinement. 

If such injury sludl, within ninety days from the date of the accident and as a direct 
and proximate result thereof, necessitate a surfpcal operation enumerated in the following 
schedule of surgical operations, the company will pay In addition to the weekly indemnity 
to which the insured may be entitled, the surgical operation-indemnity specified below 
for such operation; provided that payment shall not be made for more than one opera- 
tion as the result of^any one injury. 

The amounts in this schedule are payable if the smgle wedcly indemnity for total dis- 
abiUty in this policy b twenty-five dollars. If such weekly indemnity is greater or less 
than twenty-five dollars the amount to be paid will be mcreased or reduced propor- 
tionately. 

Schedule of Sitrgical Operation Indemnities. — Amputation of foot, hand or fore- 
arm, $25; leg or arm, $50; thigh, $125; thumb, finger or fingers, $10; toe or toes, $10; 
bones — ^removal of diseased portion, $25; curetting only, $10; dislocation — reduction of 
shoulder, elbow, hip, knee or ankle, $25; two or more bones in body of hand or foot (not 
thumb, finger or toe), $15; wrist or lower jaw, $15; thumb, finger or fingers, toe or toes, 
$10. Excision of shoulder, hip or knee joint, $125; elbow, wrist or ankle joint, $50; 
eye — complete removal, $75; eye, ear, nose or throat — any cutting operation, $15. Frac- 
tures — reduction of nose, lower jaw, collar bone or shoulder blade, $25; forearm, one or 
both bones, $25; breast bone or coccyx, $20; two or more bones in body of hand or foot 
(not thumb, finger or toe), $15; upper arm, $35; rib or ribs, thumb, finger or fingers, toe 
or toes, $15; any of the bones of the pelvis, $75; thigh, $75; kneecap or leg bone, one or 
both, $50. Gun shot wounds — treatment not necessitating amputation or laparotomy,, 
$25. Laparotomy, opening of the abdominal cavity for an operation on any organ 
contained therein, $100. Nerve— cutting or stretching, $25. Skull— trephining, $100. 
Synovitis — ^incision, $25. Wounds — suturing, $5. 

For Standard Provisions See Page U. 
Additional Provisions. 

Assignment.— No assignment of interest under this policy shall bind the company 
unless consent thereto b formally endorsed hereon by an executive officer of the company. 
Any failure to comply with the provbions of thb policy shall render invalid any claim 



AMERICAN FIDELITY COMPANY 



made hereunder. A copy of any assignment shall be given, within thirty days, to the 
company, which shall not be respcmsible for its invalidity. 

INSUKANCE Effective.— There shaU be no loss imder this policy unless the event 
causing the injury shall occur while the policjr is in force. 

Limits. — ^The occurrence of an accident causing any one of the losses for which indem< 
nity b payable under Schedule A shall terminate all liability under this policy for any losa 
resultins from any subsequent accident. The payment of any one of the indemnitid 
specified in Schedule A shall terminate the policy. 

Risks not Covered.— This policy does not cover disappearance: nor war risk; nor 
intentional or self-inflicted bodily injurv; nor any loss sustained while participating ini 
or in consequence of having participated in aeronautics; nor any bodily injury caused oq 
contributed to by sickness or disease. 1 

Application Part of Policy. — The provisions above and the application for the poUcrj 
a copy of which is endorsed hereon, are made a part of this contract, which is made sub^ 
ject thereto. I 

In witness whereof, the American Eiddity Company of Montpelier, Vt., has caused this| 
policy to be signed by its president and secretary and countersigned by a duly authorized' 
representative of the company. 

POLICY FORM— "Ideal Disability." 

Principal Sum, $7,500-115,000. Weekly Indemnity, $25-$50. 
Annual Premium, $60. 

This form is the same as the foregoing, with the health featurej 
added, except where the phraseology conflicts with the health prol 
visions and in the following clauses: ' 

Health Insitramce. — ^If such sictness shall totally and continuously disable and pre- 
vent the insured from performing any and all busmess duties and shall, during the perio^ 
' hin fifty-two weeks from the beginning thereof, result in i 



of such disability and within \ „ 

one of the losses enumerated in the following Schedule B, and the insured survives sud 
loss for a period of fifty-two weeks, the company will ^y the amoimt specified for such 
loss, and in addition weekly indemnity as provided herein; provided, however, that at the 
end of such ^riod of fifty-two weeks such loss is permanent in the opinion of medical 
authority satisfactory to the company. 

Schedule B. — Loss of Sight and Use of Ldcb Indemnities.— For loss of sight of 
both eyes or use of both arms or use of both legs, or use of one arm and one Ie« one-halLJ 
principal sum; or sight of one eye, or use of one arm, or use of one leg, one-third prindpai 
sum. Payment shall not be made for more than one of the indemnities q)ecified in 
Schedule B. 

Weekly Indeicntty Total Disabiuty.— If such sickness, commencing while this 
policy is in force, shall totally and continuously disable and prevent the insured from 
performing any and all business duties and shall necessitate treatment by a legally i 
qualified physician, the company will pay the weekly indemnity specified in this policy 
for the period of such disabihty and treatment, not exceeding fifty-two consecutive weeks. 

Hospital Indemnity Accident and Health. — ^If such injury or sickness results in 
disability for which weekly indemnity is payable under this policy and shall, within ninety 
days from the date of the accident or the commencement of disability from sickness, 
necessitate the removal of the insured to a hospital^ and re<]iiires continuous confinement 
therein, the company will pay the double weekly mdemnity specified in this policy for 
a period not exceeding ten consecutive wedcs, provided the insured shall not make claim 
for any surgical operation-indemnity under the schedule of surgical operations contained 
herein. If the insured is entitled to double weekly indemnity as provided in the para- 
graph of this policy entitled double indemnities, he shall not be entitled to the double 
wedcly indemnity payable for hospital confinement. 

If such injury or sickness shall, within ninety days from the date of the accident or 
the commencement of disability from sickness and as a direct and proximate result, 
thereof, necessitate a surgical operation enumerated in the following schedule of surgical ! 
operations, the company will pay in addition to the weekly indemnity to which the in- 1 
sured ma}r be entitled, the surgical operation-indemnity specified below for such opera- 
tion; provided that pajrment shall not be made for more tlmn one operation as the result 
of any one injury or sickness. 

The amounts in this schedule are payable if the single weekly indemnity lot total dis- 
ability in this policy is twenty-five aoUars. If such weekly indemnity is greater or less' 
than twenty-five dollars the amount to be paid will be increased or reduced proportion- ! 
ately. 

Schedule of Surgical Operation Indemnities Accident and Health. — ^Abscess 
or boil — incision, $5. Amputation of foot, hand or forearm. $25; leg or arm, $50; thigh, 
$125; thumb, finger or fingers, $10; toe or toes, $10. Aneurism — ^ligation, $50. Appendi- 
citis, $100. Bones — ^removal of diseased portion, $25; curetting only, $10. Bronchot- 
omy, thyrotomy, laryngotomy, laryngotracheotomy or tracheotomy, $50. Cancer or 
cataract — extirpation of, $50. Carbuncle — incbion and treatment, $5. Cyst — ^removal 
b}^ incision, $15. Diphtheria — injection of anti-toxin, two or more treatments, $25. 
Dislocations — ^reduction of shoulder, elbow, hip, knee or ankle, $25; two or more bones 
in body of hand or foot (not thumb, finger or toe), $15; wrist or lower jaw, $15; thumb, 



fin^r or fingers, toe or toes, $10. Dropsy — tapping and removal of fluid, $25. Ex- 
dsion of shouldeTi hip or knee joint, $125; elbofw, wrist or ankle joint, $50. Eye— 



AMERICAN FIDELrry CX)MPANY 29 

aplete removal, $75. Eye, car, nose or throat — any catting operation, $15. Felon — 
bion, $5. Fractures — ^reduction of nose, lower jaw, collar bone or shoulder blade, 
>; forearm, one or both bones, $25; breastbone or cocqnc, $20; two or more bones in 
ly of hand or foot (not thumb, finger or toe), $15: upper arm, $15; rib or ribs, thumb, 
Ber or fingers, toe or toes, $15; any of the bones of the pdvis, $75; thigh, $75; kneecap 
leg bone, one or both, $50. Ganglion — incision and curetting, $15. Goitre — ^radical 
e by cutting, $75. Gun shot wounds^-treatment not necessitating amputation or 
ATotomy, $25. Hernia — scrotal or abdominal radical cure by cutting, $100. Hem- 
cele or hydrocele — ^tapi>ing — ^incision — excbion, $25. Intestinal obstruction, see 
arotomy. Kidney — ^fixation or removal, $100. Laparotomy, opening of the abdom- 
1 cavity for an oiieration on any organ contained therein or tor traumatic peritonitis 

exploratory incisbn, $100. Lithotomy — any cutting, $75. Mastoiditiflr-<^)eration 
. $50. Nerve — cutting or stretching, $25. Oesophagotonw for stricture or other 
ises, SIOO. Paracentesis — tapping of abdomen, chat or bladder, $25; ear drum, $15. 
ntonitis, see laparotoniy. Rectum — operation for hemorrhoids — excision or Usation, 
5; prolapsed, $25; fistula in ano — ^incision, $25; pol^rpus — extirpation, $25; mal^nant 
icture — excision or colostomy, $100. SkuU — tzephininf, $100. Ssmovitis — ^incision, 
5. Tetanus — injection of anti-tetanic serum into frontal lobe of brain^ $100. Thorax — 
pping or incision for removal of pus or fluid, $25. Tumors — extinction from any part 

the body. Benign, $15; malignant, $50. Varicose veins — ligation or excision, $25. 
iiicocde — acupressure — ^liisation or excision, $25. Wounds — suturing, $5. 
For Stamdabd Provisions See Page U. 

Additional Provisions. 
Assignment. — ^No assignment of interest under this policy^ shall bind the company 
iless consent thereto is formaUy endorsed hereon by an executive officer of the company, 
ly failure to comply with the provisions of this policy shall render invalid any claim 
ade hereunder. A copy of any assignment shall be ipven within thirty days, to the 
•mpany, which shall not be responsible for its invalidity. 

Insurance Effective. — ^There shall be no loss under tins policy unless the event caus- 
Kthe injury shall occur or unless disability from sickness begins while the policy is in force. 
The occurrence of an accident causing anv one of the Tosses for which indemnity is 
yable under Schedule A shall terminate all liability under this policy for any loss re- 
Iting from any subsequent accident. The payment of any one of the mdemnities sped- 
;d in Schedules A or B shall terminate the policy. 

Lncns. — If the insured makes claim or becomes entitled to indemnity under this policy 
om this company or any companv or association for disability or loss caused by sick- 
sss, he shall not be entitled to indemnity hereunder for the same or concurrent loss on 
:count of bodily injury. 

Risks not Covered. — ^This policy does not cover disappearance; nor war risk; nor 
itentional or self-inflicted boduy injury; nor any loss sustained while participating in 
r in consequence of having participated in aeronautics; nor any bodily injury caused or 
)ntributed to by sickness or disease; nor u indemnity payable for any operation which 
necessitated by a condition or 6iaeaae existing or contracted prior to the issue of this 
olicy. 

Application Part of Poucy. — ^The provisions above and the edification for the pol- 
y, a copyy of which is endorsed hereon, are made a part of this contract, which is made 
ibject thereto. 



BANKERS ACaDENT INSURANCE COMPANY 



Ba9K^r8 Peeidept Ipsurapee Qo/npapy. 

FLYNN BUILDING, DES MOINES, IOWA. 



Commenoed BuaineBS 1893. Reorganised as a Stock Company 1914. 
F. L. MzNZR, Prea.. E. C. Budiong. Vice-Pres. & Agency Mgr., J. A. Kizxk. See. 



This Company issues all forms of Accident & Health Insurance' 
in three Departments — Commercial Department, Intermediate 
and Monthly Premium Department. The leading Commercial 
Policy, the New Universal (text below), gives option of from $5 
to $50 weekly with a choice of death indemnity in any amount 
from $1,000 to $5,000, or with even indemnities of $5 with each 
$1,000 Death Indemnity. The Universal Disability Policy is in 
effect for sickness the clay issued and pays 52 weeks for sickness 
whether confined or not; 50 per cent, extra for Hospital Confinement 
and Surgical Fees in addition to other indemnity. 

The Intermediate Department issues a monthly indemnity con- 
tract sold on annual basis with privilege of four equal monthly instal-j 
ments. As implied by the name, the Intermediate Policy is "some 
thing between the limited Industrial Policy and the more liberal I 
Commercial form. The death indemnities are larger than oni 
Industrial Policies; sickness benefits in effect 15 days; pays after 3d^ 
day of sickness and full time if disabled 28 days. In Class AA, 
benefits of $60-$60, $1,250 cost $19.00 first year— $16 thereafter 
— other classes in proportion. Women regularly employed written 
on this policy at rates charged for men over 50. A straight accident 
policy with Triple Indemnities is also issued in Intermediate Depart-, 
ment. 

Monthly Premium Department. — Four policies are written 
with privilege of Monthly Premium payments. The General Disa- 
bility Policy — a standard form dollara-month policy containing 
the usual GO-day clause and 30-day limit for certain disabilities. 
The Accumulative Accident Policy is a companion policy to the Gen- 
eral Disability Policy. Both of these policies pay for blood poison- 
ing under accident clauses — fee $2. 

The Sterling Disability Policy is a conditionless Policy 
effective for sickness in 30 days; pays after first week for sickness 
— for full time if disabled 28 days. Larger specific benefits. Cost 
of this policy is $1.25 per month upward. Fee $2. 

The Peerless Policy. — An unrestricted policy paying for every 
day and covering non-confining sickness at full indemnity up to one 
month. This policy pays one-quarter indemnity for life following 
usual policy indemnity limits — ^also pays additional for Hospital Con- 
finement — no policy fee. Cost $1.50 per month up. 

Age limit 16 to 60 on Disability Policies. Sickness carried to 65. 
Accident Benefits carried to age 70 on most policies. 

POLICY FORM— "New Universal Disability." ' 

Principal Sum, $5,000-$10,000. Weekly Indemnity, $25-^50. 
Annual Premium, $60. 

The Bankers Accident Insurance Company, Des Moines, Iowa, 
(hereinafter called the company), does hereby insure John Doe of 
Chicago, Illinois (hereinafter called the insured), by occupation an 
Attorney, in class A, for twelve months, beginning at noon standard 



BANKERS ACCTOENT INSURANCE COMPANY 31 

time, on the first day of January, 1915, subject to the provisions 
and conditions and limits herein, against loss resulting directly 
and independently of any and all other causes from bodily injury 
efiEected solely through external, violent and accidental means 
herein called such injury, and against loss residting from sickness 
or disease, herein called such siclmess, as follows: 

AcaDSNT Insxtkamce. 

SxcnoN I. Loss or Lxtk, Loss of Sioht» and Loss of Ldcb Indemmttt. — (1) If 
such injury shall, from the date of accident, immediately, continuously amd totally 
disable and prevent the uisured from perfomung any and every duty pertaining to his 
occupation, and shall, during the period of such disability and within 200 weeks, result 
in any one of the losses eniunerated in the following "Schedule of Specific Losses," the 
Company will pay the amount specified in said schedule for such loss, and in addition 
thereto, for the period between the date of accident and the date of such loss, an indem- 
nitv per week in the amount specified in Section II for total disability; or. 

C2^ If such injury shall not unmediately, continuously and totally disable and prevent 
the msured from performing any and every duty pertaining to his occupation, but shall, 
within ninety days from the date of accident, result in any one of the losses enumerated in 
the following "Schedule of Specific Losses," the Company will pay the amount specified 
in said schedule for such loss, and in addition thereto, for the period between the date of 
accident and the date of such loss, an indemnity per week in the amotmt specified in 
Section II for total disability. 

Schedule of Specific Losses.— Loss of life or both hands by actual separation at 
or above the wrists, or both feet by actual separation at or above aisles, or one hand 
and one foot by actual separation at or above wrist and ankle, or entire sight of both 
eyes if irrecoverably lost, $5,000; loss of one lee by actual separation at or above knee. 
or one arm by actual separation at or above elbow, $3,750; loss of one hand by actual 
separation at or above wrist, or one foot by actual separation at or above ai^e, or entire 
sight of one eve if irrecoverably lost, $2,500. 

Indemnity tor loss of life shall be pavable to ( ) herein called the beneficiary. Pay- 
ment of indemnity under this section ^U be in lieu of all othor indemnity (the indemnity 
pa^ble as provided in Sections XI and XII excepted) and shall immediately terminate 
this policy. Payment shall not be made for more than one loss enumerated in the above 
"Schedule of Specific Losses." 

SEcnoN n. Total Disability Indeidhty. — ^If such injury shall not result in any 
one of the specific losses enumerated in Section I but shall, from the date of accident 
immediately, continuously and totally disable and prevent the insured from performing 
any and eveipr duty pertaining to his occupation, the Company will pay for the period 
of such disabililv, not exceeding two hundred consecutive weeks, an indemnity per week 
of twenty-five dollars ($25). 

Paktial Disabiuty Imdeunity.— If such injury shall not result in any one of the 
specific losses enumerated m Section I but shall, from the date of accident or imme- 
mately following a period of total disability as above defined, continuously partially 
disable and prevent the insured from performing one or more of the important duties 
pertaining to his occupation, the Company will pay for the period of such disability, 
not exceeding thirty consecutive weeks, an mdenmity per week of one-half of the weekly 
indemnity specified in this Section for total disability. Payment shall not be made 
for more than two hundred consecutive weeks total and partial disability combined. 

Seciion ni. Double Indemnity. — ^If such injury shall result as aforesaid and is 
sustained, (1) whfle the. insured is a passenger and is in or on a public conveyance pro- 
vided by a common carrier for passenger service (including the platform, steps or runnmg- 
board <h railway or street railway cars); or, (2) while the insured is a passenger within 
a passenger elevator (nuBce elevators excepted); or, (3) in consequence of the collapse 
of the outer walls of a building while the insured is therein; or, (4) in consequence of 
the destruction of a buildingby fire while the insured is therein, then the amount payable 
as provided in Sections I, II or VI sludl be doubled. 

SiBcnoN IV. Special Tsavel iNDEicNrrY. — ^If such injury shall result as aforesaid 
and is sustained by the insured while riding as a passenger within the enclosed part of 
any railway, interurban or street railway passenger car provided for the exclusive use 
of passengers and propelled by steam, cable, compressed air or electricity, or as a passenger 
on board of a steam vessel licensed for the transportation of passengers, and such injury 
shall be due directly to the wrecking of such car or vessel, then the amount to be paid 
as provided in Sections I, II or VI shall be two and one-half times the indemnity other- 
wise payable. 

Section V. Indemnity foe Blood PoisomNG, Sunstroke, Freezing, Hydro- 
PHOBIA, Asphyxiation. — Blood-poisonin/s resulting directly from such injury, or sun- 
stroke, freezing, hydrophobia or asphyxiation suffered through accidental means, shall 
be deemed a bodlhr injury within the meaning of this policy. 

Section VI. ^.ective Indemnity. — If the insured shall be entitled to indemnity 
for an injury and such injury shall result in a loss enumerated in the " Schedule of Elec- 
tive Indemnities" endorsed hereon, he may elect to receive in lieu of all other indem- 
nity (but not excluding any additional indemnity that may be due under Section IX) 
the amount provided in said Schedule for such loss, provided he shall signify his choice 
in writing to the (>>mpany at its Home Office in Des Moines, Iowa, within thirty days 
bom the date of accident. Payment shall not be made for more than one of the losses 
enumerated in said Schedule as the result Of any one accident. The amounts specified 
in a«id ScMvk mt payable U the total dJ9»biUty iodeumity specified in Section II is 



32 BANKERS ACCIDENT INSURANCE COMPANY 

$25.00 per week; if such indemnitv u greater or less, the amounts payable under said 
Schedule shall be increased or decreased proportionately. 

Schedule of Elective Indemnities. — Complete dislocation of hip, $300; knee, 
$160: ankle, $160; two or more bones of foot (not toes), $160: wrist, $120; elbow, $100; 
shoulder, $75; two or more toes, $50; two or more fingers, $50; loss of one entire finger, 
$200; one or more entire toes, $160. Complete fracture of skull (both tables), $320; 
thigh, $300; pelvis. $240; collar bone, $160; teg (tibia and fibula), $200; knee cap, $200; 
upper arm, $160; forearm (both bones), $100; two or more bones of the foot (not toes), 
$120; two or more bones of the hand (not fingers), $120; two or more fingers, $100; lower 
jaw, $100; two or more toes, $80; two or more ribs, $50. 

Section VII. Medical Attendance Indemnity. — ^If such mjury shall not result 
in any one of the losses enumerated herein but shall require treatment by a physician, 
the Company will reimburse the insured for the cost thereof, not exceeding; an amount 
equal to the indemnity for one week specified in Section II for total disabihty, orovided 
the physician's receipt and affidavit on the Company's form be furnished the (Company 
at its Home Office in Des Moines, Iowa, within ninety days from the date of accident 

Sickness Insiteance. 

Section Vm. Total Disabiuty 52 Weeks Limit.— ^If such sickness, contracted by 
the insured, during the term of this policy or any renewal hereof^ and not hereinafter 
ezceptad, shall wholly and continuously disable and prevent the msured from attend- 
ing to any and every kind of duty pcataining t6 his occupation and shall necessitate 
treatment by a legalfy qualified pl^rsician, the Company will pay for the period of such 
disability, not exceedmg fifty-two consecutive weeks, an indemmty per wefk of twen^- 
five dollars ($25). 

Indemnity Following 52 Weeks of Total Disability. — ^If immediately following 
the ezpiratbn of the said fifty-two weeks of continuous total disability as aforementioned, 
the insured continuously suners said disability and shall be prevented by reason thereof 
from performing any and every kind of duty pertaining to his occupatbn or to anv other 
business or occupatbn whatsoever, the Company wm pav the insured for each week 
that he is continuously so disabled one-quarter of the weekly sickness indemmty afore- 
mentioned. 

Section IX. Blindness and Paxalysis Indemnity. — Upon satisfactory proof to 
the Company that the insured has, as the result of disease contracted during the term 
of this policy and not hereinafter excepted, entirely and irrecoverably lost the sight of 
both ^es, or permanently and entirely lost the use of both hands or both feet, or of one 
hand and one foot, or has suffered incurable paralysis, and also that he has beien for one 
year and will thereafter and during hi9 life, oy reason thereof be permanently disabled 
from engaging in any work for wages or profit, the Company will extend the penod during 
which it will i>ay indenmity under the first paragraph of Section VIII to one hundred 
(100) consecutive wedcs. 

Accident ok Sickness Indemnity. 

Section X. Hospital Indemnity. — ^If such injury or such sickness shall necessitate 
the removal of the insured to a hospital and shall require continuous confinement thereijpw 
the Company will pa^, in addition to any other indemnity to which theinsured m^y ht 
entitled^ for the period of such confinement, not ezceeoing ten consecutive weeks, an 
indenmity per week equal in amount to one-half of the weddy indenmil^ specified in 
Section U or VIII for total disability. 

Section XI. Additional Indemnity for Surgical Operations.— If such injury 
or such sickness shall, within ninety days from the date of accident, or beginning of sick- 
ness, necessitate one of the surgical operations enumerated in the ''Schedule of Surgical 
(^rations A and B" endorsed hereon, the Company will pay, in additbn to any' other 
indemnity to which the insured may be entitled, the amount provided in said Schedule for 
such operation, but payment shall not be made for more than one operation resulting 
from any one accident or sickness, nor for any operation not enumerated in said Schedule. 
The amounts s^ified in said Schedule are payable if the total disability indenmity 
specified in Section II or VIII is $25 per week; if such indenmity is greater or less, the 
amounts payable imder said schedule shall be increased or decreased proportionately. 

Section XII. Identification Indemnity. — If such injury or such sickness shall 
render the insured physically unable to communicate with relatives or friends the Com- 
pany wUl, upon the receipt of a telegram or other message giving this policy number, 
immediately transmit to the beneficiary all information in its possession respecting the 
insured and will pay, in addition to the indenmity otherwise provided herein, the expense 
necessary to place the insured in communication with and in care of relatives or f nends, 
but the liabihty of the Company under this Section shall not exceed one hundred dollars 
($100). 

For Standard Provisions, See Page 11. 

Additional Provisions. 

(a) Sections I to VII of this policy do not extend to nor cover any acddental bodily 
injury caused or contributed to, durectly or indirectly, by si^ess or disease. This policy 
does not cover disappearance, nor war risk, nor loss resulting from any means or act 
which if used or done by the insured while in possession of all mental faculties would be 
deemed intentional or self-infficted; nor loss suffered while or resultmg from riding or 
being in or on any aerial device or conveyance, nor while participating in any motor, 
vehicle, speed or endurance contest, nor loss caused by any sickness or disei^ existing or 
contracted prior to the issue of this policy, nor loss caused by any'sicknoas or disease 
unless disability resultmg therefrom begins while this policy is in' force. 

(b) Strict compliance on the part of the insured andTbeoefidacy with all ot the terms 



BANKERS ACCIDENT INSURANCE COMPANY 



and conditions of this policy shall be a condition precedent to recovery hereunder and 
any failure in this respect shall forfeit to the Company all right to any indemnity. 

(c) No provision of the charter or bv-laws of the Company, not incorporated in full 
herein, shall void the poli<^ or be used in evidence in any legal proceedmg hereunder. 

(d) No assignment of this policy and no waiver of any of its provisions shall be valid 
. unless agreed to in writing by an executive officer of the Company, and attached hereto 

or endorsed hereon. 

(e) The insured may, at any time, release the Company from any and all liability then 
existing or thereafter accruing to the Beneficiar>[. 

^f ) n any obligation is received and accepted in lieu of cash for payment of premiunu 
ana the obligation is not paid when due, this policy and insurance shall termmate and 
become void at 12 o'clock noon, standard time, of the day when such obligation shall 
become due and unpaid, and remain void until payment has been accepted at JDes Moines, 
Iowa, and notice of reinstatement has been given by the president or secretary. 
(g) The premium for this policy is sixty dollars (^^). 

In witness whereof. The Bankers Accident Insurance Company, of Des Moines, Iowa, 
has caused these presents to be signed by . its president and attested by its secretary, 
at the office of the Company, in the City of Des Moines, State of Iowa, and counter- 
signed by its authorized representative at 12 o'clock noon, standard time, this first day 
of January, nineteen hundred and fifteen. 

Schedule A or Surgical Operations (see Section XI). Accident. — Amputation of 
thigh, $100; leg above knee, $50; arm above elbow, $50; foot^ hand or forearm, $25; one or 
more entire fingers, $10; one or more entire toes, $10. Excision of shoulder, hip or knee 
joint, $100; elbow, wrist or ankle joint, $50. Reduction of dislocation of shoulder, elbow. 
Lip, knee or ankle, $25; wrist or jaw, $15; one or more fingers, $10. Reduction of fracture 
of thigh, $75; one or more bones of the pelvis or sacrum, $50; knee cap or leg bones (one 
or both), $50; upper arm, $35; nose, $25; lower jaw, $25; collar bone or shoulder blade, 
$25; forearm (one or both bones), $25; wrist or hand, $15; two or more bones of foot 
(not toes), $15; one ot more toes, $10; one or more ribs, $10; breast bone, $10; two or more 
fingers, $10; coccyx, $10. Laparotomy — opening of abdominal cavity for operation 
on organ therein, $100. Tetanus — injection of antitoxin into frontal lobe of brain, 
$100. Skull — ^trephining for fracture, $100. Peritonitb — (see Laparotomy). Seques- 
trotomy — removal of dead bone, $35. Gunshot woimds — removal of shot or bullet 
not necessitating amputation or laparotomv, $25. Sjrnovitis (inflammation of the 
lining membrane of a joint) — incision for, $25. Suturing wounds of scalp or other 
parts, $5. 

Schedule B of Surgical Operations (see Section XI). Sickness. — Appendicitis 
— ^laparotomy (abdominal incision), $100. Abdomen — opening the cavity for treatment 
or diagnosis, $100. Amputation of— leg above knee, $100; arm above elbow, $50: foot, 
hand or forearm, $25; one or more entire toes, $10; one or more entire fingers, $10. Aneur- 
ism — ligation (tying) of artery, $50. Bone abscess — curetting (scraping), $10. Bone 
ulcer — curetting (scraping), $15. Cancer — extirpation (removal), $50. Cataract — 
extirpation (removal), $25. Cyst — incbion Qancmg), and removal of, $10. Dropsy 
(abdominal)— tapping, $25. Excision of — shoulder, hip, or knee joint, $100; elbow, 
wrist or ankle jomt, $50. Eye — enucleation (removal), $75. Ganglion— incision Oanc- 
ing) and curetting (scraping), $15. Goitre — cutting operation for radical cure, $75. 



(abdominal ii ., ^ 

Kidney — ^incision (cutting) for fixation or removal, $100. Liver^opening of gall blad- 
der for removal of stones, $50. Mastoiditis — removal of pus and bone, $50. Men- 
ingitis — trephining for dramage, $100. Nerve — cutting operation for stretching or 
removal, $25. ^ Peritonitis — ^laparotomy (abdominal incision), $100. Piles — ligation 
(tyin^) or excision (removal), $25. Polypus — extirpation (removal). $15. Skull — 
trephining, $100. Stone in bladder — ^lithotomy (operation for removal), $75. Syno- 
vitis — aspiration (tapping) of joint for removal of fluid, $25. Tetanus — injection of 
antitoxin into the frontal lobe of brain, $100. Thorax — aspiration (tapping) or in- 
cision (opening), $25. Throat — ^tonsillotomy (operation for removal of tonsils), $25. 
Tumor (malignant) — extirpation (removal), $50. Varicocele — incision Oancing) or 
tapping for radical cure, $2SF. Varicose veins — ^ligation (tying) or excision (removal) $25. 

Agreement in Application. 
I hereby apply to the Banfefe»^'Accident Insurance Company of Des Moines, Iowa, 
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 baired 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 
|s false, or in the event that any one of the following statements is false and made with 
intent to deceive. I agree that this application shall not be binding upon the Company 
until accepted by the Secretary at the Home Office and policy issued. 

POLICY FORM— "STERLING Disability." 

Principal Sum, $700. 

Monthly Accident Indemnity, $60. Monthly Premium, $1.25. 

Monthly Sickness Indemnity, $50. Policy Fee, $2.00. 

The Bankers Accident Insurance Company, Des Moines, Iowa, 
hereinafter called the Company, in consideration of the xJolicy fee 



84 BANKERS ACCIDENT INSURANCE COMPANY 

of two dollars ($2.00), the monthly premium of one and 25-100 
dollars, and of the application, a copy of which is endorsed hereon 
and made a part of this contract, hereby accepts John Doe (herein- 
after called the insured), residing in Chicago, State of Illinois, by 
occupation an attorney in class A, as a member of said Company . 
and subject to said application, and to the agreements, provisions 
and limitations contained in and endorsed upon this policy, insures 
him from 12 o'clock noon, standard time, of the day this contract 
is dated, until 12 o'clock noon, standard time, of the first day of 
January, 1915, and for such further periods stated in the renewal 
receipts as the premium specified in such renewal receipts will main- 
tain this policy and insurance in force against — 

The Insuring ^^use. (1) The effects resulting directly and exclusively of all other 
causes from bodily injiuy sustained during the life of this policy solely through external, 
violent and accidental means (suicide, sane, or insane^ or any attempt thereat, sane or 
insane, not covered), said bodily injiuy so sustained bemg hereinafter referred to as "such 
injury," and against — 

(2) Disabilit]^ through sickness which b contracted and begins during the life of this 
policy and after it has been maintained in continuous force for thirty days from its date, 
hereinafter referred to as "such sickness,*' as follows: 

Part I. Principal simi, $700; monthly accident indemnity, $60; monthly sickness 
indemnity, $50. 

Part II. Accident Indeunity — Specific Losses. — ^If any one of the following 
specific total losses shall result solely from^ "such injury" withm ninety da3rs from the 
date of the accident, the Company will pay in lieu of all other indemnity the sum specified 
below for such loss, provided that not more than one such indemnity shall be payable 
as a result of any one accident: For loss of life, or both eyes, or both hands, or both feet, 
or one hand and one foot, or one eye and one hand, or one e/e and one foot, the principal 
sum; for loss of either hand or either foot — one-half the pnncipal sum; for loss of eitner 
eye — one-third the principal sum. 

In every case referred to in this policy, the loss of any member or members above speci- 
fied shall mean loss by severance at or above the wrist joints or ankle joints, and the loas 
of eye or eyes shaU mean the irrecoverable loss of the entire sight thereof. 

Part III. Accumulations and Increases. Sec. (a). Specific Indemnities. 
For each period of three consecutive months immediateljr preceding the date of the acci- 
dent that this policy shall have been maintained in continuous force by the payment of 
the premiums on the dates due, five per cent, shall be added to the original amount pro- 
vided for anv loss under Part II sustained by the insured, but all such additions snail 
never exceed fifty per cent, of such original amoimt. 

Monthly Indemnities. Sec. (b). The indemnity on anv claim accruing imder 
Part IV or X shall be increased ten per cent, if the premiiuns nereon are paid annually 
in advance, and five per cent, if the premiums hereon are paid semi-annually in advance. 

Part IV. Total Disability. Monthly Accident Indemnity. Sec. (a). Or, 
for the period of total loss of time commencing on date of the accident, during which 
"such injury" alone shall wholly and continuously disable and prevent the Insured from, 
performing any and every duty pertaining to any business or occupation, the Company 
will pay accident indemnity at the rate per month specified in Part I. 

Partial Disability. Sec. (b). Or, if "such injury" shall not from date of accident 
wholly disable the Insured, but shall within thirty days thereafter wholly and continu- 
ously disable him, or if "such injury" abne shall, commencing on date of the accident 
or immediately foUowing total loss of time, wholly and continuously disable and prevent 
him from performing one or more important daily duties pertaining to his occupation, 
the Company will pay for the period of such disability, not exceeding six consecutive 
months, one-half of said monthly accident indemnity. 

Provided, that indemnity imder this part shall not be paid for a longer period than five 
consecutive years, nor for disability resulting from any loss specified^ in Part II, nor in 
excess of the time the insured is under the regular treatment of a legally qualified physi- 
cian or surgeon. 

Part V. Double Indemnity. — ^The amount otherwise payable under Part U or IV 
shall be doubled if "such injury" is sustained by the Insured, (1) while riding as a passen- 
ger in a passenger elevator (elevators in mines excepted), or (2) while riding as apassenger 
within the enclosed part of a railway passenger car provided by a common earner for the 
exclusive use of passengers, or (3) while riding as a passenger on board a steam vessel 
licensed for the regular transportation of passengers, provided "such injury" is due di- 
rectly to the wreckmg of such elevator, car or vessel; or (4) in consequence of the burning 
of any building while the insured is therein and is not acting as a volunteer or paid fireman, 
he having been in said building when the fire started; or (5) in consequence of the collapse 
of the outer walls of any building while the insured is therein; or (6) in consequence of a 
stroke of lightning. 

Part VI. Special Death Indemnity. — Or, if loss of life of the insured shall within 
ninet/ days from the date of exposure or infection, result solelv from (1) sunstroke, 
freezmjj^ or hydrophobia, due direcuy to such injury; or (2) the involimtary or unconscious 
inhalation of gas, or other poisonous vapor, the Company will pay in lieu of all other in- 
demnity, the original principal sum. 

Pasz VII. Immediate Settlement fos. Specific lNjnRiES*r~Or. if "such injury" 



BANKERS ACCroENT INSURANCE CX)MPANY 35 

is one set forth in Schedule A, and the instued so elects in writing within ten days from 
date of the accident, he nuiy take an immediate settlement, in lieu of all indemnity 
that might otherwise accrue under Part IV hereof, for the amount sijeciAed for "such 
injury" in Column 1 of said schedule; or, if "such injury" is sustained solely under 
conditions specified in Part V he may so elect to receive the amount specified for "such 
injury" in Column 2 of said schedule; provided that not more than one such indemnity 
shall be payable as the result of any one accident, and 

Schedule A. — Provided always, that the amounts specified herein shall be payable 
only in case the Monthly Accident Indemnity is $50; if such monthly mdemnity is greater 
or less than $50, then the amounts to be paid shall be increased or reduced proportionately. 

Optional with Insuked. — For loss, by severance: of one or more entire fingers (at 
least one entire phalanx), $50; one or more entire toes, $50. For complete dislocation: 
of the shoulder, $50; elbow, $50; wrist, $50; hip, $90; knee, $60: two or more bones of foot 
(not toes), $50; ankle, $50; two or more toes, $15; two or more nngers, $15. For complete 
fracture: of the sktill, both Ubles, $160; lower jaw, $35; collar bone, $70; pelvis, $115; 
thigh, $140; leg (tibia and fibula), $90; knee cap, $90; arm, between elbow and shoulder, 
$80; forearm (both bones), $75; two or more ribs, $35; foot (two or niore bones, not toes), 
$55; hand (two or more bones, not fingers), $50; two or more toes, $25; two or more fingers, 
$25; scapula, $75. 

Part VIII. Surgeon's Fees— Non-Disabling Injuries. — Or, if "such injury" 
sustained by the insured shall not disable him or entitle him to any other indemnity 
under this policy^ but shall require surgical treatment by a legally qualified surgeon, the 
Company will reimburse him for the cost of such treatment in an amount not to exceed 
two ($2) dollars per visit for five visits, provided, that the attending surgeon's receipt 
and affidavit on the Company's blanks are furnished the Company within ninety days 
^m date of the accident. 

Part IX. Blood Poisoning and Septicaemia. — Blood poisoning and septicaemia 
due solely to "such injury" shall be considered as covered by the accident clauses of this 
policy. 

Part X. (>>nfining Sickness. Monthly Sickness Indemnity. — Sec. (a). Or. 
for the period during which the insured shall be necessarily and continuously confined 
within the house and therein regularly visited by a legally qualified physician, solely 
by reason of "such sickness," the Company will pay sickness mdemnity at the rate per 
month specified in Part I. 

Boils, Felons and Abscesses. — Sec. (b). Or, for the period during which the insured 
shall be regularly attended by. a legally qualified physician, and wholly and continuously 
disabled and prevented from performm^ any and every duty pertaining to any business 
or occupation though not confined within the house by reason of external boils, felons or 
abscesses, the Company will pay sickness indemnity at the rate per month specified in 
Parti. 

-x Non-Confining Sickness. — Sec. (c). Or, for the period, not exceeding two consecu- 
tive months immediately following said confinement, or by reason of non-confining sickness 
during which the insured shall be regularly attended by such phsrsician, and wholly and 
continuous disabled and prevented from performing any ana every duty pertainmg to 
any business or occupation, the Company will pay one-half of said monthly sickness 
indemnity. Provided that indemnity under this part shall not be paid for a longer 
period than eight consecutive months; nor for t^e first seven days of any sickness unless 
dbability therefrom continues for at least twenty-eight consecutive days. 

Part XI, Certificate op Identification and Registration. — The Company 
will i^ace the insured's name on its registratbn list, and if by reason of "such injury^' 
or "such sickness" he shall be physically unable to communicate with friends, the Com- 
pany will, upon receipt of a telegram or other message ^ving this policy number, imme- 
diately transmit to his relatives or friends any information respecting him and defray all 
expenses, not exceeding fifty dollars, necessary for placing him in their care. 

Miscellaneous Provisions. 
Strict compliance on the part of the insured and beneficiary with all of the terms and 
conditions of this policy shall be a condition precedent to recovery hereunder and any 
failure in this respect shall forfeit to the Company all right to any indemnity. If the 
insured is disabled by said injury or sickness for more than thirty days, he or his repre- 
sentative must furnish the Company every thirty days, if reasonably i>ossible to do so, 
with report in writing from his attending physician or surgeon, fully stating the condition 
of the insured. The acceptance of any renewal premium shall be optional with the Com- 
pany. No provision of the charter or by-laws of the Company, not incorporated in 
full herein, shall void the policy or be used in evidence in any legal proceeding here- 
under. No assignment of this policy and no waiver of any of its provisions shall be 
valid unless agreed to in writing by an executive officer of the Company, and attached 
hereto or endorsed hereon. The insured may, at any time, release the Company from 
any and all liability then existing or thereafter accruing to the Beneficiary. If any 
obli^tion is received and accepted in lieu of cash for payment of premium, and the obliga- 
tion is not paid when due, this policy and insurance shall terminate and become void at 
12 o'clock noon, standard time, of the day when such obligation shall become due and 
unpaid, and remain void until payment has been accepted at Des Moines, Iowa, and notice 
of reinstatement has been given by the president or secretary. This insurance shall not 
take effect until after the pavment of the first premium and the delivery of the policy to 
the applicant while in good health and free from injury, and shall continue in force only 
ao k>ng as the premiums required hereon are paid, on or before they respectively mature. 
For Stanoasd Provisions, See Page 11. 



CASUALTY COMPANY OF AMERICA 



5;a8(ialty QDmpaijy of /Jm^riea. 

68 WILLIAM STREET, NEW YORK 
CommeDced Business October 1, 1903. 

Edwasd L. Heasn, Pres. John S. Jenxxms, Sec. Treas. 

Lyman A. Spai4>ing, Chairman of Board of Directors. 



The company issues forms of policies as follows: Regular Accident, 
form A; Improved Disability, form I D; Life Payment Accident, 
form L P A; Double Life Payment Accident, form D L P A; Double 
Life Payment Disability, form D L P D; Improved Health, form I H. 

Rates. — Select Classification. — ^Regular Accident, $4 per $1000 
and $5 weekly; Combination Accident, $5 per $1000 and $5 weekly; 
Disability poUcy, covering everjr accident and every disease or illness, 
$12 per $1000 and $5 weekly indemnity, ages 18 to 55; $14, ages 
56 to 60. D L P A, $6 per $1000 and $5 weekly; D L P D, $14 per 
$1000 and $5 weekly indemnity, ages 18 to 50; $16, ages 51 to 60. 

Age Limits. — ^Accident, 18 to 65; disability, 18 to 60. 

POLICY FORM— "Double Life Payment Accident." 

Principal Sum, $7,500-$15,000. Weekly Indemnity, $25-$50. 

Annual Premium, $30. 

Casualty Company of America in consideration of the state- 
ments in the application, a copy of which is endorsed hereon, and 
of thirty dollars, premium, hereby insures John Doe (hereinafter 
called the insured), whose occupation is broker, class, select, in 
the principal sum of seventv-five hundred dollars, and for a weekly 
indemnity of twenty-five dollars, for the term of twelve months, 
from the first day of November, 1914, beginning and ending at 
twelve o'clocJc noon, standard time, at the place where this policy 
is countersigned. 

Against Loss of Life, Limb, Sight and Tose. — Resulting from bodily injuries, 
hereafter called "such injuries," effected directly and independently of all other causes 
throujy^h external, violent, and accidental means, subject to all provisions, conditions 
and limitations hereinafter contained. 

Section A.— Indemnity for Loss of Life, Limb or Sight. — Single Payments. — If 
any one of the losses named in this sectbn shall result directly and independently of all 
other causes from such injuries within ninety days from the date of accident, but not 
necessarily causmg immediate or continuous disability, the company will pa^ the sum 
named below opposite such loss, and in addition thereto, the weekly indemmty for the 
period of continuous total disability between the date of accident and date of dismem- 
berment, loss of si^t, or loss of life by accident 

Or, if such injuries shall, directly and independently of all other causes, immediately, 
continuously and wholly disable and prevent the insured from performing any ana 
every kind of duty pertaining to his occupation, and during the period of such continu- 
ous and total disability, and within two hundred weeks from date of the accident shall 
result in any one of Uie losses hereafter named in this section, the companjr will i>ay 
the sum named below opposite such loss, and in addition thereto, the weekly indemnity 
from date of accident to date of dismemberment, loss of sight, or loss of life hy accident. 

For loss of life or both hands or both feet or one hand and one foot or entire sight of 
both eyes or entire sight of one eye and one hand or entire sight of one eye and one foot 
the ptnndpal sum. • Either hand or either foot or entire sight of one eye, one-half the 
principal sum. 

Double Payments. — If the insured shall sustain such injuries in any mannw as 
hereinafter described, the company will pay the amount named below opposite such 
loss, and in addition thereto, double weekly indemnity from date of accident to date 
of dismemberment, loss of sight, or loss of life by accident: 

(1) While riding 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; 

(2) Or, while in an elevator used for passenger service (excluding elevators in mines); 

(3) Or, in consequence of the burning of a Duilding while the insured is therein; 

(4) Or, in consequence of the collapse of the outer walls of a building while the in- 
sured is therein; 

(5) Or, through bemg struck by lightning; 

(6) Or, in a>nsequence of a cyclone or tornado, reported to be such by the Weather 
Bureau of the United States: 

(7) Or, in consequence of the explosion of a stationary boiler. 



CASUALTY COMPANY OP AMERICA 37 

Section B.— Weekly Indemnity, Total oe Paetial DisAsiUTy.— If such injuries 
do not result in any of the losses named in Section A, but shall immediately, continu' 
ously, and whol^ disable and prevent the insured from performing any and every kind 
of duty pertaining to his occuoation, the company will pay the insured the weekly 
indemnity heretofore named, so long as he lives and is contmuously and wholly disabled ; 

Or, if such injuries shall not wholly disable the insured, but shall immediately (or 
following total disability) and continuously disable and prevent the insured from trans- 
acting a material part of the daily duties pertaining to his occupation, the company 
will pay him for the period of such partial disability, not exceeding fifty-two consecutive 
weeks, one-half the weekly indemnity stated above. 

Section C. — Double Weekly Indemnity, Total or Paetial Disability. — If such 
injuries are sustained in the manner set forth in the column, "Double Payments," here- 
tofore given, or, in consequence of being struck by a movinj[ conveyance (excluding motor 
cycles) while crossing a public highway at any regular crossing or mtersection, the weekly 
indemnity otherwise payable shall be doubled. 

Section D. — Indemnity for Sunstroke. Freezing, Hydrophobia, Asphyxiation, 
Blood-Poisoning. — Sunstroke caused directly by the sim's rays, freezing, hydrophobia, 
or blood-poisoning, effected solely through accidental means, or involuntary and un- 
conscious inhalation of gas or other poisonous vapor, shall be deemed bodily injury 
within the meaning of ^is policy. 

Section £.— Indemnity for Hospital Charges. — In case the insured, by reason of 
such injuries and within ninety days from the date of accident, is removed to any hos- 
pital or sanitarium, the company will pay the insured, in addition to the weekly in- 
demnity otherwise payable, but m lieu of any sum payable under Section I, "Indemnity 
for Operations," the anu>unt expended by him on account of such hospital or sanitarium, 
charges not excfieding said single weekly indemnity, during each wedt that the insured 
is necessarily confined therein, but for not more than thirteen weeks,- provided that a 
receipted bill for such hospital or sanitarium charges b furnished to the company within 
ninety days after leaving said hospital or sanitarium. 

Section F. — Indemnity for Non-Disabling Injuries.— If such injuries do not 
result in any loss of time, but require medical or surgical treatment by a physician or 
surgeon, the company will pay the amount actually expended by the msured for such 
treatment, but such payment shall not aceed the single weekly indemnity payable 
for one wedc, provided that the physician's or surgeon's receipted bill and statement 
oi injuries is furnished to the company, within thirty days from the date of the accident. 

Section G. — Accumulations — Weekly IndeIboty. — Each consecutive year's re- 
newal of this policy shall add 10 per cent, to the weekly indemnity payable under Sec- 
tion B, — "Weekly Indemnity, Total or Partial" — until such accumulation amounts to 
50 per cent, thereof. Thereafter, so long as this policy is maintained in force, the amount 
insured shall be for the original weekly indenmity pLus the accumulation. 

Section H. — Identification. — Upon the receipt of the premium for thb policy, the 
company will forward to the insured a certificate of identification, wherein it is agreed 
that, if he shall, during the term of this policy or any renewal thereof, be physically 
unable to communicate with relatives or fnends, the company will, on receipt of a mes- 
sage giving the certificate and polky number, at once use all reasonable means and defray 
all expenses (not exceeding one hundred dollars) necessary for placing him in then- care. 

Section t. — Indemnity for Operations. — If the insured shall sustain such injuries 
as heretofore defined, that shall within ninet^^'days from date of accident necessitate 
any surgical operation named in the section, if such operation be performed, the com- 
pany wul pay the insured in addition to the indemnity otherwise provided, the sum set 
opposite that operation; but not more than one of the amounts so specified shall be 
payable to the insured under this clause, for injuries resulting from one accident. 

Based upon a policy for $7,500.00 principal sum. Proportionate amounts are payable 
if the poliQ^ is issued for a larger or smaller stun. Amputation of foot, hand or forearm, 
(25; 1^ or arm, fSO: finger or fingers, $10; thigh, $100. Dislocations, reduction of: 
shoulder, dbow, hip, knee or ankle, $25; wrist or lower jaw, $15; thumb or fingers, $10. 
Excisbn of: shoulcier, hip or knee joint, $100; elbow, wrist or ankle joint, $50; toe or 
toes, $25. Fractures, reduction of: nose, lower jaw, collar bone or shoulder blade, $25; 
breast bone, $10; rib or ribs, $10; upper arm, $35; forearm (one or both bones), $25; 
wrist or hand, $15; fingers, $10; any of the bones of the pdvis or sacrum. $50; coccyx, 
$10; thigh, $75: knee cap or leg bones (one or both), $50; bones of foot, $15; toes, $10. 
Gunshot woimos— treatment not necessitating amputation or laparotomy, $25. Hernia 
(abdomhial) — anv cutting operation for the radical cure of the reducible, irreducible 
or strangulated u>rm, $100. Laparotomy (opening of the abdomjoal cavity for an op- 
eration on any organ contained therein, or for traumatic peritonitis or exploratory in- 
cision), $100. Necrosis (death of bone)— sequestrotomy Removal of dead bone). $35. 
Skull trephining for fracture or other cause, $100. Synovitis (mflammation of the lini)ig 
membrane of a joint)— incision, $25. Tetanus— injection of anti-tetanic scrum into 
frontal lobe of brain, $100. Wounds of scalp or other parts — suturing, $5. 

Section }. — ^Fixed Indemnity. — If such mjuries shall result in any disability named 
in thb section, the insured may elect to receive the indemnity for smgle payments set 
opposite such injury, in lieu of all other indemnity for total or partial disability, pro- 
vided he gives to tne company at its home office in New York, written notice of his 
election so to do, within twenty days from the date of accident; or, if such injuries are 
sustained in the manner set forth m the column "Double Payments," or as stated in 
Section C heretofore given, the amount payable shall be the indemnity for double pay- 
ments set opposite such injury; but not more than one of the amounts so specified shall 
be payable to the insured under this clause, for injuries resulting from one accident. 

Based upon a policy for $7,500.00 principal sum. Proportionate amounts are payable 
if the policy is issued for a larger or smaller sum. For loss by severance: of one or morg 



CASUALTY COMPANY OF AMEMCA 



fingers (at least one entire phalanx), $150; of one or more entire toes, $200. For complete 
hernia, caused solely and directly by accidental injury, $70. For complete dislocation: 
of the shoulder. $100; elbow, $100; wrist, $125; hip, $300; knee. $150; any bones of the 
foot, $150: ankle, $150; two or more toes, $50; two or more fingers, $50. For complete 
fracture of bones: of the skull, both tables, $325; lower jaw, $75; clavicle (collar bone), 
$150; pelvis, $250; thigh, $300; leg, $200; patella (knee cap), $200; arm, between elbow 
and shoulder, $150; forearm, between wrist and elbow, $150; two or more ribs, $100; foot, 
$125; hand, $125; two or more toes, $100; two or more fingers. $100. 

Special Provisions. 

A. "Loss" shall mean, whether referring to one or more bodily members, as fol- 
lows: of foot or hand, — complete amputation at or above ankle, wrist or metacarpo- 
phalangeal joints; of sight — ^total, permanent and incurable blindness. 

B. The company's liability shall not in any case extend to more than one section 
of this policy on account of any one accident except as provided in Section £, H and I 
hereof. 

C. The acknowledgment by the company of the receipt of notice given imder this 
policy, or the furnishing of forms for filing proofs of loss, or the acceptance of such proofs, 
or the investigation of any claim hereunder, shall not operate as a waiver of any of the 
rights of the company in defense of any claim arising under this policy. 

D. This [wlicy does not cover disappearance; nor suicide, sane or insane, or any 
attempt thereat, sane or insane, nor cover injuries, fatal or non-fatal, sustained as the 
result of participation in aeronautics, or in any motor vehicle speed or endurance con- 
test, or while in military or naval service in time of hostilities. 

£. This policy is issued for the term stated in the insuring clause, but it miy be 
renewed subject to all the conditions of the policy contract from term to term upon 
the advanced payment of the premium stated. 

F. A copy of any assignment of interest shall be given, within thirty days, to the 
company, which shall not be responsible for its validity. 

G. No provision of the Charter, constitution or by-laws of the company shall be 
used in defense of any claim arising under this policy, unless the same is incorporated 
in full herein. 

H. The copy of the application endorsed hereon is hereby made a part of this contract. 

POLICY FORM— "Double Life Payment Disability." 

Principal Sum, $7,500-$15,000. Weekly Indemnity, $25-$50. 

Annual Premium, Select, $70; Age, 18-50. 

Casualty Company of America in consideration of the statements 
in the application, a copy of which is endorsed hereon, and of 
seventy dollars, premium, hereby insures John Doe, hereinafter 
called "the insured," whose occupation is banker, class, select, in 
the principal sum of seventy-five hundred dollars, and for a weekly 
indemnity of twenty-five dollars, for the term of twelve months, 
from the first day of November, 1914, beginning and ending at 
twelve o'clock noon, standard time, at the place where this policy 
is counter-signed. 

Against Loss op Life, Limb, Sight and Time. — (1) Resulting from bodily injuries, 
hereafter called "such injuries," effected directly and independently of all other causes 
through external, violent and accident means; (2) against oisability from bodily disease 
or sickness, contracted by the insured during the term of three hundred and mty days 
from noon, standard time, of. the fifteenth day after this policy becomes effective and for 
which the insured is treated by a licensed phjrsician; (3) subject to all provisions, con- 
ditions and limitations hereinafter contained. 

For Sections A, B, C, D and K, See Preceding Policy. 



Section E. — Indemnity for Hospital Charges. — In case the insured, bjr i 

of such injuries or of disease or sickness, for which indemnity is payable under this policy 
and within ninety days from date of accident, or beginning of sickness, is removed to 
any hospital or sanitarium, the company will pay the insured, in addition to the weekly 
indemnity otherwise payable, but in lieu of any sum payable under Section J, "indemnity 
for operations," the amount expended by him on account of such hospital or sanitarium 
charges not exceeding said single weekly indemnity, during each week that the insured 
is necessarily confined therein, but for not more than thirteen weeks, provided that a 
receipted biU for such hospital or sanitarium chaise is furnished to the company within 
ninety days after leaving said hospital or sanitarium. 

Section F. — Indemnity for Blindness and Paralysis from Sickness. — ^In case 
the insured shall, after the first fifteen days of the date when this policy becomes effective, 
- Contract any disease or sickness for which indemnity is payable under this policy, that 
shall not result in death, but shall result, independently of all other causes, within one 
year from the date of sickness, in the total and irrecoverable loss of s^ht of both eyes 
or in permanent paralysis, whereby the insured shall entirely lose the use of both hands 
or of both feet, or of one hand and one foot, and is thereby rendered permanent^ unable 
to engage in any occupation for wages or profit, the company win pay him one-half 
the principal sum, less any weekly indemnity previously paid therefor, as provided in 



CASUALTY COMPANY OF AMERICA dd 

Sectkm G, upon tlw filing at tbe company's home office within nine^ days after the oc- 
cunence of such loss, of due proofs to the company, of total and irrecoverable loss of 
sight of both eyes, or of pennanent paralysis. 

Section G. — ^Imdeknity tor Disabixxty nioic Sickness.— If such disease or sickness 
shall not result in total irrecoverable blindness or in i)ermanent paralysis, but shall im- 
mediatdy, continuously and wholly prevent the insunxl from performing anv and every 
kind of dutv pertaining to his occupation, the company will ^y the insured the weekly 
indenmity tor the period of said total disabilitv, dunng which he shall be necessarily 
confined to the house: and if following the period of said total disability and confinement 
to the house, he shall be wholly disabled and prevented from performmg any and every 
kind of duty pertaining to his occupation, but shall not be necessarily confined to the 
house, the company wm continue to pay him the said weekly indemnity, so long as the 
insured continuously suffors said total disability. 

Section H. — ^iNDEUNiry for Non-Disabling Injuues or Sickness.— ^If such in- 
juries or sickness do not result in any loss of time, but require medical or surgical treatment 
by a plnraidan ot surgeon, the company will pay the amount actually e]q)ended by the 
insured tor such treatment, but such pavment shall not exceed the single weekly indenmity 
payable for one week, and provided that the physician's or surgeon's receipted bill and 
statement of injuries or siduiess is furnished to the company, within thirty days from the 
date of the accident ox inception of sickness. 

L Section^ L — ^Accumulations— Weekly Indemnity.— Each consecutive year's re- 
newal of this poticy shall add ten per cent, to the we^y indenmity payable under Section 
B, weekly indemnity, total or partial — until such accumulation amounts to fifty per 
cent thereof. Therrafter, so long as this insurance is maintained in force, the amount 
insured shall be for the original weekly indemnity plus the accumulation. 

SscnoN L— ^Indemnity for Operations. — ^If the insured shall sustain such injuries 
or suffer sirkness as heretofore d^ned, that shall within ninety days from date of accident 
or sickness necessitate any surgical operation named in this section, if such operation 
be performed, the company will pay the insured, in addition to the indenmitv otherwise 
provided, the sum set opposite that operation: but not more than one of the amounts 
80 specified shall be pasraUe to the insured under this clause, for injuries resulting from 
ooe accident or one sickness. 

Based Upon A Policy for $7,500 Principal Sum. Proportionate Amoxtnts are 
Payable if the Policy b Issued for a Larger or Smaixer Sum. — ^Abscess or boil — 
jnctsion, $5. Amputation of foot, hand or forearm, $25; leg or arm, $50; finger or fin|;ers, 
$1(^ thigh, $100. Aneurism (tumor produced by arterial dilation or rupture), ligation, 
ISO. Appiendidtis (see laparotomy), $100. Bone abscess — trephining, $25. Bronchot- 
pmjTj thyrotomy, laryngotomy, laiyngotracheotomy, or tracheotomy, $50. Carbuncle — 
jnssion and treatment, $5. Caries (bone ulcer) — curetting, $15. Dislocations, reduction 
of shoulder, elbow, hip, knee or ankle, $25; wrist or lower jaw, $15; thumb or fingers, $10. 
gcBion of shoulder, hip or knee joint, $100; elbow, wrist or ankle joint, $50; toe or toes, 
125. Eye, ear, nose or throat — any cutting operation, $10. Felon — ^incision, $5. Frac- 
tures, rMuction of nose, lower jaw, collar bone or shoulder blade, $25; breast bone, $10; 
nb or ribs, $10; upper arm, $35; forearm (one or both bones), $25; wrist or hand, $15; 
™fliers, $10; any of die bones of the pelvis or sacrum, $50; coccyx, $10; thigh. $75: knee 
cap or kg bones (one or both), $50; bones of foot, $15; toes, $10. Ckughon (csrstic 
tuniOT of tendon sheath) — incision and curetting, $15. (]iunshot wounds — treatment 
not necessitating amputation or laparotomy, $25. Hernia (abdominal) — any cutting 
gi^tion for the radical cure of the reducible, irreducible or strangulated form, $100. 
nydrocde — tai>ping — ^incision or excision of sac,_$25. Ingrowing toe nail — removal, 

y — ^fixati 



flO. Intestinal obstruction • (see laparotomy). Kidney—fixation or removal, $100. 
^Parotomy (opening of the abdomimd cavi^ for an operation on any organ contained 
"*oan, or for traumatic peritonitis or exploratory incision), $100. Lithotomy (op- 
oauon for removal of stone in bladder) — any cutting, $100. Mastoiditis— operation 
I^ySO. Necrosis(deathof bone)— sequestrotomy (removal of dead bone), $35. Oesoph- 
"""^ 7 {Qf stricture or other cause, $100. Paracentesis — ^tapping of abdomen, $25; 



S33S' 




ojafflon or colotomy, $100. Skull trephining for fracture or other cause, IfOO. Syno- 
P[B (mflammation of the lining membrane of a joint)— incision, $25. Tetanus — ^m- 
l^cUon of anti-tetanic serum into frontal lobe of brain, $100. Tumors— extirpation 
[F™n. any part of the body. Benign, $15; mali^^nant, $50. Varicocele— acupressure — 
ugation or excision, $25. Varicose vein»--ligation or excisbn, $25. Wound of scalp 
or other parts-suturing, $5. 

ascnoN L.— Identification. — ^Upon the recdpt of the premium for this policy, the 
^Pany wiD forward to the insured a certificate of identification, wherein it is agreed 
«at, u he shall^ during the term of this policy or any renewal thereof, be physically 
jpable to communicate with relatives or friends, the company will, on receipt of a message 
^^ the certificate and policy number, at once use all reasonable means and defray 
*^ expenses (not exceeding one hundred dollars) necessary for placing him in their care. 
For Standard Provisions Seb Paob 11. 



40 THE COLUMBIAN NATIONAL L1f£ mstJRAKCE COJilPAMY ^ 

6f)e QolumbiaQ j^fatiopal Cife lijsuraij^e ^ompaijy, 

77 FRANKLIN STREET, BOSTON, MASS. 



Commenced Business, 1902. 

Arthur E. Chuds, Pres. Wm. H. Brown, Sec. 

Chabt.f-s a. Bennett, Manager Accident Department. 



The Accident and Health Department of The Columbian Na- 
tional Life insures all classes of risks, issuing a great variety of 
policies. The "Double Indemnity" and other leading forms are 
written on all classes. Separate health policies, and disability 
insurance are provided for women of occupation away from place 
of residence. Weekly indemnity under all forms is payable monthly. 

Annual Premium Rate. — $5000-$25 form, Male Risks, Classes 
1 and 2.— "Sterling Disability" policy, $60; "Sterling Straight 
Disability" policy, $55; "Columbian Accumulated Disability" 
policy, $75; "Sterling Double Indemnity Accident" policy, $25; 
"Sterling Straight Accident" policy, $20. The "Sterling Death 
and Dismemberment Accident policy, $5000 principal sum, $15; 
"Sterling Weekly Indemnity Accident" policy, $25 weekly indem- 
nity, $15; "Sterling Accidental Death" policy, $5000 principal sum, 
$10; and the "Sterling Health" policy, $25 weekly indemnity, 
$35 to all classes of risks up to and mcluding age 40; $40 ages 41 to 
50 and $45 ages 5 1 to 55 inclusive. Annual premiums on all disability 
policies, ages 51 to 55 inclusive, are increased at the rate of $10 ad- 
ditional for each $25 of weekly indemnity. Issues twenty-two dif- 
ferent forms of accident and health policies. 

All policies providing a principal sum and weekly indemnity 
are issued for three and six months at pro rata rates. Premium 
rates for other classifications vary proportionately to the " Sterling 
Straight Accident," which for each ilOOO principal sum and $5 
weekly indemnity, are as follows: 



Class 


land 2 


24- 


3 


4 


5 


6 


7 


Premimu 


14.00 


S5.00 


S7.60 


S10.J0 


S12.50 


S15.00 


S20.00 



Age Limits (new risks). — ^Accident, 65. years; disability, 60 
years; health, 55 years. 

Maximum Indemnity. — Death, $30,000; weekly indemnity, 
$150; doubling for accidents of travel, etc., to $60,000 and $300 
respectively, and accumulating to $90,Ci00 maximum principal sum. 

POLICY FORM— "Columbian Maximum Accident." 

Principal Sum, $7500-415,000. Weekly Indemnity, $25-150. 
Annual Premium, $25. 

The Columbian National Life Insurance Company, of Boston, 
Mass., does hereby insure 

John Quincy Adams, whose occupation is attorney-at-law, against loss resulting from 
bodily injuries, effected directly and independently of all other causes through accidental 
means (excluding self-destruction, or any attempt thereat, while sane or insane), as here- 
inafter specified, subject to the provisions and limitations contained herein. 

This policy is issued for the principal sum of seven thousand five hundred dollars and 
weekly mdemni^ of twenty-five dollars. 

Article 1. Death, Dismemberment or Loss of Sight.— If such injuries result in 
any one of the losses named below within ninety days of the accident, or if as the result 
of such injuries the insured continuously from the accident to date of loss is totally dis- 
abled and within two hundred weeks of the accident as the result of such injuries suffers 
one of said losses, the Company, in addition to the weekly indemnity accrued to date of 
loss will pay for: Death, or loss of both hands or both feet, or loss of one hand and one foot, 



THE COLUMBIAN NATIONAL LIFE INSURANCE COMPANY 41 

or loss of tlie sijslit of both eyes, the principal sum; loss of either arm or either leg, three- 
fifths the principal sum; loss of either hand or either foot, or loss of the si^ht of one eve, 
one-half the principal sum; loss of speech or hearing, or permanent paralysis or incurable 
insanitv, one-third the principal simi. Loss in any such case shall tenmnate this policy, 
toss of hands or feet means severance at or above wrist or ankle joint. Loss of arm or 
leg means severance at or above elbow or knee. Loss of sight, speech or hearing must be 
entire and irrecoverable. Paralysis must cause total and permanent disabilitv. 

Article 2. Total Disability. — ^If such injuries result in continuous total disabilitv, 
immediatdy following the accident or following partial disability as defined below, the 
Company will pay for the period of such total disability^ the weekly indemnitv. 

Article 3. Partial Disability. — Or, if such injuries result in partial disability 

which prevents the insured from fully performing work essential to his occupation, the 

Company will pay for the period of such partial disabili^, not exceeding twenty-six 

weeks, provided the insured is continuously disabled from the date of the accident, one- 

■ half the weekly indemnity. 

Article 4. Double iNDftacNiTY. — ^If such injuries are sustained (1) while a passenger 
in or on a public conveyance (including the platforms, steps or running board thereof) 
provided by a corporate common carrier for passenger service, (2) while a passenger in a 
passenger elevator (excluding devators in mmes), or are exclusively caused, (3) by the 
Duming of a building or by the collapse of the outer walls thereof while the insured is 
therein, or (4) by a stroke of lightning, the Company wOl pay under Articles 1, 2, 3, and 
7, double the amounts otherwise payable. 

Akxiclb 5. BLOGD-PoisaiaNG, Sttnstroke, Fseetoto, Hydrqfbobia, Asphyxia* 
TION. — Blood-poisoning resulting immediately and solely from an accidental bodily 
injury, sunstr^e ^s a direct result of exposure to the rays of the sun, freezing caused by 
invtmintaiy^ exposure, hydrophobia or involuntary asphyxiation, shall be deoned bodily 
injuries accidentally received within the meaning of this policy. 

Articlx 6. Surgeon's Fees, Hospital Benefits.— If such injuries within ninety 
days of the accident necessitate asurgicaloperation named in the" Schedule of Operations'' 
endorsed hereon, the Company will pay in addition a pro rata proportion of the amount 
set opposite such operation; not more than one amount (the larger) being pa3rable for one 
acdoent. If such injuries necessitate the removal of the insured to a hospital withm 
ninety days of the accident, if no claim be made for surgeon's fee, the Company will pay 
during his confinement therein for not more than twenty-six weeks, in addition to the 
we^ly indramity, one-half the single weekly indemnity. 

ARncLB 7. OimoNAL Indemnity.— ^If such injuries result in a loss or disability named 
in the " Schedule of Injuries" endorsed hereon, the insured may elect to receive a pro rata 
portion of the amount set opposite said injury in lieu of all other indemnity to which 
be may be entitled except suneon's fee; provided that written notice of his election is 
given to the Company within fifteen days from the accident, not more than one amount 
being payable for one accident. 

Aruclb 8. Surgeon's Fees vor Non-Disabling lNjuiiis.^If such injuries do not 
entitle the insured to taty indemnity but necessitate medical or surgical treatment, the 
Comfmay, provided the bill of the attending physician or sun^n dmy receipted is filed 
with it witnhi thir^ days of the aoddent, wiU reimburse the insured for the same to an 
amount not ezceeoing one week's single weekly indemni^. 

Articu 9. iDENimcATiON.^-If by reason of such injuries the insured shall be onabb 
to communicate with friends, the Company, upon receipt of a message to that effect, wfll 
take reasonable steps to transmit such inloimation to his rdatives or friends, and will 
defray the expenses necessary to put him in their care, not exceeding an amount eqoal 
to four times the single weekly indemnity. 

Arxiclb 10. Indemnity Payable Monthly. — ^Upon request of the insured and od 
proof of dJoability payment on account of weekly indeiouuty will be made monthly. 

General Provisions. 

1. If the insured changes his occupation and sustains such injuries (l)whik 

ing duties pertaining to an occupation chusified by the Conqiany as more hazard 

that stated in the pMicy (except ordinanr duties about his residence or while engaged in 
recreation) , or (2) after having been sole& and exclusively engaged for a period ofnot las 
than ninety days in an o<!cupation dassined by the Company as less hazardous than Uiat 
stated in the policy, the Company will pay the amount of indemnity which the premium 
paid would liave pittchased under the same policy at the rate established for such occupa- 
tion according to its limits, rates and classification of risks last filed with the Insurance 
Commissioner prior to the accident for which indemnity b claimed. If the insured by 
changing to a less hazardous occupation is not entitled to the full amount of such indemnity 
bf reason of said limits, rates and classifications, the Ccmipany will return a pro rata part 
of the excess unearned premium. Thu policy, with a copy of the application and any 
other papers attached to or endorsed hereon, constitutes the entire contract. No agent 
has power to waive or alter any of the provisions of thu policy, and no change in its 
printed conditions shall be vahd unless contained in an endorsement attached hereto 
and signed by the president or secretary. No statement not incorporated herein or en- 
dorsed hereon, and no provision of the charter or by-bws, shall avoid this policy or be used 
in defence to or in evidence of any cbim hereunder, but thb requirement shall not apply 
to the Company's rates and classification of risks filed as above. 

2. If reasonably poasibb written notice of accident shall be given the Company 
at its home oflke in Boston or to any of its authorized agents not later than twenty days 
firam occurrence of aoddent, or within the statutory time in jurisdictions providing 
for a longer period. 

3. Tlus policy shall not be in force until the payment of the first premium hereon. 
thb pottqr bat not been cancelled or icnewal xctused, thirty-one daiys' grace will be 



42 THE COLUMBIAN NATIONAL LIFE INSURANCE COMPANY 

allowed for the payment of all renewal premiums, during which poiod the policy remains 
in full force. If, alter the exi)iration of the days of grace, a past due premium be acxepted 
by the Company or any of its branch offices, or by any of its duly authoriased agents, 
auch acceptance shall reinstate the policy for the balance of its then term. 

4. The Compai^ may cancel this policy at any time by written notice delivered to 
the insure or mailed to mm at his last address on the Company's records, with its chedk. 
for the unearned portion of the premiums, but this shall not affect any claim for disability 
commencing prior to the date when the cancellation takes effect. 

5. Due proof of loss must be furnished to the Comi>any within ninety days after the 
occurrence of loss, or in case of loss of time from disability within ninety days after the 
termination of disability. The indemnity provided herein will be paid on receipt ol such 
proof. Leeal proceedings may not be brought before the expiration of sixty days nor after 
two years from the date when proofs may be filed. Death indemnity and any other bene- 
fits accrued and unpaid at death shall be payable to the beneficiary, if any; otherwise to 
the executors, admmistrators or assigns of the insured. 

6. This policy does not cover death or injuries resulting from disease infectious or 
otherwise, or death or injuries sustained as the result of participation in aviation or 
aeronautics or subaquatics, or while in military or naval service in time of war. During 
the pendency of a state of war and for three months thereafter, this policy shall not 

(1) msure combatants or non-combatants against injuries, fatal or non-fatal, caused di- 
rectly or indirectly by an act or accident of war or riot ansrwhere on land or water, nor 

(2) cover injuries, fatal or non-fatal, sustained l^ any means in any country (including 
its colonies or possessions) at war, outside the United States and Canada, or while eh 
route to or from any port of any country at war. 

7. Payment for anv loss under Article 1 and weekly indemnity then accrued shall 
relieve the Company from all liability thereafter on account of such accident. If such 
loss causes totsd disability under Article 2, the insured shall be indemnified under either 
Articles 1 or 2 at his option, but not under both. 

8. Where not forbidden by statute any medical adviser of the Company shall have the 
right and opportunity, (1) to examine the person of the insured in respect to a,ny injury 
as often and in such manner as he reguires during the pendency of the disability, (2) to 
examine the body or make an autopsy m case of death, and (3) to be present if any autopsy 
be made, timely notice of which must be given to the Company. 

9. Consent of the bcaieficiary shall not be requisite to a surrender or assignment of 
this policy, or to a change of beneficianr, or to any other changes in the policy. No assign» 
ment shall bind the Company unless the same be filed at the home office prior to payment 
of any indemnity claimed. The Company assumes no responsibility for the validity 
of any assignment. 

10. This policy is issued in consideration of the statements made in the application 
and of the payment of the premium of twenty-five dollars, for the term of twelve months, 
beginning at twelve o'clock noon, standard time, on the second day of February, 1914; 
and it may be renewed with the consent of the Company from term to term of twdve 
months each, dating from the expiration of the original term specified above, by pajmient 
of the premium in advance. No premium whenever paid wiU cany the policy beyond 
its then term. 

In witness whereof. The Columbian National Life Insurance Company has caused 
this policy to be signed by its president and secretary, but it will not be binding until 
countersigned by an authorized representative. 

Schedule or Operations. — (Referred to in Article 6.) Payable pro rata for each 
$50 of single weekly indemnity. Abdomen, cutting into abdommal cavity for diagnosb 
of treatment of organs therein, $200. Abscess, incision, $10. Amputation of arm above 
elbow, $100; foot, forearm or entire hand, $50: leg above knee, $100. Artery, tsring of, 
for aneurism, $70. Bone, injuries to, $30. Chest, cutting into for removal of pus, $50. 
Dislocation, reduction of shoulder, elbow, hip, knee, or aiikle, $50; wrist or lower jaw, 
$30; finger or fingers, $20. Excision of shoulder, hip, or knee joint, $200; elbow, wrist 
or ankle joint, $100; toe or toes, $50. Eye, any cutting operation, $20. Fractures, 
setting of nose, lower jaw, collar bone, shoulder blade Of forearm, $50. Breast bone, 
rib or ribfi. fingers, toes, cocc3rx, $20; uoper arm, $70; wrist or hand, bones of foot, $30; 
bones of the pelvis (except coccyx), $100; knee cap or leg, $100; thigh, $150. Gunshot 
wounds, treatment of, not necessitating opening of abdomen or amputation, $50. Joints, 
inflammation of, incision into, $50. Lockjaw, injection of antitoxin into brain, $200; 
injection of antitoxin into spinal canal, $100. SkuJl, cutting into cranial cavity, $200. 
Spine, removal of fractured vertebra, $200. Wounds, stitching, $10. 

Schedule of Injuries. — (Referred to in Article 7.) Payable pro rata for each $50 
of single weekly indemnity. IjOss of one or more entire fingers, $320; of one or more 
entire toes, $320. Complete dislocation of the shoulder, $100; of the elbow, $200; of 
the wrist, $240; of the hip, $600; of the knee, $300; of the ankle, $300. Complete rupture, 
caused solely and directly by injury, $160. Complete iracture of the skull, both tables, 
$640; of the lower jaw, $150; of the collar bone, $300; of the pelvis, $480; of the thigh, 
$600; of the leg (tibia and fibula), $400; of the knee cap, $400; of the arm, $310; of two or 
more ribs, $200. 

POLICY FORM— "Columbian Maximum Disability." 

Principal Sum, $7500-$ 15,000. Weekly Indemnity, $25-h$50. 

Annual Premium, $60. 

This policy insures against accidents under similar provisions as 
the one preceding, and against disease as follows: 



THE COLUMBIAN NATIONAL LIFE INSURANCE COMPANY 43 

HXALTB ImDXICNIIIES. 

Article 8. Dusnio CoiminEicENT to House.— If such disease results immediately 
in continuous total disability and necessarily confines the insured to the house, the Com- 
pany will pajr for the period of such total disability and confinement, not exceeding fifty- 
two consecutive weeks, the weekly indemnity. 

Article 9. Followino Contineiient to HotTSE. — li the insured becomes entitled 
to indemnity under the precedinjs article, and if continuously themfter is. totally disabled 
bv such disease (but is not confined to the house), the Company wfll pay for the period 
of such total disability (provided that indemnity under this and the preceding article 
taken together shall not oe payable for more than fifty-two weeks), one-half the weekly 
mdemnity. 

Article 10. Blindness, Paralysis, Permanent DiSABiury. — If such disease results 
within one year in the irrecoverable loss of the si|;ht of both eyes, or in paraljrsis, insanity 
or other permanent disability, and such condition continues ior one ^ear immediately 
following fifty-two weeks of such total disabOity and proof is given within ninety davs 
that fhe insured is thereby permanently unable to engage in any gainful occupaUon, the 
Oimpany wiU pay in addition one-fourth the principal sum. 

Accident and Health Indeknities. 

Article 11. Sxtrgeon's Fees, Hospital Benefits.— If such injury or such disease 
within ninety days of the accident or inception of disease necessitates a surgical operation 
named in the " Schedule of Operations " endorsed hereon, the Company will pay in addition 
a pro rata portion of the amount set opposite such operation j not more than one amount 
(the larger) being payable for any one disability. If such injury or such disease necessi- 
tates the removal of the insured to a hospital within ninety days of the accident or ince^ 
tion of disease, if no claim be made for surgeon's fee, the Company will pay during his 
confinement therein few not more than twenty-six weeks, in addition to the weekly in- 
demnity, one-half the single weekly indemnity. 

Article 12. Identification. — ^If by reason of such injury or disease the insured 
shall be unable to communicate with friends, the Company, upon receipt of a message to 
that effect, will take reasonable steps to transmit such information to his relatives or 
friends, and will defray the eroenses necessary to put hun in their care, not exceeding an 
amount equal to four times the single weekly indemnity. 

Article 13. Indemnity I^ayable Monthly. — Upon request of the insured and on 
pnxrf of disability payment on account of weekly indemnity will be made monthly. 

General Provisions. 

1. If the insured changes his occupation and sustains such injuries (1) while perform- 
ing duties pertaining to an occupation classified by the Company as more hazardous than 
that stated in the policy (except ordinary duties about his residence oc while engaged in 
recreation), or (2) after having been solely and exclusivdy engaged for a period of not less 
than nine^ days in an occupation classified by the Company as less hazardous than that 
stated in the policy, the Company will pay the amount of indenmity which the accidoit 
portion of the premium paid would have purchased under the same policy at the rate 
established for such occupation according to its limits, rates and classification of risks 
jast filed with the Insurance Commissioner prior to the accident for which indemnity 
is daimed. U the insured by changing to a less hazardous occupation is not entitled to 
the full amount of such indemnity By reason of said limits, rates and classifications, the 
Company will return a pro rata part of the excess unearned premium. This policy, with 
a copy of the application and any other papers attached to or endorsed hereon, constitutes 
the entire contract. No agent has power to waive or alter any of the provisions of this 
poUcy, and no change in its printed conditions shall be valid unless contained in an endorse- 
ment attached hereto and signed by the president or secretary. No statement not incor- 
porated herein or endorsed hereon, and no provision of the charter or by-laws, shall avoid 
this policy or be used in defence to or in evidence of any claim hereunder, but this require- 
ment shall not apply to the Company's rates and classification of risks filed as above. 

2. If reasonao^ po^ible written notice of accident or illness shall be given the Com- 
pany at its home (^ce in Boston or to any of its authorized agents not later than twenty 
days from occurrence of accident or the b^nnning of illness, or within the statutory time 



layment of the first premium hereon. 
. ^ jfused, thirty-one days' grace will be al- 
lowed tor the payment of all renewal premiums, during which period the policy remains 
m fun force. If, after the expiration ot the days of grace, a past due premium be accepted 
by the Company or any of its branch offices, or by any of its duly authorized agents, 
such acceptance shall reinstate the policy for the balance of its then term. 

4. The (Company may cancel this policy at any time by written notice delivered to 
the insured or mailed to him at his last address on the Company's records, with its cheque 
lor the unearned portion of the premiums, but this shall not affect any claim for dis- 
ability commencing prior to the date when the cancellation takes effect. 

5. Due proof en loss must be furnished to the Company within ninety days after 
the occurrence of loss or in case of loss of time from disability within ninety days after 
the termination of disability. The indemnity provided herein will be paid on receipt 
of such proof. Legal proceedings may not be brought before the expiration of sixty days 
nor after two years from the date when proofs may be filed. Death indemnity and any 
other benefits accrued and unpaid at death shall be payable to the beneficiary, if any; 
otherwise to the executors, adminbtrators or assigns of the insured. 

6. This policy does not cover any of the losses or disabilities described in Articles 
1 to 7, both indusive, where the same are the result of disease infectious or otherwise. 



44 THE COLUMBIAN NATIONAL LIFE INSURANCE COMPANY 

or death or injuries sustained as the result of participation in aviation, aeronautics or 
subaquatics, or death or injuries sustained or disease contracted in military or naval 
service in time of war, or disease for which the insured is not treated b]r a licensed phy- 
sician or which is contracted outside the United States or Canada, or in Alaska or the 
Insular oossessions of the United States; nor will the Compan v be liable for both accident 
and health indemnity for anv one period. During the pendency of a state of war and 
for three months thereafter, this policy shall not (1) insure combatants or non-combatants 
against injuries', fatal or non-fatal, caused directly or indirectly by an act or accident of 
war or riot anywhere on land or water, nor (2) cover injuries, fatal or nonfatal, sustained 
by any means in any country (including its colonies or possessbns) at war, outside the 
United States and Canada, or while en route to or from an^ port of any country at war. 

7. Pa3rment for any loss under Article 1 and weekly moemnity then accrued shall 
relieve the Company m>m all liability thereafter on account of such accident If such 
loss causes total disability under Article 2. the insured shall be indemnified under either 
Articles 1 or 2 at his option, but not under both. 

8. Where not f(Hrbidaen by statute anv medical adviser of the Company shall have 
the right and opportunity, (1) to examine the person of the insured in respect to any injury 
or disease as often and in such manner as he requires during the pendency of the disability, 
(2) to examine the body^ or make an autoiMv in case of death, and (3) to be present if 
any autopsy be made, timelsr notice of wnich must be given to the Company^. 

9. Consent of the beneficiary shall not be requisite to a surrender or assignment <4. 
this policy, or to a change of beneficiary, or to any other changes in the policy. No 
assignment shall bind the Company unless the same be filed at the home office prior 
to Dayment of any indemnity claimed. The Company assumes no responsibility for the 
validity of any assignment. 

10. This policy is issued in consideration of the statements made in the application 
and of the pajrment of the premium of sixty dollars, for the term of twelve months, be^- 
ning at twelve o'clock noon, standard time, on the second day of February, 1914, against 
such injuries, and for the term of 350 days from twelve o'clock noon, standard time, oi 
the fifteenth day after the above date, against such disease; and it may be renewed with 
the consent of the Company from term to term of twelve months each, dating from the 
expiration of the original term specified above, by pasrment of the premium in advance. 
No premium whenever paid will carry the policy b^ond its then term. When the in- 
sured shall pass age fifty the premium will be adjusted to a>nform to the Company's 
rates for disability insurance at his then age. 

Schedule of Operations. — (Referred to in Article 11.) Payable pro rata for each $50 
of single weekly indemnity. Abdomen, cutting into abdominal x:avity for diagnosis or 
treatment of organs therein, $200. Abscess or boil, incision, $10. Air passages, any 
operation below vocal cords, $100. Amputation of arm above elbow, $100; foot^ fore- 
arm or entire hand, $50: leg above knee, $100. Appendicitis, $200. Artery, tying of, 
for aneurism, $70. Bladder, any cutting or crushing operation for removal of stone, 
$200; tapping for removal of fluid, $50. Bone, injuries to, or disease oi, $30; removal 
diseased portion, $70; operation on mastoid Ixme, $100. Cancer of lip, removal of, by 
cutting operation, $50. Carbuncle, indsionj $10. Chest, cuttinjs into chest for cUag- 
nosis or treatment of organs therein, $50; tapping of, $30. Dislocation, reduction of shoul- 
der, elbow, hip, knee or ankle, $50; wrist or lower jaw, $30; finger or fingers, $20. Ear- 
drum, tapping of, $^0. Excision « shoulder, hip, or knee joint, $200; dbow, wrist or 
ankle joint, $100; toe or toes, $50. Eye, ear, nose or throat, any cutting operaticm, $20. 
Felon, incision, $10. Fracture, setting of nose, lower jaw, coUar bone, shoulder blade 
or forearm, $50; breast bone, rib or ribs, fiingera, toes, cocpyx, $20; upper arm, $70; wrist 
or hand, bones of foot, $30; bones of the pelvis (except coccyx), $100; knee cap or leg, 
$100; thigh, $150. Goitre, cutting operation for permanent cure, $150. Gunshot 
wounds, treatment of, not necessitatmg opening of abdomen, or amputation, $50. Hy- 
drocele, incision and treatment of sac, $50; tapping oi, $20. Intestinal obstruction (see 
Abdomen). Joints, inflammation of, incision into,^ $50. Kidney (see Abdomen). 
Lockjaw, injection of antitoxin into brain, $200; injection of antitoxm into spinal canid, 
$100. ^ Nerve, cutting operation for stretching, $50. Oesophagus, cutting operation 
for stricture or other cause, $200. Peritonitis (see Abdomen). Rectum, any operation 
for hemorrhoids, prolapsed rectum^ fistula or polypus, $50; nmlignant stricture or open- 
ing of colon, $200. Skull, cutting mto cranial cavity, $200. Spine, removal of fractured 
vertebra, $200. Toe nail, ingrowing, removal of, $20. Tumors, removal of, by cutting 
operation, malignant, $100; benign, $30. Varicocde, any cutting operation, $50. Veins, 
varicose, any cutting operation, $50. Wounds, stitching, $10. 

POLICY FORM. — "Columbian Accumulated Disability." 

Principal Sum, $7,50(>-$15,000. Weekly Indemnity, $30-$60. 

Annual Premium, $75. 

This policy contains all the benefits given in the "Sterling Dis- 
ability, and in addition provides: 

FiiU weekly indemnity while totally disabled by sickness, not 
requiring house confinement, and one-half weekly indemnity if 
partially disabled by sickness. Total losses under Article 1 are 
extended to include: 

Loss of eye and hand or eye and foot, the principal sum. 

Lqss q£ ^ther 9,vm qv either leg, three-fifths the principal ^mu 



THE COtmiBlAN NATIONAL LlFfi INSTOANCE COMPANV 48 



Hospital Benefit is increased from one-half extra to two-thirds 
the weekly indemnitjr; or in lieu of hospital benefit the same extra 
indemnity is paid while insured is attended by a nurse. Operation 
fee is paid in addition to Hospital or Nurse's Indemnity. 

Health Insurance. 
One form of policy insuring against sickness only is issued. It 
provides indemnity during fifty-two weeks for sidaiess causfed by 
any disease and if so permanently disabled an additional sum 
will be p^d equal to fifty times the weekly indemnity. This policy 
is issued independent of accident insurance to all classes of risks, 
any amount ?5 to $125 of weekly indemnity. 

POLICY FORM.— "Sterling Health." 

Veekly Indemnity, $25. 

Annual Premium, Ages 18 to 40, $35; Ages 41 to 50, $40; 

Ages 51 to 55, $45. 

The Columbian National Life Insurance Company of Boston, 

Mass., does hereby insure, 

John Qulncy Adams, whose occupatioii Is attome^-at-Iaw, against loss of time from 
diaa,bility from dis^Lse contracted while this policy is in force, as hereinafter specified, 
suHect to the provisions and limitations contained herein. 

'Hiis policy is issued for the weekW indemnity of twenty-five dollars. 

Article 1. Health Indemnity Dxtrikg CoNTiNEifENT to House. — If such disease 
results immediately in continuous total disability and necessarily confines the insured to 
the house, the G>mpany will pay for the period of such total disability and confinement, 
not exceeding fifty-two consecutive weeks, the weekly indemnity. 

Articxe 2. Health Indemnity Following Confinement to House. — If the insured 
becomes entitled to indemnity under the preceding Article, and if continuously thereafter 
is totally disabled by such disease (but is not confined to the house), the Company will 
pay for the period en such total disability, provided that indemnity under this and the 
preceding Article taken together shall not be payable for more than fifty-two weeks, 
one-half the weekly indemnity. 

Article 3. Blindness, Paralysis, Permanent Disability.— If such disease results 
within one year in the irrecoverable loss of the sight of both eyes, or in paralysis, insanity 
or other permanent disability, and such condition continues for one year immediately fof- 
veeks of such total disability and proof is given within ninety days that 



lowing fifty-two weeks c , ^ „ ^ , 

the insur^ is thereby pennanently unable to engage in any gainfiU occupation, the 
Company will pay in addition an amount equal to fifty times the weekly indemnity. 

Article 4. Surgeon's Fees, Hospital Benefits. — If such disease within ninety 
days of its inception necessitates a surgical operation named in the " Schedule of Opera- 
tions" endorsed hereon, the Company will pay in addition a pro rata portion of the 
amount set oppotdte such operation; not more than one amount (tne larger) being payable 
for any one disability. If such disease necessitates the removal of the insured to a hos- 
pital within ninety days of its inception, if no daim be made for surgeon's fee, the Company 
will pay during his confinement therein for not more than twenty-six weeks, in addition 
to the weekly mdemnity, one-half the weekly indemnity. 

Article 5. Indemnity Payable Monthly. — Upon request of the insured and on 
proof of disability payment on account of weekly indemnity will be made monthly. 

General Provisions. 

1. This policy, with a copy of the application and any other pajiers attached to or 
endorsed hereon, constitutes Uke entire contract. Change of occupation shall not affect 
the indemnity payable hereunder. No a^^t has power to waive or alter any of the pro- 
visions of this policy, and no change in its printed conditions shall be valid unless con- 
tained in an endorsement attachedhereto and signed by the president or secretary. No 
statement not incorporated herein or endorsed hereon, and no provision of the charter or 
by-laws, shall avoid this policy or be used in defence to or in evidence of any claim here- 
imder, but this requirement shall not apply to the Company's rates and deification of 
risks last filed with the Insurance Commissioner prior to the date of the commencement of 
the sickness for which indemnity is claimed. No assignment shall bind the Company 
unless the same be filed at the home office prior to payment of any indemnity claimed. 
The Company assumes no responsibility for the vahdity of any assignment. 

2. If reasonably possible written notke of illness shall be given the Company at its 
home office in Boston, or to any of its authorized agents not later than twenty days from 
the beginning of the disability, or within the statutory time in jurisdictions providing 
for a longer period. 

3. This policy shall not be in force until the pasrment of the first premium hereon. 
If this policy has not been cancelled or renewal refused, thirty-one days grace will be al- 
lowed tor the pa3rment of all renewal premiums, during whicti period the policy remains 
in full force. If, after the expiration of the days of grace, a past due premium be accepted 
by the Company or any of its branch offices, or by any of its duly authorized agents, such 
acceptance ahall reinstate the policy for the balance of its then term. 



46 THE COLUMBIAN NATIONAL LIFE INSURANCE COMPANY 

4. The Company may caned this polky at any time by Written notice deliveied to the 
insured or mailed to him at his last address on the Company's records, with its cheque 
for the unearned portion of the premiums, but this shall not affect any claim for disability 
commencing prior to the date when the cancellation takes effect. 

5. Due proof of loss must be furnished to the Company within ninety days after the 
termination of the disability. The indemnity provided herein will^ be paid on receipt 
of such proof. Legal proceedings may not be brought before the expiration of sixty days 
nor after two years from the date when proofs may be filed. 

6. This policy does not cover disease contracted outside the United States, or Canada, 
or in Alaska or the Insular possessions of the United States, or while the insured is en- 
gaged in military or naval service in time of war, or disease for which the insured is not 
treated by a licensed physician, or which results from accidental injury. 

7. Where not forbidden by statute any medical adviser of the Company shall have 
the right and opportunity to examine the person of the insured in respect to any disability 
as often and in such manner as he requires during its pendency. 

