Common use of Loss of License Clause in Contracts

Loss of License. While your Injury or Sickness may result in the loss or restriction of a professional license, occupation license or certification, that loss or restriction, by itself, does not constitute a Disability. (This space is intentionally left blank.) ICC17-B180(07/17) NOTICE OF CLAIM CLAIMS This section outlines how claims are evaluated and benefits are paid. When you file a claim, you’ll be required to send us “proof of loss.” We explain what that means in this section. To satisfy the proof of loss requirement, we may require medical records, income documentation and other information. If we don’t receive the information within 45 days after we request it, your claim may be turned down. You or the Owner, or your authorized personal representative, must send written notice of claim within 30 days after your Disability or your Family Member’s Serious Health Condition starts, or as soon as is reasonably possible. Written notice must be given to us at our Home Office or to any of our authorized sales representatives. It must include your name and the policy number. CLAIM FORMS After we receive written notice of claim, we will provide our claim form(s) to be completed and submitted as part of the required Proof Of Loss. If we do not provide our form(s) within 15 days after we receive written notice of claim, you may submit a letter of claim to our Home Office. The letter must include the date the Disability or Serious Health Condition began, and the cause and nature of the Disability or Serious Health Condition. PROOF OF LOSS You are responsible for providing Proof Of Loss. Proof Of Loss must be sent to our Home Office. We must receive Proof Of Loss within 90 days after the end of each monthly period for which you claim benefits. If that is not reasonably possible, the claim will not be affected, provided Proof of Loss is furnished as soon as is reasonably possible. However, unless you lack legal capacity, we must be given Proof of Loss within one year after the 90th day referred to above, for that claim to be valid. Proof Of Loss means written proof that you are or were Disabled and entitled to Disability Benefits under this policy. In addition to the completed claim form(s), or your letter of claim, Proof Of Loss includes proof that: • you became Disabled while this policy was in force; and • you are or were Disabled through the Benefit Waiting Period and the Commencement Date; and • you are or were receiving Regular Medical Care from one or more Physician(s) appropriate for your Injury or Sickness. For purposes of the Family Care Benefit, Proof Of Loss means written proof that, while this policy was in force and continuous through the Benefit Waiting Period, your Family Member had a Serious Health Condition; and you worked reduced hours and had reduced earnings during that Family Member’s Serious Health Condition. Proof Of Loss for any claim may also include any information and documentation we may reasonably require in order to substantiate and evaluate your claim, including but not limited to: • medical records and physicians’ notes or statements; and • medical examinations; and • documentation of your prior and current income, including tax returns; and • examination(s) of financial and operational records. ICC17-B180(07/17) Page 11 If any required information or documentation is not provided within 45 days after we send our request, your claim may be denied. Except for medical or financial records examinations, you are responsible for all costs of providing Proof Of Loss. We will require written authorization for us to obtain the information or documentation we require as Proof Of Loss. We will also require you to submit additional documentation of your claim at your expense at reasonable intervals while you are receiving Disability Benefits. EXAMINATIONS As part of the required Proof Of Loss, we have the right to require periodic examinations to determine your eligibility for Disability Benefits. These examinations will be done at our expense and by examiner(s) selected by us. We will choose examiner(s) appropriate for the evaluation of your claim. Examinations may include but are not limited to: • independent medical and psychiatric examinations by physicians or specialists; and • functional capacity examinations and occupational and vocational evaluations; and • examinations and analyses of your financial and operational records and those of any business in which you have an interest. Such records may include tax returns, financial statements, billing and expense information, bank statements, cancelled checks or other documents. We may deny or suspend payment of Disability Benefits if you fail to submit to an examination, or if you fail to cooperate with the person conducting the examination. Disability Benefits may be resumed, provided that the required examination occurs within a reasonable time and benefits are otherwise payable. In the event of death, we may require an autopsy, at our expense, where permitted by law. TIME OF PAYMENT After we receive satisfactory written Proof Of Loss and all other conditions are met, we will pay Disability Benefits under this policy. Any accrued Disability Benefits will be paid immediately. Any Disability Benefits due thereafter will be paid monthly. For periods of less than one month, we will pay a prorated portion of the monthly benefit for each day benefits are payable. Payment will be subject to our receipt of continued Proof Of Loss. If we pay benefits more than 30 days after we receive satisfactory Proof Of Loss, the delayed payment shall be subject to simple interest at the rate of 10% per year beginning with the 31st day after receipt of satisfactory Proof Of Loss and ending on the day the benefit is paid. Once your claim is approved, Disability Benefits will continue until the end of the period for which you have provided us with satisfactory written Proof Of Loss, subject to the terms and limits of this policy. We will require you to submit additional Proof Of Loss at reasonable intervals while you are continuing to receive Disability Benefits. ICC17-B180(07/17) Page 12 There may be times when we ask you to undergo medical or financial exams -- at our expense -- to confirm that you continue to be eligible for disability benefits. We will make benefit payments to the owner unless another recipient is designated. If we close or deny your claim, you have up to 180 days to request a review. When we receive your written request, we will give it our prompt attention.

