Common use of Accidental Death and Dismemberment Coverage Clause in Contracts

Accidental Death and Dismemberment Coverage. Limits of Liability Death, Dismemberment or Loss of Sight Covered Events Seat Belt Coverage Exclusions Additional Terms for Part VI Notice of Claim Proof of Loss Payment of Claims Physical Examination and Autopsy Worker’s Compensation PART VII - GENERAL PROVISIONS Policy Period / Territory Two or More Cars Insured Claims Settlement Practices Receipt of Notice of Claim Notice of Acceptance or Rejection of Claim Payment of Claim Delay in Payment of Claim Extension of Deadlines Liability for Violation Suits Against Us Our Recovery Rights (Subrogation & Reimbursement) Assignment Policy Changes Cancellation and Non-Renewal Automatic Termination Proof of Notice Conditional Reinstatement Our Right to Rescind for Fraud & Misrepresentation Policy Conformed to Statutes Fraudulent Claims Conditions Precedent REPORTING A CLAIM - INSUREDS DUTIES Notice of Accident or Loss Other Duties POLICY ENDORSEMENTS E-5 Named Driver - Non-Owned Vehicle E-6 Named Driver Exclusion E-200 Rental Car (Substitute Vehicle) Coverage IMPORTANT NOTICE Have a complaint or need help? If you have a problem with a claim or your premium, call your insurance company first. If you can’t work out the issue, the Texas Department of Insurance may be able to help. Even if you file a complaint with the Texas Department of Insurance, you should also file a complaint or appeal through your insurance company. If you don’t, you may lose your right to appeal. AssuranceAmerica Insurance Company To get information or file a complaint with your insurance company: Call: 000-000-0000 Toll-free: 0-000-000-0000 Email: Xxxxxxxx_Xxxxxxx@xxxxxxx.xxx Mail: P.O. Box 723128, Atlanta, GA 31139 The Texas Department of Insurance To get help with an insurance question or file a complaint with the state: Call with a question: 1-800-252-3439 File a complaint: w xx.xxx.xxxxx.xxx Email: XxxxxxxxXxxxxxxxxx@xxx.xxxxx.xxx Mail: MC 111-1A, P.O. Box 149091, Austin, TX 78714-9091 To compare policies and prices To compare policies and prices: Visit XxxxXxxxxx.xxx to compare prices and coverages on home and auto insurance policies. The website is a service of the Texas Department of Insurance and the Office of Public Insurance Counsel. Attach this to your policy This notice is for information only and does not become a part or condition of the attached document. AVISO IMPORTANTE ¿Tiene una xxxxx o necesita ayuda? Si tiene un problema con una reclamación o con su prima de seguro, llame primero a su compañía de seguros. Si no puede resolver el problema, es posible que el Departamento de Seguros de Texas (Texas Department of Insurance, por su nombre en inglés) pueda ayudar. Aun si usted presenta una queja ante el Departamento de Seguros de Texas, también debe presentar una xxxxx a través del proceso de quejas o de apelaciones de sucompañía de seguros. Si no lo hace, podría perder su derecho para apelar. AssuranceAmerica Insurance Company Para obtener información o para presentar una queja ante su compañía de seguros: Llame a: 000-000-0000 Teléfono gratuito: 0-000-000-0000 Correo electrónico: C xxxxxxx_Xxxxxxx@xxxxxxx.xxx Dirección postal: P.O. Box 723128, Atlanta, GA 31139 El Departamento de Seguros de Texas Para obtener ayuda con una pregunta relacionada con con los seguros o para presentar una queja ante el estado: Llame con sus preguntas al: 1-800-252-3439 Presente una xxxxx en: w xx.xxx.xxxxx.xxx Para comparar pólizas y precios Para comparar pólizas y precios: Visite XxxxXxxxxx.xxx para comparar precios y coberturas en pólizas de seguro para el hogar y automóvil. El sitio web es un servicio del Departamento de Seguros de Texas y de la Oficina del Asesor Público de Seguros (Office of Public Insurance Counsel, por su nombre en inglés w xx.xxxxxxxxxx.xxx Una este aviso a su poliza Este aviso es solo para proposito de informacion y no se convierte en parte o condicion del documento adjunto. w xx.xxxxxxxxxx.xxx Correo electrónico: XxxxxxxxXxxxxxxxxx@xxx.xxxxx.xxx Dirección postal: MC 111-1A, P.O. Box 149091, Austin, TX 78714-9091 INSURING AGREEMENT If you pay your premium when due, we agree to insure you, subject to the terms of this policy, for the coverage shown on the Declarations Page of this policy, up to the limits of liability. If you make your initial payment by check, this policy is void and there will be no coverage at any time if the check is not honored for any reason when first presented to your bank. The Declarations Page and any endorsements issued by us are part of this policy contract. Please review your Declaration Page and policy contract immediately upon first receipt.

