DISABILITY BENEFIT PAYMENT RIDER
BENEFIT
We will provide one of the following after the Insured's Total Disability has
continued for 6 consecutive months and a claim for Total Disability has been
approved.
1. If Total Disability starts before age 60, we will
credit the Disability Benefit Amount to the value of
this policy on each Monthly Anniversary Day, as shown
on the Policy Schedule, while Total Disability
continues.
2. If Total Disability starts on or after age 60, but
before age 65, we will credit the Disability Benefit
Amount to the value of this policy on each Monthly
Anniversary Day prior to age 70 while Total
Disability continues.
Age
Insured's age 60 or 65 means the policy anniversary nearest the Insured's 60th
or 65th birthday, respectively.
Total Disability
Total Disability is disability which:
1. Results from bodily injury or disease; and
2. Prevents the Insured from engaging in an occupation.
During the first 24 months of disability, an
occupation is the occupation of the Insured at the
time disability began; this includes attendance as a
student at a school or college. After the first 24
months of disability, an occupation is any occupation
for which the Insured is qualified by education,
training, or experience.
Even if the Insured engages in an occupation, the total, permanent loss of the
use of one of the following is considered a total disability:
1. Both eyes; or
2. Both hands; or
3. Both feet; or
4. One hand and one foot.
Limitations
No amount will be paid under this rider if the Insured's disability results
from:
1. Voluntary self-inflicted injury, whether sane or insane; or
2. War or an act of war, whether declared or not; or
3. Injury, disease, or infection which first manifested itself
before or at the time of application for this rider unless noted
on the application for this rider; or
4. Injury, disease, or infection which first manifested itself
before reinstatement of this rider if lapsed and then reinstated,
unless noted on the application of reinstatement.
Notice of Claim
Written notice of a claim must be given to our Home Office during:
1. The Insured's lifetime; and
2. The continuance of total disability.
Failure to give notice will not invalidate a claim if it is shown that notice
was given as soon as reasonably possible. No monthly payment due more than one
year prior to proof of claim will be waived.
Prior to the approval of any claim, we will have the right to have one or more
physicians examine the Insured at our expense as often as we may reasonably
require.
Requirements
Total Disability of an Insured must:
1. Require regular treatment by a licensed physician other than the
Insured;
2. Be caused by accidental bodily injury occurring, or disease first
manifesting itself, after the effective date of this rider but
before age 65;
3. Continue for 6 consecutive months; and
4. Start when this rider and this policy are in force with respect
to the Insured.
Proof of Continuance
After the approval of a Total Disability claim, we may:
1. Require due proof of the continuance of Total Disability; and
2. Have one or more physicians designated to examine the Insured at
reasonable intervals at our expense.
After Total Disability has continued for 2 full years, we will not require proof
of examination more than once a year.
Disability Benefits will not be credited to the Policy if:
1. Proof of continuance of Total Disability is not furnished upon
request; or
2. The Insured fails to submit to examination.
Notice of Recovery
The Owner shall give immediate notice to us when the Insured recovers from Total
Disability.
Recurrence of Prior Disability
If, following recovery from a Total Disability which has continued for at least
6 consecutive months, the Insured suffers another Total Disability which:
1. Begins within 30 days of recovery; and
2. Is due to the same or related causes as the prior Total
Disability;
then, Total Disability shall be deemed to have been continuous.
Incontestability
We will not contest this rider after it has been in force, in the absence of
fraud, during the Insured's lifetime for two years from the effective date of
this rider or the effective date of reinstatement.
Termination
The benefit will terminate if:
1. If any monthly payment for this policy or benefit is not paid
before the end of the grace period; or
2. If the policy is surrendered or lapsed according to the Policy
Values Provisions; or
3. If reduced paid up insurance is purchased with the policy's cash
surrender value; or
4. If the policy terminates for any reason; or
5. On the Insured's age 65, unless monthly payments are then being
paid under this rider; or
6. When monthly payments terminate, if monthly payments are being
paid under this rider at the Insured's age of 65; or
7. On written request to us.
Reinstatement
This rider may be reinstated if:
1. The Insured is an insurable risk acceptable to us; and
2. The reinstatement provision of the policy is also satisfied.
Effective Date
If this benefit is included in the policy at issue, the effective date will be
shown on the Policy Schedule. If this benefit is added to a policy already in
force, the effective date will be shown on the Policy Contract Amendment.
The benefit will take effect provided:
1. The monthly cost of insurance is deducted from the Accumulated
Value during the Insured's lifetime; and
2. The Insured's risk class has not changed since the application
for this benefit.
Consideration
This rider is part of the policy to which it is attached. It is issued in
consideration of the application and its cost of insurance. The cost of
insurance for this rider is deducted from the Accumulated Value at the same time
and in the same manner as the cost of insurance for the policy.
Cost of Insurance
The monthly cost of insurance for this rider is equal to the product of A times
B times C where:
A - is a factor based on the attained age and sex of the Insured
and is shown in the table below; and
B - is the classification factor for this rider and if included in
the policy at issue is shown on the Policy Schedule. If this
rider is added to a policy already in force the classification
factor will be shown on the Policy Contract Amendment; and
C - is the Disability Benefit payment amount.
TABLE OF FACTORS
(Described in A Above)
For Determining Cost of Insurance for this Rider
Attained Factor Attained Factor
Age Male Female Age Male Female
5 0.042 0.055 35 0.044 0.074
6 0.042 0.055 36 0.046 0.074
7 0.042 0.055 37 0.046 0.074
8 0.042 0.055 38 0.047 0.074
9 0.042 0.055 39 0.047 0.074
10 0.042 0.058 40 0.047 0.074
11 0.042 0.060 41 0.048 0.074
12 0.042 0.064 42 0.048 0.074
13 0.042 0.067 43 0.049 0.074
14 0.042 0.070 44 0.050 0.074
15 0.042 0.071 45 0.052 0.074
16 0.042 0.072 46 0.053 0.074
17 0.042 0.072 47 0.055 0.076
18 0.042 0.072 48 0.056 0.077
19 0.042 0.072 49 0.060 0.078
20 0.042 0.072 50 0.064 0.080
21 0.042 0.073 51 0.068 0.084
22 0.042 0.073 52 0.073 0.089
23 0.042 0.073 53 0.078 0.092
24 0.042 0.073 54 0.085 0.096
25 0.042 0.073 55 0.094 0.100
26 0.043 0.073 56 0.102 0.012
27 0.043 0.073 57 0.115 0.104
28 0.044 0.073 58 0.122 0.107
29 0.044 0.073 59 0.134 0.111
30 0.044 0.073 60 0.143 0.118
31 0.044 0.073 61 0.152 0.126
32 0.044 0.074 62 0.161 0.131
33 0.044 0.074 63 0.169 0.139
34 0.044 0.074 64 0.175 0.145
Signed for the Pan-American Assurance Company at its Home Office in New Orleans,
Louisiana.
/s/Ted Tumminello
Vice President, General Counsel
and Secretary