Loss of License. While your Injury or Sickness may result in the loss or restriction of a professional license, occupation license or certification, that loss or restriction, by itself, does not constitute a Disability. LIMITATION FOR RESIDENCE OUTSIDE THE UNITED STATES AND CANADA Payment of Disability Benefits will not be paid for more than an aggregate total of twelve months of benefits for each period of Disability while you reside outside of the United States or Canada. If Disability Benefits should cease after the payment of 12 months of Disability Benefits, premiums will become due beginning on the next monthly premium due date. If you should return to reside in the United States or Canada after Disability Benefits cease, you may become eligible to resume receiving Disability Benefits if you satisfy all terms and conditions of the policy. (This space is intentionally left blank.) ICC17-B180(07/17B180GSI(7/17) NOTICE OF CLAIM CLAIMS This section outlines how claims are evaluated and benefits are paid. NOTICE OF CLAIM CLAIMS MT: The written notice of claim must be sent within When you file a claim, you’ll be required to send us “proof of loss.” We explain what that means in this section. To satisfy the proof of loss requirement, we may require medical records, income documentation and other information. If we don’t receive the information within 45 days after we request it, your claim may be turned down. You or the Owner, or your authorized personal representative, must send written notice of claim within 30 days after your Disability or your Family Member’s Serious Health Condition starts, or as soon as is reasonably possible. Written notice must be given to us at our Home Office or to any of our authorized sales representatives. It must include your name and the policy number. CLAIM FORMS After we receive written notice of claim, we will provide our claim form(s) to be completed and submitted as part of the required Proof Of Loss. If we do not provide our form(s) within 15 days after we receive written notice of claim, you may submit a letter of claim to our Home Office. The letter must include the date the Disability or Serious Health Condition began, and the cause and nature of the Disability or Serious Health Condition. PROOF OF LOSS You are responsible for providing Proof Of Loss. Proof Of Loss must be sent to our Home Office. We must receive Proof Of Loss within 90 days after the end of each monthly period for which you claim benefits. If that is not reasonably possible, the claim will not be affected, provided Proof of Loss is furnished as soon as is reasonably possible. However, unless you lack legal capacity, we must be given Proof of Loss within one year after the 90th day referred to above, for that claim to be valid. Proof Of Loss means written proof that you are or were Disabled and entitled to Disability Benefits under this policy. In addition to the completed claim form(s), or your letter of claim, Proof Of Loss includes proof that: • you became Disabled while this policy was in force; and • you are or were Disabled through the Benefit Waiting Period and the Commencement Date; and • you are or were receiving Regular Medical Care from one or more Physician(s) appropriate for your Injury or Sickness. For purposes of the Family Care Benefit, Proof Of Loss means written proof that, while this policy was in force and continuous through the Benefit Waiting Period, your Family Member had a Serious Health Condition; and you worked reduced hours and had reduced earnings during that Family Member’s Serious Health Condition. Proof Of Loss for any claim may also include any information and documentation we may reasonably require in order to substantiate and evaluate your claim, including but not limited to: • medical records and physicians’ notes or statements; and • medical examinations; and • documentation of your prior and current income, including tax returns; and • examination(s) of financial and operational records. ICC17-B180(07/17B180GSI(7/17) Page 11 If any required information or documentation is not provided within 45 days after we send our request, your claim may be denied. Except for medical or financial records examinations, you are responsible for all costs of providing Proof Of Loss. We will require written authorization for us to obtain the information or documentation we require as Proof Of Loss. We will also require you to submit additional documentation of your claim at your expense at reasonable intervals while you are receiving Disability Benefits. EXAMINATIONS As part of the required Proof Of Loss, we have the right to require periodic examinations to determine your eligibility for Disability Benefits. These examinations will be done at our expense and by examiner(s) selected by us. We will choose examiner(s) appropriate for the evaluation of your claim. Examinations may include but are not limited to: • independent medical and psychiatric examinations by physicians or specialists; and • functional capacity examinations and occupational and vocational evaluations; and • examinations and analyses of your financial and operational records and those of any business in which you have an interest. Such records may include tax returns, financial statements, billing and expense information, bank statements, cancelled checks or other documents. We may deny or suspend payment of Disability Benefits if you fail to submit to an examination, or if you fail to cooperate with the person conducting the examination. Disability Benefits may be resumed, provided that the required examination occurs within a reasonable time and benefits are otherwise payable. In the event of death, we may require an autopsy, at our expense, where permitted by law. TIME OF PAYMENT After we receive satisfactory written Proof Of Loss and all other conditions are met, we will pay Disability Benefits under this policy. Any accrued Disability Benefits will be paid immediately. Any Disability Benefits due thereafter will be paid monthly. For periods of less than one month, we will pay a prorated portion of the monthly benefit for each day benefits are payable. Payment will be subject to our receipt of continued Proof Of Loss. If we pay benefits more than 30 days after we receive satisfactory Proof Of Loss, the delayed payment shall be subject to simple interest at the rate of 10% per year beginning with the 31st day after receipt of satisfactory Proof Of Loss and ending on the day the benefit is paid. Once your claim is approved, Disability Benefits will continue until the end of the period for which you have provided us with satisfactory written Proof Of Loss, subject to the terms and limits of this policy. We will require you to submit additional Proof Of Loss at reasonable intervals while you are continuing to receive Disability Benefits. ICC17-B180(07/17) Page 12 There may be times when we ask you to undergo medical or financial exams -- at our expense -- to confirm that you continue to be eligible for disability benefits. We will make benefit payments to the owner unless another recipient is designated. If we close or deny your claim, you have up to 180 days to request a review. When we receive your written request, we will give it our prompt attentiondays.