Accidental Death and Dismemberment Coverage. Insuring Agreement Limits of Liability Death, Dismemberment or Loss of Sight Covered Events Seat Belt Coverage Exclusions Additional Terms for Part VI V Notice of Claim Proof of Loss Payment of Claims Physical Examination and Autopsy Worker’s Compensation PART VII VI - GENERAL PROVISIONS Policy Period / & Territory Two or More Cars Insured Claims Settlement Practices Receipt of Notice of Claim Notice of Acceptance or Rejection of Claim Payment of Claim Delay in Payment of Claim Extension of Deadlines Liability for Violation Handling Suits Against Us Our Recovery Rights (Subrogation & Reimbursement) Assignment Transfer of Your Interest in This Policy Policy Changes Cancellation and Non-Renewal Automatic Termination Proof of Notice Conditional Reinstatement Void the Policy for Fraud or Misrepresentation Our Right to Rescind Deny Coverage and End the Policy for Fraud & or Misrepresentation Our Right to Void for Failure of Initial Payment Policy Conformed to Statutes Fraudulent Claims Conditions Precedent Bankruptcy YOUR DUTIES & REPORTING A CLAIM - INSUREDS DUTIES ALL ACCIDENTS AND LOSSES Notice of an Accident or Loss Other Duties POLICY ENDORSEMENTS E-5 Named Driver - NonNAMED DRIVER – NON-Owned Vehicle E-6 Named Driver Exclusion E-200 Rental OWNED VEHICLE COVERAGE NAMED DRIVER EXCLUSION RENTAL CAR COVERAGE ENDORSEMENT E NDORSEMENTS Please read your Personal Car (Substitute Vehicle) Coverage IMPORTANT NOTICE Have Policy. It is a complaint or need help? If binding legal contract between you have a problem with a claim or your premium, call your insurance company first. If you can’t work out the issue, the Texas Department of Insurance may be able to help. Even if you file a complaint with the Texas Department of Insurance, you should also file a complaint or appeal through your insurance company. If you don’t, you may lose your right to appeal. AssuranceAmerica Insurance Company To get information or file a complaint with your insurance company: Call: 000-000-0000 Toll-free: 0-000-000-0000 Email: Xxxxxxxx_Xxxxxxx@xxxxxxx.xxx Mail: P.O. Box 723128, Atlanta, GA 31139 The Texas Department of Insurance To get help with an insurance question or file a complaint with the state: Call with a question: 1-800-252-3439 File a complaint: w xx.xxx.xxxxx.xxx Email: XxxxxxxxXxxxxxxxxx@xxx.xxxxx.xxx Mail: MC 111-1A, P.O. Box 149091, Austin, TX 78714-9091 To compare policies and prices To compare policies and prices: Visit XxxxXxxxxx.xxx to compare prices and coverages on home and auto insurance policiesus. The website is a service of the Texas Department of Insurance Application and the Office of Public Insurance Counsel. Attach this to your policy This notice is for information only and does not become a part or condition of the attached document. AVISO IMPORTANTE ¿Tiene una xxxxx o necesita ayuda? Si tiene un problema con una reclamación o con su prima de seguroDeclarations Page, llame primero a su compañía de seguros. Si no puede resolver el problema, es posible que el Departamento de Seguros de Texas (Texas Department of Insurance, por su nombre en inglés) pueda ayudar. Aun si usted presenta una queja ante el Departamento de Seguros de Texas, también debe presentar una xxxxx a través del proceso de quejas o de apelaciones de sucompañía de seguros. Si no lo hace, podría perder su derecho para apelar. AssuranceAmerica Insurance Company Para obtener información o para presentar una queja ante su compañía de seguros: Llame a: 000-000-0000 Teléfono gratuito: 0-000-000-0000 Correo electrónico: C xxxxxxx_Xxxxxxx@xxxxxxx.xxx Dirección postal: P.O. Box 723128, Atlanta, GA 31139 El Departamento de Seguros de Texas Para obtener ayuda con una pregunta relacionada con con los seguros o para presentar una queja ante el estado: Llame con sus preguntas al: 1-800-252-3439 Presente una xxxxx en: w xx.xxx.xxxxx.xxx Para comparar pólizas y precios Para comparar pólizas y precios: Visite XxxxXxxxxx.xxx para comparar precios y coberturas en pólizas de seguro para el hogar y automóvil. El sitio web es un servicio del Departamento de Seguros de Texas y de la Oficina del Asesor Público de Seguros (Office of Public Insurance Counsel, por su nombre en inglés w xx.xxxxxxxxxx.xxx Una este aviso a su poliza Este aviso es solo para proposito de informacion y no se convierte en parte o condicion del documento adjunto. w xx.xxxxxxxxxx.xxx Correo electrónico: XxxxxxxxXxxxxxxxxx@xxx.xxxxx.xxx