8. This policv is issued in consideration of the statements made in the application 
and of the premium of thirty-five dollars, for the term of 350 days, beginning at twelve 
o'clock noon, standard time, on the fifteenth day after the second day of Februaiy, 1914; 
and it may oe renewed with the consoit of the Company from term to term of twelve 
months each, dating from the expiration of the original term sjiecified above, by payment 
of the premium in advance. When the insured shaU pass age forty, and agam when he 
shall pass age fifty, the premium will be adjusted to conform to the Company's rates for 
health insurance at his then age. 

Schedule of Operations. — (Referred to in Article 4.) Payable pro rata for each $50 
of weekly indemnity. Abdomen, cutting into abdommal cavity for diagnosis or treatment 
of organs therein. $200; topping of, $30. Abscess or boil, incision, $10. Air passages, 
any operation bdow vocal cords, $100. Amputotion of arm above elbow. $100; foot, 
forearm or entire hand, $50; leg above knee, $100. Appendicitis, $200. Artery, tying 
of, for aneurism, $70. Bladder^ anv cutting or crushing operation for removal of stone, 
$200; topping for removal of fluid, $50. Bone, disease of, $30; removal diseased portion, 
$70; operation on mastoid bone, $100. Cancer of lip, removal of, by cutting operation 
$50. Carbuncle, incision, $10. Chest, cutting into chest for diagnosis or treatment of 
organs therein, $50; toppmg of, $30. Eardrum, topping of, $20; excision of shoulder, 
hip or knee joint, $200; elbow, wrist or ankle joint, $100; toe or toes, $50. ^ Eye, ear 
nose or throat, any cuttmc operation, $20. Felon, incision, $10. Goitre, cutting opera- 
tion for permanent cure, $150. Hyorocele, incision and treatment of sac, $50; topping 
of, $20. Intestinal obstruction (see Abdomen). Joints, inflammation of, incision mto, 
^0; topping of, $20. Kidney (see Abdomen). Nerve, cutting operation for stretch- 
ing, $50. O^phagus, cutting operation for stricture or other cause, $200. Peritonitis 
(see Abdomen^. Rectum, any operation for hemorrhoids, prolapsed rectum, fistula or 
polypus, $50; malignant stricture or opening of colon, $200. Skull, cutting into, 6ranial 
cavity^ $200. Toe nail, ingrowing, removal of, $20. Tumors, removal of, bv cutting 
operation, malignant, $100; oenign. $30. Varicocele, any cutting operation, $50. Veins, 
varicose, any cutting operation, $50. Wounds, stitching, $10. 

The policies shown cionfonn to the Massachusetts Standard and 
are issued in all admitted States except those having adopted the 
New York Standard Provision Laws. In the latter group of States 
the forms of policies issued carry the same benefits and the New 
York Standard Provisions. 



COM JlONWEALTH CASUALTY COMPANY 47 

Common'^KaUh Casualty Company 

PHILADELPHIA. PA. 

Empire Bldg., 13th and Walnut Streets. 
Began BuainesB in 1906. I N. Stevhis, Prei E. S. Cook, Seoetaxy. 



The company's "Monarch Combination** policy is given in full 
below. Besides this policy the company issues a separate health 
policy, weekly indemnity, $25; separate accident policy, principal 
sum $5000, increasing annually to maximum $7500, weekly in- 
demnity, $25; ages 18 to 60 years. 

POLICY FORM.— "Monarch Combination." 

Principal Sum, $5000-$! 0,000. Weekly Indemnity, $25-50. 
Annual Premium, Select, $60. 

Commonwealth Casualty Company, Philadelphia, in considera- 
tion of the annual premium' of sixty dollars and the statements and 
representations in the application, a copy of which is endorsed 
hereon and made a part hereof, the company. 

Does hereby insure John Doe, Philadelphia, Pa., under classification .... by occupa- 
tion, broker the person described in said application, subject to all the provisions, limita* 
tions and agreements contained herein and indorsed hereon, from 12 o'clock noon, stand- 
ard time, ofthe first day of January, 1914, at the place of the assured 's address as set forth 
herein, until 12 o'clock noon^ standard time, ofthe first day of January, 1915, and for 
such further periods, stated m the renewal receipt, as the payment of the premium spe- 
cified in said applicatbn will maintain this policy and insurance in force; (1) against loss 
resulting from bodily injuries, effected directly and independently of all other causes, 
through external, violent and accidental means (suicide, sane or insane, is not covered) 
as specified in the following schedules, respectively; and (2) against disability from disease 
or sickness as hereinafter defined, subject to the provisions and limitations hereinafter 
contained. 

Schedule of Indemnities 

Accident Insurance.— Principal sum of this policjr in the first year is S5000; double 
indemnity, $10,000. Increases annually until the maximum is $7500; double indemnity, 
$15,000 as provided for in Part E. ToUl disability, weekly benefits, $25; double indemnity 
$50; partial disability, weekly benefiU, $12.50; double mdemnity, $25. 

Paet a. Death, Dismemberment and Loss of Sight. — If such injuries shall wholly 
and continuously disable the insured from date of accident from performine any and 
every kind of duty pertaining to his occupation, and during the period of such continu- 
ous disability, but within two hundred weeks from date of accident, shall result inde- 
pendently and exclusively of all other causes in any of the losses enumerated below 
or within ninety days from the date of the accident, irrespective of totaldisability, result 
in like manner in any one of such losses, the company wul pay the sum set opposite such 
loss and in addition weekly indemnity as provided m Part B to the date of death, dis- 
memberment, or loss of sight; but only one of the payments named in part A will be made 
for injuries resulting from one accident. For loss of life, or both hands, or both feet, or 
sight of both eyes, or one hand and one foot, or either hand or foot, and sight of one eye, 
the principal sum; either hand or foot, or sight of one eye, one-half the principal sum; 
thumb and index finger of either hand, one-third of principal sum. Loss shall mean, 
with regard to hands and feet, dismemberment by severance at or about wrist or ankle 
joints; with regard to eyes, entire and irrecoverable loss of sight; with regard to thumb 
and index finger, severance at or about metacarpo-phalangeal joints. The payment 
in any such case shall end this policy. 

Part B. Total and Partial DiSABiLrrv. Total Loss of Time. — Or, if such in- 
juries alone shall not result in any of the losses above specified, but shall from the date of 
accident disable and prevent the injured from performing every duty pertaining to any 
and evecjy kind of business or occupation, the company will pay for such total disability, 
for a period not exceeding two hundred consecutive weeks, indemnity at the rate per week 
of twenty-five dollars ($25.00). 

Partial Loss of Time.— Or, if such injuries alone shall from date of accident or imme- 
diately following total disabiUty, disable and prevent the insured from performing one 
or more important daily duties pertaining to his business or occupation, the company will 



48 COMMONWEALTH CASUALTY COMPANY 

pay for such partial disability, for a period not exceeding thirty consecutive weeks, in- 
demnity at the rate per week (one-half of rate for total loss of time) of twelve dollars 
and fifty cento ($12.50). 

Provided always that the combined periods for which indemnity will be paid lor any 
one accidental disability shall not exceed two hundred consecutive weeks. 

Part C. Medical Attendance. — ^If such injuries shall not result in any of the abo> e 
losses, but reauire medical treatment, the company will pay the amount actually paid 
by the insured for such treatment, not exceeding, however, one week's indenmity as pro- 
vided for in Part B; provided the surgeon's receipt and certificate on the company's 
blank are furnished the company within twenty days from the date of the acdoent. 

Paet D. Double iNDEicNrriES.— Indemnities under Parts A and B shaU be doubled 
(.as shown in schedule of indemnities), if such injuries shall be received: (1) while rid- 
ing as a passenger in or on a public conveyance, including i>latf orm, stej^ or running 
board thereof, provided b^ a common carrier for passenger service; or (z) while a passenger 
within an elevator provided for passenger service omv, excepting elevators in mines; 
or (3) while in a burning building in which the insured shall be at the beginning of the 
fire; or (4) through bein^ struck by lifl;htning;or(5) throughthecollapseof the outer walla 
of a finished building while the insured is therein; or (6) by the explosion of a steam boiler. 

Part E. Accumxtlative Beneftts. — ^If the premium is paid annually in advance, 
each consecutive year's renewal of this poliqy shall add 10 per cent to the principal sum 
of the first year until such additions shall amount to fifty per cent and henceforth so long 
as this policy shall be maintained in force by[ the payment of annual premium in advance , 
the insurance shall be for the original prindpd sum plus the accumulations. If premium 
is paid semi-annually or quartenv, commencing; with the second year of this insurance, 
five per cent shall be added annually to the prinapal sum of the first year until such addi- 
tions shall amount to fifty per cent and henceforth so long as this policy shall be main- 
tained in force, the insurance will be for the original principu sum plus the Accumulations . 

Part F. (Optional Annual Income for the Insured or Beneficiary. — ^In the 
event b^ loss by accident covered by this policy, for any indemnity other than weekly 
indemmty , the insured or beneficiary, as the case may be, may, when the right to indemnity 
is established, elect to receive the amount thereof in equal annual installmento extending 
over a period of five or ten years. Interest at the rate of three per cent per annum 
will be paid on deferred paymento. In the event of the death of the person to whom 
such yearly income is payable before the termination of the period selected for annual in- 
stallmento, the annual income for the remainder of the said period shall be paid to the 
executor or administrator of such person's estate. 

Part G. Special Indemnities— Sunstroke^ freezing, hydrophobia, or the involuntary 
and unconscious inhalation of ^ or other poisonous vapor, shall be deemed a bodily 
injury within the meaning of this policy, when suffered through accidental means. 

Part H. Blood Poisoning. — ^Blood poisoning resulting directly from a bodily injury 
caused solely by external and acddentol means is covered by this policy. 

SXCKHESS iMDnUUZlES 

Past 1. Loss of Tims. Confining Period.— If uxsr sickness shall totally disable 
and prevent the insured from transacting any and every kind of business, and necessarily 
and continuously confine him within the house where he shall be regularly visited by a 
licensed physician, the company will pay for the period of such confinement not exceed- 
ing one year, a weeklv indemnity of twenty-five dollars. 

Loss OF Time. Non-Confining Period.— If immediately followmg such confine- 
ment within the house or if by reason of any sickness the insured^iallcontinue totally 
disabled and prevented from transacting any and every kind of business and regularly 
treated bv a licensed phvsician. but not necessarily confined within the hoUse, the company 
will pay for such period, but the combined periods for any one sickness shall not exceed 
one year except as below provided, a weekly indemnity of twelve and one half-dollars. 

Loss of Time After One Year. — If immediately following oneyearof total disability 
and continuous confinement within the house, the insured shall continue totolly disabled 
and prevented from transacting any and every duty pertaining to any and every busi- 
ness or occupation, and confined within the house, and regularly visited by a bcensed 
physician, the company will pav so long as such total disability and confinement shall 
continue, a weekly indemnity of six dollars and twenty-five cento. 

Part J. Loss from Blindness or Paralysis.— If any sickness contracted during 
the term of this policy shall, independently of all other causes, result during the term of 
this policy in the entire loss of the sight of both eyes, or by paralysis, in the entire loss 
of the use of both hands, or of both feet, or of one hand and one foot, the ccirpany shall 
in lieu of all other indemnity, be liable under Part I^ Paragraph I, but the limit of the 
period of which indemnity shall be paid is hereby extended to two years. 

Part K. Surgeons' Fees for Accident or Sicsness. — If such injuries received or 
sickness contracted after the date of this policy shall alone within three months from date 
of the accident or commencement of the sickness and during the term oi this policy 
necessitate a surgical operation named in the "schedule of operations" hereinafter 
mentioned, the company will pay, in addition to the indemnity, the sum provided for 
such operation, but when more than one operation is required payment shall be made 
only for the first. 

Part L. Hospital Indemntty. — If such injuries received or sickness contracted 
after the date of this policy shall within three months from the date of the accident or 
commencement of the sickness, necessitate the removal of the insured, to a regularly 
incorporated hospital, the company, provided that no claim is made under Part K, will 
pay in addition to the indemnity for a period not exceeding three months of confinement 



COMMONWEALTH CASUALTY COUP ANT 40 

in said hospital the amount cxpondsd for hospital chaiges not exceeding per week twelve 
and one-haJf dollars. 

Part M. Registration and Indentification.— If the insured shall, by reason 
of such injuries or sickneas be physically unable to communicate with friends, the com- 
pany will, upon receipt of a message giving this policy number, immediately transmit 
to such rdatives or fnends as may be known to it, any information respecting bim, and 
will defray any expenses necessary to put him in communication with and in the care of 
fiien(fe, not exceeding a sum equal to four weeks 'indemnity under Part B. 

Part N. Monthly Ssttlements.— In case of loss of time, payment will be made 
monthly upon request of the insiured and hling of proof satisfactoiV to the company. 

Part O. Iiuiediate Optional Settlements. — The insured, if he so elect m writing 
within ten days from date of accident, may take, in lieu of the weekly indemnity herein- 
before provided f (m: total or partial disability, indemnities in one sum, according to the 
"schedule oi optional indemnities" hereinafter mentioned, if the injunr is one set forth 
insudh schedule, but not more than one elective benefit shall be paid for injuries result- 
ing from one accident. When the insured is entitled to double mdemnity tl« dective 
inaemnity shall be doubled in like manner. 

ScHEDULK or Operations.— Appendicitis, $100. Aneurism (tumor of artery)— liga- 
tion. $50. Amputation of foot hand or forearm, $25; leg, $50; arm above elbow, $50; 
thign, $100; one or more entire fingers, $10. Absc^s or boil — incision, $5. Bone ab- 
scess — trephining, $26. Bronchotomy, thyrotomy, laiyngotomy. laryngotracheotomy, 
or trachectomy , $50. Carbuncle — ^incision and treatment, $5. Canes (bone ulcer) T-curet- 
ting$15. Di^ocations, reduction of shoulder, elbow, hip, knee or ankle, $25; wrist or jaw, 
$15; finger or fingers, $10. Excision of shoulder, hip or knee joint, $100; elbow, wrist 
or ankle joint. $50; toe or toes, $25. Eye, ear, nose or throat — any cutting operation, 
$lu. Felon — incision, $5. Fractures, reduction of nose, lower jaw, collar bone or shoul- 
der l^ade, forearm (one or both bones), $25; breast bone, rib or ribs, fingers, coccyx, toes, 
$10; upper arm, $35; wrist or 'hand, bones of foot, $15; any of the bones of pelvis or sac- 
rum, $150: thigh, $75; knee cap or one or both leg bones, $50. Ganglion (cystic tumor of 
tendcm sneath) — incision and curetting, $15. Gunshot wounds — treatment not neces- 
sitating amputation or laparotomy, $25. Hernia (abdominal) — any cutting operation 
for the radical cure of the reducible, irreducible or strangulated form, $100. Hydro- 
cele— tapping — incision or excision of sac, $25. Ingrowing toe nail — ^removal, $10. 
Intestinal obstruction— ^see laparotomy). Kidney — ^fixation or removal, $100. Lapa- 
rotomy (opening of the aodominal cavity for an operation on any organ contained therein) 
$100. Lithotomy (operation for removal of stone in bkidder)— any cutting, $100. 
Mastoiditis — operation for .$50. Oesophagotomy for stricture or other cause, $100. 
Peritonitis (see laparotomy). Paracentesis — ^tapping of abdomen, bladder, $25; ear 
drum, $15. Rectum— operation for hemorrhoids (external or internal), excision or liga- 
tion, prolapsed — operation for fistula in ano — indsion, polypus — extirpation, $25; malig- 
nantstricture — excision or colostomy, $100. Sequestrotomy (removal of dead bone) , $35. 
Skull trephining for fracture or other cause^ $100. Suturing wounds of scalp or other 
parts, $5. Synovitis (inflammation of the hning membrane of a joint) — ^incision, $25. 
Tetanus — injection of anti-tetanic serum into frontal lobe of brain, $100. Tumors — 
extirpation from any part of the body — benign, $15; malignant, $50. Varicose veins — 
ligation or excision, $25. Varicocele — acupressure— 4igation or excision, $25. 

Schedule of Optional Indemnities.— Loss of one or more entire fingers, $160; one 
or more entire toes, $200. Complete hernia, $80. Complete dislocation of the shoulder, 
$60; elbow, $100; wrist, $120; hip, $300; knee, $100; two or more bones of foot (not toes), 
$160; ankle, $1 60; two or more toes, $60; two or more fingers, $60. Complete fracture 
of the skull, both tables. $320; lower jaw, $80; coUar bone, $160; pelvis, $240; thigh, $300; 
leg (tibia and fibula), $200; knee cap, $200; of the arm (between elbow and shoulder), 
$300; fore arm (between wrist and elbow) , $150; two or more ribs, $100; two or more bones 
of the foot (not toes), $120; two or more bones of the hand (not fingers), $120; two or 
m<Nre toes, $100; two or more fingers, $100. 

Ageeehemts 

n)This insurance does not cover disappearance or loss from injuries intentionally 
inflicted upon himself by the insured, sane or insane, or recieved by him while insane; 
or injuries or sidi^ness resulting wholly or in part, directly or indirectly, while under the 
influence of any intoxicant or narcotic ; or from riding in or on, or being in, or attempting 
to get in or out of any aerial machine or conveyance. 

The sickneas insurance hereunder does not cover any loss from sickness contracted 
while engaged in military or naval service or prior to the date of this policy, or any loss 
from sickness while the insured may be entitled to indemnity for accidental injuries. 

(2) Thii insurance covers loss from injuries, fatal or otherwise, only when received, 
and from sickness only when contracted or suffered in the United States, Canada or Eur- 
ope, or while traveling by regular passenger lines between those places, excepting Alaska 
and territory north ox the nfty-fifth degree of north latitude ana the insular possessions 
of the United States; unless the company issues a permit extending these limits signed 
by an executive officer at the home office aiid said permit is attached hereto. The com- 
pany will not beliablef orindemnityf orloss or disability in excess of the period the insured 
IS. by reason of injury or sickness, under the professional care and regular attendance 
<H a legally qualified physicain or surgeon. If the insured is disabled by injury or sick- 
ness for more than thirty days, he or his representatives shall, as a condition precedent 
to recover hereunder, furnish the company every thirty days a report in writing from his 
attencKng physician or surgeon, f uUy stating the condition of the insured and the probably 
duration of his disability. 

For Standard Provisions Sex Page 11 



60 



aniMONWEALTH CASUALTY COMPANY 



Industrial DEPARTifENT 

Tabub or Rates and Imdemnities 



Class AA 



Class D 






I 



a 
i 



$ 

60 
60 
70 
80 
QO 
100 



« 

50 
60 
70 

,80 
QO 

100 



« 

600 
600 
700 
800 
900 
1,000 



« 

300 
300 
350 
400 
450 
500 



$ 

150 
150 
175 
200 
225 



$ 

1.00 

1.15 

1.60 

1.85 

2.20 



250 2.50 



$ 

30 

35 

40 

45 

50 



$ 

80 
35 
40 
45 
50 



« 

300 
300 
400 
400 



« 

150 
150 
200 
200 



600 250 



$ 

76 
75 
100 
100 
125 



$ 

IJOO 

1.60 
1.76 
2jOO 



ClassA 



Class E 



« 
50 
50 
60 
70 
80 
90 
100 



$ 


$ 


$ 


$ 


40 


500 


250 


125 


50 


500 


250 


125 


60 


600 


300 


150 


70 


700 


350 


175 


80 


800 


400 


200 


90 


900 


450 


225 


100 


1,000 


500 


250 



$ 

1.00 
1.15 
1.50 
1.85 
2.20 
2.55 
3.00 



$ 

25 

30 

35 

40 



$ 


« 


« 


$ 


26 


200 


100 


60 


30 


300 


150 


76 


35 


300 


150 


76 


40 


400 


200 


100 



$ 

1.00 
1.30 
1.60 
1.90 



Class B 



Class F 



40 
50 
60 
70 



40 
50 
60 
70 



400 
500 
600 
700 



200 
250 
300 
350 



100 
125 
150 
175 



1.00 
1.40 
1.80 
2.25 



20 
25 
30 
35 
40 



s 


$ 


$ 


$ 


20 


200 


100 


60 


25 


200 


100 


60 


30 


300 


150 


76 


35 


300 


150 


76 


40 


400 


200 


100 



1.00 

ijao 

1.00 
1.90 
2.20 



Class C 



Class X 



« 

35 

40 

45 

50 

60 



$ 


$ 


$ 


$ 


35 


300 


150 


76 


40 


400 


200 


100 


45 


400 


200 


100 


60 


500 


250 


125 


60 


600 


300 


150 



1.00 
1.25 
1.50 
1.75 
2.25 



« 

20 

25 

30 

35 

40 



$ 


$ 


s 


$ 


20 


100 


50 


26 


26 


100 


50 


26 


30 


100 


60 


26 


35 


100 


60 


26 


40 


100 


60 


26 



$ 

1.00 
1.30 
1.60 
1.90 
2.20 



Class XX 



25 
30 
35 
40 



$ 


« 


$ 


$ 


20 


100 


60 


25 


25 


100 


60 


25 


30 


100 


60 


26 


35 


100 


50 


25 


40 


100 


50 


26 



$ 

2.00 
2.60 
3.20 
3.80 
4.40 



Add fifty per cent, (one-half) to the above premiums for api^cants over fifty veais 
of a^e. Accident benefits in force from date of policy. Illness benefits 60 dagrs wter. 
Partial illness benefits fifty per cent of total. 

POLICY FORM.--"Standard Provident." 

Principal Sum, $600. Monthly Premium, Class AA, $1. 

Monthly Accident Indemnity, $60. 
Monthly Sickness Indemnity, $50. 

Commonwealth Casualty Company, Philadelphia, hereinafter 
called the company, in consideration of the pcdicy fee, $3, the 



COMMONWEALTH CASUALTY COBiPANY 61 

monthly premium of one dollar, and the statements and repre* 
sentations in the application, a copy of which is endorsed hereon 
and made a part hereof, the company, 

, Does hereby insure John Do^ Philadelphia, Pa., under classification. .^ .by occupa- 
tions and ag 

standard time, , ,. . „ 

as set forth herein, until twelve o'clock noon, standard time of the first day of Februazy 
1914, and for such further periods, stated in the renewal receipt, as the payment of the 
premium specified in said application will maintain this policy and insurance in force: 
(1) against loss resulting from bodilv injuries, effected directly and independent!]^ of all 
other causes, through external, violent and accidental means (suidde, sane or insane 
b not recovered); as specified in the following schedules, respectively; and (2) against 
disability from disease or sickness as hereinafter defined, subject to the provision and 
limitations hereinafter contained. 

Section 1. BeNBFits for Accidents. — If any one of the following losses shall result 
solely and exclusively from such purely accidental injuries within ninety days from date 
of the accident the company will pay, in lieu of any other indemnity: For loss of life, 
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 at or 
above the wrist or ankle, or entire sight of both eyes, if irrecoverably lost, S600, the prin- 
cipal sum; For loss of either hand by complete severance at or above the wrist, or either 
foot by complete serverance at or above the ankle, one-half the prmcipal sum; for loss 
of entire sight of one eye, if irrecoverably lost, one-forth the principal sum. 

Section 2. Total Loss of Tncs-^Or, if such injuries alone shall not result in any 
of the losses above si>ecified, but shall from the date of accident disable and prevent the 
insured from performing every duty pertaining to any and every kind of business or occu- 
pation, the company wul pav for sucn total disability, for a period not exceeding twenty- 
four consecutive months, maemnity at the rate per month, of ^ixty dollars. 

PARTIA.L Loss OF TiiCB.^!)r. if such injuries shall alone from date of accident, or im- 
mediately following total disability, disable and prevent the insured from performing 
im'portaat daily duties essential to his business or occupation, the company will p«y 
for such partial disability, for a period not exceeding six consecutive months, indemnity 
at the rate per month of thirty (fifty per cent) dollars. 

Provided always that the combined periods for which indemnity will be paid for any 
one accidental disability shall not exceed twenty -four consecutive months. 

Section 3. Special Inoeicnities.— Or, for loss of life from sunstroke caused by tne 
sun's direct rays, freezing or hydrophobia caused directl^f and independently of all other 
causes by external, violent and accidental means within ninety days from date of exposure 
or infection, the company will pay in lieu of all other benefits the principal sum named 
in Section 1 hereof. 

Section 4. Double Benefits.— Or, if such injuries are sustamed by the insured (1) 
while riding as a passenger within the enclosed part of any railway passenger car pro- 
vided for the exclusive use of passengers and propelled by steam, cable, compressea air 
or electricity, and not attached to any freight, coal or logging train; or (2) while riding 
as a passenger on board a steam vessel ficensed for the regular transportation of passengers. 

Provided such injuries shall be caused directly by the wrecking of such car or vessel 
then the company will pay double the indemnities otherwise payable under Sections 
1 and 2 hereof. 

Section 5.^ Fifty Pee Cent. Accumulations.— For each full year this policy shall 
have been maintained continuously in force the benefits under Section 1, shall be increased 
ten per cent., but the sum of all such accumulations shall never exceed fifty per cent. 

Benefits foe Sickness 

No indemnity will be paid for any sickness not common to both sexes. 

Section 6. Confining Disability.— If the insured shall, independently of all other 
causes, be immediately and wholly disabled and prevented from performing every 
duty pertaining to any and every kind of business or occupation by bodily disease or 
sickness that is contracted and begins after this ppUcy has been m continuous force 
for sixty dasrs, and shall be necessarily and continuously confined within the house 
and regulariy visited therein by a legally qualified physician, for a period not exceeding 
six consecutive months, the company will pay for the number of consecutive days ol 
disability after the first week, indemnity at the rate per month of fifty dollars. 

NoN-CoNFiNiNO Disability.— Or, if immediately following confinen-.ent within the 
house by such sickness, or if by reason of any sickness contracted and beginning after 
this polic^r has been in continuous force for sixty days, the insured shall be wholly disabled 
from performing any and every duty pertaining to any and every kind of business or occu- 
pation and require the regular attendance of such physician but shall not necessarily 
be confined within the house, the company will pay, tor the number of consecutive days 
of disabihty after the first week, for a period not exceeding eight weeks, indemnity at 
the rate per month of twenty-five {fiftv per cent) dollars. 

Provided alwasrs that the combined periods for which indemnity will be paid for any 
one illness shall not exceed six consecutive months. 

Section 7. Special Diseases.— In case of any loss or disability resulting wholly or 
in {^rt directly or indirectly from tuberculosis, rheumatism, paralysis, apoplexy, or- 
chitis, neuritis, locomotor ataxia, hernia, lumbago, lame back, strains, sciatica, vaccina- 
tion, dementia or insanity, the limit of the company's liability (after the first week^ 
shall not exceed eight weeks' indemnity in any one policy year at the rate which 
otherwise be payable under this policy. 



52 C0MM6KW£AtTft CASt^AttV COM^AKY 

Disftbllity or loss of time xesulting wholly or in part, directly or indirectly, from son- 
stroke, freezing, carbuncles, boils, felons, absceaes, uken, blood poison or sraticemia. 
or contact with, poisonous or infectious substances b classified as sickness and corered 
dafy under Section 6 of this policy, the original cause thereof notwithstanding^ 

Section 8. Ten Per Cent: lMCKEAS£.^The indemnities under Sections 2 and 6 of 
this policy shall be increued ten per cent if the premitmis are paid annually in advance. 

Section 9. Annual Income for BENsncURY or Insured.— In the event of any 
loss by accident covered by this policy, involving the payment of one thousand doUaxs 
or more for any indemnity other tnan monthly indemnity, the insured or the beneficiary, 
as the case may be, may dect to receive one-fifth thereof upon approval of satisfactory 
proofs; and one-fifth thereof annually for four years thereattier; together with interest 
at the rate of three per cent per annum on the deferred payments. And in the event of 
the death of the person to whom such yearly income is payable, before the termination 
of the said period of four years, the annual income for the remainder of the said period 
shall be payable to the executors or administrators of such person. 

Agreements 

1. Insurance under this policy does not cover death, loss or disability, resulting wholly 
or in part, directly or indirectly, from any venereal disease or any surgical operation for 
any chronic ailment, or from nding or driving races of any kind, or aviation. 

2. In event of injury or loss, fatal or otherwise, of which there shall be no external or 
visible marks on the body (the body itself in case of death not to be deemed such mark), 
or resulting wholly or in part, directhr or indirectly, from disease or bodily infirmi^; 
or injury, ntal or otherwise, or disabilitv or loss resulting^ directly or indirectly, wholly 
or in part, from any gas, vapor, narcotic, anaesthetic, poison intentionally taken, aca- 
dentally or otherwise, riot, str&es, exposure to obvious risk of injury or obvious danger, 
or from injuries intentionally inflicted upon the insured by any other j^rson (assaults 
by burgUrs or robbers excei>ted); or from injuries received by him while insane, or while 
under the influence of any intoxicant or narcotic, or while attempting to evade arrest, 
or while violating the law, or the rules of a corporation, or the rules of a public carrier 
afifecting the safety of its passengers; or while on the right of way, bridee, trestle, or other 
property of a railway corporation other than stations, platforms and regular crossings 
prescribed by law, not being at the time a passenger or empbyee of such railway in the 
discharge of duty. Then in any such case referred to in this paragraph the limit of the 
Company's liabiuty shall be a sum not exceeding one month's indemnity as provided in 
Section 6 of this policy. 

For Standard Provisions See Page 11 

POLICY FORM— "New Era." 

Principal Sum, $500. Monthly Premium, Class AA, $1.25 

Monthly Accident Indemnity, $50. 
Monthly Sickness Indemnity, $50. . 

Commonwealth Casualty Company, Philadelphia, hereinafter 
called the company, in consideration of the policy fee, $3, the 
monthly premium of $1.25, and the statements and representa- 
tions in the application, a copy of which is endorsed hereon and 
made a part hereof, the Company, • 

Does hereby insure John Doe, Philadelphia, Pa., under classification AA, by occupation 
clerk, the person described in said apj^lication, subject to all the provisions, limitations 
and agreements contained herein and indorsed hereon, from twelve o'clock noon, stand- 
ard time, of the first day of January, 1915, at the place of the assured's address as set 
forth herein, until twdve o'clock noon, standard time of the first day of February, 1915, 
and for such further periods, stated in the renewal receipt, as the payment of the premium 
q)ecified in said application will maintain this policy and insurance in force; (1) against 
loss resulting from bodily injuries, effected directly and independently of all other causes, 
through external, violent and accidental means (suicide, sane or insane, is not covered), 
as specified in the following schedules, respectively; and (2) against disability from disease 
or sickness as hereinafter defined, subject to the provisions and limitations hereinafter 
contained. 

Accident Insurance 

Pa&t a. Schedule ov Indemnities.— If any one of the following losses shall result 
solely and exclusively from such purely accidental injuries within ninety days from date 
of the accident the Company will pay, in lieu of any other indemnity: For loss of life, or 
both hands by complete severance at or above the wrist, or both feet by complete sev- 
erance at or above the ankles, or one hand and one foot by complete severance, as de- 
fined above, or entire sight of both eyes, if irrecoverably lost, $500, the principal sum, 
for loss of either hand by complete severance at or above the wrist, or either f oot oy com- 
plete severance at or above the ankle, one-half the principal sum; for loss of entire sight 
of one ^e, if irrecoverably lost, one-third the principal sum. 

Part B. Total Loss of Tdce. — Or, if such injuries alone shall not result in any of 
the losses above specified, but shall from the date of accident disable and prevent the 
insured from performing every dutv pertaining to any and every kind of ousiness or 
occupation, the company will pav for such total disability, for a period not exceeding 
twenty-four consecutive months, indemnity at the rate per month oi fifty dollars 



COMMONWEALTH CASUALTY COMPANY 63 

Pait C. Dooble Benefits.— Or, if such injuries are sustained by the insured (1) 
while ridins as a passenger within the enclosed pi^ oi any railway passenger car provided 
for the exclusive use of passengers and propelled by steam, cable, compressed air or elec- 
tricity; or, (2) while ridmg as a passenger on board a steam vessel licensed far the regulu 
transportation of passengers, or (3) while riding as a passenger in a passenger elevator 
(elevators in mines excepted), provided such mjuries shall be caused directly by the 
wrecking of such car, ve^ or elevator, then the Company will pay double the indem- 
titles otherwise payable under Part A and B hereof. 

Part D. Special Indemnities.— Or, for loss of life from sunstroke caused by the 
son's direct rays, freezing or hydrophobia caused directly and independently of all other 
causes by external, violent and accidental means within mnety days from date of exposure 
or infection, the Company will pay in lieu of aU other benefits the principal sum named in 
Part A hereof. 

Part £. Surgical Attention. — ^If the insured sustains bodily injuries as described 
m Part B, and such injuries do not cause either total or partial disability, but require 
unmediate surgical treatment, the Company will reimburse the insured for the amount 
actually expended for such treatment^ not exceeding thcsum of $5, upon presentation of 
receipted bill of the doctor. 

Part F. Blood Poisoning or Septicaemia.— If blood poisoning or septicaemia 
sball result from bodily injuries, through external, violent and accidental means, the 
Company's liability shul be only for wedriy indemnity, as specified under Part B of this 
policy. 

Part G. Sixty Per Cent. Accumulations.- Each consecutive month's renewal of 
this policy without delinquency shall add one per cent, of the original principal sum of this 
policy to the indemnities under Part A, but the sum of all such accumulations shall never 
exceed sixty per cent. 

Part H. Increase in Indemnities.— The monthly indemnities under Parts B and 
J of thb policy shall be increased ten per cent, on any claim accruing hereunder if the 
premiums hereon are paid twelve months in advance, or shall be increased five per cent. 
if premiums are paid six months in advance. 

Part I. Optional Annual Income for the Insured or Beneviciary.— In the 
event of loss by accident covered by this policy^ involving the payment of Sl.OOO or more 
for any indemnity other than monthly indemmty, the insured or the beneficiary, as the 
case may be, may, when the right to indenmity is established, elect to receive the amount 
thereof m equal annual installments extending over periods of five or ten years. Interest 
at the rate of three per cent, per annum will be paid on deferred payments. In the event 
of the death of the person to whom such yearly income is payable before the termi- 
nation of the periodf selected for the annual installments, the annual income for the 
remainder of the said period shall be paid to the executor or administrator of such person's 
estate. 

Benefits for Illness. 

Part J. Confining Disability.— (1) If the insured shall suffer from any illness 
which is contracted and begins after this policy has been maintained in continuous force 
for sixty days, and is necessarily, totally and continuously confined within the house 
and therein r^^ularly visited by a legally qualified physician, the Company will pay for 
the number of consecutive days after the first week, tor a period not exceeding six months, 
at the rate per month of $50; provided, however, that it the insured is disabled for any 
one illness as above described, for thirty consecutive days, then no deduction shall be 
made for the first week. 

Convalescino Disability. — (2) If the insured, inunediately following confinement 
within the house by such illness, as above described, shall be wholly and continuously 
disabled from performing every duty pertaining to any business or occupation and reguires 
the regular attendance of such physician but shall not necessarily be confined within the 
house, the Company will pay for a period not exceeding eight weeks, indemnity at the 
nte per month of (50 per cent.), $25; provided always that the combined periods for 
which indenmity will be paid for any one ilhiess shall not exceed six consecutive monthi. 

Non-Confinimo Disability. — (3) If the insured, by reason of any illness contracted 
and beginning after this policy has been in continuous force for sixty days, shall be wholly 
and continuously disabl«l from periorming every duty pertaining to any business or occu- 
pation and requires the r^ular attendance of a legally qualified physician, but shall not 
oecessariW be confined within the house, the Company will pay for the number of con- 
secutive days after the first week, for a period not exceeding eight weeks, indemnity at 
the rate per month of (50 per cent.) $25. 

Part K. Boils and Felons.— Disability or loss resulting wholly or in part, directly 
or indirectly from carbuncles, boils, felons, abscesses, or ulcers, shall be classed as illness 
and covered only under Part J of this policy the original cause thereof notwithstanding 
(provided that the words in Part J "continuously confined within the house " do not apply 
to carbunc^, boils, felons, abscesses and ulcers). 

Part L. Monthly Settlements.— In case of loss of time extending beyond thirty 
days, benefits, under Parts B and J, will be paid monthly upon request of the insured and 
filing of due proof of loss. 

Part M. Insurance under this policy does not cover death, loss or disability, resulting 
wholly or in part, directly or indirectly, from any venereal disease or any surgical opent" 
tion for any chronic ailment. 

Fo^ Standard Provisions, See Pace 11, 



54 CONNECTICUT GENERAL LIFE INSURANCE COMPANY 

Connecticut General Life Insurance Company. 

HARTFORD, CONN. 



Acddent Dept. commenced business, 1912. 
R. W. HuNTiNGTOM» Jr., Pws. G. E. Bulkley, Sec. A. P. Woodwabd, Sec Ace. DepL 



"The Connecticut General** issues the following accident policies 
to men: "Special Accident Policy'*" Form F on Select, Preferred, 
Extra Preferred and some Ordinary risks, premium $5 per $1,500 
and $5 weekly indemnity (Select and Preferred); "Life, Limb and 
Sight," Form D, to Select, Preferred, Extra Preferred and Ordi- 
nary risks, Select and Preferred, $3 per $1,000; "Regular Acci- 
dent'* Form R, to Select, to Extra Perilous, Select and Preferred, 
$5 per $1,000 and $5 weekly indemnity; "Death Only" Form D O., 
$2.50 per $1,000, Select and Preferred; "Accumulative Indemnity" 
Form C, to Select, Preferred, Extra Preferred and some Ordinary 
risks, Select and Preferred, $6 per $1,500 and $5 weekly indemnity. 
Weekly indemnity accumulates 10% per anntun for five years 
under this form. A "Special Weekly Indemnity *' policy. Form I O, 
to Select to Ordinary, no principal sum, $5 to $75 weekly indemnity. 
Premium Select and Preferred, $3 per $5 weekly indemnity. Age 
limits 18 to 65. 

The Company issues Health insurance to both men and women 
under the "General Health" policy. Form H, in classifications from 
Select to Medium inclusive, in amounts of $5 to $125 weekly in- 
demnity in connection with its accident policies providing at least 
an equal amount of weekly indeninity, ^or a term of 76, 167 or 350 
days, and renewable for three, six or twelve months respectively, 
paying full weekly indemnity for house-confinement from any 
disease, and 50% weekly indemnity for convalescent period follow- 
ing house-confinement, total disability not to exceed 52 weeks. 
Permanent disability, blindness and paralysis are covered by a 
sum equal to 100 times the weekly indemnity; surgical and hospital 
fees to 50% of the weekly indemnity for a maximum of ten weeks. 
Premium for men per $5 weekly mdemnity, ages 18 to 50, $7; 
ages 51 to 65, $9; for women, ages 18 to 50, $9.50; ages 51 
to 60, $11.50. The "Limited Health" policy. Form L, is issued 
to both men and women classed from Select to Extra Perilous 
who also carry accident insurance in the Company between the 
ages of 18 and 55, and covers thirty specific diseases. Premiiun, 
Select to Ordinary, $2 per $5 weekly inaettmity; Ordinary to Extra 
Perilous, $3 per $5 weekly indemnity. 

The Company also issues to either men or Twomen a "General 
Disability" policy, Form G H, which combines in one contract all 
benefits contained in the "General Accident" policy, Form G, and 
the "General Health" policy. Form H, the premiums for men being 
Select or Preferred, ages 18 to 50, $12; ages 51 to 65, $14. For 
women, ages 18 to 50, $14.50; ages 51 to 60, $16.50. It issues for 
men only a "Special Disability" policy, Form F H, combining the 
benefits of the "Fully Accumulated Accident" policy. Form F, 
the health insurance sold only in this form providing for both total 
and partial disability irrespective of house-confinement. Written 
in amounts from $1,500 principal sum and $5 weekly indemnity to 
$37,500 and $125 weekly indemnity, the premium being $12.50, 
ages 18 to 50; $14.50, ages 51 to 60, in the Select or Preferred classi- 
fications, issued annuafly, semi-annually or quarterly. 



CONNECTICUT GENERAL LIFE INSURANCE COMPANY 55 

POLICY FORM.— "Special Disability, Form F H." 

Principal Sum, $7,500-^15,000. Weekly Indemnity, $25-|50 

Annual Premium, $62.50. 

The Connecticut General Life Insurance Compan)r of Hartford, Conn, 
in consideration of the statements contained in the application 
for this policy, a copy of which is endorsed hereon and made a 
part hereof, and of the premium of sixty-two dollars and a half, 
does hereby insure John Doe, of Hartford, in the State of Connecti- 
cut, the person named and described in said application under 
classification, Select, by occupation Attomev, for the term of 
twelve months from the day this policy is dated, beginning and end- 
ing at twelve o'clock noon, standard time, of the place where the 
Insured resides, against loss from bodily injuries effected directly 
and independently of all other causes through accidental means, 

suicide (sane or insane) not included, and for the term of 

days beginning on the fifteenth day after the day this policy is 
dated, at twelve o'clock noon, standai'd time, of the place where 
the Insured resides, and ending at the same hour, against dis- 
ability from sickness or disease, subject to the following provisions 

Accident Insxtrance. 

Seciion I. Loss 07 Life, Limb or Sight. — If such injuries alone, independently and 
exclusively of all other causes^ and witlun ninety days from the date of the accident result 
in any (me of the losses described in this section; or from the date of the accident wholly 
and continuously prevent the Insured from performing any and every kind of duty per- 
taining to his occupation and during the period of such disability and within two hundred 
wedbi from the date of the accident result in any one of said losses, the Company wDl 
pay the sum specified for said loss, and in addition weekly indemnity as hereinafter pro- 
vided for the period of said disability. If more than one such loss results from injuries 
sustained in one accident, the Insured shall receive only the largest benefit provided in 
this aecticm for an]r one of the losses so sustained. Upon occiirrence of any mjury caus- 
ing any loss described in this section all insurance hereunder shall immediately cease 
and the payment of indemnity therefor shall terminate this policy. 

For low of life, or both hands or both feet by severance at or above the wrist or ankle, 
or entire and irrecoverable loss of sight of both eyes, or one hand and one foot by sever- 
ance at or above the wrist or ankle, or either hand or foot by severance at or above the 
wrist or ankle and entire and irrecoverable loss of sight of one eye, the principal sum: 
either hand or foot by severance at or above the wrist or ankle, one-half ol the principal 
sum; entire and irrecoverable loss of sight id one eye, one-third of the principal sum; 
thumb and index finger by severance at or above tne metacarpophalangeal jomt, one- 
fourth of the principal sum. 

Section II. Disability. — ^Total. (A) Or if such injuries alone, independently and 
exclusively ctf all other causes, shall from the date of the accident wholly and continu- 
ously prevent the Insured from periorming any and every kind of duty pertaining to 
his occupatum, the Company will pay so long as the Insured lives and sixers such total 
disability a weekly indenmity^ of twenty-five dollars. 

Partial. (B) Or if such injuries alone, independently and exclusively of all other 
causes, do not totally disable the Insured as defined in clause (A) of this section, but do 
from the date oi the accident, or inunediately following the period of total disability as 
hereinbefore defined, continuously prevent the Insured from performing one or more 
important dailv duties pertaining to his occupation, the Company will pay one-half of 
the week^ indemnity hereinbefore provided for the period of such disability, but not 
exceeding twenty-six consecutive weeks. 

Section III. Optional Indemnities. — If the Insured suffers a loss covered by Section 
II and the injury is one described in this section, he may if he so elect in writing within 
twenty days from the date of the accident, take in lieu of the indemnity provided in 
Section II, the sum provided in this section for such injury; but not more than one op- 
tional indemnity shdl be paid for injuries resulting from one accident. 

For the loss of: one or more fingers (at least one entire phalanx), a sum equal to weekly 
indemnity for six wedu; one or more entire toes, 8 weeks. Complete dislocation: of 
the shoulder or elbow, 4 weeks; wrist, 5 weeks; two or more fingers or two or more toes, 
2 wedcs; hip, 12 wedu; knee, ankle or bones of the foot other than toes, 6 weeks. For 
the complete fracture of: skull, both tables, 13 weeks; lower jaw, 3 weeks; collar bone 
or forearm between wrist and elbow, 6 weeks; arm between elbow juid shoulder or the 
thigh, 12 we^s; hand other than the fingers or the foot other than the toes, 5 weeks; 
two or more ribs, two or more fingers or two or more toes, 4 weeks; pelvis, 10 weeks; 
leg or knee cap, 8 weeks. 

Section Iv. Double Indemnity. — If such injuries, cau^ng any of the losses de- 
scribed in Sections I, II or III, are sustained fa) while a pai^nger in or on a public con- 
ve3rBnce provickd by a common carrier for i>assenger service (including the platform, 
§tepa or running board of railway or street railway cars); or (b) while a passen^r in a 
elevator (excluding elevators in mines); or are caused (c) by the burmng of a 



56 CONNECTICUT GENERAL LIFE INSURANCE COMPANY 

building while the Insured is therein at the commencement of the fire; or (d) by the 
collapse of the outer walU of a building whQe the Insured is therein; or (e) by a stroke 
of lightning; or (f ) by a cyclone or tornado; or (g) by the explosion of a steam boiler; 
the Company will pay double the amount otherwise payable under the sections above 
mentioned. 

Health Insurancx. 

Section V. Temporary Disability.— Total. (A) If by reason of any sickness 
or disease contracted during the term of this policy and not hereinafter excepted, the 
Insured shall be treated by & physician and independently and exclusively of all other 
causes be wholly and contmuously prevented from perf ormin|[ any and every duty per- 
taining to his occupation, the Company will pay a weekly mdemnity of twenty-five 
dollars, for the period of such disability, but not exceeding fifty-two weeks. 

Partial. (B) If immediately following such period of tot^ disabilitv the Insured 
shall by reason of such sickness or disease, and independently and exclusively of all 
other causes, be wholly and continuously prevented from performing one or more im- 
portant daily duties pertaining to his occupation, sustaining a loss of at lea.st one-half 
nis business time each day, the Company will pay one-half of the weekly indemnity 
hereinbefore provided for the period of such disability but not exceeding twenty-six 
wedLs, nor will payment be made for total and partial disability combined in excess of 
fifty-two consecutive weeks' duration. 

Section VI. Pericanent Disability. — If, bv reason of any sickness or disease 
contracted during the term of this policv and not hereinafter excepted, the Insured shall 
be treated by a physician and independentlv and exclusively of all other causes, during 
the term hereof, entirely and irrecoverably lose the sight of both eyes, or pomanently 
and entirely lose the use of both hands or both feet, or one hand and <me foot, and shall 
by reason thereof be wholly and continuously prevented for the term of one year, add 
will thereafter and during his life, by reason thereof, be prevented from engaging in any 
work or occupation for wages or profit, the Company will, in addition to the weekly 
indenmity provided for in Section V (A), pay a sum equal to the weekly indemnity 
hereinbe/ore provided for forty-eight weeks. Payment for permanent disability under this 
section shaU terminate this policy. 

Section Vn. Surgical and Hospital Benefits. — A. If the Insured shall sustain 
a bodily injury covered by this policy and solely as a result thereof, or if by reason of 
any sickness or disease not hereinafter excepted, any operation described in this dause 
"Schedule of Operations" shall be performed by a surgeon within ninety days from 
the date of the accident or commencement of said sickness or disease, the Company will 
pay the sum specified for said operation in addition to any other indemnity to which 
the Insured may be entitled. It more than one such operation shall be penormed, on 
account of any one cause of disabUity, the Insured shall receive only the largest surgical 
benefit provided in the Schedule for any one of the operations so performed. 

Schedule of Operations. — ^The amounts payable are the following stated percentages 
of the weekly indemnity for one week: Abscess — incision, 20; abdomen — (laparotomy), 
cutting into abdominal cavity for diagnosb or treatment of organs therein, 400; ampu- 
tation of: arm or leg, 200; forearm, hand or foot, 100; finger or fingers, toe or toes, 40; 
thi^h, 300; aneurism — tymg of arte^, 140; appendicitis — (see abdomen). Bone — ^in- 
juries to or disease of. Removal of diseaisea portion, 100; carbuncle — ^incision, 20; 
chest — cutting into lot diagnosis or treatment of organs therein, 100; cancer of lip — 
removal of by cutting operation, 100; dislocation — reduction of: lower jaw or wrist, 60; 
shoulder, elbow or ankle. tOO; thimb, 40; fingers or toes, 20; hip or knee, 140; excision — 
removal of: shoulder or hip joint, 400; elbow, wrist or ankle joint, 200; knee joint, 300; 
eye, ear, nose or throat — any cutting operation, 40; eye — ^removal of, 200; felon — incision, 
20; fractures — ^reduction of: nose, lower jaw, collar bone, shoulder blade, forearm or 
wrist, 100; breast bone, ribs, coa:3rx, or toes, 40; arm, 140; bones of the hand or foot, 
60; fingers, 20; bones of the pelvis (except coccyx) or thigh, 300; knee cap, or leg, 200; 
goitre — cutting operation for permanent cure, 300; gunshot wounds — treatment of, not 
necessitating amputation or any cutting operation into abdominal cavity, 50; hydrocele — 
incision and treatment of sac, 100; hydrophobia — Pasteur treatment, 200; intestinal 
obstruction — (see abdomen). Kidney (see abdomen). Mastoiditis — cutting operation 
for removal of diseased bone, 200; nerve — cutting operation for stretching, 100; par- 
acentesis — ear drum, hydrocele or joints, 40; chest or bladder, 60\ abdomen, 100; peri- 
tonitis — (see abdomen). Rectum — cutting operation for hemorrhoids, external, 60; hem- 
orrhoids, internal, 100; prolapsed, 100; fistula in ano, 100; maligmmt stricture, 400: 
skull — cutting into cranial cavity^ 400; spine or spinal cord — operation with removal 
of fractured vertebra, 400; stone m bladder — ^removal of by crushing or cutting opoa- 
tion, 300; stricture of oesophagus — cutting operation (external), 400; synovitis — mcision 
into joint for treatment, 100; tetanus — objection of anti-toxin into skull, 400; injection 
of anti-toxin into spinal canal, 200; trachea — cutting into for removal of foreigp bodies 
or for relief of difficult breathing, 140; tumors — removal of, by cutting operation: ma- 
lignant, 200; benign, 60; varicose veins — ligation or excisbn, 100; varicocele — cutting 
operation for permanent cure, 100; wounds — suturing, 20. 

B. If the Insured shall sustain a bodily injury covered by this policy, which shall not 
result in death or other disability but which shall require surgical treatment, the Com- 
pany will pay the amount actually expended for such treatment, but not exceeding the 
amount herembefore provided for weekly indemnity for one week. 

C. If a bodily injury or sickness or disease causing any loss described in or for which 
indemnity as provided in Sections II, III or V is payable, necessitates the removal of 
the Insured to a hospital within ninety days from the date of the accident or commence- 
ment of disability from sickness or disease, the Company, in addition to the other in- 
-'-nmity payable, will pay the amount expend^ weekly by him for hospital charges, 



but not in excess of fifty per cent, of the weekly indemnity hereinbefore provided for 
one week, or for a period of more than twenty weeks. 

Section VIII. iDENrmcATiON. — ^If the Insured by reason of injury or illness shall 
be physically imable to communicate with his relatives or friends, the Company, upon 
receipt of a telegram or other message giving the number of this policy, will immediately 
transmit to his relatives or friends any information respecting him and defray the ex- 
pense necessary to put the Insured in the care of his relatives or friends, provided such 
expense shall not exceed the sum of one hundred dollars. 

Foe Standard Provisions See Page 11 

Additional Provisions. 
(a) A copv of any assignment of interest under this policy shall be given to the Com- 
pany within thirty days from the date thereof; and the Company shall not be responsible 
for the validity of any assignment. 

^ (b) The insurance under Sections I, IT, m and IV shall not cover accident, injurv, 
disability, death or other loss caused directly or indirectly, wholly or iMurtly, by bodily 
or mental infirmity, ptomaines, bacterial infections (except pyogenic infections which 
shall occur simultaneously with and through an accidental cut or wound), or b^ any 
otha kind of disease; nor shall it cover any injury, fatal or non-fatal, caused du-ectly 
or indirectly by war or by any act of war, or sustained by the Insured while participating 
in or in consequence of havmg participated in aeronautics; nor shall it cover naval or 
military service in time of war. 

^ (c) The insurance under Sections V and VI shall not cover sickness or disease occa- 
sioned by or while engaged in milita^ or naval service; nor shall it cover sickness or 
disease contracted or disability sustained in the tropics or any part of Alaska or the 
British possessions in America north of the sixtieth d^ree of north latitude. Nor shall 
it cover any disability for any period for which the Insured has either made claim or 
may be entitled to indemnity from this or any other company or association, for or on 
account of injuries by accidental violence. 

(d) The copy of the application endorsed hereon is hereby made a part of this con- 
tract; no provision of the charter or by-laws of this Company shall avoid this policy 
<a be used in evidence or defence of any claim arising hereunder; but these requirements 
shall not be deemed to apply to the premium rates and classification of risks referred to 
in Standard Provision 1. 

(e) This policy may be renewed subject to all its provisions, from term to term of 
twelve months with the consent of the Company and by the payment of the premium 
in advance until the Insured shall attain the age of fifty-one years. If the policy shall 
be renewed thereafter, the premium shall be seventy-two and one-half dollars. 

In witness whereof, the Connecticut General Life Insurance Com^ny has caused 
this policy to be signed by its presidmt and secretary, and countersigned by a duly 
commissioned agent. 



58 THE CONTTNENTAL CASUALTY COMPANY 

The Continental Casualty Company 

CHICAGO, ILL. 

Commenced Business 189S. H. G. B. Alexander, Prs. and Gen. Mgr. 

W. H. Betts, Secretary. 

The Continental issues accident policies under the following 
classifications of risks: Select, preferred, extra preferred, ordinary, 
medium, special, hazardous, extra hazardous, perilous, extra 
perilous and classes for railroad engineers, firemen and freight 
conductors, freight brakemen and sectionmen. 

PkEMiUMS. — For $5000 death and $25 weekly indemnity the 
annual rate is $20 for select risks, $25 for preferred and $37.50 
for ordinary. Combination policies providing double benefits for 
railway, steamship, elevator and burning hotel, and theatre 
accidents are issued at an increased cost of $5 per annum. Health 
insurance covering 42 specified diseases, in connection with acci- 
dent policies, costs $10 additional per annum for each $25 weekly 
indemnity, covering all diseases, in connection with accident 
policies, costs $30 additional per annum for each $25 weekly 
indemnity. 

Benefits. — A $5000 policy provides the following benefits: 
For accident, death, loss of two limbs, or the entire sight of both 
eyes, $5000; for loss of one hand or one foot, $5000; for loss of the 
entire sight of one eye, $2500; for total loss of time, $25 per week, 
limit 5 years; partial loss of time, $2.50 to $22.50 per week, limit 
52 weeks. 

Age Limit. — Eighteen to sixty. 

Maximum Indemnity. — Death, $10,000; weekly, $75. 

POLICY FORM—'Terfection," No. 9, Duability. 

Principal Sum, $5000-$ 10,000. Weekly Indemnity, $25-$50. 

Annual Premium, $60. 

The Continental Casualty Company, in consideration of the 
agreements and statements contained in the application herefor 
and the payment of an annual premium of $60 as therein provided, 
does on this first day of December A. D. 1913, 

Hereby insure Mr. John Doe (hereinafter called the Insured), in class select of the com- 
pany, as a bank cashier, in the principal sum of five thousand dollars with weekly acci- 
dent indemnity of twenty-five dollars, and weekly sickness indemnity of twenty-five dollars, 
and promises to pay to him or his beneficiary, Maxy Doe, his wife, the respective indemni- 
ties hereinafter provided. 

The insurance given by this policy is against loss of life, limb, limbs, sight or time 
resulting from personal bodily injury (suicide or self-destruction while either sane or insane 
not included) which is effected solely and independently of all other causes by the hap- 
pening of a purely accidental event and against loss of time from sickness, all in the 
manner and to the extent hereinafter provided. 

Part I. Specific Accident Indemnity. — If, within the limit of time named in this 
part, any one of the following losses shall result to the insured necessarily and solely 
from such injury as is before described, the companv will pay the respective indemnity 
here provided, (a) For loss of life, or (6) for loss of both hands or f cnr loss of both feet 
or for ioss of the entire sight of both eyes, or (c) for loss of one. hand and one foot or 
for loss ot one hand and tne entire sight of one eye or for loss of one foot and the entire 
sight of one eye, said principal sum^ (d) for loss of either arm ot either leg, three-fourths 
said prindiNil sum; (e) for loss of either hand or for loss of either foot, or (/) f or loss of 
the entire sight of one eye, one-half said principal sum. 



THE CONTINENTAL CASUALTY COMPANY «0 

It the iosuxed, during the entire period intervening between the happening of the mc{o 
dental event and the occurrence of any one of the above losses, shall be whdly and con- 
tinuously disabled by the injury from performing each and every dut^ pertaining to hi$ 
occupation, then the company in addition to the above indemnity will pay said weekly 
accident indemnity for such period of the disability. 

Loss as above used with reference to hand or foot means complete severance at or above 
the wrist or ankle; as used with reference to arm or leg means complete severance at or 
above the elbow or knee; and as used with reference to sight means a loss that is irrecover- 
able. 

The limit of time referred to i»this part is five ycais in all cases where the insured is 
at once after the happening of the accidental event wholly disabled thereby from perform- 
ing each and every duty pertaining to his occupation and remains continuously so dis- 
abled until the occurence of the loss. The said limit of time is one himdred days in all 
other cases. 

Part II. Weekly Accident Indemnity.— Indemnity as provided in this part is 
passable only in the event the injury does not result in any of the losses for which pro- 
vision is made in part I. 

A. Total Loss of Time.— If injuiy such as before described shall at once and continu- 
ously after the occurence of the accidental event wholly disable the insured from per- 
forming each and every duty pertaining to his occupation the company will pay said 
weekly accident indemnity for such period as the insured shall be so disabled. 

B. Partial Loss o» Time.— If injury such as before described shall not at once 
wholly and continuously disable the insured but shall thereafter within one hundred 
days wholly disable him, or shall» either at once after the injury or at once after a period 
of total disEibility, prevent him from periorming work substantially essential to his duty 
or duties, the company will pay one-half said weekly accident indemnity for such consec- 
utive period, not exceeding fifty-two weeks, as he shall be so disabled. 

Part III. Double Accident Indemnity— The company will pay double the indemnity 
otherwise payable under Part I or Part II of this policy if the injury causing the loss 
is sustained by the insured (1) while riding as a passenger in or on any passenger 
conves^ance (including the platform, steps or running board thereop provided and operated 
by a common carrier for a regular passenger service; or (2) while riding as a passenger 
in an elevator provided for passenger service only; or (3) while in or on a burning build- 
ing or while escaping therefrom; or (4) by a stroke cd lightning; or (5) by the collapse 
of any building; or (6) by the explosion of a steam boiler. 

Part IV. Annual Increase.— Each annual renewal of this policy shall add ten per 
cent to the principal sum hereof, if the whole annual premium be paid in advance, and 
shall add five per cent to the principal sum hereof if the premium be paid otherwise; 
but the total of such increase in either or both instances shall not exceed fifty per cent. 

Part V. Speoal Specific AcaoENT Indemnity. — If sunstroke, hydrophobia or 
the involuntary and unconscious inhalation, of gas or other poisonous vapor, caused in 
either instance by purely accidental means shalTresult independently of aU other causes 
in the death of the insured within one hundred davs from the date of exposure or infec- 
tion, the company will pay said principal sum and in addition thereto said weekly acci- 
dent indemnity for the period from the time of occurrence to death. Blood poisoning 
or septicaemia resulting dizectly from bodily injury shall be deemed to be included in 
the term " bodily injury.'* 

Part VI. Accident Indemnity Optional wriH the Insured.— If the insured shall 
sustain such injury as is before described and which is also named in the schedule in this 
Part, he may elect, subject to all the terms and conditions of the policy, to receive in 
advance and in lieu of all other indemnity provided in this policy, except such as may be 
payable under the provisions of Part VII, indemnity in one sum according to such sched- 
ule, provided he signifies his choice in writing, mailed to and received by the company 
at its office named herein as place of issue, within twenty days from the date of the aca- 
dent causing the injury. If the insured is entitled to double indemnitv as provided 
in Part III, the indemnity payable at his election under this part shall be doubled in like 
manner. 

If the ori^nal weeklv accident indemnity provided in this policy is twentv-five dollars 
the indenuuties payable shall be the respective amounts named below. If the original 
weekly accident mdemnity named in this policy is more or less than twenty-five dollars 
the indemnities payable shall be increased or reduced proportionately. Fcnr loss of cer- 
tain members by. complete severance, viz.: Of one or more fingers (at least one entire 
phalange), $150; of one or more entire toes, $200. For complete hernia: caused solely 
and directly by accidental injury, $75. For complete dislocation, viz.: Of the shoulder, 
1100; of the elbow, $100; of the wrist. $125; of the hip. $300; of the knee. $150; of the bones 
of foot, not toes, $150; of the ankle, $150; of two or more fingers, $50; of two or more 
toes, $50. For complete fracture of bones, viz.: Of the skull, both tables, $300; of the 
lower jaw, $75; of the clavicle (collar bone), $150; of the pelvis, $250; ci the thigh. 
1300; of the leg, $200; of the patella (knee cap), $200; of the arm between elbow and 
shoulder , $200; of the forearm, between wrist and elbow, $150; of two or more ribs, 
1100; of the foot or two or more toes, $125; of the hand or two or more fingers, $125; 
of the scapula, $175. 

Part VII. Indemnity for Operations.— If injury or sickness sustained by the In- 
sured and covered by this policy shall necessitate any surgical operation named in the 
schedule endorsed hereon and which is performed within one hundred days of the injury, 
or the commencement of the sickness, the company will pay the sum therein specified 
in addition to the indemnity otherwise given, but such payment shall not be niade for 
more than one operation at the result of any one accident or sickness. 

Part VIII. Fhysioan's Services. — If the insured shall suffer injury as aforesud 
and such iiyuiy doss not cause any loss or operation for which mdemnity is payable under 



t 



the terms of this policy, but does necessitate a physician's services, the compahy will 
reimburse the insured for the reasonable cost of such physician's services, not to exceed 
the sum hereinbefore named as weekly accident indemnity, provided the physictan's 
receipt on the company's blank is furnished to the company at its office named herein 
as place of ijsue witnin thirty days of the event causing the injury. 

Part IX. OaDiNxay Sickn£SS Indeunity.— The health insurance given by this 

•licy do2s not take effect until fifteen days after the rest of the policy is effective. 
. the policy lapses for non-pavment oi premium, the health insurance can be rein- 
stated only as provided in the third standard provision. 

In the event that the insured, while this part is in force shall suffer from any bodily 
sickness or disease, which is contracted and begins during said time, the company will 
pay for loss of time, not exceeding fifty-two consecutive weeks in duration, and actually 
and necessarily resulting from such sickness or disease, as foUows: (a) For loss of time 
during confinement, said weekly sickness indemnity; (o) for loss of tune during conva- 
lescence, one-half said weekly sickness indemnity. 

"Loss of time during confinement," as herein used, means that period of time during 
which the insured is rendered continuously unable to transact each and every part of 
his business duties and is also necessarily and continuously confined within the house 
arid is therein regularly treated by a legally qualified physician. "Loss of time during 
convalescence," as herein used, means that period of time during which the Insured is 
rendered continuously unable to transact each and eveiv part of nb business duties and 
is under treatment by a legally qualified physician, although not necessarily confined 
within the house. 

Part X. Special Indeunity foe Blindness or Paralysis.— In the event that any 
disease for which indemnity is pavable under the terms oi this policy shall result, inde- 
pendently of other causes, in the irrecoverable loss of the entire sight of both eyes or in 
permanent paralysis whereby the insured shall lose the use of both hands or both feet, 
or of one hand and one foot, and on account of either of said conditions be permanently 
unable to en:^ge in any labor or occupation, the company will pay said weekly sickness 
indemnity for the period of such blindness or paralysis, but not extending beyond one 
hundred and four weeks from the commencement oi the illness or disease causing the 
blindness or paralysis. 

No payment under the terms of this part X shall be due or payable until such perma- 
nent blindness or paralysis has continued for one year; further payments, if any, shall 
then be due and payable every sixty days but no payment whatever shall be due or pay- 
able except up3n proof of the continuance of the blindness or paralysis during the period 
for which payment is claimed. No claim will be paid under both Part IX and 
Part X for any concurrent time and all indemnity shall cease upon the death of the insured. 

Part XI. Hospital Indemnity. — If the insured by reason of injury or sickness for 
which indemnity is payable under the terms of this policy shall be under treatment 
and abo be resident at a licensed hospital, the weekly indemnity otherwise payable for 
loss of tinne during the period of sucn residence, not exceeding ten consecutive weeks, 
shall be increased fifty per cent. 

Part XII. Registration and Identipication.— The insured is registered with the 
company under the number of this policy and the company agrees that in event he 
shall by reason ci injurv or illness be physically unable to communicate with his friends 
it will, upon receipt of telegram or other message giving policy number, immediately 
transmit the information received to the beneficiary named herein or if his estate be 
named os oenelciary then to such person as he may have designated for that purpose; 
and, further, that it will pay all expenses necessary to put the insured in communicatiou 
with and in the care of friends; provided, however, that the expense to the company 
of all such prodeecings shall not exceed the siun of twenty dollars for each one thousand 
dollars of the principal sum named in this policy. - 

Part XIII. Miscellaneous Provisions. — The copy of application hereto attached 
or hereon endorsed is hereby made a part of this contract. No provision of the charter 
or by-laws of the company not included herein shall avoid the policy or be used in evidence 
in any lei^ proceeding thereunder. Strict compliance on the part oi the insured and 
the beneficiary with all the provisions <rf this policy is a condition precedent to recovery 
hereunder, and any failure in this rexpect shall foiieit to the company all right to any 
indemnity. Indemnity will be paid for sickness only for the time the insured is under 
theprofessional care and regular attendance of a legally qualified phvsician or surgeon. 

The occurence of any loss for which indemnity is pa^ble under the terms of Part I 
shall at once terminate the insurance effected by this policy and no indemnity will be paid 
under any circumstances for more than one of the losses for which provision is made in 
that part. Not more than one indemnity provided in this policy will be paid for loss 
resulting concurrently from accident and sickness. 

This policy covers only those injuries received within the civilized limits of the globe, 
or received anywhere while traveling by regular lines of passenger conveyance, and does 
not cover any loss or operation caused by disease contracted or sustained in the tropics 
or Alaska or America north of the sixtieth parallel of latitude. 

No assignemnt of this policy or of any claim arising hereunder and no waiver or change 
of any of its provisions, definitions or limits shall be valid unless approved in writing 
by the president or secretary of the company and such api»-oval endorsed hereon. Tli« 
insured may at any time release the company from any and all liability then existing 
or thereafter accruing to the beneficiary. 

^ This pdicy, except Parts IX and X, takes effect at twelve o'clock, noon, standard 
time, at residence of insured, of the date hereof and the whole policy expires one year 
therefrom at the same time, unless renewed. Parts IX and X take effect fifteen days 
after said oate hezeu i all premium due meanwhile has been paid as agreed. 

For Standard Provisions Seb Page U 



THE CONTINENTAL CASUALTY COMPANY 



61 



In witness wkereqf, the Continental Caaoalty Company has caused theae preaente 
to be signed by its pzesident and secretary; but the same shall not be binding upon the 
company unless countersigned by a policy writer. 

Issued with rider form No from the oGot of the company at and 

countersigned the day and year fint written above. 

Schedule ov Operations. — (Indemnities for surgical operationa— See Part VTI)* 
If the principal sum of this policy is $5,000 or over, the amounts payable shall be the respec- 
tive amounts named below. Ii less than $5,000 the payments shall be reduced propor- 
tionately. Appendicitis see li^parotomy, $100. Amputation of foot, hand or forearm, 
$25; leg, or arm above elbow. $50; thigh. $100; finger or fingers, $10. Aneurism (tumof 
ai artery) — ligation, $50. Abscess or boil— incision, $5. Bone abscess — trephining, 
$25. Bronchotomy, thryotomy» bryngotomy, laryngotracheotomy ot tracheotomy, 
$50. Cancer — extirpation, $50. Carbuncle— incision and treatment, $5. Caries (bone 
ulcer) — curetting. $15. Cyst— incision and removal, $10. Dislocation, reduction of 
fhoulder, elbow, hip, knee or ankle, $25; wrist or lower jaw, $15; thumb or finger, $10. 
Excision of shoulder, hip (V knee joint, $100; elbow, wrist or anklejdint, $50; toe or toes. 
$25. E^e, ear, nose or throat — any cutting operation, $10. Eye — enucleation, $7& 
Felon — ^incision, $5. Fractures, reduction of nose, lower jaw, collar bone or shoulder 
blade, $25; breast bone, $10; rib or ribs, $10; upper arm. $35; forearm (one or both bones), 
$25; wrist or hand, $15; fingers, $10; any of the bones of the pelvis or sacrum, $50; coccyx, 
$10; thigh, $75; knee cap or leg bones (one or both), $50; bones <rf foot, $15; toe or toes, 
$10. Ganglion (cystic tumor of tendon sheath) — incision and curetting, $15. Goitre — 
cutting operation for radical cure, $75. Gunshot wounds, treatment not necessitating 
amputation or laparotomy, $25. Hernia (abdominal) — ^any cutting operation for the 
radical cure of the reducible, irreducible or strangulated form, $100. Hydrocele — tap- 
ping — indsion or excision of sac, $25. Hydrophobui — Pasteur treatment, $50. Ingrow- 
ing toe nail — removal, $10. Intestinal obstruction see laparotomy, $100. Kidney — 
fixation or removal, $100. Laparotomy (opening of the abdominal cavity iot an opera- 
tion on any organ contained therein, or f<Hr traumatic, peritonitis or exploratory incision), 
$100. Lithotomy — operation for removal of stone in bladder— any cutting, $100. 
Mastoiditis — operation for, $50. Meningitis — ^trephining for drainage, $25. Necrosis 
(death of bone), sequestrotomy (removal of dead bone), $35. Oesophagotomy for stric- 
ture or other cause; $100. Paracentesis — tapping of abdomen, $25; bladder, $25; ear 
drum, $15. Peritonitis (see laparotomy), $100. Rectum — operation for hemorrhoids 
(external or internal)— excision or ligation, $25; prolapsed— operation for, $25; fistula 
in ano — incision, $26; polypus — extirpation, $25. Malignant stricture — excision or 
colostomy, $100. Skuu trephining for fracture, $100; Syiiovitis (inflammation of the 
lining membrane of a joint) — incision, $25. Tetanus — injection of anti-tetanic serum 
into frontal lobe of brain, $100. Tumors— extirpation from any part of the body— be- 
nign, $15; malignant, $50. Varicose veins — ligation or excision, $25. Varicocde — 
acupressure — ^ligation or excision, $25. Wounds ci scalp, or other parts, suturing, $5. 



INDUSTRIAL DEPARTMENT. 

A policy fee of $5 is payable when the policy is issued and pays 
for the policy and the insurance for the current month. Insurance 
against accident takes effect immediately upon the issuance of the 
policy; insurance against illness takes effect at the expiration of 
sixty days. 

Men between ages 18 and 50 are taken at schedule rates and ages 
51 to 60 at 50 per cent over schedule rates. 

Two forms of policy are issued, "special" and "ordinary," the 
only difference between the two being that the "special" pays for 
the first week of illness, which the "ordinary" does not. 

Reinstatement. — Policies in arrears can be reinstated upon pay- 
ment of the premium and a small fee. 
The following table shows the indemnities provided for a monthly premium of $2. 



For Loss or Lite. 


OR Both Hands, or Both Feet. 






OR One Hand and One Foot, or Entire 


Monthly Indemntty 




Sight of Both Eyes 


For Loss o» Timb 






Additional 


Totol 


Accident 






Payment 


Monthly Annuity 


Payment 


.?y 


i^ss 






Single, 10 year 










Illness 




Single 


Double 


Double, 20 year 


Single 


Double 


Single 


Double 






$ 


$ 


$ 


$ 


$ 


$ 


$ 


A .... 


250 


500 


50 


6,250 


12,500 


50 


100 


50 


B ... 


225 


450 


45 


5,625 


11,250 


45 


90 


45 


C .... 


200 


400 


40 


5,000 


10.000 


40 


80 


40 


XC... 


176 


350 


35 


4,375 


8.760 


35 


70 


35 


D.... 


150 


300 


30 


3,750 


7,500 


30 


60 


30 



C2 THE CONTINENTAL CASUALTY COMPANY 

Proportionate indemnities and annuities ace provided for the loss of either hand, or 
the loss of either foot, or the loss of the sight of either eye. Policies providing larger 
indemnities are sold at proportionate cost. 

POLICY FORM— "Perfection" General Health. 

The Continental Casualty Company, hereinafter called the 
company, in consideration of the agreements and statements con- 
tained in the application herefor and the payment of an annual 
premium of $35 does on this first day of December, A. D. 1913, 

Hereby insure Mr. John Doe (hereinafter called the insured), and promises to pay 
him a weekly indemnity of twenty-five dollars in the event that he shall suffer loss from 
sickness or disease, all m the manner and to the extent hereinafter provided. 

Part I. Ordinary Sickness Indemnity.— In the event that the insured, shaR suffer 
from any bodily sickness or disease, which is contracted and begins not less than fifteen 
days after the delivery oi this policy to him while he is in good health, the company will 
pay for loss of time, not exceeding fifty -two consecutive weeks in duration, ana actually 
and necessarily resulting from such sickness or disease, as follows: (<i) For loss of time 
during confinement, said weekly iademnity; (6) for loss ol time during convalescence, 
one-half said weekly indemnity. 

*'Loss of time during confinement,*' as herrin used, means that period off time during 
which the insured is rendered continuously unable to transact each and every part of 
his business duties and is also necessarily and continuously confined within the house 
and is therein regularly treated by a legally qualified physician. "Loss of time during 
convalescence, ** as herein used, means that period of time during which the insured 
b rendered continuously unable to transact each and every part <» his business duties 
and is under treatment by a legally qualified physician, although not necessarily coo- . 
fined within the house. 

^Part IL Hospttal Indemmtty.— The indemnity otherwise payable tinder the pro- 
visions of paragraph A of Part I hereof shall he increased fifty per cent for such period of 
time, not exceeding ten consecutive weeks, as the insured shall be under treatment at 
a licensed hospital and also be resident therein. 

Part III. Special Indemnity for Bluioness or Paralysis.— In the event that 
any diseases for which indemnity is payable under the terms of this policy shall result, 
independently of other causes, in the irrecoverable loss of the entire sight of both eyes 
or in permanent paralvsis whereby the insured shall lose the use of both hands or both 
feet, or of one hand and one foot, and on account of either of said conditions be permanently 
unable to engage in any labor or occupation, the company will pay said weekly indemnity 
for the period of such blindness or paralysis, but not extending beyond one hundred and 
four weeks from the commencment of the illnwn or disease causing the blmdness or para- 
lysis. 

No payment under the terms of this Part III shall be due or payable until such per- 
manent blindness or paralysis has continued for one year; further payments, if any, 
shall then be due and payable every sixty days but no payment whatever shall be due or 
payable except upon proof of the continuance of the olmdness or paralysis during the 
period for which payment is claimed. No claim will be paid imder Part I and Part III 
MMT any concurrent time and all indemnity shall cease upon the death of the insured. 

Part IV. Indemnity for Operations.— In the event that any disease for which in- 
demnity is provided by the terms of this policy shall necessitate a surgical operation 
named in the schedule of operations in this part, and such operation shaU be Derformed 
within one hundred days of the commencement of the disease, the company will pay the 
sum specified in said schedule for each five dollars of said weekly indemnity provided by 
this policy; provided always that indemnity under this Part shall not be payable for more 
than one operation as a result oi any one sickness or disease: it being agreed in this con- 
nection that in the event of two or more operations for which indenmity otherwise would 
be payable the insured may elect the one for which the company shall be liable. Appendi- 
citis (see laparotomy) $20. Aneurism (tumor of artery)— ligation, $10. Abscess or 
boil — incision, $1. Bone abscess — trephining, $5. Bronchotomy, thyrotomy, laryn- 
gotomy, laryngotracheotomy, or tracheotomy, f 10. Cancer — extirpation, $10. Car- 
buncle—incision and treatment, $1. Caries (bone ulcer) — curetting, $3. Cyst— ina- 
sion and removal, $2. Eye, ear, nose or throat — any cutting operation, $2. Eye— enu- 
cleation, $15. Felon— incision, $1. (Sanglion (cystic tumor of tendon sheath)— inci- 
sion and curetting, $3. Goitre— cutting operation for radical cure, $15. Hernia (ab- 
dominal) — ^any cutting operation for the radical cure of the reducible, irreducible or 
strangulated form, $20. Hydrocele — tapping — incision or e.Tcision of sac, $5. Hydro- 
phobia — Pasteur treatment, $10. Ingrowing toe nail— removal, $2. Intestinal obstruc- 
tion (see laparotomy), $20. Kidney— fixation or removal, $20. Laparotomy (open- 
ing of the abdominal cavity for an operation on any organ contained therein, or for 
traumatic peritonitis or exploratory insicion), $20. Lithotomy (operation for removal 
of stone in bladder)— any cutting. $20. Mastoiditis— operation for, $10. Meningitis-- 
trephining for drainage, $5. Necrosis (death of bone), sequestrotomy (removal of deao 
bone), $7. Oesophagotomy for stricture or other cause, $20. Paracentesis— tapping oi 
abdomen, $5; bladder. $5; ear drum, $3. Peritonitis (see laparotomy), $20. Rectum- 
operation for — hemorrhoids (external or internal) — excision or ligation, $5; prolapsed 
operation for, $5; fistula in ano— incision, $5; polypus— extirpation, $5. Mahgnani 
stricture— excision or colostomy, $20. Synovitis (inflammation of the hning membrane 
of a joint)— incision, $5. Tetanus— injection of anti-tetanic serum into frontal tobeji 
bcBin,$2Q. Tumop-^xtirpation fram any part of the body— benign, $3; maKgnant, tw 



THE CONTINENTAL CASUALTY COMPANY 



Varicose vdnsn-ligfttioii or eadsion, 15. Varicocele— acupressure— ligation or excision. 

Part V. Miscbllansous Peovisions. — The copy of application hereto attached or 
hereon endorsed ia hereby made a part of this contract. No provision of the charter or 
by-laws of the comoany not included herein shall avojd the policy or be used in evidence 
in any legal proceeding thereunder. 

Strict compliance on the part of the insured with all the provisions of this policy is a 
ooinditi<»i precedent to recovery hereunder, and any failure in this respect shall forfeit 
to the company all ri^ht to any indemnity. This policy does not cover any loss or opera- 
tion unless the same is caused by disease covered hy Part I hereof; nor does it cover any 
loss or operation caused by disease contracted or sustained in the tropics or in Alaska 
or in America north of the sixtieth parallel of latitude. 

Indemnity will not be paid under this policy for any loss which results wholly or in 
purt from injury or accident, nor for any loss of time which results concurrently from in- 
jury and disease. Indemnity will be paid for sickness only for the time the insured is 
under the professional care and regular attendance of a legally qualified physician or 
surgeon. 

No assignment of this policy of any claim arising hereunder shall be valid unless ap- 
pioved in writing by the president or secretary of the company and such approval en- 
dorsed hereon. The insurance given by this policy takes e£fect fifteen days after its 
delivery to the insured while he is in good health, and the company shall not be liable 
for any losa resulting from any disease contracted or comraencmg before that time or 
contracted or commencing while the insured shall be in default in the payment of premium. 
This poJicy expires at twelve o'clock, noon, standard time, at residence of insured, one 
year uom date hereof unless it be renewed. 

For Szamdard Provisions See Page 11 



64 



EMPLOYERS LIABILITY ASSURANCE CORPORATION 



Emplovers Liabilitv Assurance Corporation 



LONDON, ENG. 



Commenced Business 1880. 



Samuil Appuetoii, Manager and Attorney. 



U. S. Office, Boston, Mass. 



The Employer's Liability issues accident policies under numerous 
classificatons, but its business is mostly confined to risks of the 
Select, Preferred, Extra Preferred and Ordinary classification. 
The premium rates for three of the main policy forms are as follows: 





Classification 


BsNEPrrs 


FORM OF POLICY 


Select 


Prefer- 
red 


Extra 
Prefer- 
red 


Ordi- 
nary 


Prin- 
cipal 
Sum 


Weekly 
Indem- 
nity 


Regular Accident, (no double indemnities) 
Combination accident, (double indemnities) 
Disability Policy, (accident and sickness) 
Ages, 18 to 60 
Ages, 51 to 60 


$4.00 
6.00 

12.00 
14.00 


$5.00 
5.00 

12.00 
14.00 


$6.00 
7.00 

14.00 
16.00 


$7.60 
8.60 

15.50 
17.50 


$1,000 
1.500 

4.500 
1.500 


$5.00 
5.00 

5.00 
5.00 



POLICY FORM— "Maximum Disability— Form M. D." 
Principal Sum, $7500— $15000. Weekly Indemnity, $25.— $50. 

The Employers Liability Assurance Corporation of London, Eng- 
land, in consideration of sixty dollars premium, and of the statements 
contained in an application for this policy, a copy of which is en- 
dorsed hereon, does hereby insure John Doe (the Insured) of New 
York, engaged in the occupation of an attorney, under classification 
select for the term of twelve months, beginning on the first day of 
January, 1916, at noon, and ending on the first day of January, 1917, 
at noon, standard time, at the place where the Insured resides, 
against bodily injuries sustained during the term of this policy, 
solely and independently of all other causes through external, vio- 
lent and accidental means (suicide whether sane or insane is not 
covered), and against disability by disease or illness, as specified 
in the following schedules, respectively, subject to the provisions 
and limitations hereinafter set forth: — 

SCHEDXTLE 07 INDEMNITIES — ^ACCIDENT INSURANCE. 

The principal sum of this policy is seventy-five hundred dollars ($7,500). 

Section A. Single Indemnity — Death, Dismemberment and Loss op Sight. — If 
such injuries shall wholly and continuously disable the Insured from the date of accident 
from performing any and every kind of duty pertaining to his occupation, and during 
the period of such continuous disability, but within two himdred weeks from date of 
accident, shall result inde^ndently and exclusively of all other causes in any one of 
the losses enumerated in this section, or within ninety days from the date of the accident, 
irrespective of total disability, result in like manner in any^ one of such losses, the corpora- 
tion will pay the sum set opposite such loss and in addition weekly indemnity as pro- 
vided in Section B to the date of death, dismemberment, or loss of sight; but only one 
of the amounts so specified and the additional weekly indemnity will be paid for injuries 
resulting from one accident. 

For loss of life, the principal sum and in addition the cost of transportation of the 
remains from the place (city or town) where death occurred to place (city or town) of 
burial, but not to exceed one-twentieth of the amount payable for loss of life. Both hands 
by severance at or above the wrists, or both feet by severance at or above the ankles, or 
one hand at or above the wrist and one foot at or above the ankle by severance, or entire 
sight of both eyes if irrecoverably lost, or entire sight of one eye if irrecoverably lost and 
one hand at or above the wrist by severance, or entire sight of one eye if irrecoverably 
lost and one foot at or above the ankle by severance, the principal sum; either hand 
by severance at or above the wrist, or either foot by severance at or above the ankle, 
or entire sight of one eye if irrecoverably lost, one-half of principal sum. The payment 
in any such case shall end this policy. 



EMPLOYERS LIABILITY ASSURANCE CORPORATION 65 

Section B. Single Weekly Indemkity— Total and Partial Disability. — If such 
injuries shall not result m any of the losses mentioned in Section A, but shall immediately, 
continuously and wholly disable and prevent the Insured from performing any and 
every kind of duty pertaining to his occupation, the corporation will pay him so long 
as he lives and simers suj± total disability, a weekly indemnity of twenty-five dollars 
($25). Or, if such injuries shall not whoUv disable the Insured, as above, but shidl 
immediately, or immediately following total disability^ and continuously disable and 
prevent him from performing one or more important daily duties pertaining to his occu- 
pation, the corporation will pay for the period of such partial disability, not exceeding 
50 consecutive weeks, a weekly indemnity of one-half the sum stipulated in this section 
for total disability. No i)ayment of weekly indemnity shall be made in case of any 
disability specified in Section A, except as therein provided. 

Section C. Elective Benefits.— If the Insured shall sustain an injury as herein- 
bdore defined, and which is named in the "Schedule of Injuries" hereinafter contained, 
he may elect to receive the amount of indonnity set opposite to said injury in said sched- 
ule in lieu of all other indemnity, except for surgical operations or hospital expenses to 
which Insured may be entitled, provided written notice of his election b given to the cor- 
poration within twenty days trom the date said injury is received, but not more than 
one of said amounts shall be payable for injuries sustained in any one accident. 

Section D. Double Indemnities. — If the Insured shall sustain such injuries while 
a passenger in or on a public conveyance (including the platform, steps or running-board 
thereof) provided by a common carrier for passenger service (including Pullman cars); 
or whOe riding in a passenger elevator or escalator; or in consequence of the burning 
of a building while the Insured is therein, or caused by the collapse of the outer walls dt 
a building while the Insured is therein, or caused by a stroke of lightning, or caused by 
the explosion of a steam boiler, or caused by a cyclone or tornado; then the corporation 
wfll pay double the amoimt otherwise payable under the preceding sections. 

Section E. Indemnity for Medical or Surgical Treatment of Minor Injuries. 
— If such injuries shall not result in disability, but shall require medical or surgical at- 
tention, the corporation will reimburse the Insured for the cost thereof to an amount 
not exceeding one week's single indemnity as provided under Section B, provided the 
physkian's or surgeon's bill is furnished the corporation within thirty days from the 
date of the accident. 

Section F. Sunstroke, Freezing, Hydrophobia or Asphyxiation. — Any of the 
following, namely, — sunstroke, freezing, hydrophobia or asphyxiation suffered through 
accidental means (sukide whether sane or insane is not covered) shall be deemed boduy 
iniuries within the meaning of this policy. 

Section G. Blood-Poisoning. — Blood-poisoning resulting directly from bodily in- 
juries shall be deemed to be included in the said term, bodily injuries. 

Schedule of Indemnities— Health Insurance. 

Section H. Bundness or Paralysis.— If during the term of this policy the Insured 
shall contract any bodily disease or illness, not hereinafter excepted, whkh within one 
year from the date of commencement of disability shall result in the entire and irrecover- 
able loss of ^ght of both eyes, or in permanent paralysis, whereby the Insured shall en- 
tirely lose the#se of both Jumtk, or both feet, or of one hand and one foot, and on account 
of any out '^fiaid conditions will thereafter, and during his life, be permanently dis- 
abled frorit en^ging in any work or occupation for wages or profit, the. corporation 
will, upon rec<iipt by it ol satisfactory proofs of the continuance for one year of such 
blindness or paralysis, pay the Insured a sum sufficient to increase the indemnity there- 
tofore paid for the disease or illness which shall have caused such dbability to a sum 
equal to one hundred weeks' indenmity at the rate specified in Section B. 

Section I. Weekly Indemnity for Illness. — For the period of continuous disabil- 
ity during whkh the Insured shall, independently of all other causes be wholly disabled 
and prevented by bodily disease or illness, not hereinafter excepted, from performing 
any and every kmd of duty pertaining to his occupation, the corporation will pay the 
weekly indemnity specified in Section B: and if following such a penod of total disability, 
he shall be continuously wholly disabled and prevented by bodily disease or illness, 
not hereinafter excepted, from performing at least half the work essential to the duties 
of his occupation, the corporation will pay during the period of such partial disability, 
a we^y indonnity of one-half of the weekly amoimt provided for total disability; but 
no payment shall be made for disability of either or both kmds in excess of fifty-two 
consecutive wedu' duration; payment to be in lieu of all other indemnity under this 
policy eircept for surgical operations or hospital expenses to which he may be entitled. 

Indemnities— Accident and Health Insurance. 

Section J. Surgical Operations. — If by reason of such injuries or illness any of the 
operations named in the "Schedule of Operations" shall be performed upon the Insured 
by a surgeon within ninety days from the date of commencement of disability, the cor- 
poration will pay to the Insured, in addition to the indemnity herein provided, the sum 
specified for such operation in said schedule, but payment shall not be made for more 
than one operation as the result of any one cause of disability. 

SEcnoN K. Hospital Expenses. — If a bodily injury, or an illness for which indemnity 
is payable under this policy, is suffered by the Insured, and if on account of said bodily 
uijury or illness and within ninety days from the date of the accident or inception of 
illness, the Insured is removed to a regular hospital, provided that no claim is made 
under Section ], the corporation will pay the Insured (in addition to the indemnity pay- 
able for said injury or illness) for the period, not exceeding ten weeks, during which the 
umutd is necessarily confined in the said hospital, the amount expended by him oq 



66 EMPLOYERS LIABILITY ASSURANCE CORPORATION 

account of the hospital charges, but not exceeding per week one-half the weekly indemnity 
specified in Section B. 

. Section L. loENnncATiON. — If the Insured by reason of injury or illness shall be 
physically unable to communicate with friends, the corporation, upon receipt of a tele- 
sram or other message giving the number of this imlicy, wil> immediately transmit to 
Bis relatives or ineaak any information respecting him, and will defray all expenses not 
CTCceding one hundred dollars, necessary to put the Insured in the care ci fnends. 
For Stakdard Provisions Sex Page 11 

Other Provisions. 

17. This insurance does n^t cover disability from disease or illness unless the Insured 
is treated by a licensed physician; nor from any disease contracted within fifteen days 
from noon of the date this policy is issued, unless this is a renewal of a previous poUcy 
which i>rovided for indemmt^ against disease or illness; nor does it cover on account 
of any illness contracted while engaged in military or naval service, or contracted or 
suffered outside of the Ihnits of the United States, Canada or Europe, or in the insular 
possessions of the United States, other than the Hawaiian Islands; nor does it cover 
mjuries, fatal or nonfatal, sustained while participating in or in consequence of having 
participated in aeronautics, 

18. During the continuance of war in Europe, Asia and Africa, or any of them, and for 
three months after the declaration of peace by the governments at war, this polky shall 
not cover accident or injury, whether fatal or non-fatal, or illness, sustained anywhere 
on land or sea within the war zone herein described, to wit: the two hundred and ten 
degrees of longitude lying between east of meridian twenty west of Greenwich, and west 
of meridian one hun<u«d and seventy west of Greenwich, which shall result wholly or 
partly, directly or indirectly, from war or riot, or from any weapon, instrument, imple- 
ment, tool, projectile, explosive, gas or contrivance of any kind, used in warfare, or 
which shall result or be caused by damage to, wreckage or loss of, any vessel by whatever 
cause. 

19. If the Insured shall become entitled to indemnity for disability on account of 
accidental injuries, the corporation shall not for the same period of time be liable for 
any disability on account of disease or illness. 

20. Any claims arising hereunder on account of the death of the Insured shall be 
subject to proof of interest. Copy of any assignment shall be given within thirty days 
to uie corporation, which shall not be responsible for its validity. 

Schedule of Operations. 
The amounts stated in the following "Schedule of Operations'* are payable under this 
policy if issued for twenty-five dollars weekly indemmtv, i>roportionate amounts being 
payable if the policy is issued for a larger or smaller weekly inoemnity: Appendicitis (see 
Laparotomy), llOO; aneurism (tumor of artery) — ^ligation, $50; amputation (A: foot, hand 
or forearm, $25; leg or arm, $50: thigh, $100; finger or nngers, $10; abscess or bou — ^in- 
cision, $5; bone abscess — ^trephining, $25; bronchotomjr, thyrotomy, brjmgotoniy, 
laryngotracheotomy or tracheotomy, $50; carbuncle — ^incision and treatment, $5; caries 
(bone ulcer) curetting, $15; dislocations, reduction of: shoulder, elbow, hip, knee or 
anklcj $25; wrist or lower jaw, $15: thumb or fingers, $10; excision of: shoulder, hip or 
knee joint, $100; elbow, wrist or ankle joint, $50; toe or toes, $25; ^e, ear, nose or throat — 
any cutting operation, $10; felon — ^incision, $5; fractures, reduction of: nose, lower jaw, 
collar bone or shoulder blade, $25; breast bone, $10; rib or ribs, $10; upper arm, $35; fore- 
arm (one or both bones), $25; wrist or hand, $15; fingers, $10: any of the bones of the 
pelvis or sacrum, $50; coccyx, $10; thigh, $75; knee cap or leg bones (one or both), $50; 
bones oi foot, $15; toe or toes, $10: ganglion (cystic tumor of tendon sheath) — ^indsion 
and curetting, $15; gunshot wounds— treatment not necessitating amputation or lap- 
arotomy, $25; hernia (abdominal) — any cutting operation for the radical cure ci the 
reducible, irreducible or strangulated form, $100; hjrdrocele — tappin^-^indsion or exci- 
sion of sac, $25; ingjrowing toe nail — removal, $10; intestinal obstruction (see Laparot- 
omy); kidne>^-— fixation or removal, $100; laparotomy (opening of the abdominal cavity 
for an operation on any organ contained therein, or tor traumatic peritonitis, or exidora- 
tory incision), $100; lithotomy (operation for removal of stone in bladder), and cutting. 
$100; mastoiditis — operation for, $50; necrosis (death of bone) — Sequestrotomy (removal 
of dead bone), $35; Oesophagotomy for stricture or other cause, $100; peritonitis (see 
laparotomy); paracentesis — ^tapping of: abdomen, $25: bladder, $25; ear dnnn, $15; 
rectum, operation for: hemorrhoids (external or internal), excision or Ugation, $25; pro- 
lapsed — operation for, $25; fistula in ano — incision, $25; poljrpus — extirpation, $25; 
malignant stricture — excision or colotomy, $100; skull trephining for fracture or other 
cause, $100| synovitis (inflammation of the lining membrane of a joint), incision, $25; 
tetanus — ^injection of anti-tetanic serum into frontal lobe of brain, $100; tumors — tx- 
tupation from any part of the body, benign, $15; malignant, $50; varicose veins — liga- 
tion or excision, $25; varicocele — acupressure — ^ligation or excision, $25; wounds of 
scalp or other parts — suturing, $5. 