Loss of License. While your Injury or Sickness may result in the loss or restriction of a professional license, occupation license or certification, that loss or restriction, by itself, does not constitute a Disability. (This space LIMITATION FOR RESIDENCE OUTSIDE THE UNITED STATES AND CANADA Payment of Disability Benefits will not be paid for more than an aggregate total of twelve months of benefits for each period of Disability while you reside outside of the United States or Canada. If Disability Benefits should cease after the payment of 12 months of Disability Benefits, premiums will become due beginning on the next monthly premium due date. If you should return to reside in the United States or Canada after Disability Benefits cease, you may become eligible to resume receiving Disability Benefits if you satisfy all terms and conditions of the policy. B180(7/17) Page 10 SD and MT: The pre- existing conditions provision is intentionally left blank.) ICC17-B180(07/17) NOTICE OF CLAIM CLAIMS not included in the policy. WY: In Wyoming, this period is six months. ND and WY: Prudent person language is not included in the policy. This section outlines how claims are evaluated and benefits are paid. NOTICE OF CLAIM CLAIMS MT: The written notice of claim must be sent within When you file a claim, you’ll be required to send us “proof of loss.” We explain what that means in this section. To satisfy the proof of loss requirement, we may require medical records, income documentation and other information. If we don’t receive the information within 45 days after we request it, your claim may be turned down. You or the Owner, or your authorized personal representative, must send written notice of claim within 30 days after your Disability or your Family Member’s Serious Health Condition starts, or as soon as is reasonably possible. Written notice must be given to us at our Home Office or to any of our authorized sales representatives. It must include your name and the policy number. CLAIM FORMS After we receive written notice of claim, we will provide our claim form(s) to be completed and submitted as part of the required Proof Of Loss. If we do not provide our form(s) within 15 days after we receive written notice of claim, you may submit a letter of claim to our Home Office. The letter must include the date the Disability or Serious Health Condition began, and the cause and nature of the Disability or Serious Health Condition. PROOF OF LOSS You are responsible for providing Proof Of Loss. Proof Of Loss must be sent to our Home Office. We must receive Proof Of Loss within 90 days after the end of each monthly period for which you claim benefits. If that is not reasonably possible, the claim will not be affected, provided Proof of Loss is furnished as soon as is reasonably possible. However, unless you lack legal capacity, we must be given Proof of Loss within one year after the 90th day referred to above, for that claim to be valid. Proof Of Loss means written proof that you are or were Disabled and entitled to Disability Benefits under this policy. In addition to the completed claim form(s), or your letter of claim, Proof Of Loss includes proof that: • you became Disabled while this policy was in force; and • you are or were Disabled through the Benefit Waiting Period and the Commencement Date; and • you are or were receiving Regular Medical Care from one or more Physician(s) appropriate for your Injury or Sickness. For purposes of the Family Care Benefit, Proof Of Loss means written proof that, while this policy was in force and continuous through the Benefit Waiting Period, your Family Member had a Serious Health Condition; and you worked reduced hours and had reduced earnings during that Family Member’s Serious Health Condition. Proof Of Loss for any claim may also include any information and documentation we may reasonably require in order to substantiate and evaluate your claim, including but not limited to: • medical records and physicians’ notes or statements; and • medical examinations; and • documentation of your prior and current income, including tax returns; and • examination(s) of financial and operational records. ICC17-B180(07/17B180(7/17) Page 11 If any required information or documentation is not provided within 45 days after we send our request, your claim may be denied. Except for medical or financial records examinations, you are responsible for all costs of providing Proof Of Loss. We will require written authorization for us to obtain the information or documentation we require as Proof Of Loss. We will also require you to submit additional documentation of your claim at your expense at reasonable intervals while you are receiving Disability Benefits. EXAMINATIONS As part of the required Proof Of Loss, we have the right to require periodic examinations to determine your eligibility for Disability Benefits. These examinations will be done at our expense and by examiner(s) selected by us. We will choose examiner(s) appropriate for the evaluation of your claim. Examinations may include but are not limited to: • independent medical and psychiatric examinations by physicians or specialists; and • functional capacity examinations and occupational and vocational evaluations; and • examinations and analyses of your financial and operational records and those of any business in which you have an interest. Such records may include tax returns, financial statements, billing and expense information, bank statements, cancelled checks or other documents. We may deny or suspend payment of Disability Benefits if you fail to submit to an examination, or if you fail to cooperate with the person conducting the examination. Disability Benefits may be resumed, provided that the required examination occurs within a reasonable time and benefits are otherwise payable. In the event of death, we may require an autopsy, at our expense, where permitted by law. TIME OF PAYMENT After we receive satisfactory written Proof Of Loss and all other conditions are met, we will pay Disability Benefits under this policy. Any accrued Disability Benefits will be paid immediately. Any Disability Benefits due thereafter will be paid monthly. For periods of less than one month, we will pay a prorated portion of the monthly benefit for each day benefits are payable. Payment will be subject to our receipt of continued Proof Of Loss. If we pay benefits more than 30 days after we receive satisfactory Proof Of Loss, the delayed payment shall be subject to simple interest at the rate of 10% per year beginning with the 31st day after receipt of satisfactory Proof Of Loss and ending on the day the benefit is paid. Once your claim is approved, Disability Benefits will continue until the end of the period for which you have provided us with satisfactory written Proof Of Loss, subject to the terms and limits of this policy. We will require you to submit additional Proof Of Loss at reasonable intervals while you are continuing to receive Disability Benefits. ICC17-B180(07/17) Page 12 There may be times when we ask you to undergo medical or financial exams -- at our expense -- to confirm that you continue to be eligible for disability benefits. We will make benefit payments to the owner unless another recipient is designated. If we close or deny your claim, you have up to 180 days to request a review. When we receive your written request, we will give it our prompt attentiondays.

Loss of License. While your Injury or Sickness may result in the loss or restriction of a professional license, occupation license or certification, that loss or restriction, by itself, does not constitute a Disability. (This space is intentionally left blank.) ICC17-B180(07/17B180GSI(07/17) NOTICE OF CLAIM CLAIMS This section outlines how claims are evaluated and benefits are paid. When you file a claim, you’ll be required to send us “proof of loss.” We explain what that means in this section. To satisfy the proof of loss requirement, we may require medical records, income documentation and other information. If we don’t receive the information within 45 days after we request it, your claim may be turned down. You or the Owner, or your authorized personal representative, must send written notice of claim within 30 days after your Disability or your Family Member’s Serious Health Condition starts, or as soon as is reasonably possible. Written notice must be given to us at our Home Office or to any of our authorized sales representatives. It must include your name and the policy number. CLAIM FORMS When you file a claim, you’ll be required to send us “proof of loss.” We explain what that means in this section. After we receive written notice of claim, we will provide our claim form(s) to be completed and submitted as part of the required Proof Of Loss. If we do not provide our form(s) within 15 days after we receive written notice of claim, you may submit a letter of claim to our Home Office. The letter must include the date the Disability or Serious Health Condition began, and the cause and nature of the Disability or Serious Health Condition. PROOF OF LOSS You are responsible for providing Proof Of Loss. Proof Of Loss must be sent to our Home Office. We