Document zzNZ4RyBkxM04owKmpkNDDZoB

FILE NAME: Metropolitan Life (ML) DATE: 0000 DOC#: ML038 DOCUMENT DESCRIPTION: Group Policy Details for Raybestos - Manhattan - Date Illegible ' * /. . "Vf o * ) *4 CL- `VEkEIK CALLED THE T '-*'.'r.A :CE COMPANY) > - " > . si . .>- V M A . Y/fj ~ r-2 - !& GROUP POLICY No. . ?'~rO.... IN C O \TS ID E tt.-.71C N if the ntiplicntioii fm fl l\. , v nt.nk* hv i v c r j r f - r r . ?: / *, ik c . .......................... .................... H t ' S C A V r l> V"-Yl.r* I ] a copy of which rpplicut'o- w Attached hereto >ni- made a part herecf. and in,conaiderarion^ [ $ ' pcvment by the Employer o. :."*.e nitia'-prermum and "he oaviuent hereafter by die Employe^during? `j^y jjj# the continuance of *h Fo'icv, of rii p*cmiums .-en t'-ev fid' due as hereinafter provided--" '**. ' IIRII7.Y A ;i v t o itri! v t l i ' i n t y l n c h t ' l i c t V i jis n v id ts l. w ltii iaccr joni : w itlt rud Mi1'- * *< r ite i ' m h -is o ii. . !* Tin* Piuv'sMii.s jt"?-- * !n.'-'iu.-i-' it /-HaBtiinifVN iivi'i ??; !. ! .m ". *!!!!.tyees insured hereunder, in ".*' t * ; ; . .. % v , . .s**. ' '> fs ft'iiy ns il recited.ovcr the 1U i ....' J*t 3 t OtttPBF d h frP llf. hv Mesroi\i!iian iie executed id ` v y .,? '/. o i . 'upt'i.y has caused this Policy to .Lr'seMri **# ,/! Cf it V _7 to take effect as oi c..........' : '"s* .................... l r - c i _ a t ^ i , 1 9 5 6 ____ /tirtoefic ktsstrisKsaxiutrs-oj.'-Kfiycc:"- t.-' in . . - . t :o - . -ay P o lic y Ho 8577-G beariSg-':. t , I t date of hsy i*--*. ' *.* - ' * 'i t ; to b he date of. iss u e w - th is P olicy. /; k- fa , /P f / J il { ^ C A 'JLs*i ^ l''-esit{<nt. (*' *j* 1 Lift* In su ra n ce-- A- ` V f ' in*.' Pcrcc:/fL end ..'* * il I .rcace y-. Perron d. o--i l ?-. * Poraonitl end Prpr.-nde: * C- ' l.*.--.t.U -- . - . lfi.,irc.r.co *.*. -or Physiclane* Attendance Form G.L.H. t93i Jan. r04C PS1NTED IN ,'.S.A . A f.iJS . 0 ' " bur .'*f v iurp'cs ; l\y M' p *. Schedule A Attached to Group Policy Be. 8577-G as a p a rt thereof* Ttelt o r Clang * Manhattan ftebber D lrid o a Salaried Baployecs Employees a t Eoeneh* Wisconsin -- Enployoes subject to the Bargaining Agreement between Ifcahattaa Rubber Vorfcers ZndcF&nlcnt Uaion, Xnc* and th e Manhattan Eubbar Division, Employees -who ora 'members o f Manhattan lodge 1679, In tern atio n al Association o f Machinists Employees on the Main O ffice Payroll * t 1 A 7l Section 1, XEPIHnxOB or t X J . 3SO "Ei?lor22".--2 ia vord "2 s'W .ia " a s used In th in P olicy neau * tlui-tdiaa enployo uho la d ir e c tly splayed cad conpenaatcd fe r se rv ic e s by tha Manhattan Rubber d v lo lo a , the Waited S tates Asbestos K.v isio n , tb s General Asbestos sad Rubber SLvtsten* tb s Roy bestoo m v id o a , or tb s Wabash E ivisio a o f tb s Eaployor. of nulated service within tuolva tsontho of k le date of c^lcyaar.t is ell^blo for on Doce->cr 1, 1956 Each Daplaara vLo bos not craplotod oust period of hareuodor service on Decctabcr 1, 1955 and each Eaployce splayed srjbzc^pant to Ducoibor 1, 1956 be /HgiKi-y far tnsuxoaoo UcrasA&Jsr on the day l^cdlatoly follovlag tl'a date of coqplatloa of three TMTMfhm 0f accuaalated service \dt!da twelve xacatha of hlo date cf cs/Ioyaaat* (8) /bpllcable to oil other 3plo.vcoa~Each itclcyec '.o has coepleted throe on** of ** service prior to Pcccabor 1# l$5o ic eligible to r irrvraaco ioreanlor oa Eececber 1, 1956* Each Eks Applicable to I^ioryeos o f tb s uaVis ea?l d a r s s s c/c c iflo f. a gcbcdalq A hsroof-- ifafcirt**.^ ,. csQrthi&s in Section 3 hereof to th e haromader on any**Bh^iqyga vaa : Section 3. EFFECTIVE DATES O F INSURANCE.--A n Employee may become insured hereunder only by making written request to the Employer on forms furnished by the Insurance Company. The insurance o n any Employee who makes such request o n o r before the date o f his eligibility shall become effective on the date o f his eligibility, provided ...*........ ...................... * . ______ * .................................................... * ......................... he is actively at work on the dare o f his eligibility. The insurance on any Employee who makes such request after the date of his. eligibility and o n or before the thirty-first day following the date o f his eligibility, or o n or before the thirty-first day following the date o f his return to active work if he is not actively at work on the date o f his eligibility, shall become effective, provided he is then actively at work, o n the . . * .......................................... .?* _____26_........................................ 