Schedxtle of Injuries. 
The amounts stated in the following "Schedule of Injuries" are payable under this 
policy if issued for twenty-five dollars weekly indemnity, proportionate amounts bcdng 
payable if the policy is issued for a larger or smaller weekly indemnity. Ordinary Acci- 
dents, Section B. For loss of certain members by severance, viz.: Of one or more fingers 
(at least one entire phalanx), $150; of one or more entire toes. $200; for complete hernia 
caused solely and directly by accidental injury, $70; for complete dislocatbn, viz.: of the 
fltwulder, $100; of the elbow, $100; of the wrist, $125; of the hip. ^300; of the knee, $150; 



EMPLOYERS LIABILITY ASSURANCE CORPORATION 67 

of any bones of foot or toes, $150; of the ankle, $150; for the complete fracture of bones, 
viz.: of the skull, both tables, $325: of the lower jaw, $75; of the clavicle (collar bone), 
$150; of the pelvis. $250; of the thigh, $300: of the leg, $200; of the patella (kneecap), 
1200; of the arm, between elbow and shoulder, $300; of the forearm between the wnst 
and elbow, $150; of two or more ribs, $100; of the foot other than toes, $125; of the hand 
other than fingers, $125; of two or more toes, $100; of two or more fingers, $100. 

In witness whereof, the corporation has caused this^ policy to be executed by its au- 
thorized manager acting under power of attorney, but it shaU not be in force until coun- 
tersigned by a duly authorized agent ol the corporation. 

POLICY FORM — Maximum Combination Accident, Form M. R. 
Pmncipal Sum, $750(>-$1S,000. Weekly Indemnity, $25-<50. 

Annual Premium, Select, $25. 

This policy is practically the same as the Maximum Disability 
form M. D., with the sickness features excluded. 

Death and Dismemberment Accumulative Accii^nt Policy 
Age Limits. — Eighteen to sixty. 

This policy pays for loss of life or both hands or both feet or one 
hand and one foot or sight of both eyes, $5000. For loss of one 
hand or one foot, $2500. For loss of sight of one eye, $2500. 

If the Insured shall sustain such injuries while a passenger in or 
on a public conveyance (including the platform, steps or running- 
board thereof) provided by a common carrier for passenger service 
(including Pullman cars) ; or while riding in a passenger elevator or 
escalator; or in consequence of the burning of a building while the 
Insured is therein, or caused by the collapse of the outer walls of a 
building while the Insured is therein, or caused by the explosion of 
a steam boiler, or caused by a cyclone or tornado; then the Cor- 
poration will i)ay double the amount otherwise payable under the 
preceding Section. 

Accumulative Benefit. — Each full year's renewal adds five 
per cent to all payments, until such additions amount to fifty per 
cent of the origmal sums. 

Special Indemnities. — For death from sunstroke, freezing or 
asphyxiation, $5000. 

Surgical Operation Expenses. — In addition to the indemnity 
hereinbefore mentioned, will pay actual expenses for surgical treat- 
ment,, hospital charges and graduate nurses. 

Annual Cost. — $3 per $1000 for select and preferred classifi- 
cations. Policies for other amounts at proportionate rates. 



e^ THE EQUITABLE ACCIDENT COMPANY 

J\je Equitable /^^^^^id^i^t Qo/npa^y 

BOSTON, MASS. 



Comiiienced Business 1892. Albert C. Smith, Pres. D. T. Montague, Sec. 

WzuiAic H. Jones, General Manager. 

Plan of Operation. 



The Equitable Accident Comi>any issues combined accident and 
health policies, also separate accident policies for all classifications, 
with standard provisions. 

The Company now has two Departments — Industrial and Inter- 
mediate. The Intermediate policies are quarterly payment policies 
at $4, $5 and $6 a quarter covering both accident and sickness. 

Special attention, however, is paid to the Industrial business, 
with policies at $1, $1.25 and $1.50 a month. The $1.50 per month 
policy called the "Teaco" is the latest Industrial policy and is also 
written on a quarterly basis. No policy fee required. Monthly 
indemnity $60 for total disability from accident for a period not to 
exceed 5 years. Partial disability indemnity, 50% of total for a 
period not exceeding six consecutive months. A special death in- 
demnity for sun-stroke, freezing, hydrophobia, septicaemia and the 
involuntary inhalation of gas is also provided. Surgeon's fees are 
granted up to $10 for any one injury. Disability from blood 
poisoning is covered by the accident provisions. The special 
monthly indemnity provides half monthly accident indemnity for 
total disability for five years for loss of both feet or both hands or 
one hand and one foot in addition to the specific amounts payable 
for such losses. Confining sickness is covered at $50 per month 
for 8 months and non-confining sickness for 2 months at 50% in- 
demnity for confining sickness. One hundred per cent accumula- 
tion and optional cash settlements are also provided. 

Intermediate Department. 

POLICY FORM— "Eureka Disability." 

Princtpal Sum, $1000. Monthly Accident Indemnity, $60. 

Quarterly Premium, $6. Monthly Sickness Indemnity, $50. 

The Equitable Accident Company, Boston, Mass., in considera- 
tion of the representations contained in the application for this 
policy, a copy of which is endorsed hereon, and the payment of 
a premium of six dollars, hereby insures John Doe (hereinafter 
called the insured), occupation banker, with duties as described 
in the application under classification, select, subject to all con- 
ditions and limitations hereinafter contained, from twelve o'clock 
noon standard time at the place where the insured resides on the 
day this policy is dated until twelve o'clock noon such standard 
time of the first day of February, 1915, and upon the payment 
of a premium of six dollars per Quarter, payable in advance on 
"^r before twelve o'clock noon of the first day of the quarter, for 
such further periods as may be mutually agreed upon and paid 
for, with indemnities as follows: 

Accident iNDSBiNrnES. 
Section 1. Total Loss op Time.— At the rate of sixty dollars per month, for loss 
of time, for a period of continuous disability (not exceeding five years), resulting solely 
from bodily injuries sustained through external, violent and accidental means (here- 
inafter called ''such injuries"), which except in cases of accidental drowning shall leave 
external wounds upon the body, visible to the eye, and which shall, from date of accident, 
independent of all other causes, immediately, wholly and continuously disable and pre- 



THE EQUITABLE ACCIDENT COMPANY 69 

vent the insured from perfonuing every duty pertaining to any occupation, but which 
shall not cause the loss of one or both hands, feet or eyes. 

Section 2. Paktial Loss or Tdce.— Or, at the rate of fifty per cent, of the monthly 
benefit provided for total disability for a period not exceeding six consecutive months, 
if "such injuries" shall not from date of the accident wholly disable the insured, but 
shall within thirtv days thereafter wholly disable him, or shall from date of accident, 
orimmediately following total disability, disable and i»]eventthe insured from performing 
at least one-half of the important daib^ duties essential to his occupation, provided the 
maTimum ixriod for which indemnity shall be paid under all accident provisions shall 
not exceed sixty consecutive months. 

Section 3. Specific Total Losses.— Or. if any one of the following specific total 
losses shall result solely from "such injuries" within ninety days from date of accident 
in fieu of any other indemnity. 

For loss of life, or both hands by severance at or above the wrist, or both feet by sev- 
erance at or above the ankle, or one hand, and one foot, by severance at or above the wrist 
and ankle, or entire sight or both eyes if irrecoverably lost, or entire sight of one eye 
if irrecoverably lost and one foot by severance at or above the ankle, or entire aight of 
one eye if irrecoverably lost and one hand by severance at or above the wrist, the prin- 
cipal sum. Either hand by severance at or above the wrist, or either foot bv severance at 
or above the ankle, one-half the principal sum. Entire sight of one eye it irrecoverably 
lost, one-third the principal sum, provided, however, that if prior to the accident the 
insured shall have lost or had only the impaired use of either hand, foot or eye, the loss 
of the other shall be held to be the loss of one member only. If "such injuries" result 
in any of the above-named specific total losses and ako in total or partial disability the 
Company shall not be liable for the disability, except as set forth in Section 7. nor shall 
it in any event be liable for more than one of the specific total losses. 

Section 4. Double Indekmity. — Or, at the rate of double the sum that would, 
under the terms of this policy, be otherwise payable if "such injuries" are sustained 
by the insured while riding as a passenger in or on any railway passenger car provided 
for the exclusive use of passengers, and propelled by steam, cable, compressed air or 
electricity, and not attacned to any freignt, coal or logging train, or while riding as a 
passenger on board a steam vessel licensed for the regiuar transportation of passengers, 
provided "such injuries" shaU be caused directly by or in consequence of the wrecking 
of such car or vessel; by a stroke of Uj^tning; by Uie burning of any building in which 
the insured may be bunied by fire or suffocated by smoke, out this shall not apply to 
oi- cover the insured while acting as a volunteer or paid fireman; by a cyclone or tornado 
causing the destruction of a building whfle the insured is therein; by the explosion of a 
steam Doiler; but excluding from the foregoing double benefits empbyees on or about 
the premises of their employer. 

Section 5. Special Death Indemnity. — If sunstroke, freezing;, septicaemia, caused 
by "such injuries," hydrophobia, or the involuntary or unconscious inhalation of gas 
or other poisonous vapor shall result in the death of uie insured within ninety days from 
date of exposure or infection, the Company's liability shall be one-half the principal sum 
of this policy, and the Company shall not be liable under any other provision of this policy 
for death caused by or contnbuted to, directly or indirectly, by sunstroke, freezing, 
septicaemia, hydrophobia, gas or other poisonous vapors. 

Section 6. Suegeon's Fees. — If ''such injuries" are sustained by the insured and 
are not serious enough to entitle him to indemnity, but do require immediate medical 
or surgical treatment, the Company will reimburse him for the amount expended on account 
of such treatment not exceeding ten dollars for any one injury. 

Section 7. Special Monthly Indeiocnity.— If "such injuries" shall not result in 
death, but shall, within ninety days from date of accident, result, independently and 
exclusively of all other causes, in the loss by complete severance at or above the wrists 
or ankles or both hands or botii feet or one hand and one foot, the Company will pay 
the insured, in addition to the amount specified in Section 3 for such loss, at the rate of 
one-half of the monthly accident indemnity for such a period as the insured shall be wholly 
disabled from engaging in any productive occupation, not to exceed five years from date 
of accident. 

Section 8. Blood Poisoning. — ^Disability resulting from blood poisonini^ (septi- 
caemia) due solely to "such injuries" shall be covered by the accident provisions of 
this policy. 

Section 9. Ten Per Cent Inceease.— The monthly indemnities payable under this 
policy shall be increased ten per cent, if premiums are paid annually or five per cent ii 
paid semi-annually in advance; but such addition shall never exceed ten f>er cent, of 
the original indemnities if premiums are paid annually or five per cent, if paid semi-an- 
nually. 

Section 10. Fifty Per Cent. Accumulation.— Each consecutive yearly renewal of 
the policy shall add ten per cent, to the benefits provided under Section 3 until such ad- 
ditions shall amount to fifty per cent, and thenceforth so loof as this policy is maintained 
in continuous force the amount payable under Section 3 wiU be the original indemnities 
plus the accumulations. 

Section U. Immediate Cash Settlements.— The insured may elect to receive for 
"such injuries" the amount of indemnity hereinafter stated j;>rovided he receive such 
amount in place of other indemnities for total or partial disabihty. Such choice must be 
expressed in writin£[, addressed to the Company, within twenty days of the date of the 
occurrence of the injury, provided that not more than one amount ^11 be payable under 
this paragraph for injuries resulting from any one accident, and provided always, that 
the amounts specified herein shall be payable only in case the monthly accident indemnity 
is $60; if such monthly indemnity is greater or less than $60, then the amounts to be paid 
shall be increased or reduced oroportionately. 

Schedule of Ophonal Cash Settlements.— Optional With Insured.— For losf^ 



70 THE EQUITABLE ACCIDENT COMPANY 

by aeveraztce of one or more fin|{en (at least one entire phalaxiz), $50; one or more entire 
toes, $50. For complete hernia, the inunediate and oirect result of th^ accident, $35. 
For complete dislocation of the shoulder, $50; elbow, $50; wrist, $50; hip, $90; knee, $60; 
two or more bones of foot (not toes), $50: anUe, $50; two or more toes, $15; two or more 
fingers. $15. For complete fracture of the skuH, both tables, $150; lower jaw, $35; 
collar bone, $50; pelvis, $100; thigh. $135; leg (tibia and fibula), $90; knee cap, $75; 
arm, between elbow and shoulder, $57; two or more ribs, $35; foot (two or more bones — 
not toes), $55; hand (two or more bones — not fingers), $50; two or more toes, $25; two 
or more fingers, $25; scapula, $75. 

Section 12. Sickness Indemnities — Confinino Sickness.— At the rate of fifty 
dollars per month for loss of time (not exceeding eight months) resulting from sickness 
not venereal in cause and not a chronic sickness contracted prior to the date of this 
policy, for the number of consecutive days that the insured is totally disabled and nec- 
essarily and continuouslv confined within the house, and therein regularly visited, at least 
once a week, by a legaUy qualified ph^cian, by reason of sickness that is contracted 
and begins after this policy has been in force for fifteen days from date of issue, pro- 
vided, however, that no period of disability of less than seven consecutive days shaU be 
covered. 

Section 13. Non-Confining Sickness.— Or, at the rate of one-half the benefit pro- 
vided for such confining sickness, for a period not exceeding two months, if during con- 
valescence immediately following such confinement, or by reason of any non-confining 
sickness, beginning after said fifteen days, the insured shsill be wholly and continuously 
disabled from performing every duty pertaining to bis occupation, and require a similar 
attendance of such physician provided, the maximum period for which indemnity shall 
be paid for any one sickness shall not exceed eight months, and provided that no period 
of non-confinine sickness of less than seven consecutive days shall be covered, and that 
the first week if partly confining and partly non-confining shall be covered at non-con- 
fining rates. 

Section 14. Blindness, Paralysis, Pericanent DiSABiuTy.— If such sickness 
results within one year in paralysis, insanity, or other permanent total disability, and 
such condition continues for one year after said period of eight months of total disability, 
and proof is then made that the insured is, because of such disability, permanently unable 
to engage in any gainful occupation, the Company will pay in admtion to other benefits 
for such sickness, one-fourth of the principal sum. 

Section 15. Carbuncles, Boils and FELONS.^Disability caused by carbuncles, 
boils or felons shall be considered as sickness and covered accordingly, except that full 
benefits will be paid r^ardless of house confinement. 

Section 16. Arbitration.— It is agreed by the Company that if any dispute shall 
arise as to the amount due upon any claim under this policy, at the request of the insured 
the same shall be submiitea to three disinterested arbitrators, to be chosen as follows: 
One by the Company, one by the insured, and the other to be mutually agreed upon. 

Section 17. Identification and Registration.— An identification badge will be 
furnished the insured; if he shall, by reason of injury or sickness during the time this 
policy is in force, be physically unable to commumcate with friends, the Company will, 
upon receipt of a telegram or other message giving this policy number, immediately 
transmit to the relatives or friends of the insured any information respecting him, and 
will defray all expenses necessary to put the insured in communication with and in care 
of friends, providing such expense shall not exceed the sum of fifty dollars ($50). 

Section 18. Surgeon's Fees, Hospita l Benefits. — If "such injuries" or such sick- 
ness within ninety days of the accident or beginning of sickness necessitates a surgical 
operation named in the "Schedule of Operations" endorsed hereon, the Company will 
pay in addition to other benefits and as a surgeon's fee a pro rata portion of the amount 
Si^t opposite such operation; not more, than one amount (the larger) being payable for 
any one disability. If "such injuries" or such sickness necessitates the removal of Uie 
insured to a hospital within ninety days of the accident or beginning of sickness, if no claim 
be made for surgeon's fee, the Company will pay during his confinement therein for not 
more than three months, a sum per month equal to one-half the single monthly indemnity* 
in addition to the month^ indemnity otherwise provided. 

For Standard Provisions, See Page 11. 

Additional Provisions. 
(a) The copy of application hereto attached or hereon eihdoited is hereby made a part 
of this contract. No provision of the charter or by-laws of the Company not included 
herein shall avoid the policy or be used in evidence in any legal proceeding thereunder. 
The insured may &t any time release the Ompany from any and aU liability then existing 
or thereafter accruing to the beneficiary. The falsity of any representation in the applica- 
tion for this policy materially affecting either the acceptance of the risk or the hazard 
assumed hereunder, or made with intent to deceive, shall bar all right to recovery under 
this policy. The acceptance of any renewal premium shall be optional with tbe Com- 

{b) If on any date to which insurance has been paid the policy has not been renewed, 
insurance shall cease without notice and the policy shall lapse, and neither the sending 
to the insured by tbe Company or by any person of a lapse notice or a notice of a subse- 
quent premium due, nor the acceptance by the Company of payment for insurance for a 
subsequent period, shall constitute a waiver of such lapse or a renewal of the insurance 
for the lapsed period. The payment of a past due premium shall not carry the insurance 
beyond the first day of the next quarter. The sending of lapse or other notices is a 
c6urtesy, not a requirement. 

(c) The insured shall not be entitled to indemnity for two disabilities at one and the 
lame time, resulting respectively from lickness and accident Failure to comply with 



THE EpmrABLE ACCIDENT COMPAOT 71 

an the tenns, conditions and provisions of this policy shall bar he right to recoveqr 
for any daim made hereunder. 

(d) This policy does not cover loss of any kind resulting wholly or in part, directly or 
indirectly, from nding in or on, or being in or on. or attempting to ^et in or out of a balloon 
or any aerial machine or conveyance, or from the use of mtozicatmg liquors or narcotics, 
or death or injuries sustained oy the insured while insane, suicide or attempted suicide 
or self-destruction (sane or insane), violation of law by the insured, or death or injuries 
sustained or sickness contracted in military or naval service in time of war, or death or 
injuries sustained or sickness contracted outside the United States, Canada or Europe. 
"United States" does not in this connection include Alaska or a^ insular possessions, 
and "Europe" includes the continent and British Isles only. This policy does not 
cover death, or other specific loss, resulting wholly or in part, directly or mdirectly, from 
disease or bodily infirmitv or disability where the regular attendance of a physician b 
not required during disability and indemnity wiU not be allowed outside the period , 
comprised between the first and last visits of the physician. 

^In wihuss whereof, the Equitable Accident Company has caused this policy to be 
signed by its president and secretary, and countersigned by its policy writer at Boston, 
Mass., this first day of November, 1914. 

Industrial Dbpartmbnt. 

POLICY FORM— "Teaco." 

Principal Sum, $1000. Monthly Accidbnt Indemnity, S60. 
Monthly Premium, $1.50. Monthly Sickness Indemnity, $50. 

The Equitable Accident Company, Home Office, 161 Devonshire 
Street, Boston, Mass., in consideration of the representations con- 
tained in the application for this policy, a copy of which is endorsed 
hereon, and the payment of a premium ot $1.50, hereby insures 
John Doe (hereinafter called the insured), occupation bookkeeper, 
with duties as described in the application, under classification AA, 
subject to all conditions and limitations hereinafter contained, from 
12 o'clock noon standard time at the place where the insured re- 
sides on the day this policy is dated until twelve o'clock noon such 
standard time of the nrst day of February, 1915, and upon the pay- 
ment of a premium of $1.50 per month, payable in advance on or be- 
fore 12 o'clock noon of the first day of the month, for such further 
periods as may be mutually agreed upon and paid for. with indem- 
nities as follows: 

AcczDBirr Imdemnitiks. 

SscnoN 1. Total Loss of TzME.^At the rate of sixty dollars per month, for loss of 
time, for a period of ccmtinuous disability (not exceeding five years), resulting soldy £rom 
bodihr injuries sustained through external, violent and accidental means (heremafter called 
"such injuries"), which shall, »om date of accident, independent of all other causes, imme- 
diately, wholly and continuously disable and prevent the insured from performing every 
duty pertaining to any occupation but which snail not cause the Ion of one or both hands, 
feet or eyes. 

Section 2. Partial Loss of Time.— Or, at the rate of 50 per cent, of the monthly 
benefit provided for total disability for a period not exceedug six consecutive months 
if "such injuries" shall not from date of the accident whdly disable the insured, but shall 
within thirty days thereafter wholly disable him, or shall from date of accident, or imme- 
diately following total disability, disable and prevent the insured from performing at least 
one-half of the miportant daily duties essential to his occupation, i»pvided the maximum 
period for which mdemnity shall be paid under all accident provisions shall not exceed 
sixty consecutive months. 

Section 3. Specific Total LossES.--Or, if aay one of the following specific total 
losses shall result solely from "such injuries" withm ninety days from date of accident 
in lieu of any other indemnity, 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 sev- 
erance at or above the wrist and ankle, or entire sight of both eyes if irrecoverably lost, 
the principal sum; entire sight of one eye if irrecoverably lost, one-third the prmdpal 
sum; entire sight of one eye if irrecoverably lost and one foot by severance at or above the 
ankle, or entire sight of one eye if irrecoverably \oat and one hand.by severance at or above 
the wrist, the principal sum; either hand by severance at or above the wrist, or either foot 
by severance at or aoove the ankle, one-haH the principal sumj provided, however, that if 
prior to the accident the insured shall have lost or had <mly the impaired use of either hand, 
toot or e^e, the loss of the other shall be held to be the loss of one member only. If 
"such injuries" result in any of the above-named specific total losses and also in total or 
partial disability the Company shall not be liable for the disability, except as set forth in 
Section 7, nor shall it in any event be liable for more than one of the specific total losses. 

Skuon 4. Double iNDnoaiY.— Or, at the rate of doable the sum that would, under 



72 THE EQUITABLE ACCIDENT COMPANY 

the tenns of this policy, be otherwise payable if "such injuries" are sustained by the 
insured while riding as a passenger in or on any railway passenger car provided for the 
exclusive use of passengers, and propelled by steam^ cable, compressed air or electricity, 
and not attached to any freight, coal or logging tram; or while riding as a passenger on 
board a steam vessel licensed for the regular transportation of passengers, provided^' such 
injuries" shall be caused directly by or in consequence of the wrecking of such car or 
vessel; by a stroke of lightning; by the burning of any building in which the insured may be 
burned by fire or suffocated bv smoke, but this shall not apply to or cover tne insured while 
acting as a volunteer or paid fireman; by a cyclone or tornado causing the destruction 
of a building while the insured is therein. 

Section 5. Special Death Imdeunity. — ^If sunstroke, freezing, septicaemia, caused 
by "such injuries," hydrophobia, or the involimtary or unconscious inhalation of gas or 
other poisonous vapor shall result in the death of the insured within ninety days from date 
of exposure or infection, the limit of the Company's liability shall be one-half the prin- 
ci|)al sum of this policy, and the Company shall not be liable tmder any other provision of 
this policy for death caused by or contributed to, directly or indirectly, by sunstroke, 
freezing, septicaemia, hydrophobia, gas or other i>oisonous vapors. 

Section 6. Surgeon's Fees. — If "such injuries" are sustained by the insured and 
are not serious enouxh to entitle him to indemnity, but do require immediate medical or 
surgical treatment, the Company will reimburse hun for the amount expended on account 
of such treatment not exceeding $10 for any one injury. 

Section 7. Special Monthly Indemnity.— If '•such injuries" shall not result in 
death, but shall, within ninety days from date of accident, result independently and ex- 
clusively of all other causes, in the loss by complete severance at or above the wrists or 
ankles of both hands or both feet or one hand and one foot, the Company will pay the 
insured, in addition to the amount specified in Section 3 for such loss, at the rate of one- 
half of the monthly accident indemnity for such a period as the insured shall be wholly 
disabled from engaging in any productive occupation, not to exceed five years from date 
of accident. 

^ Section 8. Blood Poisoning. — ^Disability resulting from blood poisonmg (sep- 
ticaemia), due solely to "such injuries," shall be covered by the accident provisions of this 
policy. 

Section 0. Ten Per Cent. Increase.— The monthly indemnities payable under 
this policy shall be increased ten per cent, if premiums are paid annually or five per cent, 
if paid semi-annually in advance; but such addition shall never exceed ten per cent, of 
the original indemmties if premiums are paid annually or five per cent, if paid semi- 
annually. 

Section 10. One Hundred Per Cent. AccuinTLATiON. — ^Each consecutive monthly 
renewal of the policy shall add one per cent, to the benefits provided under Station 3 untu 
such additions shall amount to one hundred per cent, and thenceforth so long as this policy 
is maintained in continuous force the amount payable under Section 3 will be the original 
indemnities plus the accumulations. 

Section U. Immediate Cash Settlements.— The insured may elect to receive for 
"such injuries " the amount of indemnity hereinafter stated provided he receive such 
amount in place of other indemnities for total or partial disability. Such choice must be 
expressed in writing, addressed to the Company, within twenty days of the date of the 
occurrence of the injury, provided that not more than one amount shall be payable under 
this paragraph for injuries resulting from any one accident, and provided always, that the 
amounts specified herein shall be payable only in case the monthly accident indemnity is 
t60: if such monthly indemnity is greater or less than $60, then the amounts to be paid 
shall be increased or reduced proportionately. 

Schedule or Optional Cash Settlements. — ^For loss by severance of one or more 
fingers (at least one entire phalanx), $50; one or more entire toes, $50. For complete 
hernia, the immediate and direct result of the accident, $35. For complete dislocation 
of the shoulder, $50; elbow, $50; wrist, $50; hip, $90; knee, $60; two or more bones of 
foot (not toes), $50: ankle, $50; two or more toes, $15; two or more fingers, $15. For 
completefractureoitheskull, both tables, $150; lower jaw, $35; collar bone, $50; pdvis, 
$100: thiffh, $125; leg (tibia and fibula), $90; knee cap, $75; arm, between elbow and 
shoulder, $75; two or more ribs, $35; foot (two or more bones — ^not toes, $55; hand (two 
or more bones — not fingers), $50; two or more toes, $25; two or more fingers, $25; 
scapula, $75. 

Sickness Indemnities. 

Section 12. Confining Sickness.— At the rate of fifty dollars per month for loss of 
time (not exceeding eight months) , resulting from sickness not venereal in cause, and not a 
chronic sickness contracted prior to the date of this policy, for the number of consecutive 
days that the insured is totally disabled and necessarily and continuously confined within 
the bouse, and therein regularly visited, at least once a week, by a legally qualified physi- 
cian, by reason of sickness that is contracted and begins after this policy has been in force 
for thirty days from date of issue, provided, however, that no penod of disability of less 
than seven days shall be covered. 

Section 13. Non-Conpinino Sickness. — Or, at the rate of one-half the benefit pro- 
vided for such confining- sickness, for a period not exceeding two months, if during con- 
valescence immediately following such confinement, or by reason of any non-coimning 
sickness, beginning after said thirty days, the insured shall be wholly and continuously 
disabled from performio^ every duty pertaining to his occupation, and require a similu 
attendance of such physician; provided, the maximum period for which indemnity shall 
be paid for any one sickness shall not exceed eight months, and provided that the first 
weex of sickness which is partly confining and partly non-confining shall be covered at 
non-confining rates and that no disability of less than a week shaU be covered. 

Section 14. Carbuncles, Boils and Felons.— Disability caused by carbundes. 



THE EQUITABLE ACCIDENT COMPANY. ^73 

boils or felons shall be considered as sickness and covered acocxdin^* ooqit that full 
benefits will be paid regardless of bouse confinement. 

SscnoN 15. AsBiTRATiON. — ^It IS agreed by the Company that if any dispute shall 
arise as to the amount due upon any chum under this policy, at the request of the insured 
the same shall be submitted to three disinterested arbitrators, to be chosen as follows:'— 
One by the Company, one by the insured, and the other to be mutually agreed upon. 

Section 16. Identxticatxon and Registkahon. — ^An identification badge will be 
furnished the insured; if he shall, bv reason of injury or sickness during the time this 
policy is in force, be physically unable to conunumcate with friends, the Company will, 
upon receipt of a telegram or other message giving this policy number, immediately 
transmit to the relatives or friends of the insured any information respecting him, and will 
defray all expenses necessary to put the insured in communciation with, and in care of, 
friends, providing such expense shall not exceed the sum of fifty dollars ($50). 
For Standasd Provisions, Seb Page U. 

ADDmoNAL Provisions. 

(a) The copy of application hereto attached or hereon endorsed is hereby mads a part 
of this contract. No provision of the charter or by-laws of the Company not included 
herein shall avoid the policy or be used in evidence in any legal proceeding thereunder. 

The insured may at any time release the Company from any and all liability then exist- 
ing or thereafter accruing to the beneficiary- The falsity of any representation in the 
application for this policy materially affecting either the acceptance of the risk or the 
haisard assumed hereunder, or made with intent to deceive, shall bar all right to recovery 
under this policy. The acceptance of any renewal premium shall be optional with the 
Company. 

(6) If on any date to which insurance has been paid the policy has not been renewed, 
insurance ^lall cease without notice and the policy shall lapse, and neither the sending to 
the insured by the Company or by any person of a lapse notice, or a notice of a subsequent 
premium due, nor the acceptance by the Company of payment for insurance for a subse- 
quent period, shall coqstitute a waiver of such lapse or a renewal of the insurance for tiie 
lapsed period. The payment of a past due premium shall not carry the insurance beyond 
the first day of the next month. The sending of lapse or other notices is a courtesy, not a 
requirement. 

(c) The insured shall not be entitled to indemnity for two disabilities at one and the 
same time, resulting respectively from sickness and accident. Failure to comply with all 
the terms, conditions and provisions of this policy shall bar the right to recovery for any 
daun made hereunder. 

id) This policy does not cover loss of any kind resulting wholly or in part, directlv or 
mdirectly , from riding in or on, or being in or on, or attempting to ^et in or out of a balloon 
or anjy aerial machine or conveyance, or from the use of mtoxicatmg liquors or narcotics, 
injunes received by the insured while insane, suicide or attempted suicide or self-destruc- 
tion (sane or insane), violation of law by the insured. This policy does not cover death, or 
other specific loss, resulting wholly or in part, directly or indirectly, from disease or bodily 
infirmity, disabiUtv where the attendance of a physician is not required during disabQity, 
and indemnity will not be allowed outside the period comprised between the first and last 
visits of the physician. 

In int$tess whereof, the Equitable Accident Company has caused this policy to be signed 
by its preaidmt and secretary, and countersigned by its policy writer at Boston, Mass., 
this first day of January, 1015. 



74 FEDERAL LIFE INSURANCE COMPANY 

Federal Life Insurance Company. 

CHICAGO, ILLINOIS 

Isaac Miller Haiolton, President. Chas. S. Rannells, Secretaiy. 

The principal policies issued in the Accident and Health Depart- 
ment of the Federal Life Insurance Cgmpany are as follows: Fed- 
eral's Income Policy, Peerless Protection Policy, Safety First Acci- 
dent Policy, and Accumulative Accident Policy. 

The Accumulative Accident Policy covers every injury caused by 
accident, and is issued from $1,000 principal sum and. $5 weekly 
indemnity to $10,000 principal sum and $50 weekly indemnity, 
pays hospital benefits, double indenmity, and carries accumulation 
feature. Age limit 18 to 59. Premitun Classes "AA" and *'A," 
$5 per $1,000 with $5 weekly indemnity. This policy is issued as a 
. Combination Accident and Life Policy providing for $250 of in- 
surance against death in addition to the regular accident benefits of 
the policy. For a premium of $10 in Classes "AA" and "A" this 
policy would pay ^250 for loss of life from any cause, $1250 for 
death from oroinary accident, $2,250 for death from travel accident 
or from burning building, $1,000 for loss of both hands or feet, 
any two limbs, or sight of both eyes, $500 for loss of one hand or 
one foot and $5 per week for total loss of time. 

The Safety First Accident Policy is written on all classes of 
risks, and provides indemnity for all kinds of accidents. 

The Peerless Protection Policy is issued to Classes "AA," "A," 
"B," *'C" and "D" and is a policy practically without restrictions, 
and provides indemnity for accident and illness, has double indem- 
nity and accumulation features, and is especially attractive to 
business and professional men. 

The Federsu's Income Policy is issued to all classes of risks and 
provides indemnity for accident and illness. Copy of this policy 
appears below. 

POLICY FORM— ."Federal's Income." 
Principal Sum, $450. Monthly Indemnity, $45. 

Monthly Premium, $1. Policy Fee, $3. 

Federal Life Insurance Company, Chicago, 111. (hereinafter called the 
Company) , in consideration of the agreements and answers contained 
in the application heref or , a copy of which is endorsed hereon and made 
a part hereof, which agreements Insured undertakes to fulfill and 
each of which answers by the acceptaiice hereof he represents to be 
material and true, full and complete in every respect, the pajmient 
of the policy fee of $3.00, the pajmient of the premium of one dollar 
on or before the first day of February, 1916, and the further pay- 
ment of a like amoimt on or before twelve o'clock noon standard 
time at the place of residence of the Insured on the first day of each 
month thereafter, does hereby insure John Doe (hereinafter called 
the Insured), by occupation accoimtant, in Class AA of said Com- 
pany and subject to the agreements, limitations, provisions and 
conditions of this policy and those endorsed hereon, promises to 
pay benefits as hereinafter set forth for loss resulting from accident 
or illness: 

Total Accident Indemnity. — (a) In the event that the Insured, whfle this policy 
is in force, shall sustain personal bodily injury, which is effected solely, directly and in- 
de];>endenUy of all other causes through external, violent and purely accidental means and 
which injury causes at once total and continuous inability to engage in any and evoy 
kind of business, occupation or labor (suicide, sane or insane, or any attempt thereat, 
sane or insane, not included), the Company will pay to the Insured an accident indem- 



FEDERAL LIFE INST7RANCE COMPAKV 75 

^ I — ■' III. , , , 

nity of forty-five doUan per month or at that rate for any proportionate part of a month 
for the time of such total and continuous disability for a period not exceeding sixty con* 
secutive months from the date of such accident. 

Specific Total Losses.— (b) If any one of the following specific total losses shall 
result solely from injuries described in paragraph (a), within nmety days from date of 
accident, the Company will pay, in lieu of any other hidemnity: For loss of life, or both 
hands by severance at or above the wrist, or both feet by severance at or above the anUe, 
or one hand and one foot by severance at those places, or one hand or one foot by sev- 
enmce as above and irrecoverable loss of sight of one eye^ or entire sight of both eves, if ir- 
recoverably lost, four hundred and fifty dollars, the pnncipal sum; either hand by sev- 
erance at or above the wrbt, or either loot by severance at or above the ankle, one-half 
of the principal sum: entire si^ ht of one eye, if irrecoverably lost, one-third principal sum. 

In tne event of a loss described in paragraph (b) no daui shsdl exist for comp^nsatbn 
other than that specifically provided for therein, and in no event shall the Company be 
liable under paragraph (b) i<a more than one of the losses named therein. The Company 
shall not be liable tor indemnity under this policy in excess of the average monthly 
earnings of the Insured, except as provided in paragn^h (b). 

Partial Acx^demt Indemnity. — (c) Or if injury as described. in paragraph (a) shall 
not at. once totally and continuously disable the Insured, but shall witJun thirty days 
thereafter totally disable him, or if injury as above described, shall, either at once after 
the injury or at once after a period of total disability, jsevent the Insured from perform- 
ing one or more of hb important daily duties, the Company will pay as indemnity for 
partial l<»s of time and for a period not exceeding six consecutive months, one-half of 
said accident indenmitjr; provided, however, that the combined period for which in- 
demnity is payable under paragraphs (a) and (c) shall not exceed a period of sixty con- 
secutive months from the date of the accident. 

Double Indemnities. — (d) If injury as described in paragraph (a) is sustained by 
the Insured while riding (1) as a passenger within the enclosed part of any railway pas- 
senger car provided for the exclusive use of passengers, and propdled by steam, cable, 
compressed air or electricity; or (2) as a passenger on board a steam vessel hcensea 
for the regular transportation oi passengers, and such injury in each case shall be due 
directly to and received hi consequence of the wrecking of such car or vessel and shall 
not have been received when ^ettmg on or off or being on the steps thereof, then the 
Company will pay double the mdenmity otherwise payable as above. 

Sickness Indemnities — For Confining Period. — (e) The Company will pay in- 
demnity at the rate oi forty-five dollars per month, not exceeding six (6) consecutive 
months, for each whde day after the first seven, that the Insured is actually, necessarily 
and continuously confined within the house by any bodily sickness or disease, not here- 
maiter excepted, or for which other indemnity is not specified, and tha*ein professionally 
visited by a Ucensed physician at least once each.conaecutive week, if such confinement 
is caused solely and exclusively by an illness that is contracted and begins tditer this 
policy has been in continuous force thirty (30) days. 

For Non-Confining Feriod of Total Disability. — (f ) The Company will pay indem- 
nity at one-half the rate specified in paragraph (e). not exceeding one month, for total 



ifter the first seven days as provided in para- 
i continuously disabled and prevented from per- 



mty at one-halt tne rate specined m paragrap 
loss of time following a confining penod uter 

paph (e) above, that Insured is totally and conluiuuuai^ uisauicu ouu pccvcuicu iium pu- 
lonnin^ every duty pertaining to his business or occupation and b continuously under the 
professional care ana treatment of a licensed physician, although not necessarily confined 
within the house, if such total disability b caused solely and exclusively by an illness 
Uiat b contracted and begins after thb policy has been in continuous force thirty {30) 
days, provided the combined periods for which indemnity will be paid for any one sick- 
ness shall not exceed six (6) consecutive months. 

Ten Per Cent Increases. — (j;) Monthly benefits or proportionate parts thereof 
payable under thb policy will be increased ten per cent on any claim accruing here- 
under, if the premiums hereon are paid annually in advance; if such premiums are paid semi- 
aimualbr in advance, then such benefits wiU be increased five per cent, provided the 
injury or Olnesa for which indemnity b claimed occurs or begins subsequent to such pAy- 
Q^t and within the twelve or six months for which the premiums have been so paid m 
advance. 

Sixty Per Cent Accumulation Principal Sum. — (h) For each period of one year 
uat this policy shall have been continuously in force the indemnity under paragraph 
(b) will be increased ten per cent but the sum of all such accumulatbns shall not exceed 
sixty per cent. • 

Classed as Illness. — (i) Abscesses, boib, carbuncles, infected wounds, felons, blood- 
poisoning, septicaemia, pyaemia, tetanus or lockjaw, contact with either poisonous or 
infectious substances, freezing, hydrophobia and sunstroke are hereby considered, classed 
and defined as illness, the origin and cause thereof notwithstanding, and for any loss 
or disability resulting therefrom, which solely and exclusively prevents the Insured 
irom periorming each and every duty pertainmg to hb occupation, business or labor, 

the Company will pay indemnity at tne rate of dollars per month, 

not excemlinff six (6) consecutive months, provided such illness b contracted and begins 
after thb policy has been in continuous force thirty (30) days. 

Indemnity in Special Cases. — (j) In the event of injury, fatal or non-fatal, sickness, 
loss of limb or sight or disability resulting wholly or in part, directly or indirectly, from 
mtoxicajits or the use of a narcotic or narcotics, balloon ascension or aerial navigation; 
gas, pobon, vapor or anaesthetic, voluntarily or involuntarily, consciously or uncon- 
sciously, accidentally or otherwise taken, adminbtered, absorbed or inhaled; injuries, 
fatal or otherwise, of which there shall be no vbible mark on the body (drowning ex- 
cepted); injuries, fatal or otherwise, received while violating the law, then and m all 
Wfia owes referred to in thb paragraph, the limit of the Company's liability shall be one- 



76 FEDERAL LIFE INSURANCE COMPANY 

fifth of the amount that would otherwise be payable under thb polky, anything to the 
cx>ntranr herein notwithstanding. 

Should the Insured, while unemployed, sustain accidental injuries as |»x>vided in 
paragraph (a) then the Company will pay indemnity only as provided in said paragraph 
(a). 

Should the Insured, while unemployed, contract illness which b^^ after thb policy 
has been in contmuous force sixty (60) days, then the Company wiupay indemnity only 
at the rate specified in paragraph (e) for a period not exceeding one month for each 
whole day, after the first seven, Insured is actually confined to his bed and continuously 
under the professional care and treatment of a licensed ph3rsician. 

In the event of disability, due to either accident or iUness, resulting wholly or in part, 
directly or indirectly, from any chronic disease or infirmity, from tuberculosis, cancer 
rheumatism, paralysis, apoplexy, orchitis, neuritis, locomotor ataxia, lumbago, lame 
back, strains of the back or muscular tissues, sciatica, vaccination, Bright's disease, 
dementia, insanity, neurasthenia, surgical operations not necessitated solely by injury 
covered under this policv, and made within ninety days from date of accident, then and 
in all such cases referred to in this paragraph the limit of time for which indemnity shall 
be payable for loss resulting from any of the causes aforesaid, shall be not to exceed one 
month, in the manner and at the rate which otherwise would be payable imder this 
policy, anything to the contrary herein notwithstanding. 

No recovery shall be had on account of disability from illness for an^ period of time 
for which the Insured is entitled to indemnity on account of a bodily injury. 

Conditions Not Covered. — 1. Venereal diseases or disease or condition not com- 
mon to both sexes are not covered by this policy, and no indemnity is payable for any 
loss resulting directly or indirectlv, wholly or in part, from such disease or diseases. 

2. Hernia and rupture are risks not covered by this policy. 

3. This Company will not be liable for any mjuries intentionally inflicted by the 
Insured, or any other person (assaults for the purpose of robbery or burglaiv excepted) 
whether fatal or non-fatal, nor for suicide, sane or insane, or any attempt thereat, sane 
or insane. 

4. Thb policy does not cover injuries received or illness contracted while in militaiv 
or naval service m time of war, nor any injuries received or illness ccmtracted as the result 
of war. 

5. Fraud or concealment in obtaining this policy or any attempt by like means to 
obtain indemnity sliall render this policy absolutely null and void and forfeit all rights 
hereunder of the partv penietratuig such fraud or concealment. 

Reinstatement.- -(k) This policy shall terminate and cease to be in force if the 
premium is not paid in full as and when required by the terms thereof and the Company 
will not be liable for any injury or accident occurring or for any illness beginning while 
any.j^remium or part thereof is past due and unpaid. The acceptance of any renewal 
premium shall be optional with the Onnpany; provided that if this policy shall terminate 
by reason of the non-payment of any premium on or before its due date, it will be rein- 
stated automatically if the premium in full is paid to and accepted by the Company or 
its duly authorized agent, within ten days after such due date, such reinstatement to 
take effect at the time such past due premium is paid and accepted. If a premium b 
paid when more than ten day^ in arrears the Insured must fumbh a health certificate 
on the Company's printed form azui when such certificate b approved and premium 
accepted by the Company the policy will be reinstated from the date of such acceptance. 
The acceptance of an over-due premium or premiums shall not constitute a waiver of 
the reqmrement that all renewal premiums shall be paid in advance, as specified in thb 
contract. 

General Provisions 

1. Thb insurance begins and ends at twelve o'clock noon, said standard time. 

2. This policy, provided the first monthly payment has been made to the Company 
or its duly authorized agent, shall take effect at noon, standard time, of the place of 
residence of Insured, of the date hereof, and shall continue in force only so long as the 
premiums required hereon are paid on or before twelve o'clock noon, said standard 
time, on the first day of each month in advance to the Company at its Home Office in 
Chicago, niinob, or to the person designated in writing by the Company to receive 
them, without notice. 

3. Indemnity will not accrue hereunder in excess of the time the Insured b, by reason 
of mjury or illness, under professional care and regular attendance of a legally qualified 
physician or surgeon. 

4. If the Insured b disabled by injury or illness more than thirty days, he or hb 
representative shall fumbh the Company every thirty days, or as near thereto as may be 
reasonably possible, with a report m writing from hb attending physician or surgeon, 
fully stating the condition of the Insured and the probable duration of disability. 

5. No provbion of the charter or by-laws of this Company shall be used in defense 
of any claim arising under this policy. 

6. The Insured may at any time release the Company from any and all Ibbflity 
thereon exbting or thereafter accruing to the beneficiary. 

7. Strict compliance on the part of the Insured and beneficiary with all the terms 
and provisions oi thb policy b a condition precedent to recovery hereunder and any 
failure in this respect will forfeit to the Company all rights to any indemnity. 

For Standard Provisions See Page 11 

In witness whereof, the said Company has caused thb policy to be signed by its Presi- 
dent and Secretary, but the same shall not be effective until properly dated and counter- 
signtkl by duly commissioned authority of the Company. 

Dated thb first day of January, 1916. 



FEDERAL LIFE INSURANCE COMPANY 77 



Identification.— Upon receipt of an annual premium under this poUcy the Company 
J!r*^*lt T ^'ao?™^ to the Insured a certificate of identification wherein it is agreed 
inat u inc insured, by reason of injury or illness, is physically unable to commumcate 
witn mends, the Company, upon receipt of a telegram or other message giving the num- 
ber of the certificate (which is carried by the Insured in a leather Identification Card Case 
wftich the Com^y provides for the purpose), will immediately transmit to his relatives 
or fnends any mformation respecting him and will defray all expenses, not exceeding 
$25, to put the Insured in the care of friends. 

NoncE.— Premiums are due on the first day of each month, m advance, and must be 
so pajd either at the Home Office of the Company, or to such person as may be designated 
^.T* V:?™pa»y "» writing to receive them. Payments made to any other person shall 
not be binding on the Company. ^ m- 

In case of death by accident or disability by accident or illness, written notice thereof 
containing particulare should be given immediately to the Company at its Home Office 
m Chicago or to its duly authoriaed agent. Give policy number when writing the Com- 



W Vm, tflDEtrrV AI«> CASUALTY C6M?AI4Y 

The Fideiitv and Casualtv Company 

92 LIBERTY STREET. NEW YORK. 



Robert J. Hxllas. President. Geokob W. Allen, AMisUnt SccreUiy. 

^'tiASK. £. Law, Vice-President. Claiidb E. Scattcrgooo, Assistant Secretary. 

Theodore E. Gaty, Secretary. . Cbarles L. Newmiller, Aaaistant Secretacy. 
Walter McK. Hillas, Aaaistant Secretary. 



The Fidelity and Casualty Company issues a variety of policy 
forms insuring applicants against accidents and sickness. All 
grades of risks are insured. The principal policies issued are the 
Life Indemnity Accident, Life Indemnity Disability, Full Life 
Indemnity Disability and Special Life Indemnity Accident. 

Premiums. — ^Annual premiums for the best grade of risks are 
as follows: The $10,000 Combination Accident only policy, $25; 
the $10,000 Combination Disability policy, $60, ages eighteen to 
fifty inclusive, $70, ages fifty-one to sixty, inclusive; the $10,000 
Full Life Disability, $85, ages eighteen to fifty, inclusive; $95, 
ages fifty-one to sixty, inclusive; the $10,000 Special Life Indem- 
nity Accident, $45. Larger or smaller amounts at proportionate 
rates. 

Age Limit. — For accident policies sixty-five years and for dis- 
ability policies sixty years. 

Maximum Indemnity. — For injuries to the assured — death 
$100,000, weekly $500. 

POLICY FORM— "Special Life Indemnity Accident." 
Principal Sum, $5000-$ 10,000. Weekly IndeMnityd, $25-$50. 
Annual Premium, $45. 

The Insuring Clause. — The Fidelity and Casualty Company 
of New York (herein called the company) 

Does hereby insure the person (herein called the assured or insured) named in statement 
A of the copy of the application against bodily injury sustained during the term of one 
year from noon, standard time, of the day that this policy is dated, through accidental 
means (excluding suicide, sane or insane, or any attempt thereat, sane or insane), and 
resulting directhr, independently and exclusively of all other causes, in {q) total disability 
that immediately (as respects the injury) and continuously prevents the assured from 
performing each and every dut^ pertaining to his occupation, (b) partial disability that 
mimediatdy (as respects the injury or as respects preceding total disability) and continu- 
ously prevents the assured from performing work essential to the duties <A his occupati(m, 
(c) specific injury (specified in the schedule of injuries set forth hereon) sustained within 
ninety days from the date of the accident, or at any time while the assured suffers total 
disability as the direct result of the bodily injury causing the specific injury, (d) death: 
Subject to all the provisions and limitations hereinafter contained. 

Indemnities 

ARncLE 1. Total Disability.— If the assured suffers total disability, the company 
will pay the assured so long as he lives and suffers said disability twenty-five doUars a 
week. 

Article 2. Paetial DiSABiLrrY.— If the assured suffers partial disability the company 
will pay for a period not exceeding twenty-six consecutive weeks, as follows: Eighteeik 
doUars and seventy-five cents a week for that portion of the said period throughout 
which the assured suffers totol disability for three-quarters of his business time; twelve 
dollars and fifty-cents a week for that portion of the said period throughout which the 
assured is wholly disabled from performing any important duty pertaining to his occu- 
pation; six dollars and twenty-five cents a week for that portion of the said period during 
which the assured is not entitled to a benefit under either of the preceding sections of 
this article, and throughout which his efficiency is impaired for performing the work 
pertaining to his occuiMtion. But no recovery may be had under more than one of the 
preceding sections for any one portion of the period of twenty-siz weeks. 



^ THE FIDELrrY AND CASUALTY COMPANY 79 

Article 3. Dsath.— If the assured suffers total disability, and if. during the period 
of said disability, the assured suffers death as the direct result of the bodily injury causing 
the said disability; or, if within ninety days from the date of the accident, irrespective 
of disability, the assured suffers death as the direct result of a bodily injiuy: the company 
will pay the beneficiary five thousand dollars, and in addition twenty-five dollars a week 
for that part of the period between the date of the accident and the date of death for which 
no weekly indemnity has been paid. 

Article 4. OprioNAL Indemnity for lNjuRiB8.^If the assured sustains a specific 
mjurv he mav elect to receive either any indemnity to which he may be entitled under 
Articles 1 and 2 or the amount of indemnity set opposite the said injurv in the schedule 
(rf injuries set forth hereon. In addition to the payment of any mdemaity that the 
assured may be entitled to and may elect to receive hereunder, the company will pay the 
assured t wenty-a ve dollars a weeK for the period between the date of tne accident and the 
datethat the assured sustains the specific injury. If a claim is made for an injury defined in 
section 2 of the said schedule, written notice of the assured's election must be given to 
the company at its home office in New York City within twenty days from the date 
that the assured suJers the said injury. 

Article 5. Djjble Indeunities.— The amounU pasrable for total disability, partial 
disability, specific ini'uries, and death shall be doubled, if the bodily injury is sustained 
by the assured ^1) while in a passenger elevate (excluding elevators in mines); (2) while 
in <» on a pubhc conveyance (including the platform, steps, and nmning-boara thereof) 
provided by a common carrier for passenger service; (3) while in or on a private convey- 
ance (excluding bicycles, motorcycles, and saddle-horses); (4) in consequence of the burn- 
ing of a building while the assured is therein; (5) in consequence of being struck by light- 
oing; (6) in consequence of the collapse of the outer walls of a building while the assured 
is tberein; (7) in consequence of the explosion, coUapse, or rupture of a steam-boiler; 
(8) in consequence of a hurricane or tornado. 

Article 6. Freezing, Hydrophobia, Asphyxiation.— Any one of the following 
namely, -freezing, hydrophobia, asphyxiation — suffered through accidental means 
(excluding suicide, sane or insane, or any attempt thereat, sane or insane) , shall be deemed 
a bodily injury within the meaning <rf this policy. 

Article 7. Blood-Poisoning.— Blood-poisoning resulting directly from a bodily 
ii^ury shall be deemed to be included in the said term, bodily injury. 

Article 8. Hospital Charges.— If a bodily injury, for which indemnity is pasrable 
under this policy, is suffered by the assured, and if on account oi said bodily injury. 
and within ninety days from the date of the accident, the assured is removed to a h<ispital 
or sanitorium, the company, provided that no cUim is made under article 9, will pay 
the assured (in addition to the indemnity payable for said bodily injury) for the period, 
not exceeding ten weeks, during which the assured is necessarily confined in the said 
hospital or sanitorium, on account of the said bodily injury, the amount expended by 
him weekly on account of the hospital or sanitorium charges, not exceeding twelve dollaia 
and fifty cents a week. 

Article 9. Sitrgeon's Fees. — ^If a bodily iniuiv, for which indemnity is pa^ble 
under this policy, is suffered by the assured, ana if on account of said bodily injury, 
and within ninety days from the date of the accident, the assured undergoes a suigiod 
operation named in the schedule of operations set forth hereon, the company will pay 
the assured, in addition to the inckmnity payable for said bodfly injury, the sum set 
opposite such operation in said schedule; provided that if the assured undergoes more 
than one such surgical operation on account of bodily injuries resulting from one accident, 
he must elect for which operation payment shall be made; and not more than one of the 
said amounts so named shall be payable for bodily injuries resulting from one accident, 
nor shall any amount be payable on account of a surgical operation required by a bodily 
condition that existed prior to the date of the policy. 

Article 10. Surgeon's Fees for Non-Disabling Inturies.— Or. if the assured 
suffers a bodily injury that daes not disable him or entitle him to any indemnity under 
this policy, but on account of said bodily injury he receives immediate treatment by a 
legally qualified physician or surgeon, the company will reimburse the assured for the 
cost thereof, upon satisfactory proof from the attending physician or surgeon, not exceed- 
ing twenty-five dollars. 

Article 11. loENTincATiON. — The company makes a complete registry of its clients 
in the accident and health departments. Upon receipt of the i>remium for this policy 
it will issue and transmit to the assured a certificate of identification wherein it is agreed 
that if the assured by reason of injury or illness is physically unable to communicate 
with friends, the company, upon receipt of a telegram or other message siving the number 
of the certificate (which is carried by the assured in a leather identification card case 
which the company provides for the purpose), will immediately transmit to his relatives or 
friends any information respecting him ana will defray all expenses (not exceeding the 
sum of one hundred dollars) necessary to put the assured in the care of friends 

For Standard Provisions See Page 11 
Special Provisions 

Article 12. No recovery shall be had under more than one article of this policy 
cm account of bodily injuries the result of one accident, except as provided in articles 
2, 3, 8, and 9. Not more than one of the amounts specified in the schedule of injuries 
set forth hereon will be paid for injuries the result of one accident. Any failure to comply 
with the provisions of this policy shall render invalid any claim under this policy. 

Article 13. No assi^ment of interest under this policy shall bind the company 
unless the written consent of the company b endorsed hereon by the president, a vice- 
president, the secretary, or one of the assistant secretaries of the company. Neither 
Botice given to nor the knowledge of any agent or any other person, whether receivod 



80 THE FTOEUTY AND CASUALTY COMPANY 

or acquired before or after the date of this policy, shall be held to waive any of the terms 
or provisions or statements of this policy, or to preclude the company from asserting any 
deiense under said terms, provisions, ana statements, unless set xorth in an endorsement 
added hereto and signed by one of the said officers. 

Article 14. The terms, bodily injury, specific injury, total disabilitv. partial disa- 
bility, and death, are defined in the insuring clause, and as so defined shall be understood 
wherever used in this policy. 

Article 15. This policy does not cover any bodily injury, fatal or non-fatal, sus- 
tained by the anured while participating in, or in consequence of having participated 
in, aeronautics. 

Article 16. This policy is issued in consideration of the premium charged tberefor 
and of the statements made in the application, a copy cl which is endorsed upon and is 
hereby made a part of this contract. The falsity of any statement in the appucadon for 
this policy materially affecting either the acceptance of the risk or the hazard assumed 
hereunder, or made with intent to deceive shall bar all right to recovery under this policy 
No provision of the charter or by-laws of the company not included nerein shall avoid 
the policy or be used in evidence in any l^al proceeding hereunder. 

Article 17. llie assured's occupation is 

Article 18. The duties of the assured's occupation are f uUy described as f dIIows: . . 

Article 19. The assured's occupation is classed by the company as 

Article 20. The premium for the term of this poUcy is 

Article 21. This policy is dated the first day of January, 1914, at noon, standard 
time, at the place of the assured's address set forth in the copy of the application. 

In witness whereof , the company has caused this policy to be signed by its president 
and its secretary; but the policy shall not be bindmg upon the company until counter- 
signed by a duly authorized representative of the company. 

Schedule or Operations. — Amputation of foot, hand, <x forearm, S25; leg, at or be- 
low knee, $50; arm above elbow, $50; thigh, $100; fingers, one or more entire, $10; toes, 
one ex more entire, $25. Reduction of dislocation of shoulder, elbow, hip, knee, or ankle, 
$25; wrist or jaw, $15; fingers, one or mor6, $10. Excision of shoulder-, hip-, or knee- 
joint, $100; elbow-, wrist-, or ankle-joint, $50. Laparotomy (opening of the abdominal 
cavity for an operation on any organ contained therein), $100. Incision for — synovitis 
(inflammation of the lining membrane of a joint), $25. Injection of — anti-tetanic serum 
into frontal lobe of brain, $100. Sequestrotomy (removal of dead bone), $35. Reduc- 
tion of fracture <tf — nose, lower I'aw. collar bone, or shoulder blade, $25; breast bone, 
$10; rib or ribs, $10; upper arm, $35; forearm, one or both bones> $25; wrist or hand, $15; 
fingers, one or more, $10; pelvis or sacrum, any of the bones of, $50; coccyx, $10; thigh 
$75; knee cap, $50; leg bones, one or both, $50; foot, two or more bones not toes, $15; 
toes, one or more, $10. Gunshot wounds— removal of shot or bullet, $25. Skull tre- 
phining for fracture, $100. Suturing wounds, $5. 

Schedule of Injuries 

Section 1. — Dismemberment by actual separation at or above the wrist joints wankle 
joints of both hands or both feet, $5000; one hand and one foot, $5000; one hand, $2500; 
one foot, $2500; one hand and the irrecoverable total loss of the sight of one eye, $5000; 
one foot and the irrecoverable total loss of the sight of one eye, $5000. Dismemberment 
by actual separation at or above the knee-joint or elbow-joint of one arm. $3750; one leg, 
$3750. Irrecoverable total loss of the sight of both eyes, $5000; one eye, $2500. 

SEcnoN 2. — Dismemberment of fingers, one or more entire, $160: toes, one or more 
entire. $200. Complete dislocation of shoulder, $60; elbow, $100; wrist, $120; hip, $300; 
knee, $160; foot, two or more bones not toes, $160; ankle, $160; toes, two or more, $80; 
fingers, two or more, $60. Complete fracture of skull, both tables, $320; lower jaw, $80; 
collar bone, $160; pelvis, $240; thigh shaft, $300; leg, tibia and fibula, $200; knee cap, 
$200; upper arm, humerus, $160; forearm, both ulna and radius, $160; forearm, either 
ulna or radius, $80; ribs, two or more, $100; foot, two or more bones not toes, $120; hand, 
two or more bones not fingers, $120; toes, two or more, $100; fingers two or more, $100. 

POLICY FORM— "Full Life— Indemnity Disability." 

Principal Sum, $5000-$10,000. Weekly Indemnity, |25-$50. 
Annual Premium, |85. 

The Insuring Clause. — The Fidelity and Casualty Company 
of New York (herein called the Company) 

Does hereby insure the person (herein called the assured or insured) named in State- 
ment A of the copy of the application against (1) bodily injury sustained during the term 
of one year from noon, standard time, of the day that this policy is dated, through acci- 
dental means (excluding suicide, sane or insane, or any attempt thereat^ sane or insane), 
and resulting (Urectly , independently and exclusively of all other causes, m (a) total disa- 
bility that immediately (as respects the injury) and continuously prevents the assured from 
performing each and every duty pertaining to his occupation, (b) partial disability that im- 
mediately (as respects the injury or as respects preceding total disability) and continuously 
prevents the assured from performing work essential to the duties of his occupation, 
(c) specific injury (specified in the schedule of injuries set forth hereon) sustained within 
ninety d&ys from the date of the accident, or at any time while the assured suffers total 
disability as the direct result of the bodily injury causing the specific injunr, id) death: 
(2) illness or sickness which is contracted by the insured during the term of three hundred 
and fifty days from noon, standard time, of the fifteenth day after the day that this polkgr 



THE FTDELnY AND CASUALTY COMPANY 81 

is dated, and for which the assuted b treated l^ a legally qualified phywdan other than 
the assured; and which necessarily results in (a) confining disability that necessitates 
the aasuied's remaining in the house for a period beginning during the said term and totailv 
prevents the assured throughout the period of said confinement from performing each 
and every duty pertaining to hb occupation; (jb) non-confining disability that immediately 
and continuously follows a period of confining disability and results from the illness caus- 
ing the said confining disability and totailv prevents the assured (but not necessarily 
to the extent of confinmg him in the house) from performing each and every duty pertain- 
ing to his oocapation: Subject to all the provisions and limitations hereinafter contained. 

Article 1. Illness Indemnities. Confinino Disability. — ^If the assured 8u£Fers 
confining disability, the company will pay the assured so long as he lives and suffers said 
disability, twenty-five dollars a week. 

Article 2. Sbction 1. NoN-CoNmoNO DiSABiUTy.— If the assured suffers non- 
confining disability after a period of confining diasbility of not less than seven consecu- 
tive days, the company will pay the assured so long as he lives and continuously suffers 
non-confining disability, twenty-five dollars a week. 

SBcnoN 2. Or if the assured suffers non-confining disability after a period of confin- 
ing disability of less than seven consecutive days, the company will pay the assured as 
follows: for the part d said non-confining disability, if any, within fifty-two weeks from 
the beginning d the preceding confining disability, twelve dollars and nfty cents a week, 
and after the said fifty two weeks so long as the assured lives and continuously suffers 
non-confining disability, six dollars and twenty-five cents a week. 

Article 3. Accident iNDsiiNrnES. Total DiSABiLiTy.^If the assured suffers 
total disability, the company will pay the assured so long as he Uves and suffers said 
disability twentv'-five dollars a week. 

Abticls4. Paktial Disabiuty .— If the assured suffers partial disability the company 
will pay for a period not exceeding twenty-six consecutive weeks, as follows: eighteen 
dollars and seventy-five cents a week for that portion of the said period throughout which 
the assured suffers total disability for three-quarters of hb business time; twelve dollars 
and fiftv cents a week for that portion of the said period throughout which the assured 
is wholqr disabled from performing any important duty pertaining to his occupation; 
six dolhus and twenty-five cents a week for that portion of the said period during which 
the assured is not entitled to a benefit under either of the preceding sections of thb article, 
and throughout jrhich his efficiency is impaired for performing the work pertaininR to 
his occupation. But no recovecy may be had under more than one of the preceding 
sections for any one portion of the period of twenty six weeks. 

Akticle 5. Death. — If the assured suffers total disabilitv, and if. during the period 
of said disability, the assured suffers death as the direct result of the bodily injury caus- 
ing the said disability; or, if within ninety 6&ys from the date of the accident, irrespective 
of disability, the assured suffers death as the direct result of a bodily injury: the com- 
pany wiU pay the beneficiary five thousand dollars, and in addition twenty-five dollars 
a week for that part of the period between the date of the accident and the date oi death 
for which no weekly indemnity has been paid. 

AsncLB 6. Optional iNDEMNrrv for iNmRiES.— If the assured susUins a specific 
injury he may elect to receive either any indemnity to which he may be entitled under 
Articles 3 and 4 or the amount <A indemnity set opposite the said injurv in the schedule 
of injuries set forth hereon. In addition to the payment of any indemnity that the 
assured may be entitled to and may elect to receive hereunder, the company will pay 
the assured twenty-five dollars a week for the period between the date of the accident 
and the date that the assured sustains the specific injiuy. If a claim is made for an in- 
jury defined in Section 2 of the said schedule, written notice of the assured's election 
must be given to the company at Its home office in New York City within twenty days 
from the date that the assured suffers the said injury. 

Akticle 7. Double iNDEUNrriES. — The amounts payable for total disability , partial 
disability, specific injuries, and death shall be doubled, if the bodily injury Is sustained 
by the assured ^1) while in a passenger elevator (excluding elevators m mines); (2) while 
in or on a public conveyance (including the platform, steps, and runnmg-board thereof) 
provided by a common carrier for passenger service; (3) while in or on a private convey- 
ance (excluding bicycles, motorcycles, and saddle-horses); (4) in conseauence of the 
burning of a building while the assured b therein: (5) in consequence of being struck 
by lightning; (6) in consequence of the collapse of the outer walb of a building while the 
assured is therein; (7) in consequence of the explosion, collapse, or rupture of a steam- 
boiler; (8) in consequence of a hurricane or tornado. 

Article 8. Freehno, Hydrophobia, Asphyxiation.— Any one of the following, 
namely,— freezing, hydrophobia, asphyxiation— suffered through accidental means 
(excluding suicide, sane or insane, or any attempt thereat, sane or insane ) shall be deemed 
a bodily injury within the meaning of thb policy. . .n • 

Article 9. Blood-Poisoninc— Blood-poisoning resulting directly from a bodHy u- 
jury shall be deemed to be included in the said term, bodily injury. 

Article 10. Accident or Illness Indemnities. Hospital Charges.— If a bodily 
injury or an illness, for which Indemnity is payable under this policy, Is suffered by the 
assured, and if on account of said bodily injury or illness, and within ninety days from 
the date ojf the accident or contraction of illness, the assured Is removed to a hospital or 
sanatorium, the company, provided that no claim b made under Article 1 1 , will pay the 
assured (in addition to the indemnltv payable for said bodily Injury or illness) for the 
period, not exceeding ten weeks, during which the assured is necessarily confined in the 
said hospital or sanatorium, on account of the said bodily injury or illness, the amount 
expended by him weekly on account of the hospiUl or sanatorium charges, not exceeding 
twelve pilars and fifty cents a week. 



THE FIDELITY AND CASUALTY COMPANY 



AsncLE 11. Sttrobon's FisES.—If a bodily bijury or an illnett, for which indemnity 
is payable under this policy, is suffered by the assured, and if on account of said bodily 
injury or illness, and within ninety days from the date of the accident or contraction of 
illness, the assured undergoes a surgical operation named in the schedule of operations 
set forth hereon, the company will pay the assured, in add tion to the indemnity payable 
for said bodily injury or illness, tne sum set opposite such operation in said acnedule; 
provided that if the assured undergoes more than one such surgical operation on account 
of one illness, or on account of bodily injuries resulting from one acadent, he must dect 
for which operation payment shall be made; and not more than one of the said amounts 
so named shall be payable for one illness or for bodily injuries resul ing from one accident, 
nor shall any amount be payable on account of a surgical opoation required by a bodily 
condition that existed prior to the date of the policy. 

Article 12. Surgeon's Fees ior Non-Disabuno Injuries or Illness.— Or, if the 
assured suffers a bodily injury or an illness that does not disable him or entitle him to 
any indemnity under this pob<^, but on account of said bodily injury or illness he receives 
immediate treatment by a legally qualified physician or surgeon, the company will reim- 
burse the assured for the cost thereof, upon satisfactory proof from the attending physi- 
cian or surgeon, not exceeding twenty-five dollars. 

Article 13. Optional iNDEMNrry For Blindnbss or Paralysis prov Illness.— 
If any illness contracted by the assured during the term specified in part 2 of the insur- 
ing cause results during the said term in the irrecoverable total loss <A the sight of both 
eyes, or in permanent paralysis whereby the assured during the said term irrecoverably 
loses the entire use of both hands, <x both feet, or of one hand and one foot; and if the 
assured, on account of the said loss of sight o» one of the said losses resulting from perma- 
nent ];)aralysis, — (1) is permanently unable to engage in any work or occupation for wages 
or profit, the assured mav elect to receive for the period that the assured survives the 
said loss of sight or one oi the said losses resulting from permanent paralyse, not exceed- 
ing fifty-two weeks, twenty-five dolhus a week in lieu of all other indemnity under this 
policy except the additional amount specified in the next section and any surgeon's fees 
and hospital charges to which he maybe entitled; and (2) if the assured survives, for the 



or the entire use of both hands or both feet or one hand and one foot, and to be p^t mi»- 
nently unable to engage in any work or occupation for wages or profit by reason of the 
said loss of sight or one of the said losses resulting from permanent paralysis, the weekly 
indemnity for the fifty-second week of the said cusabili^ shall be increased by the sum 
of twelve hundred dollars. 

Article 14. Identification.— The company makes a complete registry of its dients 
in the accident and health departments. Upon receipt of the premium tor this policy 
it will issue and transmit to the assured a certificate of indentification wherein it is agreed 
that if the assured by reason of injury or illness is physically unable to communicate 
with friends, the compMiny, upon receipt of a telegram or other message jrivinjs the number 
of the certificate (which is carried by the assured in a leather identification card case 
which the company provides for the purpose), will immediately transmit to his relatives 
or friends any information respecting him and will defray all expenses (not ^exceeding 
the sum of one hundred dollars) necessary to put the assured in the care of friends. 
For Standard Provisions Sex Page 11 
Special Provisions 

Article 15. No recovery shall be had under more than one article of this policy on 
account of bodily injuries the result of one accident nor on account of one illness, except 
as provided in Articles 2, 4, 5, 10 and 11. No recovery shall be had on account of dis- 
ability from illness for any period of time for which the assured is entitled to weekly in- 
demnity on account of a bodily injury. Not more than one of the amounts spedhtd in 
the schedule of injuries set forth hereon will be paid for injuries the result of one accident. 
Any failure to comply with the provisions of this polity shall render invalid any claim 
under this policy. 

Article 16. No assignment of interest under this policy shsll bmd the company 
unless the written consent of the company is endorsed hereon by the president, a vice- 
president, the secretary, or one of the assistant secretaries of the company. Neither 
notice given to nor the knowledge of any agent or any other person, whether received 
or acquired before or after the date of this policy, shall be held to waive any of the terms 
or provisions or sUtements of this policy, or to preclude the company from asserting any 
defense under said terms, provisions- and statements, unless set forth in an endocsement 
added hereto and signed by one of the said officers. 

Article 17. The terms, illness or sickness, bodily in juiy, specific bjury, total dis- 
ability, partial disability, confining disability, non-confining disability, and death, are 
defined m the insuring clause, and as so defined shall be undinstood wherever used in this 
policy. 

Article 18. This poHcy does not cover— (1) any iHness contracted or suf- 
fered while the assured is engaged in military or naval service in time of war; (2) women; 
(3) any illness contracted or suffered outside the limits of the United States, Canada, 
and Europe, or in Alaska or the insular posessions of the United States j (4) ai^ bodily 
injury, fatal or non-fatal, sustained by the assured while participating m« or m conse- 
quence of having participated in, aeronautics. ... 

Article 19. This policy is issued in consideration of the premium diaiged therefor 
and of the statements made in the application, a copy of which is endorsed upon and is 
hereby made a part of this contract. The fabity of any statement in the appucation for 
this policy materially affecting either the acceptance of the risk or the haiard — — ^ 



Mfi ftDfiLttV AND CASt ALfV C0M1»ANY 



hereunder, or made with intent to deceive shall bar all right to recoveiv under this policy. 
No provKdon of the charter or by-laws of the company not included herein shall avoid 
the policy or be used in evidence in any le^l proceeding hereunder. 

Article 20. The assured's occupation is 

Akticle 21 . The duties of the assured's occupation are fully described as fdlows: .... 

Aeticlx 22. The assured's occupation is classed by the company as 

Aettcle '23. The premium for the term of this policy is dollars ($ ). 

Aeticle 24. This poUcy is dated the first day of fanuary, 1914, at noon, standard 
time at the place of the assured's address set forth in the copy of the appb'cation. 

In witness whereof, the company has caused thb policy to be signed by iU president 
and its secretary; but the pohcy shall not be binding upon the company until counter- 
signed by a duly authorized representative of the company. 

Schedule of Injuries 

Section 1. — Dismemberment by actual separation at or above the wrist joints or 
ankle joints of both hands or both feet $5000; one hand and one foot, $5000; one hand, 
$2500; one foot, $2500; one hand and the irrecoverable total loss of the sight of one eye, 
$5000; one foot and the irrecoverable total loss of the sight of one eye $5000. Dismem- 
berment by actual separation at or above the knee-joint or elbow-joint of one arm. $3750; 
one leg, $3750. Irrecoverable total loss of the sight of both eyes, $5000; one eye. $2500. 

SficnoN 2. Dismemberment of fingers, one or more entire, $160; toes, one or more entire, 
$200. Complete dislocation of shoulder, $60; elbow, $100; wrist $120: hip, $300; knee, $160; 
foot, two or more bones not toes, $160; ankle, $160; toes, two or more, $60; fingers, two 
or more, $60. Complete fracture of skull, both tables, $320; lower jaw, $80; collar bone, 
$160; pelvis, $240; thigh shaft, $300: leg, tibia and fibula, $200; knee cap, $200; upper 
arm, humerus, $160; forearm, both ulna and radius, $160; forearm, either ulna or radius, 
S80; ribs two or more, $100; foot, two or more bones not toes, $120; hand, two or more 
bones not fingers, $120; toes, two or more, $100; fingers, two or more, $100. 

Schedule of Operations. Section 1. Opening the abdominal cavity (laparotomy) 
for appendicitis or any operation on any organ, (tapping excluded), $100. Fixation or 
removal of kidney, $100. Tapping of abdomen or bladder, $25. Rectal operations, 
exdsion or ligation of hemorrhoids (internal or external), $25; operation for prolapsed 
rectum, $25; operation for fistula in ano, $25; excision of rectal polypus, $25; excision of 
or colostomy for malignant rectal growth, $100. Any cutting operation on bladder, 
(excluding tapping), $100. Ligation of artery for aneurism, $50. Ligation or excision 
of varicose veins, $25. Acupressure, ligation, or excision for varicocele, $25. Bron- 
chotomy, thyrotomy, laryngotomy, laryngo-tracheotomy, or tracheotomy, $60. Esopha- 
gotoray, $1(X>. Incision of abscess, boil, felon, or carbuncle, $5. Minor operation on 
eye, ear, nose or throat, $10. Removal of .ngrowing toe nail, $10. Incision and curet- 
ting cystic tumor of tendon sheath, $15. Intision or excision of hydrocele sac, or tapping 
same, $25. Extirpation of benign tumor, $15: malignant tumor, $50. Sequestrotomy 
(removal of cdead bone), $35. Skull trephining, $100. Curetting for bone ulcer, $15. 
Operation for mastoiditis, $50. Incision for synovitb (inflammation of the lining roej"™" 
brane of a joint), $25. Injection of anti-tetanic serum into frontal lobe of brain, $1()0. 

Section 2-— Amputation of foot, hand, or forearm, $25; leg, at or below knee. $50; 
arm above elTww, $50; thigh, $1(X); fingers one or more entire $10; toes, one or more, 
entire, $25. Reduction of dislocation of shoulder, elbow, hip, knee, or ankle, $25; wnst 
or jaw, $15; fingers, one or more, $10. Excision of shoulder-, hip-, or knee-joint, $100; 
elbow-, wrist,- or ankle-joint, $50. Reduction of fracture of nose, lower jaw, collar bone, 
or shoulder, blade, $25: breast bone, $10; rib or ribs, $10; upper arm, $35; forearm, one 
or both bones, $25: wnst or hand, $15; fingers one or more $10; pelvis or sacrum, any 
of the bones of $50; coccyx, $10; thigh. $75; knee cap, $50; leg bones, one or both, $50: 
foot, two or more bones not toes, $15; toes, one or more, $10. Removal of shot or bullei. 
S25. Suturing wounds, $5. 



84 FIDELITY AND DEPOSIT COMPANY OF MARYLAND 

Fidelity and Deposit Companv of Maryland 

BALTIMORE, MD. 



Commenced Business 1890 
Edwim Waxfield, President. Robert S. Hart, Secretary. 



The Fidelity and Deposit Company issues policy forms in its 
accident and health department with annual premiums per 
$5000 principal sum, Select, as follows: ''Universal Accident," 
annual premium, $25; ''Universal Disability," annual premium, 
$60; ^'Ordinary Accident," annual premium, $20; "General 
Sickness," annual premium, $35. 

The "Universal Disability" policy calls for an increase in pre- 
mium of $2 per $1000 when insured reaches age 51. The "General 
Sickness*' policy requires an increase of $2 for each $5 weekly 
indemnity at age 50 and an additional $1 increase at age 55. 

The "Ordinary" accident policy provides indemnities for death 
and disability or dismemberment for 200 weeks. The "General 
Sickness" contract provides weekly indemnities for confining 
illness not exceeding 26 weeks, and one-half weekly indemnity for 
non-confining illness not exceeding eight weeks. The company's 
liability in no event to exceed 26 weeks in any policy year. 

POLICY FORM— "Universal Accident." 

Principal Sum, $5000-$ 10,000. Weekly Indemnity, $25. 

Annual Premium, $25. 

Fidelity and Deposit Company of Maryland, Home Office, 
Baltimore, Md. (herein called the company), in consideration 
of the agreements and statements in "The Copy of Application" 
set forth hereon, which statements the insured makes and warrants 
to be true by the acceptance of this policy, and which are made a 
part hereof, and of the annual premium of twenty-five dollars, 
does hereby insure, subject to all the provisions and conditions 
herein contained or endorsed hereon, Henry Stevens (herein 
called the insured) of Baltimore, Md., and whose occupation is 
accountant, for the period of twelve months, from twelve o'clock 
noon (Standard time) of the twentieth day of January, 1912, 
against disability or death, as herein defined, resulting directly, 
independently and exclusively of any and all other causes /rom 
bodily injury effected solely through accidental means (suicide, 
or any attempt thereat, sane or insane, not included) as specified 
in the following Schedules: 

Part I. — ^Principal sum, first year, five thousand ($5000) dollars; weekly accident 
iDdemnity, twenty-five ($25) dollars. 

Schedule of Indemmtties 
Single Iia)EMNrrY.— Death, dismemberment or loss of sight. If such bodily injury 
shall from the date of the accident, independently and exclusively of all other causes 
directly, continuously and totally disable and prevent the insured from performing any 
and every kind of dutv pertaining to his occupation, and if, during the period of such 
continuous and total disability, and within two hundred weeks from date of accident, 
such bodily iniury shall be the sole and direct cause of any one of the losses enumerated 
in thb part, the company will pay the sum specified opposite such loss and in addition 
thereto aa indemni^ M specified in Part I for the penod of such continuous and total. 



FIDELITY AND DEPOSIT COMPANY OF MARYLAND 85 

disability between the date of the accident and the date of such loss. Or, if within ninety 
days from the date of the accident, irrespective of total disability, such bodily injury 
shall be the sole and direct cause ot any one of the losses enumerated in this part, the 
company will pay the sum specified opposite such loss. 

Specific lin>EicNin£s. — 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 sever- 
ance at or above the wrist or ankle, or entire sight of both eyes, if irrecoverably lost, 
or entire .sight of one eye, if irrecoverabty lost, and one foot by severance at or above 
the ankle, or entire sight of one eye, if irrecoverably lost, and one hand by severance 
at or above the wrist, the imndpal sum; either leg by severance at or above the knee, or 
either arm by severance at or above the elbow, three-fifths the principal sum; either 
hand by severance at or above the wrist, or either foot by severance at or above the 
ankle, or entire sight of one eye, if irrecoverably lost, one-half the principal sum. 

Part IL Single Indemnity— Total and Partial Disability. 

Total Loss of Time. — Or. if such injury shall not result in an^ of the losses enu- 
merated in Part I, but shall directly, immediately, whollv and continuoiisly disable and 
prevent the insured from attending to any and every kind of duty pertaining to his occu- 
pation, the company will pay him, while so disabled, the weekly mdemnity as specified 
in Part I. 

Partial Loss of Time. — Or, for a period, not exceeding twenty-six consecutive weeks, 
during which the insured shall, by reason of such injury, be immediately and continu- 
ously disabled and prevented from performing fully work essential to the duty or duties 
pertaining to his regular occupation, or for like disability not exceeding twenty-six weeks 
immediately following totally disability and not extending bejrond the limit thereof 
the company will pay him one-half the weekly indemnity as specified in Part I. 

Part III. Double Indemnity.— Or, if such bodily injury is sustained by means 
a.« aforesaid (1) while the insured is a passenger in or on a public conveyance (including 
the platform, steps or running board thereof) provided by a common carrier for pas- 
senger service, or, (2) while a passenger and within a passenger elevator (elevators in 
mines, excepted), or (3) if such injury is caused by the Duming oi a building while the 
insured is therein, or (4) if caused by a stroke of lightning, or (5) if caused by the col- 
lapse of the outer walls of a building while the insured is therein, — then the amount 
to be paid shall be double the sum that would otherwise be payable as provided in 
Parts I or II or V or VII hereof. 

Part IV. Special Indemnity. — ^Freezing, ' hydrophobia or asphyxiation caused 
solely by accidental means (suicide, or any attempt thereat, sane or insane, not included) 
shall be considered as covered by this policy. Blood-poisoning resulting directly from 
an accidental bodily injury shall be deemed to be included in the said term bodUy injury. 

Part V. Accumulative Provision.— Each consecutive full year's renewal of this 
policy, if the premium be paid annually in advance, will increase the respective sums 
specified in Part I by ten per cent.; if paid other than annually in advance, by five per 
cent., until in either case, according as premium mav be paid, fifty per cent, is thus 
added to the original princiiMtl sum. Thereafter, so long as the policy is in force, the 
insurance will be for the said principal sum plus the accumulations. This provision 
shall not apply to increase the weekly indemnity under this or any other section of the 
policy. 

Part VL Weekly Indemnity Accumulations.— If the insured sustains a bodily 
mjury and is totally disabled as set forth in paragraph I of Part II of this policy, and 
is so totally and continuously disabled for a period exceeding ten consecutive weeks, 
the weekly indemnity to which he may be entitled as specified in Part I of this policy 
will be increased as follows: Commencing with the eleventh week twenty per cent, 
and twenty per cent every ten weeks thereafter of continuous and total disabihty, until 
such increase has reached one hundred per cent, of the original weekly indemnity as 
specified in Part I; provided, that no claim is made under Part III of this policy and 
that no claim shall be in excess of the original principal sum unless the insured is entitled 
to a specific indemnity as provided in Part I cf this policy. 

Part VII. Surgical Operation Fees. — If a bodily injury, for which indemnity 
b payable under this policy, is suffered by the insured, and if on account of said bodily 
injury, and within ninety days from the date of the accident, the insured undergoes a 
surgical operation named in the ''Schedule of Operations" set forth hereon, the com- 
pany will pay the insured (in addition to the indemnity pasrable for said bodily injury) 
the sum set opposite such operation in said schedule; provided^ that not more than one 
of the said amounts so named shall be payable for bodily injuries resulting from one 
accident. 

Part VIIL Ophonal Indemnity.— If the insured shall sustain bodily injury re- 
ceived as set forth in this policy and named in the "Schedule oi Injuries" endorsed 
hereon, he may elect, subject to all the terms and provisions hereof, to receive the amount 
of indemnity specified opposite such injury in lieu of all other indemnity for either total 
or partial disability, except as provided in Part VII, provided he shall signify his choice 
in writing, addressed to the company at Baltimore, within two weeks from the date 
of accident. No claim for more than one of the indemnities in said schedule, the result 
of any one accident, shall be valid. 

Part IX. HospriAL Indemnity.— If a bodily injury, for which indemnity is payable 
under this policy, is suffered by the insured, and if on account of said bodily injury, and 
within ninety days from the date of the accident, the insured is removed to a regularly 
incorporated hospital, the company, provided that no claim is made under Part VII, 
will pay the insured (in addition to the indemnity payable for said bodily injury) for 
the penod. not exceeding ten weeks, during which the insured is necessarily confined 
in the said hospital, the amount expended by him weekly on account of the hospital 
duuies, not eiceeding one-half the weekly indemnity as specified in Fftct L 



86 FIDELITY AND DEPOSIT COMPANY OF MARYLAND 

Past X. Msdical Attiiidancs Imdkmiiity.— Or» if tuch iajfry shall not result 
in either disability or death, but shall require immediate medical or surdcal treatment 
by a physician or surgeon^ the company will reimburse the insured for the cost thereof 
not to exceed the weekly mdemnity as specified in Pazt I, provided the physician's or 
surgeon's receipt and afddavit on the company's blank is furnished the company within 
thirty days from the date ol the accident. 

Part IX. Certivicats or Identification and Registration.— In consideration of 
the receipt at the home office of the premium for this policy* the Fidelity and Deposit 
Company of Maryland has placed the insured's name on the ref^tration list. Ii the 
insured shall, by reason of injury during the time this policy is m foice, be physically 
unable to communicate with friends, the company wfll, upon receipt of a telegram or 
other message giving this policy number^ immediatelv transmit to the relatives or friends 
of the insured any information respecting him, ana will defray all expenses necessary 
to put the insured in communication with, and in care of friendb, not exceeding the sum 
of twenty doUara ($20) for each $1,000 of principal sum mentioned in this policy. 

Schedule of Injuries. — (Optional Indemnities— see Part VIII.) The amounts 
stated in the fdlowmg "Schedule of Injuries" are payable under this policy if issued 
for five thousand dollars principal sum, proportionate amounts being payable if the 
policy is issued for a larger or smaller principal sum: Ordinary accidents. Part I. For 
loss of one or more fingers (at least one entire phalanx). 1150; one or more entire toes, 
$200. For complete hernia, caused solely and directly by accidental injury, $70. For 
complete dislocation, viz.: of the shoulder, $100; elbow, $100; wrist, $125; hip $300; 
knee, $150; any bones of foot, $150; ankle, $150; two or more toes, $50; two or more 
fingers, $50. For the complete fracture of bones, viz.: of the skull, both tables. $325; 
lower jaw. $75; clavicle (collar bone), $150; pelvis. $250; thigh, $300; leg, $200; patella 
(knee cap), $200; arm between elbow and shoulaer, $300: forearm between the wrist 
and elbow, $150; two or more ribs. $100; foot. $125: handtll25; two or more toes, $100; 
two or more fingers, $100. lYavel, etc., accidents. Part III, double the above amounts. 

Genxbal Provisions 

(1) This policy, with a*copy of "The Application" therefor signed by the insured 
and any rider or endorsements bearing the signature of the president, a vice-president 
or the pecretaiy oi the company, and endorsed hereon, or attached hereto, constitutes 
the entire contract of insurance except as the same may be effected by any table of rates 
or classification of risks filed by the com];>any with the insurance department of the state 
wherein this policy was issued, and effective at the time of such issuance or delivery. 

(2) No statement made bv the insured, not incorporated in or endorsed on this policy 
issued to the applicant, shaU void the policy, or be used in evidence, and no provision 
of the charter, constitution or by-bws shall be used in defense of any claim under this 
policy unless such provision is incorporated in full in this policy: but this requirement 
shall not be deemed to apply to the table of rates or manual of classification of risks 
filed by this company with the state official having supervision of insurance companies 
in the state wherein this pplicv was issued prior to the date of the oocuixence of the 
injury for which indemnity is claimed. 

(3) If the insured is injured, fatally or otherwise, after having changed his occupa- 
tion to one classified by the company as more hazardous than that nerein stated, ot while 
he b doing anj^ act or thing pertaining to any occupation so classified (except ordinary 
duties about his residence or whUe en^^a^ed in recreation) the company s liability shall 
be only for such proportion of the pnncipal sum or other indenmity under this policy 
as the premium paid by him would have purchased at the rates, but within the limits 
fixed by the company for such increased hazard, according to its rates and classification 
of risks filed, prior to the occurrence of the injury for which indemnity ia claimed, with 
the state official havings supervision of insurance companies in the state where the insured 
resides at the time this policy was issued. 

(4) If a past due premium shall be accepted on this policy by the company or by 
branch office or by a duly authorized agent of the company in the city^ town or county 
in which the insured shall reside, or by the duly authorized agent of the company who 
accepted the last premium on the policy, if so authorized at the time of the acceptance 
of the past due premium, such acceptance shall remstate the policy in full as to disability 
resulting from accidental bodily injuries thereafter sustained. 

(5) Written notice, with full particulars and the full name and address of the insured 
of an accident on account of which a claim may be made under this policjr, must be given 
to the company at its home office in Baltimore, Marvbmd, or to one of its duly author- 
ized agents in the city, town or cotmty in which the insured shall reside at^the time 
giving of such notice, within thirty days from the date of the accident^ provided that 
m the event of accidental death immediate notice must be given, unless such notices 
as herein specified may be shovm not to have been reasonably possible. 

(6) Payment of any claim hereunder will be made immediately upon receipt at the 
home office of the company of due and satisfactory proofs of claim. No action-at-Iaw 
or in eouity shall be begun before sixty days nor after two years from the date when 
the final proof of claim is filed with the company. 

(7) Proof ot claim in writing must be furnished to the company at its home office, 
Baltimore, Maryland, in case of claim for loss of time within ninety days after the ter- 
mination of the period of disability for which the company is liable, and in case of claims 
for loss of life, limb, limbs, or sight, within ninety days after the occurrence of such loss. 

(8) The company may cancel this policy at any time by written notice delivered to 
the insured or mailed to him at his last address as shown by the records of the company 
and the tender qf the c^mpany'a cfa^ iqt th^ unc y oed portion of the premiitfvu M 



FIDELITY AND DEPOSIT COMPANY OF MARYLAND 87 

such canceflation shall be without prejudice to any claim arising on account of disability 
commencing pricMr to the date on which cancellation takes effect. 

(9) The company shall, in case of injury, disability or death, have the right and oppor- 
tunity to examme the person of the insured when and as often as is required, and shall 
also have the right and opportunity to make an autop^ in case of death, where not for- 
bidden by statute. 

(10) The consent of the beneficiary shall not be requisite to a surrender, alteration 
or assignment of ^is policy, nor to a chan^ of beneficiary. 

(11) Indemnity for loss of life of the msured, or disabili^ indemnity accrued and 
not paid the insured prior to death, shall be paid to the beneficiary, if surviving: other- 
wise, to the executors, administrators, or assigns, of the insured. Claims for disability 
indemnity of less than three months' duration shall be payable at termination of dis- 
ability only; claims in excess thereof shall be payable at the end of each three months 
of continuous disability, due and satisfactory proofs, as aforesaid, being required before 
each payment. 

(12) This policy covers accidental bodily injuries onlv when sustained by a male 
person over eighteen and under sixty-five years of age, and while not engaged in military 
or naval service in time of war. aviation or ballooning. 

(13) Complian:e with all ot the terms and conditions of this policy shall be a con- 
dition i^recedent to the recovery of any claim hereunder. No agent has authority to 
alter thb {wlicy or to waive any of its conditions. Notice to or from any agent, or knowl- 
edge acquired by him shall not be held to effect a change or waiver of this policy, or 
any condition thereof. All death claims under this policy shall be subject to proof of 
insurable interest, and no assignment of, or change m this policy, or waiver ot any of 
its conditions, sluiU be valid unless agreed to in writing by the president, vice-president, 
or secretary of the company and endorsed hereon. 

Ih witness whereof ^ the Fidelity and Deposit Company of Maryland has caused this 
policy to be signed by its president and secretary, and couhtersigned by its duly author- 
ized representative. 