must receive Proof Of Loss within 90 days after the end of each monthly period for which you claim benefits. If that is not reasonably possible, the claim will not be affected, provided Proof of Loss is furnished as soon as is reasonably possible. However, unless you lack legal capacity, we must be given Proof of Loss within one year after the 90th day referred to above, for that claim to be valid. Proof Of Loss means written proof that you are or were Disabled and entitled to Disability Benefits under this policy. In addition to the completed claim form(s), or your letter of claim, Proof Of Loss includes proof that: • you became Disabled while this policy was in force; and • you are or were Disabled through the Benefit Waiting Period and the Commencement Date; and • you are or were receiving Regular Medical Care from one or more Physician(s) appropriate for your Injury or Sickness. For purposes of the Family Care Benefit, Proof Of Loss means written proof that, while this policy was in force and continuous through the Benefit Waiting Period, your Family Member had a Serious Health Condition; and you worked reduced hours and had reduced earnings during that Family Member’s Serious Health Condition. Proof Of Loss for any claim may also include any information and documentation we may reasonably require in order to substantiate and evaluate your claim, including but not limited to: • medical records and physicians’ notes or statements; and • medical examinations; and • documentation of your prior and current income, including tax returns; and • examination(s) of financial and operational records. ICC17-B180(07/17B180GSI(07/17) Page 11 There may be times when we ask you to undergo medical or financial exams — at our expense — to determine if you are eligible for disability benefits. If any required information or documentation is not provided within 45 days after we send our request, your claim may be denied. Except for medical or financial records examinations, you are responsible for all costs of providing Proof Of Loss. We will require written authorization for us to obtain the information or documentation we require as Proof Of Loss. We will also require you to submit additional documentation of your claim at your expense at reasonable intervals while you are receiving Disability Benefits. EXAMINATIONS As part of the required Proof Of Loss, we have the right to require periodic examinations to determine your eligibility for Disability Benefits. These examinations will be done at our expense and by examiner(s) selected by us. We will choose examiner(s) appropriate for the evaluation of your claim. Examinations may include but are not limited to: • independent medical and psychiatric examinations by physicians or specialists; and • functional capacity examinations and occupational and vocational evaluations; and • examinations and analyses of your financial and operational records and those of any business in which you have an interest. Such records may include tax returns, financial statements, billing and expense information, bank statements, cancelled checks or other documents. We may deny or suspend payment of Disability Benefits if you fail to submit to an examination, or if you fail to cooperate with the person conducting the examination. Disability Benefits may be resumed, provided that the required examination occurs within a reasonable time and benefits are otherwise payable. In the event of death, we may require an autopsy, at our expense, where permitted by law. TIME OF PAYMENT After we receive satisfactory written Proof Of Loss and all other conditions are met, we will pay Disability Benefits under this policy. Any accrued Disability Benefits will be paid immediately. Any Disability Benefits due thereafter will be paid monthly. For periods of less than one month, we will pay a prorated portion of the monthly benefit for each day benefits are payable. Payment will be subject to our receipt of continued Proof Of Loss. If we pay benefits more than 30 days after we receive satisfactory Proof Of Loss, the delayed payment shall be subject to simple interest at the rate of 10% per year beginning with the 31st day after receipt of satisfactory Proof Of Loss and ending on the day the benefit is paid. Once your claim is approved, Disability Benefits will continue until the end of the period for which you have provided us with satisfactory written Proof Of Loss, subject to the terms and limits of this policy. We will require you to submit additional Proof Of Loss at reasonable intervals while you are continuing to receive Disability Benefits. ICC17-B180(07/17) Page 12 There may be times when we ask you to undergo medical or financial exams -- at our expense -- to confirm that you continue to be eligible for disability benefits. We will make benefit payments to the owner unless another recipient is designated. If we close or deny your claim, you have up to 180 days to request a review. When we receive your written request, we will give it our prompt attention.

Loss of License. While your Injury or Sickness may result in the loss or restriction of a professional license, occupation license or certification, that loss or restriction, by itself, does not constitute a Disability. (This space is intentionally left blank.) ICC17-B180(07/17) LIMITATION FOR RESIDENCE OUTSIDE THE UNITED STATES, CANADA AND MEXICO Payment for Disability Benefits will not be paid for more than an aggregate total of twelve months of benefits for each period of Disability while you reside outside of the United States, its possessions, Canada, and Mexico. If Disability Benefits should cease after the payment of 12 months of Disability Benefits, premiums will become due beginning on the next monthly premium due date. If you should return to reside in the United States, its possessions, Canada, and Mexico after Disability Benefits cease, you may become eligible to resume receiving Disability Benefits if you satisfy all terms and conditions of the policy. B180GSI(9/16)NY Page 8 NOTICE OF CLAIM CLAIMS This section outlines how claims are evaluated and benefits are paid. You or the Owner, or your authorized personal representative, must send written notice of claim within 30 days after your Disability starts, or as soon as is reasonably possible. Written notice must be given to us at our Administrative Office or to any of our authorized sales representatives. It must include your name and the policy number. CLAIM FORMS When you file a claim, you’ll be required to send us “proof of loss.” We explain what that means in this section. To satisfy the proof of loss requirement, we may require medical records, income documentation and other information. If we don’t receive the information within 45 days after we request it, your claim may be turned down. You or the Owner, or your authorized personal representative, must send written notice of claim within 30 days after your Disability or your Family Member’s Serious Health Condition starts, or as soon as is reasonably possible. Written notice must be given to us at our Home Office or to any of our authorized sales representatives. It must include your name and the policy number. CLAIM FORMS After we receive written notice of claim, we will provide our claim form(s) to be completed and submitted as part of the required Proof Of Loss. If we do not provide our form(s) within 15 days after we receive written notice of claim, you may submit will be deemed to have complied with the requirements of this Policy upon submitting to us within the time stated in the Proof Of Loss provision, a letter that includes written proof of claim to our Home Office. The letter must include the date the Disability or Serious Health Condition began, began and the cause character and nature extent of the Disability or Serious Health ConditionDisability. PROOF OF LOSS You are responsible for providing Proof Of Loss. Proof Of Loss must be sent to our Home Administrative Office. We must receive Proof Of Loss within 90 days after the end of each monthly period for which you claim benefits. If that is not reasonably possible, the claim will not be affected, provided Proof of Loss is furnished as soon as is reasonably possible. However, unless you lack legal capacity, we must be given Proof of Loss within one year after the 90th day referred to above, for that claim to be valid. Proof Of Loss means written proof that you are or were Disabled and entitled to Disability Benefits under this policy. In addition to the completed claim form(s), or your letter of claim, Proof Of Loss includes proof that: •  you became Disabled while this policy was in force; and •  you are or were Disabled through the Benefit Waiting Period and the Commencement Date; and •  you are or were receiving Regular Medical Care from one or more Physician(s) appropriate for your Injury or Sickness. For purposes of the Family Care Benefit, Proof Of Loss means written proof that, while this policy was in force and continuous through the Benefit Waiting Period, your Family Member had a Serious Health Condition; and you worked reduced hours and had reduced earnings during that Family Member’s Serious Health Condition. Proof Of Loss for any claim