36 ........................................... X . date o f such request. A ny Employee making such request after such thirty-first day and any Employee requesdhg reinstatement of his insurance hereunder after his insurance hereunder has been discontinued in accordance with item (a) of Section 5 hereof, must furnish at his own expense evidence of insurability satis factory to the'Insurance Company before he may be insured hereunder/A ny such insurance shall become effective, provhl<*J the Employee is then actively at work, o n the X X date the Insurance Compariy accepts as satisfactory such evidence of insurability. T he insurance o n any Employee not actively at work on the date when his insurance heteunder would other wise become effective shall b eo jjg ^effective o n the next following ..on which he is actively at work. Section 4. EMPLOYEES' CONTRIBUTIONS.--No Employee insured hereunder shall be required to contribute to the cost ; of his insurance more th a n the maximum am ount specified in Section 6 hereof in accordance with the insurance in force here under on his account. Section 5. CESSATION O F INSURANCE.--(a) A s to the Life Insurance hereunder:--T he Life Insurance on any Employee, insured hereunder shall automatically cease on the date of the CONTRIBUTORY INSERT termination of his employment. Termination o f employment, for the purposes o f Life Insurance hereunder, means cessation o f active work as an Employee as defined in Section 1 hereof, except that (i) in case o f the absence o f an Employee from active work because of sickness, injury or retirement.... ...............h is employment may, for the purposes of his Life Insurance hereunder, be deemed to continue until termi nated by the Employer, or (ii) in case o f the absence o f an Employee from active work because o f leave o f absence o r temporary lay-off, his em ployment may, for the purposes o f his Life Insurance hereunder, be deemed to continue untfiterm inated. by tahepEemripolodyecr*bu(sain? nsoiccasceobaeyiaonsd as to Replace o r la ste d S t a t a s i ^ such leave o f absence o r lay-off commenced. In the case of either o f the above exceptions, the Life Insurance hereunder on such Employee shall automatically, cease on the date of mic!i 'erminatinn o f his employment by the Employer, as evident ed *o the Insurance Company by the Employer, whether by notification or by cessation of premium payment on account of such Fmpltivcc's Life Insurance hereunder. As to the Accident and Health Insurance hereunder:--The Accident and Health Insurance o n any Employee insured, here under shall automatically cease on the date of the termination o f his employment, except th at an Employee's Accident and Health Insurance hereunder shall continue during any period for which he is entitled to receive Weekly Benefits hereunder. Termination of employment, for the purposes of Accident and Health Insurance hereunder, means cessation of active work as an Employee 'as defined in Section 1 hereof, except that (i) in case of the absence o f a n Employee from active work because of sickness or injury, his employment may, for the purposes of his Accident and Health Insurance here under, be deemed to continue until terminated by the ord jy'%'33'SaAfce rs to any (2) ether ley'-c, fsllordrs the C its G.L.H. 1931-1-40 PRINTED IN U.S.A. ) Insured hereunder oa the date applicable to hie unit or class as specified In Schedule A hereof become effective oa the later of (a) thedate applicable to hie unit or class as spyjf* la Schedule A hereof esd (a) the date of his eligibility for each Insurance hereunder# provided ho Is actively at cork' on such later date end if not then actively at vork, oa the date of his return to active vork* ' ^ .'jvsrthe puxpoeee of datomlning effective dates of Accident and Health Insurance w vlth Section 3 hereof, all Employees insured in Her York State shall be deemed to have mede vritton request for Accident and Health Insurance hereunder prior to the date of their eligibility therefor. _ * r iK-**1 * *** - t V Health Insurance h r ^ u n ^ oo s ^ h ^ p l ^ e e shall auUimatfcaUt;, .Vu Section . AM OUNT O F I N S U ^ N C E ^ T ii !U o t o t l ) f :' * on th e ^ a tc ^ f siieh .'rtinc*. liamundot^aM : ^ 'finployw' lfidl' W Emolover. as evidenced to the insurance Comnanv bv the Em* ' c __j . . nr> ^ n n u i i a (&) The Insurance bn anyEm ployeeinsured hereunder who shall have notified* th Etnploycr that' his insurance hereunder 4 In tIh- # .<;* ........ ... 'm ay othsr -- ---------i-- fUy*a *n the 4 .U . f fciii* ta-*; * * a- . t:- ^ SCHEDULE O F INSURANCE AND ..EMPLOYEES!, MAXIMUM C O ^ R I B tjn O N S . / 0: V .F. sx ... daaa ' ',, .' .. > . . : " *.- V .*; Snployeea of class or unit' specified la Schedule A hereof, except such Eeptogrees at Beenah, Wisconsin loyee ait Heeaah, Wisconsin life 'v Insurance- h,000.00 3,000.00 Accident ' .and-Health ^ insurance''," (VeeKLv Benefit! *. '..