Schedule of Operations. — (Indemnity for surgical operations— see Part VID 
The amounts stated in the following ''Schedule of Operations" are payable under this 
policy if issued for five thousand dollars principal sum, proportionate amounts being 
payable if the policy is issued for a larger or smaller principal sum. Amputation of 
toot, hand or forearm, $25; leg or arm, S50; thigh, S1(X); finger or fingers, $10. Dislo- 
cations, reduction of shoulder, elbow, hip, knee or ankle, $25; wrist or lower jaw, $15; 
thumb or fingers (two or more), $10; Excision of shoulder, hip or knee joint, $100; 
elbow, wrist or ankle joint, $25; toe or toes, $25 Fractures, reductions, nose, lower jaw, 
collar bone or shoulder blade, $25; breast bone, $10; rib or ribs, $10; upper arm, $35; 
forearm (one or both bones), $25; wrist or hand, $15; fingers (two or more), $10; any 
of the bones of the pelvis or sacrum, $50; cocc3rx, $10; thigh, $75; knee cap or legbones 
(one or both), $50; bones of foot, $15; toe or toes, $10 Gunshot wounds— treatment 
not necessitating amputation or kporotomv. $25 Hernia (abdominal)— any cutting 
operation for the radical cure of the reducible, irreducible or strangulated form, $100 
Hydrophobia— Pasteur treatment, $50 Laparotomy (opening of the abdominal cavity 
for an operation on any organ contained therein, or for traumatic, peritonitis, or explo- 
ratory incision), $100 Necrosis (death of bone)— sequestrotomy (removal of dead 
bone) . $35 Skull trephining for fracture or other cause, $100 Synovitis (inflammation 
of the lining membrane of joint) , incision, $25 Lockjaw— injection of anti-tetanic serum 
into frontal lobe of brain, $100; into spinal canal, $50 Wounds of scalp or other parts . 
—suturing, $5 

Copy ov Appucation endorsed on policy. 

POLICY FORM— "Universal Disability" 

Principal Sum, $5000— $10,000. Weekly Indemnity, $25. 

Annual Premium, $60. 

This form is the same as the foregoing, with the health fea- 
ture added, except where the phraseology conflicts with the 
health provisions, and in the following clauses: 

Past VII. OmoNAL iNDtMmry.— If the insured shall sustain bodily injury received 
as set forth in this policy and named in the "Schedule of Injuries" endorsed hereon 
he may elect, subject to all the terms and provisions hereof, to receive the amount of 
indemnitv specified opposite such injury in lieu of all other indemnity for either total 
or partial disability, except as provided in Part XIII, provided he shall signify his choice 
in writing, addressed to the company at Baltimore, within two weeks from the date of 
accident. No claim for more than one of the indenmities in said schedule, the result 
of any one accident, shall be valid. 

Part VIII.— See Part X preceding contract. 

Part IX.—Sec Part XI preceding contract. 

SCHEDTTLE OF InDEMNTTIES — SiCKNESS. 

Part X. Weekly Indemnity— Total Disability. 

House Confinement.— If any sickness contracted by the insured, during the term 
of this policy or any renewal hereof, and not hereinafter excepted, necessanly confines 
Uk invizod in the hoiue for a period beginning during the said term, and prevents thfi 



88 FIDELITY AND DEPOSIT COMPANY OF MARYLAND 

insured throughout the period of such confinement irom performing nny and every kind 
of duty pertaming to his occupation, the company will pay the insured for the period of 
such conhnement, not exceedmg fifty-two consecutive weeks, the weekly indemnity as 
specified in Part X. 

Disability Following House Confinement. — If the insured shall be confined in 
the house and disabled within the terms of the preceding paragraph, and if continuously 
thereafter the sickness causing the said confinement in the house totally disables and 
prevents the insured from performing any and every kind of duty pertaining to his occu- 
pation (but not necessarily to the extent of confining him in the house); the company 
will pay the insured for the period of said disability, if any, following said confineir.ent 
in the house and within fifty-two weeks from the beginning of the said confinement, one- 
half the weekly indemnity as specified in Part I. 

Part XI. Paralysis from Sickness. — If any sickness contracted by the insured 
during and under the terms of this ix>licv, and not hereinafter excepted, results during 
the said term in permanent paralysis whereby the insured ^during the said term irre- 
coverably loses the entire use of both hands, or both feet, or one hand and one foot, and 
if the insured on account of one of the said losses resulting from permanent paralysis— 

(1) is permanently unable to engage in any work or occupation for wages or profit; and 

(2) survives, for the period of one year, one of the said losses resulting from permanent 
paralysis; and (3) at the end of the said period of one year is declared by medical author- 
ity satisfactory to the conu>any to have irrecoverabqr lost entire iuse of both hands or 
both feet, or one hand and one foot, and to be permanently unable to engage in any 
work or occupation for wages or profit by reason of one of the said losses resulting from 
permanent paralysis; the insured may elect to receive, in lieu of all other indemnity under 
this policy except surgeon's fee or hospital charges to which he may be entitled, one-half 
the ongmal prinapal sum. 

Accident or Sickness Indemnity. 

Part XII. Hospital Indemnity. — If a bodily injury or sickness for which indem- 
nity is payable under this policy, is suffered by the insured, and if on account of said 
bodily injury or sickness, and within ninety days from the date of the accident or incep- 
tion of sickness, the insured is removed to a regularlv incorporated hospital, the com- 
pany, provided that no claim is made under Part XIII, will pay the in&ured (in addition 
to the indemnity payable for the said bodily injury or sickness) for the period, not exceeding 
ten weeks durug which the insured is necessarily confined in the said hospital, the 
amount expended by him weekly on account of the hospital charges, not exceeding on 
half the weekly indemnity as specified in Part I. 

Part XIII. Surgical Operation Fees. — If a bodilv injury or a sickness, for which 
indemnitor is payable under this policy, is. suffered by the insured, and if on account of 
said bodily injury or sickness, and within ninety days from the date of the accident or 
inception of sickness, the insured undergoes a surgical operation named in the " Schedule 
of Operations" set forth hereon, the company will pay the insured (in addition to the 
indemnity payable for said bodUy injury or sickness) the sum set opposite «uch opera- 
tion in said schedole; provided that not more than one of the said amounts so named 
shall be payable tor one sickness or for bodily injuries resulting from one accident. 

Schedule of Operations. — (Indemnitv for suigical operations — see Part Xm.) 
The amounts stated in the following "Schedule of Operations" are payable under this 
policy if issued for five thousand dollars principal sum, im>portionate amounts being 
payable if the policy is issued for a larger or smaller prmdpal sum: Abscess or boil (one 
or more) — incision, $5. Amputation of foot, hand or forearm, $25j le^ or arm, S50; 
thigh, SlOO; finger or fingers, SIO. Aneurism (tumor of artery) — ^hgation, $50. Ap- 
pendicitis, $100. Bone abscess — trephining, $25. Bronchotomy, thyrotomy laryn- 
gotomy, laryngotracheotomy or tracheotomy, $50. (Carbuncle (one or more) — incision 
and treatment, $25. Caries (bone ulcer) curetting, $15. Dislocations, reduction of 
shoulder, elbow, hip, knee or ankle, $25; wrist or lower jaw, $15; thumb or fingers (two 
or more), $10. Excision of shoulder, hip or knee jomt, $1(X); elbow, wrist or ankle joint, 
$50; toe or toes, $25. Eye, ear nose or throat — any cutting operations, $10. Felon — 
incision, $5. Fractures reduction of nose, lower jaw, collar bone or shoulder blade^ 
$25; breast bone, $10; rib or ribs, $10; upper arm, $35; forearm (one or both bones). 
$25; wrist or hand $1.^; fingers (two or more), $10; any of the bones of the pelvis or 
sacrum, $50; coccyx, $10; thigh, $75: knee cap or leg bones (one or both), $50; bones 
of foot, $15; toe or toes, $10. Ganglion (cystic tumor of tendon sheath) — ^incision and 
curetting, $15. Gunshot wounds — ^treatment not necessitating amputation or laparo- 
tomy, $25. Hernia (abdominal) — any cutting operation for the radical cure of the 
reducible, irreducible or strangulated form, $100. Hydrocele — ^tapping — incision or 
excision of sac, $25. Hydrophobia — ^Pasteur treatment, $50. Inlawing toenail— 
removal, $10. Intestinal obstruction (see laparotomy). Kidney — ^fixation or removal, 
$1(X). Laparotomy (opening of the abdominal cavity for an operation on any organ 
contained therein, or for traumatic peritonitis, or exploratoiy mdsion), $100. Litho- 
tomy (operation for removal of stone in bladder), any cutting, $100. ^ Lockjaw — ^in- 
Sction of anti-tetanic serum into trontal lobe of bram, $100; into spinal canal, $50 
astoiditis — operations for, $50. Necrosis (dea)h of bone) — sequestrotomy (removal 
of dead bone), $35. Oesophogotomy for stricture or other cause, $100. Peritonitis 
(see laparotomy). Paracentesis — tapping of abdomen, $25; bladder,^ $25; ear drum, 
$15. Rectum — operation for hemorrnoids (external or internal) excision or Ugation, 
$25; prolapsed — operation for, $25; fistula in ano — ^incbion, $25; polypus — extirpation 
$25; malignant stricture — excision or colostomy, $100. Skull trephining for fracture 
or other cause, $100. Synovitis (inflammation of the lining membrane of a joint) in- 
cision, $25. Tumors — extirpation from any part of the body: benign, $15; malignant, 
$50. Varicose veins — ligation or excision. $25. Varicocele — acupressure — lifflition oc 
excision, $25. Wounds of scalp or other parts — suturing, $& 



FIDELITY AND DEPOSIT COMPANY OF MARYLAND 89 

POLICY FORM-""CoMPETrTiyB Disability." 

Principal Sum, $5000. Monthly Indemnity, SIOO. 

Annual Premium, $36. 

Fidelity and Deposit Company of Maryland, Home Office, Bal- 
timore, Md. (herem called the Company), in consideration of. the 
representations and agreements contained in the application for 
tms policy, a copy of which is endorsed hereon, and made a part 
hereof, and of the premium of thirty-six dollars, does hereby insure, 
subject to all the provisions, limitations and conditions herein 
contained or endorsed hereon, John Doe (herein called the insured) 
of Baltimore, Md., by occupation a bookkeeper, for the period of 
twelve months from twelve o'clock noon (Standard time, at 
the place where the insured resides at the time this policy is 
issued),' of the first day of January, 1915 (1) against loss or dis- 
ability as herein defined, resulting from bodily injury, effected solely 
through external, violent and accidental means, independently 
and exclusively of disease, whether disease prc'^xists or be afterward 
contracted, and all other causes, and (2) against disability from sick- 
ness, independent of injury, whether injury pre-exists or be after- 
ward sustained, as herein defined, and contracted by the insured 
after thirty days from the date aforementioned, and as specified in 
the following Schedules: 

Pakt 1. — ^Principal sum, first year, five thousand ($5000) dollars; moathly acddent or 
sickness indcmni^, one hundred ($100) dollars. 

Schedule of Indemmhies— Accident. 

Single iNDEmnrv.— (A) Death, dismemberment or loss of sight. If such bodily 
injury ahalk immediately from date of accident, independently and exclusively of all other 
causes, directly, continuously afid totally disable ana prevent the insured from performing 
any and eveiy Kind of duty j)ertainiD|[ to his occupation, and if, during the penod of such 
continuous and total disabihty, and Vnthin ninety days ^m date of accident, such bodily 
injury shall be the sole aad duect cause of way one of the losses enumerated in this iMirt. 
the Company will pay the sum specified opposite such loss in lieuof all other indemnities 
under this policy, except as may oe provided in paragraph B of this part. 

SpEcmc iHDEmnnBS. — ^For loss of life, or ooth hands by severance at or above the 
wrists, or both feet by severance at or above the ankles, or one hand and one foot by sev- 
erance at or above the wrist and 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 sever- 
ance at or above the ankle, one-half the principal sum; entire sight of one eye, if irrecov- 
erably lost, one-third the principal sum. Payment shall not be made for more than one 
loss enumerated in the above "Specific Indemnities." 

(B) Or, if such bodily injury shall not result in death, but shall, immediately, wholly 
and continuously disable Uie insured and within ninetv days from date of accident, result 
independent^ aiid exclusively of all other causes in the loss by complete severance at or 
above the wnsts or ankles of both hands or both feet or one hand and one foot; or the entire 
and irrecoverable loss of the sight of both eyes, the company will pay the insured, in addi- 
tion to the amount specified in the preceding paragraph lor such loss, one-half the monthly 
indemnity during such period as the insured shall be wholly and continuously disabled and 
prevented from attending to any and every kind of duty pertaining to his occupation, but 
no indemnity shall be paid for a period exceeding twelve months from date of accident. 

Past II. Fifty Per Cent. Accumulatigns in Principal Sum. — ^Each consecutive 
fun year's renewal of this policy, if the raeihium be paid annually in advance, will increase 
the principal sum specified in Part I oy ten per cent.; if paid other than annually in 
advance ay five per cent., until in either case, accordiiue as premium may be paid, fifty 
per cent, is thus added to the original principal sum. Thereafter, so long as the policy 
IS in force, the insurance will be for the said principal sum plus the accumulations. This 
provision shall not apply to increase the monthly mdemnity under this or any other part 
of thepoli<7- 

Past III. Total Monthly Indemnity.— Or, if such bodily injury shall not result 
in any of the losses enumerated in Part I, but shall directly, immediately, wholly and 
continuous disable and prevent the insured from attending to any and every kmd of 
duty pertaining to hia occupation, the Company will pay him. for a period not exceeding 
forty-eight omsecutive months, the monthly indemmty specified in Fart I. 

Part IV. Partial Monthly Indemnity.— Or, if such bodily injury shall not imme- 
diately, but shall, within thirty days after the date of accident, totally disable the insured; 
or, if such bodily injury shall, either immediately after the accident or immediately afta a 
period of total disability, prevent the msured from performing one or more important 
daily duties pertaining to his occupation, the Company will pay him, for a penod not 
exceeding six consecutive months, one-half the monthly indemnity specified in Part I; 
provide^ however, that the combined periods for which indemnity is payable under Parts 
Ul and IV shall not exceed forty-eight consecutive months. 



90 FIDELITY ANt) DEP6slt COkl»Ai^ OF kARVLANft 

r Paet V. DouBLS iNDBiCNiTy.— Or, il such bodily iaiuy i* wUinwl by the insuted 
while riding as a passenger within any railway passenger car provided for the exclusive 
use of passengers and propelled by steam, compressed air, cable, dectridty, and not 
attached to any freight, coal or logging train; or, while ridmg as a passenger oa board 
a steam vessel licensed for the regular transportation of passengers, and such bodily 
injury is due directly to or in consequence of the wrecking of such car or vessel; or, while 
riding as a passenger within a passenger elevator (elevators in mines excepted), then the 
amount to be paid shall be double the sum that would otherwise be payable as provided 
in Parts I or II or III or IV. Double indemnity as herein provided shall not be payable, 
however, for any injury, fatal or otherwise, sustained while getting in or out, on or off, or 
while being upon the step or steps, gang punk or other landing contrivance of any con- 
vej^nce referred to in thispart. 

Part VI. Sukgical TKEATiatn.—Or, if such bodily injury shall not result in either 
disabilitv or death, but shall require immediate medical or suxiqpcal treatment by a legally 
qualified phy&ician or surgeon, the Company wiU reimburse the insured for the cost thereof, 
not to exceed a sum equal to seven days' indemnity. The Company must be given notice 
of injury within twenty days from date of accident and must be furnished with the physi- 
cian's or surgeon's receipted bill. 

Part VIl. Sunstroke, Freeong, Hydrophobza. — Sunstroke due to the sun's rajrs, 
freezing, hydrophobia, caused solely by accidental means, shall be deemed a bodily injuxy 
within the meaning oi this policy. 

Part VIII. Blood Poisonino.— This policy is hereby extended to cover blood 
poisoning, resulting directly from an accidental bodily injury, and not otherwise, pro- 
vided it does not result in any of the losses eniunerated in Paragraph A of Part I. 

Schedule op InDsicMinES— Sickness. 

Part IX. Total Loss of Time. (A) House CoMnNEUEMT. — ^If any sickness con- 
tracted by the insured, during the term of this policy or any renewal hereof, and not 
hereinafter excepted, and for which the insured is regidarly treated by a legally qualified 
physician, necessarily and continuously confines the insured in the house for a period 
beginning during the said term, and prevents the insured throughout the period of such 
confinement from performing way and every kind of duty oertaining to his occuiiation, 
the Company, will pay the insured for the period of such confinement, not exceeding twdve 
consecutive months, the monthly indemnity specified in Part L 

(B) DisABEuiY Following House Confinement. — If the insured shall have been con- 
fined in the house and disabled within the terms of the preceding paragraph, and iff con- 
tinuously and immediately thereafter the sickness causmg the said confinement in the 
house totally disables and prevents the insured from performing any and eyery kind a< 
duty pertaining to his occupation (but not necessarily to the extent of confining him in 
the h^use), the Company wul pay the insured for the period of such disabilit]^, not exceed- 
ing one month, one-hf.If the monthly indemni^ specified in Part I; provided that the 
combined periods for which indemnity is payable under Paragraphs A and B ci this part 
shall not exceed twelve consecutive months. 

Part X. Registration and Identification.— The Company has registered the 
insured named in this policy upon its records at its home oflBice at Baltimore, Md. If the 
' insured shall, by reason of injury or illness during the tiipe this policy is in force, be phsrsic- 
illy unable to communicate with friends, the Company will, upon receipt of a tcieijTam 
or other message giving the i>olicy number, immediateljr transmit to the relatives or f nends 
of the insured any information respecting him, and will defray all expoises necessary to 
put the insured in communication with, and in the care of friends, providiiig such expenses 
shall not exceed the sum of one hundred dollars. 

For Standard Provisions. See Page 11. 

Additional Provisions. 

Assignment.— A. No assignment of interest hereunder shall be valid unless consent 
thereto is endorsed hereon andf is signed by an executive officer of the Company. 

When Illness not Covered.— B. This insurance does not cover disability from 
dis«ise or illness suffered or contracted outside of the United States (United States insular 
possessions and Alaska not included), Canada or Europe. If the insured shall become 
entitled to indemnity for disability on account of accidental injuries, the Company shaQ 
not, for the same period of time, be liaUe iar ainy disability on account of disease or illness. 

When Injury or Death Not Covered. — C. This policy does not cover disappear- 
ance; nor war risk; nor suicide or an^ attempt thereat sane or insane; nor loss sunored 
while or resulting from riding or b eing m or on any aerial device at omveyance. 

Application a Part of Contract. — D. The copy of the application endorsed 
hereon is hereby made a part of this contract 

Provisions of Charter, etc. — E. No provision of the charter, constitution or by- 
laws of the Company shall be used in defense of any claim under this policy unleas such 
provision is incorporated in full in this policy. 

Renewal. — ^F. This pdicy may be renewed only with the consent of the Company 
and by the payment of tne premium in advance, subject, howevw, to its conditions and 
limitations. 

In witness whereof, the Fidelity and Deposit Compamr of Maryland has caused this 
I>olicy to be signed by its president and secretary, but it shall not be valid unlesa counter- 
signed by its duly authorized representative. 



WUNltPOftT GfiNERAL INStJltAKCft COMl^AMY 



dl 



Frankfort General Insurance Company. 

FRANKFORT-ON-THE-MAIN, GERMANY, 
United States Office, 123-133 William Street, New York, N. Y. 



Commenced Bnsneas 1805 



C. H. Franklin, U. S. Manager. 



The Frankfort issues a "Full Accumulation Disability" policy 
(called Full Protection Disability Policy in Standard Provision 
states) covering all accidents and all diseases. Annual premium, 
$7500 principal sum, first (A special) class and second (preferred) 
class, ages 16 to 50, $60; ages 51 to 60, $70. 

"Full Accumulation Accident" (Full Protection Accident) 
policy, $7500, principal sum, annual premium, select, $25; pre- 
ferred, $30. 

The " Full Accumulation Accident " policy is similar to the above 
disability policy except where the phraseology conflicts with the 
Health Features. The parts referring to illness indemnities are 
omitted. The age limits are 16 to 65 instead of 16 to 60, as in the 
disability policy. 

"Accumulative Combination Accident" policy, annual pre- 
miums, $5000 principal sum, first class (A special) $25; second 
class (preferred) $30; third class (ordinary) $42.50. "Accumulative 
Disability, " annual premium, $5000 principal sum, $60, ages over 
50. 

"Everybody's Accident" policy, principal sum, $2500, weekly 
indemnity, $20. Annual premiums, first class, $12; second class, 
$15; third class, $22.50; fourth class, $30. 

" Everybody's Disability " policy, the rates and benefits of which 
are shown in the table below. 

Indemnities and Annual Psemiums. 











ANNUAL PREMIUMS 










(50%moie for ages above 50.) 


. 


Accidental 












MONIHLT 

Accident 


Death or 
Loss of 












Loss of 


Loss of 








OR Ill- 


two Limbs 


One 


One 




CLASS. 




mess In- 


or both 


Limb. 


Eye. 








demnity 


Eyes. 


















Fint 


Second 


Third 


Fourth 


S 


$ 


S 


$ 


$ 


$ 


S 


S 


50 


500 


250 


167 


12.50 


15.00 


22.50 


30.00 


60 


600 


300 


200 


15.00 


18.00 


27.00 


36.00 


70 


700 


350 


233 


17.50 


21.00 


31.50 


42.00 


80 


800 


400 


267 


20.00 


24.00 


36.00 


48.00 


90 


900 


450 


300 


22.50 


27.00 


40.50 


64.00 


100 


1.000 


500 


333 


25.00 


30.00 


45.00 


60.00 



" Personal Accident " policy (straight accident) covering all ac- 
cidents, principal sum $5000, annual premiums, first class, $20, 
second class, $25, third class, $37.50, fourth class, $50, 



02 FRANKFORT GENERAL INSURANCE COMPANY 

"Travel Accident" policy, principal sum $3000, weekly indem- 
nity, $25, annual premium, $5. 

Frankfort Health Policy. 

("Unlimited Health Policy" in states without uniform or 
standard provision laws.) 

As its name implies, the company's unlimited health policy 

covers disability caused by any illness: From one day to fifty-two 

weeks of total disability (house confinement not required), $25 per 

week. After that, if total disability continues, $6.25 i>er week for 

life. Up to thirty weeks of partial disability, $12.50 i>er week. 

Double hospital indemnity up to thirty weeks. Surgeon's fees for 

operations. $2500 for loss of sight of both eyes or loss of use of two 

limbs. $1250 for loss of sight of one eye or loss of use of one limb. 

Weekly indemnity for continuing disability payable every eight 

weeks. Identification card furnished. 

Schedule ov Operations.— For each 15 of weekly mdenmity. Appendicitis (see 
laparotomy), $20. Aneurism (tumor oi artery) , — ^ligation, $10. Amputation of foot 
hand or forearm. $5; leg, $10; arm below elbow, $10; thigh, $20; one or more entire 
fingers or toes, $2. Abscess or boil — ^incision, $1. Bone abscess — trephining, $5; re- 
moval of diseased portion, $5; curetting only, $3. Bronchotomy. thyrotomy, Uuyn- 
gotomv, laryngotracheotomy or tracheotomy, $10. Carbuncle — incision and treatment, 
$1. Caxiu (bone ulcer) curetting, $3. Ezdsicm 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. Ganglion (cystic tumor of tendon sheath) — 



incision and curetting, $3. Hydrocele — tapping — ^incision or excision of sac,JI5. In- 
■ " ■ stinal obstruc 

rth 

>y. any cut „ , . 
of stone in bladder), $20. Mastoiditis— operation for, $10. Necrosis (death of bone) — 



growing toe nail — removal, $2. Intestinal obstruction (see laparotomy). Kidnesr — 
fixation or removal, $20. Laparotomy (opening of the abdominal cavity iot an operation 
on any organ contained therein), $20. Lithotomy, any cutting (operation for removal 



sequestrotomy (removal of dead bone). $7. (Esophogotomy for stricture or other cause. 
$20. Paracentesis — tapping of abdomen, bladder, $5; ear drum, $3. Peritonitis (see 
laparotomy), $20. Rectum, operation for hemorrhoids (external or internal) excision 
or ligation, prolapsed — operation for fistula in ano — incision, polypus — extirpation, S5; 
malignant stricture — excision or colostomy, $20. Skull trephining, $20. Tetanus — 
injection of anti-tetanic serum into frontal lobe of brain, $20. TSimors — extirpation 
from any part of the body, benign, $3; malignant, $10; Varicose veins— ligation or 
excision, $5. Varicocele — acupressure — ligation or excision, $5. 

Annual Premiums. — Ages 18 to 50 ^inclusive, $45; ages 15 to 60, 

inclusive, $60; larger or smaller policies at proportionate rates. 

Only for risks classed 1, 2, 2 + and 3. 

POLICY FORM— "Full Protection Disability." 

Principal Sum, $7500-$15,000. Weekly Indemnity, $25-$50 

Annual Premium, $60. 

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 sixty dollars. 

Does hereby insure Mr. John W. Frankfort, of New York. N. Y., age 35, occupation 
attomey-at-law, under clarification No. AA, the person named and described in said 
application (herein called the insured), for the term of twelve calendar months beginning 
on the first day of January, 1913, and expiring on the first day of January, 1914, at noon, 
standard time, at the place where this policy has been countersigned, 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 as heremafter defined, subject to the limitations, statements, and provisions 
herein contained, which are to be considered as limitations, statements, and provisions 
precedent. 

The principal sum of this policv is seven thousand five hundred dollars ($7500); the 
weekly indemnity (for total disability) under this policy is twenty-five dollars ($25). 



FRANZFORT GENERAL INSURANCE COMPANY 93 

Division I.— Accident Indemnities 

Section I. Specific Losses. Death. Disicbmbbriient, and Loss of Sight. — 
If such injuries shall from date of accident continuously and totally disable and pre- 
vent the insured from performing any and every kind of duty pertaining to his busi- 
ness or occu^tion and shall during the period of such disability and within two hundred 
weeks, or within ninety days, irrespective of such total disability, result in any one 
of the specific losses enumerated below^ the company will ^y the specific amount in- 
dicated opposite such respective loss and m addition thereto will pay the weekly indemnity 
for each week between the date of accident and the date the specific loss shall occur. 
Loss of life, payable to the benefiduy named in the application, or both hands, by com- 
plete 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 en- 
tire sight of both eyes if irrecoverably lost ^ or entire sight of one eve and severance of one 
foot as respectively defined above, or entire sight of one eye ana severance of one hand 
as respectively defined above, the principal sum; or <Mie arm by complete severance 
at or above Uie elbow, two thirds principal sum; or one hand by complete severance 
at or above the wrist, one-half principal sum; either leg by complete severance at or above 
the knee, two-thirds principal sum: or either foot by comi^ete severance at or above the 
ankle, or entire sight ci one eye it irrecoverably lost, one-half principal sum. 

SEcnoN II. Disabiuty Benefits and Doctor's Bills.— Or, if none of the losses 
named in Section I shall occur the company will pay the insured for disability as a result 
of said injuries as follows: 

For Total Disabiuty. — (a). The weekljr indemnity for each week during the period 
immediately and continuously following said injuries in which said injuries alone, in- 
dependently and exclusively of all other causes, shall wholly disable and prevent the 
insured from performing any and every kind of duty pertaining to his business or 
occupation. 

For Partial Disability. — (5) Or, if such injuries shall not totally disable the in- 
sured as above, but shall immediately, or immediately following total disability, inde- 
pendentlv and exclusively of all other causes, continuously disable and prevent the 
insured from performing some one or more necessary important duty or duties per- 
taining to his Dusiness or occupation, the company will pay the insured for each week 
during the period of such^ disability, not exceeding thirty consecutive weeks, fifty per 
cent of the weekly indemnity. 

Optional iNDEiiNrriES. — (c) Or, at the op^xm of the insured, tf he shall suffer anv 
of the injuries named in the schedule of injuries endorsed hereon, the company wiU 
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 davs after said injuries are received, and that the com- 
pany shall not be liable for more thao one of said injuries in oonsequeDoe of any one 
accident. 

For Doctor Bills if no DiSABnJTY.-^d) Or, ff said 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 the weekly indemnity for one week. 

Section ill. Double Indemntties. Travel, Elevator, Bubnino Building, 
Lightning, Etc. — ^The company will pay double the indemnities specified in Section I 
and in clauses (a), (Jb) and {c) m Section II in case the said injuries shall be sustained 
b^ the insured: (1) While traveling as a passenger in or on a public conceyance pro- 
vided by a common carrier for passenger service(including the platform, steps, or running 
board thereoO; 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 tor 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; or (5) through the cdlapse of the 
outer walls of a finished building, while the insured is therein; or (6) by the eq>losion 
of a steam boiler. 

Section IV. Special iNDEinnTY. Sunstroke, Freezino, Hydrofhobia, In- 
halation OF Gas, Etc. — Sunstroke, freezing or hydrophobia, or blood-poisoning due 
ic either case to external, violent and accidental means, or the involuntary and uncon- 
scious inhalation of gas or other poisonous vapor shall be deemed a bodily injury within 
the meaning of this policy. 

Division IL Sickness Indemnities 

Section V. Weekly Indemnity. Total DiSABiLrrv with House Confinement. — 
(a) The company will pay the insured the weekly indemnit]^ for each week, but not jfor 
more than fiity-two consecutive weeks, during which any sickness, commencing during 
the term of this policy and not hereinafter excepted, shall independently of all other 
causes necessarily and continuously confine him to the house and wholly disable and 
prevent him from performing any and every kind of duty pertaining to his business or 
occupation. 

Total DisABiLmr Nonconfining.— (6) If immediately following a period of such 
confinement to the house and total disability he shall be continuously and wholly dis- 
abled and prevented from performing any and every kind of duty pertaining to his 
business or occupation, but shall not necessarily be confined to the house, the company 
will pay for each week of the latter period of disability, one-half the weekly indemnity: 
but no indemnity shall be payable for combined periods under (a) and ib) together of 
more than fifty-two coosecutive weeks of disability in alL 



94 FRANKFORT GENERAL INSURANCE COMPANY 

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 m loss of sight or 
loss of use of limbs as defined in Section VI, the company will pay the insured one-fourth . 
tne weekly indemnity for each week of the period immediately and continuously follow- 
ing said tifty-two consecutive weeks, during which said disability, independently and 
exclusively of all other causes shall totally disable and prevent the insured from per- 
forming any and every kind of duty pertaining to any ana 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 per- 
forming 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 medi- 
cal authority, satisfactory to the company, to be irrecoverable and for life, the com- 
pany 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 tne use of one arm, or one 
leg, one-fifth principal sum, less such sums as have been paid b^ way of weekly indemnity. 

This policy under Sections V and VI does not cover disability resulting from any sick- 
ness commencing within fifteen days from noon of the day this policy b dated. 

Section VII. Surgeon's Fees or Hospital Expenses. Accident or Sickness. — 
(a) In addition to the mdemnities 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. (6) 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 penod of confinement 
in said hospital, not exceeding twelve consecutive weeks. (0 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, pajrment shall be made for the first operation or hospital confinement; and m 
case of two or more such operations at one time, payment shall be made for one opera- 
tion to be specified by the insured. No paynient will be made for any operation result- 
ing from any condition which existed prior to the issuance of this policy. 

Section VIII. Identification.— The company will furnish the insured with an iden- 
tification 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, bt physically unable to 
communicate with relatives or fnends, the company will on receipt of a message giving 
the policy number, at once use all reasonable means and defray all expenses, not ex- 
ceeding one hundr^ dollars, necessary for placing him in their care. 

For Standard Provisions See Page 11 

Genz&al Provisions 

1. If the insured is entitled under this or any other policy to indemnity for loss result- 
ing from sickness or disease, he shall not be entitled under this policy to udemnity 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 sui- 
cide, sane or insane. , . . , . ^ . ^ . , 

3. The insurance hereunder shall not cover any injury, fatal or non-fatal, sustamed 
by the insured while participating in or in consequence of having parUapated in aero- 
nautics 

4. the company shall not be liable for more than one of the losses provided for m 
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 orie uxident 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. . . 

6. This insurance shall cover only accidents occurring or disability from sickness 
contracted within the Umits 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 CPhuipPuic Islands, 
Hawaii, Porto Rico, Canal Zone and Guam.) .,„,.,, , 

6. No assignment of interest under this pohcy shall bind the company unless consent 
thereto is formally endorsed hereon by the United States Mana-^erof the company, 
Any failure to comply with the provisions of this policy shall render invahd 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. ... , _^ ^ *t.. 

7. The copy of the application endorsed hereon is hereby made a part of this con- 
tract; no provision of the charter, constitution or by-laws of the company not included 
herein shall avoid the policy or be used in evidence m 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 m this re- 
spect ^all forfeit to the company all rights to aoy iodemmty. 



FRANKFORT GENERAL INSURANCE COMPANY W 

In wUness whereof. The Frankfort General Insurance Company, of Frankfort-on-the- 
Main, 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 Injukies. Optional Indemnities.^— For each $5 of the weekly indemnity. 
Far loss of certain members cd 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, $^; kunee, $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 
skuU, 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. 

ScHEDiTLB OF Operattoms. — ^Maximum amounts payable for surgeon's fees for each 
$5 of weekly indemnity. Appendicitis (see laparotomy), $20. Aneurism (tumor of 
artoy) — ligation, $10. Amputaticm of hand, foot or forearm, $5; leg. $10; arm below 
dbow. $10; thigh, $20; one or more entire fingers. $2. Abscess or Doil— incision, $1. 
Bone abscess — ^trephinmg. $5. Bronchotomv, thj^rotomy, laryngotomy, la^n^ 
tracheotomy or tracheotomy, $10. Carbuncle — incision and treatment, $1. Canes 
(bone ulcer) — curettmg, $3. Dislocations, reduction of shoulder, elbow, hip, knee or 
anklcj $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 Dcme or dioulder 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. Gan^ion (cyaXic tumor ot tendon sheath) — incision and curetting, $3. Gun- 
shot wounds — treatment not necessitating amputation or laparotomy, $5. Hernia 
(abdominal) — anv cutting operation for the radical cure of the reducible, irreducible 
or strangulated form, $20. Hydrocele — ^tapping — incision or excision of sac, $5. In- 
growing toe nail — removal. $2. Intestinal obstruction — (see laparotomy). Kidney — 
Dzation or removal. $20. Laparotomy (opening of the abdominal cavity for an opera- 
tion on any organ cont^ned therem), $20. Lithotomy any cutting ^operation for 
removal of stone m bladder), $20. Mastoiditis — operation for, $10. Necrosis 
(death of bone) — sequestrotomy (removal of dead bone), $7. (Esophogotomy for stric- 
ture or other cause, $20. Peritonitis (see laparotomy), $20. Paracentesis — ^tappin^ 
tA abdomen, bladder, $5; ear drum, $3. Rectum, operation for hemorrhoids (external 
or internal) exdsion or ligation, prolapsed — operation for fistula in aiio — incision, poly- 
pus-extirpation, $5; malignant stricture, -excision or solostomy, $20. Skull trephining 
for fracture or other cause, $20. S;^ovitis (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 — lii^ation or excision, $5. Varicocele— acupressure — ligation or 
excisi(Mi, $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 appli- 
cation 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 anv 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. 

Monthly Premium, $4. Policy Fee, $2. 

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, a^ 25, occupation clerk, under classi- 
ficatk>n AA, the person named and described in said application (herein called the In- 
sured), for the term beginning on the first day of January, 1916, and exjiiring 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 pay- 
ment of four dollars in advance on or before the first day of each calendar month there- 
after, against djaaibility 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). 



96 FRANKFORT GKTORAL INSURANCE COMPANY 

Division I.— Accident Indemnities 

Section 1. Specihc Losses — Death, Dismembericent 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 pav in lieu of all other indemnities 
under this policy (except as provided in Section VII) the specific amoimt indicated op- 
posite such respective loss. 

Loss of life — ^payable to the benefidary 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 bv complete severance «ls defined 
above, or entire sight of both c^es if irrecoverably lost, or entire siffht of one eye and 
severance of one foot as respectively defined above, or entire sight of one eye and sev- 
erance 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 si^t of one eye if iirecover- 
abj^ lost, one-third principal simi. 

Section 2. Disability BENEFrrs and Doctor's Bnxs.— 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 con- 
secutive months, during which such injuries shall, from the date of accident, wholly and 
continuously disable and prevent the Insured from performing every dut^ pertaining 
to any business or occupation, and he is attended by a legally qualified physician at least 
once a week. ( ^ 

For Partiai. ©iSABility. "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 con- 
secutive months, at the rate of one-half the monthly mdemnity, provided that the max- 
imum 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 Indeicnities. "C."— Or, at the optk>n of the Insiured, 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 m said schedule, in lieu of all indemnities 
lor total or partial disability; provided, that the Insured shall give the Company notio 
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 disabilitv, but shall require immediate medical or surgical treat- 
ment, the Company will reimburse the Insured for the amount actually expended for 
such treatment, upon presentation of the recapted bill of the doctor therefor; ixovided, 
such amount shall not exceed one-quarter of the monthly indemnity for one month. 

Section 3. Double Indemnities. — ^Travel, Elevator, Burning Buhding, Light- 
ning. — ^The Company will pajr double the indemnities specified in S«3tion 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 [Mwided by a common 
carrier for passenger service (including the platform, steps or running boud 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 m mines) provided for passenger service only; or, (3) In 
consequence of the burning of a building, while therem at the beginning ci the fire; or, 
(4) Through being struck by lightning. 

Section 4. Special Indemnity. — Sunstroke, Freezing, Hydrophobia, Inhala- 
tion OF Gas, Etc. — Sunstroke, freezing, hydrophobia or blood-poisoning, due in either 
case to external, violent and accidental means, or the involuntaiv and unconscious in- 
halation of gas or other poisonous vapor shall be deemed a boculy 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 at- 
tending 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 lea.st once in each seven days. 

Total Dlsabiuty, Non-Confining. "B." — Or, if during convalescence immedi- 
ately following said confinement, or by reason of any non-confining sickness, the In- 
sured 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 indemmty at one-half the above rate for a penoa 
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 per- 
forming any and all duties pertaining to his business or occupation and shall during 
the penod of such disability and within twelve months, indepenoently of {U} ptber CftUSCS 



FRANKFORT GENERAL INSURANCE COMPANY 97 

result in any <me of the specific losses enumemted 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 oitire sight of both eyes, the use of both arms, or both legs, or one arm 
and one leg, the principal simi. Loss of entire sight of one eye, or the use of one arm, 
or one leg, one-half principal siun Gess 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 Insiured, he shall, 
within ninety days from the date of acddent 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 opera^on in said schedule. 

"B.'' — Or, at the option of Insured, if said surgical operatbn is performed in an in- 
corpcorated hospital, and requires continuous confinement therein, the Company will 
pay, in lieu of said surgeon's fees, a monthly hospitel 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 siirgeon's fees or hospital expense be payable for more 
than one operation or hospital confinement as the result of ainr 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 ccmfinement; and in case of two or more such operations at one time, pay- 
ment 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 issu- 
ance of this policy. 

For Standard Provisions See Page U 

General Provisions 

1. If the insured is entitled under this or any other policy in this or any other Com- 
pany to indemnity for loss resulting from sickness or disesise, 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 mtoxicants 
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 aero- 
nautics. 

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 speci^c losses shallterminate 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. Any 
settlement with the Insured or the beneficiary shall finally release the Company from aU 
further claims in respect of said accident or sickness. 

5. The acknowledgment by the Company of the receipt of notice given imder 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 oi the Company in defense of any claim arising under this policy. 

6. If at the time of filing ckum 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 
amoiuit for which it would otherwise be liable under this policy. 

7. If the Insured be disabled by accident or sidmess for more than one month, he 
or his representative shall furnish to the Company, every thirty days, or as near thereto 
as may oe reasonably possible, with a written report from his attending physician or 
»irgeon, fully stating his condition and probable duration of his disabihty. 

8. liie copy of application endorsed hereon is hereby made a part of this asntract. 
No provision of the diarter, constitution or by-laws of the Company not included herein 
shall avoid the policy or be used in evidence in any legal proceeding hereunder. Com- 
pliance on the part of the Insured and beneficiary with all the provisbns of this policy 
IS a condition precedent to recover]^ hereunder and any failure in tUs respect shall torieit 
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 Alas^ 
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 xmless con- 
sent 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 COA* 
paoy, which shall not b^ responsible for its vaUdity. 



te GENERAL ACCIDENT, FIRE & LIFE ASSUR. CORP.. LTD. 

Qeperal /leeid^pt, pir^ & £if^ /)S8ur. ^orp., Ctd. 

PERTH. SCOTLAND. 

Commenced Business 1885. U. S. Office, 55 J6!m St, New Yock. 

FiEDERiCK Richardson, United States Manager. 

The General Accident issues the following policies in its Com- 
mercial Accident and Health Department: "Genaco Disability/' 
$15 per $1500, and $5 weekl)^ 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 Indenmity 
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 premmm 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 75& 
for each $5 weekly indemnity. 

POLICY FORM— "General Accident." 

Principal Sum, $5000. Weekly Indemnitt» $25. 

Annual Premium, $15. 

General Accident, Fire and Life Assurance Coiporation, 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 ex- 
pressed, 

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 aU other causes through external, violent and 
accidental means (excluding suicide, sane or insane, or any attempt thereat, sane or in- 
sane), as specified in the following schedules. 

Part I. Specific Total Losses. — If such injury shall, independently and ezdusivelv 
of all other causes, immediately, wholly and continuously from date of accident. disaUe 
and prevent the insured from performing each and eveiy duty pertaininc^ to his business 
or occupation and shall, diuring 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-phalaogeal 
joints, one-third of the principal sum. The payment of any one such loss shall end this 
policy. 

Paet II. Total Loss of Time Iia>EifNiTY.(a) If such injury shall not result in any 
of the losses enumerated in Part I, but shall bom the date of accident directly and in** 
dependently 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 oor- 
)>oration will pay for the period of such disability, not exceeding two hundred consecutive 
weeks, an indemnity per week of twent-five douars. 

Partial Loss of Tiue Indemnity. — (6)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 
biin from performing one or more of the important daily duties pertaining to his business 



GENERAL ACCIDENT, FIRE & LIFE ASSUR. CORP.. LTD. 99 

or occupation, the corporation will |>ay for the period of such disability, not f«rfH«ng 
thirtv consecutive weeks, an indemnity per week at one-half the rate specified in para- 
{[raph A of Part II. Payment of indemmty under this section shall be in lieu of all other 
indemnity except that accruing under Part III. 

Past III. Registkation and Identificatiom.— If the insured shall, by reason of 
such injur/, be rendered physically unable to communicate with friends, the corporatioa 
apon receipt of telegraphic or other message givinj^ the number of this policy, wHl im- 
mediatehr transmit to his relatives or friends any mformation respecting him and will 
defray all necessary expenses (not exceeding twenty dollars for each five dollars weekly 
indemnity for total loss of time) to put the insured in care of friends. 

Part IV. Retukn Premium Agreement. — If premiums on this policy are paid an- 
nually in advance, the corporation agrees, in case of loss of life of the insured within the 
meaning and intent of this policy, to return to the beneficiary named all premiums so pdd. 
For Standard Provisions See Page 11. 

OiHER Provisions. 

21. No assignment of interest under this policy shall bind the corporation unless 
consent thereto is formally endorsed hereon by && executive officer of the corporation. 
A copy of any assignment must be given within thirty days, to the corporation which 
shall not be responsible for its validity. 

22. This policy dott not cover disability sustained outside of the limits of the United 
States, Canada and Eurc^ie or in Alaska or the insuhur possessions of the United States, 
or while engaged in military or naval service. 

23. The insurance hereunder shall not cover any injury, fatal or non-fatal, sustained 
bv the insured wliile participating in or in consequence of having participated in any form 
01 aeronautics, or which shall result directly or indirectly from ptomaines. 

24. The copy of the ai^cation oidorsed hereon is hereby maae a part of this contract. 

25. No provision of the charter, constitution or by-laws of the corporation shall 
avoid this policy or be used in defense of any claim arising under this poU(^. 

26. This policy is issued for the term stated in the insuring clause, out it may be re- 
newed subject to all the conditions of the policy contract from term to term upon the ad- 
vanced payment of the memium stated. 

In tntness wkereo(,the General Accident, Fire and Life Assurance Corporation, Ltd.. 
has caused this policy to be signed by its United States manager, but the same shall 
not be binding upon the corporation until countersigned by a du^ authorized represent- 
ative d the corporation. 

POLICY FORM— "Complete Disability." 

Principal Sum, $7500-115,000. Weekly Indemnity, $25*$50. 

Annual Premium, $60. 

General Accident, Fire and Life Assurance Corporation, Ltd. 
of Perth, Scotland (herein called the corporation), in consideration 
of the premium of sixty dollars, and the statements in the applica- 
tion for this policy, a copy of which is endorsed hereon ana made 
part hereof, and subject to the provisions and limitations here- 
inafter expressed, does hereby insure John Doe, occupation 
attorney (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 and independently of all other 
causes through accidental means (excluding suicide, sane or insane, 
or any attempt thereat, sane or insane) and against disability 
by sickness as specified in the following schedules: 

Past I. Accident iMOEiCNniES— -Death, Diskeubekment and Loss ov Sight.— If 
any one of the losses enumerated below shall result from such injuries alone, within 
ninety days from the date of accident, the corporation will pay the sum specified op- 
posite such loss and in addition the weekly indemnity, as provided in Part II, for total 
disability t from the date of the accident to the date of death, dismemberment or loss 
of sight; or, if such injuries shall, independently and exclusively of all other causes, 
immediately, wholly and continuously disable and prevent the insured from perform- 
ing any and everv kind of duty pertaining to his occupation, and shall at any time dur- 
inE the period of such continuous disability result in an^ one of the losses enumerated 
Mow, tne corporation will pa]^ the sum specified opposite such loss and in addition,- 
weekly indemnity as provided in Part II for total disability, to the date of death, dia 
membennent or loss ot sight, provided that not more than one such loss shall be payable 
as the result of any one accicfent. 

Payments in One Sum. roR 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 at or above the 
wrist and one foot at or above the ankle (by severance) or entire sight of^both eyes irre- 
coverably lost, or either hand bv severance at or above the wrist and enUie sight of one 
eye if irrecoverably lost, or either foot by severance at or above the ankle and entire 
sight of one eye if mecovexably lost, the prind^ sum. Either hand by severance at or 



713338 



100 GENERAL ACCIDENT, FIRE k LIFE ASSTJR. CORP., LTD. 

above the wrist, or dtlier foot by severance at or above the ankle, or entire sight of one 
eye irrecoverably lost, one-half of principal sum, or thumb and index finger of either 
hand by severance at or above metacarpo-phalangeal joints, one-third of principal stun. 
The payment of any one such loss shall end this policy. 

In the event of death the principal sum insured shall, as hereinafter provided, be paid 
to Mary Doe (the beneficiary), whose relationship to the insured is that of wife. 

Part II. Weekly Indemnity— Total Disability.— If such injuries do not result 
in any one of the lasses enumerated in Part I, but shall immediately, wholly and contin- 
uously disable and prevent the insured from performing any and every duty pertaining 
to his occupation, the corporation will pay for the entire period of such total disa«}flity 
weekly indemnity at the rate of twenty-five dollars (125) per week. 

Partlil Disability. — If such injuries result in immediate and continuous partial 
disability from date of accident, or from the termination of total disability, the cor- 
poration will pay for such partial disability for a period not exceeding fifty-two (52) con- 
secutive weeks, as follows: 

For the period during which the insured is totally disabled for three-<]uarters of his 
business time, weekly indemnity at the rate of three-fourths of the amount pajrable for 
total disability. 

For the period during which the insured is unable to perform any important duty 
pertaining to his occuixition, weekly indemnity at the rate of one-half of the amount 
payable for total disability. 

For the period durinff which the insured is not entitled to benefits under either of the 
preceding sections and during which he is unable to fully perform all of the work pertaining 
to his occupation, weekly indemnity at the rate of one-fourth of the amount payable 
for total disability. 

Part III. Double Benefits —Any amount which may become i>ayable tmder Parts 
I. II and IV shall be double the sum specified therein if such injuries are sustained by 
the insured,. (1) while a passenger in or on any regular passenger convevance provided 
l^ a conunon carrier (including the platform steps or running-board uiereof); (2) or, 
while a passenger in a passenger elevator (excluding elevators m mines); (3) or, in con- 
' ^ -. . . . . jj^ 



sequence of being struck by lightning; (4) or, caused by the burning of a building m which 
the insured may be at the commencement of the fire: (5) or, caused by the collapse of a 
building while the insured is therein; (6) or, caused by the explosion of a steam boiler; 
(7) or, caused by a cyclone, tornado or earthquake. 

Part IV. Fixed iNDEMNiriES for Specific Injxtries when Desired.— If the insured 
shall suffer a non-fatal injury, specified in the following schedule of fixed indemnities, 
he mav, subject to all the provisions and limitations ofthis policy, elect to receive, in 
lieu of any weekly indemmty provided under Part II, the sum specified onx)site such 
injunr in said schedule, provided the insured signifies his choice within twenty days from 
the date of an injury for which claim is made under this policy. 

Schedule of Fixed Indemnities. — ^If the original single weekly indemnity payable 
under Part II of this policy for total disability is f 25 the following amounts wiU be paid. 
If said weekly indemnity is greater or less than $25 the amounts to be paid shall be in- 
creased or reduced proportionately. 

For the Complete Fracture of Bones.— Of the skull, both tables, f350; lower jaw, 
$75; collar bone. U65; pelvis, $350; thigh, $350; leg, $200; kneecap, $215; arm, between 
elbow and shoulder, $300; arm, between wrist aiid elbow, $165; two or more ribs, $115; 
foot other than toes, $125; hand other than fingers, $125; two or more toes, $103; two or 
more fingers, $100. 

For Loss.—Of one or more fingers, at least one entire phalanx, $160; one or more 
entire toes, $200. 

For Complete Hernia. — Caused solely and directly by accidental injuiy, $80. 

For a Complete Dislocation.— Of the spine or neck, $300; shoulder, $125; dbow, 
$115; wrist, $140; hip, $315; knee. $175: cny bones other than toes, $160; ankle, $175; 
two or more toes, $65; two or more fingers, $65; jaw, $65; two or more bones of the hand, 
not finders. $50. 

Provided, however, that no claim for more than one of the losses in said schedule, 
the result of any one accident, shall be valid. 

Part V. Sunstroke, Freezing, Hydrophobia, Asphyxiation. — Sunstroke, freezing, 
hydrophobia or asphyxiation, suffered through accidental means (excluding suicide, 
sane or insane, or any attempt thereat (sane or insane) shall be deemed a boduy injuiy 
within the meaning of this policy. 

Part VI. Blood Poisoning or Septic Infection.— ^Blood poisoning or septic in- 
fection, resulting directly from a bodily injury, shall be deemed to be included in said 
term "bodily injury." 

Part VII. Physicians' Bills for Injuries not Causing Disability. — If such in- 
jury does not result in a loss specified herein, but requires treatment of the insured by 
a physician, the corporation, upon satisfactoiy proof from the physician in attendance, 
wul reimburse the injured for the cost thereof, not to exceed one week's single indemnity 
as provided under Part II for total disability. 

Part VIII. Return Premium Agreement. — ^If premiums on this policy are paid 
annually in advance, the corporation agrees, in case of loss of life of the insured within 
the meaning and intent of this policy, to return to the beneficiary named all premiums so 
paid. 

Part DC. Sickness Indemnities— Weekly Indemnity— Total Disability. — If the 
Insured shall, independently of all other causes, be wholly disabled and prevented by 
sickness from performing any and every kind of duty pertaining to his otxupation, the 
corporation will pay the weekly indemnity provided under Part II for total disabUity. 

Partial Disability. — ^For the period following any period of total disability, during 
which the insured is not totally disabled, but suffers a material loss of his business time, 
which shall be deemed partial disability, the coipoiation will pay weekly indemnity at 



GEKERAL ACCmfiNT. FtltE k LIFE ASSPR. CORP., LTD. 101 

tfaie zaU of one-half of the amoont paid for total disability. Weekly isdenmity on ac- 
count of sickness, total and partial disability combined, will not be paid in excess of 
fifty-two consecutive weeks. 

Part X. PBRifAHXNT Disabilty.— Upon due proof to the corporation that the hi- 
sored has, as the result of sickness contracted during the term of this policy, and not 
hereinafter excepted, entirely and irrecoverably lost the sight,of both eyes, or permanently 
and entirely lost the use of both hands or both feet, or of one hand and one foot, or has 
differed incurable paralysu, and also that he has been for one year and will during his 
life, by reason thereof, be permanently disabled from ennging in any work or occupation 
for wages or profit, Uie corporation will pay one-half <h the principal sum of this policy, 
in lieu of all other indemnities. 

PaKT XI. ACCTOEMT OR SICKNESS INDEMNITIES. — SURGBONS' FeES FOR OPERATIONS 

ON Insured. — ^Ix any injury or sickness covered by this policy shall, within ninety days 
from the date of accident or commencement of disability from sickness necessitate a 
surgical ofieration named in the schedule of (^wrations endorsed hereon, which forms a 
part of this policy, the corporation will pay the insured, in addition to the indemnity 
DTOvided, the sum set opposite such operation on said schedule, but payment shall not 
be made for more than one operation. 

Part XII. Hospital Expenses. — If such injury or sickness shall necessitate any one 
of the surgical operations named in the schedule of operations endorsed hereon, and such 
operation is performed in an incorporated hospital, the insured may elect to receive 
in lieu of any sum payable as surgeon's fee under the schedule of operations, and in addi- 
tion to the indemnity otherwise payable, an amount equal to one-half ot the original 
single weekly indemnity as provided under Part II for total disability, for each week 
that the insured is necessarily confined in said hospital not exceeding twelve (12) con- 
secutive weeks. 

Part XIII. Registration and Identification. — ^If the insured shall, by reason ci 
injury or sickness, during the time this policy is in force, be physically unable to communi- 
cate with friends, the corporation will, upon receipt of any message, giving this policy 
number, immediately transmit to the relatives or friends of the insureoTany information 
respecting hun, and will defray all expense necessary to put the insured in the care of 
friends, but the coriwration's liability therefor sha 1 not exceed the sum of one hundred 
dollars ($100). 

For Standabd Provisions See Page 11. 

OiHER Provisions. 

21. No assignment of interest under this policy shall bind the a»p(nation unless con- 
sent thereto is formally endorsed hereon by an executive o£Bk:er of the corporation. A 
copy of any assignment must be dven, within thirty days, 'to the corporation, whidi 
shall not be responsible for its validity. 

22. Thispoubr does not cover sickness contracted or disabih'ty sustained outside of 
the limits of the United States, Canada and Europe or in Alaska or the insular possessions 
of the United States, or while enmed in military or naval service. 

23. 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 any 
form of aeronautics. 

24. The copy of the application endorsed hereon is hereby made a part of this contract. 

25. No provisions of the charter, constitution or by-laws of the corporation shall 
avoid this policy, or be used in defense of any claim arising under this policy. 

26. This pdicy is issued for the term stated in the insurance clause, but it may be re- 
newed subject to all the conditions of the policy contract from term to term upon the 
advanced payment of the premium stated. 

In witness whereof, the General Accident, Fire and Life Assurance C>>rporation, Ltd., 
has caused this policy to be ugned by its United States manager, but the same shall not 
be binding upon the corporation until countersigned by a duly authorized representative 
of the corporation. 

Schedule of Operations. — ^If the single original weekly indemnity of this policy 
is $25 the following amounts will be paid: If said weekly mdemnity is greater or less 
than $25 the amounts to be paid shall be increased or reduced proportionately. Abscess 
or boil, $5. Abdomen — cutting into abdominal cavity for diagnosis or treatment of 
organs therein, $1 15. Amputation of foot, hand or forearm, $25; leg or arm, %30; thigh, 
$75; fincer or fingers, $10. Aneurism— operation for tying of artery, $40. Apoendiatis 
(see abdomen), $115. Bladder-operation for removal of stone by cuttinis, $1 io; opera- 
ticm by crushing, $50. Bone — injuries to or disease of. Removal of diseased portion 
of bone, $25. Carbuncle — ^incision and treatment, $10. Chest— incision into tnoradc 
cavity (exclusive of tapping) for diagnosis or treatment of organs within, except the lungs, 
$25. Dislocations— reduction of shoulder, elbow, hip, knee or ankle $25; wrist or lower 
jaw, $15: thumb or fingers, $10. Ear, nose or throat — any cutting operation, $10. Esopha- 
gotomy for stricture or other cause, $100. Excision of shoulder, hip or knee joint, $100; 
elbow, wrist or ankle joint, $50; toe or toes, $15. Eye, removal, $50: cataract, $25; 
any other cutting operation, $15. Fractures, reduction of nose, lower jaw. collar bone 
or shoulder blade, $25; breastbone, $10; rib or ribs. $10; upper arm, $35; forearm (one 
or both bones), $25; wrist or hand, $15; fingers, $10; bones of the pelvis except coccyx, 
$75; coccyx, $10; thigh^ $75; kneecap, or leg bones (one or both), $50; bones of foot, $15; 
toes, $10. Felon — incision, $5. (joitre— cutting operation for permanent cure, $75. 
Gunohot wounds — treatment not necessitating amputation or cutting operation into 
abdominal cavity, $15. Hernia (abdominal) — any cutting operation for radical cure, 
$115. Hydrocele — ^incision or excision of sac, $25. Hydrophobia — Pasteur treatment, 
$65. Ingrowing toe nail— removal, $10. Intestinal obstruction (see abdomen), $115. 
Kidney (see abdomen), $1 15. Lockjaw — ^treatment by anti-tetanic serum, $50. Lung — 
operation within the lung, $75. Mastoiditis — operation for mastoid— abscess or removal 



102 GENERAL ACCIDENT, HRE & LIFE ASSUR. CORP., LTD. 

of diseased bone, $50. Nerve— cutting operation for stretching, $25. Peritonitis (see 
abdomen), $115. Rectum— operation for hemorrhoids: External, $15; internal, $25: 
prolapsed, $25; fistula in ano, incision, $20; curettement, $15; malignant disease ot 
rectum, $115. Skull^operation for fracture or other cause, $100. Spine or spfaial cord — 
operation thereon, $100. Tapping of abdomen, $25; bladder, $15; cnest, $15; ear-drum, 
$10; hydrocele, $10; joints, .$10; pericardium, $75. Trachea— cutting operation for any 
cause, $40. Tumors— benign, $15; malignant (except when spedficaUy covered else- 
where n this schedule), $50. Varicocele — acupressure, ligation or exdsKMi. $25. Vari« 
cose veins— ligation or excision. $25. Wounds— suturing, $10. 



GEORGIA CASUALTY COMPANY 103 



Georgia CasualtY Companv. 

MACON, GA. 



Comiiienoed Busiiiess 1900. W. E. Small. Pres. E. P. Amerine, Sec. 

The following forms are issued in the accident and health branch: 
"Regular Accident/* form R, annual premium, select, $20; 
"Combination Accident," form C, select and preferred, annual 
premium, $25; "Limited Disability," form D, select and pre- 
ferred, annual premium, $60; "Limited Disability," select and 
preferred; annual premium, $35; "Combination Death and 
Dismemberment," form CDD, select and preferred, $15; "Dixie 
Combination Accident," form X, select and preferred, $30; 
"Dixie Disability," form Y, select and preferred, $70. The 
above premiums are on a $5000 basis. All classifications may be 
written on the regular accident poHcy while only the select, 
preferred, extra preferred and ordinary classifications are eligible 
for any of the other forms. The accident features of C, D, AL, 
X and Y are the same except that in the "Dixie" policies forms 
X and Y, the accumulative provision applies to weekly indemnity 
and contains also a return premium agreement. 

POLICY FORM C— "Combination Accident." 

Principal Sum, $5,000-$! 0,000. Weekly Indemnity, $25-$50. 

Annual Premium, $25. 

In consideration of the statements in the schedule of warranties 
hereinafter contained and of $25 premium, the Georgia Casualty 
Company of Macon, Ga. , herein called the company, 

Does hereby insure John Adams, herein called the assured, in the initial principal sum 
of 15000, and for a weekly indemnity of $26, for the term of 12 months hrom the loth day 
of April, 1010, be^iinning and ending at 12 o'clock, noon, standard time, against bodilv 
injuries, herein called "such injuries," efiFected directly, independently and exclusively of all 
other causes through accidental means (suicide, sane or insane, not mduded); as follows: 

Schedule of Indeicnities. 

1. Death, Dismeubesment or Loss of Sight Within Ninety Days.— If any one 
of the loas^ enumerated in this section (1) shall result solely from such injuries within 
nmety days from the date of the accident, the company will pay the sum set opposite such 
specific loss. 

Death, Dbmzmbewient or Loss of Sight Within Two Hundred Weeks. — Or, 
if such injuries shall, independendy and exdusively of all other causes, immediately, 
continuously and wholly disable and prevent the assured from performing any and every 
kind of duty pertaining to his occupation, and during the period of such continuous dis- 
ability, and within 200 weeks from date ot the accident shall result in any one of the said 
losses, the company will pay the sum set opposite such specific loss and in addition weekly 
indemnity as provided for herein to date of death, dismemberment or loss of sight, as the 
case may be. For loss of life, or both hands by severance at or above the wrists, or both 
feet by severance at or above the ankles, or one hand at or above the wrist and one foot at 
or above the ankle by severance, or entire sight of both eyes, if irrecoverably lost, or entire 
sight (rf one eye^ if nrecoverably lost, and one hand at or above the wrist by severance, 
or entire sight of one eye, if irrecoverably lost, and one foot at or above the ankle, by sever- 
ance, the principal sum. Either hand by severance at or above the wrist, or foot by 
severance at or above the ankle, one-half of principal sum. Entire sight of one eye, if 
irrecoverably lost, one-third of inincipal sum. (One loss only is payable for one accident.) 

Accumulative Provision. — Each consecutive full year's renewal of this policy, if the 
premium be paid annually in advance, will increase the respective sums specified in this 
section (1) by ten per cent; if paid other than annually in advance, by five per cent; until 
in either case according as premium may be paid, fifty per cent is thus added to the initial 
principal sum. Thereafter, so long as me policy is maintained in force, the insurance will 
be for the said initial principal sum {dus the accumulations. This provision shall not 
apply to increase the weekly indemnity under this or any other section ol the policjr. 

2. Weekly iNDEMNrrY— Total or Partial Disability. — Or, if such mjuries shall 
Dot result m any of the losses mentioned in Section 1 but shall immediately, continuously 
and wholly disable and prevent the assured from performing any and every kind of duty 
pertaining to his occupation, the company will pay him for the period of such total dis- 
ability, the weekly indemnity above specified, to an amount not exceeding the initial prin- 
cipal sum plus any accumulations which may have accrued under this policy at the time 
such injuries are sustained. Or, if such injuries shall not wholly disable the assured, as 
above, but shall Immediately (or immediatdy following total disability) and continuously 



i04 GEORGIA CAStAt'Tsr (JbMl^ANV. 

- • ■ ■• — - — : I . ■ , ■ -I.I rTW»ir— ri 

disable and prevent him from performing one or more Important daily duties pertaining 
to his occupation, the company will pay one-half the weekl]^ indemnity above specified for 
the period of such partial aisability not exceeding twenty-six consecutive weeks from the 
date of injury or from the termination of total disability. Weekly indemnity will not be 
payable under the provisions of Section 1 except as therein stated. 

3. Optional Indemnity. — If the assured shall sustain an injury by means aforesaid, 
and such injury is named in the "Schedule of Injuries" endorMd horeon, he may elect, 
subject to the terms and conditions of this policy, to receive Uie amount of indemnity as 
specified for such injury in said schedule, in lieu of all other indemnity under tnis policy, 
except for surgical operation or hospital expenses to which assured may be entitled, pro- 
vided written notice of his choice is ^iven to the company at Macon, Ga., within ten days 
from the date of occurence of said injury; provided further that not more than one amount 
shall be payable for injuries sustained in any one accident. 

4. Double Indemnity. — ^If the assured shall sustain such injuries; (1) while a passen- 
ger in or on a public conveyance provided by a common carrier for passenger service; 
(2) or, while a passenger in an elevator used tor passenger service only; (3) or, in conse- 
quence of the burning of a building while the assured is therein; (4) or, by the explosion 
of a stationary, locomotive, marine, or portable boiler; then, and in such event only, the 
company will pay double the amount otherwise payable under the preceding sections. 

5. Indemnity for Paralysis or Insanity. — If such injuries shall not result in any 
loss enumerated in Section 1 hereof, but shall immediately, continuoushr and wholly dis- 
able and prevent the assured from performing any and every kind of duty pertaining to 
his occupation; (a) (Paralysis). — And during the period of such disability, and within 
ninety days from the date of the accident, shall directly, independendy and exclusively of 
all other causes result in permanent paralysis^ and if within thirty days after the expiration 
of one year from the date of such paralysis he shall be declared by competent and duly 
coi;i8tituted medical authority to be permanently paralyzed, and to be thereafter imable 
to engage in an^ work or occupation tor wa^s or profit, the company will pay the assured 
the initid principal sum of this policy, and m addition thereto weekly indemnit>r as herein 
provided for the said period of one year; (5) (Insanity). — Or, shall within sue months 
from the date of the accident result directly, independently and exclusively of all other 
causes in the assured being adjudged insane by competent and duly constituted medical 
authority, and he shall within said six months be committed to a duly licensed asylum for 
the insane, and shall be continuously confined therein for a period of not less than two 
years and within thirty days after the expiration of said period of two years shall be de- 
clared by such medical authority to be incurably insane, the company will pay to the per- 
son or persons duly authorized to receive the amoimt on behalf of the assured the initial 
principal sum of this policy, and in addition thereto weekly indemnity as herein provided 
fen* the said period of two years. Payment under either paragraph (a) or (6) of this 
Section (5) slmll be in lieu of all other indemnity under this policy. 

6. Indemnity for Sunstroke. — If sunstroke, effected directly, independently and ex- 
clusively of all other causes through external violent and accidental means, shall result in 
the death of the assured within ninety days from the date of the accident, the company, 
upon proof thereof, will pay the initial principal sum dL this- policy in lieu ol all other in- 
demnity. . . . 

7. Indemnity for Sitrgical Operations. — If such mjuries sustained by the assured 
shall within ninety days from the date of accident necessitate a surgical operation named 
in the "Schedule of Operations" endorsed hereon, and the same shall be performed, the 
company will pay, in suldition to the indemnity otherwise provided, the sura as specified 
for such operation in said schedule; but such amount shall,not be payable for more than 
one operation necessitated by injuries sustained in one accident. 

8. Reimbursement for Hospital Expenses. — If such injuries sustained by the as- 
sured shall within ninety days from the date of the accident necessitate his removal to an 
incorporated hospital, the company, provided no claim is made under Section 7 hereof, 
will pay, in addition to the indemnity otherwise provided, for a period not exceeding 
ten weeks, during which the assured shall be necessarily confined to the hospital, the amount 
expended by him weekly for hospital expenses, but not exceeding per week one-half of the 
amount payable hereunder as weekly indemnity for single benefits. 

9. Indemnity for Surgical Treatment op Mikor Injuries. — Or if such injuries 
shall not result in either death or disability, but shall require surgical attention, the com- 
pany wfll reimburse the assured for the cost thereof to an amount not exceedinff one 
week's single indemnity as provided for herein, provided the surgeon's receipt and affi- 
davit on the company's blank are furnished the company within thirty days from the date 
of the event causing the injury. ^, . * . , . . 

10. Weekly Indemnity Payable in iNSTALMENTs.^-Claims for mdenmity for dis- 
ability of less than thirteen weeks* duration shall be payable at the termination of the dis- 
ability; claims of longer duration shall be payable at the expiration of thirteen weeks 
from date of accident and at intervals of thirteen weeks thereafter, satisfactory affirmative 
proof of disability and of its continuance to be furnished before each payment, and final 
proof in all cases to be furnished in accordance with Section 15. 

11. Special (Coverings. — ^Subject to its terms, limits and conditions thfa policy covers 
the assured in the event of death or disability due to freezing, hydrophobia, gas- or poison 
(suicide, sane or insane, not included); likewise in the event of death or disability from 
blood poisoning due direcdy to a bodily injury sustained while this policy is in force. 

12. Schedule of iNOEMNrriEs for Injuries to the BENEFiciARY.-:-If one person 
only is specifically named as the beneficiary of the assured in the ' 'Schedule of Warranties" 
hereinafter contamed and such person is not under 18 nor over 60-' years of age, and is in 
sound condition mentally and physically; then, and not otherwise, this policy shall also 
insure such beneficiary against bodily injuries, effected directly, independently and ex- 



GEORGIA CASUALTY COMPANY. 105 

dnsivdy of aU other cauaes, through external, violent and accidental means (suicide, sane 
or insane, not included), and received: (1) while a iMssennr in or on a public conveyance 
provided by a common carrier for passenger service; (2) or, while a passenger in an 
elevator used for passenger service only; (3) or, in consequence of the burning of a build- 
ing while said beneficiary is therein; (4) or. caused by the exnlosion of a stationary. 
locomotWc. marine, or portable boiler; as follows: If any one of the losses enumcntf^^l 
in this sectioa shall result solely from such injuries within ninety days from the date of the 
accident, the company will pay for loss of life, or both hands by severance at or above the 
wrists, or both feet by severance at or above the ankles, or one hand at or above the wrist 
and one foot at o' above the ankle, by severance, ot entire sight of both eyes, if irrecoverably 
lost, or entire sight of (Uie eye, if irrecoverably lost, and one hand at or above the wrist, 
by severance, or entire si^ht of one eye, if irrecoverablv lost, and one foot at or above the 
ankle, by severance, the mitial principal sum. One hand by severance at or above the 
wrist, or one foot by severance at or above the ankle, one-half the initial principal sum. 
Entire sight tji one eye, if irrecoverably lost, one-third the initial principal sum. (One 
loss only is payable for one accident.) Or, if such injuries do not result in any of the 
losses enumerated m this Section (12) but are named m the "Schedule of Injuries" en- 
dorsed hereon, the company will pay such beneficiary one-half of the sum specified in 
said schedule for "Ordinarv Accidents" for such injuries; but not more than one-half 
of any sum so specified shall be payable for injuries sustained in any one accident. If the 
beneficiary shall sustain an injury in the manner defined in this Section (12) and such 
injury sh^dl within ninety days from the date of accident necessitate an operation as named 
in the "Schedule of Operations" endorsed hereon and, the same shall be performed, the 
company wSl pav one-half of the sum specified in said schedule for such operation; but 
no pajrment shall be made for more than one operation necessitated bv injuries sustained 
in any one accident. The amount payable in the event of the loss of life of the beneficiary 
shall be paid to the estate of the beneficiary; the payment of any other sum provided for 
in this section shall be made to the person insured as beneficiary. 

13. Agr^ments. — If the assured is injured fatally or otherwise in any occtipation 
classified by this company as more hazardous than that stated in the schedule '*of War* 
ranties" hereinafter contained, the company's liabilitv shall be only for such i»-oportioa 
of the principal sum or other indemnity provided for herein as the premium paid by him 
will purchase at the rates fixed by the company fear such increased accident hazard. 

14. — No daim against this company on account of accidental injuries shall be valid 
in excess of fifty thousand dollars, under policies or tickets, either separately or together. 
Insurance in excess shall be void and the premimn paid for such excess will be refimded on 
demand. 

15. Written notice must be given to the companv at Macon, Ga., or to the agent 
countersigning this policy^ as soon as may be reasonably possible, of any injury for which 
a daim is to be made, with full particulars thereof ana full name and address of the as- 
sured or beneficiary, as the case may be. Aflirmative proof of death, or loss of limb, or 
sight, or surgical operation, or.duration of disability, must be furnished to the company within 
two months from the time of death, or loss of limb, or sight, or surgical operation, or termina- 
tion of disability. Affirmative preliminary proofs under Section 5 must be filed with the 
company within two months from date of the beginning ol paralysis or insanity, as the case 
may be, and affirmative final proofs under said section must be filed within two months 
from date of final examination as required by said section. Legal proceedings for recovery 
hereunder may not be brought until after three months from date of filing final proofs at 
the companjr's home office. The company shall not be liable in any suit to recover under 
this policy luiless the same shall be commenced within one year from time of death, or loss 
of limb, or sight, or surdcal operation, or from the date when the weekly indemnity herein 
provided for becomes due and payable hereunder. Claims not brought m accordance 
with these requirements will be forfeited to the company. 

16. — If the limitations of time for notice of mjury, proof of daim or for legal proceedings 
herem contained shall differ from the statutory ivovisions in rdatbn thereto of the state 
wherein the assured resides, it is agreed that such statutory provisions shall supersede sudi 
limitations in this policy. 

17.— The company may cancel this policy at any time by written notice mafled to tlift 
assured at the address given in the "Schedule of Warranties" hereinafter contahied, and 
the unearned premium, if any, shall be returned to the assured, and the company's chedc 
for such amount, mailed with such notice shall be sufficient tender. Persons under 18 
or over 65 years of age are not covered by this policy. Women are only insured when 
named as beneficiary as herein provided. 

18. — ^The company shall have the right and opportunity to examine the person of the 
assured or benjeficiary when and so often as it requires in case of injury, and also the rigiht 
and opportimity to make an autopsy in case of death. 

19. — Any claim shall be subject to proof of interest and no assignment of interest imder 
this policy shall be valid unless the consent of the company thereto is formally endorsed 
hereon by an executive officer. 

20. Indemnity for loss of life of (he assured shall be pakl to the beneficiary named in 
the "Schedule of Warranties" hereinafter contained (or to such other beneficiary as the 
assured may designate), if surviving; otherwise to the executors, administrators, or as- 
signs of the assured. 

21. — The consent of the beneficiary shall not be requisite to a surrender, cancellation, 
change or assignment of this policy or to a change of beneficiary. 

22.— An agent has no atithority to change this policy, or to waive any of its provisions, 
nor shall notice to any agent or knowledge of hb or any other person be held to effect a 
waiver or change in this contract, or any part of it. No change whatever fai this policy. 
«od °^ waiver of its provision^ sbaU b« v^id unleM an endorsement is added hereto signed 



106 GEORGIA CASUALTY COMPANY. 

by the president or secretary of the company, expressinR such chanae or waiver. In any 
matter relating to this insurance no person, unless duly authorized m wntmg, sbaU be 
deemed the agent of this company. • . , ,. 

23.— That all of the warranties made by the assured upon the acceptance of this policy 
are true, vir.: 

ScHEDXTi^ OF Wakkanties accompanies poHcy 

In witness whereof, the Georgia Casualty Co., of Macon, Ga., has caused these pre- 
sents to be signed by its president and secretary; but the same shall not be binding upon 
the company unless countersigned by a duly authorized agent of the company. 

Identification.— Upon the receipt of the premium for this policy, provided it is not 
less than $20, a certificate of identification will be issued wherem it is agreed that if tne 
assured shall, during the term of this policy or any renewal herecrf, be physically unable, 
as the result ot such injuries, to communicate with relatives or friends, the company ^ ill. 
upon receipt of tele^aphic or other advices, transmit to such persons as may be desig- 
nated any information respecting him, and defray the expense (not exceeding $100) 
necessary to place him in their care. 

Schedule of Injuries. — (Optional Indemnities— See Section 3). The amounts 
stated m the following * 'Schedule of Injuries" are payable under thb policy if issued for 
five thousand dollars principal sum, proportionate amounts being payable if the policy is 
issued for a larger or smaller principal sum. Ordinary accidents, Section 2. For loss 
of one or more fingers (at least one entire phalanx) $150; one or more entire toes, $200; 
For complete hernia caused solely and directly by accidental injury, $70. For complete 
dislocation, viz.: Of the shoulder, $100; dbow, $100; wrist, $125; hip, $300; knee, $lf0; 
anybonesof foot, $150; ankle, $150; two or more toes. $60; two or more fingers, $50. 

For the complete fracture of bones, viz.: Of the skull, both tables, $325; lower jaw, $75; 
clavicle (collar bone), $150; pelvis, $250; thigh, $300; leg, $200; patella (Vnee cap) 
$200; arm, between elbow and shoulder, $300; forearm between the wrist and elbow, 
$150; two or more ribs, $100; foot, $125; hand, $125; two or more toes, $100; two or 
more fingers, $100. 

Travd^ etc., accidents, section 2, double above amounts. 

Schedule of Operations. — (Indemnities f<n: surgical operations — ^See section 7). 
The amounts stated in the following "Schedule of Operations" are payable under this 
policy if issued for five thousand dollars principal sum, proportionate amounts being 
payable if the policy is issued for a larger or smaller principal sum. Amputation of foot, 
hand or forearm, $25; leg or arm, $50; thigh, $100; finger or fingers, $10. Dislocations, 
reduction of shoulder, elbow, hip, knee or smkle, $25; wrist or lower jaw, $15; thumb or 
fingers (two or more), $10. Excision of shoulder, hip or knee joint, $100; elbow, wrist or 
ankle joint, $50; toe or toes, $25; Fractures, Reduction of nose, lower jaw, collar bone 
or shoulder blade, $25; breast bone, $10; rib or ribs, $10; upper arm, $35; forearm (one 
or both braies), $25; wrist or hand, $15; finnrs (two or more), $10; any of the bones of 
pelvis or sacrum, $50; Coccyx, $10;- thigh, $75; knee cap or leg bones (one or both), $50; 
bones of foot, $15; toe or toes, $10. Gunshot wounds — ^Treatment not necessitating 
amputation or laparotomy, $25. Hernia (Abdominal) — Any cuttmg operation for the 
radical cure of the reducible, irreducible or strangulated form. $100. Hydrophobia — 
Pasteur treatment, $50. Lapeu'otomy (opening of the abdominal cavity for an operation 
on any organ contained therein, or for Traumatic Peritonitis, or exploratory mciskm) 



JixuBg membrane of a joint). Incision, $25. Woonds ol scalp or other parttr— Suturing, $5. 
POLICY FORM B— "Disability." 
The disability policy, containing accident and health insurance, 
is similar to the combination accident policy, except where the 
phraseology conflicts with the health provisions and in the fol- 
lowing paragraphs : 

7. Indemnity for Surgical Treatment of Minor Injuries. — See *' Combination 
Accident" policy, 9.) 

8. SPEaAL Coverings. — (See "Combination Accident" policy, 11.) 

Schedule of Indemnities — Disease or Illness. 

9. Indemnttv for Blindness or Paralysis.— If, during the term of this policy Uie 
assured shall contract any bodily disease or illness which shall not terminate m death, but 
independently of all other causes, and within one year from the date of commencement 
of disabilitv, shall result in the entire and irrecoverable loss of sight of both eyes, or m the 
permanent and entfre loss of the use of both hands or both feet, or of one hand and one 
loot, and on account of any one of said conditions will thereafter, and durmg his life, be 
permanently disabled from engaging in any work or occupatbn for wages or profit, the 
Smpany wfll, upon the filing at its home oflfice of satisfactory proofs of the contmuance for 
one ySr of such blindness or paralysis, pay the assured a sum equal to one hundred week's 
indemnity at the rate hereinbefore specified; payment to be m lieu of all other mdemmty 

"°1? Weekly Indemnity for Illness.— If the assured shall suffer bodily disease or 
illness not hereinafter excepted and such disease or illness shall wholly disable and prevent 
him from performing any and every kind of duty pertaining to his occupation, the company 
wiU pay for the period of such disability during which he shaU be necesswily confined to the 
bouse ttie wedk^indemnity hereinbefore specified; or if such illness shall wholly disable 



GEORGU CASUALTY COMPANY. 107 

as herein provided but not neoessarfly confine him to the home, the company wHl pay 
one-half of the weekly indemnity payable for disability requiring confinement to the house; 
provided alwasrs that the combined periods for which indemnity will be paid for any illness 
shall not exceed fifty-two consecutive weeks; payment to be in lieu of all other indemnity 
under this policy except for surgical operations or hospital expenses to which he may be 
enuiled. 

IT. Indemnity it Quarantined.— If, durinf[ the term of this policy or any renewal 
hereof, the assured shall, as a consequence of his having been exposed to a contagious or 
infectious disease, be quarantined by order of the civil authorities, and shall thus be pre- 
vented from performing any and every kind of duty pertaining to his occupation, the com- 
Vany will pay him the weekly indemnity as herein provided for the period of such quaran- 
tine, not exceeding thirteen consecutive weeks; payment to be m lieu of all other indemnity 
under this policy. 

Indemnities for Either Accident or Illness. 

12. Indemnity for Surgical Operations. — If such tniuries sustained or illness con- 
tracted by the assured shall within ninety days from the date of commencement of dis- 
ability necessitate a surgical operation named in the "Schedule of Operations" endorsed 
hereon, and tne same shall be performed, the company will pay, in additbn to the indem- 
nity otherwise provkied, the sum as specified for such operation m said schedule; but such 
amount shall not be payable for more than one operation necessitated by injuries sustained 
in one accident, or as the result of any one cause of illness. 

13. Re-Imbursement tor Hospital Expenses.— If such injuries sustamed or illness 
contracted by the assured shall within ninety days from the date of the commencement of 
disability necessitate his removal to an incorporated hospital, the company, provkied no 
claim is made imder Section 12 hereof, will pav, in addition to the indemnitv otherwise pro- 
vided, for a period not exceeding ten weeks during which the assured shall be necesi>arily 
confined to the hospital, ihe amount expended by him weekly for hospital expenses, but 
not exceeding per week one-half of the amount payable hereunder as weekly indemnity 
for single benefits. 

14. Weekly Indemnity Payable in Instalments. — Claims for indemnity for dis- 
ability of less than thirteen weeks' duratk>n shall be payable at the termination of the dis- 
ability; claims of longer duratk)n shall be payable at the expiration of thirteen weeks from 
the date of accident or illness and at intervals of thirteen weeks thereafter, satisfactory, 
efiirmative proof of disability and of its continuance to be furnished before each pasrment, 
and final proof in all cases to be furnished in accordance with Sectbn 21. 

16. (See "Combination Accident" policy, 12.) 

16. Agreements. — i nis insurance does not cover disability from illness unless the 
assured is treated by a regularly qualified physician for the disease by reason of which 
be claims indemnitv; nor from any disease if contracted within fifteen da^s from noon of 
the date of issue unless this is a renewal of a prevk>us policy which provided for indem- 
nitv against disease or illness. 

17. — This insurance does not cover disease or Oiness suffered or contracted outside of the 
United States (not including Insular Possessions or Alaska), Canada and Europe. 

18. — If the assured shall become entitled to indemnity tor disability on account of acci- 
dental m juries, the company shall not for the same period of time be liable for any disability 
on account of illness. 

19. — If the assured is injured fatally or otherwise in any occupation classified by this 
company as more hazardous than that stated in the "Schedule of Warranties" hereinafter 
contained, the company's liability shall be only for such principal sum or other indemnity 
as the premium paid by him for the accident portion of this contract will purchase at the 
rates fixed by the company for such increased accident hazard. 

20. — No oaim against this company for injuries tmder accident policies shall be valid in 
excess of fifty thousand dollars. Insurance m excess shall be void and the premium paid 
for such excess will be refunded on demand. 

21. — Written notice must be given to the company at Macon, Ga., or to the agent coun- 
tersigninff this policy, as soon as mav be reasonably possible, of any mjury or ulness for 
which a daim is to be made, with full particulars thereof and full name and address of the 
assured or beneficiary as the case may be. Affirmative proof of death, or of loss of limb, 
or sight, or surgical operation, or duration of disability, must be furnished to the company 
withm two months from the time of death, or loss of lunb, or sight, or surgical operation, 
or termination of disability. Affirmative preliminary proofs under Sections 6 and 9 must 
be filed with the company within two months from date of the beginning of blindness, 
paralysis or insanity, as the case may be, and affirmative final proofs under said Sections 
must be filed within two months from date of final examinatk>n as stipulated in said sections 

22. — Legal proceedings for recovery hereunder may not be brought until after three 
months from date of filing final proofs at the company's home office. The company shall 
not be liaUe ra any suit to recover under this policy unless the same shall be commenced 
within one year from the time herein provided for the filing c^ final proofs hereunder. 
Claims not brought m accordance with these requirements will be forfeited to the company. 

2i, (See "Onnbination Accident" policy, 16.) 

24. The company may* cancel this policy at any time by written notice mailed to the 
assured at the address given in the "Schedule of Warranties" hereinafter contained, and 
the unearned premium, if any, shall be returned to the assured, and the company's check 
for such amount mailed with such notice shall be sufficient tender. Persons under 
eighteen or over sixty years of age are not covered by this policy. Women are only 
insured when named as beneficiary as herein provided. 



108 GEO RGIA CASUALTY CX)MPANY. 

25.— The compwiy shall have the right and opportunity to examine the person of die 
assured or beneficiary when and so often as it requires in case of injury or iUness, and alao 
the rii^ht and opportuni^ to make an autopsy in case of death. 

26. (See -'Combination Accident" policy. 19.J 

27. (See "Combination Accident" policy. 20.) 

28. (Sec "Combination Accident" policy. 21.) 

29. (See "Combination Accident" policy, 22.) 

30. That all the warranties made by the assured upon the acceptance of this policy 
are true, viz.: 

Schedule ot Waekanties accompanies policy. 

In witness whereof, the (Georgia C:asualty Company, of Macon, Ga., has caused these 
presents to be signed by its president and secretary; but the same shall not be bmdmg 
upon the company unless countersigned by a duly authorized a^ent of the company. 

Schedule of Injuries.— (See preceding contract.) e. • *«v 

ScKEDiTJt nr OpEBATiovi! — (Tndnnrniif^ for surfrtcal operations — see Section 12). 
The amnunts atatfd in ihf l^Mnmna. ' Schedule of Om-faticms " are payable under this 
policy \i i^iufd f^r five Ihousmfl rtnltara pniiriQAl sum, prDTinrtiansite amounts being 
pavabit if the polity i?i issiH'H fnr a. iur^tr or smnllrr princi|Al suth. Ali?ress or boil — in- 
riar*n. FJi. Ampulatinn oi fcmt, hand or l^t-HTm, 12.1; W or arm. t50; thigh, $100; 
fingpr or fin^er^, %\Ci, Aneitriam riiinrinr of arttry— l]((aHoii>, IStV Apptn-iidtis, $100. 
Bont a^irsct'&ii — trcrihining %2^ P oi hol'-'^v. thyrntomy, larv-n^^lomy, l^rMigotracheo- 
tomy <?r tmcheolomy, IfiO. Carbuiicb--Xndb$aa and tFcatmeiil, 125^ Caries (bone 
uker) Cureitbg, |15. Dislacations, Reduction of sboulder> elboWt hip, knee cm- ankle, 
$2&-^ wrist or lowtr jaw, |15; thumb or fingera (two or more), 110. Efcision of shoulder, 
kip or knee joint, 1)00; elbow, wrist or afiklc jnicit. I&O; toe or tties, |2S. Eve, ear, nose 
or throil— Any cut lint! oiieriiiion^ 110. Ftlon — IncisionH $5, Fnicmres, Reduction of 
OQst^ lower JQW, cotUr bone or shoulder hlude, 1 25; breast bo«e. tlO; rib or ribs, $10; 
upper ATii^ in,^; forrirrri Tine or bu!h firitic?;\ 135;^ wrist Dr h.i,nd. |1S; fingers (two or 
more-, il'-'i ■■..."/■■ ^•■ ■ ■ ^'^n. ^ ■. \ti. |10; thigh, 175; knee cip 

or ]i . ■•cs. 110. G^nt^ion (cystic 

tumor ot lendon sheam; — incision ana cureiimg, $ib. Gunshot wounds — I'reatment not 
necessitating amputatbn or laparotomy, $25. Hernia (Abdominal) — Any cuttmg opera- 
ation for the radical cure of the reducible, irreducible or strangulated form, $100. Hydn>- 
cde — ^Tappin^; — Incision or Excision of Sac, $25. Hydrophobia — Pasteur treatment, • 
$50. Ingrowing toe nail — Removal, $10. Intestinal obstruction (See laparotomy). 
Kidney — ^Fixation or removal, $100. Laparotomy (opening of the abdominal cavity for 
an operation on any organ contained therein, or for traumatic peritonitis, or exploratory 
incision, $100. Lithotomy (operation for removal of stone in bladder) any cutting, $100: 
Lockjaw — Injection of anti-tetanic serum mto frontal lobe of brain, $100; into spinal 
canal. $50. Mastoiditis — Operation for, $50. Necrosis (death of bone)— Seguestrotomy 
(removal ol dead bone), $35. Oesophogotomy for stricture or other cause, $100. Perit- 
tonitb (see laparotomy). Paracentesis — Tapping of abdomen, $25; bladder, $25; 
ear drum. $15. Rectum — Operation for hemorrhoids (external or internal) Excision or 
ligation, $25; prolapsed — Operation for, $25; Fistula in ano — Incision, $26; Polypus— 
Extirpation, $25; Malignant stricture — Excision or colostomy, $100. Skuu trephining 
for fracture or other cause, $100. Synovitis (Inflammation of the lining membrane <^ a 
joint). Incision, $25. Tumors— Extirpatkm from any part of the body, benign, $15; 
malignant, $50. Varicose vefaia— Ligation or exciskm, $25. Varicocele— Acupressune— 
Ligackm or exdsKMi, $25, Wounds of scalp or other part9--SiituriDg,$5b 



CLOBE tNDEMKltY COMPAfflf OP K£W YOMt 100 

Qlobe Iiydemplty ^ompai>y of flew Yori{. 

45 WILLIAM STREET, NEW YORK. 



fV>f^^«>i n;if^ Business 1911 
HsMKY W. Eaton, Pres. A. Dxtncan Reid, Sec. and Gen. Man. 

This company issues the "Ultima" disability policy, which 
covers disability from both accident and disease, and which in its 
entirety, is as follows: 

POLICY FORM— "Ultima Disability," 

Principal Sum, I7500-S15,000. Weekly Indemnity, $25-150. 
Annual Premium, 175. 

Globe Indemnity Company hereby insures subject to the terms, 
provisions and linutations hereinafter contained, the Person named 
in answer 1 of the copy of the application endorsed hereon against 
loss, caused (1), directly and exclusively by bodily injury sustained 
solely through accidental means, or caused (2), directly and exclu- 
sively by any physical or mental disease or illness if contracted 
and disability begins, necessitating treatment by a legally qualified 
physician, while this policy is in force, and designated as "such 
injury" or "such disease," as follows: 

The capital sum is seventy-five hundred (17500) dollars. 

Section 1. Acodimt iNDKMNiry. — (a) If such injury, within 180 days fxom date 
of accident, irresi^ective of disability, causes the insured to sustain any one of the losses 
enumerated in tins section, the Companv will pay the amount specified for such loss, as 
follows: For loss of life, or both feet, or both hands, or one foot and one hand, or sight of 
both eyes, or one foot and sicht of one ore, or one hand and sight of one eye, capitafsum: 
one leg or one arm, two-thirds of capitafsum; one foot, or either hand, one-halt of capital 
sum; sight of one eye, one-third of capital sum; thumb and index nnger, either hand, 
one-sixth of capital sum. (6) Under this section " loss " shall mean, whether referring to 
one or more bodily members, as follows: of leg, arm, foot, hand, thumb and index-finger — 
complete am^tation at or above the knee, elbow, ankle, wrist or metacarpo-phalangeal 
joints; of siffikt — total, permanent and incuraole blindness, respectively, (c) The 
occurrence of any loss enumerated in this section shall immediately terminate all insurance 
hereunder, and when liabilitv for such loss is released this entire contract shall be sur- 
rendered to the Company, {d) If such injury, from date of accident, renders the insured 
totally and continuously unable to transact all of his business duties and, during the 
period of such disability, causes any one of the losses enumerated in this section, the 
Company will pay the amount syedfied for such loss and in addition, until the loss occurs 
indemnity at the rate per week specified in Section 2 for total disability. The week^ 
indemnity is twenty-five ($25) dollars. 

Section 2. Total DiSABmrv. — (a) If such injury does not cause a loss enumerated 
above but, from date of accident, renders the insured totally and contmuously unable 
to transact all of his business duties, the Company will pay for the entire period thereof, 
indemnity at the rate per week of $5 for each $1500 capital sum. 

Intermediate Disability.— (ft) If such injuijr, from date of accident or immediately 
following a period of total disabiUty, renders the insured continuously unable to transact 
a major portioa of all of his business duties, the Company will pay for the period thereof 
not exceeding fifty-two consecutive weeks, indcmmly at the rate per week of three- 
fourths the amount specified in this section for total disabiUty. 

Paetial Disability — (c) If such injurv, from date of accident or immediately folbw- 
ing a period of total or intermediate disability, renders the insured continuouslv unable 
to transact a material portion of any or all of his business duties, the Company will pay for 
the period thereof, not exceeding fifty-two consecutive wedcs, indemnity at the rate per 
w^ of one-half the amount specified in this section for total disability, (d) Indemmty 
under clauses (b) and (c), singly or combined, of this section will not be paid for more than 
a total period of fifty-two consecutive weeks. 