may also include any information and documentation we may reasonably require in order to substantiate and evaluate your claim, including but not limited to: •  medical records and physicians’ notes or statements; and •  medical examinations; and •  documentation of your prior and current income, including tax returns; and •  examination(s) of financial and operational records. ICC17-B180(07/17) B180GSI(9/16)NY Page 11 9 There may be times when we ask you to undergo medical or financial exams — at our expense — to determine if you are eligible for disability benefits. If any required information or documentation is not provided within 45 days after we send our request, your claim may be denied. Except for medical or financial records examinations, you are responsible for all costs of providing Proof Of Loss. We will require written authorization for us to obtain the information or documentation we require as Proof Of Loss. We will also require you to submit additional documentation of your claim at your expense at reasonable intervals while you are receiving Disability Benefits. EXAMINATIONS As part of the required Proof Of Loss, we have the right to require periodic examinations to determine your eligibility for Disability Benefits. These examinations will be done at our expense and by examiner(s) selected by us. We will choose examiner(s) appropriate for the evaluation of your claim. Examinations may include but are not limited to: • independent medical and psychiatric examinations by physicians or specialists; and • functional capacity examinations and occupational and vocational evaluations; and • examinations and analyses of your financial and operational records and those of any business in which you have an interest. Such records may include tax returns, financial statements, billing and expense information, bank statements, cancelled checks or other documents. We may deny or suspend payment of Disability Benefits if you fail to submit to an examination, or if you fail to cooperate with the person conducting the examination. Disability Benefits may be resumed, provided that the required examination occurs within a reasonable time and benefits are otherwise payable. In the event of death, we may require an autopsy, at our expense, where permitted by law. TIME OF PAYMENT After we receive satisfactory written Proof Of Loss and all other conditions are met, we will pay Disability Benefits under this policy. Any accrued Disability Benefits will be paid immediately. Any Disability Benefits due thereafter will be paid monthly. For periods of less than one month, we will pay a prorated portion of the monthly benefit for each day benefits are payable. Payment will be subject to our receipt of continued Proof Of Loss. If we pay benefits more than 30 days after we receive satisfactory Proof Of Loss, the delayed payment shall be subject to simple interest at the rate of 10% per year beginning with the 31st day after receipt of satisfactory Proof Of Loss and ending on the day the benefit is paid. Once your claim is approved, Disability Benefits will continue until the end of the period for which you have provided us with satisfactory written Proof Of Loss, subject to the terms and limits of this policy. We will require you to submit additional Proof Of Loss at reasonable intervals while you are continuing to receive Disability Benefits. ICC17-B180(07/17) Page 12 There may be times when we ask you to undergo medical or financial exams -- at our expense -- to confirm that you continue to be eligible for disability benefits. We will make benefit payments to the owner unless another recipient is designated. If we close or deny your claim, you have up to 180 days to request a review. When we receive your written request, we will give it our prompt attention.

Loss of License. While your Injury or Sickness may result in the loss or restriction of a professional license, occupation license or certification, that loss or restriction, by itself, does not constitute a Disability. LIMITATION FOR RESIDENCE OUTSIDE THE UNITED STATES, CANADA AND MEXICO Payment for Disability Benefits will not be paid for more than an aggregate total of twelve months of benefits for each period of Disability while you reside outside of the United States, its possessions, Canada, and Mexico. If Disability Benefits should cease after the payment of 12 months of Disability Benefits, premiums will become due beginning on the next monthly premium due date. If you should return to reside in the United States, its possessions, Canada, and Mexico after Disability Benefits cease, you may become eligible to resume receiving Disability Benefits if you satisfy all terms and conditions of the policy. (This space is intentionally left blank.) ICC17-B180(07/17) B180AMR(9/16)NY NOTICE OF CLAIM CLAIMS This section outlines how claims are evaluated and benefits are paid. You or the Owner, or your authorized personal representative, must send written notice of claim within 30 days after your Disability starts, or as soon as is reasonably possible. Written notice must be given to us at our Administrative Office or to any of our authorized sales representatives. It must include your name and the policy number. When you file a claim, you’ll be required to send us “proof of loss.” We explain what that means in this section. To satisfy the proof of loss requirement, we may require medical records, income documentation and other information. If we don’t receive the information within 45 days after we request it, your claim may be turned down. You or the Owner, or your authorized personal representative, must send written notice of claim within 30 days after your Disability or your Family Member’s Serious Health Condition starts, or as soon as is reasonably possible. Written notice must be given to us at our Home Office or to any of our authorized sales representatives. It must include your name and the policy number. CLAIM FORMS After we receive written notice of claim, we will provide our claim form(s) to be completed and submitted as part of the required Proof Of Loss. If we do not provide our form(s) within 15 days after we receive written notice of claim, you may submit will be deemed to have complied with the requirements of this Policy upon submitting to us within the time stated in the Proof Of Loss, a letter that includes written proof of claim to our Home Office. The letter must include the date the Disability or Serious Health Condition began, began and the cause character and nature extent of the Disability or Serious Health ConditionDisability. PROOF OF LOSS You are responsible for providing Proof Of Loss. Proof Of Loss must be sent to our Home Administrative Office. We must receive Proof Of Loss within 90 days after the end of each monthly period for which you claim benefits. If that is not reasonably possible, the claim will not be affected, provided Proof of Loss is furnished as soon as is reasonably possible. However, unless you lack legal capacity, we must be given Proof of Loss within one year after the 90th day referred to above, for that claim to be valid. Proof Of Loss means written proof that you are or were Disabled and entitled to Disability Benefits under this policy. In addition to the completed claim form(s), or your letter of claim, Proof Of Loss includes proof that: • you became Disabled while this policy was in force; and • you are or were Disabled through the Benefit Waiting Period and the Commencement Date; and • you are or were receiving Regular Medical Care from one or more Physician(s) appropriate for your Injury or Sickness. For purposes of the Family Care Benefit, Proof Of Loss means written proof that, while this policy was in force and continuous through the Benefit Waiting Period, your Family Member had a Serious Health Condition; and you worked reduced hours and had reduced earnings during that Family Member’s Serious Health Condition. Proof Of Loss for any claim may also include any information and documentation we may reasonably require in order to substantiate and evaluate your claim, including but not limited to: • medical records and physicians’ notes or statements; and • medical examinations; and • documentation of your prior and current income, including tax returns; and • examination(s) of financial and operational records. ICC17-B180(07/17) B180AMR(9/16)NY Page 11 10 If any required information or documentation is not provided within 45 days after we send our request, your claim may be denied. Except for medical or financial records examinations, you are responsible for all costs of providing Proof Of Loss. There may be times when we ask you to undergo medical or financial exams — at our expense — to confirm that you continue to be eligible for disability benefits. We will require written authorization for us to obtain the information or documentation we require as Proof Of Loss. We will also require you to submit additional documentation of your claim at your expense at reasonable intervals while you are receiving Disability Benefits. EXAMINATIONS As part of the required Proof Of Loss, we have the right to require periodic examinations to determine your eligibility for Disability Benefits. These