Dirección postal: MC 111-1A, P.O. Box 149091, Austin, TX 78714-9091 INSURING AGREEMENT If you pay your premium when due, we agree to insure you, subject to the terms of this policy, for the coverage shown on the Declarations Page of this policy, up to the limits of liability. If you make your initial payment by check, this policy is void and there will be no coverage at any time if the check is not honored for any reason when first presented to your bank. The Declarations Page and any endorsements issued by us us, are part of the contract formed by this policy. This policy describes which vehicles and persons have coverage, and which vehicles and persons do not have coverage. It includes language that excludes, restricts and limits coverage. It also describes the duty to give us notice of an accident or loss, and to notify us about changes in vehicles or drivers in your household. IMPORTANT: Coverage does not apply under this policy contract. Please review your Declaration Page and policy contract immediately upon first receipt.for any person who does not comply with all:

Accidental Death and Dismemberment Coverage. Insuring Agreement Limits of Liability Death, Dismemberment or Loss of Sight Covered Events Seat Belt Coverage Exclusions Additional Terms for Part VI V Notice of Claim Proof of Loss Payment of Claims Physical Examination and Autopsy Worker’s Compensation PART VII VI - GENERAL PROVISIONS Policy Period / & Territory Two or More Cars Insured Claims Settlement Practices Receipt of Notice of Claim Notice of Acceptance or Rejection of Claim Payment of Claim Delay in Payment of Claim Extension of Deadlines Liability for Violation Handling Suits Against Us Our Recovery Rights (Subrogation & Reimbursement) Assignment Policy Changes Cancellation and Non-Renewal Automatic Termination Proof of Notice Conditional Reinstatement Our Right to Rescind Void for Fraud & or Misrepresentation Our Right to Void for Failure of Initial Payment Policy Conformed to Statutes & Laws Fraudulent Claims Conditions Precedent Bankruptcy YOUR DUTIES & REPORTING A CLAIM - INSUREDS DUTIES ALL ACCIDENTS AND LOSSES Notice of an Accident or Loss Other Duties POLICY ENDORSEMENTS E-5 Named Driver - NonMISSOURI PROPERTY AND CASUALTY INSURANCE GUARANTY ASSOCIATION ENDORSEMENT & NOTICE NAMED DRIVER – NON-Owned Vehicle E-6 Named Driver Exclusion E-200 Rental OWNED VEHICLE COVERAGE NAMED DRIVER EXCLUSION LIMITED COVERAGE ENDORSEMENT DIRECT REPAIR PROGRAM (DRP) ENDORSEMENT RENTAL CAR COVERAGE ENDORSEMENT Please read your Personal Car (Substitute Vehicle) Coverage IMPORTANT NOTICE Have Policy. It is a complaint or need help? If binding legal contract between you have a problem with a claim or your premium, call your insurance company first. If you can’t work out the issue, the Texas Department of Insurance may be able to help. Even if you file a complaint with the Texas Department of Insurance, you should also file a complaint or appeal through your insurance company. If you don’t, you may lose your right to appeal. AssuranceAmerica Insurance Company To get information or file a complaint with your insurance company: Call: 000-000-0000 Toll-free: 0-000-000-0000 Email: Xxxxxxxx_Xxxxxxx@xxxxxxx.xxx Mail: P.O. Box 723128, Atlanta, GA 31139 The Texas Department of Insurance To get help with an insurance question or file a complaint with the state: Call with a question: 1-800-252-3439 File a complaint: w xx.xxx.xxxxx.xxx Email: XxxxxxxxXxxxxxxxxx@xxx.xxxxx.xxx Mail: MC 111-1A, P.O. Box 149091, Austin, TX 78714-9091 To compare policies and prices To compare policies and prices: Visit XxxxXxxxxx.xxx to compare prices and coverages on home and auto insurance policiesus. The website is a service of the Texas Department of Insurance Application and the Office of Public Insurance Counsel. Attach this to your policy This notice is for information only and does not become a part or condition of the attached document. AVISO IMPORTANTE ¿Tiene una xxxxx o necesita ayuda? Si tiene un problema con una reclamación o con su prima de seguroDeclarations Page, llame primero a su compañía de seguros. Si no puede resolver el problema, es posible que el Departamento de Seguros de Texas (Texas Department of Insurance, por su nombre en inglés) pueda ayudar. Aun si usted presenta una queja ante el Departamento de Seguros de Texas, también debe presentar una xxxxx a través del proceso de quejas o de apelaciones de sucompañía