Section 3. Elective Indemnity. — If such injury, within ninety days from date of 
accident, causes any one of the losses enumerated in this section, the insured may elect 
to claim the amount specified for such loss, in lieu of all other indemnity, except as pro- 
vided in Section 10, if notice to that effect is mailed to the Company at its home office in 
New York Citv not later than twenty days from the date the loss occurs. If the capital 
sum of this policy is larger or smaller than $7500, any amount payable hereunder shall be 
increased or reduced proportionately. Amputation — complete dt — fingers or toes, one or 
more, $160. Dislocation of— ankle or knee, $175; elbow, shoulder or wrist, $125; hip. 
$300; jaw, two or more fingers or toes. $60; spine or neck, $300; two or more bones of 
loot, not taes« 175; two or more bones of hand, not fingers, $50. Fracture— complete of— 



no GLOBE INDEMNITY COMPANY OF NEW YORK 

femur, patella, or tibia and fibula, $225; fingers, ribs or toes, two or moce, $100; foot or 
hand, two or more bones, not toes or fingers, $125; humerus, or radius and ulna, $175; 
Jaw , scapula, sternum or clavicle, $175; Skull, both tables, pelvis or thigh, $350. Hernia — 
double, $160. Hernia— single, $80. 

Section 4. Double iNDEinnTY.^The amount specified for a loss enumerated in any 
of the foregoing sections shall be doubled if such iniury is sustained by the insured while 
in or on a public conveyance, including the platform steps or running board thereof, 
provided by a common carrier for passenger service; in an elevator used for passenger 
service only, mine elevators excepted; in a completed building which bums Or collapses; 
or in consequence of a cyclcme, tornado, the explosion of a steam boiler, or being struck 
by lightning. 

Section 5. Special Indemnity. — If choking while swallowing, sunstroke, somnam- 
bulism, freezing, assault by burglars or highwavmen, involuntary or unconscious inhala- 
tion of gas or other poisonous vapor, hydrophobia or septicemia results directly and 
exclusively from such injuiy and causes a loss enumerated m sections 1. 2 or 3, the same 
shall be covered hereunder. 

SEcnoN 6. Disease or Illness Indevnity. — (a) If such disease renders the 
insured totally and continuously unable to transact all of his business duties and, during 
the period of such disability and within fifty-two weeks fitnn its beginnmg, causes any 
one of the losses enumerated in this section, and the insured survives such loss for fifty- ' 
two weeks and it is thereafter established by competent medical authority that the loss is 
as defined below, the Company will pay the amount specified for such loss and in addition, 
until the loss occurs, indemnity at the rate per week specified in Section 2 for total dis- 
ability. 

For loss of si^ht of both eyes, one third of capital sum; use of both feet and hands, 
one-third of capital sum; use ot both feet, one-fifth of capital sum; use of both hands, 
one-fifth of capital sum; use of one foot ana one hand, one-fifth of capital sum; use of one 
foot, one-sixth of capital sum; use of right hand, one-sixth of capital sum; sight of one 
eye, one-tenth of capital sura; speech, or hearing of both ears, one-tenth of capital sum ; 



use of left hand, one-twelfth of capital sum. (6) Under this section "loss" shall mean , 
whether referring to one or more bodily members, as follows: Of sight, foot, hand, speech 
or hearing — total, permanent and incurable blindness, paralysis or deafness, respectively, 
(c) The occurrence of any loss eniunerated in this section shall immediately terminate all 
insurance hereunder, and when liability for such loss is released this entire contract shall be 
surrendered to the Company. 

Section 7. Total Disability. — (a) If such disease does not cause a loss enumerated 
above, but renders the insured totall> and continuous unable to transact all of his 
business duties, the Company will pay tor the entire period thereof, indemnity at the rate 
per week specified in Section 2 for total disability. 

Intermediate Disabiuty.— (ft) If such disease, immediately following a period of 
totafdisability , renders the insured continusouly unable to transact a major portion of all 
of his business duties, the Company will pay for the period thereof, not exceeding fiftv- 
two consecutive weeks, indemnity at the rate per week of one-half the amount specified m 
section 2 for total disability. 

Partial Disability.— (c) If such disease, immediately following a period of total or 
intermediate disability, renders the insured continuously unable to transact a material 
portion of any or all of his business duties, the Company will pay for the period thereof, 
not exceeding fifty-two consecutive weeks, indemnity at the rate per week of one-fourth 
the amount specmed in Section 2 for total disability, (d) Indemnity under clauses (6) 
and (c), singly or combined, of this section will not be paid for more than a total period of 
fifty -two consecutive weeks. 

Section 8. Hospital Indemnity. — If such injury or disease causes the insured to 
sustain a loss covered by this policy and, within ninety days from date of accident or con- 
traction of disease, necessitates concurrent confinement in a regular hospital or sanitarium, 
ths Company will pay for the period thereof, not exceeding fifteen consecutive weeks, 
indemnity at the rate per week of $2.50 for each $1500 capital sum, and in addition the 
amount specified in Section 2 for total disability. 

Section 9. Increased Weekly Indemnity. If all premiums are paid in advance, 
each consecutive annual renewal of this policy shall add ten per cent., beginnmg the second 
year, to any amount due for a loss covered under Sections 2 or 7, until such additions aggre- 

gEite fifty per cent, of the original weekly indemnity, as follows: If disability begins during 
rst year, original indemnity; second year, ten per cent, increase; third year, twenty per 
cent, increase: fourth year, thirty per cent, increase; fifth year, fwty per cent, increase; 
sucth year ana thereafter, fifty per cent increase. 

Section 10. Surgical Operation Indemnity.— If such injiiiy or disease necessi- 
tates an operation enumerated in this section and the same is performed within ninety 
days from date of accident or contraction of disease, the Company will reunburse the in- 
sured for the actual cost thereof, not exceeding the amount speciBed for such operation, 
in addition to any other indemnity that may be due; but if one accident or disease neces- 
sitates more than one operation, payment will be made for the first only. If the capital 
sum of this policy is larger or smaller than $7500, any amount payable hereunder shall be 
increased or reduced proportionately. Abdomen — Opening cavity for treatment or 
diagnosis, $100. Amputation of— Both legs above knees, $150; both arms above elbows, 
$150; both feet or hands above ankles or wrists, $125; thigh, $100; one leg or arm above 
knee or elbow, $75; one entire foot, hand or forearm, $50; one or mwe entire toes or 
fingers, $15. Appendicitis — ^removal of entire appendix, $100. Aneurism — ^ligation 
of artery . $50. Boil or abscess — incision and removal of pus, $ 10. Bone Abscess or uker 
— trephining or curetting, $25. Cancer or cataract — extirpation of, $50. Carbuncle — 
incision and curetting, $10. Cyst — ^removal by incision, $15. Diphtheria — injection of 
antitoxin, two or more treatments, $25. Di«docation--Teductk>n of — ^hip, knee, ankle, 
shoulder or elbow, $25; jaw, wrist, one or more toes or fingers, $16. DropflQr — ^tapping 



GLOBE INDEMNITY COMPANY OF NEW YORK 111 

and removal of fluid^25. Excision of— hip, shoulder or knee joint. $125; elbow, wrist 
or ankle joint. ^. £ye— enucleation, $75. Fracture-^-reduction of— thigh, $75; pelvis, 
patdla, femur, or tibia and fibula, $50; humerus, or radius and ulna, nose or jaw. $25; 
scapula, clavicle or sternum. $25; sacnim, coccyx or wrist, $ 15; two or mote bones of foot 
orhand,not toes or fingers. $15; one or more ribs, toes or fingers. $15. Ganglion — incision 
and removal of, $15. Goitei^-radical cure by cutting, $75; Gun shot wound— Probing 
or dressing, $25. Hematocele or hvdrocele — tapping, incision or excision, $25. Hernia, 
scrotal or abdominal— radical cure by cutting, $75. Hydrophobia— Pasteur treatment, 
tlOO. Intestinal obstruction— treatment by abdominal incision, $100. Kidney— 
ncision and fixation or removal. $100. Liver, removal of malignant growth or gall 
stones, $75. Malignant tumor— complete extirpatwn, $50. Mastoiditis— trephining 
and removal of pus, $50. Nerve— cuttmg or stretching. $25. Peritonitis— treatemnt by 
abdominal inasioUi $100. Polypus — removal of, $15. Rectum — spiles, polvpus or 
fistula; ligation or mdsion, $25. Sequestrum — removal of, $50. Stone in bladder — 
removal by incision or crushing, $75. Skull — trephining for fracture or meningit is, $ 125 
Synovitis — incision and removal of fluid, $25. Tetanus — ^injection of antitoxin into 
frontal lobe of brain. $100. Thorax — tapping or incision for removal of pus or fluid, $25. 
Throat— removal of tonsils or malignant growth, $25. Varicocele — cutting or tapping, 
125. Varicose veins — ^tying or removal, $25. Woimds — ^not gun shot — sutunng or 
dressing, $5. 

SienoN 11. Medical Attencance iNDSiCNnY.- If such injury or disease does not 
cause a loss enumerated in any of the foregoing sections, but necessitates treatment by a 
physician or the services of a graduate nurse, the Company will reimburse the insured 
tor the actual cost thereof, provided a receipted bill on the Company's form is filed at the 
borne oflke in New York City not later than ninety days from date of accident or con- 
traction of disease, but liability for such treatment or services, singly or combined, shall not 
exceed $5 for each $1500 capital sum. 

Section 12. Ekergency Indemnity. — If such injury or disease causes the insured 
to be physically or mentally unable to communicate with the beneficiary designated 
berem, the Company will, upon receipt of a message giving the number of thb policy, 
transmit an^ information it may possess and defray the expenses necessary to place the 

irviceandei 



insured in the care of relatives or friends, but liability for such service and expense shall 
not exceed $20 for each $1500 capital sum. 

For Standard Provisions See Page 11. 

Special Provisions. 

A. Losses Not Covered.— This policy does not cover (1) disappearance; (2) loss 
due to any means, act, injury or disease which, if used, done or self inflicted by the insured 
while in possession of all mental faculties, would be deemed intentional. 

B. Assignment of Interest. — ^A copy of any assiniment must be given to the Com- 
panjr within thirty days, which shall not be responsible for its validity. 

C. Policy Ldctcation. — ^Reimbursement will not be made for any <^)eration which 
is necessitated by a disease or bodily condition contracted or existing i»ior to the issue 
of this policy; no accident indemnity will be paid for any loss caused by disease, nor dis- 
ease indemnity for any loss caused by injury; nor, except as provided, will payment be 
made under more than a single section for loss caused by one accident or disease. 

D. Policy Inclusion.— ^o provision of the charter, constitution or by-laws of the 
Campixiy not included herein shall avoid this policy or be used in evidence in any legal 
proceeding hereunder. 

E. Premium Consideratiok and Term of Poucy.— ^This policy is issued in consider- 
ation of seventy -five dollars ($75) premium, for a term of twelve months, from the first day 
of January, 1915, beginning and endins at twelve o'clock noon, standard time, at the place 
where countersigned, but subject to its provisions and the Company's consent may be 
renewed from term to term of twelve months by payment of such premium imtil the insured 
if fifty years of age. If thereafter renewed, the premium shall be $ 

F. Occupation and Class. — ^The insured's occupation and business duties, fully 
described, areas follows: Attomey-at-law. Class No. 1. 

G» Copy of Appucation Part of Contract.— The copy of the application endorsed 
bere(» is hereby made ft J>&rt of this contract. 

. In witness whertoj the Globe Indemnity Company has caused this policy to be signed by 
Its president and its secretary, but the same shall not be binding upon the Company until 
cottntessigned by a duly authorized representative of the Company. 



112 GkEAt EASTfikK CASUALTV COMPANY 

Qreat Easter^ (^asuaity (^o/npaQy* 

85 JOHN STREET, NEW YORK, N. Y. 



Conuaenoed Bosbeas in 1S93. Loms H. Fzbel, Prea. Tbqmas H. Dakuho, Sec 
C Clask Howasd, Agency Director. 



' The Great Eastern issues accident and health policies in various 
forms, writing all classes of personal accident risks. 

Premiums. — "Ultra Protection" policy providing for any acci- 
dent or illness (no exceptions), surgeon's fees, hospital indem- 
nity, fixed indemnities, double benefits, beneficiary insurance, 
and medical attendance, $15 per $1500 and S5 per week indemnity 
for extra preferred risks. Issued to extra preferred and preferred 
risks onlv. "Ultra Gilt-Edge," a combination policy covering 
any loss by accident, $5 per ll500 and $5 per week for extra pre- 
ferred, and $6 for preferred. "Ultra Perfection" policy covering 
any disease or sickness, $50 per year for $25 per weel|: indemnity 
issued to extra preferred and preferred risks. The $5000-$ 10,000 
"Double Weekly Indemnity," giving $50 weekly indemnity, $30 
per annum for extra preferred and $40 for preferred risks. The 
company also issues special policies for policemen and firemen; 
a general form for all classes other than extra preferred and pre- 
ferred, and several other forms. 

1 Age Limit.— 18 to 60. 

Maximum Indemnity. — Death, $15,000; weekly indemnity* 
$100.00. 

POLICY FORM— "Double Weekly Indemnity." 

Principal Sum, $5000-$10,000. Weekly Indemnity, $504100. 
Maximum Sum, $10,000. Annual Premium, $30. 

Great Eastern Casualty Company of New York, in consideration 
(of the agreements and statements in the application, a copy of 
which is endorsed hereon and made a part hereof, : and of thirty 
dollars premium. 

Hereby insures John Watson, by occupation, editor, subject to all the provisions 
and limitations herein contained for the term oC twelve months from noon, standard 
time, where the insured resides when the policy is issued, of Janiiaiy 1, 1914, against 
tiie effects of bodily injuries, caused directly, solely and independently of all other causes 
by external, violent and accidental means and which shall result in immediate and con- 
tinuous disability as follows: 

Section 1. Accidemt Indemnitzes. — ^If any loss specified in this section shall result 
aoldy and exclusively from such injuries within three months from date of the acci- 
dent, the company wall be liable only for such loss and will pay for loss of. life, or both 
han^ 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 defined above, or entire sight of one eye and severauce of one hand as de- 
fined above, SdOOO; right arm by complete se\'erance at or above the elbow, $3500; right 
hand by complete severance at or above the wrist, $3000; left arm by complete severance 
at or above the elbow, S3000; left hand by complete severance at or above the wrist 
$2500; either leg by complete severance at or above the knee, $3000; either foot by com- 
plete severance at or above the ankle, $2500; entire sight of one eye if irrecoverablv lost 
$1700; and in addition $50 a week for any period between date of the accident and date 
of the loss for which no weekly indemnity has been paid. 

Section 2. Loss of Time, Total.— If such injuries shall from date of the acddent 
continuously and totalhr disable and prevent the insured fnnn transacting eveiy kind of 
business, pertaining to his occupation, the company will pay for the period of such total 
disability, not excx^eding two years, a weekly indemnity of $50. 



GREAT EASTERN CASUALTY COMPANY 113 

I«08S or Tdkb. Partui.— If such injuries shall from date of the accident or immediately 
foUowing total disability, continuously disable and prevent the insured from transacting 
a material part of the duties essential to his business, the company will i>ay for the period 
of such paxtial disability, not exceeding seven months, but the combined periods for 
any one accident shall not exceed two years, a weekly indemnity of $25. 

SscnoN 3. Medical Attendance.— If such injuries shall not result in any of the 
above losses, but require medical treatment, the company will pay the amount actually 
paid by the usured for such treatment, not exceeding, however, $50, 

SEcnoN 4. DouBLB Indemnities.— All the above amounts shall be doubled if such 
injuries shall be received (1) while riding as a passenger in or on any passenger car of any 
street or other railway; or (2) while a passenger and on board a steam vessel licensed for 
the regular transportation of passengers. The amounts under Section 2 only shall be 
dottUed if such injuries shall be received; (1) while a passenger in an elevator provided 
for passenger service only, excepting elevators in mines; (2) or while in a burning build- 
ding in which the insure/ shall be at the beginning of the fire; (3) or through being 
■truck 1^ lightning; or (4) through the coUapse of the outer waJb of a finished building 
while the insured is therein. 

SEcnoii 5. Special iMDEiaimES.— Sunstroke, freedng, hsrdrophobia, or the in- 
voluntary and unconscious inhalation of gas or other poisonous vapor shall be covered 
with one-half of each of the indemnities provided by this policy when suffered through 
external, violent and accidental means. 

Section 6. Blood Poisoning. — Blood poisoning resulting directly from a bodily 
Injury caused by solely external, violent and accidental means is covered by this policy. 

SBcnoM 7. SxTRGEON's FEES.— If such injuries received after the date of this poli^ 
ihaill akme within three months from date of the accident and during the term of this 
policy necessitate a surgical operation named in the "Schedule of Operations" herein- 
after mentioned^ the company will pay in addition to the indemnity, the sum provided 
for such operation, but when more than one operation is required payment shall be 
made only tor the first. 

Section 8. Rxgistkation and Identificatiob.— If the insured shall by reason 
of such injuries, be physically unable to communicate with friends, the company will 
upon receipt ci a message giving this policy number, immediately transmit to such imtivts 
or friends as may be known to it, any inf OTmation respecting him, and will defray any 
expenses necessary to put him in communication with and in the care of friends not ex- 
ceeding a sum equal to four weeks' indemnity under Section 2. 

SEcnoN 9. Settlements Every Thirty Days.— In case of loss of time, pavment 
will be made at the expiration of each thirty days upon request of the insured and filing 
of due proof. 

Section 10. fHMEDiATX Optional Settlements.— If the insured shall susUin 
an injury specified in the "Schedule of Optional Indemnities," hereinafter mentioned, 
he may, subject to all the conditions of the policy, elect to receive in lieu of all other in- 
demnity the sum specified in said schedule tor such injury, provided, however, that he 
signify his election m writing to the company at its home office in New York City within 
twenty days from the date of the injtu^, and provided further that the election may not 
be for more than one of the sums spedncd in said schedule. 

Schedule ov Operations. — For each $5 of single weekly indemnity. Amputation 
of foot, hand or forearm $5; leg, $10; arm above elbow, $10; thigh. $20; one or more 
entire fingers, $2. Dislocations, reduction of shoulder, elbow, hip knee or ankle $5; 
wrist or jaw $i; finger or fingers $2. Excision of shoulder, hip or knee joint $20; 
elbow, wrist or ankle joint, $10; toe or toes, $6. 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 one or both leg bones, 
$10. Gunshot wounds — treatment not necessitating amputation or laparotomy, $5. 
Hernia (abdominal) — any cutting (^ration for the radical cure of the reducible, irre- 
duciple or strangulated form, $20. Hvdrophobia— Pasteur treatment, $10. Laparot- 
omy (opening oT the abdominal cavity for an operation on any organ contained therein), 
$20. Sequestrotomy (removal of dead bone), $7. Skull trephining for fracture or 
other cause, $20. Suturing wounds of scalp or otherparts, $1. Synovitis (inflammation 
of the lining membrane of a joint)— incision, $5. Tetanua-4ockjaw— injection of anti- 
tetanic serum into frontal lobe of brain, $20. 

Schedule or Optional Indemntiies. — ^For eadi $5 of single weekly indemnity. 
Loss of one or more entire fingers $32; of one or more entire toes $40. Complete hernia 
$16. Complete dislocation of the shoulder, $12; elbow, $20; wrist $24; hip $60; knee, 
$32; two or more bones of foot (not toes). $32; ankle, $32; two or more toes, $12; two or 
more fingers, $12. Complete fracture of the skull, both tables, $64; lower jaw $16; 
collar bone $32; pelvis $48; thigh, $60; leg (tibia and fibula), $40; knee cap. $40; arm, 
$32; forearm (radius and ulna), $20; two or more ribs. $20; two or more bones of the foot 
(not toes), $24; two or more bones of the hand (not fingers), $24; two or more toes, $20; 
two or more fingers, $20. 

For Standard Provisions See Page 11 
Additional Provisions 

(a) No claims shall be valid for more than one of the losses herein specified, except 
as hereinbefore provided. 

(fi) This insurance does not cover suicide or any attempt thereat, sane or insane, or loss 
from injuries received by him while insane, or injuries fatal or otherwise, resulting wholly 
or in part, direcUy or indirecUy, from riding in or on or being in, or attempting to get in 
or out of any aerial machine or conveyance. 

(e) In case of injuries, fatal or otherwise, except drowning, of which there shall be 
tt> eitemal and visible contusion oc wound on the exterior of the body «t the place of 



114 GREAT EASTERN CASUALTY COMPANY 

the injury, the body itself in case of death not to be deemed sach; or any loss resulting wholly 
or in part, directly or indirectly, from ptomaines or from the bite or sting of an insect 
except a spider, bee, wasp or hornet, or from intoxicants, corrosives, poisonous substances, 
war, unnecessary exposure to obvious danger, violating the law, ridmg in or on any loco- 
motive, freight or hand-car, bein^ on the road bed or bridge of any railwa]^ except while 
crossing at a public highway or with a legal right to be there, medical or surgical treatment 
except amputation within three months from date of accident and made necessarv thereby, 
or any altercation or quarrel except unprovoked assualt. then and in every such case the 
company's liability for any loss specified in Section 1 shall be one-twentieth of the amount 
provided therefor, and for any other loss one-fifth of the amount otherwise payable. 

(d) Loss from injuries, fatal or otherwise, received bv the insured while entering or 
leaving, or attempting to enter or leave, or while upon the step or. steps, or platform or 
running board of any conveyance, shall be covered only by single indemnity. 

(e) The copy of application endorsed hereon is hereby made a part of this contract 
No provision ot the charter, or by-laws of the company shall be used in defense of any claim 
arising under this policy. 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. Thb policy 
may be renewed subject to all its provisions from term to term, with the consent of the 
company, and by the payment of the premium in advance. 

^ in witness whereof, the Great Eastern Casualty Companjr has caused this policy to be 
signed by two of the following officers: President, vice-president, secretary ^nd treasurer 
in the City of New York. 

POLICY FORM— "Ultra Protection." 

Maximum Death Benefit, $15,000 
Annual Premium, $75. Maximum Weekly Indemnity, $50. 

Great Eastern Casualty Company, in consideration of the 
agreements and statements in the application a copy of which 
is endorsed hereon and made part hereof, and of seventy-five 
dollars, premium, hereby insures Welland Strong, by occupation 
attorney at law, subject to all the provisions and limitations nerein 
contained, for the term of twelve months from noon, standard 
time, where the insured resides when the policy is issued, of January 
1, 1916, against the effects of bodily injuries caused directly, 
solely and independently of all other causes by accidental means, 
and which shall result in immediate and continuous disability, 
and also against the effects of sickness as follows: 
Accident Indemnities 
Section 1. — If any loss specified in this section shall at any tune result solely and ex- 
clusively from injuries which shall have continuously and totally disabled the Insured 
and prevented him from transacting every kind of duty pertaining to his occupation 
from date of injury to date of such loss, or if such loss shall so result within twenty-six 
weeks from date of accident regardless of total disability, the Company will pay for loss 
of life, or both hands by complete severance at or above the wrists, or Doth feet by com- 
plete severance at or above tne ankles, or one hand and one foot by complete severance 
as defined above, or entire sight of both eyes if irrecoverably lost, or entu-e sight of one 
eye and severance of one foot as defined above, or entire sight of one eye and severance 
of one hand as defined above, $7,500. Either arm by complete severance at or above 
the elbow, or either leg by complete severance at or above the knee, $5,000. Either 
hand by complete severance at or above the wrist, or either foot by complete severance 
at or above the ankle, $3,750. Entire sight of one eye if irrecoverably lost, $2,500. 
Thumb and index finger of either hand by complete severance at or above metacarpo- 
phalangeal joints, $2,500. And in addition the indemnity for loss of time which has 
not previously been paid, from date of accident to date of loss. For any loss stated in 
this section, except life, the Insured may elect to receive in lieu of the amounts above 
provided for such loss the indemnity under Sections 2, 8 and 9 to which he may be en- 
titled. 

Section 2. Loss or Time — Total. — If such injuries shall immediately, continu- 
ously and totally disable and prevent the Insured from ^ansacting every kmd of. duty 
pertaining to his occupation, the Company will pay as long as tne Insured lives and 
suffers such total disability, a weekly indemnity of $25. 

Loss OF Time — Partial. — If such injuries shall from date of the accident or imme- 
diately following total disability, continuously disable and prevent the Insured Inm 
transacting a material part of the duties essential to his business, the Company will 
pay for the period of such partial disability, not exceeding fifty-two weeks, a we^ly 
indemnity of $12.50. 

Section 3. Double Indemnities. — All the above amounts shall be doubled if such 
injuries shall be received: 

1. While riding as a passenger in or on a public conveyance provided by a common 
carrier for passenger service, including platform, steps or running board thereof; or 



GREAT EASTERN CASUALTY COMPANY 116 

2.^ Whfle a passeni^ within an elevator provided for passenger service only, ex- 
cepting devators in mines; or 

3. While in a burning building in which the Insiured shall be at the beginning of the 
fire; or 

4. Through being struck by lightning; or 

5. Through the collapse of the outer walls of a finished building while the Insured 
is therein; or 

6. By the explosion, collapse or rupture of a steam boiler. 

SEcnoN 4. Special Indemnities. — Sunstroke, freezing, hydrophobia, or the invol- 
untary and unconscious inhalation ot gas or other poisonous vapor shall be deemed a 
bodily injury within the meaning of this policy, when suffered through accidental means. 

Section 5. Blood-Poisoning. — Blood-poisoning resulting directly and scddy from 
such iiuunes is covered by this policy. 

Sickness Imdemnhies 

Section 6. Loss of Time— Total.— If any sickness, not hereinafter excepted, shall 
continuously totally disable and prevent the Insured from transacting every kind of 
duty pertaining to his occupation, the Company will pay for the period of such total 
disability, which must begin during the term of the polic^, a wedcnr indemnity of $25. 

Loss of Time — ^Partial. — ^If such sickness shall contmuously disable and prevent 
the Insured from performing the duties of his occupation for at least half of his business 
time each day, the Company will pay for the penod of such partial disability, not ex- 
ceeding twdve months a weekW indemnity of $12.50. 

Section 7. Blindness or Paralysis. — U the Insured, as the result of blindness or 
paralysis, has been totallv disabled and received indemnity for a period of fifty-two 
consecutive weeks under the conditions of Section 6, and any surgeon's fees and hospital 
indemnity to which he may be entitled and if at the end of said fifty-two weeks he shall 
be declared by medical authority, satisfactory to the Company, to be irrecoverably 
blind or paralyzed and in consequence totally and pormanently disabled and prevented 
from engaging in every kind of work or occupation for wages and profit, he may elect 
to receive either (1) further weekly indemnity as provided in Section 6, or (2) a final 
settlonent of thirteen hundred ($1,300) dollars. 

Section 8. Surgeon's Fees for Accident or Sickness.— If such injuries received 
or sickness contracted shall alone within three months from date of the accident or 
commencement of the sickness and during the term of this policy necessitate a surgical 
o^ration named in the Schedule of Opoations hereinafter mentioned, the Company 
ym\ pay, in addition to the indemnity, the sum provided for such operation, but whoi 
more than one operation is required payment shall be made only for the first. 

Section 9. Hospital Indemnity.— If such injuries received or sickness contracted 
shall within three months from the date of the accident or commencement of the sick- 
ness, necessitate the removal of the Insured to a hospital or sanitarium, the Company 
win pa/ in addition to the indemnity, for a period not exceeding three months of confine- 
ment m said hospital or sanitarium, per week. $12.50. 

Section 10. Medical Attendance. — ^If such injuries received or sickness contracted 
shall not result in any of the above losses, but require medical treatment, the Company 
will pay the amount actually paid by the Insured for such treatment, not exceeding, 
however, $25. 

Section 11. Registration and Xdentification.— If the Insured shall, by reason 
of such injuries or sickness, be physically unable to communicate with friends, the Com- 
pany win, uix>n receipt of a message givmg this policy number, immediatdy transmit 
to such relatives or friends as may be known to it, any inftmnation respecting him, 
and win defray any expenses necessary to put him m communication with and m the 
care of friends, not exceeding a sum equal to four weeks' indemnity under Sectk>n 2. 

Section 12. Settlements Every Thirty Days. — In case of loss of time, pavment 
wUl be made at the expiration of each thirty days upon request of the Insured and filing 
of due proof. 

Section 13. Immediate Optional Settlements. — If the Insured shall sustain an in- 
jury specified in the "Schedule of Optional Indenmities," hereinafter mentioned, he may, 
subject to an the conditions of the policy, elect to receive in lieu of an otho* indemnity 
the sum specified in said schedule for such injuiy, provided however, that he signify 
his election in writing to the Company at its Home Office in New York City within twen^ 
days from the date of the injury^ and provided further that the election may not be for 
more than one of the sums specified in said schedule. 

Schedule of Operations for Each $5 of Single Weekly Indemnity. — Appendicitis, 
$20. Aneurism (tumor of artery) — ligation, $10. Amputation of foot, hand or forearm, 
$5; lef , $10; arm above elbow, $10; thigh, $20; one or more entire fingers, $2. Abscess 
or bolt— incision, $1. Bone abscess — ^trephining, $5. Bronchotomy, thyrotomy, lar- 
yngotomy, laryngo-tracheotomy or tracheotomy, $10. Carbuncle — incision and treat- 
ment, $1. Caries (bone ulcer) — curetting, $3. Diskxrations, reduction of shoulder, 
elbow, hip, knee or ankle, $5; wrist or jaw, $3; finder or fingers, $2. Excision of shoul- 
der, Mp or knee joint, $20; elbow, wrist or ankle joint, $10; toe or toes, $5. Eye, ear, 
nose or throat — any cutting operation, $2. Febn — ^incision, $1. Fractures, reduction 
of nose, lower jaw, collar bone, shoulder blade or forearm (one or both bones), $5. Breast 
bone, rib or ribs, fingers, coccjrx, 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 one or both leg bones, 
$10. Ganglion (C3rstic tumor of tendon sheath) — incision and curetting, $3. Gunshot 
wounds — ^treatment not necessitating amputation or laparotomy, $5. Hernia (abdom- 
inal) — any cutting operation for the radical cure of the reducible, irreducible or strangu- 
lated form, $20. Hydrocele — ^tapping — incision or excision of sac, $5. Ingrowing toe 
nail— removal, $2. Intestinal obstruction (see Laparotomy), $20. Kidney— fixation or 



116 GREAT EASTERN CASUALTY CX)MPANY 

lemoval, $20. Laparotomy (openins of the abdominal cavity for an operation on any 
organ contained therein)^ ^20. Lithotomy (operation for removal of stone in bladder)— - 
any cutting, $20. Mastoiditis — operation for, $10. Oesophagotomy for stricture or other 
cause, $20. Peritonitis (see Laparotomy). Paracentesis — tapping of abdomen, bladder, 
$5; ear drum, $3. Rectum (operation for) hemorrhoids (external or internal), ezdsion 
or ligation, prolapsed — operation for fistuk in ano — ^incision, polypus — extirpation, $5; 
malignant strictiu-e — excision or colostomy, $20. Sequestrotomy (removal of dead bone), 
$7. Skull trephining for fracture or other cause, $20. Suturing wounds of scalp or other 
parts, $1. Synovitis (inflammation of the linmg membrane of a joint) — ^incision, $5. 
Tetanus — objection of anti-tetanic serum into frontal lobe of brain, $20. Tumors-^ex- 
tirpation from anv part of the body — benign, $3; malignant, $10. Varicose veins — liga- 
tion or excisbn, $5. Varicocele — acupressure— ligation or excision, $5. 

Schedule of Optional Indemnities por Each $5 op Single Weekly Indemnity.— 
Loss of one or more entire fingers. $32; of one or more entire toes, $40. Complete hernia, 
$16. Complete dislocation of the shoulder, $12; of the elbow, $20; of the wrist, $24; 
of the hip, $60; of the knee, $32; of two or more bones of foot (not toes), $32; of the aii^e, 
$32: of two or more toes, $12: of two or more fingers, $12. Complete fracture of the 
skull, both tables, $64; of the lower jaw, $16; of the collar bone, $32; of the pelvis, $48; 
of the thigh, $60; of the leg (tibia and fibula), $40; of the knee cap. $40; of the arm, $32: 
of the fore arm (radius and ulna), $20; of two or more ribs, $20; ot two or more bones o! 
the foot (not toes), $24; of two or more bones of the hand (not fingers), $24; of two or 
more toes, $20; of two or more fingers, $20. 

For Standard Provisions See Page U 

Additional Provisions 

(a) No claims shall be valid for more than one of the losses herein specified, except 
as hereinbefore provided. 

(b) This insurance does not cover suicide or any attempt thereat, sane or insane, 
or loss from injuries received while insane, or injuries, fatal or otherwise, resulting wholly 
or in part, directly or indirectly, from riding in or on, or being in, or attempting to get 
in or out of any aerial machine or conveyance, or loss fatal or otherwise, caused by war, 
acts of an3^ country at war, or by conditions arisii^ from a state of war. 

(c) Thb policy does not cover any loss from sickness, contracted while engaged in 
military or naval service in time of war or prior to the date of this policy, or for which 
the Insured is not treated by a licensed physician other than himself, or while the In- 
sured may be entitled to indemnity for accidental injuries, or contracted or suffered 
outside the limits of the United States, Canada or Europe, or while in Alaska or the 
insular possessions of the United States. 

(d) The copy of application endorsed hereon is hereby made a part of this contract. 
No provision of the charter or by-laws of the Company shall be used in defense of any 
claims arising under this policy. 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 tim respect shall forfeit to the Company ail right to any indemnity. This 
poucy may be renewed subject to all its provisions from term to term, with the consent 
of the Company, and by the payment of the premium in advance. 

The accident portion of the above policy is issued separately 
in the "Ultra Gilt Edge" form; premium $25 for extra preferred 
risks. 

Illness Insurance 

The company issues two forms: The "Ultra Perfection," which 
provides $25 weekly indemnity .during and following confining 
period for total disability from illness and in addition surgeon's 
fees, blindness or paralysis is covered by weekly indemnity of $25 
for fifty-two weeks after which, if declared irrecoverable by com- 
petent medical authority, an additional indemnity of $1300 cash 
is granted or further weekly indemnity for life as provided by the 
contract for total . disability, annual premium $50; medical at- 
tendance when no disability is suffered not exceeding $25, hospital 
charges $12.50 per week for three months. The "Perfection," 
providing $25 weekly for one year confining period; $12.50 weekly 
for non-confining period and $6.25 weekly for loss of time after 
one year, hospital charges $12.50 per week and surgeon's fees, 
annual premium $35. These policies contain monthly settlement 
clauses. 

INDUSTRIAL DEPARTMENT 

All classes of risks are written in this department. 



GREAT EASTERN CASUALTY COMPANY 117 

Age Limits: Males, 16 to 64, at schedule rates. For ages 
over 49 add 10 per cent, to schedule rates for each additional year. 

Policy Fee: A policy fee and one monthly premium are col- 
lected when the application is taken, which pays for the policy 
and the insurance for the month during which it is written. 

Monthly Premiums are due and payable without notice on 
the first day of each month. 

Lapsed Policies are reinstated on satisfactory certificate of 
good health, and upon payment of current monthly premium. 

Women— Housewives and domestics between ages 16 and 39, 
inclusive, insured under regular policy for $20 per month accident 
and sickness indemnity, with $200 death indemnity for monthly 
premium of $ 1 .00. Between ages 40 and 49, inclusive, for monthly 
premium of $1.25. 

Wage earning women between ages 16 and 39, inclusive, insured 
as per schedule for additional premium of 25%. Between ag^ 
40 and 49, inclusive, for additional premium of 50%. 

Special Policy. — (for which an additional premium is charged) 
provides the same benefits as regular policies, except the words 
"after the first week" in health provision are eliminated, thereby 
X)aying for and from the first day of sickness. 

The "Complete Benefit" policy covers all accidents and all 
diseases from the first day of sickness, pays full indemnity for 
one month for non-confining illness. Benefits monthly accident, 
$40; monthly sickness, $40; accidental death, $1000; premium, 
$1.50 monthly; larger amounts proportionate rate and premium. 

POLICY FORM— "Income Shield." 

"Policy," Class AA. 

Principal Sum, $600. Monthly Accident Indemnity, $60. 

Monthly Premium, $1. Monthly Sickness Indemnity, $60. 

Great Eastern Casualty Company, in consideration of the 
policy fee of $2 and the premium of one dollar per month, and the 
statements and agreements in the application, a copy of which 
is endorsed hereon and made part hereof. 

Hereby insures John Doe, by occupation clerk, subject to all the agreements and 
limitations hereinafter contained from 1 2 o'clock noon, standard time, where the in- 
sured resides when the policy is issued, of the day this contract is dated, until 12 o'clock 
noon, such standard time of the first day of January, 1916, and for such further periods, 
stated in the renewal receipts, as the pajrment of the premiiun specified herem will main- 
tain this policy and insurance in force, against the efiFects of bodily injuries, caused di- 
rectly, solely and independently of all causes by external, violent and accidental means 
(suicide, sane or insane excepted), which bodily injuries or their effects shall not be 
caused wholly or in part, directly or indirectlv, by Siny disease^ defect or infirmity, and 
which shall from the date of the accident result in continuous disability; and also against 
the effects of sickness, as follows: 

Accident Indeicnities. 

Section 1. — If any loss specified in this section shall result solely and exclusively 
from such injuries within three months from date of the accident, the company shall 
be liable only for such loss and will pay for loss of life, or loss of both hands by com- 
plete severance at or above the wrists, or both feet by complete severance at or above 
the ankles, Ar one hand and one foot by complete severance at or above those places, or* 
entire sight of one eye and severance of one foot as defined above, or entire sight of one eye 
and severance of one hand as defined above, or loss of entire sight of both eyes, if irre- 
coverably lost, the principal sum; loss of either hand by complete severance at or above 
the wrist, or either foot by complete severance at or above the ankles, one-half the prin* 
dpal sum; loss of entire sight of one e^e, if irrecoverably lost, one-third of the prindpal sum 



118 GREAT EASTERN CASUALTY COMPANY ^^ 

Section 2. Loss op Time— Total— Past A.— If such injuries shall not result in 
any <^ the losses above specified, but shall from the date of the accident disable and pre- 
vent the insured from performing every duty pertaining to any and every kind of busi- 
ness or occupation, and be regularlv attended by a licensed physician, the Company 
will pay for the period of such tottu disability, not exceeding twenty-four consecutive 
months, indemnity at the rate per month of sixty dollars ($60). 

Loss OP TniE — ^Partial — ^Part B. — If such injuries shall not from date of accident, 
totally disable the insiured, but shall within thirty days thereafter totally and continu- 
ously disable him; or if such injuries shall from date of accident, or immediately follow- 
ing total disability, disable and prevent the insured from performing important daily 
duties essential to his business or occupation, and be re^^larly attended by a Ikensed 
physician, the Company will pay for the period of such disabilitv, not exceeding six con- 
secutive noonths, one-half of the amount provided in Part A of this section. Provided 
always that the combined periods for which indemnity will be paid for any one accident 
shall not exceed twenty-four consecutive months. 

Section 3. Double Indemnities. — All the above amounts shall be doubled if such 
injuries shall be received. — 1st. While riding as a i^assenger within the enclosed part 
of any railway passenger car provided for the exclusive use of passengers and propelled 
by steam, compressed air, cable or electricity and not attached to any freight, coal or 
logging train; or, — 2nd. While riding as a passenger on board a steam vessel licensed for 
the regular transportation of passengers; and if such injuries shall be caused directly by 
or in consequence of the wrecking of such car or vessel. 

Section 4. Fipty Per Cent Accumulations. — For each full three months immedi- 
ately preceding the date of the accident that this policy shall have been maintained in 
continuous force the indemnities under Section 1 shall be increased five per cent, but the 
sum of all such accumulations shall never exceed fifty per cent. 

Sickness Indemnities 

Section 5. Part A. Loss op Time — Conpining Period. — If sickness, contracted 
and bcq^iiming after thb policy has been in continuous force for 60 days from its date, shall 
totally disable and prevent the insured from performing any and every duty pertaining 
to any and ever^ kmd of business or occupation and shall necessarily and continuously 
confine him within the house wherein he shall be regulariy visited by a licensed physician, 
the Company will pay for such period after the first wedc and not exceeding six months, 
indemnity at the rate per month of sixty dollars ($60). 

Part B, Loss op time— Non-Conpining Period. — ^K immediately following such 
confinement or if bv reason of anv sickness so contracted the insured shall be totally and 
continuously disabled as above defined and regularly attended by a licensed phy;sician 
but not necessarily confined within the house the Company will pay, for the period of 
such disability after the first week and not exceeding one month, one-half of the amount 
provided in Part A of this section. Provided always that the combined periods for which 
mdenmity will be paid for any one sickness shall not exceed six consecutive months. 

Full Indemnity por Boils, Felons and Carbuncles. — Full indemnity for loss of 
time from boils, felons and carbuncles shall be paid r^ardless of confinement within the 
house. 

Section 6. Ten Per Cent Increase. — ^The indemnities under Secticms 2 and 5 
of this policy shall be increased ten per cent if the premiums are paid annually in advance, 
or five per cent if the premiums are paid semi-annually in advance. 

Section 7. Increased Indemnity por Hospital Conpinemznt.— If such injuries or 
such sickness necessitates the assured's to a regularly incorporated hospital within 90 
days from the date of the accident or commencement of the sickness, the company will 
pay the assured an additional ten per cent of the amount that woula be payaole under 
this policy for the period of such confinement not exceeding tiiree consecutive months. 

Section 8. Surgeon's Fees— Non-Disabling Injuries.— In the event of proper 
notice of injury being given the company by the insured, which injury shall not result 
in either di^bflity or death, but shall reouire surgical treatment, the company will reim- 
burse the insured for the cost thereof for an amount not eneeding two treatments 
at $2 each. The surgeon's receipts for services shall be sufficient proof under this dauae, 
but it must be furnished the company within 90 days from the date of accident. 

Section 9. Registration and Ioentipication. — If the insured shall by reason of 
such injuries ox sickness be physically unable to communicate with friends, the company 
will upon receipt of a message giving his policy number, immediatelsr transmit to such 
relatives or friends as may be known to it, any information respecting him and will defray 
any expense necessary to put him in communication with and in care of friends not exceed- 

Special Provisioms 

Section 10. (1) If the policy is issued before the insured a)mpletes his 49th year, 
then beginning with his 50th year all benefits shall be reduced five per cent each year 
until the end of his d4th year; or. if the policy is issued after the insured enters his oOth 

Sear then beginning one year after the date of the policy all benefits shall be reduced 
ve per cent each year untu the end of his 64th year. This policy shall terminate when 
the insured has completed his 64th year, and the company's liability is limited after such 
time to the amount of premiums paid after such terminattve date. 

(2) In the event of death, loss or disability of longer duration than one month, result- 
ing from the following causes, the company's liability shall be one month's inaemnity 
as provided in sections 2 and 5 of this policy; for disability not extending one month, 
liability shall be limited to the period of disability under the said sections of the policy. 
Injury of which there^ shall be no external and visible contusion or wound, except 
drowning, the body itseU in case of death not to be deemed such mark; injury intentionalqf 



GREAT EASTERN CASUALTY COMPANY 119 

infficted upon tbe insured by any other person; unnecessary exposure to danger: riot 
strike or evading arrest; gas, vapor or poison; contact with poisonous substances; blood 
pcHson or septicemia; or while under the influence of an intoxicant or narcotic; or while 
violating law or the rules of a corporation, or the rules of a public carrier affecting the safety, 
of its passengers; or while on the right of way, bridge, trestle or other property of a rail- 
way corporation other than stations, platforms and regular crossings prescribed by law, 
not being at the time a passenger or employee of such railway in the discharge of duty; 
or due partlv to injury and partly to disease or bodily infirmity; sunstroke, freezing, 
abscesses, ulcers, rheumatism, paralysis, tuberclosis, sciatica, lumbago, crick or lame 
back, stiain, hernia, dementia, insanity, vaccination or venereal diseases. 
For Standard Provisions See Page 11 
Additional Provisions 

(a) No claim shall be valid for more than one of the losa. nerein specified, and any 
payment hereunder, other than for loss of time shall terminate this policy. Premiums 
must be paid either at the home office of the company, New York City, or to a duly author- 
ized agent of the company, and if paid to any other person, such payments shall not be 
binding on the company. 

(b) The company's liability for indemnity is limited to period the insured is regu- 
larly attended by a legally qualified physician, during disability. If the insured is dis- 
abled by injury or sickness for more than thirty days, he or his representative shall fur- 
nish the company, every thirty days or as near thereto as may be reasonably possible 
a report in wriUng from his attending physician or surgeon, fully stating the condiUon 
of the insured and the probable duration of his disability. No assignment of interest 
hereunder shall be valid unless the consent of the company, signed by one of its officeis, 
is attached hereto. 

(c) This policy does not cover any loss suffered in consequence of being in or on or 
attempting to get in or out of any aerial machine or conversance or while participating 
in any motor, vehicle, speed or endurance contest or while in military or naval service 
in times of hostilities caused by war, acts of any count^^ at war, or by conditions arising 
from a state of war, or intentionally self-inflicted injuries (sane or insane) fatal or non-fatal. 

(e) The copy of applicadon endorsed hereon is hereby made a part of this contract. 
No provision of the charter, or by-laws of the Company shall be used in defense of any 
claims arising imder thb policy. 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 shaU forfeit to the Company aU right to any indemnity. 

In witness whereof, the Great Eastern Casualty Company has caused this policy to be 
signed by its president and secretary in the City of New York, but the same shall not 
be binding on the company until signed by its authorized agent. 



120 LONDON GUARANTEE AND ACCIDENT COMPANY 

ZoT)doT) Quarapt^^ ai^d /)(:(:ide9t Qompapy. 

LONDON, ENG. 



Commenced Business 1869. F. W. Lawson, Gen. Mgr. U. S. Office, Chkago, HI. 



The London Guarantee and Accident insures against personal 
accidents under eight classifications of occuf>ations, viz.: Select, 
Preferred, Extra Preferred, Ordinary, Medium, Speaal, Hazardous 
and Extra Hazardous. 

Premiums. — Ordinary Policy A. O. Select, $4; Preferred, $5; 
Extra Preferred, $6; Ordinary, $8.50; Medium, $10; Special, $12.50; 
Hazardous, $15; Extra Hazardous, $20 per annum for each $1000 
principal sum. 

Policies are issued on semi-annual and quarterly payments 
without additional charge for the short term, but to persons 
classed as "Select." ''Preferred" and "Ordinary" only, ana for an 
amount not less than $3000. 

Benefits. — For each $1000 principal sum. accidental death or 
loss of both eyes or two limbs, $1000; loss of either hand or foot, 
$500; loss of one eye, $340; weekly indemnity for total disability 
(200 weeks), $5; partial disability (26 weeks), $1.25 to $3.75. 

Superior Accident, A. P. — Rates, $5 per $1500 for Select, $5 
for Preferred, $6 for Extra Preferred, and $8.50 for Ordinary. 

Age Limits. — Eighteen to sixty-five. 

Maximum Indemnity. — Death, $30,000; weekly, $100. 

POLICY FORM— "Maximum Benefit Accident" 

Form A. L. 

Principal Sum, $7500. Weekly Indemnity, $25-$50. 

Maximum Sum, $15,000. Annual Premium, Select, $25. 

London Guarantee and Accident Company, Ltd., hereinafter 
called the Company, 

Does hereby insure John Doe of Chicago, lU. (hereinafter called the insured), under 

classification Select, wly>se occupation is editor, the duties of which are against 

bodily injuries effected within the period of this policy through Accidental means, directly 
and independently of all other causes, subject to all conditions and limitations hereinafter 
contained. 

Section I. — Schedxtle of iNDSicNinss. 

Clause A Total DiSABnirv. — ^For the period during which the insured shall be 
immediately, continuously and wholly disabled by injuries effected through accidental 
means as iLforesaid and wholly disabled from periorming an^ and every iiJnd of duty 

gertaining to his occupation, the Company will payi naenmit^ at the rate of twen^- 
ve dollars (S25) per week so long as he suffers said total disability. 

Clause B. Partial Disability. — For the period not exceeding two hundred con- 
secutive weeks, during which the insured shall oe in manner as aforesaid continuously 
disabled from performing one or more important daily duties pertaining to his occupa- 
tion, whether following total disability under Clause A or not, the Company wfll pay 
weekly indemnity at one-half the rate specified in Clause A. 

Clause C. Death. — If the insured suffers total disabilitv as set forth in Clause A 
and during the period thereof dies as the direct result of accidental injuries as aforesaid ; 
or if within ninety days from the date of the accident, irres]>ective of total disability , 
the insured dies as the result of accidental injuries as aforesaid the Company will pay 
the principal sum of seventy-five hundred dollars (S7500) and in addition thereto ^e 
weekly indemnity specified m Clause A for the jperiod between the date of the accident 
and the date of death. 

Clause D. Optional Indemnities. (Part 1.) — If the insured suffers total disability 
as set forth in Clause A and if, during the period of said total disability and within two 
hundred weeks from the date of the acciclent, the insured suffers, as the direct result 
of the bodily injuries causing the said total disability and independentlv and exclusively 
of all other causes, one of the injuries defined in parts 2 and 3 of this clause; or if within 
ninety days from the date of the accident, irrespective of total disability, the insured 
suffers in like manner one of the said injuries--the insured may dect to receive the 
amount of indemnity set ojppoaitt said injury in the said part 2 or 3. together with the 
weddy indemnity for the poiod between the date ol the accident ana the date that the 



LOKPOM CtAftAm^B AJft) ACttbftKt C6Mt>AKY Ml 

msoitd suffers the injury defined in the said part 2 or 3, in lieu of all other indemnity under 
this policy except surgeon's fees and hospital charges to which he may be entitled; but 
if the insured elects to claim indemnity under part 3 of this Gause, notice in writing of 
his election shall be given to the Company at its head office in Chicago. III., within twenty 
days from the date the insured suffers such injury. In no evoit shall more than one of 
the said amounts named in parts 2 and 3 of this Clause be pnrable for bodily injuries 
resulting from one accident. (Part 2.) For loss of 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 
severed as described above, or sr.tire sight of both eyes, if irrecoverably lost, the principal 
sum; loss of one leg by actual separation at or above knee, or loss of one arm by actual 
separation at or above elbow, three-quarters of principal sum; either hand by severance at 
or above the wrist, or either foot by severance at or above the ankle, or entire sight of 
one ^e, if irrecoverably lost, one-half of principal sum; thumb and index finger of either 
hand, one-third of principal sum. The pavment in any^ such case shall end this policy. 
(Part 3. ) If the weekly mdemnity for total loss of time in this policy is $50, the amounts 
named below shall be payable; if said indemnity is greater or less than $50, the amounts 
to be paid shall be increased or reduced proportbnately. For loss of one or more fingers 
(at least one entire phalanx), S3(X); one or more entire toes, $4(X). For complete hernia 
caused solely and directly by accidental injiuy , S140. For complete dislocation, shoulder 
or elbow, 1200; wrist, S250; hip, S6(X); knee, or ankle, or any bones of the foot other than 
toes, $300: two or more toes or any two or more fingers, $ 1(X). For the complete fracture 
of bones of the skull, both tables, $650; lower jaw, $ 150: collar bone or the forearm between 
wrist and elbow, $300; pelvis, $500; thigh or the arm between elbow and shoulder, $600; 
leg or the knee cap, $400; two or more ribs, or two or more toes, or two or more fingers, 
S200; foot, two or more bones other than toes, $250; hand, two or more bones other than 
fingers, $250. 

CLAT25B E. DoTTBLE Indebinhy. — ^The amount i)ayable under the foregoing clauses 
shall be double the sum therein specified if such injuries are sustained by the insured: 
(1) While a passenger in or upon a public conveyance (including platform, steps or run- 
ning board thereof) provided by a common earner for passenger service; or (2) while a 
passenger in a passenger elevator (excluding elevators in mines); or (3) through the bum- 
mg of a building while the insured is therein; or (4) by being struck by lig^htning; or (5) by 
the collapse of the outer walls of a building while the insured is therein; or (6) by the 
explosion of a steam boiler; or (7) as the result of a cyclone or tornado. 

Clause F. Sunstroke, Freezing, Hydrophobia and Asphyxiation. — ^Any of the 
f<^owing, namely, sunstroke, freezing, hydrophobia and asphyxiation, suffered through 
accidental means (excluding suicide, sane or insane, or anv attempt thereat, sane or 
insane) , shall be deemed a bodily injury within the meaning of this policy. 

Clause G. Blood Poisoning. — Blood-poisoning, resulting directly from bodily 
injuries as aforesaid, shall be deemed to be included in the said term, bodily injury. 

Clause H. Surgical Benefits.— (Part 1.) If injuries covered by this policy shall 
necessitate a suraical operation named in Section IV endorsed hereon, within ninety days 
from the date ofaccident, the Company will pay as specified in said Section, in addition 
to the indemnity hereinbefore provided, but such payment shall not be made for more 
than the first operation for any one accident. (Part 2.) If injuries are sustained which 
shall not result m death or other disabilitv , but which shall require surgical treatment other 
than specified in said Section IV, the Compuiy will pay the amount actually expended 
for such treatment, but not exceeding the single indemnity for one week at the rate 
specified in Clause A. 

Clause I. Hospital Cbaroes. — ^If the insured suffers bodily injury through acci- 
dental means as aforesaid and on account thereof, and within ninety days from the date 
of the accident, the insured is removed to a hospital, the Company, provided no claim 
is made under such Clause H, will pay the insured (in addition to the mdemnity payable 
for said bodily injury) for the period, not exceeding fifteen weeks, during which the insured 
is necessarily confined to the said hospital, the amount expended by him weeklv on account 
of the hospital charges — not exceeding one-half of the amount of weekly indemnity pro- 
vided for total disability. 

Clause J, ^ Iobntipication Benefits. — If the insured, by reason of injury or illness. 
shall be physically unable to communicate with friends, the Company, upon receipt ot 
a telegram or other message giving the number of this policy, will immediately transmit 
to his relatives or friends any information respecting him. and will, without prejudice as 
to other benefits to which he may be entitled under this policv, defray all expenses neces- 
sary to put the insured in the care of friends, provided such expense shall not exceed 
in sill a sum equal to four times the amount specified in Clause A as the weekly indemnity. 
Section II— For Standard Provisions, See Page 11. 

Additional Provisions. 

Provision 17. No assignment of interest under this policy shall bind the Company 
unless consent thereto is formally endorsed hereon by the general manager of the Com- 
pany of the United States. Any failure to comply with the provisions of this policy 
shaU render invalid any claim made hereunder. A copy of any assignment shall be given 
within thirty days, to the Company, which shall not be responsible for its validity. 

Provision 18. Surgical Operation Fees, or Hospital Indemnitv — Affirmative proof 
<A a surgical <n)eration, or of nospital confinement, must be furnished to the Company 
at its said heaa office, within ninety days from the date of the operation, or of the termi- 
nation of the confinement in a hospital. 

Provision 19. The Company's liability shall not in any case extend to more than 
onepart of this policy on account of any one accident to the insured, except as provided 
in Clauses B, H, I and T hereof. .... . . . , , , * , 

Provision 20. The insurance hereunder shall not cover any mjuiy, fatal or non-tatai. 



L 



122 LONDON GUARANTEE AND ACCIDENT COMPANY 

sustained by the insured while participating in or in consequence of having participated in 
aeronautics, or from disease in any form. 

Provision 21. — ^The copy of the application endorsed hereon is hereby made a part 
of this contract. 

Provision 22. — ^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. 

This policy is issued in consideration of the premium of S25 and of the statements made 
by the msured in his application, as shown in copy endorsed hereon, for the term of twelve 
months, beginning at twelve o'clock noon, standard time, of the day this pcdicy is dated, 
but it may oe renewed subject to all provisions of the poUcy, from term to term, by pay- 
ment of such premium. 

In witness whereof, the London Guarantee and Accident Company, Limited, has caused 
these presents to be signed by its authorized general manager for the United States of 
America, acting under power of attorney, and dated this first day of Tanuaiy, 1915; but 
the same shall not be bmding upon the Company unless countersigned by a duly author- 
ized representative of the Company. 

Section IV. Schedule of Operations. — ^If the weeklv indemnity fpr total loss of 
time in this policy is $50, the amounts named below shall be payable; if said indenmity 
is greater or less than S50, the amounts to be paid shall be incroised or reduced propor- 
tionately. Abscess, incision, SIO; abdomen, cutting into abdominal cavity for diagnosis 
or treatment of organs therein, $200. Amputation of entire hand, forearm or foot^ $50; 
leg or arm, $100; thi^h, $150; finger or fingers, $20. Aneurism, operation for tymg of 
artery, $70. Bone, mjuries to or disease of. Removal of diseased portion of bone, 
$50. Chest — cutting into for removal of pus as result of traumatism, $50. Dislocation 
— ^reduction of hip or knee, $70; shoulder, elbow or ankle, $50| wrist or lower jaw, $30; 
thumb, $20; finders, $10. Excision — ^removal of shoulder or hip joint, $200; knee joint, 
$150; elbow, wnst or ankle joint, $100; toe or toes, $20. Eye — any cutting operation, 
$20. Eye — ^removal, $100. Fractures — ^reduction of^ iy)se, lower jaw, collar bone, 
shoulder blade, forearm or wrist^ $50; breast bone or nbs, $20; upper arm, $70; bones of 
hand other than fingers, $30; fingers, $10; bones of the pelvis (except coccyx), $150; 
coccyx or toes, $20; thigh, $150; knee cap or leg, $100; bones of foot other than toes, 
$30. Gunshot wounds — ^treatment of, not necessitating amputation or any cutting 
operation into abdominal cavity, $25. Hernia (abdominal) — any cutting operation 
for radical cure of reducible, irreducible or strangulated form, $200. Hydrophobia — 
Pasteur treatment, $100. Inflammation of joint. Incision of joint,^ $50. Lockjaw. 
Injection of antitoxin into skull, $200; injection of antitoxin into spinal canal, $100: 
Skull — cutting into cranial cavity, $200. Spine or spinal cord — openmon with removal 
of fractured vertebra, $200. Wounds — suturing, $10. 

POLICY FORM— "Maximum Benefit Non-Confining 
Disability D. M." 

"Maximum Benefit Non-Confining Disability" policy, form 
D. M., is issued to select and preferred risks as follows: Annual 
premiums, ages 18 to 50, inclusive — select, $60; preferred, $65; 
Ages 51 to 60, inclusive — select, $70; preferred, $75. 

London Guarantee and Accident Company, Ltd., hereinafter 
called the Company, 

Does hereby insure John Doe, of Chicago, HI. (hereinafter called the insured, under 
classification select whose occupation is attorney, the duties of which are . . . . , against 
bodily injuries effected within the period of this ^licy through accidental means, directly 
and independently of all other causes, and against disabilitv by disease, contracted by 
the insured during the period beginning at noon, standard time, of the fifteenth dav 
after this policy is dated, subject to all conditions and limitations hereinafter contained. 

Section I — Schedule of Indemnities. 

Claxtse a. Total Disability from Accident. — For the i>eriod during which the 
insured shall be immediately continuously and wholly disabled by injuries effected throiigh 
accidental means as aforesaid and wholly disabled from performing any and eveiy kind 
of duty pertaining to his occupation, the Company will pay indemnity at the rate cH 
twenty-five dollars ($25) per week so long as he suffers said total disability. 

Clause B. Partial Disability from Accident. — ^For the period not exceeding two 
hundred consecutive weeks, during which the insured shall be in manner as aforesaid 
continuously disabled from performing one or more important daily duties pertaining 
to his occupation, whether following total disability under Clause A or not, the Company 
will pay wedcly indemnity at one-half the rate specified in Clause A. 

Clause C. Death from Accident. — If the insured suffers total disability as set forth 
in Clause A and during the period thereof dies as the direct result of accidental injuries 
as aforesaid: or if within ninety days from the date of the accident, irrespective of total 
disability, the insured dies as the result of accidental injuries as afor^aid the Company 
will pay the princii)al sum of seventy-five himdred dollars ($75(X)) and in addition thereto 
the weekly indemnity specified in Clause A for the period between the date of the accident 
and the (mte of death. 

Clause D. Optional Indemnities — ^Accident. — If the insured suffers total duabiHty 
as set forth in (Hause A and if, during the period of said total disability and within two 
hundred weeks from the date of the accident, the insured suffers, as the direct result 



LONDON GUARANTEE AND ACCIDE14T COMPANY 128 

of the bod0y. injuries causing the said total disability and independently and eidusively 
of all other causes, one of the injuries defined in parts 1 and 2 of Section IV endorsed 
hereon; or if within ninety days from the date of the accident, irrespective of total disa- 
bility, the insured suffers in hke manner one of the said injuries— the insured may ekct 
to receive the amount of indemnity set opposite said injury in the said part 1 or 2. together 
with the weekly indemnity for the period between the date of the accident and the date 
that the insured suffers the injury defined in the said part 1 or 2, in lieu of all other indem- 
nity under this policy except surgeons' fees and hospital charges to which he may be 
entitled; but if the insured elects to daim Indemnity under part 2 of said Section IV 
notice in writing of his election shall be given to the Company at its head office in ChicagOj 
in., within twenty days from the date the insured suffers such mjurv. In no event shall 
more than one of the said amounts named in parts 1 and 2 of said Section IV be payable 
for bodily injuries resulting from one accident. 

Clattsk E. Double Imdemnihes— Accident.— The amount |>ayable under the f ore- 
goin|( elapses shall be double the sum therein specified if such injuries are sustained by 
the msured (1) while a passenger in or upon a public conv^ance (including platform, 
steps or running board thereof) provided by a common carrier for passenger service; 
or (2) while a passenger in a passenger devator (exdudin^ elevators in mines); or (3) 
through the burning of a buildmg whfle the insured is therem; or (4) by beinc struck by 
ligihtmng; or (5) by the coUapse ofthe outer walls of a building while the msurea is therem; 
or (6) by the explosion of a steam boiler; or (7) as the result of a cydone or tornado. 

Clause F. Special Indemnitv.— Sunstroke, freezing, hydrophobia, asphsrxiation, 
clK^ing while swallowing, sonmambulism, assault by burglars or highwaymen, mvoluntary 
ex unconscious inhalation of gas or other poisonous vapor, suffered through accidental 
means (exduding suicide, sane or insane, or any attempt thereat, sane or insane) shall 
be deemed a bodily injury within the meaning of this policy. 

Clause G. Blogd-Poisoning.— Blood-poisoning, resulting directly from accidental 
injuries as aforesaid, shall be deemed to be induded in the said term, Dodily injury. 

Clause H. Total Disability from Disease. — (Part I.) For the period, not exceed- 
ing fifty-two consecutive weeks, during which the insured shall, independently of all other 
causes, be contmuously and wholly disabled by disoise as aforesaid from performing any 
and every kind of duty pertaining to his occupation, the Company will pay weekly indem- 
nity at ue rate spedfied in Clause A; or 

(Part 2.) Total Disabiuty While Confined in a Hospital. — For the period, 
not exceeding fifty-two consecutive weeks^ during which the insured shall, independently 
of all other causes, be necessarily confined m a regularly incorporated hospital and wholly 
disabled and prevented by disease as aforesaid, and not hereinafter excepted, from per- 
forming any and every kind of duty pertaining to his occupation, the Company will pay 
weekly indemnity at double the rate specified in Clause A, but the Company s liability 
under parts 1 and 2 of this dause shall not exceed a total period of fifty-two consecutive 
weeks m all. 

Clause I. Partial DiSABiUTy from Disease.— For the period, following toUl 
disability as M>ecified in Clause H, during which the insured shall, independently of all 
other causes, be necessarily prevented by disease as aforesaid from attending to some 



material part of his business and is attended by a regulart^ licensed physician, the Ck>m- 
pany wilfpay weekly indemnity at one-half the rate specified in Clause A, but the Com- 
pany shall not be liable for disability in excess of fifty -two consecutive weeks' duration 



under this Chtuse and Clause H together. 

Clause J. Permanent Disability from Disease.— If, as the result from disease 
contracted during the term of this insurance and not hereinafter excepted, the Insured 
shall, independently of all other causes and within the said term, suffer the irrecoverable 
loss of the entire sight of both eyes, or permanently and entirely lose the use of both 
hands, or of both feet, or one hand and one foot, and bv reason thereof shall be wholly 
and continuously disabled and prevented from performing any and every kind of duty 
pertaining to his occupation, the Company will pay week& indemnity at the rate spea- 
fied in Clause A for the period, not exceeding fifty-two consecutive wedcs, that the insured 
survives such loss; and if the insured survives for the said period of fifty -two consecutive 
weeks the said loss of sight or said loss of the use of both hands, or of both feet, or of one 
hand and one foot, and shall be declared by competent medical authority, sati^actory to 
the Company, to have suffered such loss and to be thereafter and durinshis life by reason 
thereof permanently disabled from engaging in any work or occupation for wages or profit, 
the Company will pay to him a sum sufficient to increase the indemnity, theretofore paid 
for the disease whkh shall have caused such disability Jko an amount equal to.two hundred 
weeks' indemnity at the rate specified in Clause A. The payment for permanent disabil- 
ity shall terminate the policy. 

Clause K. Surgical Benefits.— (Part 1.) If injuries or disease covered by this 
policy shall necessitate a surgical operation named in Section V endorsed hereon, within 
nmety days from the date of accident or commencement of disease, the Company will 
pay as specified in said Section, in addition to the indemnity hereinbefore provided, but 
such payment shall not be made for more than the first operation for any one cause of 
disability. (Part 2.) If the insured suffers bodily injury or illness which shall not 
result in death or other disability, but which shall require surgical treatment other than 
specified in the said Section V, the Company will pay the amount actually expended 
for such treatment, but not to exceed the single indemnity for one week. 

Clause L. Hospital Charges.— If the insured suffers bodily injury through acci- 
dental means as aforesaid and on account thereof, and within ninety days from the date 
of the accident, the insured is removed to a hospital, the Comcany, provided that no 
ckim is made under Clause K, will pay to the insured (in addition to the indemmty 
payable for said bodily injury) for the period, not exceeding fifteen weeks, during which 
the insured is necessarily confined to the said hospital, the amount expended weekly 
for hospiUl charges but not exceedhig per week one-half of the amount of weekly indem- 
nity provided for total disability. 



m LONDON GUARANTEE AN1> kCCtOtm COMPANY 

Clause M. Idsntifzcation Benefits. — If the insured, bv reason of hijuiy or dis- 
ease, shall he physically unable to communicate with friends, the Company, upon receipt 
of a telegram or other message giving the number of this policy, will mmiediately trans- 
mit to his rebtives or friends any information respecting hmi, and will, without prejudice 
as to other benefits to which he may be entitled under this policy, defray all expense 



necessary to put the insured in the care of friends, provided sudi expense shall not exceed 

in all a sum equal to four times the amount specified in Clause A as the weekly indemnity. 

Section II.->-For Standard Provisions, See Page 11. 

Additional Provisions. 

Provision 17. — No assignment of interest under this policy shall bind the Company 
imless consent thereto is formally endorsed hereon bv the general manager of the Company 
for the United States. Any failure to comply with the proviskms Of this policy shall render 
invalid any claim made hereunder. A copy of any assicnment shall be given, within 
thirty days, to the Company, which shall not be res|>onsiDle for its validity. 

Provision 18. Surgieal Operation Fees, or Hospital Indemnity— Afl5nnative proof 
of a surgical operation, or of nospital confinement, must be furnished to the Comfniiy 
at its said head office, within ninety days from the date of the operation, or of the termina- 
tion of the confinement in a hospital 

Provision 19. The Companv^s liability shall not in any case extend to more than one 
part of this poHcy on account of disability to the insured due to any one accident, or any 
one illness, except as provided in Clauses B, I, K, L and M of Section I, nor does it cover 
disability from any disease or sickness duriiu( any part of any period for which the insured 
has either made claim' or may become entitled to indemnity from this or any other Com- 
pany or Association, for or on account of injury by accidental violence. 

Provision 20. The insurance hereunder shall not cover any injury fatal or non-fatal, 
sustained by the insured while partidpatmg in or in consequence of having participated 
in aeronautics. 

Provision 21. The copy of the application endorsed hereon is hereby made a part 
of this contract. 

Provision 22. No provision of the charter, constitution or by-laws of the Company 
not included herein shall avoid the poli^ or be used in evidence in any legal proceeding 
hereunder. 

Section IV.— Schedule of Optional Indemnities— Accident Insurance. — (Pay- 
able under conditions stated in Clause D of policy on which this is endorsed.) (Part 1.) 
For loss of 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 severed as described above, or entire sight 
of both ^es if irrecoverably lost, the principal sum; one leg by actual separation at or 
above knee, or one arm by actual separation at or above elbow, three-fourths principal 
sum; either hand severed as described above, or either foot severed as described above, 
or entire sight of one eye, if irrecoverably lost, one-half principal sum; thumb and index 
finder of eiUier hand, one-third principal sum. The payment in any such case shall end 
this policy* (Part 2 ) If the weekly indemnity specified in the policy on which this is 
endorsed is $50, the amounts named below shall be payable; if said indemnity is greater 
or less than $50, the amounts to be paid shall be increased or reduced proportionately. 
For loss of one or more fingers (at least one entire phalanx), $300; of one or more entire 
toes, $400. For complete hernia caused solely and directly by accidental injury, $140. For 
complete dislocation of the shoulder or elbow, $200; wrist, $250; hip, $600; knee, or ankle, 
or any bones at the foot other than toes, $300; two or more toes or two or more fingers, 
$100. For the complete fracture of bones of the skull, both tables^ $650; lower jaw, $ 150; 
collar bone or of the forearm between wrist and elbow, $3(X); pelvis, $500; thigh or of the 
arm between elbow and shoulder, $600; leg or knee cap, $400; two or more rilis, or two or 
more toes, or two or more fingers, $200; foot, two or more bones other than toes, $250; 
hand, two or more bones other than fingers, $250. 

Section V.— Schedule of Operations. — (Payable under conditions stated in Clause 
K of policy on which this is endorsed.) If the weekly indemnity specified in Clause A 
of the policy on which this is endorsed is $50, the amounts named below shall be payable; 
if said indemnity is greater or less than $50, the amounts to be paid shall be increased or 
reduced proportionately. Abscess — ^incision, $10. Abdomen — cutting into abdominal 
cavity for diagnosis or treatment of organs therein, $200. Amputation of entire hand, 
forearm or foot, $50; leg or arm, $100; thi^h, $150; finger or fingers, $20. Aneurism- 
operation for tying artery, $70. Appendicitis — (see abdomen.) Bone — injuries to or 
disease of. Removal of diseased portion of bone, $50. Cancer of lip — removal of by 
cutting operation, $50. Ourbuncle— incision, $10. Chest — cutting into for removal of 
pus as result of traumatism, $50. Dislocation — ^reduction of hip or knee, $70; shoulder, 
elbow or ankle, $50j wrist or lower jaw , $30; thumb, $20; fingers, $10. Excision — ^removal 
of shoulder or hip joint, $200; knee joint, $150; elbow, wrist or ankle joint, $100; toe oi 
toes, $20. Eye, ear, nose or throat — any cutting operation, $20. Eye — removal, $100 
Fractures — ^reduction of nose, lower jaw, collar bone, shoulder blade, forearm or wrist, 
$50; breast bone or ribs, $20; upper arm, $70; bones of hand other than fingers, $30; 
fingers, $10; bones of the pelvis (except coqcyx), $150; coccyx or toes, $20; thigh, $150; 
knee cap or leg, $100; bones of foot oUier than toes, $30. Goitre — cutting operation for 
permanent cure, $150. Gunshot wounds — treatment of, not necessitating amputation 
or any cutting operation in abdominal cavity, $25. Hernia — (abdominal.) Any cutting 
operation for radical cure of reducible, irreducible or strangulated form, $200. Hydiro- 
cele — ^incision and treatment of sac, $50. Hydrophobia — Pasteur treatment. $100. 
Inflammation of joint — incision of joint, $50. Intestinal obstruction — (see abdomen). 
Kidney (see abdomen). Lockjaw— injection of antitoxin into skull. $200; injection of 
antitoxm into spinal canal, $100. Mastoiditis — cutting operation for removal of diseased 
bone, $100. Nerve— cutting operation for stretchmg, $50. Rectum— cutting opeiatioQ 



LONDON GUARANTEE AND ACCIDENT COMPANY 128 



f or hacmonjqids. $3^ haenmhoids. internal. $50; prolapaed, IM; fistuU in uo, $40: 
malignant stnctuie, $200. SkuU— cutting into cramal cav^*^ *^>'^* <C'«<"- '^« »<^<»-i 
coid— ofKiatioa with removal of fractatfed vertebra, $20a 



by ca^ng or cruahing operation. $15a Stricture-oeaopliagas-cattinff opera- 
tion (^emal) for pomanent cure of. $20a Tapping of abdomen. $fiO; bladder. $30: 
chest, $30: eardrum.$20: hvdrocele. $20; jointe,$2aTrachea--cattingfaito for removal 
of foreign bodies or for rehef of difficult breathing. $7a Tumoa— removal ol by cutting 
operaUon. malignant,. $100; benign, $3a Vaiicocefe— cutting qperatioa for permanent 
cure. $5a Veinft-Vancose— cutting for permanent cure, $5a Wounda— suturing. $ia 

POLICY FORM — "Complete Indemnity Accumulativb Dis- 
ability D. N." 
Principal Sum, $7,500. Annual Premium, $75. 

London Guarantee and Accident Company. Limited, of London, 
England (hereinafter called the Company), does hereby insure 
John Doe of New York (hereinafter called the Insured), under 

classification Select, whose occupation is , the duties 

of which are editor, against bodily injuries effected within the 
period of this policy through accidental means, directly and inde- 
pendently of aU other causes, and against disability by disease con- 
tracted by the Insured during the period beginning at noon, standard 
time, of the fifteenth day aiter this policy is dated, subject to all 
conditions and limitations hereinafter contained. 

SEcnoN 1. Schedule of Indemnities — For Total Disability from Accident. — 
See preceding policy. 

For Partial Disability from Accident. — See preceding policy. 

For Death from Accident. — See preceding policy. 

For Optional Indemnities — Accident. — See preceding policy. 

For Double Indemnities — ^Accident. — ^See ptreceding policy. 

Clause F. Accumulations.— Each consecutive full year's renewal of thb policy 
shall add ten per cent to the original indemnities specified as payable under Clauses A. 
B, I. J, Part 2 of Clause K, and Part 2 of Section IV. uAUl each of the said indemnities 
is increased fifty per cent. Thereafter, so long as this policy is maintained in force said 
indemnities shul remain increased by said accumulations. 

Clause G. Sunstroke, Freezing, Hydrophobia and AsPHYXiAnoN. — ^Any of the 
following, namely, sunstroke, freezing, hydrophobia and asphyxiation, suffered throujsh 
accidental means (excluding suicide, sane or msane, or any attempt thereat, sane or m- 
sane), shall be deemed a bodily injury within the meaning of this policy. 

Clause H. Blcxid-Poisoning. — Blood-poisoning, resulting directly from bodily in- 
juries as aforesaid, shall be deemed to be mcluded in the said term, bodily injury. 

Clause I. Total Disability from Disease. — For the period during which the In- 
sured shall be continuously and wholly disabled by disease as aforesaid from performmg 
each and every duty pertaming to his occupation, the Company will pay weekly indemnity 
at the rate specified in Clause A. 

Clause J. Partial Disability from Disease. — For the period not exceeding fifty- 
two consecutive weeks, during which the Insured shall be omtinuously disabled by 
disease as aforesaid from periorminE at least one-half of the work essential to the duties 
of his occupation, the Company will pay weekly indemni^ at one-half the rate specified 
in Clause A. 

Clause K. Surgical Benefits— Part 1 . — ^If injuries or disease covered by this policy 
shall necessitate a surgical operation named in SecUon V endorsed hereon, within ninety 
days from the date of accident or commencement of disease, the Company will pay as 
specified in said section, in addition to the indemnity hereinbefore provided, but such 
payment shall not be made for more than the first operation for any one cause of dis- 
ability. 

Part 2. — If accidental injuries are sustained which shall not result in death or other 
disability, but which shall require surgical treatment other than specified in Section V, 
the Company will pay the amount actually expended for such treatment, but not ex- 
ceeding the single indemnity for one week. 

Clause L. Hospital Charges.— Part 1.— If the Insured suffers bodily injury 
through accidental means as aforesaid and makes no claim for benefits under Clause 
K, but, on account of said bodily injury, and within ninety days from th^ date of the 
accident, is removed to a hospital, or sanitorium, or 

Part 2. — If the Insured shall, independently of all other causes, be necessarily con- 
fined in a hospital or sanitorium and wholly disabled and prevented by disease as afore- 
said, and not hereinafter excepted, from performing any and every kind of duty per- 
taining to his occupation, 

Part 3. — Then, m either of the above cases (and in addition to the indemnity payable 
for said bodily injury or disease) the Company will pay to the Insured for the period, 
not exceeding fifteen weeks, during which the Insured is necessarily confined to said 
hospital or sanitorium, the amount expended by him weekly on account of the hospital 
charges— not exceeding one-half of the amount of weekly indeouiity provided for total 
disability* 



126 LONDON GUARANTEE AND ACCIDENT COMPANY 

Clause M. iDENrmcATiON Benefits. — If the Insured, by reason of injury or dis- 
ease, shall be physically unable to communicate with friends, the Company, upoD re- 
ceipt of a telegram or other message ^ving the number of this policy, will immediately 
transmit to his relatives or friends anv mformation respecting him, and will, without preju- 
dice as to other benefits to which he may be entitled under this policy, defray all ex- 
penses necessary to put the Insured in the care of friends, provided such expense shall 
not exceed in all a sum equal to four times the amount specified in Clause A as the weekly 
indenmity. 

For Schedule of Optional Indemnities— Acxhdent Insurance— See preceding 
pohcy 
For Schedule of Options — See {receding policy 

For Standard Provisions See Page 11 

For Additional Provisions See Preceding Poucy 



L 



THE LOYAL PROTECTIVE INSURANCE COMPANY. 



127 



5^8 Coyal proteetiue l98ura9Q6 Qo/npaijy, 

BOSTON, MASS. 



Commenced Business 1805. 

S. AUOVSTDS AXXEN, Pfes. 



Reorganised on stock basis, 1900. 

Francis R. Parks, Sec. 



This company is incorporated under the laws of Massachusetts 
for the purpose of furnishing protection against accident, sickness 
and death by accident to Odd Fellows under fifty-five years of 
age. 

PrBmiums. — Policy fee of $5 and one quarter's dues must 
accompany application. 

BenBPits. — Accident benefits are paid for one hundred and four 
weeks, one-half benefits for the first week and full benefits for the 
next fifty-one weeks, and one-half benefits for the next fifty-two 
weeks, one hundred and four weeks in all. For partial disability 
benefits, one-half rate. Special benefits are paid for travel 
accidents. Sick benefits are paid at half rate for first week, full 
rate for the next fifty-one weeks, fifty-two weeks in all. An 
identification badge goes with each certificate. 

Peerless Special Policy (Sicknes«« and Accident). 













Weekly Indeunitv. 






Death or Loss 
of Hand and 


Loss 


For Loss 






















Foot, or Both 


of Hand 


of One 


Travel 


Ordinary 


Sick- 


Class. 


Hands, or 


or Foot 


Eye 


Accident. 


Accident. 


ness. 




Both Feet, 
or Both Eyes 


Accident. 


by 
Accident. 
























by Accident. 






Total 


Partial 


Total 


Partial 












10 


10 


104 


30 


52 










Weeks. 


Weeks. 


Weeks. 


Weeks. 


Weeks. 




-$ 


1 


S 


S 


1 


1 


1 


1 


A 


iooo 


500 


250 


50 


25 


14 


7.00 


14 


B 


750 


375 


200 


50 


25 


12 


6.00 


12 


C 


600 


300 


150 


50 


25 


10 


5.00 


10 


D 


400 


200 


100 


50 


25 


10 


5.00 


10 


E 


200 


100 


60 


50 


25 


7 


3.50 


7 


F 


IS' 


50 


25 


50 


25 


5 


2.50 


6 


X 


75 


50 


50 


25 


10 


5.00 


10 


Y 


. .50 


50 


25 


50 


25 


7 


3.50 


1 


Z 


50 


50 


25 


50 


25 


5 


2.50 


5 



Guaranteed Quarterly Cost. 




Age when applyins.*. 


Under 50 


Between 50 and 55 






Benefits described above 


$ 

4.00 
5.50 
7.00 


S 
6.00 


Fifty per cent additional benefits 


8 50 


Double benefits described above 


11.00 







Weekly indemnity increased. 10% if premium paid yearly in advance. 

POLICY FORM— "Peerless Special," Class A. 

Maximum Death Benefit, $1000. 

Weekly Accident Indemnity, $14. 

Annual Premium, $16. 

In consideration of the statements in his application for policy, 

copy of which appears hereon and is made a part hereof, the Loyal 



^ 



128 THE LOYAL PROTECTIVE INSURANCE COMPANY 

Protective Insurance Company, subject to all the conditions, 
limitations and provisions hereinafter contained, 

Promiaes to indemnifY John Jones (hereinafter called the insured), occupation account- 
ant, with duties as described in the application, against disability, during which the insured 
shall be attended by a duly authorized and legally practising physician with reasonable 
promptness and frequencpr, and further promises to pay. to the oeneficiar^ named in his 
application, the sum herem after mentioned in the event of death as heremafter provided. 

Payments by Insured. — Said promises are upon the conditions precedent that the 
insured shall pay the policy fee of five dollars upon signing his application, and on the 
first business dav of March, June, September and December in each year, a premium of 
four dollars, and after reaching sixty five ^ears of age, a premium of twice the aforesaid 
amount on said days, subject to the option in Condition F of this policy. Failure to 
pay any premium upon the appointed day shall terminate this ooutiact, except as to such 
claim as has then accrued. 

The payment of four quarterly premiums, in one sum, In advance, shall entitle the in< 
sured to an increase of ten per cent, over the weekly mdemnity hereinafter provided, 
in the event of disablity beginning during the term covered by such payment. 

Accidental Death. — This company promises to pay one thousand dollars if the death 
of the insured occurs while this contract is in force^ and within nmety days after the 
injuries have been received, as the result, alone and independently of all other causes, 
of bodily injuries. 

Special Accident (Loss of Eye or Limb).— Tf an injurv shall alone, witbm ninety 
days after its happening cause the loss (either directly or through amputation), by ac- 
tual separation, at or above the wrist or ankle, of one hand and one foot or both hands 
or both feet or entirely and permanently destroy the sight of both eyes, this company 
will pay the sum of one thousand dollars in lieu of all other benefits hereunder, or the 
sum of five hundred dollars in lieu of all other benefits if the accident shall within said 
time cause such loss of one hand or one foot, or the sum of two hundred and fifty dollars 
in lieu of all other benefits if such accident shall within ninety days permanently destro v 
the sight of one eye, provided the insured possessed the full use of both hauids, both 
feet and both eyes previous to such injury. 

Travel Accident (Total). — If, in consequence of an accident causing injury to a 
public conveyance, propelled by steam, electricity or cable, and provided b^ common 
carriers for the transportation of passengers, the insured shall receive an injury while 
riding therein as a passenger, causing immediate total disability, this company will pay 
to said insured a sum computed at the rate of fifty dollars per week for each consecutive 
full week of seven days that he is totally disabled, not exceeding ten weeks; or 

Travel Accident (Partial) .—If such accident shall alone and independently of 
an other causes, immediately partially disable him from performing a majority of the duties 
of or pertaining to his occupation, this company will pay, during the continuance of such 
partial disability one-half the amount provided above for total disability, but for not ex- 
ceeding ten weeks. 

Accident (Total Disability). — ^Tf the insured shall receive an injury except as a 
passenger as aforesaid, which shall independently of all other causes, immediatelv, wholly 
and continuously disable him for seven consecutive dajrs, the insured shall be indemnified 
for the term of such total disability at the rate of seven dollars for the first week and 
fourteen dollars a week thereafter for not exceeding fifty-one weeks and se\en dollars 
a week thereafter for not exceeding fifty-two weeks; provided, that in no event shall the 
insured be indemnified against disability for a longer total period for one or more accidental 
injuries than one hundred and four weeks; or 

Accident (Partial Disability). — In case of accidental injury not totally disabling 
which shall, alone and independently of all other causes immediately partially disable 
him from performing a majority of the duties of or pertaining to his occupation, this 
company will pay, during the continuance of such partial disability one-half the amount 
provided in preceding paragraph for total disability, but for not firrfriing thirty weeks; 
or, 

Sickness. — It the insured shall be totally disabled by sickness for seven consecutive 
days, he shall be indemnified during the disability term at the rate of seven dollars for 
the first week and fourteen dollars a week thereafter for not exceedins fifty-one weeks, 
provided that if under the personal care of a lodge of the Independent Order of Odd Fello«-s 
during disability and visited regularly by its visiting committee, the disability term shall 
be the number of weeks not exceeding the foregoing number he is totally disabled and 
under care of the lodge; and if not under the care of any lodge of the I. O. O. F.. the dis- 
ability term shall be the period not exceeding the foregoing number of weeks of his actual, 
nece^ry, absolute and continuous confinement within the house; and further provided 
that in no event shall the insured be indemnified for sickness commencing within sixty 
days from the date hereof nor for a longer total period for one or more sicknesses than 
fifty-two weeks. 

Conditions and Provisions 

^ (a) Injury, except in case of accidental drowning, includes only the result of external, 
violent and accidental means, leaving upon the body marks of contusion or wound visible 
to the eye. Total disability means inability to perform any of the duties of any occupadon. 
Immediate means immediate in time. The disability term includes only a continuous 
period of disability while the policy is in force. Statement of facts in all proofs submitted 
shall be conclusive upon the insured or claimant but not upon the company. The fur- 
nishing of blanks shall under no circumstances be deemed a waiver of anything by the com- 
pany. Chims shall become null and void if any wilfully false statements of any material 
fact or thing are made in the application or proofs. Failure to comply with conditions 
four and five of standard provisions shall not iAvalidftte claJO* CSWcpt ps (9 ^uch period 
ol disability w precedes the giving of notice. 



THE LOYAL PROTECTIVE INSURANCE COMPANY 129 

(ft) In case insured shall be killed or injured whfle walking or being on the right of 
way of a railroad, not including stations, platforms or crossings lawfully established 
(railway employees in the discharge of their duties excepted) , or while entenng or leaving 
or trying to enter or leave a movmg conveyance, or while engaged in hunting, aviation, 
or ballooning, this company will pay one-fifth of the amount called for above for accidental 
death or weekly indemnity, or si>ecial accident. 

(e) No indemnity shall be paid for disability resulting wholly or in part form tuber- 
culosis or cancer originating within one year from the date hereof. 

(</) No claim shall be presented or allowed for any disability, or death, which shall 
direct^ or indirectljr result from or be caused by any sickness, ailment or infirndity that 
may have existed prior to the date hereof. 

(e) No benefits or indemnity under this policy shall accrue while insured is exposed 
or engaged temporarily or otherwise in an employment not insurable under the classi- 
fication of occupations in the manual of this company in force at the date hereof. 

(/) The insured shall have the option of continuing this policy in force, after reaching 
sixty-five years of age at the original premium, in which case the weekly indemnities 
provided above shall be reduced by one-half. 

(g) Indemnity shall not be payable for injuries, or death resulting therefrom, inten- 
tionally inflicted upon himself by the insured, or inflicted upon himself or received by him 
while msane; or for disappearances, or for war or riot risks, or for voluntary exposure 
to unnecessary danger, or for injuries or death received while fighting, wrestling or while 
under or in consequence of the insured being or having been under the influence of in- 
toxicating liquors or narcotics; or while engaged or as a result of having been engaged 
in any unlawful act; or for disability where there shall be no external or visible sign or 
symptom of disease or bodily injury: or where the nature, cause and name of disability 
is unknown or incapable of direct ana positive proof; or for disability arising from the use 
of intoxicating liquors, or from the abuse of or disease of the genital organs. 

For Standard Provisioks see Page 11 



tfit^ 



130 MARYLAND CASUALTY COMPANY 

(Harylai^d Casualty Qompa9y. 

HOME OFFICE— BALTIMORE, MD. 

Commenced business 1898. 



RiCHASD H. Thompson, 4 V. P. and Manager. 

Geo. W. Powell, Mgr. in charge of Underwriting. 
F. L. Templehan, Manager in charge of Claims. 

POLICY FORM— "Perfection Disability." 

Principal Sum, $7,500. Weekly Indemnity, $25. 

Annual Premium, $60. 

Maryland Casualty Company of Baltimore (herein called the 
Company), in consideration of the statements in the application 
for this policy, a copy of which is endorsed hereon and made apart 
hereof, and of sixty ($60) dollars premium, does hereby insure ^hn 
Doe (herein called the Insured), by occupation an attorney, and 
classified by the Company as a select risk, subject to all provisions 
and limitations hereinafter contained, in the principal sum of sev- 
enty-five hundred ($7500) dollars, and for a weekly indemnity of 
twenty-five ($25) dollars, for the term of twelve months from the 
first day of January, 1916, beginning and ending at 12 o'clock noon, 
standard time, at the place of coimtersignature hereof, against loss 
resulting from (1) bomlv injuries, including death resulting there- 
from, eSected independently and exclusively of all other causes 
directly through accidental means, (2) disability by disease or ill- 
ness, as follows: 

Accident Benetits 

Part A. Death, Dismemberment or Loss of Sight. — (1) If such injuries shall from 
the date of accident, continuously and wholly disable and prevent the Insured from i>er- 
forming any and every kind of duty i^ertainmg to his occupation, and during the poiod 
of such continuous disability, but within two hundred and eignt weeks^ from date of 
accident, shall result independently and exclusively of all other causes in any one of 
the losses enumerated below; (2) or, if within one himdred and ei^fhty days from the 
date of the accident, irrespective of total disability, such injmies shall result m Uke man- 
ner in any one of such losses, the Company will pay the sum set opposite such loss and 
in addition weekly indemnity as provided in Part B, to the date of death, dismembar- 
ment or loss of sight, as the case may be; but only one of the payments named in Part A, 
the greatest, will be made for injuries resulting from one accident. 

For loss of life, or both hands or both feet or sight of both eyes, or <me hand and one 
foot, or either hand or foot and sight of one eye, the principal sum. Either le^ or arm, 
two-thirds principal sum. Either foot or hand, or sight of one eye, one-half principal sum. 
Thumb and index finger of either hancC one-third principal sum. Loss shall mean^ with 
regard to leg or arm, dismemberment oy severance at or above knee or elbow; with re- 
gard to hands and feet, dismemberment by severance at or above wrist or ankle joints: 
with regard to eyes, entire and irrecoverable loss of sight; with regard to thumb and 
index finger, severance at or above metacarpo-phalangeal loint. 

Part B. Total Disability— Weekly indemnity. — (1) Or, if such injuries shall 
not result in any of the losses mentioned in Part A, but shall independently and ex- 
clusively of all other causes, continuously and wholly disable and prevent the Insured 
from the date of accident, from performing any and every kind of duty pertaining to 
his occupation, the Company will pay so long as he lives and suffers such disability, the 
weekly mdemnity above specified for the period of such disability. ' 

Intermediate Disability. — (2) Or, if such injuries independently and exdusivdy 
of all other causes, shall from the date of accident (or immediately following total dis- 
ability) continuously disable 'and prevent the Insured from periorming a major portion 
of the daily duties ^rtaining to his occupation, the Company will pay three-fourtns (K) 
the weekly indemnity above specified for the period of such disability. 

Partial Disability. — (3) Or, if such injuries independently and exclusively of aO 
other causes, shall from the date of accident (or immediately followiiig a period of total 
or intermediate disability) continuously disable^ and prevent the uisured from per- 
forming one or more material daily duties pertaining to his occupation, the Company 
will pay one-half (H) the weekly mdemnity above specified for the penod of such dis- 
ability. Indemnity for intermediate or partial disability, or for both, shall not be pay- 
able in excess of fifty-two consecutive weeks. 

Part C. Double Indemnity.— If the Insured shall sustain such injuries (1) while 
a passenger in or on a public conveyance provided by a common carrier for passenger 
service, mduding platform, steps and running board thereof; (2) or, while a ] 



m a passenger elevator (e«chiding elevators in mmes); (3) or, in consequence of the buni- 
ing of a buUdiog while the loaiued is tb«reini (4) or, by the expkision, coUapae or cop- 



MARYLAND CASUALTY COMPANY 131 

ture of a steam boiler; (5) or, by the collapse of the outer walls of a building while the 
Insuml is therein; (6) or, as the result of a cyclone or tornado; (7) or, bv bong struck 
by Ughtidng; then, and in such event only, the Company will pay double the amoimt 
otherwise payable under Parts A, B, E or G of this policy. 