examinations will be done at our expense and by examiner(s) selected by us. We will choose examiner(s) appropriate for the evaluation of your claim. Examinations may include but are not limited to: • independent medical and psychiatric examinations by physicians or specialists; and • functional capacity examinations and occupational and vocational evaluations; and • examinations and analyses of your financial and operational records and those of any business in which you have an interest. Such records may include tax returns, financial statements, billing and expense information, bank statements, cancelled checks or other documents. We may deny or suspend payment of Disability Benefits if you fail to submit to an examination, or if you fail to cooperate with the person conducting the examination. Disability Benefits may be resumed, provided that the required examination occurs within a reasonable time and benefits are otherwise payable. In the event of death, we may require an autopsy, at our expense, where permitted by law. TIME OF PAYMENT After we receive satisfactory written Proof Of Loss and all other conditions are met, we will pay Disability Benefits under this policy. Any accrued Disability Benefits will be paid immediately. Any Disability Benefits due thereafter will be paid monthly. For periods of less than one month, we will pay a prorated portion of the monthly benefit for each day benefits are payable. Payment will be subject to our receipt of continued Proof Of Loss. If we pay benefits more than 30 days after we receive satisfactory Proof Of Loss, the delayed payment shall be subject to simple interest at the rate of 10% per year beginning with the 31st day after receipt of satisfactory Proof Of Loss and ending on the day the benefit is paid. Once your claim is approved, Disability Benefits will continue until the end of the period for which you have provided us with satisfactory written Proof Of Loss, subject to the terms and limits of this policy. We will require you to submit additional Proof Of Loss at reasonable intervals while you are continuing to receive Disability Benefits. ICC17-B180(07/17) Page 12 There may be times when we ask you to undergo medical or financial exams -- at our expense -- to confirm that you continue to be eligible for disability benefits. We will make benefit payments to the owner unless another recipient is designated. If we close or deny your claim, you have up to 180 days to request a review. When we receive your written request, we will give it our prompt attention.

Loss of License. While your Injury or Sickness may result in the loss or restriction of a professional license, occupation license or certification, that loss or restriction, by itself, does not constitute a Disability. (This space is intentionally left blank.) ICC17-B180(07/17) NOTICE OF CLAIM CLAIMS This section outlines how claims are evaluated and benefits are paid. When you file a claim, you’ll be required to send us “proof of loss.” We explain what that means in this section. To satisfy the proof of loss requirement, we may require medical records, income documentation and other information. If we don’t receive the information within 45 days after we request it, your claim may be turned down. You or the Owner, or your authorized personal representative, must send written notice of claim within 30 days after your Disability or your Family Member’s Serious Health Condition starts, or as soon as is reasonably possible. Written notice must be given to us at our Home Office or to any of our authorized sales representatives. It must include your name and the policy number. CLAIM FORMS After we receive written notice of claim, we will provide our claim form(s) to be completed and submitted as part of the required Proof Of Loss. If we do not provide our form(s) within 15 days after we receive written notice of claim, you may submit a letter of claim to our Home Office. The letter must include the date the Disability or Serious Health Condition began, and the cause and nature of the Disability or Serious Health Condition. PROOF OF LOSS You are responsible for providing Proof Of Loss. Proof Of Loss must be sent to our Home Office. We must receive Proof Of Loss within 90 days after the end of each monthly period for which you claim benefits. If that is not reasonably possible, the claim will not be affected, provided Proof of Loss is furnished as soon as is reasonably possible. However, unless you lack legal capacity, we must be given Proof of Loss within one year after the 90th day referred to above, for that claim to be valid. Proof Of Loss means written proof that you are or were Disabled and entitled to Disability Benefits under this policy. In addition to the completed claim form(s), or your letter of claim, Proof Of Loss includes proof that: • you became Disabled while this policy was in force; and • you are or were Disabled through the Benefit Waiting Period and the Commencement Date; and • you are or were receiving Regular Medical Care from one or more Physician(s) appropriate for your Injury or Sickness. For purposes of the Family Care Benefit, Proof Of Loss means written proof that, while this policy was in force and continuous through the Benefit Waiting Period, your Family Member had a Serious Health Condition; and you worked reduced hours and had reduced earnings during that Family Member’s Serious Health Condition. Proof Of Loss for any claim may also include any information and documentation we may reasonably require in order to substantiate and evaluate your claim, including but not limited to: • medical records and physicians’ notes or statements; and • medical examinations; and • documentation of your prior and current income, including tax returns; and • examination(s) of financial and operational records. ICC17-B180(07/17) Page 11 If any required information or documentation is not provided within 45 days after we send our request, your claim may be denied. There may be times when we ask you to undergo medical or financial exams — at our expense — to confirm that you continue to be eligible for disability benefits. Except for medical or financial records examinations, you are responsible for all costs of providing Proof Of Loss. We will require written authorization for us to obtain the information or documentation we require as Proof Of Loss. We will also require you to submit additional documentation of your claim at your expense at reasonable intervals while you are receiving Disability Benefits. EXAMINATIONS As part of the required Proof Of Loss, we have the right to require periodic examinations to determine your eligibility for Disability Benefits. These examinations will be done at our expense and by examiner(s) selected by us. We will choose examiner(s) appropriate for the evaluation of your claim. Examinations may include but are not limited to: • independent medical and psychiatric examinations by physicians or specialists; and • functional capacity examinations and occupational and vocational evaluations; and • examinations and analyses of your financial and operational records and those of any business in which you have an interest. Such records may include tax returns, financial statements, billing and expense information, bank statements, cancelled checks or other documents. We may deny or suspend payment of Disability Benefits if you fail to submit to an examination, or if you fail to cooperate with the person conducting the examination. Disability Benefits may be resumed, provided that the required examination occurs within a reasonable time and benefits are otherwise payable. In the event of death, we may require an autopsy, at our expense, where permitted by law. TIME OF PAYMENT After we receive satisfactory written Proof Of Loss and all other conditions are met, we will pay Disability Benefits under this policy. Any accrued Disability Benefits will be paid immediately. Any Disability Benefits due thereafter will be paid monthly. For periods of less than one month, we will pay a prorated portion of the monthly benefit for each day benefits are payable. Payment will be subject to our receipt of continued Proof Of Loss. If we pay benefits more than 30 days after we receive satisfactory Proof Of Loss, the delayed payment shall be subject to simple interest at the rate of 10% per year beginning with the 31st day after receipt of satisfactory Proof Of Loss and ending on the day the benefit is paid. Once your claim is approved, Disability Benefits will continue until the end of the period for which you have provided us with satisfactory written Proof Of Loss, subject to the terms and limits of this policy. We will require you to submit additional Proof Of Loss at reasonable intervals while you are continuing to receive Disability Benefits. ICC17-B180(07/17) Page 12 There may be times when we ask you to undergo medical or financial exams -- at our expense -- to confirm that you continue to be eligible for disability benefits. We will make benefit payments to the owner unless another recipient is designated. If we close or deny your claim, you have up to 180 days to request a review. When we receive your written request, we will give it our prompt attention.