-'Z`: *. tafiis.- I*^'l iy**xT-j^*, ' *' --iH'M, :'# 28.X00r --'>*.-*i-S**;. ' 2m8.00.; employed at Hanhein, . Pennsylvania *vith vee&y earnings aa determined by the Eh^loyer) of: 20*00 or Bore /lees than $50.00'*;^` ' : Enployees of General Asbestos and L Rubber Division - i-'^ 3,0 0 0 .0 0 3,000.00 2,000.00 >Tsr : * 35.00 31.50 30.00 ... w - - - l?#S ivTMV: *v.- - ployes f Raybestoa Division ' Soi Xnmupncm ; $5*00 AU.jbt&er&3tayeea _ le A 2,000.00 -v:r\' " ^ a K o 6 y^ m y `t .. *c*-'Ho Accident' end Health yIns*urance .<- . v-y * laprovlded hereunder for any il-* r ; ^sr 1 ' * 'Any Employe employed"la HvJIbxa State n^o.doea not'aake ^tt^^req^ -..-forlAfe Insurance hereunder shall be~lnsred hereunder.`for Accident aad^ReC - . .^inourance only. -vr-rfisr '*W*^ fvJ - - * . jOo^niUBtmwi 'fNSimr # ` * r > x . *. .**V " ;**' .iT&V 'y - :r v : yiAytwny The amount of life Insurance as to any Employea of (1) Manhattan Rubber Division, (11) Wabash Division, or (ill) General Asbestos and Rubber Division retired on or subsequent to (i) October 15, 1951, but prior to tho date specified In the next following sentence, (ii) September 22, 1952, or (ill) January 2, 1953, respectively, shall be $1,000.00. For the Manhattan Rubber Division, the amount of Life Insurance as to (i) Salaried Employees, other than Employees on the Main Office Payroll, and Ennloyoes subject to tho Bargaining Agreement between Manhat tan Rubber Workers Independent Union, Inc., (ii) Employees who ere members of Manhattan Lodge 1679, International Association of Machinists, end (ill) Main Office Payroll Employees retired on or subsequent to (i) October 28, 1955, (ll) November 25, 1955, or (ill) January 1, 1956, respectively, shall be 505 of the amount for which, such Employee was Insured hereunder on the day immediately preceding the date of hi8 retirement. The amount of Life Insurance as to any other retired Employee shall be the amount of life Insurance in force on his account hereunder on tho day immediately preceding the date of his retirement. No retired Employee and no Employee of a class or unit specified in Schedule hereof shall be roqutred to contribute to the cost of {'ho Life Insurance. The amount which any other Snployce may contribute tc tho cost of the Life Insurance shall not exceed C-0.60 per month ($0.14 per week in the case of eny Employee who contributes weekly) per $1,000 of Life Insurance end tho amount which any Employee nay contribute to the coat of the Accident and Wealth Iuawrance ahull not exeood tho premium charged for tho amount of hio Accident and Health Insurance, subjeet to such further limitation otherwise provided for tknnloyeos employed In the State of Now 'fork. Esch Employee whose Life Insurance hereunder ia reduced because of his retirement, shell hove the same privilege, on the date of such reduction with respect to the excess of, (a) the amount of Life Insurance for which such Employes vv.s insured hereunder on the day immediately prior to the date of such re* Auction, over (b) the amount of Life Insurance for which such Employee may be insured hereunder on end aftor the date cf such reduction as la applicable upon termination of employment, os sot forth in Sootion 9 hereof. Contributory Insert (2b) G.L.H.1931-1-40 Printed'in U.3i $ V.'.'^.iti>*ey*i>\ +J\'StMXz `<rr*r.-". . .1.1-s-;'*;'TIS&''vtilhfeY,N 'V- ; r.-.., Section 7. INSURING C L SES^-(A ) Life Insurance.-- : U pon receipt' by. the Insurance Company of satisfactory proof, ' in writing* that any Employee insured hereunder shall have d ie d . while an Employee of die Employer,, as defined in Section 1 . hereof, the Insurance Company shall pay, subject to the terms hereof, to the Beneficiary of record of such Employee, the amount of Life Insurance, if any, in force hereunder on account of such Employee, in accordance with Section 6 hereof, at the date of his death. ... - (B) A ccident and H ealth Insurance.--Upon receipt by the Insurance Company of notice and satisfactory proof, as required herein, that any Employee while insured hereunder shall have become wholly and continuously disabled so as to be prevented from performing any and every duty of his occupation by cither (A), ary InJmy .^^agiglng,,out..af-jQg-ln..that- Section & DEATH BENEFIT IN TH E EVENT O F TOTAL DISABILITY.-- V 1. If any Employee, while insured hereiindw and priq fW h is V : - sixtieth birthday, becomes totally 'disabled as.a'resuU ofV bodily injury or disease so as to be wholly prevented thereby from engaging in any and every business or. occupation and from performing any work for compensation or profit, and ' continues to be so totally disabled uninterruptedly!beyond =' ' the termination' of his employment and until th e'd ate of* ; : his death, then upon receipt of satisfactory proof of such, death (and provided no Death Benefit is payable the',; provisions of .subsection 2 of Section 9 hereof}, the' ln* ! ' surance Company shall pay to the Beneficiary of record ih e TOQ.iitttt...0.f...th9.Etoplos^a*a LifInmirno in fPT.