Pakt D. Extra Indemnity. — ^If such injuries shall be sustained while the Insured 
is a passenger on and is within an^^ railway passenger car (trolley and cable cars ex- 
cepted) provided by a common carrier for passenger service and forming part of a reg- 
ular passenger train propelled by steam (or electricity} on a steam railroad and shall withm 
ninety (90) days from the date of the accident causing such bodily in juiv result in the 
death of the Insuz«d, then the amount to be paid in lieu of any and all other indemnities 
shall be two and one-half times the sum that would otherwise be payable for loss of life 
as provided in Part A hereof. 

Pakt E. Elective Benefits. — ^The Insured, if he so elect in writing within twenty 
days from date ol the acddoit, may take in lieu of the weekly indemnity hereinbefore 
provided for totaJ or partial disability, indemnity in one sum, according to the following 
schedule, if the injury is one set forth in said schedule, but not more than one elective 
benefit shall be ptud iar injuries resulting from one accident. If the Insured is entitled 
to double indemnity the elective indemnity shall be doubled in like manner. 

Schedule of Injuries. — ^The amounts stated in the following schedule are payable 
under this policy if issued for twenty-five dollars weekly indemnity, proportionate amounts 
being payable if the policy is issued for a larger or smaller weekly indemnity. 

For loss of one or more entire toes, $200; of one or more fingers (at least one entire 
phalanx), $150. For complete dislocation, viz.: of the hip, $300: knee joint, $150; any 
bones of foot, other than toes, $150; ankle, $150; wrist, $125; shoulder, $100; elbow, $100; 
two or more toes, $50; two or more fingers, $50. For the complete fracture of bones, 
viz.: of the skull, both tables, $325; thigh, $300; arm between elbow and shoulder, $300; 
pelvis, $250; les (one or both bones), $200; patella (knee cap), $200; forearm between 
the wrist and elbow, $150; clavicle or shoulder blade, $150; foot, other than toes, $125; 
hand, other than fingers, $125; two or more toes, $100; two or more fingers, $100; two or 
more ribs, $100; lower jaw, $75. 

Part F. Indemnity foe Medical or Surgical Treatment of Minor Injuries. — 
Or, if such injuries shall not result in either death or disability, but shall require medical 
or surgical attention, the Company will reimburse the Insured for the cost thereof to 
an amount not exceeding one wedc's single indemnity as specified herein, upon filing 
the surgeon's recapt and certificate. 

Part G. Special Indemnity. — Subject to its terms, limits and c6nditions this pol- 
icy covers the Insured in the event of death or disability due to freezing, hydrophooia, 
somnambttlism, drowning, choking in swaUowing, assaults by burglars or highwaymen, 
asphyxiation or poison (suicide, sane or insane, or any attempt thereat not included); 
aJid subject to its terms, limits and conditions in event of death or disability from sep- 
ticemia or blood poisoning due directly to an accidental mjury sustained while this policy 
is in force. 

Illness Benefits 

Part H. Total Disability — ^Weekly Indemnity. — (1) If, during the term of this 
policy the Insured shall contract any disease or illness for which he shall be treated by 
a regularly qualified physician and which shall, beginninjg during said term, wholly 
disable and prevent hun from performing any and every kind of duty pertaining to his 
occupation, the Company will pay for the period of such disability the weddy indemnity 
hereinbefore specified. 

Intermediate Disability. — (2) If the Insured shall be totally disabled as above 
and immediately following the period of total disability, he shall by reason of any disease 
or illness be disabled and prevented from performing a major portion of the daily duties 
pertaining to his occupation^ the Company will pay for the period of such disability 
one-half (V^) of the weekly mdemnity payable for total disability. 

Partial Disability. — (3) Or, if immediately following a period of total or interme- 
diate disability the Insured shall by reason of any disease or illness be prevented from 
performing a material portion of the daily duties pertaining to his occupation, the Com- 
pany will pay for the period of such partial disability one-fourth (H) of the weekly 
mdemnity payable for total disability. 

(4) Indemnity under Part H for total, intermediate or partial disability, singly or 
combined, shall not be payable in excess of 52 consecutive weeks. 

Part I. Indemnity for Blindness and Paralysis. — If the Insured shall con- 
tract, during the term of this poWcy, any illness not hereinafter excepted, that shall not 
result in death but shall result, independently of all other causes, within one year from 
the date of its contraction, in the entire and irrecoverable loss of the sight of both eyes 
or in permanent paralysis, whereby the Insured shall entirely lose the use of both hands 
or both feet or m one hand and one foot, and on account of either of said conditions 
shall have been totally disabled for one full year and will thereaf tn and during his life, 
be permanently disabled by reason thereof, from engaging in any work or occupation 
whatsoever for wages or profit, the Company will pay him, m lieu of all other indemnity* 
except for surgicaT operation or hospital expenses, upon filing affirmative and positive 
proof thereof, a sum equal to one hundred weeks' indemnity at the rate herembefore 
specified. 

Part J. Reimbursement for Hospital Expenses — Accident or Illness. — If such 
injuries sustained or illness contracted by the Insured and covered by this isolicy shall 
within ninety days from the date of the commencement of disability necessitate his re- 
moval to a hospital, the Cominny, provided no claim is made under Part K hereof, will 
pay^ in addition to the indemnity otherwise provided, for a period not exceeding ten weeks 
during which the Insured sbaU o« ia the hospital, the amount expended by hiia weekly 



182 MARYLAND CASUALTY COMPANY 

for hospital expenses, but not raceeding per week the amount payable hereunder as 
single weekly indemnity. 

Past K. Indemnity foe Surgical Operations — Accident or Illness. — If such 
injuries sustained or illness contracted by the Insured and covered by this policy shall 
within ninety days from the date of the commencement of disability necessitate a sur- 
gical operation named in the following Schedule of Operations, and the same shall be 
performed, the Company will pay, in addition to the indemnity otherwise provided, the 
sum as specified for such operation in said schedule; but the Company shall not be liable 
for more than one operation (the greater) necessitated by injuries sustained in one acci- 
dent, or by any one illness. 

Schedule of Operations. — ^The amounts stated in the following schedule are payable 
under this policy if issued for twenty-five dollars weekly indemnity, proportionate amounts 
being payable if the policy is issued for a larger or smaller weekly indemnity. 

Abscess, boil or felon (one or more) — incision, $5. Amputation of foot, hajid or fore- 
arm, $25; leg or arm, $50; thigh, $100; finger or fmgers. toe or toes, $10. Aneurism (tumor 
of artery)— ligation, $100. Appendicitis, $100. Carbuncle (one or more)— incision and 
treatment, $10. D^ocations, reduction of shoulder, elbow, hip, knee or ankle, $25; 
wrist or lower jaw, $15; thumb or fingers (two or more), $10. Excision of shoulder, hip, 
or knee joint, $100; elbow, wrist or ankle joint, $50. Eye, ear, nose or throat — any 
cuttinc operations, $10. Eye, removal of, $25. Fractures, reduction of lower jaw, 
collar Done, shoulder blade or forearm, $25; breast bone, ribs or coccyx, $10; nose. $5; 
ui^xr arm, $35: wrist or hand, $15; fingers (two or more), toe or toes, $10; any of Uie 
bones of the pelvis, except coccyx, $25; thigh, $75; knee cap or leg bones (one or both), 
$50; bones of foot, $15. Ganglion — ^incision and curetting, $15. Gunshot wounds- 
treatment not necessitating amputation or laparotomy, $15. Hernia (abdominal) — 
any cutting operation for radical cure, $100. Hydrocele — ^ta^pin^, $5; excision of sac, 
$25. Hydrophobia — Pasteur treatment. $50. Ligrowing toe nail — ^radical operation, 
$10. Kidney — ^fixation or removal, $100. Laparotomy (opening of the abdommal cav- 
ity), $100. Laryngotomy or tracheotomy, $50. Lithotomy (operation for removal of 
stone in bladder) — any cutting, $100. Lockjaw — injection of anti-tetanic serum into 
skull, $100; into spinal canal, $25. Mastoiditis-^peration for, $50. Necrosis of bone— 
sequestrotomy, $35. CEsophagotomy for stricture or other cause, $100. Paracentesis— 
tapping of abdomen, $25; bladder, $25. Rectum — hemorrhoids, fistula or polypus; liga- 
tion or incision, $25; prolapsed — operation for, $25; malignant stricture — excision or 
colostomy, $100. SkuU trephining, $100. Synovitis (inflammation of joint) — ^incision, 
$25. Tumors — extirpation from any part of the body, boiign, with local anesthesia, 
$10; with ether, $35; malignant — ^palliative operation, $15; radical operation, $100. 
Varicose veins or varicocele— 4igation or excision, $25. Woimds — suturing, $5. 

Part L. Redcbursement for Graduate Nurse. — In lieu of any sum payable for 
reimbursement for hospital expenses or indenmity for surgical operations, the Company, 
in addition to the indemnity otherwise payable, will pay the amount expended each 
week for graduate nurse, not exceeding the single weeluy indemnity nor for more than 
ten consecutive weeks. 

Part M. Identification. — If the Insured by reason of injury or illness shall be 
physically unable to communicate with. friends the Company, upon receipt of a tele- 
gram or other message giving the niunber of this policy, will immediately transmit to his 
relatives or friends any information respecting him, and will defray all expenses neces- 
sary to put the Insured in the care of friends, provided the Company's liability for such 
expense shall not exceed the sum of one hundred dollars. 

For Standard Provisions See Page U 

Additional Provisions 

20. A copy of any assi^^nment shall be given within thirty days to the Company, 
which shall not be responsible for its validity. 

21. This policy does not cover disability from disease or illness existing or contracted 
prior to the date of thb iMlicy; nor from disease or illness suffered or contracted outside 
of the United States and its insular possessbns, Canada, Europe, Alaska, Mexico. Canal 
Zone and the West Indies. If the Insured shall become entitled to indemnity for dis- 
ability on account of accidental injuries, the (Company shall not, for the same period of 
time, be liable for any disability on account of disease or illness. 

22. This policy shall not cover injuries, fatal or non-fatal, sustained by the Insured 
in consequence of war, riot or invasion, or while participating in or in consequence of 
having participated in aeronautics; nor suicide, sane or insane, or any attempt thereat; 
nor loss resulting from any means or act which if used or done by the Insured while in 
possession of all mental faculties would be deemed intentional or self-inflicted. Parts A 
to G of this policy shall not cover death or disability resulting from ptomaines or bac- 
terial infections (except pyogenic infections which shall occur through an accidental 
cut or wound), nor any loss caused or contributed to, directly or indirectly, by any 
disease or illness. 

23. The copy of the ai^lication endorsed hereon is hereby made a part of this con- 
tract which b made subject thereto. No provision of the charter, constitution or by- 
laws of the Company not included herein shall void the policy or be used in evidence 
in any legal proceeding hereimder. Failure to comply with a^ of the requirements 
contained herein shall mvalidate all claims under this policy. Tnis policy may be re- 
newed with the consent of the Company by the payment of the prenuum m advance. 

In witneffi whereof, the Maryland Casualty Company, of Baltimore, has caused these 
presents to be signed by its president and secretary; but the same shall not be biodioj 
upoD the Company unless countersigned by a duly ftutborized agent. 



MARYLAND CASUALTY COMPANY 133 

POLICY FORM— "Marcasco Disability." 
Principal Sum, $5,000. Monthly Indemnity, $100, 

Annual Premium, $36. 

Maryland Casualty Company of Baltimore (herein called the 
Company), in consideration of the representations and agreements 
cxDntained in the application for this policy, a copy of winch is en- 
dorsed hereon, and made a part hereof, and of the premium of 
thirty-six ($36) dollars, does hereby insure, subject to all the pro- 
visions, limitations and conditions herein contained or endorsed 
hereon, John Doe (herein called the Insured), by occupation an 
accotmtant, and classified by the Company as a select risk, for the 
period of twelve months, from 12 o'clock noon, standard time, at 
the place where the Insured resides at the time this policy is issued, 
of the first day of January, 1916, (1) against loss or disability as 
herein defined, resulting from bodily injury, effected solely through 
external, violent and accidental means, independently and exclu- 
sively of disease, whether disease pre-exists or be afterwards con- 
tracted, and all other causes, and (2) against disability from sick- 
ness, independent of injury, whether injury pre-exists or be after- 
wards sustained, as herein defined, and contracted by the Insured 
after fifteen days from the date aforementioned, and as specified, 
in the following schedules: 

Part I. — Principal sum first year, five thousand ($5,00Q) dollars; 
monthly accident or sickness indemnity, one hundred ($100) dollars. 

Schedule of Indemnities — ^Accident 
(A) Single Indemnity — Death, Dismemberment or Loss of Sight. — If such 
bodily injiuy shall, immediately from date of accident, independently and exclusively 
of all other causes, directly, continuously and totally disable and prevent the Insured 
from performing any and every kind of duty pertaining to his occupatoin, and if, during 
the period of such continuous and total disability, and within ninety days from date 
of accident, such bodily injury shall be the sole and direct cause of any one of the losses 
enumerated in this part, the Company will pay the sum specified opposite such loss in 
lieu of all other indemnities under this policy, except as may be provided in Paragraph B 
of this part. 

Specific Indemnities. — For loss of life, or both hands by severance at or above the 
wrists, or both feet by severance at or above the ankles, or one hand and one foot by 
severance at or above the wrist and ankle, or entire sight of both eyes, if irrecoverably 
bst, the principal simi. Either hand by severance at or above the wrist, or either foot 
by severance at or above the ankle, one-half the principal sum. Entire sight of one 
eye, if irrecoverablv lost, one-third the principal sum. Payment shall not be made 
for more than one loss enumerated in the above "Specific Indenmities." 

(B) Or, if such bodily injury shall not result in death, but shall, immediately, wholly 
and continuously disable the Insured and within ninety davs from date of accident, 
result independently and exclusively of all other causes in the loss by complete severance 
at or above the wrists or ankles of both hands or both feet or one hand and one foot; 
or the entire and irrecoverable loss of the sight of both eyes, the Company will pay the 
Insured, in addition to the amount specified in the preceding paragraph for such loss, 
one-half the monthly indemnity during such period as the Insured shall be wholly and 
continuously disabled and prevented from attending to any and every kind of duty per- 
taining to his occupation, but no indenmity shall be paid for a period exceeding twelve 
months from date of accident. 

Part II. Fifty Per Cent Accumulations in Principal Sum. — Each consecutive 
full year's renewal of this policy, if the premium be paid annually in advance, will in- 
crease the prindpal sum specified in Part I by ten per cent; if paid other than annually 
in advance by five per cent, until in either case, according as premium may be paid, 
fifty per cent is thus added to the original principal sum. Thereafter, so long as the policy 
is in force, the insurance will be for the said principal sum plus the accumulations. This 
provision shall not ai^ly to increase the monthly indemnity under this or any other 
part of the policy. 

Part III.— Total. Monthly Indemnity.— Or, if such bodily injury shall not result 
in any of the losses enumerated in Part I, but shall directly, immediately, wholly and 
continuously disable and prevent the Insured from attending to any and every kind of 
duty pertaining to his occupation, the Company will pa/ him, for a period not exceeding 
fifty consecutive months, tne monthly indemnity specified in Part I. 

Part IV. Partial Monthly Indemnity. — Or, if such bodily injury shall not imme- 
diately, but shall, within thirty days after the date of accident, totally disable the In- 
sured; or, if such bodily injury shall, either immediately after the accident or immediately 
after a period of total disability, prevent the Insured from performing one or more im- 
portant daily duties pertaining to his occupation, the Company will pay him, for a period 



134 MARYLAND CASUALTY COMPAKt 

not exceeds nj; six cansccutivG monthfl, onc^kUf the aumthly indemnity 8i>ecified in 
Pajt I; provided, however. tha.t the cooiblned periods for which indemnity is payable 
iindeT Parts IH ftiiiii IV shall aol txjccal Gftv consecutive months. 

Part V. Dol'ble iNDEitmTY.— <Jr, if such bodily injury is sustained by the Insured 
while ddin!? as a p&sficngffT witbin any taihviij ]:>assenRer car provided for the exclusive 
use of iiiiSiieflKerB and prppcilod by iteajn. ciriuftressea air, cable or electricity, and not 
bttacbcd to uny freight, coal r>r Logtrini^ iniin; ur, while riding as a passenger on board 
a jteflm ve<i&el Ikeo^ed for the re^uUr tran^r>^>rtation of passengers, and such bodily 
injury ia due directly to or in a>nsequci3M of iho wrecking of such car or vessel; or, while 
rii:lijiK HA is. passenger within a. pnsSf^ngcr deviifirr (elevators in mines excepted), then the 
iimr>nnt to be paid shall be double the sum tli.it virould otherwise be payaole as provided 
in Pfliis 1 or 11 or lU or IV. Double indemnky as herein provided shall not be payable, 
however, for any injury, fatal or ollwrwyscT ^vif^tained while getting in or out, on or oflf, 
nr while bein^ upon tJie ste^ or Btep&, sEmg-plank or other landing contrivance of any 
donveyance rtferred to in thi^ pwrt. 

PART VI. Surgical Treataiewt.— Dr, if such bodily injury shall not result in either 
disability or death, but HhsU r^^uire immcfliate meclical or surgical treatment by a 
Ir.T.ih/ -^n.|>''h,^ft '-liiv^i'-i jn r-r ^.|r.r^..^« i \;,. f .^rp.^auy will relmbuTse the Insured for the 
^ ■ ^en da3rs' single total indenmity. The 

i^iu^uy ii;uoL U; ^i'.t.ii. uuucc ul i;ijaf> ^mIm^il twenty days from date of acci(Knt and 
must be furnished with the physician's or surgeon's receipted bill. 

Part VII. Sunstroke, Freezing. Hydrophobia. — Simstroke due to the sun*s rays, 
freezing, hydrophobia, caused solely by accidental means, shall be deemed a bodily m- 
jury within the meanmg of this poligr. 

Part VIII. Blood-Poisoning.— This policy is hereby extended to cover blood- 
poisoning, resulting directly from an accidental bodily injury, and not otherwise, pro- 
vided it does not result in any of the losses enumerated in Paragraph A of Part I. 

Schedule of iNDSHMmsa— Sickness 

Part DC. Total Loss of Time— House Confinement. — (A) If any sickness con- 
tracted by the Insured, during the term of this policy or any renewal hereof, and not 
hereinafter Excepted, and for which the Insured is regularly treated by a l^ially qualified 
phy]sician, necessarily and continuously confines the Insiued in the house for a period 
beginning during the said term, and prevents the Insured throughout the period of 
such coimnement from performing any and every kind of duty pertaining to nis occu- 
pation, the Company wiU pay the Insured for the period of such confinemoit, not ex- 
ceeding twelve consecutive months, the monthly^ indemnity specified in Part I. 

(B) DisABiLrry Following House Confinement. — If the Insured shall have been 
confined in the house and disabled within the terms of the preceding paragraph, and 
if continuously and immediately thereafter the sickness causmg the said coimnement 
in the house totally disables and prevents the Insured from penorming any and every 
kind of duty pertaining to his occupation (but not necessarily to the extent of confining 
him in the house), the Company will pay the Insured for the period of such disability, 
not exceeding two months, one-half the monthly indemnity specified in Part I; provided 
that the combined periods for which indemnity is payable under Paragraphs A and B of 
this part shall not exceed twelve consecutive months. 

Part X. Registration and Identification. — ^The Company has registered the 
Insured named in this policy upon its records at its Home Office at Baltimore, Md. If 
the Insured shall, by reason of injury or illness during the time this policy is in force, 
be physically unable to communicate with friends, the Company will, upon receipt of 
a telegram or other message giving the policy number, immediately transmit to the 
relatives or friends of the Insured any information respecting him, and will defray all 
expenses necessary to put the Insured m communication with, and in the care of friends, 
providing such expenses shall not exceed the sum of one hundred dollars. 
For Standard Provisions See Page 11 

Additional Provisions 

Assignment. A. No assignment of interest hereimder shall be valid unless consent 
thereto is endorsed hereon and is signed by an executive officer of the Company. 

When Illness Not Covered. B. This insurance does not cover disability from 
disease or illness suffered or contracted outside of the United States (United States in- 
sular px>ssessions and Alaska not included*), Canada or Europe. If the Insured shall 
become entitled to indemnity for disability on account of accidental injuries, the Om- 
pany shall not, for the same period of time, be liable for any disability on account of 
disuse or illness. 

When Injury or Death Not Covered. C. This policy docs not cover disam)e^' 
ance; nor war risk; nor suicide or any attempt thereat, sane or insane; nor loss suffered 
while or resulting from riding or being in or on any aerial device or conveyance. 

Application a Part of Contract. D. The copy of the application endorsed hereon 
is hereby made a part of this contract. 

Provisions of Charter, Etc. E. No provision of the charter, constitution or by- 
laws of the Company shall be used in defense of any claim under this policy iinless such 
provision is incorporated in full in this policy. 

Renewal. F. This policy may be renewed only with the consent of the Ompany 
and by the payment of the premium in advance, subject, however, to its conditi(His and 
limitations. 



MASSACHUSETTS ACCIDENT COMPANY 135 

/T\a55aG|7(J5ett5 /l^^id^pt ^OAipapy* 

Fofmaly The Massachusetts Mutual Accident A aao c ia t Soa. 
BOSTON, MASS. 

IncorpofBted 1883. Reincoiporated October 1» 1908. G. Leonasd McNeill, Pies. 
I. M. Hathaway, Sec 

The businesg of thb cgmpany la cxmAa&d to the writing of Peirsaiial; Accident and 
Health InauratiCfi. It divides its business into two Departmenti; Tht Commurcial^od 
the Ordiimry* In the CammenciaJ DErpartmEnt it issues the "Btjstotim Disability'* 
Policy to CliLSSCd 1,2 and 2X, annual premium in classes 1 and 2, orcs IS to 50, $70^ 51 
to 60. tSO. t7 ,500— » 1 h"j ,0(X), P ri nchjti I Sum. S3i^--50. W«klyAcciaentIndeinnity,I25. 
Weekly Sickness Indemnity — the Boston ia. Accident containing the Accident provKi&nfl 
of the foTCRoin^ only. Priacipal Sum. *7.r>0(3-^$l5,miO. Weekly Indemnity, $25 
— tSO. annual premiuni, $30; The New Devonshire Accident, Friacipal Sum, $5,000;— 
S J 0.000+ Weekly Indemnity ^ |2f> — S50, annual prentium, ^"2^1, Mas?iacco Disability, Prin" 
cipal Sum^lfj/JlXl — |ll>rO(H>, Weekly Accident Indemnity, S25— ^5U, Weekly Sickness In- 
demnity, 125 — 5oOi annual premium, JfM}; The Anreum Accident, Principal Snm, Sn.ODO 
—110,000, Weekly Indcmrtity, $25 -$50, annual premium, $20; The Aurcum Disabilitv^ 
Frincipai Sum, $o,[KM>— SIO^OOO, Weekly Accident Indemnity, *25— *r10, Weekly Sick- 
ness Indemnity, liTv annual pramium, <50; The Radium AoridentT FriTicipal Sum, 17 ,500 
—S 15. 000, Weekly Indemnity, £25—550, annua] premium, 1 25; The Radium Disability, 
PriDcipal Sum. $7,500—115.000, Weekly Accident Indemnity, iio— SoO, Weekly Sick- 
ness Indemnity. $25^ annual premium, S6Q. Unless otherwise Quoli^ed the above 
rata ore for dkase-^ 1 and ^ 

POLICY FORM— "BosTONiA Disability." 

Principal Sum, $7,50(>-$15,000. Weekly Indemnity, $25. 

Annual Premium, $70. 

Massachusetts Accident Company, Boston. Massachusetts 
(herein called the company), in consideration of tne representations 
and a^^reements contained in the application for this policy (a copy 
of which application is endorsed herein and is made a part hereof) 
and of the premium of .... dollars, does hereby insure under classi- 
fication No , subject to all the provisions, conditions and limi- 
tations hereinafter contained or endorsed hereon. 

John Doe. of Bosfon, State of Massachusetts, by occupation an attomey-at-law, beinf 
the person described in said application and herein called the insured, for the period on 
twelve mcAths, beginning on the first dav of J[anuary, 1915, and ending on the first day 
of Januarsr, 1016, at 12 o'clock noon, standard time, at the place where this policyis counter- 
signed and for such ftu-ther periods stated in the renewal receipts as the premium paid 
wul maintain this policy in force at the rate herein specified, as follows: Against loss or 
disability as herein defined resulting from bodily injuries, effected directly and independ- 
ently of all other causes, through external, violent and accidental means (suicide, whether 
sane or insane or any attempt thereat, sane or insane, is not covered) and against disabfliW 
by disease contracted after fifteen davs from the date of this poliQr, as faeiein defined, 
and as specified in the following schedules: 

Schedule of Indemnities— Accident Insdramcb* 
Past A. Death, Dismemberment and Loss of Sight— Single Indemnity.— I 
such injuries shall whollv and continuously disable the insured from date of accident 
from performing an^ and every kind of duty pertaining to his occupation, and during the 
period o/«uch contmuous disability, but within two hundred weeks from date of acadent 
shall resuit independently and exclusively of all other causes in any one of the losses 
enumerated below or within ninety days from the date of the accident irre^)ective of 
total disability^ result in like manner in any one of such losses, the Company will pay the 
sum set opposite such loss and in addition weekly indemnity as provided in Part B to 
the date oi death, dismemberment, or loss of sight; but only one of the payments named 
in Part A will be made for injuries residting from one accident. Payments in one sum, 
lor loss of life, or both hands by severance at <st above the wrist, or both feet by severance 
at or a bove the ankle, or one hand at or above the wrist and one foot at or above iJie ankle 
Qay severance), or entire sight of both eyes if irrecoverably lost, or either hand by sever- 
ance at or above the wrist and entire sight of one eye if irrecoverably lost, or either foot 
hy severance at or above the ankle and entire sight of one eye if irrecoverably lost, the 
principal sum; either leg by severance at or above the knee, or either arm by severance 
at or above the elbow, one-half of principal sum; either hand by severance at or above 
tiie wrist, or either foot by severance at or above the ankle, or entire sight of one eye if 
iirecoverab^ lost, two-fifths of principal sum; thumb and index finder of either hand 
(by severance at or abovemetacarpo-pnalan^eal joints) one-third of principal sum. The 
payment in any such case shall end this policy. 



136 MASSACHUSETTS ACCIDE NT COMPANY 

Loss OF TxttK nou Accidkmtal Injusiss. 

Pakt B. Total Dxsability.— If such loss of time proceeds solely and exdoaivdy 
from bodilv injuries which are the direct and proadmate result of and are caused sol^ 
and exclusively by accidental means which result in immediate and continuous and total 
loss of time nece^arily sustained and effected throudli means aforesaid, the CcHupany's 
liability shall extend to and cover the insured's total loss of business time at the lateol 
twenty-five dollars ($25) per week. 

Partial DiSABZurY.— The Company's Uabilibr for such bodily injuries as above de- 
scribed shall.be at the rate of $18.75 per week tor three-quarters loss of insured's busi- 
ness time; $12.50 per week for one-half loss of insured's business time; $6.25 per we^ 
for one-quarter loss of insured's business time. If such bodily injuries cause a total loss 
of business time following a period of partial loss of business time, the Company's liabili^ 
shall extend to and cover the period of such total loss of insured's business tmie at the rate 
provided for total disability, out in no event shall the Comnany pay a week^ indemnity 
for partial and total or partial loss of insured's business Ume for a period of more than 
two hundred consecutive wedes. 

Part C. Double BENERTS.~The amount to be paid for claims under Parts A and 
B shall be double the sum therein specified if such injuries are sustained (1) while a pass- 
enger in or on any regular passenger conveyance provided by a common carrier (including 
the platform, steps or running-board of railway or street railway cars); (2) or. while in 
a passenger elevator (excluding elevators in mines): (3) or, caused by a stroke of lightning; 
(4) or. caused bv the burning of a building while the msured is therein; (5) or, caused by 
the collapse of the outer walls of a building while the insured is therein; (6) or, caused by 
the explosion of a steam boiler; (7) or, caused by a ordone or tornado. 

Part D. Medical Attendance Indemnity.— If the insured sustains a bodily injury 
that does not result in any disability, but shall require immediate medical or surgical 
treatment by a physician or surgeon, the ComjMiny will reimburse the insured for the cost 
thereof, not to exceed twenty-five dollars, provided the attending physician's or surgeon's 
receipted bill for such treatment is filed with the Company wiuun thirty days iraa ttm 
date of the accident. 

Schedule or Imdeunhies— Health Insurance. 

Part E. Total or Partial Disability 7bom Sickness. Total Disabhity.' 
H such disability results, in whole or in pi^, from any disease or sickness, the Companjr's 
liability shall extend to and cover the period during which the insured is wholly and con- 
tinuously disabled from the performance of any and every kind of dutypertaininc to his 
business and regularly attended by a regularly licensed pl^dan, not exceeding fifty-two 
(52) consecutive wedcs, a weekly indemnity at the rate of twenty-five doUars ($25) per 
week. 

Part F. Partial Disability.— Disability resulting, hi whole or in part, from any 
disease or sickness, and causing a loss of not less than fifty per cent, of insured's business 
time, shall be deemed a partiafdisability and the Compai^'s liability shall extend to and 
cover the time actually lost during the period the insured is regularly attended by a regu- 
larly licensed physician, not exceeding fifty-two (52) consecutive weeks inclusive of any 
period for which the (Company may be liable under Part G at forty per cent, of the amount 
per week provided for total disability tmder Part £. 

Part G. Permanent Disability from Sickness. — ^Upon due proof to the Company 
that the insured has, as the result of disease contracted during the term of this pcdicy 
and not hereinafter excepted, entirely and irrecoverably lost the sight of both eyes, or 
permanently and entirely lost the use of both hands or both feet, or of one hand and one 
loot, or has suffered incurable paralysis, and also that he has been for one year and will 
thereafter and during his life, by reason thereof, be permanently disabled from engaging 
in any work or occupation for wages or profit, the Ccnnpany will extend the period during 
which it will pay indemnity under Part £ to 104 consecutive weeks. The payment for 
permanent disability shall end this policy. 

Part H. Fixed Indemnities.— The insured, if he so dect in writing within twenty 
days from date of injury, may take, in lieu of the weekly indemnity herdnbefore provided 
for total or partial disability, indemnity in one sum, according to the Schedule of Fixed 
Indemnities, if the injury i? one set forth in such Schedule, but not more than one Fixed 
Indemnity shall be paid for injuries resulting from one accident. When the insured is 
entitled to double indemnity, the Fixed Indemni^ shall be doubled in like manner. 

Part I. Surgeon's Fees for Operations on Insured. — If injuries or illness covered 
by this policy shall, within ninety days from date of accident or commencement of disa- 
bility from illness, necessitate a surreal opoation named in the Schedule of Operations, 
the (Company will pay the insured, in addition to the indemnity provided, the sum set 
oppodte such operation in said schedule. In dther event such an amount shall not be 
payable for more than one (the first) operation as the result of any one acddent or cause 
of disability. 

Part J. Hospital Expenses.— Or, if such injury to or illness of the msured -shall 
necessitate any one of the surgical operations named in the schedule of operations, and 
such <q)eration is performed in a regiuar hospital, the insured may dect to recdve, in lieu 
of the amount stipulated as Surgeon's fee for such operatitm and as an additional weekly 
indemnity, for the period of confinement in said nospital, not exceeding twdve (12) 
consecutive weeks, one-half the amount per week provided for total disability from bodily 
injuries as specified tmder Part B, or one-half the amount per week provided for total 
disability from any disease or sickness as specified under Part £, provided written notice 
of his choice of this benefit shall be given to the Oimpany, at Boston, Mass., within twenty 
days of the date of the acddent or commencement of illness. 

Part K. Reoistration and Identification. — ^Upon recdpt at the home office of 
the premium for this policy, the Company will place the insured's name on its registration 
UsL If thereafter the insured shall, by reason of injury, during the time this polipy it 



MASSACHUSETTS ACCIDENT COMPANY 137 

b foEoe, be physically unable to communicate with friends, the Company will, upon receipt 
of a telegiam or other message giving this policy number, immedvitdy transmit to the 
relatives or friends of the insured any information respecting him. and will defray all ez- 
poises necessary to put the insured in communication with, ana in the care of friends, 
ENXt the Company's liability therefor shall not exceed the sum of one hundred dollars ($100). 

Past L. Ten Per Cent. Cumulative Agreeuent. — ^In consideration of the payment 
by the insured of the premium upon the issuance of this policy, and the issuance of each 
consecutive renewal thereof, the Companjr hereby agrees upon each full year's renewal 
during a term not exceeding five vears to increase the amounts of the benefits provided 
under Parts B or E for the Toss of time of the insured, at the rate of ten per cent, of the 
laid (original) amounts. 

Part M. Miscellaneous. — ^The Company's liability hereunder shall not in any case 
extend to more than one part of this policy on account of one accident to the insured, or 
on account of one sickness suffered by the msured, except as provided in Parts I, J and K 
hereof. No recovery shall be had on account of disability from sickness for any one 
period of time for wfalch the insured is entitled to weekly indemnity on account of a bodily 
mjury. This policy does not cover any injury, either fatal or non-fatal, which may be 
sustained by the insured while partidcMiting in or in consequence of havmg participated 
iu aeronautics. The copy of the application endorsed hereon is hereby made a part of 
this omtract. 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 anv legal proceeding 
hereundo'. The insurance under Parts E, F and G does not cover disease contracted, 
or sickness or disability sustained, in the tropics or in any part of Alaska or the British 
po^essions in America north of the sixtieth degree of north latitude, or while engaged in 
notary or naval service. 

Schedule of Operations. — If the original principal sum provided by this policy 
is $7500, the following amounts will be paid. If said original principal sum is greater 
or less than $7500, the amounts to be paid shall be increased or reduced proportionately 
Amndicitis (see laparotomy), $100. Aneurbm (tumor or artery) — ^ligation, $50. Ampu- 
tation of—foot, handed forearm, $25; leg or arm, $50; thigh, $100: finger or fingers, $10. 
Abscess or boil — one or more incisions. $5. Bone abscess — ^trephining, $25. Bronch- 
otomy, thsrrotomy , laryngotomy , laryngotracheotomy or tracheotomy, $5(3. Carbuncle — 
incision and treatment, $25. Canes (bone ulcer) curetting, $15. Dislocations, reduction 
of shoulder, elbow, hip, knee or ankle, $25; wrist or lower jaw, $15; thumb or fingers, $10. 
Exdsion ol shoulder, hip or knee joint, $100; elbow, wrist, or ankle joint, $50; toe or toes, 
$25. Eye, ear, nose or throat — any cutting operation, $10. Felon — ^bcision, $5. Frac- 
tures — reduction of nose, lower jaw, collar bone or shoulder blade, $25; breast bone, $1(^ 
rib or ribs, $10; upper arm, $35; forearm (one or both bones), $25; wrist or hand, $15; 
fingers, $10; any of the bones of the pelvis or sacrum, $50; coccyx, $10; thigh, $75; knee 
cap or leg bones (one or both), $50; bones of foot, $15; toes, $10. Ganglion (cystic tumor 
of tendon sheath) — incision and curetting, $15. Gunshotwounds — treatment not necessi- 
tating amputation or laparotomy, $25. Hernia (abdominal) any cutting <MDeration for 
the radical cure of the reducible, irreducible or strangulated form, $100. Hydrocele — 
tannng — ^incision or excision of sac, $25. Ingrowing toe nail — removal, $10. Intestinal 
obstruction (see laparotomy). Kidney — fixation or removal, $100. Laparotomy (open- 
ing of the abdominal cavity for an operation on any organ contained therein, or for trau- 
matic peritonitis, or exploratoiy incision), $100. Lithotomy (operation for removal of 
stone m bladder) any cutting, 1 100. Mastoiditis— operation for, $50. Necrosis (death 
of bone) sequestrotomy (removal of dead bone), $35. Oesophogotomy for stricture or 
other cause, $100; Peritonitis (see laparotomy), $100. Paracentesis— tapping of abdo- 
men, $25; bladder, $25; ear drum, $15. Rectum — operation for hemorrhoids (external 
or Internal) exdsion or ligation, $25; prolapsed— operation for, $25; fistula in ano— 
indsion, $25; polypus— extirpation, $25; malignant stricture — excision or colostomy, 
$100. Skull trephining for fracture or other cause, $100. Synovitis (inflammation of 
the lining membrane of a Joint) incision, $25. Tetanus — injection of anti-tetanic serum 
into frontal lobe of brain, $ 100. Tumors — extirpation from any part of the body, benign, 
$15; malignant, $50. Varicose veins — ligation or excision. $25. varicocde — acupressure 
^igaticm or excision, $25. Wounds of scalp or other parts — suturing, $5. 

Schedule or Fixed Indemnities (see Part H). — ^If the weekly indemnity provided by 
this policy is twenty-five dollars ($25) the following amounts will be paid, ifsaid weekly 
indemnity is greater or less than $25 the amounts to be paid shall be increased or reduced 
proportionately. For the complete fractures of bones, viz: — of the skull, both tables, 
$3Q0; lower jaw, $75; davide (collar bone), $125; scapula (shoidder blade), $175; scapula 
(shoulder blade with complications), $225; thigh, $300; thigh (involving the hip jomt), 
$350; leg (below the knee), $200; patella (knee cap), $200; patella (with serious knee joint 
complications), $250; arm, between dbow and shoulder, $300: forearm, between wrist 
and dbow, $150: two or more ribs, $75: hand or fingers, $100; toot or toes. $100: Colles' 
fracture, $150; Pott's fracture, $2()0. For complete dislocation, viz.: —of the shoulder, 
$75; dbow, $75; wrist, $100; hip, $300; knee, $200; any bonesof footor toe, $125; ankle, 
$125. For loss, by severance, within ninety da3rs from date of acddent, viz.: — one or 
more fingers (at least one entire phalanx), $100; one or more entire toes, $150. 
For Standard Provisions See Page 11. 

Ordinary Department. 
In its Ordinary Department the Company issues nine different 
policies covering accident and sickness. The Employes Relief Policy 
IS issued for a policy fee of $1.00, and thereafter $1.00 monthly; the 
Popular Premium and Fidelity policies are issued for a policy fee 
of $3.00, and thereafter $1.00 monthly; the Victor Disability policy 
is sold for a policy fee of $3.00, and premiums of $1.25, $1.50 and 



138 MASSACHUSETTS ACCIDENT COMPANY 

$2.00 monthly; the Special and Bay State policies are sold with a 
policy fee of $4.00 and premiums of $1.50 monthly; the Colonial 
policy fee, $5.00, premiums, $2.00 monthly; the Somerset, policy 
fee, $5.00, premiums $2.50 monthly; the Mercantile Disability 
policy is sold without a policy fee, premiums being due on date of 
policy. The Beacon Accident policy covers accidents alone, and 
is sold for a policy fee of $3.00, premiums thereafter $1.00 monthly. 

POLICY FORM— Victor Disability. 
Massachusetts Accident Company, herein called the Company, 
(A) in consideration of the policy fee of three dollars ($3) and of the 
representations and agreements contained in the application for 
this policy, a copy of which is endorsed hereon and made a part 
of this contract, 

(B) Herebv insures John Doe, hereinafter termed the insured, by occupation a sales- 
man, classified as select^ ag^nst loss as hereinafter set forth and defined and subject 
to all conditions and limitations hereinafter contained or endorsed hereon, teom the first 
da;^ of January, 1915, at 12 o'clock noon, Standard time, at the place where the insured 
resides, until the fifteenth day of February, 1915, at 12 o'clock noon, such Standard 
time, and for such further periods stated in the official renewal receipts, as the renewal 

premiums of per month, paid by the insured, will maintain this policy in force. Firrt 

under the 

Accident Pkoviszons. 

(C) Total Loss of TncE.~In the sum of per month tor total loss of time for a 

period not exceeding five consecutive years, resulting directlv and independently of all 
other caiises from bodily injury sustained during the life of this policy, caused sok^ 
through external, violent and accidental means (excluding suicide, sane or insane), ana 
such as shall immediately, continuously and wholly disable and prevent the insured, 
from the date of the accident, from performing every duty pertaining to any business 
ot occupation, and not resulting in any loss specified in Paragraph E; or, 

(D) Pa&tial Loss OF Time.— If such injury as described in Paragraph C, from' date 
of accident, disables and prevents the insured from performing one-half of the daily 
duties pertaining to his occupation, or in the event of uke disability immediately follow- 
ing total loss of time, the Company will pay indemnity at one-half of the rate provided 
in Paragraph C for a period not exceeding six consecutive months; or, 

(£) Specific Losses.— If such injury as described in Paragraph C shall within ninety 
days from the date of accident, result in one of the following specific losses, the Company 
wiU pay one of the following benefits: For loss of fife or both hands by severance at or 
above the wrist, both feet by severance at or above the ankle, or one hand and one foot 
by severance at those places, or entire sight of both eyes, if irrecoverably lost, or one 
hand by severance at or above the wrist and entire sight of one eye, if irrecoverably 
lost, one foot, by severance at or above the ankle and- entire sight of one eye if irre- 
coverably lost, the principal sum; or either hand by severance at at above the wrist, or 
either foot by severance at or above the ankle, one-half of the principal sum; or entire 
sight of one eye, if irrecoverably lost, one-third of the principal sum. 

(F) Accumulation Feature. — For each consecutive month immediately preradihg 
the date of the accident that this policy shall have been maintained in continuous 
force, five per cent, shall be added to the original amount provided for any loss under 
Paragraph £ sustained by the insured, but such additions shall never exceed fifty per 
cent, of such original amount; or, 

(G) Double Indemnity. — If such injury as described in Paragraph C, D or E is 
sustained by the insuied, (1) while riding as a {Missenger, within the enclosed nart of 
any railway passenger car provided for the exclusive use of passengers and propelled by 
steam, cable, gasolene, compressed air or electricity, or while riding as a passenger on 
board a boat propelled by steam or gasolene, and licensed for the regular transportation 
of passengers, or, while riding as a passenger in a passenger elevator (elevator in mines 
excepted) and such injury shall be due directly to the wrecking of such car or boat or 
elevator^ or, (2) in consequence of the total destruction by fire of any building while the 
insured is therein and is not acting as volunteer or paid fireman: or, (3) in consequence of 
the collapse of the outer walls of any building while the insured is therein; or, (4) by the 
explosion of a boiler; or, (5) by a stroke of lightning, then the company will pay double 
the amount which would otherwise be payable; or, 

(H) Special Death Indemnity. — If loss of life of the insured shall, within ninety 
days from the date of exposure or infection, result solely from (1) sunstroke, freezing or 
hydrophobia, due directly to such injury as described in Paragraph C; or, (2) the invol- 
untary and unconscious inhalation of gas or other poisonous vapor, the Company will 
pay in lieu of all other indemnity, the original principal sum; or. 

Second: — Commencing on the fifteenth day of the next month following the date on 
which this policy is countersigned, providing premium has been paid, the company will 
pay the insured under the 

Sickness Provisions. 

(1) Confinement in the House. — ^In the sum of S per month for the number ol 

consecutive days that the insured, by reason of sickness (except as provided in Pan- 
graph S) which is contracted or begun during the time the sickness provisioia ol tbii 



2 MASSACHUSETTS ACCIDENT COMPANY 189 

policy are in force, is wholly disabled and prevented from perf onning every duty pertain- 
ing to any business or occupation and solely by reason ol such sickness, is necessarily 
and continuously confined within the house; provided that no indemnity shaU be CMud 
for more than six consecutive mcmths, nor for the first seven days unlos such disaoui^ 
continues for twenty-eight consecutive days; or. 

Q) CoNVALESCEMT iNDEianTy. — ^If during convalescence immediately following at 
least seven days confinement within the house, for sickness covered under Paragraph 1, the 
insured shall be ¥^oUy and continuously disabled frcmi performing every duty pertaining 
to any business or occupati<m, but is not necessarily and continuously confined within 
the house, the Onnpany will pay indemnity at one-half of the rate provided in Paragraph 
I, for a period not exceeding two consecutive months; or, 

(K) NoN-CoNFXNXNO SiCKNiss Imdsunity.— If the insured is wholly and contin- 
uously disabled from performing every duty pertaining to any business or occupation 
on account of any sickness covered by Paragraph I, is not necessarily and continuously 
confined within the house, the Company will pay indemnity at one-half of the rate 
provided in Paragraph I for the penod of such disability, not exceeding two consecu- 
tive months, provided that no indemnity shall be allowed for the first we^ of such sick- 
ness, unless such disability continues for twenty-eight consecutive days; or, 

(L) Boils, Felons, or Abscesses. — ^For the period during which the insured shall be 
wholly and continuously disabled and prevented from i>erforming any and every duty 
pertaining to any business or occupation by reason of boils, felons or abscesses, whether 
or not confined within the house, the Company wHl pay sickness indemnity at the rate 
per month specified in Para^ph I: 

Provided that no indemmty shall be paid for more than six consecutive months, nor 
for the first seven days unless such disability continues for twenty-eight consecutive days; 
or third: under the 

Special Pkovisions. 

(M) bocEDXATK SsTiLEiaEMTS.— If such injury as described in Paragraph C causes 
one or more of the specific injuries named in Schedule of Ch>tional Advance settlements , 
and the insured so elects in writing within twenty days nom date of the accident, he 
may take an immediate settlement, in lieu of all indemnity that mi^ht otherwise accrue 
under Paragraph C or D hereof, for the largest amount specified m column 1 of said 
schedule for any one of the q;)ecific injuries so sustained; or. if such injury as described in 
Paragraph C, is sustained solely under conditions specified in Paragraph G, he may so 
elect to receive the corresponding amount specified in column 2 of saidschedule; provided 
that not more than one such indemnity shall be payable as the result of any one accident, 
and 

Provided always, that the amounts specified therein shall be payable only in case the 
Monthly Accident Indemnibr is $50.00; if such monthly indemmty is greater or less than 
150.00, then the amounts to be paid shall be increased or reduced proportionately. 

SCHXDXTLE OF OPTIONAL ADVANCE SETTLEMENTS. 

Optional Wixb Insured. — ^For loss by severance of one or more fingers (at least one 
entire phalanx), $50; of one or more entire toes, $50. For complete hernia — caused 
solely and directkr by such injuty as described in Paragraph C. $35. For complete dis- 
location—of theshoulder,$50; elbow, $50; wrist, $50; hip. $90; knee, $60; of two or more 
bonesof foot (not toes), $50; of the ankle. $50; of two or more toes, $15; of two or more 
fingers, $15. For complete fracture— of the skull, both Ubles, $160; of the lower jaw. 
$35; of the collar bone, $70; of the pelvis, $115; of the thigh, $140; of the leg (tibia and 
fihula), $90; of the knee cap, $90; of the arm, between elbow and shoulder, $80; of the 
forearm (both bones), $75; of two or more ribs, $35; of the foot (two or more bones — not 
toes), $55; of the hand (two or more bones — ^not fingers), $50; of two or more toes, $25; 
of two or more fingers, $25; of the scapula, $75. 

(N) Blood PoisoNiNC^Blood poisoning and septicaemia due solely to such injuxy 
as described in Paragraph C, shall be considered as covered by the accident clauses of 
this policy. 

.(0) Surgical Attendance. — ^In the event of the insured receiving accidental bodily 
injury as described in Paragraph C, and such injury does not cause loss as provided in 
the policy, the Companv wifl pay for the dressing of injury by a legally qualified physician 
or surgeon, the sum of $2.00, upon receipt of the surgeon s statement. 

(P) Identification.— There will be furnished to the insured with this policy, an 
identification badge bearing the number of this policy. If the insured shaU, oy reason 
<rf injury or sicknos during the time this policy Is in force be phvsically unable to com- 
municate with friends, the (Company will upon receipt of a telegram or other message 
giving policy number, immediately transmit to the relatives or friends of the insured 
any information respecting him, and will defray all expenses necessary to put the insured 
m communication with, and in care of, friends, provided such expense snail not exceed 
twenty-five dollars ($25.00). 

(Q) Increase in Benefits. — ^The benefits provided by this policy shall be increased 
ten per cent, on any claim accruing hereunder if at the date of the accident or inception 
of sickness the premium hereon has been paid annually in advance; or, five per cent, if 
at the date of the accident or inception of sickness the premium hereon has been paid 
quarterly in advance. 

General Provisions. 

(R) No indemnity shall be payable under this policy unless the insured has been 
Kgularly attended bv a l^ally qualified physician at least once in each seven days during 
the time for which claim is niade. 

(S) The Company is not liable for any loss caused by or from the use of intoxicants 
or narcotks, or resulting from violation of law by the insured, or from venereal diseases, 
<v from accidents toorcuseasesof organs not common to both sexes; or from assault, or 
^twu unneceiaaiy exposure to obvious risk or injury, or from disability originating ot 



140 MASSACHUSETTS ACCIDENT COMPANY 

suffered outside of the States of the United States^ the District of Columbia, or Canada, 
(T) If, at the date of this policy, the insured is over forty and under fifty years of 
age the sickness indemnity, when the insured reaches the age of fifty years, wul be re- 
duced to one-half of the amounts named, and to one-fourth of the amounts named when 
the insured reaches the age <A sixty years. If the insured at the date of this policy is over 
fifty and under sixty years of age the sickness indemnity, when the insured reaches the 
age of sixty years, will be reduced to one-half of the amounts named. 

(U) 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 l^al prooBeding hereunder. 
For Standard Provisions, See Page U. 
In witness whereof, the said Company has caused this policy to be signed by its i>res- 
ident and secretary, but the same shall not be binding upon the Company unleas coun- 
tersigned by its Policy Inspector. 

Agreehent in Afpucaiion. 
I hereby apply to the Massachusetts Accident Company for a policy to be based upon 
the following reinresentation of facts, and understand and agree that the right to recover 
under aay 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 intent to deceive. I further understand and 
agree that the agents and solicitors of the Company are not authorized to extend credit, 
or waive, extend or change any of the terms, conditions or provisions of thb application 
or <^ the policy. 

POLICY FORM— "Non-Cancellable Disability Policy" 

Age 35. Weekly Indemnity, $50. Premium, $109.70. 

Massachusetts Accident Company, Boston, Mass. (herein called 
the Company), in consideration of the representations and agree- 
ments contained in the application for this policy (a copy of which 
application is endorsed hereon and is made a part hereoO, and of 
the payment in advance of one hundred nine dollars and seventy 
cents, 

Does hereby insure under classification No. 1, subject to all the provisions, conditions 
and limitations herein contained or endorsed hereon, John Doe by occupation, lawyer, 
being the person described in said application and herein called the insured, for a term 
of twelve months, beginning on the first day of January, 1915, at 12 o'clock noon. Standard 
time, at the place where this policy is countersijmed, against disability as herein defined, 
resulting from bodily injuries through accidental means (suicide, sane or insane, or any 
attempt thereat, sane or msane, is not covered) ; and against disability by disease, as herein 
defined, as follows: 

Part I. Total Acx3dent or Illness Disability. — (a) If the insured suffers a disa- 
bility from accidental injury or disease which neccessarilv, wholly, and continuously dis- 
ables him from the performance of any and every kind of duty pertaining to his occupa- 
tion or business, the Company will pay a weekly indemnity at the fate of fifty dollars 
($50) per week, during the continuance of such disability, until such time as the Insured 
may engage in a gainful occupation, but no indenmity shall be payable for the first two 
weeks of disability, as above described. 

Part II. Partial Indemnity Following Total Disability.— If the insured suffers 
a disability for which indemnity is payable under Part I and if immediately following such 
a disability during which the insured b entitled to be paid indemnity, the insured is able 
to engage in a gainful occupation, but on account of the continuation of disability is 
necessarily and continuously partially disabled and suffers a loss of business time, the 
Company will pay as follows: 

(a) For such time as the insiured suffers a partial disability as defined above and be- 
cause thereof sustains a three-quarters loss of his business time the Company will pay a 
weekly indemnity at the rate of seventy-five per cent of the weekly indenmity provided 
for total disability. 

(b) For such time as the insured suffers a partial disability as defined above and be- 
cause thereof sustains one-half loss of his business time the Company will pay a weekly 
indemnity at the rate of fifty per cent of the weekly indemnity provided tor total disa- 
bility. 

(c) For such time as the insured suffers a partial disability as defined above and be- 
cause thereof sustains one-quarter loss of his business time the Company will pay a weekly 
indemnity at the rate of twenty-five per cent of the weekly indenmity provided for total 
disability. 

No Indemnity Payable tor First Two Weeks of Disability 
Part UL Total Indemnity Following Partial Indemnity.— If the insured suffers 



MASSACHUSETTS ACCIDENT COMPANY 14i 

a disability for which indemnity is payable under Part II and if immediately foUowinJi 
such a disability and solely on account of the continuation of disability the Insured is 
necessarily unable to engage in any ocoupation or business from which profit may be 
derived, the Company will pay indemnity as provided in Part I paragraph (J). 

Part IV. Fixed Indemnities.— The insured, if he so elect in writing within twenty 
days from date of injury, may take, in lieu of the weekly indemnity hereinbefore provided, 
indemnity in one sum according to the Schedule of Fixed Indemnities, if the injury is 
one set forth in such schedule, but not more than one fixed indemnity shall be paid for 
injuries resulting from one and the same accident. 

Schedule op Fixed Indeiooties. (Sec Part IV.)— If the weekly indemnity provided 
by this policy is twenty-five dollars ($25;, the following amounts will be paid. If said 
weekly indemnity is greater or less than S25> the amounts to be paid shall be increased 
or reduced proportionately. For the complete fracture of bones, viz. — of the skull, 
both tables, S2diD; lower jaw, $50; clavicle (collar bone), $75; scapula (shoulder blade), 
1125; scapula (shoulder blade with complications), $175; thigh, $250; thigh (involving 
the hip joint), $300; leg (below the knee) both bones, $150; leg (below the knee) one 
bone, $100; patella (knee cap) $150; patella (with serious knee joint complications), 
1200; arm, between elbow and shoulder, $250; forearm, both bones, $100; forearm, one 
bone, $73; two or more ribs, $50; hand. $50; fingers, two or more, $50; one finger, $25; 
foot, S-0; toes, two or more, $50; one toe, $25. C:oUes' fracture, $100; Pott'sTracture, 
1150. 1 or complete dislocation, viz. :— of the shoulder, $37.50; elbow, $37.50; wrist, $50; 
hip,$2o0; knee, $150; one or more bones of foot . $75; one toe. $25; ankle. $75. For loss 
by severance, within ninety days from date of accident, viz.:-M>f one or more fingers 
(at least one entire phaUnx), $50; of one or more entire toes, $100. 
For Standard Provisions See Page II 

Other Provisions. 

This policy does not cover (1) any disability for which the insured is not necessarily 
and regularly attended bv a legally oualified physician other than the insured; (2) women; 
(3) any illness contracted or suffered outside the limits of the States of the United States, 
Canada, or Europe: (4) bodily injury, sustained by the insured while participating 
or in consequence of having participated in aeronautics. 

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 herem 
shaU avoid the policy or be used in evidence in any legal proceeding hereunder. 

Travel — ^To entitle the insured to receive inaemnitv after the first six months of disa- 
bility, he must reside within the States of the United States unless a permit in writing 
to reside elsewhere is granted by the Company. 

Premiums — All premiums shall be payable in advance either at the home office in 
the city of Boston, or, to an authorized agent of the companjr. No premium receipt 
unless signed by the secretary or assistant secretary or treasurer is valid. 

Renewal Right. — ^The insured will have the right to renew this policy from year to 
year upon payment of the premium on or before tbe anniversary date. 

Surrender Agreement. — At any time during the life of this policy, if the insured's 
occupation or business changes to one diiTerent than that stated in the pchcy , the Company 
hereby agrees upon the surrender of this policy to issue in liau thereof, upon the written 
request of the insured, a new policy containing the same provisions as this policy except a 
change in the amount of the weekly indemnity, the new pDlicy to provide such an amount 
of weekly indemnity as the premium will purchase in accordance with the Company's 

Published rates and classification of risks and within the limits fixed by the Company 
led with the Insurance Department, said rates to be based upon the occupation ot the 
insured at the time of surrender, but so far as age may affect the rates, they are to be based 
upon the insured's age at the date of issue of the surrendered policy in accordance with said 
rates and classification. 

In witness whereof, the Massachusetts Accident (Company, of Boston, Mass., by its 
president and secretary, has executed these presents, but this policy shall not be valid 
unless countersigned by an authorized representative of the Company. 



14^ MASSACatJgETtS BOOT>mG ANt) IKStfltANCa COMPANY 

Massachusetts Bonding and Insurance Co. 

BOSTON, MASS. 

Commenced BuBineas 1907. T. J. Falvey, President. John T. Burnett, Sec and Tre» 



The Massachusetts Bonding issues a variety of accident and 
health contracts. The forms in most general use, however, are: 
the "Improved" Combination Accident — Form A3A, premium $25, 
and the "Improved" Disability — Form D3A, premium $60, age 18 
to 50: and $70, age 51 to 60. 

POLICY FORM — "Improved" Combination Accident 
Principal Sum, $7500-$15000. Weekly Indemnity. $25-$50. 

Annual Premium, $25. 

Massachusetts Bonding and Insurance Company in consider- 
tion, of the representations in the applications for this policy, a 
copy of which is endorsed hereon, and made a part hereof, and of 
twenty-five dollars premium, Massachusetts Bonding and Insur- 
ance Company Boston, Massachusetts. 

^ Hereby insores John L. Johnson, by occupAtion a lawyer, subject to all conditions and 
limitations hereinafter contained in the principal sum of seventy five hundred dollars, and 
for a weekly indemnity of twenty-five dollars, for the term of twelve months from the first 
day of January, 1914, commencing and ending at twelve o'clock noon, standard time 
at the place where this policy is countersigned, against bodily injury sustained directly 
and independently of all other causes through acadental means (suicide or any attemi^ 
thereat, sane or msane, not included) as follows: 

Accident iMDEMNitiES 

Part 1. Death, Dismeicberment, Loss op Sight, Speech or HsARiNG.-^a) If 
such injuries shall immediately, continuously and wholly disable and prevent the insured 
from the date of accident from performing any and every kind of duty pertaining to his 
occupation and during the period of such continuous disability shall mqependently and 
exclusively of all other causes result in any one of the losses specified in Part 1 , the company 
will pay the sum set opposite such loss and in addition weekly indemnity as provided 
in Part 2, paragraph (a) to the date of such loss. 

(B) Or. if withm ninety days from the date of the accident irrespective of total dis- 
ability sucn injury shall independently and exclusively of all other causes result in any 
one of the losses specified in Part 1 . the company will pay the sum set opposite such loss 
and in addition weekly indemnity from the date of the accident to the date of such loss 
at the rate provided in this policy for total disability. For loss of life, or both hands by 
severance at or above the wrists, or both feet by severance at or above the ankle, or 
one hand at or above the wrist and one foot at or above the ankle, by severance, or entire 
sight of both eyes, if irrecoverably lost, or entire sight of one eye, if irrecoverably lost, 
and one hand at or above the wrist, by severance, or entire sight of one eye, if irrecover- 
ably lost, and one foot at or above the ankle, by severance, or speech and hearing, if en- 
tire and irrecoverable, the principal sum: either arm by severance at or above the elbow, 
or either leg by severance at or above the knee, two-thirds of principal sum ; speech or hear- 
ing, if entire and irrecoverable, or either hand by severance at or above the wrist, or either 
foot by severance at or above the ankle, one-half of principal sum; entire sight of one 
eye, if irrecoverably lost, thumb and index finger of either hand, by severance at or 
above metacarpo-phalangeal joints, one-third of principal sum. 



Weekly iNDEicMrnr 



Part 2. Total or Partial Disabiuty. — (o) If such injury shall not result in any 
of the losses enumerated in Part 1, but shall immediately, contmuously, and wholly dis- 
able and prevent the insured from performing any and every kind of duty pertaining to 
his occupation, the company will pay the insured the weekly indemnity above specified 
so long as the insuied suffers said total disability; or, 

(p) If such injury shall not wholly disable the insured, as above, but shall imxnediatdy 



MASSACHtJSETtS BONDING A ND INSURANCE COMl»ANY 143 

and continuously disable and prevent him from attending to one or more important daily 
duties pertaining to his occupation, either from date of accident, or following toUl disa- 
«>»hty, the company willpay one-half the weekly indemnity above specified for a pen » 
off such partial disability not exceeding fifty-two consecutive weeks. 

Fart 3. Doublb Indebinity.— I fthe i nsured shall sustain such injuries (1) while In 
or on a public conveyance provided by a common carrier for passenger service, including 
platfom, steps and running board thereof; (2) or. while within a passenger elevatcH: 
(eacfaiding devators in mines): (3) or, in consequence of the burning of a building while 
the insured is therein; (4) or, by the explosion of a steam boiler; (5} or. by being struck 
by lightnin<|[; (6) or, in consequence of the collapse of the outer walls ot a building while 
the insured is therein; (7) or. caused by a cyclone or tornado, then and in such event onb". 
the company will pay double the amount otherwise payable under the preceding parts, 

Part 4. Optional Indemnity.— If the insured shall sustain bodily injury received as 
set forth In this policy and named in the following "Schedule of Optional Indemnities," 
he may elect, subject to all the terms and conditions of this policy, to receive the amount 
of indemnity specified opposite such mjury in lieu of all other indemnity for either total 
or partial (usability provided written notice of his choice is given to the company at 
Boston, within twenty days from the date of the accident. No claim for more than one 
of the mdemnities named in said schedule shall be payable for injuries sustained in any 
one accident. 

Schedule of Optional iNDEinnriES. — ^The amounts stated in the following Schedule 
of Option^ Indemnities are payable tmder this policy if issued for S25 weekly indemnity* 
Proportionate amounts are p^able if this policy is issued for a larger or smaller sum. 
Ordinary Accidents, Part 2. For loss of one or more fingers (at least one entire phalanx) , 
1160: one or more entire toes, $200. For comi>lete hernia caused solely and directly by 
accidental injury, $80. For complete dislocation, viz.: Of the shoulder, $100; elbow, 
$100; wrist, $120; hip, $300; knee, $160; any bones of foot (not toes), $160; ankle, $160; 
two or more toes, $60; two or more fingers, $60. For complete fracture of bones, viz.: 
Of the skull, both tables, $325; lower jaw, $80; cUvicle (collar bone), $160; pelvis, $250; 
thigh, $300; leg (one or both bones), $200; patella (knee cap), $200; arm between elbow 
andshoulder, $175; forearm between the wrist and elbow, $160; two or more ribs, $100; 
two or more bones of the foot (not toes) , $120; two or more bones of the hand (not fingers) , 
$120; two or more toes, $100; two or more finders, $100. For travel, etc. accidents. 
Part 3, the amounts will be double those for ordinary accidents, Part 2. 

Pakt 5. Fees for Non-Disablino Injuries.— If the insured sustains a bodily injury 
as set forth in this policy that does not result in any disability, but shall re(]uire treatment 
by a physician, oculist, optician or graduate nurse, the companv will reimburse the in- 
sured for the cost thereof, to an amount not exceeding one week s indemnity as si)ecified 
m PArt 2, Paragrai>h (a), provided the receipted bill for such treatment is nled with the 
company within thirty days from the date of the accident. 

Part 6. Special Indemnity. — Blood poisonmg resulting directly from bodily in- 
juries insured against, sunstroke as a direct result of exposure to the rays of the sun, 
freezing caused by involuntary exposure, hydrophobia, and involuntary asphyxiation, 
ahidl be deemed bodily mjuries within the meaning of this policy. 

Part 7. HospriAL Charges. — If a bodily injury, for which indemnity is pajrable 
under this policy, is sustained bv the insured, and if on account of said bodily injury, 
and within ninety days from the date of the accident, the insured is removed to a hospital, 
the company, provided that no claim is made under Part 8, will pay the insured (in addi- 
tion to tiie mdemnity payable for said bodily injury) for the period, not exceeding thir- 
teen weeks, during which the insured is necessarily confined in the hospital, one-half 
(A the weekly indemnity specified. 

Part 8. Indemnity for Surgical Operations.— If a bodily injury, for which in- 
demnity is payable under this policy, is sustained by the insured, and if on account of said 
bodily injury, and within ninety days from the date of the accident, the insured under- 
goes a surgical operation nan^ed in the following " Schedule of Operations, " the company 
will pay the insured in' addition to any other indemnity herein provided, the sum set 
opposite such operation in said schedule; but payment shall not be made lor more ttcii 
one operation resulting from any one accident. 

Schedule of Operations.— The amounts stated in the following Schedule of Opera - 
ticms are payable under this policy^ if issued for $25 weekly indemnity. Proportionate 
amounts are payable if thb policy is issued for a larger or smaller sum. Amputation of 
foot, band or forearm, $25; leg or arm^ $50; thigh, $100: thumb, finger or fingers, $10; 
toe or toes, $10. Dislocations, reduction of shoulder, elbow, hip, knee or ankle, $25; 
wxist or lower jaw, $15; thumb, finger or fingers, $10; toe or toes, $10. Excision of shoul- 
der, hip or knee joint. $100; elbow, wrist*or ankle joint, $50; toe or toes, $25. Fractures, 
reduction of nose, lower jaw, collar bone or shoulder blade, $25; breast bone, $10; rib or 
riba, $10; upper arm, $35; forearm (one or both bones), $25; wrist or hand, $15; fingers, 
$10; any of the bones of the pelvis, $50; coccyx, $10; thifh, $75; knee cap or leg bones 
(one or both), $50; bones of toot (not toes), $15; toe or toes, $10. Gunshot wounds — 
removal of shot or bullet not necessitating amputation or laparotomy, $25. Laparot- 
omy — opening of the abdominal cavity for an operation on any organ contained therein, 
$1(X). Skull trephining for fracture of both tables, $100. Tetanus — injection of anti- 
tetanic serum into frontal lobe of brain, $100. Wounds of scalp or other parts — sutur- 
ing, $5. 

I* ART 9. Identification. — If the insured by reason of such injury shall be physically 
unabLe to communicate with relatives or friends, the company, upon receipt of a telegram 
or message ^ving the number of this policy, will immediately transmit to relatives or 
friends any information it may possess respecting him, and will defray the expense neces- 
sary to place the insured in their care, but liability for such service and expense shall 
mA be an amount in excess of four weeks' indemnity, as specified in Part 2, Paragraph A« 



144 MASSACmJSETTS BONDING AND INSURANCE COMPANY 

For Standard Provisions See Page 11 
Additional Provisions 

Section 0. — No assignment of interest under this policy shall bind the company un- 
less consent thereto is formally endorsed hereon by an executive officer 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 
company, which shall not be responsible for its validity. 

Section P — The insurance hereunder shall not cover any injury, fatal or non-fatal, 
sustained by the insured while participating in or in consequence oi having participated 
in aeronautics. 

Section Q.— No provision of the charter or by-laws of thb company not included 
herein shall avoid this policy or be used in evidence in any legal proceeding thereunder. 

Section R. — The copy of the application endorsed hereon is made a part ofthis contract. 

Section S. — This policy is issued for the term stated herein, and subject to all its con- 
ditions and provisions it may be renewed from term to term upon the payment of the 
premium herein stated. 

In witness whereof, the Massachusetts Bonding and Insurance Company, Boston, Mass.* 
has caused this policy to be signed by its president and secretary, but the same shall 
not be binding on the company unless countersigned by its duly authorized representative! 

POLICY FORM— "Improved" Disability 

Principal Sum, $7500-$ 15, 000. Weekly Indemnity, $25-$50. 

Annual Premium, $60. 

The "Improved" Disability policy is the same as the "Improved" 
Combination Accident except where the insuring clause contains 
phraseology referring to the health feature and as follows: 

Pakt 6. Indemnitt for Illness.— If any illness contracted by the insured during 
the term of this policy or any renewal thereof, and not hereinafter excepted, shall totally 
disable and prevent the insured from performing any and every ^^ ^^ ^"^y pertaining 
to his occupation, and necessarilv and continuously confine him within the house, the 
companv will pay for the period of such confinement, not exceeding fifty-two weeks, 
the weekly indemnity specified. 

Or, if immediately following a period of total disabih'ty and confinement within the 
house, or if by reason of any illness the insured shall be wholly and continuously disabled 
and prevented from performing any and every duty pertaining to his occupation, but shall 
not be necessarily confined within the house, the company will pay him one-half of said 
weekly indemnity. No payment for confinement within the house or non-confinement 
to the house separately or combined, shall be made for disability in excess of fifty-two 
consecutive weeks, except as below provided. 

If immediately following fiftv-two weeks of total disabih'ty as defined above the insured 
shall continue totally disabled and prevented from performing any and every kind oi 
dutv pertaining to his occupation, the company will pay so long as such total disability 
shall continue one-quarter of the weekly indemnity specified. 

^ Part 7. Blindness and Paralysis Indemnity.— If the insured, by reason of any 
disease contracted during the term of this insurance and not herein excepted, shall in- 
dependentlv of all other causes and within the term of thb insurance, sufifer the irrecover- 
able loss of the entire sight of both eyes, or become permanently paralyzed whereby he 
shall entirely lose the use of both hands, or both feet, or of one hand and one foot, and shall 
by reason of same be totally disabled, that is, wholly and continuously prevented from 
engaging in any work or occupation for wages or profit, the company will pay the same 
amount of weekly indemnity per week as specified herein for the period of such total 
disability not in excess of one humdred and four consecutive weeks' duration. 

Part 8. Hospital Charges. — If a bodily injury or illness, for which indemnity is 
payable under this policy,^ is sustained by the insured, and if on account of said bodily 
mjury or illness, ana within ninety days from the date of the accident, or the beginning 
of the illness, the insured is removed to a hospital^ the company, provided that no claim 
is made under part 9, will pay the insured (in addition to the indemnity payable for said ^ 
bodily injury or illness) for the period, not exceeding thirteen weeks, during which the 
insured is necessarily confined in the hospital, one half of the weekly indemnit]^ specified. 

Part 9. iNOEMNrry for Surgical Operations. — If a bodily injury, or illness, for 
which indemnity is payable under this policy, is sustained by the msured, and if on ac- 
count of said bodily m jurv or illness, and within ninety days from the date of the accident, 
or the beginning of the illness, the insured undergoes a surgical operation named in the 
following "Schedule of Operations," the company will pay the insured in addition to 
any other indemnity herein provided, the sum set opposite such operation m said schedule; 
but payment shall not be made for more than one operation resulting from any one acci- 
dent or from any one illness. 

Schedule of Operations. — The amounts stated in the following Schedule of Opera- 
tions are payable under this policy if issued for $25 weekly indenmity. Proportionate 
amounts are payable if the i)olicy is issued for a larger or smaller sum. Ab- 
scess or boil — one or more incisions, $5. Amputation of foot, hand or'Yorearm, $25; 
leg or arm, $50; thigh, $100; thumb, finger or bngers, $10; toe or toes,' $10. Aneurism 
(tying of arteiy)~ligation, $5Dl Appendicitis (see laparotomy), $100. Bofit absecsa— 



MASSA CHU S E 'l'l'S BONDING AND INSURANCE COMPANY 146 

trephining, $25. Cancer—iemova] off, by cutting operation, $25. Carbuncle— incision 
and treatment, $5. Caries (bone ulcer)— curetting, $15. Chest— cutting into thoracic 
cavity for diagnosis or treatment or organs therein, $25. Dislocations, reduction of 
shoulder, elbow, hip, knee orankle, $25; wrist or lower jaw, $15; thumb, finger or fingers, 
110; toe or toes, $10. Ezdsion of shoulder, hip or knee joint, $100; elbow, wrist or ankle 
jomt, $50; toe or toes, $25. Eye, ear. nose, or throat— anv cutting operation', $10. Felon 
—incision, $5. Fractures— setting ox nose, lower jaw, collar bone or shoulder blade, $25; 
breast bone, $10; rib or ribs, $10; forearm (one or both bones), $25; upper arm, $35 
wrist or hand, $15; fingers, $10; any of the bones of the pelvis, $50; coccyx, $10; thigh, 
175; knee cap or leg bones (one or both), $50; bones of foot (not toes), $15; toe or toes, 
110. Ganghon (cystic tumor oi tendon sheath) — incision and curetting, $15. Goitre 
—cutting operation for permanent cure, $75. Gunshot wounds— removal of shot or 
bullet not necessitating amputation or laparotomy, $25. Hernia (abdominal)— any cut- 
ting operation for the radical cure of the reducible, irreducible or strangulated form, $100. 
Hydrocele — tapping, incision or excision of sac, $25. Inflammation of joint — incision 
into joint, $25. Intestinal obstruction (see laparotomy). Kidney — fixation or removal 
1100.^ Laparotomy (opening of the abdominal cavity for an operation on any organ 
contuned therein, or for traumatic peritonitis, or exploratory excision), $100. Necrosis 
(death ol bone) sequestrotomy (removal oi d«ul bone), $35. Oesophogotomy for stric- 
ture or other cause $1(X). Peritonitis (see laparotomy). Paracentesis — tapping of 
abdomen, $25; bladder^ $25; ear drum, $15. Rectum — operation for hemorrhoids (ex- 
ternal or internal) excision or ligation, $25; prolapsed — oi>eration for, $25; fistula in ano 
—incision, $25; polypus — extirpation, $25; malignant stricture — excision or colostomy, 
1100. Skull trephining for fracture or other cause, $100. Stone in bladder — removal 
of by cutting or crushing operation , $75. ^ Synovitis (inflammation of the lining membrane, 
of a joint) — incision, 4(25. Tetanus — ^injection of anti-tetanic serum into frontal lobe 
of, brain, $100. Tumors— extripation from any part of the body, benign, $15; malignant 
150. Varicose veins — ^ligation or excision, $25. Varicocele — acupressure — ^ligation o^ 
ezci^on, $25. Wounds of scalp or other parts — suturing, $5. 

PART 10. Fees foe Non-Disabung Injuries or Illnesses. — If the insured sustains 
a bodily injury or illness as set forth in this policy that does not result in any disability, 
but shall require treatment by a phsrsician, oculist, optician or graduate nurse, the com- 
pany will reimburse the insured for the cost thereof, to an amount not exceeding one week's 
indemnity as specified in Part 2; Para^ph (a), provided the receipted bill for such treat- 
ment is filed with the company within thirty days from the date of the accident or the 
btfinning of the illness. 

Part 11. Identification.— If the insured by reason of such injury or illness shall 
w physically unable to communicate with relatives or friends, the companv, upon 
receipt of a telegram or message giving the number of this policy, will inmiediatelv trans- 
mit to relatives or friends any information it may possess respecting him, and will defray 
the expense necessary to place the insured in their care, but liability for such service and 
expense shall not be na amount in excess of four weeks' indemnity as specified in Part 2 
Paragraph (a). 

For Standard Provisions See Page U 
Additional Provisions 

Section O. — ^No asagnment of interest under thb policy shall bind the company un- 
less consent thereto is formally endorsed hereon by an executive officer 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 
company, which shall not be responsible for its validity. 

Section P.— The insurance hereunder shall not cover any injurv. fatal or non-fatal, 
nstained by the insured while participating in or in consequence ot having participated 
in aeronautics; nor any disability resulting from any disease or illness while the insured 
isensaged in active military or naval service; nor any disease or illness for which the in- 
sured is not regularly treated by a licensed physician; nor any disability from disease 
or illness contracted or suffered outside of the United States, Canada, or Europe, nor m 
Alaska, or the insular possessions of the United States. No recovery shall be had on 
account of disability from illness for any period of time for which the insured is entitled 
to weekly indemnity on account of a bodily injurv. 

Section Q.— No provision of the charter or by-laws of this compony not included herem 
nail avoid this policy or be used in evidence in any legal proceeding thereunder. 

Section R. — ^The copy of the application endorsed hereon is made a part of this contract. 

Section S. — This policy is issued for the term stated herein, and subject to all its con- 
ditions and provisions it may be renewed from term to term upon the payment of the 
premium herein stated. 

In witness whereof, the Massachusetts Bonding and Insurance Company, Boston Mass.. 
has caused this policy to be signed by its president and secretary, but the same shall 
Bot be bindjng on the company unless countenigned by its duly authorized representative. 



146 



THE METROPOLITAN CASUALTY INSXJRANCE COMPANY 



The Metropolitan Casualty Insurance Company 



47 CEDAR STREET, NEW YORK 



Commenced Business 1874. 



Eugene H. Winslow, Pres. 



S. W. Burton, Sec 



The company issues a number of distinct forms, as follows, the 
annual rates given below being based on $5000 principal sum and 
$25 weekly indemnity in the select dass. 

The New Era, $20 combination, full indemnity, unrestricted, 
cumulative. All classes. 

The New Composite, $25. Combination, full indemnity, accu- 
mulative. All classes. 

Gold Medal Health $35 to age fifty, $45, age 51-55, unlimited, 
covers all diseases. Select and Preferred classes only. 

The Provident Health, $35 to age fifty; $45, ages fifty-one to 
fifty-five. Unlimited, covers all diseases; select and preferred classes. 

The Death and Dismemberment, $15. Combination, unre- 
stricted, accumulative. All classes. 

Gcdd Medal Accident, full indemnity, unrestricted, fully accumu- 
lated, variable indemnities see classes — urates for select class as fol- 
lows. 

Gold Medal Disability, fully accumulated, vuirestricted, variable 
indemnities; rates same as Gold Medal Accident plus $8.00 for each 
$5.00 weekly indemnity. 



Prin- 
cipal 
Sum 

Single 



Weekly iNDEMNrnr (Single) 



$1$ SIS S S SISIS S S|l_ 
5.00v 7.50 10.00 12.50 15.00 20.00 25.00) 30.00| 40.00 50.00 60.00| lOO.OO 



$ 


s 


S 


S 


S 


S 


s 


S 


S 


S 


S 


S 


S 


250 


4.00 


5.50 


7.00 


8.50 


10.00 


13.00 


16.00 


19.00 


25.00 


31.00 


87.00 


61.00 


500 


4.25 


5.75 


7.25 


8.75 


10.25 


13.25 


16.25 


19.25 


25.25 


31.25 


87.26 


61.:^ 


1,000 


4.50 


6.00 


7.60 


9.00 


10.50 


13.50 


16.50 


19.5Q 


25.50 


31.50 


87.50 


61.50 


1.500 


5.00 


6.50 


8.00 


9.50 


11.00 


14.00 


17.00 


20.00 


26.00 


32.00 


88.00 


62.00 


2,250 




7.50 


9.00 


10.50 


12.00 


15.00 118.00' 21.00 27.00 


33.00 


89.00 


63.00 


3,000 






10.00 


11.50 


13.00 


16.00 


19.001 22.001 28.00 


34.00 


40.00 


64.00 


3,750 








12.50 


14.00 


17.00 


20.00 


23.00 


29.00 


35.00 


41.00 


65.00 


4.500 










15.00 


18.00 


21.00 


24.00 


30.00 


36.00 


42.00 


66.00 


6,000 












20.00 


23.00 


26.00 


32.00 


38.00 


44.00 


68.00 


7,500 
















25.00 


28.00 


34.00 


40.00 


46.00 


70.00 


9.000 
15,000 
















30.00 
..... 


86.00 


42.00 
50.00 


48.00 
56.00 


72.00 



















80.00 



POLICY FORM— "Gold Medal Accident" 

Principal Sum, $7500-$ 15, 000. Weekly Indemnity, $25-$50. 

Annual Premium, $25 

The Metropolitan Casualty Insiu*ance Company of New York, 
in consideration of the premium, 

Hereby insures the person described in the application, copy of which is endorsed hereon, 
for the period hereinafter stated, against the effects of bodily injuries sustained directly, 
solely and exclusively through accidental means (not including suicide or any attempt 
thereat, while sane or insane, or injuries fatal or otherwise, sustained while engaged in 
aviation or aeronautics) as hereinafter limited and provided, to wit: 

Clause 1. Loss of Lite, Limb, Sight. — If such mjuries, directly, solely, exclusivdy 
and independently of all other causes, shall, from the date of the accident, wholly and 
continuously disable and prevent the insured from performing any and every kmd of 
duty pertaining to his occupation, and if, during the period of such total and continucNis 
disablement and within two hundred weeks from the date of the accident, such injuries 



W£MfitR01»0LItAI^ CASUALTY mst«ANCfi C0M1»ANY. 147 

shall, directly, M^y, exclusively and independently of all other causes, result in any 
one of the losses named in the following schedule, the company will pav the amount 
set opposite such loss and, in addition thereto, the we^y indemnity above specified 
from the date of the accident to the date of such loss. Or, if such mjuries shall not 
so disable the insured, but shall, directly, solely, exclusively and independently of all 
other causes and within ninety days from the date of the accident, result in any one of 
the losses named in the following schedule, the company will pay the amount set opposite 
such loss. 

Schedule Rkfekeed to in Clause 1.— For loss of life, or total and irrecoverable 
loss of sight of both eyes, or loss of 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 wrist and ankle, or one hand by severance at or above the wrist and the total 
and irrecoverable oss ot sight of one eye. or one foot by severance at or or above the ankle 
and the total and irrecoverable loss of sight of one eye, the full principal sum above 
specified. For loss of one hand by severance at or above the wrist, or one foot by sev- 
erance at or above the ankle, three-fifths of the said principal sum. For total and irre- 
coverable loss of sight of one eve or loss of the right thumb and index finger by severance 
at or above the metacarj^phalangeal joint, one-half of the said principal sum. For 
loss of the left thumb and mdex finger by severance at or above the metacaipo-phalangeal 
iomt, one-third of the said prmdpal sum. Provided always that if more than one of the 
loSBes enumerated in the above schedule shall result from any one accident, payment shall 
be made only for the one for which the largest amount is specified, and in event of loss of 
sight of one or both eyes or of loss of one or more hands or feet, this insurance sludl 
immediatelv cease and upon payment of the claims, therefor, if any, the policy shall be 
surrendered to this company. 

Clause 2. Total Disablement.— If such injuries shall not result as specified in 
Clause 1, but directly, solely, exclusively and independently of all other causes, shall, 
within two weeks from the date of the accident, continuously and wholly disable and 
prevent the insured from performing any and every kind of duty pertaining to his occu- 
pation, the company will pay the insured the weekly indemnity above specified for 
the entire period of such totid disablement. 

Clause 3. Partial Disablement.— If such injuries shall not result as specified in 
Clause 1, but, directly, solely, exclusively and independently of all other causes, shall, 
immediatelv or within two weeks from the date of the accident or immediately following 
total disablement continuously disable and prevent the insured from performing some 
one or more important daily duty or duties ^pertaining to his occupation, the company 
will pay the insured one-hau of the weekly mdemnity above specified for the period dt 
such partial disablement, not exceeding fifty-two weeks. 

Clause 4. Double Indemnities.— If such injuries be received (a) while the insured 
is riding as a passenger in one or on any public conveyance of a common carrier regulariy 
provided for passenger service (indudmg the platform^ steps or running board m such 
conveyance but not while or in consequence of attemptmg to enter or leave such convey- 
ance); or (b) while a passenger in a regular pa^enger devator; or (c) in conseouence 
of the burning of any building while the insured is therein or in which the insured shall 
be at the commencement of the fire: or (ji) in consequence of a stroke of lightning; or 
ie) in consequence of the collapse ot the outer walls of a completed building while the 
insured is therein; or (/) in consequence of the explosion of a steam boiler; or ^) in con- 
sequence of a cyclone or tornado; or (h) in consequence oi a collision at a pubhc crossing 
between any private vehicle in which the insured shall be riding and a moving engine, 
car or train propelled by steam or electricity over a railroad upon which trains are reg- 
ularly operated oy steam as a motive power, the amounts payable for any oi the losses 
enumerated in the preceding clauses shall be double the amounts therein provided; or 
(f) if such injuries be received while the insured is absent from his home and shall alone 
necessarily prevent his removal to his home, the weekly indemnity payable for the period 
of total disablement during which the insured shall be continuously and necessarily con- 
fined to the house and necessarily prevented, scdely by such injuries, from bein^ removed 
to his home, ^lall be double the amount provided in Clause 2; or {/) if such injuries shall 
necessitate the removal of the insured to any reg^ukr hospital, the weekly indemnity 
payable for the period, not exceeding ten consecutive weeks, during which the insured 
shall be confined to said hospital, shall be double the amount provided in Gause 2, pro- 
vided that the insured shall not make claim under Clause 8 on account of the same injuries. 

Clause 5. Special Indemnities. — Sunstroke, freezing, hydrophobia or septicaemia 
exclusively due to accidental means, or the involuntary and unconscious taking or inha- 
lation of any ns or poisonous vapor shall be fully covered by the terms of this policy. 

Clause 6. Medical Attendance. — If any injury covered by this policjr and sustained 
by the insured does not cause and effect for which an indemnity is provided by thb policy, 
but requires and receives treatment by a legally authorizea physician, the company 
will reimburse the insured for the cost of such treatment, not exceeding one week^s in- 
demnity as provided in Clause 2. 

Clause 7. Identification. — If the insured shall, wholly by reason of injury sustained 
during the time this policy is in force, be rendered physically unable to communicate 
with friends, the company will, upon receipt of a telegram or other message giving this 
policy number, immediately transmit to the relatives or friends of the insured any in- 
formation respecting him, and defray all expenses necessary to put the insured in com- 
munication with and in the care of friends, not exceeding a 8\un equal to four weeks' 
indemnity at the rate per week provided in Clause 2. 

Clause 8. Surgical Operations.— If any injury covered by this policy shall, within 
ninety days from the date of the accident, directly, solely, exclusively and independently 
of all other causes, necessitate any surgical operation named in the following schedule 
the company will, in addition to any other indemnity herein provided, pay the insured 
the sum set opposite the said operation in the said schMuU, provided always that if more 



U8 THE METROPOLITAN CASUALTY INSURANCE COMPANY. 

than one such operation shall be necessitated as the resalt of aqy one accident, payment 
shall be made for the first one only. 

Schedule Referred to in Clause 8. 

If the rate of weekly indemnity be S50 or over, the amounts below shall be payable; 
if less than $50, the amounts shall be reduced proportionately. 

Abdomen— Cutting into for treatment of organs therein, $200; Adscesses— Insicion, 
$10 Amputation of entire hand, forearm or foot, $50; leg or arm, $100; thigh, $200; 
finger of fingers, $20; toe or toes, $50. Aneurism— Tying of artery, $70. Bone — Re- 
moval of diseased portion of bone, $50. Chest — Cutting into for removal of pus, $50. 
Dislocation— Reduction of hip or knee, $70; shoulder, elbow or ankle, $50; wrist or lower 
jaw, $30: thumb or finger, $20. Fractures — Reduction of nose, lower jaw, collar bone, 
or shoulder blade, $50; breast bone or ribs, $20; upper arm, $70; forearm, $50; wrist, $50; 
hand, $30; finger, $20; bones of pdvis, $150; Coccyx, $20; thigh, $150: knee cap or leg, 
$100; bones of foot, $30; toes, $20. Gunshot wounds— Removable of shot or buUet, $50. 
Excision— Shoulder, hip or knee joint, $200; elbow, wrist or ankle joint, $100; toe joint, 
$20. Eye— Any cutting operation, $20; removal, $100. Hydrophobia— Pasteur treat- 
ment, $100. Inflamation of joint— Incision, $50. Lockjaw— Injection of Antitoxin, 
into spinal canal, $100. Skull— Cutting into, $200. Spine or spinal cord— Operation 
With removal of fractured vertebra, $200. Wounds— Suturing, $10. 

Clause 9. Optional iNDEMNmES.— ^If the insured shall, within the terms of this 
policy, sustain any injury specified in the following schedule, he mav, subject to all the 
provisions and agreements of this policy, elect to receive, in lieu of ail other sums herein 
provided, the amount set opposite such injury, provided the insured si^fies such choice 
m writing and delivers the same to the company at New York City within twenty days 
from the date of such injury, and provided always that if more than one such loss shall 
result from any one accident, payment shall be made only for the one for which the largest 
amoimt is specified. 

Schedule Referred to in Clause 9. 

If the rate of weekly indemnity be $50, the amount below shall be payable; if more cr 
less than $50^ the amounts shall be increased or reduced proportionately. If such injuries 
shall be received as provided in sub-divisions (a) to (h) iiMdusive, of Clause 4, then the 
amounts shall be doubled. 

For the complete fracture of — Skull, both tables, $600; lower jaw, $150; collar bone. 
$250; shoulder blade, $250; thigh. $600; thigh, (involving the hip joint), $700; leg, $400; 
knee cap, $400; arm. between elbow and Moulder, $300; arm, between wrist and elbow, 
$300; two or more nbs, $150; hand or finger, $200; foot or toe, $200; Colles' fracture, 
$300; Pott's fracture, $400. For the complete dislocation of— Shoulder, $150; elbow. 
$200; wrist, $200; hip, $600; knee, $300; any bone of foot or toe, $250; ankle, $300. 
For Hernia— Complete inguinal or femoral, $150. For the loss by severance, within 
ninety days from the date of the accident, of— One or more entire fingers, $200; one or 
more entire toes, $300. 

Clause 10. Special Provisions. — ^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 proceedings hereunder. This policy is issued oy the company and accepted by 
the insured subject to the following provisions prescribed by law and shall be void if any 
of the statements in the application are false and such false statements are made with intent 
to deceive or if such false statements materially a£fect either the acceptance of the risk 
or the hazard assumed by the company. 

For Standard Provisions See Page 11. 

In witness whereof. The Metropolitan Casualty Insurance Companjr of New York, has 
caused these presents to be signed by its President and Secretary in the City of New 
York, but the same shall not be binding upon the Company until countersigned by a 
duly authorized and commissioned representative of the Company. 

POLICY FORM— "Gold Medal Health." 

Principal Sum, $3750. Weekly Indemnity, $25. 

Annual Premium to age 50, $35; age 51-55, $45. 

The Metropolitan Casualty Insurance Company of New York, 
in consideration of the premium, hereby insures the person de- 
scribed in the application, a copy of which is endorsed hereon, for 
the period hereinafter stated, against disablement caused by disease 
or sickness contracted while this insurance is in force and effect, as 
hereinafter limited and provided, to wit: — 

Clause 1. Blindness ok Paralysis. — If such disease or sickness, alone and in- 
dependently of all others causes and while this insurance is in force and effect, shall result 
in the total and irrecoverable loss of sight of both eyes, or permanent paralysis whereby 
the insured shall entirely lose the use of both hands or of both feet or of one hand and one 



METROPOLITAN CASUALTY INSURANCE COMPANY. 149 

foot, and if, wholly because of such loss of sight or such paralysis, th: Insured shall be 
continuously and wholly disabled and prevented from performing any and every duty 
pertaining to his occupation for a period of one year, and at the end of said period of one 
year shaU still survive and shall be declared, by medical authority satisfactory to tne 
company, to have totally and irrecoverably lost the sight of both eyes or the entire use 
of both hands or both feet or of one hand and one foot and to be permanently unable to 
perform any and every duty pertaining to his occupation, the company will pay the full 
principal sum above specified. 

Clause 2. Total Disablement with Confinement.— If such disease or sickness, 
alone and independently of all others causes and while this insurance is in force and effect, 
shall continuousbr and wholly disable and prevent the Insured from performing any and 
every duty pertaining to his occupation and shall continuously ana necessarily confine 
the Insured to the house under the continuous care and regular treatment of a legally 
authorized physician, the company will pay the weekly indemnity above specified for the 
period of such total disablement and confinement, not exceeding 52 consecutive weeks. 

Clause 3. Total Disablement Following Conf^ement.— If such disease or sick- 
ness, alone and independently of all other causes and immediately following such confine- 
ment to house, shall continously and wholly disable and prevent the Insured from per- 
forming any and every duty pertaining to his occupation and shall require and receive the 
continuous care and res^ular treatment of a legally authorized physician, the company 
will pay three-fifths of the weekly indemnity above specified for the period of such total 
disablement, not exceeding 26 consecutive weeks. 

Clause 4. Total Disablement Without Medical Treatment.— If such disease or 
sickness, alone and independently of all other causes and immediately following such con- 
finement to house, shall continously and wholly disable and prevent the insured from 
performing any and every duty pertaining to his occupation, but sltall not require such 
medical care and treatment, the company will pay two-fifths of the weekly indemnity 
above specified for the period of such total disablement which shall be certified to as neces- 
sary by the physician or physicians in attendance throughout the entire sickness, not ex 
ceeding 10 consecutive weeks. 