Loss of License. While your Injury or Sickness may result in the loss or restriction of a professional license, occupation license or certification, that loss or restriction, by itself, does not constitute a Disability. (This space is intentionally left blank.) ICC17-B180(07/17) NOTICE OF CLAIM CLAIMS This section outlines how claims are evaluated and benefits are paid. When you file a claim, you’ll be required to send us “proof of loss.” We explain what that means in this section. To satisfy the proof of loss requirement, we may require medical records, income documentation and other information. If we don’t receive the information within 45 days after we request it, your claim may be turned down. You or the Owner, or your authorized personal representative, must send written notice of claim within 30 days after your Disability or your Family Member’s Serious Health Condition starts, or as soon as is reasonably possible. Written notice must be given to us at our Home Office or to any of our authorized sales representatives. It must include your name and the policy number. CLAIM FORMS After we receive written notice of claim, we will provide our claim form(s) to be completed and submitted as part of the required Proof Of Loss. If we do not provide our form(s) within 15 days after we receive written notice of claim, you may submit a letter of claim to our Home Office. The letter must include the date the Disability or Serious Health Condition began, and the cause and nature of the Disability or Serious Health Condition. PROOF OF LOSS You are responsible for providing Proof Of Loss. Proof Of Loss must be sent to our Home Office. We must receive Proof Of Loss within 90 days after the end of each monthly period for which you claim benefits. If that is not reasonably possible, the claim will not be affected, provided Proof of Loss is furnished as soon as is reasonably possible. However, unless you lack legal capacity, we must be given Proof of Loss within one year after the 90th day referred to above, for that claim to be valid. Proof Of Loss means written proof that you are or were Disabled and entitled to Disability Benefits under this policy. In addition to the completed claim form(s), or your letter of claim, Proof Of Loss includes proof that: • you became Disabled while this policy was in force; and • you are or were Disabled through the Benefit Waiting Period and the Commencement Date; and • you are or were receiving Regular Medical Care from one or more Physician(s) appropriate for your Injury or Sickness. For purposes of the Family Care Benefit, Proof Of Loss means written proof that, while this policy was in force and continuous through the Benefit Waiting Period, your Family Member had a Serious Health Condition; and you worked reduced hours and had reduced earnings during that Family Member’s Serious Health Condition. Proof Of Loss for any claim may also include any information and documentation we may reasonably require in order to substantiate and evaluate your claim, including but not limited to: • medical records and physicians’ notes or statements; and • medical examinations; and • documentation of your prior and current income, including tax returns; and • examination(s) of financial and operational records. ICC17-B180(07/17) Page 11 If any required information or documentation is not provided within 45 days after we send our request, your claim may be denied. Except for medical or financial records examinations, you are responsible for all costs of providing Proof Of Loss. We will require written authorization for us to obtain the information or documentation we require as Proof Of Loss. We will also require you to submit additional documentation of your claim at your expense at reasonable intervals while you are receiving Disability Benefits. EXAMINATIONS As part of the required Proof Of Loss, we have the right to require periodic examinations to determine your eligibility for Disability Benefits. These examinations will be done at our expense and by examiner(s) selected by us. We will choose examiner(s) appropriate for the evaluation of your claim. Examinations may include but are not limited to: • independent medical and psychiatric examinations by physicians or specialists; and • functional capacity examinations and occupational and vocational evaluations; and • examinations and analyses of your financial and operational records and those of any business in which you have an interest. Such records may include tax returns, financial statements, billing and expense information, bank statements, cancelled checks or other documents. We may deny or suspend payment of Disability Benefits if you fail to submit to an examination, or if you fail to cooperate with the person conducting the examination. Disability Benefits may be resumed, provided that the required examination occurs within a reasonable time and benefits are otherwise payable. In the event of death, we may require an autopsy, at our expense, where permitted by law. TIME OF PAYMENT After we receive satisfactory written Proof Of Loss and all other conditions are met, we will pay Disability Benefits under this policy. Any accrued Disability Benefits will be paid immediately. Any Disability Benefits due thereafter will be paid monthly. For periods of less than one month, we will pay a prorated portion of the monthly benefit for each day benefits are payable. Payment will be subject to our receipt of continued Proof Of Loss. If we pay benefits more than 30 days after we receive satisfactory Proof Of Loss, the delayed payment shall be subject to simple interest at the rate of 10% per year beginning with the 31st day after receipt of satisfactory Proof Of Loss and ending on the day the benefit is paid. Once your claim is approved, Disability Benefits will continue until the end of the period for which you have provided us with satisfactory written Proof Of Loss, subject to the terms and limits of this policy. We will require you to submit additional Proof Of Loss at reasonable intervals while you are continuing to receive Disability Benefits. ICC17-B180(07/17) Page 12 There may be times when we ask you to undergo medical or financial exams -- — at our expense -- — to confirm that you continue to be eligible for disability benefits. We will make benefit payments to the owner unless another recipient is designated. If we close or deny your claim, you have up to 180 days to request a review. When we receive your written request, we will give it our prompt attention.