(...hftg9mdog Bt.Jho dat8 of tho tewdnal"*234 and that-durm gthe period of such disability such Employee shall have been under treatment therefor by a physician legally licensed to-practice medicine, .Th e Insurance C ompany shall pay to such disabled Em ployee, subject to the terms and limitations hereof, the Weekly Benefits to which he shall be entitled in accordance with Section 6 hereof, during the period the Employee is so disabled and under such treatment, provided, however, that (l) in no case shall such Weekly Benefits be payable for the first.____ JRfiSSR_______ .days of disability.----- -------------- I (fi) in no case shall such Weekly Benefits be payable for more i than * _________________ Lweeks for any one continuous ( period of disability whether from one or more causes, or for successive periods of disability due to the same or related cause o r causes. For all disabilities commencing on or after tBeljimpioyee's e1xtictT blrthdav and Within any thanja w n ^ ^ -- In the :caae of an Employee employed in New York State"olFatT"the Wabash Division and In the case of any other Employee, a total of not more then /yyit'm"fi"iin"ilfirteen weeksY benefits shali be paid" ... than six treeks^ beneflts sKell bc pald; provided, however,thal_flo payroeat_of_any kind shall be made for such disability If the preonaaev existed and Health Insurance hereunder. Subject to due.proof of claim, the Weekly Benefits will be paid 5 to the Employee leach week during any periods of disability for which such Benefits are payable and any balance remaining un2 paid at the termination of such .period will be paid immediately 5 upon receipt of proof. (3) 'it . ( a) that initial satisfactory^proof that such total ___ exists' and has continued uninterruptedly ..for. a tie a s t v - nine months is submitted either before the;fenninatidn.r ^ of the Employee's employment fas defined in item (a) of " Section 5 hereof) or within one year thereafter, and (b) that acknowledgement of the receipt:of >uch initid satisfactory proof is endorsed on die Employee's .certifi-4 cate by the Insurance Company, and S '.'.' 71 (c) that each year,* within the three months preceding the . anniversary of such endorsement, during the entire remainder of die Employee's lifetime, further"satisfactory . proof is submitted that such total disability continues, and' ... ' .. .. .. .wa (d) that upon the death of the Employee, satisfactory proof: - is submitted th at such total disability continued to th e .* date of his death. . "I? If, however, the Employee's death occurs within Bne'lYcy ' j [ after the termination of his employment and berore'"siiy ' such proofs have been submitted, then satisfactory proof s that, the Emptoyce was totally disabled uninterruptedly from the date of the termination of his employment to the date'-;' of his death must be submitted within one year after .the dare of his death. . 2. Alt such proofs of total disability and of death must be 'sufe-y^' mined in writing to the Insurance Company at its HOtiic ^ Office or at one of its Head Offices on the initiative of 'the., disabled Employee or by someone on his behalf, yritK putffiv^ obligation on the part of die Insurance C om pany;to;r^uejt\5 ` any such proof. 3. Whenever proof of the Employee's, total dfaaWli^. ^ s u b - ^ mined, the Insurance Company shall h a v e -d i^ ri^ i!;an d '3 opportunity to have him examined by physicians designated''^ by it. - : 4. If the Employee ceases to be so totally disabled or fails, to su b^j j mit. any required proof- within the time' piesinibed thCTcfpr,j his rights under this Section, shall automatically 'and^im -^ mediately cease. ,. . U< V ." rjL-.0 ' .-.* <11^:1931^140. Printed InU.SA. .. . 4: . . ...*# i* JD . - ~ A lt statements made by the Employer shall'! in die absence of : If an. individual policy shall have been issued pursuant tci fraud, be deemed representation* and not warranties and no such., application.madein accordance with.Section 9 hereof; the designa-^ statement shall avoid the insurance or reduce benefits under this tion by th e Employee of a- Beneficiary 'tinder such in'dividuat. . j Policy or be used in defense of-a claim hereunder unless it is con policy, other than th Beneficiary Of record of th e ' Employee :* ' tained in the written application. . hereunder, shall, notwithstanding any other provision of this - Section 12. AGENTS; ALTERATIONS.