Clause 5. Partial Disablement.— If such disease or sickness, alone and independ- 
ently of all other causes and immediately following such confinement to house, shall 
continuously and wholly disable and prevent the insured from performing some one or 
more important daily duty or duties pertaining to his occupation and shall require and 
receive the continuous care and regualr treatment of a legally authorized physician, the 
company will pay three-tenths of the weekly indemnity above specified for the period of 
such partial disablement, not exceeding 10 weeks. 

Clause 6. Double Hospital Indemntfy.— In such disease or sickness, alone and in- 
dependently of all other causes and while this insurance is in force and effect, and within 
ninety days from the beginning of such disease or sickness, shall necessitate the removal 
of the insured to any regular hospital, the weekly indemnity payable for the period, not 
exceeding 10 consecutive weeks, during which he shall be continuously and necessarily 
confined m said hospital, shall be double the amount provided in Clause 2. 

Clause 7. Surgical Operations. — If such disease or sickness, alone and independ- 
ently of all other causes and while this insurance is in force and effect, shaJQ necessitate 
the performance upon the Insured, within ninety days from the contraction of such dis- 
ease or sickness, of any surgical operation specified in the schedule endorsed hereon, the 
company will pay the sum set opposite the said operation in the said schedule, provided 
always that if more than one such operation shall be necessitated as the result of any 
one disease or sickness, payment shall be made for the first one only, and provided that 
the Insured shall not make claim under clauses 6 on account of the same disease or sickness. 

POLICY FORM— "Gold Medal Disability" 

Principal Sum, $7500-$! 5, 000. Weekly Indemnity, $25-$50. 

Annual Premium to Age 50, $65; Age 51-55, $75 

The Metropolitan Casualty Insurance Company of New York, 
in consideration of the premium and of the statements in the appli- 
cation, copy of which is endorsed hereon, hereby insures the person 
named in Statement 1 of the said application, for the period herein- 
after stated, (A) against the effects of bodily injuries sustained 
directly, solely and exclusively through accidental means (not in- 
cluding suicide or any attempt thereat, while sane or insane, or in- 
juries, fatal or otherwise, sustained while engaged in aviation or 
aeronautics) and (B) against the effects of disease or sickness con- 
tracted while this insurance is in force and effect, as hereinafter 
limited and provided, to "^t: 

Accident Benehts 
Clause 1. Loss of Lite, Limb, Sight. — If such injuries, directly, solely, exclusively 
and independently of all other causes, shall, from the date of the accident, wholly and 
continuously disable and prevent the insured from performing any and every knid of 
duty pertaining to his occupation and if, during the period of such total and continuous 
disablement afid within 200 weeks fiom the date ol the accident, such injuxies shall. 



160 METROPOLITAN CASUALTY INSURANCE COMPANY 

directly, solel3r, exclusively and independently of all other causes, result in any one of the 
losses named in the following schedule, the Company will pay the amount set opposite 
such loss and, in addition thereto, the weekly indemnity from the date of the accident to 
the date of such loss. 

Or, if such injuries shall not so disable the insiured, but shall, directly, solely, exdu- 
sivelv and indei^endently of all other causes and within 90 days from the date of the 
accident, result in any one of the losses named in the following schedule, the Company 
will pay the amount set opposite such loss. 

Schedule Referred to in Clause 1. — For loss of life, for total and irrecdverable 
loss of sight of both eyes, for loss of both hands by severance at or above the wrLst, or 
both feet by severance at or above the ankle, or one hand and one foot b]^ severance 
at or above wrist and ankle, or one hand by severance at or above the wrist and the 
total and irrecoverable loss of sight of one eye, or one foot by severance at or above the 
ankle and the total and irrecoverable loss of sight of one eye, the full prindpal sum. 
For loss of one hand by severance at or above the wrist, or one foot by severance at or 
above the ankle, three-fifths of the principal sum. For total and irrecoverable loss of 
sight of one eye, or for loss of the right thumb and mdex finger by severance at or above 
the metacarpo-phalangeal joint, one-half of the principal sum. For loss of the left 
thumb and mdex finger by severance at or above the metacarpo-phalangeal joint, one- 
third of the principal sum. Provided always that, if more than one of the losses enu- 
merated in the above schedule shall restdt from any one accident, {>ayment shall be made 
only for the one for which the largest amount is specified and, m the event of loss d 
sight of one or both eyes or of loss of one or more hands or feet, this insurance sludl im- 
mediately cease and ypon payment of claim therefor, if any, the policy shall be surren- 
dered to the Company. 

Clause 2. Total Disablement. — ^If such injuries shall not result as specified in 
Clause 1 , but, directly, solely, exclusivdy and independently of aU other causes, shall, 
immediately or within two weeks from the date of the accident, continuously and wholly 
disable and prevent the insured from performing any and every kind of duty pertaining 
to his occupation, the Company will pay the insured the weekly indemnity for the entire 
period of such total disablement. 

Clause 3. Partial Disableicent. — ^If such injuries shall not result as specified in 
Clause 1, but, directly, solely, exclusively and independently of all other causes, shall, 
immediatelv or within two weeks from the date of the accident or immediately following 
total disablement, continuouslv disable and prevent the insured from performing some 
one or more important dailv dutv or duties pertaining to his occupation, the Company 
will pay the insured one-half of the weekly indemnity for the period of such partial dis- 
ablement, not exceeding 52 weeks. 

Clause 4. Double Indemnities. — If such injuries be received (a) while the insured 
is riding as a passenger in or on any public conveyance of a common carrier regulariv 
provided for passenger service (including the platform, steps or running board of such 
conveyance, but not while or in consequence of attempting to enter or leave such con- 
veyance) ; or (b) while a passenger in a regular passenger elevator; or (c) in consequence 
of the burning of any building while the msured is therein or in which the insured shall 
be at the commencement ol the fire: or (d) in consequence of a strdce of lightning; or 
(e) in consequence of the collapse oi the outer waUs of a completed building while the 
insured is therein: or (f ) in consequence ol the explosion of a steam boiler; or (g) in con- 
sequence of a QTclone or tornado; or (h) in consequence of a collision at a public crossing 
between any private vehicle in which the insured shall be riding and a moving engine, 
car or train propelled by steam or electricity over a railroad upon which trains are regu- 
larly operated by steam as a motive power, the amounts payable for an^ of the losses 
enumerated in the preceding clauses shall be doubled; or (i) if such injuries be received 
while the insured is absent from his home and shall alone necessarily prevent his remo>^ 
to his home, the weekly indemnity payable for the period of total disablement during 
which the insured shall be continuously and necessarily confined to the house and neces- 
sarily prevented, solely by such injuries^ from being removed to his home, shall be dou- 
bled; or (j) if such injuries shall necessitate the removal of the insured to any regukur 
hospital, the weekly indemnity payable for the period not exceeding ten consecutive weeks, 
during which the msured shall be confined in said hospital, shall be doubled, i>rovided 
that the insured shall not make claim under Clause 13 on account of the same injuries. 

Clause 5. Special Indemnities. — Sunstroke, freezing, hydrophobia or septicsemia, 
exclusively due to bodily injury caused by accidental means, or the mvoluntary and 
unconscious taking or inhalation of any gas or poisonous vapor, shall be fully covered 
under the foregoing provisions. 

Clause 6. Medical Attendance. — If any injury covered by this poUc^r and sustained 
by the insured does not cause an effect for which an indemnity is provided bv this policy, 
but requires and receives treatment by a legally authorized physician, the Companv 
will reimburse the insured for the cost of such treatment, not exceeding one week's 
indemnity. 

Clause 7. Identification. — If the insured shall, wholly by reason of injury sus- 
tained during the time this policy is in force, be rendered physically unable to com- 
municate with friends, the Company will, upon receipt of a telegram or other message 
giving this policy number, immediately transmit to the relatives or friends of the in- 
sured any information respecting him, and defray nW expenses necessary to put the 
insured in communication with and in the care of friends, not exceeding a sum equal 
to four weeks' indemnity. 

Clause 8. Optional Indemnities.— If the insured shall, withm the terms of this 
policy, sustain any injury specified in the following schedule, he may, subject to all the 
provisions and agreements of this policy, elect to receive, in Ueu of all other sums herein 
pi^Qvvlf^. the a,iaQiuit set opposite such injury, provided he signifies such choice in writ- 



METROPOLITAN CASUALTY INSUllANCE COMPANY 161 

ing and delivers the same to the Company at New York City within twenty days from 
the date of such injury, and provided always that if more than one such injury shall 
result from any one acodent, payment shall be made only for the one for which the largest 
amount is specified. 

ScHEDULB Refsrked TO IN Claxtsb 8.— If the rate of weekly mdemnity be $50, the 
amounts below shall be payable: if more or less than $50, the amounts shall be increased 
or reduced proportionately. If such injuries shall be received as provided in sub-<li- 
visions (a) to (n) inclusive, of Clause 4. then the amounts shall be doubled. 

For the complete fracture of: skull, both Ubles, $600; lower jaw, $150; collar bone, 
$200; shoulder blade, $200; thigh, $400; thigh (mvolving the hip joint), $600; leg, $400; 
knee cap, $400; arm, between abow and shoulder, $300; arm, between wrist and elbow, 
$300; two or more ribs, $100; hand or finger, $200; foot or toe, $200; CoUes' fracture, 
$300; Pott's fracture, $400. For the complete dislocation of: shoulder, $100; elbow, 
$200: wrist, $200; hip, $500; knee, $300; any bone of foot or toe. $150; ankle, $300. For 
loss by severance, within nmety days from date oi the accident, of: one or more entire 
fingers, $200; one or more entire toes, $300. 

Sickness Benefits 

Clause 9. Blindness or Paralysis. — If such disease or sickness, alone and indepen- 
dently of all other causes and while this insurance is in force and effect, shall result in 
the total and irrecoverable loss of sight of both eyes, or permanent paralysis Whereby 
the insured shall entirely lose the use of both hands or of both feet or of one hand and 
one foot, and if, wholly because of such loss of sight of such paralysis, the insured shall 
be omtinuously and wholly disabled and prevented from performing any and eveiy kind of 
duty pertaininx to his occupation for a period of one year, and at the end of said period 
of one year shall still survive and shall be declared, by medical authority satisfactory to the 
Company, to have totally and irrecoverably lost the sight of both eyes or the entire 
use of both hands or of both feet or of one hand and one foot and to be permanently 
unable to perform any and every kind of duty pertaining to his occupation, the Company 
will pay a sum equal to the weekly indemnity for 150 weeks. But the right to make claim 
under this clause shall exclude all other claims based upon the same disease, sickness 
or disablement. 

Clause 10. Total Disablebcent.— If such disease or sickness, alone and indepen- 
dently of all other causes and while this msurance is in force and effect, shall contmu- 
oudy and wholly disable and prevent the insured from performing any and every kind 
of duty pertaining to his occupation and shall require and receive the continuous care 
and r^^ular treatment of a legaUy authorized physician, the Company will pay the weekly 
indemnity above specified for the period of such total disableinent, not exceeding 52 
consecutive weeks. 

Clause 11. Partial Disablement. — ^If such disease or sickness, alone and indepen- 
dently of all other causes and immediately following such total disablement, shall con- 
tinuotKsly and wholly disable and prevent the insured from performing some one or 
more important daily duty or duties pertaining to his occupation, and shall require 
and receive the continuous care and regular treatment of a legally authorized physician. 
the Company will pay one-half of the weekly indemnity above specified for the perioa 
of such partial disaiblement, not exceeding 10 weeks. 

Clause 12. Double Hospital Indemnity.— If such disease or sickness, alone and 
independently of all other causes and while this insurance is in force and effect, and 
withm nine^ dajrs from the beginning of such disease or sickness, shall necessitate the 
removal of the insured to any regular hospital, the weekly indemnity payable for the period 
not exceeding 10 weeks, during which he shall be contmuously and necessarily confined 
in the said hospital, shall be doubled, provided that the insured shall not make claim 
under Clause 13 on account of the same disease or sic^ess. 

Accident or Sickness Benefits 

Clause 13. Surgical Operations. — If any injury or disease covered by this policy 
shall, within ninety days from the date of the accident or of the contraction of the disease, 
alone and necessarily require any surgical operation named in the followins schedule, 
the Company will pay the insured the sum set opposite the said operation in the said 
schedule, provided always that if more than one such operation shall be necessitated 
as the result of any one accident or disease, payment shall be made for the first one only. 

Schedule Referred to in Clause 13.— If the rate of weekly indemnity be $50 or 
over, the amounts below shall be payable; if less than $50, the amounts shall be reduced 
proportionately. 

Abscess — ^incision, $10. Abdomen — cutting into for diagnosis or treatment of organs 
therein, $200. Amputation of: entire hand, forearm or foot, $50; leg or arm, $100; 
thigh, $200; finger or fingers, $20; toe or toes, $30. Aneurism — operation for, by tying 
of artery, $100. Appendicitis (see Abdomen). Bone — removal of diseased portion of 
bone, $50. Carbuncle — ^incision, $10. Chest — cutting into for diagnosis or treatment 
of organs therein, $70. Cancer — ^Up, removal of, by cutting operation, $30. Dislocation 
— reduction of: hip or knee, $50; shoulder, elbow or ankle, $30; wrist or lower jaw, $20; 
thumb or finger, $10. Excision — shoulder, hip or knee joint, $100; elbow, wrist or ankle 
joint, $100; toe joint, $20. Eye, ear, nose — any cutting operation, $20. Eye, removal 
of, $100. Fractures, reduction of: nose, lower jaw, collar bone, or shoulder blade, $30; 
breast bone or ribs, $10; upper arm, $50; forearm, $30; wrist, $30; hand, $30; finger, 
$20; bones of pelvis, $100; coccsrx, $20; thi^h, $50; knee cap or leg, $50; bones of foot, 
$20; toes, $20. Gangrene — amputation of: fingers or toes, $20; foot or hand, $50. Goitre 
— cutting operation for permanent cure, $100. Gunshot wounds — removal of shot or 
bulkt, $30, Hydrocdo— inciaioa and treatment of sac, $20. Hydrophobia— Pastew 



152 METROPOLITAN CASUALTY INSXJRANCE CX)MPANY 

treatment, $100. Inflammation of joint — ^incision into joint, $30. Intestinal obstruc- 
tion (see Abdomen). Kidney (see Abdomen). Lockjaw — ^injection of antitoxin into 
skull, $100; injection of antitoxin into spinal canal, $100. Mastoiditis— cutting operatioQ 
for removal of diseased bone, $100. Nerve — cutting operation for stretching, $50. Rec- 
ttun — cutting operation for: hemorrhoids, external, $20; hemorrhoids, internal, $20; 
ptrolapsed, $30; fistula in ano, $30; mali^iant stricture, $100. Rupture — cutting opera- 
tion for complete and permanent cure, $100. Skull — cutting into cranial cavity, $200. 
Spine or spinal cord — operation with removal of fractured vertebra, $200. Stricture— 
Oesophagus. Cutting operation (external) for, $100. Stone in bladder — ^removal of, 
by cutting or crushing operation, $100. Tapping of: abdomen, $50; bladder, $30; chest. 
$30; ear drum, $20; hydrocele, $20; joints, $20. Trachea — cutting into for removal of 
foreign bodies or for relief of difficult breathing, $70. Throat — any cutting operation, 
$20. Tumors — ^removal of. by cutting operation, malignant, $100; boiign, $20. Vari- 
cocele — cutting operation for permanent cure, $50. Veins — ^varicose. Cutting operatira 
for permanent cure, $50. Wounds — suturing, $10. 

CTlause 14. Ldctt op Insusance. — ^The insurance under Clauses 1 to 8, inclusive, 
of this policv shall not cover any loss or disablement caused wholly or partly by dis- 
ease, or by bodily or mental infirmity, or b^r bacterial infection (excepting only septic 
infection of and through a visible wound accidentally sustained). The insurance under 
Clauses 9 to 13, inclusive, of this policy shall pot cover any disease, sickness or disable- 
ment contracted or suffered while engaged in militaiy or naval service, or while in Alalia, 
the insular possessions of the United States, the British possessions in America north 
of the 60th degree of north latitude, or elsewhere outside of the limits of the United 
States, Canada and Europe; nor shall it cover any disease, sickness or disablement 
which is caused wholly or partly by the use of intoxicants or narcotics or which results 
from or is the sequel of any disease contracted prior to the date of this policy; nor shall 
it cover disablement for any period for which the insured may claim or be entitled to 
claim indemnity from this or any other company or association for or on account of 
injuries caused by accidental violence. 

Clause IS. Special Provisions.— The copj; of the application endorsed hereon b 
hereby made a part of this contract No provisions of the charter, constitution, or by- 
laws of the Company not included herein snail avoid the policy or be used in evidence in 
any legal proceedings hereunder. This policy is issued by the Company and accepted 
by the insured subject to the following provisions prescribed by law and shall be void 
if any of the statements or answers in the application are false and such false statements 
or answers are made with intent to deceive or if such false statements or answers ma- 
terially affect either the acceptance of the risk or the hazard assumed by the Company. 
Failure of the insured or beneficiary to comply with any of the provisions or require- 
ments of this policy shAU invalidate all claims. 

For Standard Provisions See Page 11 

Subject to the foregoing provisions, this policy shall continue in force for the period 
of twelve months from January 1, 1916, noon, standard time at the place where the 
insured resides, for which the premium is $65, and may be renewed for any subsequent 
period, with the consent of Uie Company, by the pajrment of the premium in advance, 
subject, however, to all the conditions and provisions of the policy. The occupation of 
the insured is accoimtant, classified select. 

In witness whereof. The Metropolitan Casualty Insurance Company of New York 
has caused this policy to be signed by its president and secretary m the City of New 
York, but the same shall not be binding upon the Company unUl countersigned bv a 
duly authorized representative of the Company, and delivered to the insured wnik 
he is in good health. 



THE NATIONAL LCPF- AN© ACClDfiNT INStrttANCfi CO. 



15d 



National Life and Accident Insurance Company 



NASHVILLE, TENN. 



Commenced BusinesB 1900. C. A. Ckaio, Pres. C. R. Clekxnts, Sec'y and Treas. 



The National issues an industrial policy on the basis of 5 cents, 
weekly premium and multiples thereof up to 35 cents weekly. 
The age limits are 2 to 54. Males or females 9 and under next 
birthday are not insured for more than 10 cents per week. Males 
or females 14 and under next birthday not insured for more than 
15 cents. Males not insured for more than 25 cents on females 
for more than 15 cents except under special authority from the 
home office. The benefits per 5 cents weekly premium, class 
A policy are as follows: 



Ages next 
Burthday 


Weekly 
Death Sick and 
Benefit Accident 

Benefit 


Ages next 
Birthday 


Death 
Benefit 


Weekly 1 

Sick and Ages next 
Accident Birthday 
Benefit | | 


1 Weekly 
Death Sick and 
Benefit Accident 

1 Benefit 


2 to 9 


$24 00 
23 50 
23 00 
22 50 
22 00 
2150 

2100 
20 50 
20 00 
19 50 
19 00 

18 50 
18 00 
17 50 
17 00 
16 50 


$1 00 
1 00 
1 00 
1 00 
1 00 
1 00 

1 00 
1 00 
1 00 
1 00 
1 00 

1 00 
100 
1 00 
1 00 
1 00 


25 


$16 00 
16 50 
15 25 
15 00 
14 50 

14 25 
14 00 
13 75 
13 50 
13 25 

13 00 
12 75 
12 50 
12 00 
1175 


$1 00 
1 00 
1 00 
1 00 
1 00 

1 00 
1 00 
1 00 
1 00 
1 00 

1 00 
1 00 
1 00 
1 00 
1 00 


40. „ 

41 

42. 

43 

44. 

45 

46 

47 

48.... 

49 

50.. 


$1150 
1125 
1100 
10 75 
10 50 

10 25 
10 00 
9 75 
925 
900 

8 75 
850 
825 
800 
7 75 


$1 00 


10. 

11 

12. 


26 

27. 

2& 

29. 

30. 

31 

32. 

33. 

34. 

35. 

36....... 

37. 

38 

39 


1 00 
1 00 
1 00 


la 

14. 

15i ^... 


1 00 
1 00 


16 

17. 

1& 

19. - 

20 


1 00 
1 00 
1 00 
1 00 

75 


21.._ 


75 


22L 


52. 

53 

54. 


75 


2a.. 


75 


24 


75 



Benefits under higher rates are in exact proportion to the 
premium. 

POLICY FORM— Class A, Male Risk. 

The National Life and Accident Insurance Company, Nashville, 
Tennessee, in consideration of the application for this policy, 
which is hereby referred to and made a part of this contract, 
and in further consideration of the payment in advance of the 
premium stated in schedule below, on or before every Monday 
hereafter during the life of the insured, twenty (20) per cent of 
which premium is for life insurance, and eighty (80) per cent 
of which is for insurance against disability from sickness or ac- 
cident, The National Life and Accident Insurance Company 
doth hereby agree, subject to the conditions herein, to pay to 
the beneficiary the amount of death benefit provided herein 
within twenty-four (24) hours after due proof of death has been 
furnished the Company, and in case of sickness or accident to 
pay to the insured the weekly benefits named in schedule below 
according to the terms hereof: 



164 T*HE NATIONAL LIFE AND ACOt^fiNt WStJftAUCfi CO. 



Provided, however, that the liability of the Company shall be limited to one-half of the 
sums named in the schedule below during the first six calendar months this policy b in 
force. 

If the insured shall die as a result of accidental injuries sustained while riding as a regu- 
lar passenger within any public conveyance opeiated for the transportation of passengers 
and within ninety davs ot the date of such injuries, the death benefit shall be double the 
sum otherwise payable under this policy. 

Schedule Above Referred to 



Number 

of 
PoUcy 


Name of Ins'd 


Insured 


Weekly 
Premium 


Maximum 
Weekly 

Allowance 
for Sickness 
or Accident 


Amount 

Payable in 

Event of 

Death 


Benefidaiy 


07865 


John Jones 


25 


25ct8. 


t5.00 


180.00 


Maiy Jones 



This policy is issued and accepted subject to the conditions set forth in thb folio and 
the reverse side hereof, each and all of which are hereby made a part of the contract. 

The first year's insurance under this poli^r is term insurance. Thereafter a reserve 
shall be accumulated upon the basis of the Actuaries Table of Mortality with 4 per cent 
interest, and in the event of the default in the parent oi any premium when due, after 
premiums for three fuU years have been paid, this policy, without action on the part of 
the insured, will be extended for the full amount of the natural death benefit only, for 
such length of time as the reserve hereunder at the anniversary immediately preceding the 
date of such default, less two and one-half per centum of the amount insured, will pur- 
chase according to the Actuaries Table of Mortality with four (4) per cent in- 
terest; or in Ueu thereof, provided premiums have been paid for ten full years, the Com- 
pany will pay to the Insured, upon written ai^lication therefor and the legal surrender of 
this policy within sixtv days from date of such default, as a cash surrender value the 
amount otherwise available for the purchase of extended insurance as aforesaid. 

The production by the Company of this policy and of a receipt for the sum insured, 
signed by the beneficiary, or an executor or administrator, or lenl representative of the 
insured, shall be conclusive evidence that such sum has been paid and that all claims un- 
der this pbUcy have been fully satisfied. The beneficiary hereunder may be changed by 
the Insured by consent of the Company endorsed hereon. 

All statements made by the insured in the application herefor shall, in the absence of 
fraud, be deemed representations in so far as tney affect the life insurance hereunder, 
otherwise as warranties. Said policy, togeUier with the application, constitutes the entire 
contract, and the death benefit hereunder shall be incontestable after premiums for two 
full years have been paid except for non-payment of premiums and military and naval 
service in time of war. Whenever, for any cause, this policy shall terminate or become 
void, all premiums previoushr paid shall be forfeited to the Company, unless otherwise 
expressly provided herein. No suit shall be brought nor action commenced against this 
Company under this policy until sixty days after claim has become due, nor after two 
years from the time when the right ot action shall accrue. 

In Witness Whereof. The National Life and Accident Insurance Company, has by 
its President and Secretary, executed and attested this policy at Nashville, Tennessee, 
this 31st day of March, 1913. 

Whenever in this policy the words "the insured" are used, reference is thereby made to 
the person upon whose life the policy is issued. 

CONDinONS. 

1. This policy shall be void if there is in force upon the life of the insured a policy 
previously issued by this Company, unless the policy previously issued contains an en- 
dorsement signed by the proper officer authorizing same; and, except as otherwise ex- 
pressly provided herein, this policy shall become void if the weekly premiums shall not 
be paid according to the terms hereof. This policy and its receipt bo(» shall be exhibited 
to the authorized representatives of the Company at any time upon demand, and before 
the death benefit can be claimed this policy and the receipt book must be surrendered to 
the Company. 

2. Weekly benefits for sickness will only be paid for each period of seven consecutive 
days that the insured is, by reason of illness, necessarily confined to bed and there visited 
professionally by a duly licensed and practicing physician. Weekly benefits for accident 
will only be paid for each period of seven consecutive days that the insured is, by reason 
of accidental injury, disabled from work of any nature and there must be external evid- 
ence of such injury for the time paid. The number of weekly benefits payable under this 
policy in any twelve consecutive months is limited to twenty. 

3. The insured shall not be entitled to any benefits for sickness or accident under this 
policy unless a certificate of a regularly licensed and practicing physician (satisfactory to 
the Company) showing the nature of the sickness or injury shall be furnished the Com' 
pany or its authorized agents; and if the sickness or accidental disability of tl^ injured 
shall continue for more than one week, a like certificate must likewise be furnished at 
the b^inning of each week of sickness or accidental disability. No liability for sickness or 
accidental disability shall begin to accrue under this policy for any week imtil such a cer- 
tificate is received as above set forth. The Company will not accept as proof of sickness 
the certificate of a physician who has not actually attended the insured at hjs bedside and 
there must be an actual attendance for every certificate filed. 

The Company shall have the right at its option to make such investigation into matters 
upon which a claim may be based, or the subject thereof, as it may be neoeaaazy in order 
to deteimine its liabilily hereunder. 



tte NAtlbNAL tiFE Atrt) ACClPfeNT INStJltANCfe C6. M 

4. This policy shall not lapse for non-payment of premiums until the premiums for 
four (4) wetts are in arrears; the insured, however, shall not be entitled to sick or aoddent 
benents when premium payments are m arrears for two (2) weeks or more, and the sub- 
sequent payment of sucn arrears shall not entitle the insured to benefits for sickness or 
disability beginning or occurring during the period of such arrears. Should the insured die 
when the i»emium payments on this policy are four (4) weeks or more in arrears this 
Company shall not Se liable for any sum under this policy except as otherwise expressly 
provided herein. 

5. No liabili^ is assumed by the Company prior to the date hereof, nor unless on 
said date anddeliveiy of this policy the first payment has been legiUly made and the applic- 
ant is then in sound health. In case of mistake or misstatement in age the Company will 
only be liable for the amount of benefits payable according to its table at the proper age. 

6. No benefits will be paid for sickness or death resulting from venereal cuseases nor 
for diseases contracted or injuries received before the delivery ci this policy; nor will 
weekly benefits be paid for injuries received while violating the law. Milita^ or naval 
service in time of war is a risk not covered by this policy. 

7. Agents (which term includes superintendents and assistant superintendents) are 
not authorized and have no power to make, alter or discharge contracts, waiye forfeitures 
or to receive premiums on policies in arrears more than four weeks, or to receipt 
for the same in the receipt book, and all such arrears given to an agent shall be at the risk 
of those who pay them, and shall not be credited upon the policy whether entered in the 
the receipt book or not. Policies having lapsed will be revived b^ the Company upon 
written application of the insured showing satisfactory evidence of insurability, and upon 
payment of all inemiums in arrears; provided that the Company's consent to such revival 
shall appear by endorsement upcn the face of the Policy, and that there shall be no liab- 
ility whatever under this contract for any disability or death resulting from an acddent 
occurring or illness contracted or commencing prior to the date of the revival endorse- 
ment hereon as aforesaid. 

8. Should the total amount <A weekly benefits allowed the insured on all policies car- 
ried in this and all other companies excMd the sum of twelve dollars per week, this Com- 
pansr shall only be liable to the insured for such proportion of the amount provided for 
herein imder head "Weekly Benefits," as the said twelve dollars bears to the total weekly 
benefits allowed under all policies carried by the insured. Provided, however that 
should the insured establish the fact that his average weekly earnings for the four weeks 
immediately preceding the date of the beginning of his disability were in excess of twelve 
dollars, then the amount of such average earnings shall be used in this clause wherever 
the amount "twelve dollars" appears, the Company's liability in no instance bein^ in 
excess of that stated under head " Weeklv Benefits" on first page hereof. If the attained 
age of the insured be imder 14 years, the amount four dollars will apply in this clause 
wnere the amoimt "twelve dollars" appears. At any time while this policy is in full 
force and effect, no premiums being in arrears, the insured may elect to cancel or reduce 
the sick and accident benefits hereunder, in which event that pu-t of subsequent pre- 
miums available for such sick and accident benefits will be proporticmately reduced, such 
cancellation or reduction of benefits and reduction of premiums to take effect only upon 
endorsement hereon by the Company. 

9. The failure, of the collector to call for the premium on this policv will not be an «- 
cuse for non-payment as the insured will then be required to pay the premium at the 
branch office of the Company or remit the same direct to the Home Office. 

10. The acceptance of thi^ policy is taken as evidence by the Company that it has 
been applied for by the insured, read, undeistood and accepted in good faith. 



ffatioQal Life l^saraQee C^ofnpaQy of tl^e 
Ui^it^d states of ^/neriea. 

CHICAGO, ILLINOIS. 



Accident Department commenced business 1912. 
A. M. Johnson, Pres. R. D. Lay, Sec. 

The following commercial forms are issued: National Accident, 
Square Deal Accident, Square Deal Disability, Central Accident, 
Central Disability, Travel Accident, General Sickness and Weekly 
Indemnity Accident. 



POLICY FORM— "Square Deal Disability" 

Principal Sum, $750(H(15,000. Weekly Indemnity, $25-$50 

Annual Premium, $60. 

National Life Insurance Company of the United States of Amer- 
ica, Chicago, 111. (hereinafter called the Company), in consideration 
of the annual premium of sixty dollars, and of the representations 
in the application, a copy of which is endorsed hereon and made a 
part hereof, 

Does hereby insure John Doe, of Chicago, Illinois, hereinafter called the insured, by 
occupation a manager, under da^ssification select, for twelve months, beginning at noon, 
Standard time at the place where the insured resides, on the first day of January, 1915, 
subject to the provisions, conditions and limitations herein, against loss resulting directly, 
independently and exclusively of all other causes from bodily injury effected during the 
life of this policy solely through external, violent and accidental means (suicide, sane or 
insane, or any attempt thereat, sane or insane, is not covered), herein called such injury, 
and against loss resulting from sickness or disease which is contracted and begins while 
this policy is in force, herein called such sickness, as follows: 

Section 1. Accident Insurance. — (a) If such injury shall, independently and ex- 
clusively of all other causes, continuously and wholly disable and prevent the insured from 
the date of the accident from performing each and every kind of duty pertaining to any 
business or occupation, and diuing the period of such continuous disability shall inde- 
pendently and exclusively of all other causes result in any one of the losses specified in this 
section (1), the Company will pay the sum set opposite such loss, and in addition weekly 
indemnity as provided herein to date of death, dismemberment or loss of sight, as the case 
may be. (b) Or, if within twelve months from the date of the accident, irrespective d 
total disability, such injury shall, independently and exclusively of all other causes, result 
in any one of the losses specified in this section (1), the Company will pay the sum set 
opposite such loss. For loss of life, or both hands by severance at or above the wrist, 
or DOth 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, or one hand 
by severance at or above the wrist and entire sight <n one eye, if irrecoverably lost, or one 
foot by severance at or above the ankle and entire sight of one eye, if irrecoverably lost, 
the minimum principal sum; either hand by severance at or above the wrist, or either 
foot by severance at or above the ankle, or entire sight of one eye, if irrecoverably lost, 
one-haJf of the minimum principal sum; thumb and index finger of either hand by sev- 
erance at or above metacarpo-phalangeal joints, one-third of the minimum principal sum. 
Payment of indemnity under this section shall be in lieu of all other indemnity (the 
additional indemniw provided in Section 7 and for surgical operations set forth in Section 
10 excepted), and shiul immediately terminate this policy. Payment shall not be made 
for more than one loss resulting from any one accident. 

Section 2. Total Loss of Time Indemnity. — (a) If such injury shall not result in 
any one of the losses enumerated in Section 1 but shall, from the date of accident, render 
the insured wholly and continuously unable to transact each and every duty pertaining 
to his business or occupation, the Company will pay for the period of such disability an 
indemnity per week of twenty-five dollars. 

Partial Loss op Time Indemnity. — (b) If such injury shall not result in any one of 
the losses enumerated in Section 1 but shall, from the date of accident, or inunediately 
following a period of total loss of time as above defined, partially disable the insured ana 



NATIONAL LIFE INSURANCE CX)MPANY IW 

prevent Um from i)erfotituiig one or man of the important daily duties pertaining to his 
tion, the Company will pay for the period of such disability, m 



Business or occupation, the Company will pay for the period of such debility, not ezceed- 
ingthirty consecutive weeks, an indemnity per week of one-half the indemnitv specified 
in Parsgraph A of this section. Payment of indemnity under this section shall be in lieu 
of all other indemnity, except as provided in Sections 1 and 10 hereof. 

SEcnoN 3. Double Indemnity. — ^If such injuiv is sustained (1) while the insured is a 
passenger in or (m a public conveyance provided by a common carrier for passenger 
service; or (2) while he is a passenger within a passenger elevatOT (elevators in mines 
excepted); or (3) in consequence of the destruction of a building t^ fire or by the coU 
lapse of the walls of a buildmg, while the insured is therein in either case; or (4) through 
a stroke of lightning: or (5) through the explosion of a steam boiler, then the amoimt pay- 
able as provided in Sections 1 , 2 and 4 shall be doubled. If the insured is injured fatally 
or otherwise while getting <ni or off a train or street railway car, or while attempting to 
do so, the Company shalTbe liable for single indemnity onlv. 

Section 4. Optional Indemnities.— Insured, if he so elects within twenty days from 
the date of accident, may take in lieu of the weekly indemnity for total and partial loss of 
time indemnity in one sum for any injury named m the following "Schedule of Optional 
Indenmities" but not more than one optional indemnity shall be payable for any one 
accident. If the sm^le weekly indemnity under this policy is $25 per week, the insured 
if he so elects as provided herem, may receive the amounts named below in lieu of all other 
mdemnity; if such weekly indemnity is more or less than $25 the amounts payable shall 
be increased or decreased proportionately. For loss of one or more finders (at least one 
entire phalanx), $150; 'one or moreentire toes, $1G0. Forcomplete hernia-- caused soldy 
and directly by bodily injury, $75. For omiplete dislocation — of theshoulder,$75; elbow 
$100; wrist, $120; hip, $300, knee, $160; two or more bones of the foot (other than 
toes), $160; uikle, $160; two or more toes, $50; two or more fingers, $50. For complete 
fracture of bones-of the skull (both tables), $320; lower jaw, $100; collar bone, $160; 
pelvis, $250; thigh, $300; leg (tibia and fibula), $200; knee cap, $200; arm (between 
elbow and shoulder), $160; forearm (between wrist and elbow, both bones), $100; two of 
more ribs, $50; two or more bones of the foot (other than toes), $125; two or more bones 
of the hand (other than fingers), $125; two or more fingers, $100; two or more toes, $80. 
Section 5. Medical Expense. — ^If such injury does not necessitate any surgical 
operation named in the "Schedule of Surgical Operations" endorsed hereon and does 
not xesult in total or partial loss of time, but necessitates medical treatment, the Com- 
pany will pay, upon presentation of physician's receipted bill, the amount esmended for 
such treatment, but not exceeding <me week's single indemnity for total loss ot time. 
Section 6. Special Indemntty. — Sunstroke caused by the sun's rays, freezing, hy- 



drophobia or asphynation sustained in each case through accidental means, or 
poisoning resulting directly and solely from an accidental bodily injury shall be c 
such injury within the meaning of this policy. 

Section 7. Additional Monthly Payments.— If such injury shall result in the 
death of the insured, the Compai^ will pay to the beneficiary, in addition to the indem- 
nity otiierwise payable, a monthly income of fifty dollars for each $7500 minimum 
I»incipal sum diuing the first year following the death of the insured; the first payment 
to be made upon receipt of due proof of such death, and to continue each month there- 
after until twelve monthly payments shall have been made. If the minimum principal 
sum is more or less than $75(X) proportionate monthly payments will be made. 

Sickness Insurance. 

Section 8. Total Loss or Timb Indemntty During House CoNnNEMENT. — (a> 
If such sickness shall render the insured wholly and continuously unable to transact each 
and every duty pertaining to his business or occupation and necessitate his continuous 
confinement within the house and treatment therein by a legally qualified physician, 
the Company will pay for the period of such confinement, not exceeding fifty-two con- 
secutive weeks, an mdenmity per wedk of twenty-five dollars. 

Total Loss op Time Indemnity— Non-Conpining Illness. — (b) If such sickness, 
whether preceded by a period of house confinement or not, shall render the insured wholly 
and continuously unable to transact each and evety duty pertaining to his business or 
occupation and require treatment by a legally qualified phj^ician, but shall not necessitate 
continuous confinement within the house, the Company will pay for the period of such 
disability not exceeding fifty-two consecutive weeks, an indemnity of one-half of the 
weekly indemnity specified in thb section for house confinement, llie period of time for 
which indenmity shall be paid imder this Section for either house confinement or non-con- 
fining illness or both combined, shall not exceed fifty-two weeks. 

■ Section 9. Hosptfal Indemnity.— The rate of indemnity specified in Section 8 shall 
be doubled if the insured is necessarily confined within a regularly incorporated hospital 
by reason of such sickness; and the rate of indemnity specified in Section 2 shall be in- 
creased fifty per cent, if the insured is necessarily confined within a regularly incorporated 
hospital by reason of such injury; provided in each case that the period for which the 
Company is liable under this section (9) shall not exceed fifteen consecutive weeks and 
that no claim is made for surgeon's fees under Section 10. 

Section 10. Surgeons' Fees por Operations.— If such injury or such sickness shall 
within ninety days from date of accident or beginning of sickness necessitate an opera- 
tion named in the "Schedule of Surgical C)perations^' endorsed hereon, the C>>mi>any 
will pay, in addition to the weekly indemnity otherwise payable, the amount specified 
in said schedule for such operation, but payment shall not be made for more than one oper- 
ation as the result of any one accident or illness. 

Section 11. lbld«aiFicATiON Certipicate.— If the insured shall, by reason of such 
injupr, be rendered physically unable to communicate with friends, the Company, upon 
receipt of tel^^aphic or other message giving the number of this policy, will immediately 
Ira nanit to his ic iatives orfriends an y infoim ation respecting him and w ill defray aU 



153 NATIONAL LIFE INS URANCE CX)MPANY 

necessary oqpense (not exceeding twentv doQats for each five dollan weekbr fwfafimity 
for total loss of time), to put the insured in care of friends. 

Foe Staiidasd Provisions, Sex Page 11. 

MiscxiXANEons Provisions. 

Section O.— No asngnment of interest under this policy shall bind the Gomnny 
unless consent thereto is formalbr endorsed hereon by an executive officer of the Com- 
pany. A copy of any assignment shall be given, within thurty days, to the Company, 
which shall not be responsible for its validity. 

Section P.— Affirmative proof of a surgical opemtion, or of hospital confinement, 
must be furnished to the Company at its said home office, within ninety days from the date 
of the opemtioujor of the termination of the confinement in a hcwpital. 

Section Q. — ^The insurance under the accident provisions of this t>oIiqr does not cover 
any injury, fatal or non-fatal, suUained by the insured while participating in or in con* 
sequence of having participated in aeronautics, or which shall result direct^ or indirectly 
from the bites or stmgs ol insects, from ptomaines, or from disease in any form; nor do 
the accident or sickness provisions cover war risk, or the insured while outside the United 
States (excluding Alaska or any foreign possessions of the United States) Canada or 
Europe. 

Section R.— The limit of liability as expressed in Standard Provision No. 19 refers 
to the minimum principal sum provided by the policy or policies issued by this Com^ 
pany to the insured. On the limit stated proportionate increased, as provided by the 
'' double indemnity" provision will be allowM. 

Section S. — ^The provisions above and the cop^ of the application endorsed hereon 
are made a part of this contract which is made subject thereto and to the payment of the 
premium. Strict compliance with all the provisions and reouirements is a condition 
precedent to recovery hereunder and failure in this respect shall forfeit to the Ounpany 
all right to any indemnity. 

In vdtness whereaf^ the National Life Insurance Company of the United States of 
America, has caused this policv to be signed by its president and secretary, but it shall not 
be in force until countersigned by a 6my authorized representative of the Company. 

Schedule or Surgical Operations.— (See Section 10). The amounts specified 
below are payable where the single weekly indemnity for total loss of time fr3m accident 
or illness amounts to $25. If such single weeklv indemnity i? r\ >re or less than $25 the 
amounts payable shall be increased or decreased proportionately. Abscess — incision, $5. 
Abdomen — cutting into abdominal cavity for diagnosis or treatment of organs therein, 
$1(X). Amputation of — entire hand, forearm or foot, $25; leg or arm (above knee or 
elbow), $50; thigh, $75; finger or fingers, toe or toes, $10. Aneurism — operation for 
tying of artery, $35. Appendicitis— see alxlomen, $100. Bone— injuries to or disease 
of; removal of dbeased portion of bone, $25. Carbuncle — mdsion, $5. C^est — cutting 
into thoracic cavity for diagnosis or treatment of organs therein, $25. Cancer of lip — 
removal of, by cutting operation, $25. Dislocation, reduction of — ^hip or knee, $35; 
shoulder, elbow or ankle, $25; wrist or lower jaw, $15: thumb, $10; fingers, $5; Eye- 
removal, $50. Excision — ^removal of — shoulder or nip joint, $100; knee joint, $75; 
elbow, wrist or ankle joint, $50; toe or toes, $10. Fractures — reduction of nose, lower 
jaw, collar bone or shoulder blade, $25. Fracture — breast bone or rii^s. $10; upper arm, 
$35; forearm or wrist, $25; hand (not fingers), $15; fingers, $5: bones of the pelvis (except 
coccyx), $75; coccyx, $10; thigh, $75; knee cap or leg, $50; bones of foot (except toes), 
$15; toes, $10. Goitre — cutting operation for permanent cure, $75. Gunshot woimda— 
treatment of, not necessitating amputation or any cutting operation into abdominal 
cavity, $12.50. Hernia — (abdominal)— any cutting operation for radical cure of reduc- 
ible, irreducible or strangulated form, $75. Hydrocele — ^incision and treatment of sac, 
$25. Hydrophobia — Pasteur treatment, $50. Inflammation of joiat — incision of joint, 
$25. Lockjaw — objection of antitoxin — into skufl, $100; into spinal column, $50. Mas- 
toiditis — cutting operation for removal of diseased bone, $50. Nerve— cutting opera- 
tion for stretching, $25. Rectum — cutting operation for — ^hemorrhoids, external, $15; 
hemorrhoids, internal, $25; prolapsed, $25; fistula in ano, $20; malignant stricture, 
$100. Skull — cutting into cranial cavity, $100. Spine or spinal column— operation 
with removal of fractured vertebra, $100. Stricture — oesophagus — cutting operation 
(external), for permanent cure of, $100. Stone in bladder — removal of by cutting or 
crushing, $75. Tapping of — abdomen, $25; bladder or chest, $15; ear drum, hvdrocele 
or joints, $10. Trachea — cutting into for removal of foreign bodies or for relief of diffi- 
cult breathing, $35. Throat — any cutting operation, $10. Tumors — removal of by 
cutting operation — malignant, $50; benign, $15. Varicocele— cutting operation for 
permanent cure, $25. Veins, varicose— cutting operation for permanent cure, $25. 
wounds— suturing, $5. 

POLICY FORM— "Perfect Protection." 

National Life Insurance Company of the United States of Amer- 
ica, Chicago 111. (hereinafter called the Company), 

In consideration of the policy fee of three dollars, and the statements and agreements in 
the application for this policy, a copy of which is endorsed hereon and made a iMurt hereof, 
does hereby insure John Doe (hereinafter called the insured), the person described in the 
copy of the application endorsed hereon, by occupation a bookkeei>er, with duties as 
therein described, under .classification AA, subject to all the conditions and limitatxNis 
boeiiiafter oontauied, frain the day this cootnct is dated, 12 o'clock noon staodaidtinis 



NATIONAL LIFE INSURANCE COMPANY 1^ 

of the pLux where insured resides when this policy b issued, until 12 o'clock noon^ such 
standard time, of the first day of January, 1916, and for such further periods, stated in the 
renewal receipts, as the renewal premium of %i per month, paid by the insured, will main- 
tain this policy in force; and prcnnises to pay as follows: 

CA) Total Accident DisABniry.— At the rate of sixty dollars per month for the period. 
Dot exceeding five consecutive years, that bodily injuries effected during the life of this 
poticv through external, violent and accidental means shall, directly and independently 
ol aU other causes, wholly and continuously from date of accident disable and prevent 
the insured from performing every duty pertaininc to any business or occupation and 
require and receive the regular attendance of a legally qualified physician or surgeon but 
shall not result in any of the losses mentioned in Paragraph C. 

(B) Paktiai. AccmxNT DiSABXury.—Or, at one-half the rate of indemnity specified in 
Paragraph A, for the number of consecutive days not exceeding six months, that the 
injuries therem described shall not cause total disability and shall not result in any of the 
losses mentioned in Paragraph C,^ but shall, directly and independently of all other causes, 
wholly and continuously, immediately f oUowins the termination of total disability or the 
date of acddent if there is no total disability, disable and prevent theinsured from per- 
forming at least one-fourth of the important daily duties pertaining to his occu^tion 
uk) shall require and receive the regular attendance of a legally Qualified physician or 
surseon; provided the maximum period for which indemnity shall be paid under Par* 
agraphs A and B hereof for any one injury shall not exceed five years. 

(C) Specoic Total Losses.— If the injuries described in Paragraph A shall, inde- 
pendently of all other causes, immediately, wholly and continuously from date of accident 
disable and prevent the insured from performing 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 (suicide, sane or 
insane, is not covered), the Company will pay, in lieu of all other indemnity: For loss of 
life, or both hands by sevenuice 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, six hundred dollars (the principal sum of 
thb policy); 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, one-third of the principal sum, but only one specific total loss (the greater) resulting 
from one accident will be paid. 

(D) DouBLB Accident iNDEMNiry. — If the injuries described in Paragraph A are sus- 
tamed by the insured (1) while riding as a passenger in a passenger elevator (elevators in 
mines excepted) ; (2) or while riding as a passenger within the enclosed part of any railway 
passenger car provided by a common carrier for the exclusive use of passengers; (3) or 
while ndhig as a passenger on board a stream vessel licensed for the regular transportation 
of passengers; and such injuries shall, in each case, be due directly to and received in 
oonseauence of the wreckitu; of such devator, car or vessel and shall not have been re- 
cdved while getting on or off, or being on the step or steps thereof: (4) or in consequence 
xA the burning of a building m which the insured is at the time of the commencement of 
the fire; (5) or in consequence of the collapse of the outer walls of a building while the 
insured is therem; (6) or in consequence ot a stroke of lightning, then the amount to be 
paid shall be double the sum that otherwise would be payable for any such injuries. 

(E) Special Accident Indemnities.— Sunstroke caused by the sun's rays, freezmg, 
or hydrophobia, caused in each case by accidental means shall be deemed a bodily injuiy 
effect through external, violent and accidental means. 

(F) If the injuries described in Paragraph A, whether fatal or non-fatal, (1) do not 
make a visible contusion or wound on the exterior of the body (accidental drowning and 
aq;>hyxiation excepted), or (2) are caused wholly or in part by volunti^ exposure to 
unnecessary danger or obvious risk of injury, by gas or poison, or by the intentional act 
of any person other than the insured (assaults committed on the insured for the sole pur- 
pose of buxgUry or robbery excepted); (3) are received as the result of or while violating 
Uw, the rules of a public carrier affecting the safety of its passengers or the public, or 
being under the influence of a^y narcotic or intoxicant or on the right of way or other prop- 
erty of a railway corporatl6n other than stations, platforms or regular crossings pre- 
scribed by law, not bemg at the time a passenger or employee of such railroad in the dis- 
charge of duty, then and in all cases referred to in this paragraph the liability of the Com- 
paziy shall be only one-fifth of the amount which otherwise would be i>ayable under this 
policy. 

(G) Optional Accident Indeicnities.— If the injuries described in Paragraph A 
cause one or more of the specific injuries named below and the insured so elects in writing 
within twenty days of the date of the accident, he may take as an immediate settlemmt 
for all the nedfic injuries so sustained, the greatest amoimt specified below for any one 
of them, and such pasrment shall be in lieu ofall indemnity that might otherwise accrue 
under Paragraphs A and B hereof. The amoimt specified below will be payable only 
in case the monthly accident indemnity is $50; if such indemnity is greater or less than 
$50, then the amount shall be increased or reduced proportionately. For loss of certain 
members, l^ complete severance, viz. — of one or more fingers (at least one entire pha- 
lanx), $65; of one or more entire toes, $90. For complete dislocation, viz. — of the shoul- 
der, $46: dbow, $45; wrist, $55; hip, $125; knee, $65; bones of the foot (not toes), 
$65; ank]e^$65; two w more fingers, $20; two or more toes, $20. For complete fracture 
of bones, viz. — of the skuU, both tables, $140; bwer jaw, $35; clavicle (collar bone), $65: 
pelvis, $115; thigh, $140; leg, $90; patella (knee cap), $90; arm, between elbow and 
shoulder, $90; forearm, between wrist and elbow, $65; two or more ribs, $45; foot or two 
or more toes, $55; hand or two or more fingers, $50; acapuki,$75. 

(H) CoMiiNiNG Iixmsss iNDEKNirv.^-At the rate of sixty dollars per month for the 
munbcr of ooosecutivQ days, after the first week and not exceeding six months, except as 
oChenrise i»o?lded in Paragxaph I, that the insured is necessarily, totally and continu* 
.oa4y CQomed withm the house aod therem tcgulaily visited by alq^ally qualified physi- 



shall be paid in advance, then ten per cent., or if a half year'spremium be so paid, the 
five per cent, shall be added to the indemnity provided imder Paragraphs A, B, H and 
on any claim originating within the period' for which the premium has oeen so paid. 
(L) Registration AND ^ «« ^ .«,.,. 



160 NATIONAL LIFE INSURANCE COMPANY 

dan by reason of sickness or disease that is not venereal in character and is oontiscted and 
begins duriziK the life of this poli^ and after sixty days from date hereof. 

(I) NoN-CoNFiNiNO IiXNESS INDEMNITY. — Or, at one-half the rate of indemnity spe- 
cified in Paragraph H for the number of consecutive days, not exceeding four weeks, uid 
after the first week unless immediately preceded by at least one wedc's confinement, 
that the insured is necessarily, totally and continuously disabled from performmg each 
and every duty pertaining to any business or occupation and requires and receives the 
regular attention of a legally qualified physician, but is not confined within the house, by 
reason of sickness or disease that is not venereal in characto: and is contracted and begins 
during the life of this i>oliar and after sixty days from date hereof; provided, however, 
that the maximum i)eriod for which indemnity shall be paid under paragFaphs H and I 
hereof for any one illness shall not exceed six months, and provided further that the 
nuuimum period for which the Company shall be liable under either or both of said 
paragraphs combined for disability due to either accident or iUness whoUy or in put 
caused by or resxilting directly or indirectly in tuberculosis, rheumatism, paralysis, 
cancer, sciatica, any chronic disease, insanity, hernia, m in the event of anvacddoital 
injury otherwise covered by this policy resulting in any of said diseases or ailments, ter- 
minating fatally or otherwise, shall be four weeks in any one policy year. 

(J) Funeral Benefit. — In event of the death of the insured while this policy is in 
force, as the sole and direct result of illness or disease that is contracted and begins after 
sixty days from date hereof (accidental death, or suicide, sane or insane, is not covered), 
the Company, in consideration of the life premium spedfied on page four of this policy, 
which premium is part of the monthly premium spedned on the first page hereof, will pay 
the beneficiary, if surviving, otherwise the executor or administrat<tf of the insured, tlK 
sum of one hundred dollars; provided, however, that if said death shall occur after the 
sixty days and within one year from date hereof, the amount payable under this pwa> 
graph shall be fifty dollars, anything herein to the contrary notwithstanding. The afore- 
said pajrment shau be in lieu of all other indemnity except any sum in excess of the amount 
payable to the beneficiary under this paragraph which may have accrued to the insured 
prior to his death as disability indemnity. 

(K) Ten Per Cent. Increase.— If at any time a full year's premium for this i 

* * ' 'the- 

I 

r Aia> iDENnncAHON.^The Company will place the "insured's 
name on its registxation list, and if by reason of such injury or illness as is covered by this 
policy he shall be physically unabb to communicate with friends the Company will, 
upon receipt of a telegram or other message giving this policy number, immediately 
transmit to his relatives or friends any informatbn respecting him and defray all expenses, 
not exceeding twenty-five dollars, necessary for pUdng him m thek care. 

(M) Miscellaneous Provisions. — ^Ifthe insured is disabled by injury or sickness 
for more than thirty days, he or his representative shall furnish to the Company eveiy 
thirty days, or as near Uiereto as may be reasonably possible, with a rnwrt in writing' 
from his attending physician or sur^n fully stating the condition of the insured and 
the probable duration of his disabihty. Stnct compliance with all the provisions and 
requirements of this policy is a condition precedent to recovery hereunder and failure 
in this respect shall forfeit to the Company all right to any indemnity. No provision 
of the charter or by-laws of this Company shall be used in defense of any claim ariang 
under this policy. The payment of a past due premium shall not continue this insurance 
in force beyond the first day of the succeedmg montJi. The insured may, at any time, 
release the Company from any and all liability then existing or thereafter accruing to 
the beneficiary. 

For Stamdaid Provisions, Seb Paob 11. 

POLICY FORM— "Peerless." 

National Life Insurance Company of the United States of Amer- 
ica, Chicago, 111. (hereinafter called the Company), in consideration 
of the policy fee of three dollars, and the statements and agreements 
in the application for this policy, a copy of which is endor%d hereon 
and made a part of this contract. 

Does hereby insure John Doe (hereinafter called the insured), the person described in the 
copy of the application endorsed hereon, by occupation a cJerk, with duties as therein 
described, under classification AA, subject to all the conditions and limitations hereinafter 
contained, from the day this contract is dated, 12 o'clock noon, standard time of the 
place where insured resides when this policy is issued, until 12 o'clock noon, such standard 
time, of the first day of January, 1916, and for such further periods, stated in the renewal 
receipts, as the renewal premium of $1 per month, paid by the insured, will maintain this 
poliqf' in force; and promises to pay as follows: 

(A) Total AccmENF Disability. — ^At the rate of fifty dollars per month for the 
period, not exceeding five consecutive years, that bodily injuries effected during the life of 
this policy solely through external, violent and accidental means shall, duectly and 
independently of all other causes, wholly and continuously from date of accident disable 
and prevent the insured from performing every duty pertaining to his business or coco- 
pation and require and receive at least once in each seven days the attendance of a l^w 
qualified physician or surgeon but shall not result in any of the losses mentioQed in Pant- 
graph C. 

(B) Partial Accident Disability.— Or, at one-half the rate of indemnity specified 
m Paragraph A, for the number of consecutive days not exceeding six month*, taM the 
injuries tbereiD described shall not cause total dinbHity and sbaD D9t r^( 1a any of 



NATIONAL LIFE INSURANCE COMPANY 161 

the losses mentioned in Paragraph C, but shall directly and independently of all other 
causes, wholly and continuously, immediately following the termination of total disabiU^ 
or the date of accident if there is no total disability, disable and prevent the insui^ 
from performing at least one-fourth of the important daily duties pertaining to his occu- 
pation and shall require and receive at least once in each seven days the attendance of a 
legally qualified phj^cian or surgeon; provided the maximum period for which indemnity 
shall be paid under Paragraphs A and B hereof for any one mjury shall not exceed five 
years. 

(C) SpEcmc Total LossES.~If the injuries described in Paragraph A shall inde- 
pendently of all other causes, immediately, wholly and contfaiuously from date of accident 
disable and prevent the insured from periormizig eveiy duty pertaming to his business or 
occupation and shall, during the period of such disability and within ninety days from 
date of accident, solely result in any one of the following specific total losses (suicide, sane 
or insane, is not covered), the Company will pay, in lieu ofall other mdemnity except that 
arising under Paragraph L. For loss of life, or both hands by severance at or above the 
wristjomt, or both feet by severance at or above the ankle joint, or one hand and one foot 
by severance at or above the wrist or anicle ioint, 6t entire si^t of both eyes, if irrecover- 
ably lost, five hundred dollars, the principal sum of this policy; either hand by severance 
at or above the wrist joint, or either foot by severance at or above the ankle joint, one- 
half of the principal sum; entire sight of one eye, if irrecoverably lost, one-third of the 
principal sum; but only one specific total loss (the greater), resulting from one acdde t 
will be paid. 

For Section D, See Preceding Policy. 

^) Speciai. Accident Provisions. — Sunstroke caused by the sun's rays, freezing, 
or hydrophobia, caused in each case by accidental means, shall be deemed a bodily injury 
effected throueii external, violent and accidental means. Injuries, fatal or non-fatal, 
which do not produce immediate and continuous disability from date of accident, or 
which do not make a visible contusion or wound on the exterior of the body (accidental 
drowning and asphyxiation excepted), or which are caused wholly or in part, directly or 
indirectly by disease in any form shall be considered as arisingout of sickness or disease 
and are covered only under and subject to the provisions of Paragraphs H, I, J and L 
hereof. 

(F) Not Covered. — This polky does not cover injuries, fatal or non-fatal, which are 
received as the result of or while violating law or being under the influence of any narcotic 
or intoxicant or on the right of way or other property of a railway corporation other than 
stations, platforms or regular crossings prescribed by law, not being at the time a pas- 
ttoger or employee of such railroad in the discharge o! du^, or which are caused wholly or 
in part by the intentional act of any person other than the insured (assaults committed on 
the insured for the sole purpose of burglary or robbery excepted). 

For Section G, See Preceding Poucy. 
(H) CotmNlNO Illness Indemnity.— At the rate of fifty dollars per month for the 
number of consecutive days, after the first week and not exceeding six montJis, that the 
insured is necessarily, totally and continuously confined within the house and therein 
visited at least once m each seven days by a legally qualified physician by reason of sick- 
ness or disease that is not venereal in character and is contracted and begins during the life 
of this policy and after thirty d^^ from date hereof. 

, (I) Non-Confining Illness Indemnity. — Or, at one-half the rate of indemni^ spe- 
cified in Paragraph H for the number of consecutive days, not exceeding four weeks, 
and after the first week unless immediately preceded by at l«»t one week's confinement, 
that the insured is necessarily, totally and continuously disabled from performing each 
and every duty pertaining to any business or occupation and requires and receives at least 
once in ea(:h seven days the attention of a legally qualified physician, but is not confined 
within the house, b;y reason of sickness or disease that is not venereal in character and is 
contracted and b^ins during the life of this policy and after thirty days from date hereof; 
^ovided, however, that the maximum period for which indemnity shall be paid under 
Paragraphs H and I hereof for any one iUness shall not exceed s^ months. 

For SEcnoNS J, K aud L, See Preceding Policy. 
(M) MiscxLLANEOUS PROVISIONS. — ^If the insured is disabled by injury or sickness fof 
TDom than thirty days, he or his representative shall furnish to the Company every thirty 
dayS; or as near thereto as may be reasonably possible, a report in wnting from his at- 
tendmg physician or surgeon fully stating the condition of the insured and the probable 
duration ofhia disability. Strict compliance with all the provisions and requirements €d 
this policy is a condition precedent to recovery hereunder and failure in this respect shall 
forfeit to the Companv all right to any indemnity. No provision of the charter or by-laws 
of this Company shall be used in defense of any claim ansing under this policy. The pay- 
ment of a past due premium shall not continue this insurance in force beyond the first 
day of the succeeding month. The acceptance of any renewal premium shall be optional 
with the Company. The insured may, at any time, release the Company from any and 
all liability thm existing or thereafter accruing to the beneficiary. Fraud, conceument 
or false swearing in attempting to secure indemnity hereunder shall, subject to any 
provision of a statute of the state in which the insured shall reside, invalidate any daim* 
For Standard Provisions. Seb Page 11. 



162 NEW AMSTERDAM CASUALTY COMPANY 

K^u; /i/nsterdam Casualty Qo(npa9y. 

59 JOHN STREET, NEW YORK CITY 
7 ST. PAUL STREET. BALTIMORE, MD. 



Commenced Business 1899. J. Arthxtr Nelson, Pres. Geo. £. Taylok, Sec. 



The New Amsterdam Casualty Company issues personal acci- 
dent and health policies under six classifications of risks, besides 
special hazards. 

The leading forms are the "Maximum Indemnity Accident" pol- 
icy, "Maximum Indenmity Disability," "Cumulative Disability," 
"Combination Accident," and the "Combination Disability." The 
Company also issues two forms of travel policy, the "Special Trav- 
el" and the "Definite Payment Travel" policy. 

Age Limits. — Eighteen to sixty-five. 

The "Straight Accident" policy is issued in amotmts from $1000 
death benefit, and $5 weekly inaemnity to $10,000 death and $50 
weeklv indemnity. It gives specific indemnities for loss of limb 
or sight and pays for partial disability. Premium in Class 1 is $4 
for each $1000 principal sum. 

The "Maximum Indemnity Accident" pays surgical operations, 
doctor bills and extra indemnity for hospital confinement. Ordi- 
nary indemnities are doubled for travel accidents. Specific indem- 
nities paid in lieu of weekly indemnity. No waiting for accumula- 
tions. Full accumulations given from the start. Premium in 
Class 1 is $5 for each $1500 of principal sum. 

The "Maximum Indemnity Disability." This policy covers 
every accident and every disease. For total disabihty for illness 
or disease it pays from the first day to 52 weeks. Confinement to the 
house not necessary. If disability continues beyond the 52 weeks 
period it pays one-quarter of the weekly indemnity until disability 
ceases. No waiting for accumulations. Full accumulations given 
from the start. Premium in Class 1 is $12 for each $1500 of prin- 
cipal sum. 

The "Cumulative Disability." This is our latest accident and 
health policy. It accumulates at the rate of 10 per cent per yeai 
with each annual premium paid on cUl indemnities until they are 
50 per cent greater than at first. Additional indemnity is paid for 
hospital confinement through accident or disease, for a period of 12 
weeks. Total disability for illness or disease indemnity "is paid 
from the first day to 52 weeks. House confinement not necessary. 
Specific indemnity paid in lieu of weekly indemnity. Operation fees 
paid in addition to other indemnity. Premium in Class 1 is $15 
for each $1000 of principal sum. 

The "Combination Accident" policy doubles all ordinary indem- 
nities for travel accidents in the most liberal manner. It gives a 
long list of special valuable indemnities. It increases the principal 
indemnities 10 per cent with each annual premium until the limit 
of 50 per cent is reached. Premium in Class 1 is $5 for each $1000 
of principal sum. 

The "Combination Disability" policy. This policy covers every 
accident and everv disease and combines all of the accident indem- 
nities of the Combination Accident policy. Premium in Class 1 is 
$12 for each $1000 of principal sum. 

Health Insurance 
The company also issues health policies without the accident 
feature. The "Complete Health" covers every disease and illness, 



NEW AMSTERDAM CASUALTY COMPANY 163 

the fonner from the first day of any disease or iUness, at a premium 
in Class 1 of $7 for each $5 weekly indemnity. The "Specific" 
covers fifty specified diseases, from the first dav of any disease or 
illness, at a premium in Class 1 of $2.50 for each $5 weekly indem- 
nity. 

Travel Policies 
These policies cover accidental injuries sustained while riding 
as a passenger in or on a public conveyance regularly provided by 
a common carrier, or riding in a passenger elevator, or within any 
burning building, or in consequence of the collapse of the outer 
walls of a buildmg, or of being struck by lightning, or of the ex- 
plosion of a steam boiler, or of cyclones or tornadoes, or while walk- 
ing on or across any public highway, in consequence of being struck 
or knocked down or run over by any vehicle. Either one pays 
$5,000.00 for loss of life, of both hands, or both feet, or both eyes, 
or of one hand and foot; $2,500.00 for loss of one hand or foot; and 
$1,666.00 for loss of one eye. The Special Travel pays $15.00 
weekly for a period of 26 weeks for total disability resulting from 
such accidental injury or $7.50 weekly for 10 weeks for partial 
disability. The Definite Payment Travel Policy pays instead of 
weekly mdemnity a definite specified sum of from $10 to $400 for 
any injtiry sustained as above described if sufficientlv severe to 
require the services of a physician. Neither policy has any re- 
stnctions as to occupation or change of occupation. The definite 
payment requires no proof of absence from business or inability 
to do business and contains no restrictions as to income. 

POLICY FORM — "Maximum Indemnity Disability" 
Principal Sum, $7500-415,000. Weekly Indemnity, $25-$50 
Annual Premium, Select, $60. 
New Amsterdam Casualty Company (herein called the Compajiy) 
agrees to pay to the person named in Statement 1 of the applica- 
tion, a copy of whicn is endorsed hereon, hereinafter called the 
Insured, wnose occupation is accountant, or in the event of his 
accidental death, to the beneficiary if surviving, otherwise to the 
executors or administrators of the Insured, subject to the provi- 
sions, definitions, statements and limitations herein set forth, the 
indemnities herein stipulated. The principal sum of this policy is 
seventy-five hundred dollars ($7500). The weekly indemnity is 
twenty-five dollars ($25). The premium is sixty dollars ($60). 
The period of time for which this insurance shall be in force is 
twelve months from noon, standard time, on the first day of Jan- 
uary, 1916. 

Accident iNDEicinnES. — ^The injuries covered by this policy and which are herein- 
after referred to as Such Iniuries, are bodiW injuries not intentionally self-inflicted, 
which, independently of all other causes, are effected solely and exclusively by accidental 
means occurring dunng the period of this policy and which are not caused or contributed 
to by illness or disease, or disappearance or b}^ suicide, whether the Insured be sane or 
vaaane, or sustained while participatmg in or in consequence of hkving participated in 
aeronautics or aviation, or sustained while the insured is en^ged in military or ilaval 
service in time of war, not excluding such injuries resulting directly from a bodily injury 
caused or contributed to wholly or partly, directly or indirectly, by choking by swallow- 
u^, sunstroke, freezing, somnambulism, assault by burglars or highwaymen or blood- 



Loss of hand or hands, or loss of foot or feet shall mean actual reparation thereof at 
*u «"**^® ***® ^mst or ankle by reason of such injuries. Loss of the sight of eye or eyes 
shall mean permanent total and incurable blindness thereof by reason of such injuries. 
. A. If such injuries shall result within ninety days of the event causing such injuries, 
m any of the losses following, numbered 1 and 2, the company will pay the sum set op- 
posite such losses, or if such iniuries during a period of total disability by accident as 
^^?° defined and within two htmdred weeks of the event causing such injuries, shall 
result m one of the numbered losses above specified, then the Company will pay the 
^^ ^^ opposite such loss in addition to the weekly indemnity due hereunder for such 
Penod of total disability: 



164 NEW AMSTERDAM CASUALTY COMPANY 

1. Loss of life, or of both hands or of both feet, or of one hand and one foot, or of 
the sight of both ^es, the principal sum, 



2. JLoss of one hand or one foot or of the sight of one eye, half the | 

B. If the insured shall be immediately, continuously and wholly di - ^ 
vented from performing any- and every part of the duties pertaining to his occupation 
stated herein by reason of such injuries, whicb shall not result from loss of limb or of 
sight, the Company will pay the full weekly indemnity for such total disability while 
such disability continues. 

C. If the msured immediately following the event causing the injury, or immediately 
following a period of loss of time from total disability as defined herein, shaU be continu- 
ously and whoUy disabled and prevented from fierforming some material part of the 
important daily duties pertaining to his occupation stated herein, by reason of such 
injuries, which shall not result from loss of limb or of sight, the Company wHl pay one- 
half of the weekly indemnity for a term not exceeding twenty-six consecutive weeks. 

D. The insured may elect to receive specific iademmty for any iniury named in the 
following list in lieu of any other indemnity stipulated above ^vided he shall so notify 
the Company within twenty days of the event causing the mjiuy, and the Company 
will pay such proportion of the sum stated therein for the given injury as the prindpu 
sum of this policy bears to seven thousand five hundred dollars. 

For loss of one or more fingers (at least one entire phahinx), $160; one or more entire 
toes $200. For complete hernia caused solely and directly by accidental injury, $80. 
For complete dislocation of the shoulder, $60; the elbow, $100; the wrist. $120; the hip, 
$:100; the knee, $160; any bones of foot (not toes), $160; the ankle, $160; two or more 
toes or fingers, $60. For the complete fracture of bones of the skull, both tables, $325; 
the lower jaw. $80; the coUar bone, $160; the pelvis, $250; the thigh, $J00; the leg, the 
knee cap or the arm between elbow and shoulder, $200; the forearm, between the wrist 
and elbow, $150; two or more ribs, toes or fingers, $100; the foot (not toes) or the hand 
(not fingers), $125. 

E. If any loss designated in paragraphs A, B, C or D is sustained as follows, the in- 
demnities specified therein are doublni: (a) While riding as a passenger in or on a public 
conveyance (including the platform, steps or runnmg board thereof) regulariy provided 
by a common carrier for the transportation of pa^engers, or ^) while riding as a pas- 
senger m any passenger elevator, or (c) while within any bummg building not being on 
duty as member of a fire department, or (d) in direct consequence of cyclones or tor- 
nadoes. 

F. If the insured as a direct result of total disabflit^ by accident covered by this 
policy, during a period of such total disability and within six months from the date of 
the event causing such injuries as aforesaid, shall become irrecoverably insane by reason 
thereof and shall within such period be committed by the proper authorities to a duly 
licensed public or private asylum or hospital for the msane and shall be certified by 
competent medical authority, satisfactory to the Company, to be irrecoverably insane, 
the C^ompany will pay the principal sum. 

Illness and Disease Indemnities. — Disease or illness covered by this policy is dis- 
ease or illness which shall be treated by a licensed physician which shall begin after 
fifteen days from noon of the day this policy is issued: which shall be contracted by the 
insured during the period of this policy; which shall be contracted and suffered within 
the United States, Canada and Europe only; and shall not include any disease or illness 
resulting from voluntary or imnecessaiy exposure to contagion or infection or beginning 
while engaged in military or naval service lA time of war. 

G. Ifduring the period of this policy the insured shall suffer the entire loss of the use of 
hand or foot or of hands or feet due independently of all other causes to permanent paral- 
yse caused by such disease or illness, or if during the period of this policy the insured shall 
suffer permanent, total and incurable blindness of eye or eyes due independently of all 
other causes to such disease or illness which in either case shall be so certified by com- 
petent medical authority satisfactory to the Company, and which shall not result in 
death but shall render the msured wholly and permanently unable to engase at any time 
thereafter in any work or occupation for wages or profit, the Company will pay for any 
such loss specified below the sum set opposite such loss. 

1. For loss of sight of both eyes or of the use of both hands or both feet or of one 
hand and one foot, half the principal sum. 

2. For loss of the sight of one eye or of the use of one hand or one foot, quarter the 
principal sum. 

^ H. If the insured shall be independently of all other causes continuously and wholly 
disabled and prevented from performing any and every part of the duties pertaining 
to any business or occupation because of and while suffermg from any such disease or 
illness which condition is hereinafter referred to as total disability from disease or Sl- 
ness, or 

I. If the insured immediately following such period of total disability from disease 
or illness shall be continuously and wholly disabled from performing at least one-half <^ 
the duties pertaining to his business or occupation, which condition is hereinafter re- 
ferred to as partial disability from disease or illness, or 

J. If the insured immediately following a period of total or partial disability from 
disease or illness shall be continuously and wholly disabled and prevented from per- 
forming some material part of the important daily duties nertaining to his business or 
occupation, which condition is hereinafter referred to as Convalescent Disability from 
disease or illness, the Company will pay imder para^japhs H, I and J. for a total period 
not exceeding fifty-two consecutive w^ks, weekly indemnity as follows: 

3. For loss of time from total disability from disease or illness, the full weekly in- 



NEW AMSTERDAM CASUALTY COMPANY M 

4. For loss of time from partial disability froiq disease or illness, half the weekly 
indemnity. 

5. For loss of time from convalescent disability from disease or illness, quarter the 
weddy indemnity. 

K. If the insured immediately following a period of fifty-two consecutive weeks of 
total or partial disability from disease or illness shall stiU suffer such total or partial 
disability, the Company will pay one-quarter of the full weekly indemnity so long as 
the insuj^ shall live and such total or partial disability continues. 

General iMDEiiNiriES. — ^L. If the insured shall suffer from accidental injury or 
illness or disease not resulting in any of the losses specified herein, but requiring treat- 
ment by a physician the Company will reimburse hun for the medical expense thereof, 
not exceeding the weekly indenmity for one week and in no event exceeding twenty-five 
dollars ($25) provided that written notice of such accident or illness is given as provided 
herein and that the affidavit of the insured on the blank furnished by the Company 
and the receipted bill of the physician is furnished to the Company within thirty days 
Alter the date of the accident or the commencement of the illnos. 

M. Upon the issue of this policy the insured b entitled to a certificate of identifica- 
tion wherein the Company agrees that if the insured by reason of injury or illness is 
physically unable to communicate with friends, the Company, upon receipt of a telegram 
or other message giving the nimiber of the pc^cy, will immediately transmit to his rela- 
tives or friends anv information respecting him and will defray all expenses necessary 
to place the insured in the care <rf his family, provided that the liability of the Company 
for such e^qiense shall not exceed the sum of twenty dollars for each one thousand dollars 
of the principal smn stated herein. 

N. If the insured while suffering total disability from accident or disability from 
disease or illness by reason thereof and within ninety days from Uie date of the accident 
or the commencement of illness or disease, is confined in a regular hospital, the Company 
will pay, in addition to the indemnity othorwise payable for such disability, the amount 
expended by him weekly on account of howital charges for a period not exceeding twelve 
consecutive weeks and not exceeding one^half of the weekly mdenmity provided herein. 

0. For surgical operations such proportion of the simi specified for each in the list 
of operations beneath as the principal sum of this policy bears to seven thousand five 
hundred dollars shall be payable for the maximum oiieration only resulting from any 
disease or illness or accident covered by this policy within ninety days from the com- 
mencement of disability from such disease or illness or mjury in addition to the indem- 
nity, a any, specified otherwise by this policy. Operations not named in the list of 
operations are not covered. 

Amputation of foot, hand or forearm, $25; leg or upper arm, $50; thigh, $100: finger w 
fingers, $10. Reduction of diskxration of shomder, elbow, hip, knee or ankle, $25; wrist 
or lower jaw. $15; thumb or fingers, $10. Reduction of fracture of nose, lower jaw, 
collar bone, shoulder blade or forearm (one or both bones), $25; breast bone, rib or ribs, 
fingers or toes or coccyx, $10; ui>per arm, $35; wrist, hand or bones of foot, $15; any 
bones of pdvis or sacrum, $50; thigh, $75; knee cap or leg bones (one or both), $50. Ap- 
Dendicitis, laparotomy, lithotomy, peritonitis or any opening of the abdominal cavity, 
1100. Any cutting operation for radical cure of hernia, $100. Aneurism (tumor of 
artery), ligation, $50. Bronchotomy, thyrotomy, Uuyngotomy, laryngotracheotomy, 
tracheotomy or mastoiditis, $50. Exci^on of toe or toes, $25; shomder, hip or knee 
joint, $100: elbow, wrist or ankle joint, $50. Fixation or removal of kidney, $100. Oesoph- 
ogotomy, $100. Malignant stricture-excision or colostomy, $100. Skull trephining, $100. 
Tetanus, injection of serum, $100. Bone abscess, trephming, $25. Caries (bone ulcer), 
curetting, $15. Ganglion-incision and curetting, $15. Gunshot wounds (no amputation 
or laparotomy). $25. Hydrocele-tappuig-iacision or excision of sac, $25. Necrosis (re- 
moval of dead Done), $25. Paracentesis, ear drum, $15; tappine of abdomen or bladder, 
$25. (^ration for prolapsed rectum, hemorrhoids, incision for fistula or extirpation 
of polypus, $25. Synovitis (inflammation of the linmg membrane of a joint), incision, 
$25. Extirpation ot tumors^ benign, $15; malignant, $50. Ligation or incision varicose 
veins, $25. Ligation or excision, varicocele, acupressure, $25. Abscess, boil, carbuncle 
or fekm, incision, $5. Any cutting operations of eye, ear, nose or throat, $10. Removal 
of ingrowing toe nail, $10. Suturing wounds, $5. 

FoK Standard Provisions See Page 11 

Other Provisions 

21. The Company shall not, for the same period of time, be liable for disability on 
account of both accident and illness or disease. 

22. Loss of sight or hearing or loss of hand or foot or loss or impairment of rea.son 
shall immediatdy terminate this insurance; in such event the unearned portion of the 
premium pro rata will be returned to the insured on demand. 

23. No claim shall be valid for more than one of the losses specified in this policy 
under paragraphs A, B, C. D, F, G, H, I, J and K except that a claim may be valid 
imder paragraphs B and C or under paragraphs H, I, J and K; and it is hereby a^eed 
that this policy shall not cover any injury, disability or death resulting directly or mdi- 
rectly from any act of war, or riot, or mvasion. 

24. All death claims shall be subject to proof of interest and no assignment of interest 
shall be valid without the consent of the Company endorsed hereon and signed by the 
president, vice-president or secretary of the Company. 

25. The payment of any kras under paragraphs A, F or G herem shall terminate 
this policy. 

26. The msurance hereunder may be renewed only with the consent of the Company 
for the same premitui and the same period of time as provided in this policy, by payment 



166 NEW AMSTERDAM CASUALTY COMPANY 



pol 
do] 



of such premium in advance until the insured shall reach the age of 51 years. If the 
olicy shall be renewed thereafter, the premium shall be increased at the rate of two 
[oUars annually, for each five dollars weekly indemnity provided. 

27. No provision of the charter, constitution or by-laws of the Company not mduded 
herein shall avoid the {lolicy or be used in evidence in any legal proceedmg hereunder. 

28. This agreement is made in consideration of the premium and of the statements 
contained in the application, a copy of which is endorsed hereon and is herebv made a 
part of this contract. Claims not made in accordance with the provisions of this policy 
will be forfeited to the Company. 

POLICY FORM—" Cumulative Disability" 

(Illness and Disease) 

Principal Sum, $5000-$ 10,000. Weekly Indemnity, $25-$50. 

Annual Premium, $75 

New Amsterdam Casualty Company (herein called the Company) 
agrees to pay to the person named in Statement 1 of the applica- 
tion, a copy of which is endorsed hereon, hereinafter called the In- 
sured, whose occupation is actuary, or in the event of his accidental 
death, to ;the beneficiary if surviving, otherwise to the executors 
or administrators of the Insured, subject to the provisions, defini- 
tions, statements and limitations herein set forth, the indemnities 
herein stipulated. The principal sum of this policy is five thousand 
dollars. ($5000). The weekly indemnity is twenty-five dollars 
($25). The premium is seventy-five dollars ($75). The period of 
time for which this insurance shall be in force is twelve months from 
noon, standard time, on the first day of January, 1916. 

Accident Indemnities. — ^The injuries covered by this policy and which are herein- 
after referred to as Such Injuries, are bodily injuries which, independently of all other 
causes, are effected solely and exclusively by accidental means occurring during the 
period of this policy and which are not caused or contributed to by illness or disease, 
or dis|4l)P^'^^^^ or by suicide, whether the insured be sane or insane, or sustained while 
particii^tmg in or in consec^uence of having participated iti aeronautics or aviation, or 
.^vystained Yvl^ile the insured is engaged in mihtary or naval service in time of war, not 
€;Xcludiijigf.'sjuwph injuries resulting directly from a bodily injury caused or contributed to 
wholly or partly, directlv or indirectly, by choking by swallowing, sunstroke, freezing, 
somnambulism, assault by burglars or highwaymen or blood-poisoning. 

Loss of hand or hands, or loss of foot or feet shall mean actual separation thoeof at 
or above 'the wrist or ankle by reason of such injuries. Loss of the sight of eve or ^es 
shall mean permanent total and incurable blindness thereof by reason of such injuncs. 

For paragraphs A, B, C, D, E, F, G, H, I and J see preceding policy. 

General Indemnities. — K. If the insured shall suffer from accidental injury or 
illness or disease not resultmg in any of the losses specified herein, but requiring treat- 
ment by a physician the Company will reimburse him for the medical expense thereof, 
not e»;eeding the weekly indemnity for one week and in no event exceeding twenty-five 
dollars ($25) provided that written notice of such accident or illness is given as provided 
herein and that the affidavit of the insured on the blank furnished by the Company 
and the receipted bill of the physician is furnished to the Company within thirty days 
after the date of the accident or the commencement of the illness. 

L. Upon the issue of this policy the insured is entitled to a certificate of identification 
wherein the Company agrees that if the insured by reason of injury or illness is phys- 
ically unable to communicate with friends, the Company, upon receipt of a telegram 
or other message giving the number of the policy, will immediately transmit to his rela- 
tives or friends any information respecting him and will defray all expenses necessary 
to place the insured in the care of his family, provided that the liability of the Company 
for such expense shall not exceed the sum of twenty dollars ($20) for each one thousand 
dollars ($J000) of the principal sum stated herein. 

M. If the insured while suffering total disability from accident or disability from 
disease or illness by reason thereof and within ninety days from the date of the accident 
or the comipencement of illness or disease, is confined in a regular hospital, the Company 
will pay, in addition to the indemnity otherwise payable for such disability, the amount 
expended by him weekly on account of hospital charges for a period not exceedmg twelve 
consecutive weeks and not exceeding one-half of the weekly indemnity provided herein. 

For Surgical Operations See Preceding Policy 
O. If this policy is continuously renewed by the payment of the annual premium in 
advance, the Company will increase the indemnities specified as payable hereunder 
ten percent for each consecutive annual renewal until each of the said indemnities b 
increased fifty percent. Thereafter, so long as this policy shall remain in force, the 
insurance shall be for the original sums plus all of the accumulations. 

For Standard Provisions See Page 11 



NEW AMSTERDAM CASUALTY COMPANY 167 

OlHXK PROVISIONS 

21. The Company shall not, for the same period of time, be liable for disability on 
account of both acddent and illness or disease. 

22. Loss of sight or hearing or loss of hand or foot or loss or impairment of reason 
shall immediately terminate this insurancej in such event the unearned portion of the 
pranium pro rata will be returned to the msured on demand. 

23. No daim shall be valid for more than one of the losses specified in this policy 
under paragraphs A, B, C, D, F, G, H, I and J except that a claim may be valid under 
paragraphs B and C or under paragraphs H, I and J. 

24. All death claims shall be subject to proof of interest and no assignment of in- 
terest shall be valid without the consent of the Company endorsed hereon and signed 
by the presidait, vice-president or secretary of the G>mpany. 

25. The payment of any loss under paragraphs A, F or G herein shall terminate this 
policy. 

26. The insurance hereunder may be renewed only with the consent of the Com- 
pany for the same premiimx and the same period of time as provided in this policv, by 
payment of such i»remium in advance until the insured shall reach the age of 51. If tat 
Txmcy shall be renewed thereafter, the premium shall be increased at the rate of two dol- 
lars ($2) annually for each five dollars ($5) weeklv indemnity provided. 

27. 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. 

28. This agreement is made in consideration of the premium and of the statements 
contained in the api^ication, a copy of which is endorsed hereon and is herebv made a 
port of this contract. Claims not made in accordance with the provisions of this policy 
will be forfeited to the Company. 



166 NEW fiyrGLANt) EQtJitABtg mStJRANCfe COMPANY 

New England Equitable Insurance Company. 

BOSTON, MASS. 



Commenced Busmess 1910. B. J. Taussig, President. 

Walter H. West, First Vice-PresidcnL 



The New England issues accident and disability policies as 
follows: 

The Commercial Accident Policy, Principal Sum, $7,500-$15,000. 
The weekly indemnity of $25 is payable during the extent of total 
disability and $12.50 a week is payable for 30 weeks for partial dis- 
ability. The annual premium for select risks is $25; preferred 
risks, $30; extra preferred risks, $35; and ordinary risks, $42.50. 
Commercial Disability Policy, Principal Sum, $7,500-$15,000. 
Weekly indemnity while totally disabled, $25 and while partially 
disabled, $12.50. The weekly accident indemnity for total disa- 
bility is payable as long as the assured lives and is totally disabled, 
and the weekly indemnity for partial disability is payable up to 30 
weeks. The weekly sickness indemnity is $25 payable while totally 
disabled and confined to the house up to 52 weeks. The May- 
flower Special Accident Policy is issued to select risks with an 
annual premium of $30. This policy provides for a weekly indemnity 
while totally disabled of $25 to $37.50, or while partially disabled, 
$12.50 to $18.75 payable for 30 weeks. The Principal Sura is $7500 
doubling $15,000 if injuries are sustained while in or on a public 
conveyance. The Mayflower Special Disability Policy, Principal 
Sum $7500-$15,000. The weekly indemnity of $25 is payable for 
disease while totally disabled up to one year, whether confined to 
the house or not, and a weekly accident indemnity of $25 is paid as 
long as totally disabled. While partially disabled, $12.50 per week 
is paid up to 30 weeks. The premiumfor select risks, ages 18-50, 
is $75, and ages 51-60, is $92.50. 

POLICY FORM— "Commercial Accident." 

Principal Sum, $7500-$15,000 Weekly Indemnity, $25-$50. 

Annual Premium, $25. 

New England Equitable Insurance Company, Boston, Mass. 
(hereinafter called the Company), does hereby insure John Doe, 
under classification select, by occupation an accountant, for the term 
of twelve months, beginning at twelve o'clock noon, standard time, 
of the place where the policy is countersigned, on the first day of 
January 1915, against loss resulting from bodily injuries, effected 
directly and independently of all other causes, through accidental 
means (suicide, sane or insane, is not covered), as specified in the 
following schedule, subject to the provisions and limitations herein- 
after contained. 

Schedule of Imdeicnities. 

The principal sum insured hereby is seven thousand five hundred dollars. The weekly 
indemnity for total disability is twenty-five dollars. 

Part A. Death, Dismemberment and Loss of Sight— Single Indemnity.— If 
such injuries alone shall wholly and continuously disable the insured from date of accident 
from performing any and every kind of duty pertaining to his occupation, and during the 
period of such continuous disabilitv, but within two hundred weeks from date of acci- 
dent, shall result independently and exclusively of all other causes in any one of the losses 
enumerated below, or within ninety days from the date of the accident, irrespective of 
total disability, result in like manner in any one of such losses, the Company will pay the 
sum set opposite such loss and in addition weekly indemnity as provided in Fart B to the 
date of death, dismemberment, or loss of sight; but onlv one of the payments named will 
be made for injuries resulting from one accident. For loss of life, or both hands or both 
feet, or sight of both eyes, or one hand and one foot, or either hand or foot and sight of oae 



NEW ENGLAND EQUITABLE INSURANCE COMPANY 169 

eye, the principal sumj either hand or foot or sight of one eye, one-ha]f principal sum. 
"Loss" shall mean, with regard to hands and feet, dismemberment by severance at or 
above wrist or ankle joints; with regard to eyes, entire and irrecoverable loss of sight. 
The payment in any such case shall end this policy. 

Part B . Total Loss of Time. Total and Partial DiSABurry— Single Indemnity 
—Or, if such injuries, independently and exclusively of all other causes, shall wholly and 
continuously disable the insured from the date of accident from performing any and every 
kind of du^ pertaining to his occupiU;ion, the Company will pay the insured the weekly 
indemnity tor the period of said disability as above specified. 

Partial Loss of Time. — Or, if such injuries shall not wholly disable the insured, 
as above, but shall immediately (or immediately following total disability), and contin- 
uoudy disable and prevent him from performing one or more important daily duties per- 
taining to his occupation, the Company will pay one-half the weekly indemnity payable 
for total loss of time for the period of such partial disability not exceeding thirty weeks. 
No payment of weekljr indenmity shall be made in case of any loss enumerated in Part A, 
except as therein provided. 

Part C. Double Indemnity. — ^The amount specified for a loss enumerated in an^ 
of the foregoing parts shall be doubled, except as limited in part "D," if such injury is 
sustained by the insured (1) while riding as a passenger in or upon a public passenger 
conveyance, provided by a common earner and propelled by steam, caole or electricity 
as a motive poww; or (2) while riding as a passenger in a passenger elevator (elevators 
in mines excepted); or (3) in consequence of the burning of any building while the insured 
is therein, and is not acting as a volunteer or iMud fireman; or (4) in consequence of the 
collapse of the outer walls of any completed building, whOe the insured is therein; or (5) 
in consequence of a cyclone or tornado, reported to be such by the Weather Bureau of 
the United States; or (6) by being struck by lightning. 

Part D. Special Indemnity. — Blood>poisonmg, due solely to bodily injury, freezing, 
hydrophobia, choking while swallowing, or the involuntary or unconscious inhalation 
or ^ or other poisonous vapor shall be deemed an injury within the meaning of this 
policy except for double indemnity. 

Part E. Surgical Benefits. — ^If an operation named in the Schedule of Ojperations 
shall be performed by a surgeon on account of a bodilv injury covered by this polky 
and withm ninety days from the date of the accident which caused such injury, the Com- 
pany will pa>^ the surgical benefit specified in the schedule for such operation in addition 
to any other indemnity to whi:h the insured may be entitled. If more than one such 
operation shall be performed on account of injury sustained in one accident the insured 
snail receive the largest surgical benefit specified in the schedule for any one of the opera> 
tions so performed. If a bodily injury shall be sustained which shall not result in death 
or other disability, or necessitate an operation named in the schedule, but which shall 
require surgical treatment, the Company will pay the amount actually expended for such 
treatment but not exceeding the amount of the single indemnity hereunder for total loss 
of time for one week. 

Schedule op Operations. — Abdomen — cutting into abdominal cavity for diagnosis or 
treatment of organs therein, $200. Amputation of— entire hand, forearm, or foot, $50; leg 
or arm, $100; thigh, $200; finger or finders, $20. Aneurism — tying of artery, $70. Bone — 
injuries to. Removal of diseased portion of bone, $50. Chest — cuttmg into for removal of 
pus as result of traumatbm, $50. Dislocation — reduction of hip or knee, $70; shoulder, 
elbow, or ankle, $50; wrist or lower jaw^ $50; thumb, $20; fingers, $10. Excision — removal 
of shmildnror hip joint, $200; knee jomt, $150; elbow, wrist, or ankle joint, $100; toe or 
toes, $20. Eye— any cutting operation. $20; removal, $100. Fractures— reduction of 
nose, lower jaw, collar bone or shoulder blade, $50; breast bone or ribs, $20; upper arm, 
$70; forearm, $50; wrist, $50; hand, $30; fingers, $10; bones of the pelvis, except 
coccyx, $150; coccyx, $20; thigh, $150; knee cap or leg, $100; bones of foot, $30; toes, 
$20. Gunshot wounds — treatment of. not necessitating amputation or any cutting oper- 
ation into abdominal cavity, $25. Hydrophobia — ^Pasteur treatment. $190. inflam- 
mation of joint — incision into joint, $50. Lockjaw— Ejection of antitoxin into skull, 
$200; injection of antitoxin into spinal canal, $100. SkuU— cutting into cranial cavity. 
$200. Spine or spinal cord— operation for removal of fractured vertebra, $200. Wounds 
— suturiM. $10. 

Part F. Elective Benefits.— The insured, if he so elect in writing within twenty 
days from date of accident, may take, in lieu of the weekly indemnity hereinbefore pro- 
vided lor total or partial disability, indenmity in one sum, according to the following 
schedule, if the injunr is one set forth in such schedule, but not more than one elective 
benefit shall be paid for injuries resulting from one accident. Where the insured is 
entitled to double indemnity the elective indemnity shall be doubled in like manner. 