Loss of License. While your Injury or Sickness may result in the loss or restriction of a professional license, occupation license or certification, that loss or restriction, by itself, does not constitute a Disability. LIMITATION FOR RESIDENCE OUTSIDE THE UNITED STATES, CANADA AND MEXICO Payment for Disability Benefits will not be paid for more than an aggregate total of twelve months of benefits for each period of Disability while you reside outside of the United States, its possessions, Canada, and Mexico. If Disability Benefits should cease after the payment of 12 months of Disability Benefits, premiums will become due beginning on the next monthly premium due date. If you should return to reside in the United States, its possessions, Canada, and Mexico after Disability Benefits cease, you may become eligible to resume receiving Disability Benefits if you satisfy all terms and conditions of the policy. (This space is intentionally left blank.) ICC17-B180(07/17) B180AMR(9/16)NY NOTICE OF CLAIM CLAIMS This section outlines how claims are evaluated and benefits are paid. When you file a claim, you’ll be required to send us “proof of loss.” We explain what that means in this section. To satisfy the proof of loss requirement, we may require medical records, income documentation and other information. If we don’t receive the information within 45 days after we request it, your claim may be turned down. You or the Owner, or your authorized personal representative, must send written notice of claim within 30 days after your Disability or your Family Member’s Serious Health Condition starts, or as soon as is reasonably possible. Written notice must be given to us at our Home Administrative Office or to any of our authorized sales representatives. It must include your name and the policy number. CLAIM FORMS After we receive written notice of claim, we will provide our claim form(s) to be completed and submitted as part of the required Proof Of Loss. If we do not provide our form(s) within 15 days after we receive written notice of claim, you may submit will be deemed to have complied with the requirements of this Policy upon submitting to us within the time stated in the Proof Of Loss, a letter that includes written proof of claim to our Home Office. The letter must include the date the Disability or Serious Health Condition began, began and the cause character and nature extent of the Disability or Serious Health ConditionDisability. PROOF OF LOSS You are responsible for providing Proof Of Loss. Proof Of Loss must be sent to our Home Administrative Office. We must receive Proof Of Loss within 90 days after the end of each monthly period for which you claim benefits. If that is not reasonably possible, the claim will not be affected, provided Proof of Loss is furnished as soon as is reasonably possible. However, unless you lack legal capacity, we must be given Proof of Loss within one year after the 90th day referred to above, for that claim to be valid. Proof Of Loss means written proof that you are or were Disabled and entitled to Disability Benefits under this policy. In addition to the completed claim form(s), or your letter of claim, Proof Of Loss includes proof that: •  you became Disabled while this policy was in force; and •  you are or were Disabled through the Benefit Waiting Period and the Commencement Date; and •  you are or were receiving Regular Medical Care from one or more Physician(s) appropriate for your Injury or Sickness. For purposes of the Family Care Benefit, Proof Of Loss means written proof that, while this policy was in force and continuous through the Benefit Waiting Period, your Family Member had a Serious Health Condition; and you worked reduced hours and had reduced earnings during that Family Member’s Serious Health Condition. Proof Of Loss for any claim may also include any information and documentation we may reasonably require in order to substantiate and evaluate your claim, including but not limited to: •  medical records and physicians’ notes or statements; and •  medical examinations; and •  documentation of your prior and current income, including tax returns; and •  examination(s) of financial and operational records. ICC17-B180(07/17) B180AMR(9/16)NY Page 11 10 If any required information or documentation is not provided within 45 days after we send our request, your claim may be denied. There may be times when we ask you to undergo medical or financial exams — at our expense — to confirm that you continue to be eligible for disability benefits. Except for medical or financial records examinations, you are responsible for all costs of providing Proof Of Loss. We will require written authorization for us to obtain the information or documentation we require as Proof Of Loss. We will also require you to submit additional documentation of your claim at your expense at reasonable intervals while you are receiving Disability Benefits. EXAMINATIONS As part of the required Proof Of Loss, we have the right to require periodic examinations to determine your eligibility for Disability Benefits. These examinations will be done at our expense and by examiner(s) selected by us. We will choose examiner(s) appropriate for the evaluation of your claim. Examinations may include but are not limited to: • independent medical and psychiatric examinations by physicians or specialists; and • functional capacity examinations and occupational and vocational evaluations; and • examinations and analyses of your financial and operational records and those of any business in which you have an interest. Such records may include tax returns, financial statements, billing and expense information, bank statements, cancelled checks or other documents. We may deny or suspend payment of Disability Benefits if you fail to submit to an examination, or if you fail to cooperate with the person conducting the examination. Disability Benefits may be resumed, provided that the required examination occurs within a reasonable time and benefits are otherwise payable. In the event of death, we may require an autopsy, at our expense, where permitted by law. TIME OF PAYMENT After we receive satisfactory written Proof Of Loss and all other conditions are met, we will pay Disability Benefits under this policy. Any accrued Disability Benefits will be paid immediately. Any Disability Benefits due thereafter will be paid monthly. For periods of less than one month, we will pay a prorated portion of the monthly benefit for each day benefits are payable. Payment will be subject to our receipt of continued Proof Of Loss. If we pay benefits more than 30 days after we receive satisfactory Proof Of Loss, the delayed payment shall be subject to simple interest at the rate of 10% per year beginning with the 31st day after receipt of satisfactory Proof Of Loss and ending on the day the benefit is paid. Once your claim is approved, Disability Benefits will continue until the end of the period for which you have provided us with satisfactory written Proof Of Loss, subject to the terms and limits of this policy. We will require you to submit additional Proof Of Loss at reasonable intervals while you are continuing to receive Disability Benefits. ICC17-B180(07/17) Page 12 There may be times when we ask you to undergo medical or financial exams -- at our expense -- to confirm that you continue to be eligible for disability benefits. We will make benefit payments to the owner unless another recipient is designated. If we close or deny your claim, you have up to 180 days to request a review. When we receive your written request, we will give it our prompt attention.