---No Agent is author' ized to alter or amend this.Policy, to accept premiums in arrears or. to extend the duo date of any premium, to waive any notice or proof of claim required by this Policy, or to extend the date before which any such notice or proof must be submitted. N o change in this Policy shall be valid unless approved by an ` executive officer of the Insurance Company and evidenced by endorsement hereon, or by amendment hereto signed by die Section to the contrary, effect a change of Beneficiary hereunder.* to the Beneficiary of record under such individual policy, r e a r a r a s 1* of whether or not such change is endorsed on the Employee's .'! certificate. . . ;-* V lr-V ' Section 15. ASSIGNMENT.--T he Employee's certificate is ,' non-assignable and the insurance and benefits with respect, to any coverage are non-assignable prior to a loss under such : coverage. ' " C ` Employer and by the Insurance Company. Section 16. REGISTER-- T heL f o g ^ ^ O f t . . ( ^ I ^ a P g .holy ' Section 13. CERTIFICATES.-- T he Insurance Company will issue .to .the Employer, for delivery to each Employee insured hereunder, an individual certificate which shall state the insurance to which such Employee is entitled under this Policy and to whom benefits are payable, and shall summarize the provisions of this Policy principally affecting the Employee. T he certificate delivered to an Employee insured hereunder keep a Register which shall show at all times the names of all Employees insured hereunder and the amount of insurance in force on each of such Employees, together with the date when any insurance became effective and the effective date of lm y increase * or decrease to amount of iosurancel^ 1.9.<?i3!T.,,i?..?51<* R e g is te r a s o f t h e late of issue of tnaaTolley rad cTOiea'of'enirioaIn sSLcTRe^LaGar sub's,-,, -...i orient*^"a^3"'ffo^'''3j^ll"TGe'T0malaHS3{^''the';:'v;'- shall be surrendered to the Insurance Company after the death of Insurance Company to tho Employer . ;;? the Employee before the Insurance Company shall pay any benefits to his Beneficiary. Such certificate must be returned to the Insurance Company for appropriate endorsement or exchange before the Employee may exercise any privileges hereunder. The word "certificate" as used in this Policy includes certificate riders and certificate supplements, if any. Section 17, DUE DATE, COM PUTATION A1TO p Xy^ MONT O F PREMIUMS.--T he premiums due on andl after the. j date of issue of this Policy for the insurance provided hereunder^T hall be determined and hall be payable in accordance wid^jthe' -j following paragraphs. " T he initial premium is due on the date of issue of th lr Policy,-;^ Section 14. CHANGE O F BENEFICIARY--Any Employee insured hereunder may, from time to time, change the Beneficiary and subsequent premiums shall be A of each calender month__________ ___ .__* designated in bis certificate by filing written notice thereof with _____ .....__ .'............ ,,...,,.(herein called the due date) thereafter.,''. '..^ the.....iB.SSit9B.?5TM9.SHlP.,KiJ!'.:.....,,_.,,.accompanied by the certifi* The initial premium due on the date of issue of this Policy ami cate of such Employee. Such change shall take effect upon en the premium due on any due date after die date of issue of this v . dorsement thereof by the.._^.^f9?5 .,,9?Sl?. 5L _________ on Policy shall be the aggregate of (a) the Life Insurance premium 5 such certificate and unless the certificate is so endorsed, the change determined by applying the average..... .5f&*5tt,,..,,,,',,..Llfe Insur-7 shall not. take effect. After such endorsement, tire change shall mice premium rate then in effect to each $1,000 of Life Insurance relate back and take effect ns of the date the Employee signed said then in force on all Employees irrespective of age, plus (b) the ^ written notice of change, whether or not the Employee is living Accident ami Health Insurance premium determined by applying . . at the tim eW such endorsement, but without prejudice to the thc ....n!OI^ ^ Y ............. Accident and Health Insurance premium Insurance Company on account of any payment made before rate then in effect to each $10.00 of Accident and Health Insurance receipt of such written notice. Weekly Benefit then in force on all Employees, including those ' If, at the death of any Employee insured hereunder, there shall Employees who are receiving Weekly Benefits hereunder (subject, be nfiore than one designated Beneficiary, then, unless such Em however, in either case, to premium adjustments, if any). ployee shall have specified the respective interests of such Bene Premium adjustments involving return of unearned premiums ficiaries, the interests of such Beneficiaries shall be several and to the Employer shall be limited to the period of twelve mondis " equal! If any designated Beneficiary shall predecease the Em immediately preceding the date of receipt by the Insurance Com-lA. ployee, the rights and interest of such Beneficiary shall thereupon party of evidence that such adjustments should be mad&- . . Automatically terminate. If, a t the death of the Employee, there be The Insurance Qimpany shall compute an average..??.