Schedule of Elbctivb Benefits.— If the single weekly indemnity for total loss of 
time in this policy is $50, the amounts named below shall be payable; if such weekly 
mdemnity is greater or less than $50 the amounts to be paid shaU be increased or reduced 
proportionately. For loss of one or more fingers (at least one entire phalanx), $300; 
one or more entire toes, $400. For complete dislocation of shoulder, $200; elbow, $200; 
wrist, $250; hip, $600; knee, $300; bones of foot, other than toes, $300; ankle, $300: 
two or more toes, $ 100; two or more fingers, f 100. For the complete fracture of bones ol 
skull, both tables, $650; lower jaw, $150; coUar bone, $300; pelvis, $500; thigh, $600; 
leg, $4(X): knee cap, $400; arm, between elbow and shoulder, $600; forearm, between 
wrist and elbow, $300; two or more ribs, $200; foot, other than toes, $250; hand, other 
than fingers, $250; two or more toes, $200; two or more fingers, $200. 

Part G. Reimbursement for Hospital Charges.— Provided no claim is made for 
surgical benefits under the Schedule of Operations, if a bodily injury for which weekly 
indemnil^ is payable under the policy, necessitates the removal of the insured to a hospital 
vithia ninety days from the date of acddent, the Company (in addition to the weeUy 



170 NEW ENGLAND EQUITABLE INSURANCE COMPANY 

indemnity payable), will pay the amount appended weekly by him for hospital chain 
but not in excess of the single weekly indemmty provided in the policy for total disabiuly, 
or for a period of more than fifteen consecutive weeks. 

Part H. Identificatton and Registration. — If the insured by reason of injury 
shall be physically unable to communicate with friends, the Company, upon receipt of a 
telegram or other message giving the number of this policy, will immediately transmit to 
his relatives or friends any information respecting him, and will defrav all expenses 
necessary to put the insured in the care of fnends, not rxrreding twenty dollars for each 
one thousand dollars of the single principal sum. 

For Standard Provisions, Ske Page 11 

Additional Provisions 

(1) The copy of the application hereto attached or hereon end<n3ed is hereby made 
part of this contract. 

(2) No provision of the charter or by-hiws not included herein shall be used in defense 
of any claim hereunder. 

(3) This policy does not cover injury or accidental death sustained outside of Canada, 
Europe or the United States (not including Alaska nor the possessbns of the United 
States beyond the seas); nor suicide or any attempt thereat, sane or insane; nor acci- 
dental death or injury sustained by the insured while participating in, or in consequence 
of having participated in, aeronautics; nor while engaged in military or naval service in 
the time of war; nor does it cover women. 

(4) This policy may be renewed subject to all its provisions from term to term hoe- 
after by the payment of the premium in advance. 

(5) This policy is issued in consideration of a premium of twenty-five dollars ($25), 
and of the statements set forth in the application, a copy of which is endorsed hereon. 

In vntness whereof, the New England Equitable Tusurance Company has caused this 
policy to be signed Sy its president and secretarv, but same shall not be binding upon the 
Company unless countersigned by a duly authorized agent. 

POLICY FORM— "Commercial Disability" 

Principal Sum, $7500-$ 15, 000. Weekly Indemnity, $25-^50. 

Annual Premium, $60 

New England Equitable Insurance CompMiy, Boston, Mass. (here- 
inafter called the Company), does hereby insure John Doe, under 
classification select, by occupation an accountant, for the terni of 
twelve months, beginning at twelve o'clock noon, standard time of 
the place where the policy is countersigned, on the first day of Jan- 
uary, 1915, against loss resulting from bodily injuries, eflfected di- 
rectly and independently of all other causes, through accidental 
means (suicide, sane or insane, is not covered) ; and against dis- 
ability from disease as specified in the following schedule, subject 
to the provisions and limitations hereinafter contained. 

This form is the same as the foregoing, except in the following 
parts. 

Pakt F. Weekly Indehmity for Sickness. — If the insured shall suffer from disease 
not hereinafter excepted, and thereby be wholly and entirely prevented from performing 
any and every kind of duty pertaining to hb occupation, the Company will pay to him 
the weekly indemnity herem j^rovided for the period of such disability during which he 
shall necessarily be confined within the house, for a period of not to exceed fifty-two con- 
secutive weeks. If following a period of total disability and confinement within the 
house, the insured shall be wholly ^disabled and prevented from performing any and 
every kind of duty pertaining to his occupation. But shall not be necessarily confined 
withm the house, the Company will pay nim one-half of said weekly indemnity. No 
payment for either confinement or non-confinement, combined with confinement, shall 
be made for disability in excess of fifty-two consecutive wedcs duration, llie Company 
will not pay for any sickness for which the insured is not regularbr treated by a legally 
qualified and registered phjrsician; nor for any disease contracted within fifteen days 
from noon of the day thiis policy is dated. 

Part G. Bumdness orTakalysis from Dxskasb.— If any disease contracted by the 
insured during the term of this policy, and not hereinafter excepted, results during said 



term — (1) inuie irrecoverable loss of the sight of both ^es, or (2) in permanent tMraljrsis, 
and if the insured on account of the said loss of sisht or permanent paralysis is perma- 
nently unable to engage in any work or occupation for wages or profit, and if the insured 
survives the said loss of si^ht or the said oermanent paralysis for a period of one year, and 
at the end of the said period is declared oy competent medical authority, satisfactory to 
the Company, to have irrecoverably lost the sight of both eyes or to be permanent^ 
paralyzed, and by reason of the said loss of sight or permanent paralysis to be perma- 
nently unable to engage in any work or occupation for wages or profit, the Company 
will pay the insured one-half the principal sum, which payment shall terminate the 
policy. 

Part H. Surgk:al Bkmsfits.— If a bodily injury or a disease for which indemni ty is 
payable under thi»policy is suffered by the insured, and if said injury or disease within 
ninety days from the date oC the acdoent or inception of disease necessitates a suigicsl 



NEW ENGLAND EQUITABLE INSURANCE COMPANY 171 

operation named in tiie Schedule of Operations, the Company will pay the insured, in 
addition to the indemnity payable for such injury or disease, the sum set opposite such 
operation in said schedule; provided that not more than one of the said amounts so named 
shall be pavable for one disease or for injuries resulting from one accident. If a bodily 
injury shall be sustained which shall not result in death or other disability, or necessitate 
an operation named in the schedule, but which shall require surgical treatment, the Com- 
pany will pay the amount actually expended for such treatment, but not exceeding the 
amount ofthie single indemnity hereunder for total loss of time for one week. 

ScEaa>nLE or Opekations. — ^If the single weekly indemnity for total loss of time in 
this policy is S50, the amounts named below shall be payable; if such weekly indemnity is 
greater or less than $50 the amounts to be paid shall be increased or reduced proportionr 
ately. Appendicitis (see hiparotomy), 1200. Aneurism (tying of artery)— ligation SIQO; 
Amputation of foot, hand or forearm, S50; leg or arm, $100; thigh, $200; finger or- 
fingers, 120. Abscess or bofl — incision, 1 10. Bone abscess — ^trephining, iJ50. Bron- 
chotomy, thyrotomy, larsmgotomy, Uuyngotracheotomy or tracheotomy, $100. Car> 
bunde — incision and treatment, $10. Caries (bone ulcer) curetting, $50. Chest — 
cuttmg into thoracic cavity for dia^osis or treatment of organs therein, $50. Cancer of 
Up— removal of, by cutting operation, $50. Dislocations, reduction of, shoulder, elbow, 
hip, knee or ankle, $50; wrist or lower jaw, $30; thumb or fingers, $20. Excision ot 
shoulder, hip or knee joint, $200; elbow, wrist or ankle joint, $100; toe or toes, $50. 
Eye. ear, nose or throat — any cutting operation, $20. Eye — removal of, $100.* Fdon — 
incision, $10. Fractures, reduction of nose, lower jaw, collarbone or shoulder blade, 
$50; breastbone, $20; rib or ribs, $20: upper arm, $70; forearm (one or both bones), 
$50; wrist or hand (not fingers), $30; fingers, $20; any of the bones of the pelvis or sac- 
rum (except coccyx), $150; coccyx, $20; thigh, $150; kneecap or leg bones (one or both), 
$100; bones of foot (not toes), $30; toe or toes, $20. Goiter— cutting operation for per- 
manent cure, $150. Ganglion (cystic tumor of tendon sheath) — ^incision and curettmg, 
ISO. Gunshot wounds — treatment not necessitating amputation or laparotomy, $50. 
Hernia (abdominal)— any cutting operation for the radical cure of the reducible, irreduc- 
ible or strangukited form, $200. Hydrocele — tapping, incision or excision of sac, $50. 
Hydrophobia — ^Pasteur treatment, $100. Ingrowing toe nail — ^removal, $20. Intestinal 
obstruction (see laparotomy). Inflammation of joint — ^incision into joint, $50. Kidney 
—fixation or removal, $200. Laparotomy (opening of the abdominal cavity for an 
operation on any organ contained therein, or for traumatic peritonitis, or exploratory 
incision) , $200. Liuotomy (operation for removal of stone in bladder)— any cutting, 
1200. Mastoiditis— operation for, $100. Necrosis (death of bone) — sequestrotomy 
(removal of dead bone), $70. Nerve— cutting operation for stretching, $50. Ossopha- 
gotomy for stricture or other cause, $200. Peritonitis (see laparotomy). Paracentesis — 
tappii^ of abdomen, $50; bhtdder, $50; chest, $30; ear drum, $30; hydrocele or joints, 
120; Rectum — operation for hemorrhoids (external or internal)^xcision or ligation, 
150; prokipsed— operation for, $50; fistula in ano — ^mcision, $50; polypus— extirpation, 
150; malignant stricture — excision or colostomy, $200. Skull trephining for fracture or 
other cause, $200. Spine or spinal cord — operation with removal of fractured vertebra, 
$200. Synovitis (inflammation of the lining membrane of a joint) — ^incbion, $50. Tetanus 
—injection of anti-tetanic serum into frontal lobe of brain or spinal cord, $200. Tumors — 
extirpation from az^ part of the body: Benign, $30; malignant, $100. Trachea— cutting 
into for removal of foreign bodies or for relief of difficult breathing, $70. Varicose veins — 
ligation or excision, $50. Varicocele— acupressure— ligation or excision, $50. Wounds 
-suturing, $10. 

Part 1. Rexmbusseuent for Hospital Charges. — ^Provided no claim is made for 
Sttnical benefits vaadat the Schedule of Operations, if a bodily injury or a disease for which 
wedily indemnity is payable under the policy necessitates the removal of the insured to a 
hospital within nmety days from the date of accident or inception of disease, the Company 
(m addition to the weekly indemnity payable), will pay the amount expended weekly hjf 
him for hospital charves, but not in excess of the single weekly indemnity provided in the 
policy for total disability, or for a period of more than fifteen consecutive weeks. 

Part J. Identxficatxon and Registration.— If the insured by reason of injury shall 
be physicfdly unable to communicate with friends the Company, upon receipt of a telegram 
or other message giving the number of this policy, will immediately transmit to his relatives 
or friends any imtOTmation respecting him, ana will defray all expenses necessary to put 
the insured in the care of friends, not exceeding twenty dollars for each one thousand 
wwars of the original single principal sum. 

Foe Standard Provisions, See Page 11. 
Additional Provisions 

(1) The copy of the application hereto attached or hereon endorsed is hereby made part 
of this contract. 

(2) No provision of the charter or by-laws not included herein shall be used in defense 
of any claim hereunder. 

(3) This policy does not cover injury or accidental death sustained outside of Canada. 
Europe or the United States (not including Alaska nor the possessions of the United 
^tates beyond the seas); nor suicide or any attempt thereat, either sane or insane; nor 
doe it cover loss or disability resultmg from accident sustained or disease contracted 
while engaged in military or naval service in time of war; nor loss or injury sustained 
by the insured while participating in or in consequence of having participated in aero- 
nautics; nor docs it cover women. If the insured is entitled to indemnity for injury the 
Lompany shall not for the same period of time be liable for indemnity for disease. 

(4) This policy may be renewed subject to its provisions from term to term hereafter 
■^y Payment of the premium in advance. 

(5) This poUcy b issued in consideration of a premium of sixty dollars ($60), and of the 
Matements set forth in the application, a copy of which is endorsed hereon. 



J 



172 NEW ENGLAND EQUITABLE INSURANCE CX)MPANY 

In witness whereof, the New England Equitable Insurance Company has caused this 
policy to be signed by its president and secretary, but same shall not be binding upon 
the Company unless countersigned by a duly authorized agent. 

AOREXKENT IN APPLICATION 

I hereby apidy to the New England Equitable Insurance Company for a policy to be 
based upon the following representation of facts. I understand and a^ree 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 intent to deceive. I 
agree that this application shall not be binding upon the Company until accepted dther 
l^ the secretary at the home office or by an agent duly authorized to issue policies. 



NORTH AMERICAN ACCIDENT INSURANCE COMPANY 173 

I^Tortl^ /)m^riGa9 /l^^id^Qt li^surai^ce ^ompai^y. 

CHICAGO, ILL. 

CnnHnrmwl BuinMi 188(1 E. C Waxxsb, Pitti A. E. Foutisr, Sec. 

The North American issues a variety of forms of both acci- 
dent and health contracts, the principal one being the $5000- 
$10,000 "Accumulative Life-Income Disability/' at $60 yearly, 
text of whidh is given below. ^ The accident policy is sold with the 
same conditions, without the ackness benefit, at $25 a year. Special 
contracts for other more hazardous occupations are made. 

POLICY FORM — "Accumulative Life-Income Disability." 

Principal Sum, $5000-$10,000. Weekly Indemnity, $25-$50. 
Annual Premium, $60. 

North American Accident Insurance Company, Chicago, 111., 
(hereinafter called the Company), 

'niB Insvbino Clavss. 
Does hereby insure John Doe (herein called the insured), in class AA in the principal 
sum of five thousand dollars (herein called the inindpal sum), and in the sum oftwenty- 
five dollars a week (herdn called the weekly indemnity) against ( 1 ) bodily injury sustained 
during the term of this policy through accidental means (excluding suicide, sane or insane, 
or any attempt thereat, sane or insane)^ and resulting dhectly, independnitly and exclu- 
sively of all other causes, in (a) immediate, continuous, and total disability uat prevents 
the fiosured from perforxning any and every kind of duty pertaining to his occupation, 
(b) immediate (as respects the injury or as respects precedmg total disability) and con- 
tinuous partial disability that prevents the insured from performing fully work essential 
to the duties of his occupation, (c) death; (2) ilhiess. as hereinafter defined; contracted by 
the insured after the fifteenth day this pdicy is dated, and during the term heteof as 
foUofWs: 

ItLNXSS InDXMNIIIES. 

Asncuc 1. Illness not Excxedino Ftny-Two Weeks.— If any iUness contracted 
by the insured during the term specified in part 2 of the insuring clause, and not herein- 
alter excepted, necessarily confines the insuried in the house for a period beginning during 
the said term, and prevents the insured throughout the period of such confinement from 
performing any and every kind of duty pertaining to his occupation, the Company will 
pay the insured for the period of such confinement, not rxcffening fifty-two consecutive 
iVMks, the weekly indemnity. 

Articlb 2. Illness Followzno Confinemxnt in House.— If the insured is confined 
in the house and disabled within the terms of the preceding article and if continuously 
thereafter the illness causing the said confinement m the house totally disables and pre- 
vents the insured (but not necessarily to the extent of confining him in the house) from 
performing any and every kind of duty pertaining to his occupation, the Company will 
pay the insured for the period of sakl duability, if any, subsequent to the said confinement 
m the house and within fifty-two weeks from the beginmng of the said confinement 
half the weekly indemnity and after the said fifty-two weeks so long as the insurul lives 
and continuously suffers said disability defined in this article, the Company will pay the 
insured one-quarter of the weekly indemnity. 

AkHclb' 3. Blindness or Paralysis 7Rom Illness.— If any illness contracted by 
the insured during the term specified in part 2 of the insuring clause, and not hereinafter 
excepted, results during the said term in the irrecoverable loss of the sight of both eyes, 
or in permanent paralysis whereby the insured during the said term irrecoverably loses 
the entire use of both hands, or both feet, or one hand and one ioot} and if the insured, 
oo account of the said loss <tf sight or one of the said losses resulting from permanent 
paralysis — (1) is permanently unable to engage in any work or occupation for wages or 
profit; and (2) survives for the period of one year, the said k>ss of sight or one of the said 
looses resulting from permanent paralysis; and (3) at the end of the said period of one year 
is declared by medical authority satisfactoiy to the Company to have irrecoverably 
lost the sight of both eyes or the entire use of both hands or both feet or one hand and one 
footf and to be permanentlv unable to engage in any work or occupation for wages or 
profit by reason of the said loss of sight or one of the said losses resulting from permanent 
paralysis: the insured may elect to receive, m lieu of all other indemnity under this polky 
except surgeon's fees or hospital charges to which he may be entitled, half the principal 
sum. 

Article 4. Indemnity it Quarantined. — If the insured is quarantined during the 
term specified in part 2 of the Insuring clause, by otdat of the civil authorities, beosuse 
of an infectious or contagious disease, and by reason of said quarantine is prevented 
from performing any and every kind ot duty pertaining to his occupation: the (Company 
will pay the insured for a penod not exceeding ten weeks during which the insured is 
continuoasty quarantined the weekly indemnity. 



174 NORTH AMERICAN ACCIDENT IKStmANCE COMPANY 

Accident ImiacNtnES. 

Artxclb 5. Total Disability. — If the insured suffers total disability, the Company 
will pay the insured so long as he lives and suffers said total disability the weekly indem* 
nity. 

Article 6. Paktial DiSABiLirY.— If the insured suffers partial disability, the Com- 
pany will pay the insured for the period of such partial disability, not exceeding twenty- 
six weeks, a percentage of the weekly indemnity before specified, to be determmed upon 



the extent of the disability, but not less than 25 per cent, nor greater than 90 per cent. 

Article 7. Death. — If the insured suffers total disability, and if, during the period 

of said total disability, the insured suffers death as the direct result en the bodily rajuiy 



causing the said total disability; or, if within ninety days from the date of the accident, 
irrespective of total disability, the insured suffers death: the Company will pay the 
beneficiary the principal sum, and, for the period between the date of the accident and the 
dftte of death, an additional sum of the weekly indemnity. 

Article 8. Optional Indeiurty.— Or, if the insured suffers total disability and if, 
during the period of said total disability and within two hundred weeks from the date 
of the accidfent, the insured suffers, as the direct result of the bodily injury causing the 
said total disability and independently and exclusively of all other causes, one of the injur- 
ies dsiined in the Schedule oi Injuries; or, if within mnety days from the date of the acci- 
dent, irrespective of total disability, the insured suffers in uke manner one of the said 
injuries— -the insured may elect to receive the amount of indemnity set opposite said 
injunr in the said schedule, together with the weekly indemnity for the penod between 
the date of the accident and the date that the insured suffers the iiy'ury defined in the 
said schedule, in lieu of all other indemnity under this policy except surgeon's fees and 
hospital charges to which he may be entitled: provided that written notice ol bis election 
is given to the Company at its home office in Chica^, Illinois, within thirty days from the 
date that the insured suffers any injury defined m Section 1 of the said schedule and 
within ten davsfrom the date that the insured suffers any injury defined in Section 2 of 
the said schedule; provided further that not more than one of the said amounts so named 
shall be payable under this article for bodily injuries resulting from one accident 

Article 9. Double Indemnities.— The amounts specified in articles 5 to 8 shall be 
doubled, if the bodiljr injury is sustained by the insured — (1 ) while in a passenger elevator 
(excluding elevators in mines); (2) while in or on a public conveyance (mdudrng the plat- 
form, steps, or running-board thereof ) provided by a common carrier for passenger service; 
(3) in consequence of the burning of a building while the insured is therein; (4) in const- 
guence of a stroke of lightning; (5) in consequence of the collapse of the outer walls of a 
DuUding while the insured is therein; (6) in conseauence of the explosion of a steam boiler 
vfien such explosion causes the destruction of such boiler; (7) in consequence of a cyclone 
or tornado. 

Article 10. Accttmulativb Provision.— Each consecutive full yeai*s renewal of 
this policy, if the premium be paid annually in advance, will add ten per cent to the 
respective suma payable hereunder in case of accidental death of the insured or for dis- 
memberment or loss of sight as provided in Section 1 of the Schedule of Injuries; if paid 
other than annually in aavance^y five per cent., until, in either case, according as paid, 
fifty per cent is thus added. Thereafter, so long as the policy is maintained in lorce. 
the insurance shall be for the sums mentioned for death, dismemberment or loss of sight 
plus the accumulations; but such increase shall not be made on any amount payable tor 
weekly indemnity for total or partial disability or for any sum payable for disability 
intervening between the date of the accident and the date of death,, dismemberment or 
loss of sight. 

Article 11.. Sunstroke, Freezing, Hydrophobia, Asphyxiation.— Any one of the 
following, namely— sunstroke, freezing, h74cophobia, asphyxiation— suffered through 
accidental means, (excluding suicide, sane or insane, or any attempt thereat, sane or insane) 
shall be deemed a bodily injury within the meaning of this policy. 

Article 12. Blood Poisoning. — Blood poisoning resiutinc^ directly Itom a bodily 
injury shall be deemed to be incblded in the said term„ bodily mjuiy.. 

Accident or Illness Indeunziies. 

Article 13. Hospital Charges.- If a bodily injury or an iUness, for which indem- 
mty is payable under this policy, is suffered by the insured, and if on account of said bodilv 
injury or illness, and within ninety days from the date otthe.aoddent or inception of ill* 
hess, the insured is removed to a regularly incorporated hospital, the Con^jany. provided 
that no claim is m#de under Article 14, will pay tbp insured (in addition to themdemnity 
payable for said bodily injurjr or iUi^ss) for the period, not exceeding ten weeks, during 
which the insured is necessarily confined in the said hospital^ the amount en>eiuied by 
him weekly on account of the hospital charges, not excfisoin^ half the weekly indemnity. 

Article 14. Surgeon's Fees.— .If a bodily injuiy Qr. an illness, for whidh indemni^ 
iSk payable under this policy, is suffered by the insured, and if on account of said bodihr 
injury or illness, and within ninety days from the date of the accident or incq>tion of ill* 
nfiS^t the insured undergoes a surgical operation named in the Schedule of Opeiatioos 

it forth hereon, the Company will pay the insured, iA.addition to the indemnity payable 
.ji; said bodily injury or illness, the sum set opp(»iter such operation in said scnedale; 
provided that not more than one of the said amounts so named shall be payabk for one 
illness or for bodily injuries resulting from one accident. 

Article 15. Surgeon's Fees for Non-Disabuno lNjURiES.-~Or, if the insured 
sustains a bodily injury that does not disable- him or entitle him to any indemnity under 
this policy, but on account of said bodily injury he receives immediate medical or surgic&l 
treatment by a physician or a surgeon, the Company, provided that the bill of the at- 
tending physician or surjgeon didv receipted is filed with the Company within thirty da^ 
frun the date of the accident, wiU reimburse the insured for the amoont expended by him 



t 



NOyrH A MERICAN ACCIDENT INSURANCE COMPANY 175 

on aooount of nich medical or snigkal treatment, not exceeding the weekly indemnity. 

AsxicLB 16. BENsnciARY Insueance. — ^If one person and only one is named as bene* 
fidary in the Schedule of Warranties, and while such person is over eighteen and under 
sixty years of age. is in sound condition, mentally, and physically, and is a person other 
than the insured, then and not otherwise such beneficiary is hereby insured, as provided 
in Sections 1, 2 and 3 of this artide and subject to the general provisions of this policy 
against bodily iniurv sustained by such beneficiary in conseguence of the burning of a 
building while Such beneficiary is therein; or while such beneficiary is in a passenger ele- 
vator (excluding elevators in mines) ; or while such beneficiary is in or on a public conv^- 
anoe (including the platform steps, or running-board thereof) provided by a common 
carrier for passenger service: (I) If the bodify injury so sustained is either named in 
the Schedule cmE Injuries set forth hereon, or, within ninety days from the date of the 
accident, results directly, independently and exclusively of all other causes, in an injury 
named in said schedule, the Company will pay su h beneficianr the sum set opposite 
said injury in said schedule, but not more than one amoimt shall be payable under this 
artide for bodily injuries resulting from one accident; (2) or, should such accident suft* 
tained as aforesaid not result in an injury named in said Schedule of Injuries, but shall, 
indq>endcntly of all other causes and from date of accident, totally and continuously 
disable and prevent the said beneficiary from attending to any and every kind of busi- 
ness or labor, the Company will pay said beneficiary while so disabled, for a period not 
exTfifriin^ ten consecutive weeks, three-fifths of the weekly indemnity. (3) or, if said 
bodily injury, within ninety days from the date of the accident, results m death, the Com- 
IMoy will pay to the insured the principal sum. If such beneficiary is also covered under a 
simuar clause in any other pohcy or policies issued by the Company, such beneficiary, 
the insured, or the executors or administrators of the beneficiary , must elect under whidi 
policy all cuums on account of bodily injuries to or the death of the beneficiary shall be 
made; and the Company shall m no event be liable on account of anv such bodily injuries 
or death under more than one policy unless an endorsement is added hereto modifying this 
provisian. 

Article 1 7. Surgeon's Fees tor Beneficiary.— If a bodily injury for which bdem- 
nity is payable under the preceding artide is received by the beneficiajy therein designated, 
ana if on account of the said bodily injury and within ninety days from the date of the 
accident, the said beneficiary undergoes a surgical operation named in the Schedule of 
Operations set forth hereon, the Company will pay said beneficiary, in addition to the 
indemniW granted by the preceding article, one-hall the sum set opposite such operation 
in the said schedule: provided that not more than one of the said amounts so nanied shall 
be payable under this article for bodily injuries resulting from one accident. 

Special Pkovisions. 

AsncLS 18. Indemnity Payabu Quarterly. — ^If the insured suffers total disability 
for a period exceeding three months, the weekly indemnity to which the insured may be 
entitled under this policy for any part of the entire period of total disability (provided 
that such part is not less than three months) shall be payable upon the insured's filing 
affirmative proof of total disability and of the duration thereof for each part of the entire 
period for which daim is made. Proofs covering the entire period of total disability must 
be filed as hcrdnaf ter set forth. 

Article 19. Death Indemnity Payable to Beneticiary or Insured's Estate. — 
In the event of the insured's deaUi prior to the payment of any indemnity to which the 
insured may have become entitled under this policy, such indemnity shall be paid by the 
Ounpany to the beneficiary. In the event of the death of the beneficiary prior to the 
death of the insived, any indemnity payable under this policy to the beneficiary on account 
of the insured's death shall be paicf to the executors or administrators of the insured. 

General Provisions. 

Articix 20. Written notice of an acddent on account of which a claim may be made 
hereunder must be nven to the (Company at its home office in Chicago, 111., as soon as may 
be reasonably possible, tomther with full particulars thereof and the full name and address 
of the insured. Like notice of bodily injury or death or commencement of iUness on ac- 
count of which a claim b to be made must be given to the Company in like manner. 
Affirmative proofs in writing must be filed with the Company as follows: 

Section 1. Aoodent Claims. — ^Affirmative proofs of death, dismemberment, loss 
of sight, total disability or partial disability and the duration of total disability or partial 
diwoility, must be filed with the Company within two months from the time ofd^th 
or of diraiemberment <» of loss of sight or of the termination of the period of total disabil- 
ity or partial disability for which claim is made. 

Section 2. Surgeon's Fees or Hospital Charges.— Affirmative proofs of a surgical 
operatbn, or of hospital charges must be filed with the Company within three months 
from the date of the opemtion or of the beginning of the confinement in a hospital. 

Section 3. H ealth Claims.— Affirmative preiuninary proofs of blindness or paralysis 
most be filed with the Company within two months from the date of the begmninc of 
blindneas or paralysis. Affirmative final proofs of blindness or paralysis must be filed 
with the (Company within twelve months after the filing of the preliminary proofs. Affirm- 
ative proofs of disability on account of iUness or quarantine and the duration thereof 
>nust be filed with the Company within two months from the date of the termination of 
the period <rf disabUity for which claim is made. 

^V'^ncLE 2 1 . Legal proceedings for recovery hereunder shall not be brought before the 
c^MTstion of three months from the date of filing final proofs at the Company's home 
office, nor brought at all unless begun within one .year from Whe date specified herein for 
nlina final proou. If any limitation set forth in this and the preceding article is prohibited 
BQr ue statutes of the sUte in which this policy is issued, the said limiution shall be coop 



176 NORTH AMEiaCAN ACCIPENT IKStmANCE CX>Mf>ANY 

flidered to be amended to agree with the mlnifffflm period of limitation permitted by wash 
statutes* 

AtttXCLfi 22. Any medical adviser of the Comi>any shall be albwed to examine the 
person or body of any person insured by this policy, in respect to any alle^ bodily injury, 
disability* or cause of death, as often and in such manner as he requires, and he shall 
also have the right and opportunitv to make an autopsy in case of death. 

Article 23. No recovery shall be had under more than one provision of this policy 
on account of one accident to the insused or of one illness suffered by the insured, except 
as provided in Articles 2, 6; 13 and 14. No reoovexy shall be had on account of daabili^ 
from illness for any period of time lor which the insured is entitled to weekly indemnity 
on account of a boduy injury. Any claim shall be subject to proof of insurable interest. 
Failure to comply with any of the provisions of this praky shall render invalid any claim 
under this pohcy. 

Aruclb 24. The consent of the ben^dary shall not be requisite to a surrender or 
to an assignment of this polic^^ or to a change of beneficiary or to any other change in 
the policy. No assignment ox mterest under this poli^ shall bind the Company unless 
the written consent of the Company is endorsed hereon by the presid ent, the vice-president, 
or one of the secretaries of th e Company. 

Article 25. The terms, bodily injury, toUl disabilitv, partial disability, and death, 
are defined in the insuring clause, and as so defined shall be understood wherever uaed 
in this policy. 

Article 26. No erasure or change appearing on this policy as originally printed, and 
no change or waiver of any of its terms or conditions or statements, whether made before 
or after the date of this policy shall be valid unless set forth in an endoiaem«;nt added 
hereto and signed bjr the {Hiesident, the vice-president, or one of the secretaries of the , 
Company. Notice given to or the knovldedge of any agent or any other person, whether 
received or acquired before or after the date' of this policy, shall not be held to waive 
any of the terms or conditions or statements of this policy, or to preclude the Company 
firom asserting any defense under said terms, conditions, and statements, unless set forth 
in an endorsement added hereto and ^ned by one of the said officers. 

Article 27. Without prejudice to the rights of the insured as respects anything that 
has occurred during the time the policy has been in force, the Company may cancel 
this policy at any tinie by a written notice stating when the cancelation is effective, 
served on the insured, or sent by registered mail to the insured at the address set forth 
in the Schedule of Warranties. In case of cancelation the unearned portion of the 
premium shall be returned to the insured , and the Company's check served on the insured, 
or sent by registered mail to the insured at the said address, shall be a sufficient tender. 

Article 28. This policy does not cover — ( 1) any ilhiess contracted while the insured 
is engaged in military Or naval service in time of war; (2) any illness for which the insured 
is not treated by a licensed physician j (3) women except as beneficiary; (4) any illnon 
contracted or suffered outside the limits of the United States, Canada, and Europe, or 
in Alaska or the insular possessions of the United States. 

Article 29. This policy is issued in consideration of the premium and of the state- 
ments which are set forth hereon in the Schedule of Warranties which are made a part 
hereof and which the insured makes and warrants to be true by the acceptance hereof, 
and policy is subject to the conditions and provision's herein contained and endorsed 
hereon. 

Article 30. The insurance under this policy will be in force only for the term men- 
tioned in Schedule of Warranties, or the last renewal receipt. 

Article 31. This polic^r does not cover death within its terms and provisions fcdlow- 
ing the commission bv the insured of either defalcation, foigeiy or embezzlement. 

Article 32. The beneficiary insurance provided under Article 16 hereof shall be void 
should said beneficiary become deaf, dumb, blind, or a cripple. 

Article 33. If the i nsured is injured fatally or otherwise m any occupation classed by 
the Company as more hazardous than that stated at the foot of the Schedule or Warran- 
ties, the Company's liability shall not exceed such proportion of the principal sum or other 
indemnity under this poUcy as the premium paid oy him will purchase at the rates fixed 
by the Company for such increased hazard. 

In vitness whertof^ The North American Accident Insurance Company, by its presi- 
dent and secretary, has executed and attested these presents, but the same shall not be 
binding upon the Company unless countersigned by a duly authorised and commissiMied 
agent of tne Company. 

SchIedule o^ Injuries. 

Section 1.— The amounts stated in the following Schedule of Injuries are pajrahle 
nnder this policy if issued for' five thousand dollars, prmcipal sum. proportionate amounts 
being payable if the policy is issued for a larger or smaller principal sum. Dismember- 
ment oy actual separation at or above the wrist joints or a^e joints of both hands or 
both feet, $5000; one hand and one foot, $5000; one hand or one foot, $2500; one hand 
and the irrecoverable loss of the sight of one eye, $5000; one foot and the irrecoverable 
loss of the sight of one eye, $5000. Irrecoverable loss of the sight of both eyes, $5000; 
one eye, $2500. 

Section 2. — ^Dismemberment of fijiigers, one or more entire, $160; toes, one or more 
entire, $200; Complete hernia. $8a Complete dislocation of shoulder, $60; elbow, $ 100; 
wrist, $120; hip, $300; knee, $160; foot, two or more bones, not toes, $160; ankle. $160; 
toes, two or more, $60; fingers, two or more, $60. Complete fracture of skull, botii 
tables, $320; lower jaw, $80; collar bone, $160; pelvis, $240; thigh shaft, $300; leg, tibia 
and fibula, $200; knee cap, $200; upperarm, humerus, $160; forearm, both ulna and radius, 
$160; forearm, either ulna or radius, $80; ribs, two or more, $100; foot, two or more 
bones, not toes, $120; hand, two or more bones, not fingers, $120; toes, two or more, $100; 
fingeis, two or more, $100. _,._..,. 



NORTH AMERICAN ACCIDENT INSURANCE COMPANY 177 

Idehtification.— The Company makes a complete re^try of its die&ts in the acci- 
dent and health departments. Uiion receipt of the premiums for this policy it will issue 
and transmit to the insured a certificate of identification wherein it is agreed that if the 
insured, by reason of injury or illness, is physically unable to communicate with friends, 
the Company, upon receipt of a telegtam or other message giving the number of the 
certificate (which is carried by the insured in a leather identification card case which the 
Company provides for the purpose), will immediately transmit to his relatives or friends 
any mformation respecting nim and will defray all expenses necessary to put the insured 
in the care of friends provided such expense shall not exceed the sum of one hundred dol- 
krs ($100). 

AocuifULATiONS.— For loss of life (principal sum of policy), or both hands by severance 
at or above the wrist, or both feet at or above the ankle, or one hand and one foot by sever- 
ance at those places, or entire sight of both eyes, if irrecoverably lost, or one hand and the 
iirecoverable loss of the si^ht otone eve, or one foot and the inecoverable loss of the sight 
of one eye, $5000, value with accumulations, %75O0; either hand by severance at or above 
the wrist, or either foot by severan<% at or above the ankle, or entire sight of one ey«, il 
izzecoverably lost, $2500, ^ue with accumulations, $3,750. 

ScHSDUi£ or OPERATIONS. — Opening the abdominal cavity (laparoUHny) for — appen- 
dicitis or any operation on any organ (tapping excluded), $100. Fixation or removal of 
kidney, $100. Tapping of abdomen or q|adaer, $25. Rectal operations, ezdsion or 
ligaticA of hemorrhoids (internal or extetnal), $25; operation for prolapsed rectum, $25; 
operation for fistula in ano, $25; exdsbn of rectal po^us, $25; excision of or colostomy 
for malignant rectal growth, $1(X). Any cutting operation on bladder (excluding tap- 
ping), $100. Ligation of artery for aneurism, $50. Ligation or excision of varicose 
veins, $25. Acupressure, ligation, or excision for varicocele, $25. Bronchotomy , thryot- 
omy, lazyngotomy, laiyngo-tracheotomy, or tracheotomy, $50. Esophagotomy, $100. 
Inosion of— abscess, boil, felon, or carbuncle, $5. Minor operation on— eye, ear, nose, 
or throat, $10. Removal of ingrowing toe nail, $10. Incision and curetting cystic 
tumor of tendon sheath, $15. Incision or excision of hydrocele sac, or tapping same, 
$25. Extirpation of— benign tumor, $15; malignant tumor, $50. Sequestrotomv 
(removal of dead bone), $35; SkuU trephining, $100. Curetting for bone ulcer, $15. 
Operation for mastoiditis, $50. Indsion for — synovitis (inflammation of the lining mem- 
brane of a joint), $25. Infection of— -anti-tetanic serum into frontal lobe of brain, $100. 
Amputation of— foot, hand, or forearm, $25; leg, at or below knee, $50; arm above elbow, 
$50; thigh. $100; fiiuers, one or more entire. $10; toes, one or more entire, $25. Reduc- 
tion of dislocation or—ahoulder, elbow, hip, knee, or ankle, $25; wrist or jaw, $15; fingers, 
one or m<»e, $1(X Excision <^ — shoulder, hip, or knee-joint. $100; elbow, wrist or ankle- 
jdnt. $50. Reduction of fracture of — nose, lower jaw. collar bone, or shoulder blade, 
125; breast bone, $10; riborribs,$10; upper arm, $35; forearm, one or both bones, $25; 
wrist or hand, $15; fingers, one or more, $10: pelvis or sacrum, any of the bones of, $50; 
coc^x, $10; thigh, $75; knee cap, $50; kg bmies, one or both, $50: foot, two or more 
bones, not toes. $15; toes, one or more, $10. Removal of shot or bullet, $25. Any cut- 
ting operation for — ^the radical cure of the reducible, irreducible, or strangulated forms 
of abnomtnal hernia, $100. Suturing wounds. $5. 

POLICY FORM— "Real." 

Monthly Accident Indemnity, 160. Monthly Premium, $1.50. 
Monthly Sickness Indemnity, $50. Policy Fee, $5.00. 

North American Accident Insurance Company, Chicago, 111. 
(hereinafter called the Company), in consideration of the agree- 
ments and statements contained in the application herefor, a copy 
of which application is endorsed hereon and made a part of this 
contract, the payment of the policy fee of five dollars, the payment 
of the premium of one dollar and fifty cents on or before the first day 
of January, 1915^ and the further payment of last-mentioned sum 
on or before the first dav of February thereafter, does hereby insure 
John Doe (herein called the insured) by occupation bookkeeper, in 
Class AA of said Company and subiect to the agreements, limitations 
and provisions of this policy and those endors^ hereon, promises to 
pay benefits as hereinafter set forth for loss resulting from accident 
or sickness: 

(a) AcxaDENT iMDnanry.— In the event that the insured, while this policy b in force, 
shall sustain personal bodily injury, which is effected directly and independently of all 
other causes through external, violent and purely accidental means and whkh injury 
causes at <mce totaland continuous inability to engage in any and every kind of business 
or labor (suicide, sane or insane not included), the Company will pay: 

(b) SpBcinc Total Losses.— If any one of the following specific total losses shall 
result solely from injuries described in paragraph (a), within ninety days from date of 
accident, the Company will pay, in lieu of any other indemnity: For loss of life, or both 
hands t^ severance at or above the wrist, or both feet by severance at or above the ankle. 
Of one hand and one foot by severance at those places, or entire sight of both eyes, if 



178 NORTH AMERICAN ACCIDENT INSURANCE COMPANY 

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 the principal sum; entire sight 
of one eye, if irrecoverably lost, one-third of the principal sum. 

(c) TOTAL Accident INDEMNITY. — For total loss of time resulting necessarily and 
solely from injury as described in paragraph (a) an Accident Indemnity of sixty ddlars 
per month or at that rate for any proportionate part of a month shaU be paid to the 
msured for such period of continuous total loss of time not exceeding twenty-four months. 
And if the insured is disabled within the terms of said paragraph (a) the Company will pay 
the insured for the period of said disability, if any, subsequent to the said twen^-four 
months and within thirt)r-siz months from the beginning of said disability one-hidf the 
monthly accident indemnity. And after said thirtv-six months, so kmg as the insured 
lives and continuously suffers said disability defined in paragraph (a) the Company will 
pay the insured one-fourth the monthly accident indramity. 

(d) Accident Indemnity — Partial Loss of Tdcb.— Or if injury shall not at once 
totally and continuously disable the insured and prevent him frcHn enga^ng in any and 
every kind of* business or labor, but shall within thirty days thereafter totalty disable 
him, or shall, either at once after the iujury or at once after a period of total disability, 
prevent the insured from periormiag one or more of his important daily duties, the 
Company will pay as indemnitv for partial loss of time and for a period not exceeding 
six consecutive months one-half the month^^ accident indemnity. 

(e) Double Indemnities. — ^If the iniury as above described is sustained by the in- 
sured while riding (1) as a passenger within the enclosed part of any railway passenger- 
car provided for the exclusive use of passengers, and pr(q)eued by steam, cable, compressed 
air or electricity, or (2) as a passenger on board a steam vessel licensed for the regular 
transportation of passengers, and such injury shall be due directly to or in consequence 
of the wrecking of such car or vessel; or (3) by a stroke of lightning; or (4) by the burning 
of a dwelling, hotel, theater, club house, lodge room, school building, office building, store, 
or bam, while the msured is thereui and in which the insured may be burned by fire or 
suffocated by smoke, the insured not acting as a volunteer or paid fireman; or (5) by a 
cyclone or tornado causing the destruction of a building mentioned in Section (4) of thk 
paragraph (e) while the insured is therein, then the Company will pay double the indem- 
nity otherwise payable as above. 

(f) Additional Indemnity por Surgical Operations. — ^If a bodily injuiy, for 
which indemnity is payable under this policy, is suffered by the insured, and if on account 
of said bodily injury, and within ninety (90) days from the aate of tlie accident, the insured 
undergoes a surgical operation named in the Schedule of Oi)eration8 set iarth hereon, 
the Company will pay the insured, in addition to the indemnitjr payable for said bodily 
injury, the sum set opposite such operation (the first) in said schedule, purovided that not 
more than one of the said amounts so named shall be payable for bodily injuries resulting 
from one accident. 

(g) Sickness Indemnity.— In the event that the insured shall suffer from any bodiljr 
sickness or disease, not hereinafter excepted, which b contracted and begins after this 
policy has been maintained in continuous force and without default in the payment of 
premium for thirty consecutive days, after the date of this policy, the Company will pay 
fifty dollars per mcmth or that rate for any proportionate part of a month for the numoer 
of consecutive days, not exceeding six months, that the insured, by reason ot such sickness, 
shall be totally and continuously disabled from engaging in any and every kind of business 
or labor and De necessarily and continuous^ cooked within the house, and therein be 
regularly visited by a legally qualified physician. 

(h) And if this policy shall nave been maintained in force in the maimer provided in 
paragraph (g) the Company will pay a,t one-half said monthly rate for such period, not 
exceeding one month, as the insured, by reason of a non-confining sickness, or by reason 
of convsHescence from a confining sickness, shall be totally and continuously disabled 
from engaging in any and every kind of busmess or labor and be under the r^ular care 
of a legally qualified physician, although not confined within the house^ provided that the 
combined period for wmch indemnity is payable for sickness shall not exceed six months 
as the result of any one sickness. 

(i) Full Indemnity for Total Disability Caused by Boils, Carbxtncles oi 
Felons. — In case the insured by reason of disability caused by boils, carbuncles or felon 
be prevented from engaging in any and every kind of business or labor, the Company will 
]^y at the rate and in the manner provided in paragraph (g) for the period therein men- 
tioned, although insured may not be confined continuou^y within the house. 

(j) Hospital Benefits. — If an illness for which indemnity is payable under para- 
graph (g) of this policy, is suffered by the insured, and if on account of said iUness and 
' within ninety days from the date of the inception of said illness, the insured is removed 
to a regularly incorporated hospital, the Company wiQ pay the insured in addition to 
the indemnity payable for said illness for the period, not exceeding two months, durog 
which the insured is necessarily confined in the said hospital, the amount expended by 
him monthly on account of said hospital charges, not exceeding in any case one-half the 
amount payable under said paragraph (g). 

(k) Ten Per Cent. Increase.— If a full year's premium for this policy shall have 
been paid annually in advance, ten per cent, shall be added to the indemmties payable 
hereunder (paragraphs (b) and (e) excepted) on any claim arising within the year tor 
which the premium has been so paid in advance. 

(1) Sixty Per Cent. Accumulation.— Each consecutive month which this policy 
shall be carried without default in the i»yment of premium therefor shall add c«e per 
cent, to the indemnities payable under paragraph (b), but the total of such additions 
shall never exceed sixty per cent. , 

(m) General Provisions.— In event of a loss hereinbefore desijgnated as a to»| 
loss, no daim shall exist for compensation other than that specifically provided for SKJ 
total loss, and in no event shall the Company be liable under paragraph (b) entities 



NORTH AMERICAN ACCIDENT INSURANCE COMPANY 170 

"Specific Total Losses." for moT" than one of the losses named therein* nor under (c) — 
(d) and (g) — (h) — (i) tor the same period of disability. 

(n) The insurance hereunder does not cover any loss caused or contributed to by vene- 
real disease or condition not common to both sexes; while in military or naval service in 
time of war; while intoxicated; while engaged in balloon ascension or aerial navigation; 
while racing; as the result of the intentional act of any person; or, suicide, or an attempt 
thereat, while sane or insane. 

(o) Indemnity will not accrue hereunder in excess of the time the insured is, by reason 
of mjury or illness, under the professional care and regular attendance of a legally quali- 
fied physician or surgeon. If the insured is disabled by injury or illness for more than 
thirty days he or his representative shall furnish the Company, every thirty days, or as 
near thereto as may be reasonably possible, with a reix>rt in writing from his attending 
physician or suigeon, fully stating the condition of the insured and the probable duration 
of disability. 

(p) This policy, provided the premiiun has been paid to the Company or its authorized 
agent, shall take effect on the date hereof at noon, standard time of the place of residence 
of insured, and shall continue in force only so long as the premiums required hereon are 
paid on or before noon of the first day of each month in aidvance, without notice, to the 
Company, at its home office in Chicago, Illinois, or to the person designated by the 
Company in writing to receive them, provided that the payment of any premium after 
itut oate when it shall have become due shall not continue this insurance to a date later 
than the date for the payment of the next monthbr premium, nor shall the acceptance 
of any premium after it is due be construed as a waiver of any of the rights of the Com- 
pany under this contract. The acceptvice of any renewal premium shall be oi>tional 
with the Company. Failure to comply with any of the tenns of this policy shall invali- 
date any and all claims hereunder. 

(q) No assignment of this poUcy or change of beneficiary hereunder and no waiver 
or alteration of any of its provbions ^all be valid tmless an endorsement shall be at- 
tached hereto as provided by Standard Provision nimiber 2. 

This policy covers injuries received only within the dviUzed limits of the globe, including 
travel by common lines of passenger conveyance, and disability due to disease contracted 
and suffered within the limits of the United States or Canada. 

(r) No provision of the charter or by-laws of the Company not ino^porated in full 
herein shall avoid the policy or be used in evidence in any legal proceeding. 
For Standard Provisions See Page 11. 

Schedule of OPERATiQNS.~The amounts stated in the following Schedule of Oper- 
ations are payable under this policy if issued for $50 Monthly Accident Indemmtv. 
Proportionate amounts being payable if the policy is issued for a larger or smaller monthly 
acadent indemnity. Amputation of — foot, hand or forearm, $25; leg, at or below knee, 
$25; arm above dbow, $25; thigh, $50; toes, one or more entire, $12.50; fingers, one or 
more entire, $5; enucleation of eye, $20 (operation for removal of eye). 

Identification. — Upon receipt of an annual premium under this policy the Company 
will issue and transmit to the insured a certificate of identification wherein it is agreed 
that if the insured, by reason of injury or illness, is physically unable to communicate 
with friends, the Company , upon receipt of a telegram or other message giving the number 
of the certificate (which is carried by the insured in a leather identification card case 
which the Company provides for the purpose), will immediately transmit to his relatives 
or friends any information respecting him and will defray all expenses necessary to put 
the insured in the care of friends provided such expense shall not exceed the sum of 
fifty dollars ($50). 



180 OCEAN ACCIDENT AND GUARANTEE CORPORATloy, LTD. 

The Ocean Accident and Guarantee Corp., Ltd^ 

OP LONDON, ENGLAND. 



Commenced Business 1S69. United States Head OfiSce, New York City 

William J. Gasdnek, United States Manager 

The Ocean Accident and Guarantee Corporation issues Straight, 
Combination, Death and Dismemberment, Health and Disabflity 
policies. 

The Straight Accident policy, in addition to the usual fixed in- 
demnities for death, dismemberment and loss of sight, provides a 
five per cent accumulation and a schedule of elective indenmities. 
The premium for this policy is ^ per $1000. 

The Triple Death and Dismemberment policy carries double and 
triple indemnity and additional monthly payment clauses. The 
losses are payable if suffered within twelve months. The premium 
for this policy is $3 per $1000 to Select and Preferred risl^. 

The Health policy — "The General" covers all diseases from one 
day to fifty-two weeks. The policy contains a schedule of surgical 
fees. The premium for this policy is $7 for each $5 of weekly in- 
demnity. 

The corporation issues a Disability policy, the "Premier Disa- 
bility " which is a combination of the Premier Accident and General 
Health. The premium for the disability form is $12 per $1000, ages 
18 to 50, and $14 per $1000, ages 51 to 60. 

POLICY FORM— "Atlas Accident" 
PRiNaPAL Sum, $5000. Weekly Indemnity, $30. 

Annual Premium, $25. 

The Ocean Accident and Guarantee Corporation, Limited, in 
consideration of the premium and of the statements contained in 
the application a copy of which is endorsed hereon and made a part 
hereof, and subject to the definitions, provisions and limitations, 
as conditions hereinafter contained, hereby insures John Doe of 
New York, occupation accountant, the jperson named in the appli- 
cation against loss or disability resultmg directly, independently 
and exclusively of all other causes from bodily injuries effected 
solely through accidental means — suicide while sane or insane is 
not covered — ^in the amotmts hereinafter specified. 

Section 1. Fixed Indemnities. — (a) If such injuries shall result in any of the losses 
enumerated in this section within twelve months from the date of the accident, the 
Corporation will pay for such loss a fixed indemnity as follows: 

For loss of life, or both hands, or both feet, or one hand and one foot, or sight of both 
eyes, or one hand and sight of one eye, or one foot and si^t of one v^e, the principal 
sum. Either arm or leg, three-fifths the principal sum. either hancf, or dtner foot, 
or sight of one eye, one-half the principal sum. Thumb and index finger of either hand, 
one-third the i>rmci);>al sum. 

(b) If such injunes shall immediately, continuously and completely disable and pre- 
vent the insured from performing any and every busmess duty, and at any time duiinK 
the period of such disability shall result in any of the above losses, the Corporation wiu 
pay the fixed indemnity specified therefor, and in addition thereto ?r91 pay the weekly 
mdemnity hereafter provided for the period between the date of the injury and the date 
of the loss. 

Section 2. Weekly Indemnities.— Or, if such injuries shall result in disability, 
either total or partial, the Corporation will pay a weekly indemnity as follows: Total 
disability — ^for the period thereof, the weekly mdemnity above specified. Partial dis- 
ability — fifty per cent of rate for total disabihty for not exceeding 52 consecutive weeks. 
No payment of weekly indemnity shall be made in case of any loss enumerated in Sec- 
tion 1, except as therein provided. 

Section 3. Elective Indemnities. — If such injuries are named in the "Schedule of 
Injuries" endorsed hereon, the insured may elect to receive the amount of indemnity 
provided in said schedule, in lieu of all weekly indemnity payable, if written notice of 
such election is received at the American Head Office of the Corporation within twenty 
days from the date of the accident; but not more than one such indemnity shall be pass- 
able for injuries resulting from any one accident. 

Section 4. Travel Indemnities. — The fixed indemnities specified in Sectk»n 1 



OCEAN ACCIDENT AND GUARANTEE CORPORATION, LT D., 181 

shall be trebled if such injuries are sustained (1) while a passen^r in or on a public 
CQDveyance (including the platform, steps or running board thereof), provided by a 
common carrier for passenger service; (2) while a passenger in a passenger elevator 
(excluding mine or freight elevators); (3) in consequence of the burning or collapse of 
a building while the insured is therein; (4) by the explosion of a steam boiler. The weekly 
indemnities specified in Section 2 shall in any such event be doubled. 

Section 5. Aqdittonal Indemnities — Reimbursement for Hospital Expense. 
If the insured is necessarily and condnuqusly confined in a hospital by reason of injuries 
covered by this policy, the Corporation, in addition to the indemnity otherwise payable, 
will pay the amotmt expended for hospital expenses not exceeding fift^ per cent of the 
single weekly indemnity specified in Section 2 for each week that the msured is so con- 
fined, but for not more than ten consecutive weeks. 

Indemnity tor Surgical Operations. — If such injuries, within ninety days from 
the date of the accident, shaU necessitate a surgical operation specifically named in the 
"Schedule of Operations" endorsed hereon, and the same shall be performed, the Cor- 
poration, in lieu of reimbursement for hosfntal expenses; wiU pay as provided in said 
schedule in additbn to the indemnity otherwise payable; but payment shall not be 
made for m<Mre than one operation necessitated by any one accident. 

Reimbursement for Graduate Nurse Expense. — In lieu of any sum payable for 
reimbursement for hospital expense or indemnity for surreal operations, the Orpora- 
ticm, in addition to the indemnity otherwise payable, will pay the amount expended 
each week for graduate nurse, not exceeding fifty per cent of the single weekly indemnity 
provided in Section 2, but for not more tnan ten consecutive weeks. 

Surgical Indemnity for Minor Injuries. — ^If such injuries do not result in total 
or partial disabilitv or necessitate any surgical operation named in the "Schedule of 
Operations," but do necessitate medical treatment, the Corporation, upon presentation 
of receipted physician's bill^ will pav the amount expended for such treatment, but for 
not exceeding one week's single mdemnity. 

Special Indemnity. — Sunstroke, freezing, hydrophobia, asphyxiatbn, or septioemia 
resulting from such injuries shall be deemed to be covered by this policy. 

Identification. — ^If the insured by reason of such injuries shall be physically unable 
to communicate with relatives or friends, the Corporation, immediately upon receipt 
of advices giving the number of this policy, will transmit to his relatives or friends in- 
formaticm concerning him, and will defray all expense (not exceeding one hundred dol- 
lars) necessary for macing him in their care. 

Defdotions of Terms as Used in This Contract.—- Loss of Life. — Death occur- 
ring from such bodily injuries witMn twelve months after the acddent or ias extended 
in paragraph (b) of Section 1. 

Loss of Hand or Hands, or Loss of Foot or Feet, or Loss of Thumb and Index 
Finger. — ^The actual severance thereof at or above the proximal joints, within twelve 
months after the accident or as extended in paragraph (b) of Section 1. 

Loss of Arm or Leg. — ^The actual severance thereof at or above the elbow or knee 
within twelve months after the accidmt, or as extended in paragraph (b) of Section 1. 

Loss of Sight of Eye or Eyes.— Permanent total blindness thereof beyond remedy 
by sUKersr or other means, and occurring within twelve months after the accident or as 
extended in paragraph (b) of Secticm 1. 

Total Disability. — Continuous and complete disablement occurring immediately 
after the accident, and which prevents the insured from performing any and every busi- 
ness duty. 

Partial Disability. — ^Disablement immediately fc^lowing the acddent — or imme* 
diatdy following total disability — ^which prevents the insured from performing some 
material part ci his business duty or duties. 

For Standard Provisions, See Page 11. 

Additional Provisions 

21. If this policy shall be assigned, a cop^ of such assignment shall be given, within 
thirty days, to the Corporation, which shall not be responsible for its validity. 

22. Not more than one fixed mdemnity shall be payable as the result of any one acci- 
dent and such payment shall terminate the policy. 

23. The limit of liability expressed in Standard Provision No. 19 refers to the orig- 
inal principal sum provided by the policy or policies issued by this Corporation to the 
insured. The limit stated does not mclude increasing benefits of said policy or policies. 

24. In event of the death of the insured anjy accrued weekly indemnity for injuries 
covered hereby shall be payable to the beneficiary if surviving the insured, and other- 
wise to the estate of the insured. 

25. The insurance hereunder shall not cover any loss or disability resulting from 
or in consequence of war, or from us^ng or being upon any airship or flying device, or 
resulting directly or indirectly from ptomaine poisoning or disease. 

The premium for this contract is twenty-five dollars; and the contract is made for a 
term <» twelve months, from noon of the nrst day of January 1915, standard time of the 
place where it is coimtersigned; but the same shall not be bmding upon the Corporation 
until coimtersigned by its duly authorized agent. 

In witness whereof, the Ocean Accident and Guarantee Coiporation, Limited, has caused 
this contract to be signed by its Manager for the United States. 

Schedule of Injuries. — ^The amounts provided in the "Schedule of Injuries" and 
"Schedule of Operations" are based upon an original principal sum of five thousand 
dollars; and if the original principal sum specified in this policy is greater or less than 
five tlk)usand dollars the amounts to be paid shall be increased or reduced proportionately. 

For loss of one or more fingers (at least one entire phalanx), $180; one or more entire 
toes, |24Q, F^r ^mplete hernia, caused solely and directly by accidental injury, |84. 



182 OCEAN ACCIDENT AND GUARANTEE CORPORATION. L TD. 

For complete dislocation, viz.: of the shoulder, $120; elbow, $120; wrist. $150; hip. $360; 
knee, $180; any bones of foot, $180; ankle, $180; two or more toes, $60; two or more fingers, 
$60. For the complete fracture of bones, viz.: of the skull, both ubles, $390; lower law, 
$90; clavicle (collar bone), $180; pelvis, $300; thigh, $360; leg. $240; patella (kneecap). 
$240; arm between elbow and shoulder, $360; forearm between the wrist and elbow, 
$180; two or more ribs, $120; foot, $150; hand, $150; two or more toes, $120; two or 
more fingers, $120. « 



POLICY FORM— "Premier Disability." 

Principal Sum, $5000. Weekly Indemnity, $25. 

Annual Premium, $60. 

The Ocean Accident and Guarantee Corporation, Ltd., in con- 
sideration of the premium and of the statements contained in the 
application, a copy of which is endorsed hereon and made a part 
hereof, and subject to the Definitions, Provisions and limitations, 
as conditions hereinafter contained, 

Hereby insures James Buchanan, of Albany, New York, occupation jeweler, the per- 
son named in the application against (a) loss or disability resulting directly, independently 
and exclusively of all other causes from bodily injuries effected solely through accidentia 
means — suicide while sane or insane is not covered — and ib) against disabili^ from dis- 
ease or illness, as provided in the following sections: 

Section 1. Fixed Indemnities. — (a) n such injuries shall result in any of the losses 
enumerated in this section within twelve months from the date of the accident, the cor- 
poration will pay for such loss a fixed indemnity as follows: For loss of life, or both hands, 
or both feet, or one hand and one foot, or sight of both eyes, or one hand and sight of one 
eye, or one foot and sight of one ^e, the principal sum; either arm or leg, three-fifths 
the principal sum; either hand or either foot, or sight of (me eye, one-half the principal 
sum; t^umb and mdex finger of either hand, one-third the principal sum. (6) If such 
injuries shall immediately, continuously and completely disable and prevent the insured 
from performing any ana every business duty, and at any time during the period oi 
sudi disability shall restdt in any one of the above losses, the corporation win pav the 
fixed indenmi^ specified therefor. The payment of such fixed indemnity shall be in 
addition to the weekly indemnity payable for total disability as hereinafter provided. 

Section 2. Additional Monthly Payments. — 11 such injuries shall result in the 
death of the insured, the corporation will pay to the beneficiary, in addition to the in- 
demnity otherwise payable, -an amount equal to one hundred dollars for each one thousand 
dollars of the original principal sum; or the beneficiary in lieu thereof may elect to receive 
a monthly income ot ten dollars for each one thousand dollars of the original principal 
sum durinjs the first year following the death of the insured; the first payment to oe made 
upon receipt of sati^actory pcom of such death, and to continue each month thereafter 
until twelve montiily payments shall have been made. 

Section 3. Accumulations. — Each consecutive full year's renewal of this poliqr, 
when the premium is paid annually in advance, shall add ten per cent, (and if paid semi- 
annually in advance nve per cent.) to the indemnities provided in Section 1 until such 
accumulations shall amount to fifty per cent, of said mdemnities. Thereafter so long 
as this policy is continued in force the indemnities payable under said Section shall be 
the amount of said indemnities plus such accumulations. 

Section 4. Weekly Indemnities. — If such injuries shall result in disability, dther 
total or partial, the corporation will pay a weekly indemnity as follows: 

Total Disability. — For the period thereof the weekly indemnity above specified. 

Partial DiSABnxTY.—Fifty per cent, of rate for total disability for not emveding 30 
consecutive weeks. 

Section 5. Elective iNDEMNmEs.— If such injuries are named in the "Schedule of 
Injuries" endorsed hereon, the insured may elect to receive the amount of indemnity 
provided in said schedule, in lieu of all weekly indemnity payable, if written notice of 
such election is received at the American Head Office of the corporation within twenty 
days from the date of the accident; but not more than one such indenmity shall be payable 
for injuries resulting from any one accident. 

Section 6. Double Indemnities. — The amounts specified in the preceding Sections 
shall be doubled if such injuries are sustained (1) while a passenger in or on a public 
conveyance (including the platform, steps or running board thereof), or in a pubhc cab, 
provided by a common carrier for passenger service, (2) while a passenger in a passenger 
elevator (excluding mine or freight elevators) , (3) in consequence of the burning or col- 
lapse of a building while the insured is therein, (4) by the explosion of a steam boUer. 

Additional Indemntties. 
Section 7. Reimbursement for Hospital Expenses. — If the insured is necessarily 
and continuously confined within an incorporated hospital by reason of injuries or disease 
or illness coverol by this policy, the corporation, in addition to the indemnity otherwise 
payable, will pay hospital expenses for not exceeding the single weekly indemnity 
specified in Section 4 for each week that the insured is so confined, but for not more than 
ten consecutive weeks. 

. Indemnfty for Surgical Operations. — If such injuries or any disease or Ulness cov- 
ered hereunder, within ninety days from the date of the accident or commeocemeat of 



OCEAN ACCIDENT AND GUARANTEE CORPORATION, LTD. 183 

disability from disease or illness, shall necessitate a surgical operation specifically named 
in the "Schedule of Operations'^ endorsed hereon, and the same shall be performed, the 
corporation, in lien of reimbursement for hospital expenses, will pay as provided in 
said schedule in addition to the indemnity otherwise payable; but payment shall not be 
made for more than one operation necessitated by any one cause of loss or disability. 

Graduate Nurses' Expenses.— In lieu of any sum payable for reimbursement for 
hosi>ital expenses or indemnity for surgical operations, the corporation, in addition to 
the indemnity otherwise payable, will pay for each week of graduate nurses' expenses an 
amount not exceeding the single weekly indenmity provided in Section 4, but for not 
more than ten consecutive weeks. 

Surgical Indemnity for Minor Injuries.— If such injuries do not result in total or 
partial disability or necessitate any surgical operation named in the * 'Schedule of Opera- 
tions," but do necessitate medical treatment, the corporation, upon presentation of re- 
ceipted physician's bill,^ will pay the amount expended for such treatment, but for not 
exceeding one week's single maemnity. 

Special Indemnity. — Sunstroke, freezing, hydrophobia, asphyxiation, or septioemia 
resulting from such injuries shall be deemedto be covered by this policy. 

Identification. — If the insured, by reason of such injuries, shall be physically unable 
to communicate with relatives or friends, the corporation, immediately upon receipt of 
advices giving the number of this policy, will transmit to his relatives or friends informa- 
tion concemmg him, and will defray all expense (not exceeding one hundred dollars) 
necessary for placing him in their care. 

Sickness Indemnity. 

Section 8. Temporary Disability.— For the period during which the insured shall be 
necessarily confined in the house by reason of disease or ilhiess which shall, independently 
of all other causes, whollv disable and prevent him from performing any and every business 
duty,thccori)orationwiIlpaythesingle weekly indemmty specified in Section 4; and if 
immediately following such period of total disabilitjr and confinement in the house b« 
shall be wholly disabled and prevented from performing any^ and every business duty; 
but is not necessarily confined in^the house, the corporation will pay one-half the- 
single weekly indemnity specified in Section 4. But no payment under this section shall 
be made for disability m excess of fifty-two consecutive weeks' duration, nor for disability 
for which the insured is not treated oy a licensed physician. 

Section 9. Permanent Disability.— If the insured shall suffer the entire and irre- 
coverable loss of <a) the use of both hands of both feet or of one hand and one foot, or 
(b) the si^ht of both eyes, as the result of disease or illness contracted during the term 
of this policy, the corporation upon receipt of satisfactory proof that the insured has been 
diaablea thereby for one year and will thereafter during his life be permanently pervented 
from engaging m any work or occupation for wages or profit, will pay, in lieu of all other 
indenmities, an amount equal to one hundred weeks' single weekly mdemnity specified 
in Section 4. 

Definitions. 
(For Terms as Used in this Contract) . 

Loss OF Life. — Death occuring form such bodily injuries within twelve months after 
the accident or as extended in Paragraph (b) of Section 1. 

Loss OF Hand orJIands, or Loss of Foot or Feet, or Loss of thumb and Index 
FiNOKR. — ^The actual severance thereof at or above the proximal joints, within twelve 
months after the accident or as extended in Paragraph (b) of Section 1. 

Loss OF Arm or Leg. — The actual severance thereof at or above the elbow or knee 
within twelve m<mths after the accident, or as extended in Paragraph (b) of section 1 . 

Loss OF Sight of Eye or Eyes. — Permanent total blindness thereof beyond remedy 
by surgery or other means, and occurring within twelve months after the accident or as 
extended m Paragraph (b) of Section 1. 

Total Disabiuty. — Continuous and complete disablement, occurring immediately 
after the accident, and which prevents the insured from performing any and every busi- 
ness duty. 

Partial Disabiuty.— Disablement immediately following the accident— or immed- 
iately fcAlowing total disability^ — ^which prevents the insured from performing some ma- 
terial part of his business duty or duties. 

For Standard Provisions See Page 11 

Additional Provisions. 

21. If this policy shall be assigned, a copy of such assi^ment shall be given, within 
thirty days, to the corporation, which shall not Ifc responsible for its validity. 

22. Not more than one fixed indemnity shall be payable as the result of any one acci- 
dent and such payment shall terminate uie policy. 

23. Tlie limit of liability expressed in Standard Provision No. 19 refers to the original 
principal sum provided by the policy or policies issued by this corporation to the insured. 
The limit stated does not include increasing benefits of said policy or policies. 

24. In event of the death of the insured any accrued weekly indemnity shall be 
payable to the beneficiary if surviving the insured, and otherwise to the estate of the 
insured. 

25. Proof of loss under Section 9 of this policy for permanent disability must be fur- 
nished to the corporation within ninety days after the expiration of one year from the 
commencement of said permanent disability. . . 

26. Change of occupation shall not in any manner effect the indemnities provided 
by Sections 8 or 9. 



. 184 OCEAN ACCIDENT AND GUARANTEE CORPORATION, LTD. 

27. Loss or disability resulting from ptomaine poisoning shall be covered only under 
Section 8 or of the policy. 

28. The corporation shall not be liable for disabilitv resulting from tuberculosis or 
insanity in excess of six months' duration nor shall reimbursement for hospital expenses 
contaijied in fcction 7 aPt'.ly l^i ^^^-^ '-i-.tases. 

i^y. Tliis iaaurarice d^ni3 nut c^tver a wcunim, nor injuxiea fatal or ijoa-fatal resulLini: 
from minjiE or beiiiK upon any aii^hin or flying device; nor does it cover dlsabiLly from 
any disease or illness: contriitted within ^fiecD days from noon of tbe date of this policy: 
occasioned by or contracted while engaged in, Trijlitaiy or naval service; for any |>erit»J 
for which the insured has claimed or may daim indemnity on account of injuries sufferec! 
by accidental violence; suffered oC coatracted outside of the limits of the United Sutci 
01 America, Canada or Europe. 

ScjjEDutB OF iMjukiES. (Optional Indemnity. See Section 5.) — The amounts pro- 
vided La the "Schedule of Injuries'^ and "Schedule of Operations'* are based upon an 
original principal sum of five ihou^nd dollars; and if the orL|,'inal princIpsLl sum spcti&cd 
in this policy 13 greater or lesa than five thou^nd dollars the amounts to be paitl shall 
be increased: or reduced proportionately » Ordinary accidents . Section 4, For loss of 
on* of more £nj^er^ (at least one entire phalanx) , f 150: one or more toeSf S^OO. For com- 
plete hernia, caused solelv and directly by accidental injury, 170* For complete disiw- 
cation, viz: Of the shoulder or the elbow, flDO^ wrist, Si Erj; hjpj$300; knee or any bones 
of the foot. il50; ankle, $150; t^^o or more toes or finKerB, S50» For the complete fraclUiTe 
of bones, vii: Of the skull, both tables, %'A2^i lower jaw, $75; clavicle (collar bone), llSCi; 
pelvis, S2r50; thifjh, WW; leg or the patella (knee cap), S200; arm between elbow and shoul- 
flcr, 1300; forearm between the wrb^t and elbow, $150; two or mott ribsj SlOOf foot or 
the band. tl25; two or more toes or lingers, $100- 

ScHEDDiE OF OPERATIONS. — (bidcmnit;^ ftJf surgical operatiooa, Se« Section 7K 
Abscess— incision. 15. Abdomen -^^cutting Into abdominal cavity for dia^^bosis or treat- 
ment of organs therein, SlCW* Amputation of entire hand, forearm, or foot, $25; leg or 
arm, $50; th]ji;h,_|75; finf^cr or ^sKers^ *^P% Ancuriam ^-operation for tying of artery, 
$35, Appendicitis — see abdomen* Bone — injuries to or disease of. Removal of diaejiscd 
portion of bone^ 125. Carbuncle — incision, $5. Chest — cutting into thoracic cavjiy 
for diagnosis or treatment of organs therein^ 125* Cancer of the Up — removal of, by 
cuttin^ operation |25, Dislocation- reduction of hip or knee, $^5; shoulder , elbow or 
ank Ee, $25 ; w ri st or lower jaw ,$15; thumb ,$10; finge rs . So » Eye , ear , nose — any cu i - 
ing operation j $10. Eye — enucleatioo of $50. Extision^removal of fihoulder or bif) 
joint, $100; knee joint; $75; elbow , wrist or ankle joint, ifiO; toe qf toea^ $10» Fract- 
ures — reduction of nose, lower jaw, Collar bone , of shoulder olade, $25 j breast bone or 
ribs, $10; upperarm,$Jj^forearni or wrist, $25' hand, $15; fingefa^ $5; bones of the 
pelvis (eicept coccyx) , $75; coco":! d tlO ; thigh , (75 ; knee cap or lefr> $50; bones of fcust, 
il5j toes, $10. Goitre cutting operation for permanent cure, 175. Hydrocele — ia- 
ci Bi on and treatment of -sac, $25 j Hydrophobia — Pasteur treatment^ $50. In£aiEiati(?D 
of jdnt— incision of joint, $25. Intestinal obstruction — see abdomen , Kidney-— see 
abdomen. Lockjaw — injection of antitoxin into skull f $100; injection of antitoxin into 
-^oinaj caiialj$50. Mastoiditis — cutting operation for removal of ^diseased bone, 
$50. Nerve — cutting operation for stretching + $25, Rectum— cutting operation for 
hemiorrhoids, external^ $lfi^ hemorrhoids, internal » $25; prolapsed, $25^ ^tula is 
ano, $20; n 'I'-F-nf -ti-iV^i.TH , *ir>0. Skull — cutting into cranial cavity. sK¥> Sf.irje 
or spinal-. ' ■ mo va I of fractured vertebra, $100, St''.:'rrr :.li.i- 

gus— cutting upcruLiuia v.cj:ti;:^aai) for permanent cure of, $100. Stont- in bladdci - re- 
moval of by cutting or crushing operation , $75. Tapping — of abdomen; $25; bladder 
or chest, $15; ear drum, $10; hydrocele, $10; joints, $10. Trachea — cutting into for 
removal of foreign bodies or for relief of difficult breathing , $35. Throat— any cutting 
operation, $10. Tumors— removal of by cutting operation, malignant, $50 benign $15 
Wricocele — cutting operation for permanent cure, $25. Vein8,varioose— catting opera- 
tion for permanent cure, $25. Wo:!ads— suturing, $5. 



PKCtnC MOTPAL LtfE INStTftANCfi COMPANY 185 

Pacific Mutual Life Insurance Companv 

OF CALIFORNIA. 



Commenoed Busineas (Accident Branch) 1885. 
Geo. I. CoGHKAN, Pres. C. I. D. Moore, Sx 



Policies covering accident and illness are issued under a variety of 
forms. The "Life and Limb" policy is sold to Select and Pre- 
ferred Classes at $3 per $10P0. "Special Health" policy, $25 
weekly indemnity, covering forty-one diseases: Rate: Select or 
Preferred, $10. "General Accident" policy, rate. Select $20. 
"Eureka Accident" policy, issued to Select and Preferred risks 
only, $25 (see below). "Eureka Disability" policy, issued to 
Select and Preferred risks only, ages 18 to 50, $60; 51 to 60, $70 (see 
below). "Full Health" policy, rate Select and Preferred, ages 18 
to 50, $40; 51 to 55, $50; 56 to 60, $60. " Eureka Special Disability" 
policy, issued to Select and Preferred risks only, ages 18 to 50, $75; 
51 to 60, $87.50 (see below). 

POLICY FORM— "Eureka Accident." 

Form A-106. 

Principal Sum, $5000. Weekly Indemnity, $25. 

The Pacific Mutual Life Insurance Company of California, 
(herein called the company), in consideration of twenty- five ($25) 
dollars premium, and of the statements set forth in the copy of the 
application endorsed hereon (herein called Application), 

Hereby insures John Doe (herein called insured and described in the application), for the 
term of twelve months from the first day of January , 1914, beginmng and ending at 
twelve o'clock noon, standard time, at the place where this policy is countersigned, in 
the principal sum of five thousand dollars (nerein called principalsum), and in the sum 
of twenty-five dollars per week (herein called weekly indemnity), as a banker against, 
bodily injury sustained during tne term of this policy, through accidental means (exclud- 
ing suicide, sane or insane, or any attempt thereat, sane or iaiane), and resulting directly, 
independently and exclusively of all other causes, in — (a) immediate and continuous 
total disabilitv that prevents the insured from performing any and every kind of duty 
pertaining to his occupation, (ft) Immediate (as respects the injury or as respects pre- 
ceding total durability) and continuous partial disability that prevents the insured from 
performing fully, work essential to the duties of his occupation, (c) Loss of life; sub- 
)ect to all provisions and limitations herein contained; as follows: 

AcciDEKr iNDElDirriES. 

Arttclb 1. Total DmABiUTy.^The weekly indemnity will be paid as long as the 
faisured suffers such total disability. 

Article 2. Partial Disability. — ^Half the weekly indemnity will be paid as long 
BS the insured suffers such partial disability, not exceeding twenty-six weeks. 

Artxclz 3. Loss or Lite. — The principal sum will be paid, if at an^ time during the 
period of such total disability the insured suffers loss of life as the durect result of the 
bodily injury causing such total disability, or if within ninety days from the date of the ac- 
cident irrespective of total disability , the insured suffers loss of life, as tl^e direct result of 
bodily injury; and in either event, in addition, the weekly indemnity for the period 
between date of the accident and date of loss of life. 

Article 4. Optional Indemnity.— When the bodily injury is one named in the 
"Schedule of Injuries " endorsed hereon, and the insured suffers such total disability in 
consequence thereof, the insured has the option of receiving the amount computed and 
shown by said schedule, in addition to the weekly indemnity for the period between date 
of the accident and date that the insured suffers said scheduled injury, in lieu of all other 
indemnity under this policy except surgeon's fees and hosiMtal charges to which he may be 
entitled, if during the period of such total disability and within two hundred weeks from 
date of accident, he suffers said scheduled injury as the direct result of the bodily injury 
causing such total disability and independently and exdusivehr of all other causes; or if 
vithin ninety days from the date of the accident, irrespective of total disability, be suffen 



m PACIFIC MUTUAL LIFE INSURANCE COMPANY 

in like manner one of said scheduled injuries; provided written notice of option is given 
to the company at Los Angdes, California, or to any authorized agent of the company, 
within thirty davs from the date that the insured suffers any injury appearing in Section 
1 of said schedule, or within twenty days from date that the insured suffers any injury 
appearing in Section 2 of said schedule, but only one such optional amount shall be pay- 
able under this article as the result of one accident, and m the event of two or more 
injuries so resulting, the company will pay for the injury for which the largest amount is 
so scheduled. 

Articles. Double Indemnities. — The amounts specified in Articles 1 to 4 incluave, 
shall be doubled, if the bodily injury is sustained b:^the insured — (1) while in a passenger 
elevator (excluding elevators in mines) ; (2) while in or on a public conveyance (includ- 
ing the platform, steps, or running board thereof) ^ovided by a common carrier for pas- 
senger service; (3) in cotseauence of and while the insured is m or on a burning builmng; 
(4) in consequence of a stroke of lightning; (5} in consequence of the collapse ot the outer 
walls of a building while the insured is therem; (6) in consequence of the explosion oi a 
steam boiler; (7) in consequence of a cyclone or tornado. 

Article 6 Sunstroke, Freezing, Hydrophobia, Asphxiation. — Sunstroke, freez- 
ing, hydrophobia or asphyxiation, suffered through accidental means (excluding suicide 
sane or insane, or any attempt thereat, sane or insane), shall be deemed a bodily injury 
within the meaning <x this policy. 

Article 7. Blood Poisoning. — Blood poisioning resulting directly from a bodily 
injury shall be deemed to be included in said term, bodily injury. 

Article 8. Hospital Charges.— Half the weeklv indenmity in addition to any other 
indemnities payable, excepting under Article 9, will be paid for the period, not exceeding 
10 weeks, during which the insured is confined to a regularly incorporated hospital by 
reason of said bodily injuries which cause removal to such hospital within ninety days 
from date of the accident. 

Article 9. Surgeons' Fees.— If on account of said bodily injury, for Which indemnity 
is payable, and within ninety days from date of the accident, the insured undergoes 
asurgical operation named in the " Schedule of Operations" endorsed hereon, the company 
will pay to the insured, in addition to the indemnity payable for said bodily injury, the 
amount computed and shown by said schedule; but only one such amount shall be payable 
under this article as the result of one accident, and in the event of two or more operations 
so resulting, the company will pay for the operation for which the largest amount is so 
scheduled. 

Article 10. Surgeons' Fees for Non-Disabling Injuries.— Or if said bodily 
injuries do not disable the insured, or entitle him to any indemnity, but necessitate im- 
mediate treatment by a physician or surgeon, the company, prodded that the bill of the 
attending phyncian orsurgeon, duly receipted, is filed with the^ company within ninety 
dvys from the date of the accident, will reimburse the insured in the amount expended 
by him on account of such treatment, not exceeding the amount payable for one week of 
total disability. 

ARTitLE 11. Ten Per Cent. Annual Increase.— Upon each renewal of this poficy 
after the first year, by the payment of the aimual premium in advance, the prindpsJ 
sum payable for loss of life of the insured and the amount payable for dismemberment 
ex loss of sight of the insured under Schedule of Injuries, Section 1, will be increased 10 
per cent, until such increase is 50 percent.; but if the premiums on this policy are pasrable 
quarter-annually or semi-annually in advance, then each year's premium paid after pay- 
ment of the first year's premium will increase said benefits five per cent, \mtil such increase 
is fifty per cent.; which total increase of fifty per cent shall thereafter remain with the 
policy. 

Article 12. Special Provisions.— The terms, bodily injury, total disability, partial 
disability and loss of life are defined in the insuring clause, and as so defined shall be 
understood wherever used in this policv. 

Article IS No recovery shall be had under more than one article of this policy on 
account of one accident to the insured, except as provided in Article 2 (partial disability) , 8 
(hospital charges) , 9 (surgeons' fees) and 1 1 (ten ^r cent, annual increase) . No recovery 
shall be had on account of disability from bodily injury for any period of time for which 
the insured is entitled to weekly indemnity on account of disability from illness under any 
policy. This policy does not cover any bodily injury, fatal or non-fatal, sustained by 
the insured while participating in, or in consequence of having participated in aeronautics. 

Article 14. Any assit^nment of interest under this policy shall not bind the company 
nnless consent thereto is formally endorsed hereon by an executive officer of the company. 
A copy of any assignment shall be given immediately to the company, which shall not 
be responsible for its vah'dty. 

Article 15. The limit of liability as expressed in Standard Provision No. 19 refers 
to the original single principal sum or single weekly indemnity provided by the policy 
or policies issued by this company to the insured.^ On the limits stated proportionate 
increases, as provided by the double indemnity, surgical operation and hospital mdemni^ 
provision will be allowed. 

For Standard Provisions See Page 11 

Schedule op Inturies. — ^The following table is for policy ci $5,000 Drindpal sum: 
if the principal sum be either more or less than $5,000, the amounts shall be increased 
or decreased proix>rtionately. Section 1. Dismemberment by actual seperation at 
or above the wrist joints or ankle joints of both hands or both feet, or one haiid and one 
foot, $5,000; one hand or one foot. $2,500; one hand and the irrecoverable loss of the 
sight of one eye, or one foot and the irrecoverable loss of the sight of one eye, $5,000. 
Trrecoverable loss of the sight of both eyes, $5,000; one eye, $2,500. Section 2. Dis- 
mberment of fingers, one or more entire, $160; toes, one or mote entire, $200. Con^ 



PACIFIC MUTUAL LIFE INSURANCE COMPANY 187 

plete hernia, S80. Complete dislocation of shoulder, $60; elbow, $100; wrist, $120; hip, 
$300; knee, $160; foot, two or more bones; not toes, $160; ankle, $160; toes, two or 
more, $60; fingers, two or more, $60. Complete fracture of skull, both tables, $320; 
lower jaw, $80; collar bone, $160; pelvis, $240; thigh shaft, $300; leg, one or both bones, 
$200; knee cap, $200; upper arm humerus, $160; forearm, both ulna and radius, $160; 
forearm, either ulna or radius, $80; ribs, two or more, $100; foot, two or more bones, not 
toes, $120; hand, two or more boiies, not fingers, $120; toes, two or more, $100; fingers, 
two or more, $100. 

Schedule of Operations.— The following table is for policy of $5,000 principal sum. 
If the principal sum be either more or less than $5,000, the amounts shall be increased 
or decreased proportionately. Amputation of foot, hand, or forearm, $25; le^, at or 
below knee, $50; arm, above elbow, $50; thigh. $100; fingers,, one or more entire, $10; 
toes, one or more entire, $25. Reduction of dislocation ofshoulder, elbow, hip, knee, or 
ankle^ $25; wrist or jaw $15; fingers, one or more, $10. Excision of shoulder, hip or 
knee joint, $ 1 00; elbow, wrist, or ankle joint , $50; Reduction of fracture of nose, lower 
jaw, collar bone, or shoulder blade, $25; breast bone, $10; rib or ribs, $10; upper arm, 
$35; forearm, one or both bones, $25 ; wrist or hand. $15 ; fingers, one or more, $10; pelvis, 
or sacrum, any of the bonesof , $50;coccyz, $10; thigh, $75; knee cap, $50; 1^ bones, one 
or both. $50; foot, two or more bones, not toes, $15; toes, one or more, $ 10. Removal of 
shot or bullet, $25. Any cutting operation for the radical cure of the reducible, irreduc- 
ible, or strangulated forms of abdominal hernia, $100. Suturing wounds, $5. Seques- 
trotomy (removal of dead bone) $35. skull trephining, $100. Incision for synovitis 
(inflammation of the lining membrane of a joint), $25. Injection of anti-tetanic serum 
into frontal lobe of brain, $100. Larparotomy (opening of the abdominal cavity for 
an operation on any organ contained therein), $100. 

For an additional payment of $1 per annum for each $5 weekly 
indemnity, the weekly indemnity under this policy will be made 
to accumulate ten per cent per annum for five years. 

POLICY FORM— "Eureka Disability." 
Form A 105 

This policy is similar to the "Eureka Accident" policy, except 
where the phraseology conflicts with the health provision and in 
the following paragraphs: 
Principal Sum, $5000. Weekly Indemnity, $25. 

The Pacific Mutual Life Insurance Company of California 
(herein called company), in consideration of sixty ($60) dollars 
premium, and of the statements set forth in the copy of the appli- 
cation endorsed hereon (herein called application). 

Hereby insures John Doe (herein called insured and described in the application), for 
the term of twelve months from the first day of January, 1914, beginning and ending 
at twelve o'clock, noon, standard time, at the place where this policy is countersigned, 
in the principal sum of five thousand dollars (herein called principal sum) , and in the sum 
ci twenty-five dollars per week (herein called weekly indemnity) , as a banker against, (1) 
bodily injury sustamed during the term of this policy , through accidental means (ezdud- 
ing suicide, sane or insane, or any attempt thereat, sane or insane) , and resulting directly 
independently and exclusively of all other causes, in — (a) immediate and continuous 
total disability that prevents the insured from performing any and every kind of duty 
pertaining to his occupation, (b) Immediate (as respects the injury or as respects pre- 
ceding total disability) and contmuous partial oisabihty that prevents the insured from 
performing fully, work essential to the duties of his occupation, (c) Loss of life; (2) 
illness, as hereinafter defined, contracted by the insured during the term of this policy, 
but not within fifteen days from the time this policy becomes effective and for which 
the insured is treated by a licensed physician. Subject to aU provisions and limit- 
ations herein contained; as fbUows: 
as follows: 

Illness iNDEiDnnzs 

Artuxb 1. Illness not Exceeding Firrv-Two Weeks.— The weekly indemnity 
will be paid for the period (not exceeding fifty-two w^eks) throughout which the insured 
is necessarily confined in the house and prevented from performmg any and every kind 
of duty pertaining to hb occupation because of illness not hereinafter excepted, contracted 
by the insured during the period specified in part 2 of the insuring clause, and on account 
ci which confinement banns during such period. 

Article 2. Illness Following Confinement in House. — (a) Half the weekly in- 
demnity will be paid for the period throughout which the illness causing confinement 
in the house, within the terms of the preceding article, continuously thereafter and within 
fifty-two weeks of the beginning of such confinement, totally disables and prevents the 
insured from performing any and every kind of duty pertaining to his occupation (but 
not necessarily to the extent of confining him in the house) , and 

Illness Exceeding Fipty-Two Weeks. — (6) one-fourth of the weekly indemnity 
will be paid as long as the insured continuously suffers, beyond the said fifty-two week^ 
soch total disability defined in this article. 



Idd l^ACIFIC MtJttlAL tffg mStmANCfi COM PANY 

Article 3. Blindness or Paralysis.— One-half the principal sum will be paid if 
the insured elects to receive that amount in lieu of all other indemnity under this policy 
except surgeon's fees or hospital charges to which he may be entitled, if any illness con- 
tracted by the insured during thfc term specified in part 2 of the insurmg clause, and not 
hereinafter excepted, results during the said term in the irrecoverable loss of the sight of 
both eyes, or in permanent paralvsis whereby the insured during the said term irrecover- 
ably loses the entire use of both hands or both feet, or one hand and one foot, and on ac- 
count of the said loss of sight or one of the said losses resulting from permanent paralysis 
the insured— (1) is permanently unable to engage in any work or occupation for waces 
or profit; and (2) survives, for the period of one year the said loss of sight or one of the 
said losses resulting from permanent inralysis; and (3) at the end of the said period of 
one year is declared by medical authwity satisfactory to the company to have irrecover- 
ably lost the sight of both eyes, or the entire use of both hands or both feet or one hand 
and one foot, and to be permanently unable to engage in an^ work or occupation for wages 
or profit by reason of the said loss of sight or one ox the said losses resultmg from perma- 
nent paralysis. 

Article 4. iNDEifNmr i» Quarantined.— TTifc weekly indemnity will be paid for 
the period, (not exceeding ten weeks) throughout which the insured is continuously quar- 
antined commencing dunng the term specified in part 2 of the insuring clause, by order 
of the civil authorities, because of an infectious or contagious disease contracted by the 
insured, and by reason of said quarantine is prevented from performing any and every 
kind of duty pertaining to his occupation. 

For Accident Indemnities See Preceding Policy 
Accident and Tllnebs Indemnities 

Article 12. Hospital Charges.— Half the weeklv indemnity in addition to any 
other indenmity payable, excepting^ under article 13, will be paid for the period, not ex- 
ceeding 10 weeks, during which the msured is confined to a regularly incorporated hospital 
b^ reason of said bodily injuries or illness which cause removal to such hospital within 
mnety days from date of the accident or inception of illness. 

Article 13. Surgeons' Fees.— If on account of said bodily injury^ or illness, for which 
indemnity is pajrable, and within ninety days from date of the accident or inception of 
illness, the insured undergoes a surgical oi>eration named in the schedule of operations 
endorsed hereon, the company will pay the insured, in addition to the indemnity payable 
for said bodily injury or illness, the amount computed and shown by said schedule; but 
only one such amount shall be payable under this article as the result of one accident or 
one illness, and in the event of two or more operations so resulting the company will pay 
for the operation for which the largest amount is so scheduled. 

Article 14. Surgeons' Fees por Non-Disabuno Injuries.— Or, if said bodily 
injuries do not disable the insured, or entitle him to any indemnity, but necessitate im- 
mediate treatment by a physician or surgeon, the company, provided that the bill of the 
attending physician or surgeon, duly^ receipted, is filed with the company within ninety 
days from date of the accident, will reimburse the insured in the amount expended by him 
on account of such treatment, not exceeding the amount payable for one week of total 
disability. 

Article 15. Ten Per Cent Annual Increase.— Upon each renewal of this policy 
after the first year, by the payment of the annual premium in advance, the princip«a 
siim payable for loss of life ofthe insured and the amount payable foe dismemberment or 
loss of sieht of the insured under Schedule of Injuries, Section 1, will be increased ten per 
cent until such increase is fifty per cent: but if the premiums on this policy are payaole 
quarter-annually or semi-annually in advance^ then each vear's premium paid after pay- 
ment of the first year's premium will increase said benefits five per cent until such increase 
is fifty per cent; which total increase of fifty per cent shall thereafter remain with the 
policy. 

Special Provisions 

Article 16. The limit of liability as expressed in Standard Provision 19 refers to 
the original single principal sum or single weekly indemnity provided by the policy or 
policies issued by this company to the insured. On the limits stated proportionate 
increases, as provided by the double indemnity, surgical operation and hospital mdemnity 
provision will be allowed. 

Article 17. The terms, bodily injury, total disability, partial disability and loss of 
life are defined in the insuring clause, and as so defined shall be understood wherever 
used in this policy. 

Article 18. — No recovery shall be had under more than one article of this policy 
on account of one accident to the insured, or one illness suffered by the insured, except 
as provided in Articles 2 (Illness Following Confinement in House) , 6 (Partial Disability , 
12 (HospiUl Charees), 13 (Surgeons' Fees), and 15 (Ten Per Cent Annual Increase). 
No recovery shall be had on account of disability from bodily injury for any period of 
time for which the insured is entitled to weekly indemnity on account of disability from 
illness under any policy. 

Article 19. — Any assignment of interest under this policy shall not bind the company 
unless consent thereto is formally endorsed hereon by an executive officer of the company. 
A copy of any assijgmnent shaU be given immediately to the company, which shaU not 
be responsible for its validity. 

Article 20. — This policy does not cover — (a) any iUness contracted while the insured 
is engaged in military or naval service in time of war; (jb) any illness contracted or suf- 
fered outside the states and territories of Continental United States of America, or Canada 
or Europe, or while in Alaska; (c) any bodily injury, fatal or non-fatal, sustained by the 
osured while participating in, or in consequence of having participated in, aeronautio. 



PACIFIC MUTUAL LIFE INSURANCE COMPANY 180 

For Stamdakd Provisions Sex Pack 11 

SCFEDULB OF INJURIES. — The foUowing table is for policy of S5000 principftl sum; if 
the principal sum be either more or less than $5000, the amounts shaU be increased or 
decreased proportionately. Section 1. — Dismemberment by actual separation at or 
above the wrist joints or ankle joints of both hands or both feet, $5000; one hand and <me 
foot, $5000; one hand or one foot, $2500; one hand and the irrecoverable loss of the sight 
of one eye. $5000; one foot and the irrecoverable loss of the sight of one ^e, $5000. Joe- 
coverable loss of the sight of both eyes, $5000; one eye, $2500. 

Section 2. — Dismemberment of fingers, one or mor