--???.^ ^ . no designated Beneficiary as to all or any part of the insurance, ...... ........ Life Insurance premium irate per $1,000 of Life Insurance ^ y h e n die amoiint of the insurance payable for which there is no as of the date of issue of this Policy, using the Initial Schedule of^ designated Beneficiary shall be payable to the estate of the Em Life Insurance Premiums set forth in Section 23 hereof, which v ployee, provided, however, that the Insurance Qimpany may, in rate shall be the Life Insurance premium rate until such time ns ^ such case,;at its option, pay such amount to any one of the follow such rate is recomputed in accordance with the eighth paragraph.. ing surviving relatives: wife, husband, mother, father, child or of this Section. > . ''# children, and payment to any one or more of such surviving The initial..S?B?iii7..,,.,,,,,,...^ccidcnt and Health Insurance--- relatives shall completely discharge die Insurance Company's premium rate shall be.___ 3L-_____ ,.__ ,,...per $10.00 of Accident ,i liability with respect to the amount of insurance so paid. and Health Insurance Weekly Benefit, which rate shall be. die I (5) See Reverse Side ' t*G..LAH.-1-9'31"--guMft0ySS ' - 'PRINTEDINUSA. u.5 ,.lf an individual policy of Life InsuranKThas beenissuedln ; accordance with the provirion* of the following Section, payment may be made under die. provisions of this Section . only if such individual policy is surrendered to the Insurance Company without claim thereunder. In such case, any premiums paid on such individual policy shall be refunded by - the Insurance Company to the Beneficiary of record of the Employee. Section 9. PRIVILEGE O F OBTAINING A N INDIVIDUAL. . POLICY O F LIFE INSURANCE.-- 1. A ny Employee, upon written application made to the Insur. ance Company within thirty-one days after either (i) the date of the termination of his employment, or , p a y j .h is BeSftciary of record, whether r not the.Em*'*.. '. ^ ,, ployce shall have made application for such individual ., * policy, die maximum amount of Life Insurance for which' an.'. 7. individual policy could have been issued under this Section. * If the Employee shall have been entitled to make such appli' . cation pursuant to .paragraph (iii) of subsection l of tjiis ' Section .and shall die within one.year after the tenqjijgtipn , of his employment but before his certificate shall hav-bcn . ' endorsed in accordance with the provisions of Section 8 hereof, then satisfactory proof of the Employee's'death ' within such thirty-oneway period and that he was totally ' disabled uninterruptedly from the date of the termination of his employment to within thirty-one days of the date of his death must be submitted to the Insurance Company within one year after the date of his death. (ii) the date of the discontinuance of this Policy, provided such date is five years or more after the effective date of his insurance hereunder, or (iii) the date of the cessation pursuant to subsection 4 of ^ the preceding Section, of his rights under that Section, |l| IS shall be entitled to have issued to him by the Insurance Com- pany, without evidence of insurability, an individual policy jii of Life Insurance only, subject to_the following conditions ' eg and provisions: ~ (a) such individual policy shall be upon one of the forms then customarily issued by the Insurance Company; except Term Insurance, and (b) the premium for such individual policy shall be the pre mium applicable to the class of risk to which the Employee belongs and to the form and amount of the individual policy at the Employee's attained age (near est birthday) at the date of issue of such individual policy, and (c) the amount of such individual policy shall be equal to (or at the option of the Employee less than) the amount j of the Employee's Life Insurance or Death Benefit hereunder, as the case may be, on whichever of die I dates specified in paragraphs (i), (ii) and (iii) above is applicable, except that if the Employee's Life Insurance hereunder ceases because of the discontinuance of this Policy five years or more after the effective date of his insurance hereunder, .the amount of such individual policy shall not exceed the lesser of t / ' * ! * | (a )' the amount of the Employee's Life Insurance heref under at die date of the cessation of such insurance, reduced by any amount of Life Insurance for which .h e may be or may become eligible under any Group ` Policy issued or reinstated by the Insurance Company or by any other insurer within thirty-one days after such cessation, and / ' (b) $2,000. Section 10. NOTICE AND PROOF O F ACCIDENT AND HEALTH INSURANCE CLAIMS,-- - (a) Written notice of injury or sickness on which claim mny be based must be given to the Insurance Company within .............. iy.SD.'&T........... ,,....days after the date of the' accident causing such injury or the commencement of disability resfltingr; from such sickness. Proof of such injury or sickness m tft be'"-' : furnished to the Insurance Company not days after the termination of the period for which Weekly Bnfits are payable hereunder. The Insurance Company, upon receipt of the notice required by this Policy, will furnish such forms as are usually furnished by it for filing proofs of claim. If such forms are not received by the claimant within fifteen days after the Insurance Company receives such notice, the claimant shall be deemed to have com. . plied with the requirements of this Policy as to proof of claim . upon submitting, within the time fixed in the Policy for filing proofs of claim, written proof covering the occurrence, character .. and extent of the disability for which claim is made. . ,/ Failure to fumirii notice or proof within the titne provided in _ . this Policy shall not invalidate nor reduce any claim if it dial! . be shown not to have been reasonably possible to furnish sueh ' notice or proof and that such notice or proof was furnished as soon as was reasonably possible. ' C VvPv ? (b) T he Insurance Company shall have the right and eppof---- tunity to have a physician designated by it examine the person of the Employee when and so often as it may reasonably require during the pendency of claim hereunderTM..... ......... ............ .........., X _ M JJt B M3C ;...... ~~X X X x "X... X ... x TM *"X (c) No action at law or in equity shall be brobght to recover on this Policy prior to the expiration of.... ..... SVES?.TM_.....days _ after proof of claim has been filed in accordance with die require ments of this Policy, nor shall such action be brought at all ' unless brought within___ .liW?________years from die expiration '' of the time within which proof of claim is required by the Policy.^' 2. Any individual policy of Life Insurance so issued shall Section 21. INCONTESTABILITY.--This Policy and the become effective not earlier than the expiration of the thirty- application of the Employer, a copy of which is attached hereto, . one-day period during which application for such individual constitute die entire contract between die.parties and, except' policy may be made. If, however, the Employee dies during for nonpayment of premiums, shall be incontestable after one.year v ` such diirty-one-day period, the Insurance Company shall from the date of issue of die Policy. . . iff- (4) . G .U L 1931^M 0 ,,HUNTED IN U.S-C Employees of the Wabash Division Employees of the Raybootos Division All other Employees * $0,747 O.646 0.620 v \ --Acddent and Health'Insurance premium rate thereafter until sud) time as such rate 'changed in accordance with the eighth paragraph of this Section. . ' O n written request of the Employer, approved by the Insurance Company, premium payments' may, if not then so payable, be changed at any premium due date of this Policy, so as to be payable annually, semi-annually, quarterly, or monthly. Upon any renewal of this Policy, or whenever the terms of this Policy are changed, the Insurance Company may change the __ m o n th ly - - __ __Accident and Health Insurance premium rate per $10.00 of A cddent and Health Insurance Weekly Benefit and either the Employer or the Insurance Company may require a recomputation, as of such date, of the average__ m o n th ly ---___ Life Insurance premium rate per $1,000 of Life Insurance, using for such recomputation'such Schedule of Life Insurance Premiums as may then be determined by the Insurance Company and the amount of Life Insurance then in force a t the respective attained ages of the insured Employees on such date. All premiums falling due under this Policy, induding adjust ments thereof, if any, are payable by the Employer, on or before their respective due dates, direct to the Insurance Company, at its Home Office or one of its Head Offices. The payment of any pre mium shall not maintain the insurance under this Policy in force beyond the day immediately preceding the next due date, except as provided in the next paragraph. A grace period of thirty-one days, without interest charge, shall be granted to the Employer for the payment of any premium title after the initial premium, provided the Employer has not previously given written notice to the Insurance Company that this Policy is to be discontinued as of the due date of such pre mium, and during any such grace period this Policy shall continue in force. If the Employer fails to pay any premium within th grace period, this Policy shall be discontinued on the last day of such grace period, but the Employer shall, nevertheless, be liable to the Insurance Company for the payment- of all premiums then due and unpaid, together with the premiums for the grace period. If, hbwever, written notice is given by the Employer to the Insurance Company, during the grace period, that this Policy is to be discon tinued before th e expiration of the grace period, this Policy shall be discontinued as of the date of receipt of such written notice by the Insurance Company or the date specified by the Employer for M ich discontinuance, whichever date is later, and the Employer shall lie liable to the Insurance Company for the payment of die pro-rata premium for die jicriod commencing with the last doc date and ending with such date of discontinuance. , < Section 18. AGE.--In die event of the misstatement of the age of any Employee, there shall be an equitable adjustment of die premium. If the amount of insurance applicable to such Em ployee in accordance with Section 6 hereof would have been affected by such misstatement of age, the amount of insurance on such Employee shall be adjusted to ,,the amount for which such .Employee would have been entitled at his correct age, and the adjustment of the premium shall be based on such adjusted amount of insurance. Section 19. PARTICIPATION IN DIVISIBLE SURPLUS.-- This Policy is a participating contract and the Insurance Company shall annually ascertain and apportion any divisible surplus accru- ing under policies of this class. Any such divisible surplus appor tioned to this Policy shall be paid in cadi to die Employer or,upon written request from the Employer to die Insurance- Com pany, shall be applied towards the payment of the aggregate of . the.premiums next falling due under this Policy. In either event,' ' in the case of Contributory Insurance, an amount equal to die excess, if any, of the Employees' aggregate contributions toward. / the cost of the insurance provided hereunder over die net Cbst of `; such insurance shall be distributed or applied by the Employer for the sole benefit of the Employees. Section 20. RENEWAL PRIVILEGE^--This Policy is issued for . ' a period commencing with the date of issue and ending with the day immediately preceding..,,.July.:l,..1957---------------- on which date and on each anniversary of which date die Employer may renew this Policy for a further term oif one year, provided the ; number of Employees then insured hereunder is, in the ease of Contributory Insurance, not less than seventy-five pet centum of the number of eligible Employees and, in the case of Non-Contributory Insurance, not less than the total number of eligible Employ ees, and provided in either case the number of Employees then insured hereunder is not less than fifty. Renewal is. conditioned upon the payment of the premiums then duetas computed in the manner set forth in Section 17 hereof and based upon such Schedule of Life Insurance Premiums and such Accident arid " Health Insurance premium rote as may then be determined by the Insurance Company. Section 21. OPTIONAL MODES O F - SETTLEMENT O F LIFE INSURANCE.--U p o n w ritten " e le c tio n by th e ' .... -Em ploye*------- - or in die absence of such election by the. - .-- E m p lo y ee------ - then by the Beneficiary after th e 'death of . the Employee, in either case made to and accepted by the Insur- ' ance Company, the whole or any part of the amount of Life . Insurance payable upon the death of any Employee insured here under will be retained by the Insurance. Company and paid to the Beneficiary of record of the Employee in the following manner instead of in one sum: , By payment of monthly or annual instalments over such speci fied number of years (shown in the following table) as may be elected, the first instalment being payable inimediately upon the death of the Employee. T he amount of such instalments shall be determined by the Schedule of Instalment Payments Per $1,000 of Life Insurance in effect at the date of such election. INITIAL SCHEDULE O F INSTALMENT PAYMENTS PER $1,000 O F LIFE INSURANCE NUMBER OF YEARS SPECIFIED AMOUNT OF EACH AMOUNT OF EACH ANNUALINSTALMENT MONTHLYINSTALMENT . (per $1,000OF (PER $1,000OF insurance) INSURANCE) 1 $1,000,00 $84.47 2 507.7,6 42.86 3 343.24 28.9? . 4 261.19 22.06 5 10 212.05 17.91 ;; 15 113.78 9.61. .. 20 81.34 6.87 65.24 5.51- C-:,/.-. AMENDMENT (6) f G.PLrHin.t1ed93in1--&MA0. ` '