de seguros. Si no lo hace, podría perder su derecho para apelar. AssuranceAmerica Insurance Company Para obtener información o para presentar una queja ante su compañía de seguros: Llame a: 000-000-0000 Teléfono gratuito: 0-000-000-0000 Correo electrónico: C xxxxxxx_Xxxxxxx@xxxxxxx.xxx Dirección postal: P.O. Box 723128, Atlanta, GA 31139 El Departamento de Seguros de Texas Para obtener ayuda con una pregunta relacionada con con los seguros o para presentar una queja ante el estado: Llame con sus preguntas al: 1-800-252-3439 Presente una xxxxx en: w xx.xxx.xxxxx.xxx Para comparar pólizas y precios Para comparar pólizas y precios: Visite XxxxXxxxxx.xxx para comparar precios y coberturas en pólizas de seguro para el hogar y automóvil. El sitio web es un servicio del Departamento de Seguros de Texas y de la Oficina del Asesor Público de Seguros (Office of Public Insurance Counsel, por su nombre en inglés w xx.xxxxxxxxxx.xxx Una este aviso a su poliza Este aviso es solo para proposito de informacion y no se convierte en parte o condicion del documento adjunto. w xx.xxxxxxxxxx.xxx Correo electrónico: XxxxxxxxXxxxxxxxxx@xxx.xxxxx.xxx Dirección postal: MC 111-1A, P.O. Box 149091, Austin, TX 78714-9091 INSURING AGREEMENT If you pay your premium when due, we agree to insure you, subject to the terms of this policy, for the coverage shown on the Declarations Page of this policy, up to the limits of liability. If you make your initial payment by check, this policy is void and there will be no coverage at any time if the check is not honored for any reason when first presented to your bank. The Declarations Page and any endorsements issued by us us, are part of the contract formed by this policy. This policy describes which vehicles and persons have coverage, and which vehicles and persons do not have coverage. It includes language that excludes, restricts and limits coverage. It also describes the duty to give us notice of an accident or loss, and to notify us about changes in vehicles or drivers in your household. IMPORTANT: Coverage does not apply under this policy contract. Please review your Declaration Page and policy contract immediately upon first receipt.for any person who does not comply with all:

Accidental Death and Dismemberment Coverage. Insuring Agreement Limits of Liability Death, Dismemberment or Loss of Sight Covered Events Seat Belt Coverage Exclusions Additional Terms for Part VI V Notice of Claim Proof of Loss Payment of Claims Physical Examination and Autopsy Worker’s Compensation PART VII VI - GENERAL PROVISIONS Policy Period / & Territory Two or More Cars Insured Claims Settlement Practices Receipt of Notice of Claim Notice of Acceptance or Rejection of Claim Payment of Claim Delay in Payment of Claim Extension of Deadlines Liability for Violation Handling Suits Against Us Our Recovery Rights (Subrogation & Reimbursement) Assignment Policy Changes Cancellation and Non-Renewal Automatic Termination Proof of Notice Conditional Reinstatement Our Right to Rescind Void for Fraud & or Misrepresentation Failure of Initial Payment Policy Conformed to Statutes Fraudulent Claims Conditions Precedent Bankruptcy YOUR DUTIES & REPORTING A CLAIM - INSUREDS DUTIES ALL ACCIDENTS AND LOSSES Notice of an Accident or Loss Other Duties POLICY ENDORSEMENTS E-5 Named Driver - NonNAMED DRIVER – NON-Owned Vehicle E-6 Named Driver Exclusion E-200 Rental OWNED VEHICLE COVERAGE NAMED DRIVER EXCLUSION LIMITED COVERAGE ENDORSEMENT DIRECT REPAIR PROGRAM (DRP) ENDORSEMENT RENTAL CAR COVERAGE ENDORSEMENT Please read your Personal Car (Substitute Vehicle) Coverage IMPORTANT NOTICE Have Policy. It is a complaint or need help? If binding legal contract between you have a problem with a claim or your premium, call your insurance company first. If you can’t work out the issue, the Texas Department of Insurance may be able to help. Even if you file a complaint with the Texas Department of Insurance, you should also file a complaint or appeal through your insurance company. If you don’t, you may lose your right to appeal. AssuranceAmerica Insurance Company To get information or file a complaint with your insurance company: Call: 000-000-0000 Toll-free: 0-000-000-0000 Email: Xxxxxxxx_Xxxxxxx@xxxxxxx.xxx Mail: P.O. Box 723128, Atlanta, GA 31139 The Texas Department of Insurance To get help with an insurance question or file a complaint with the state: Call with a question: 1-800-252-3439 File a complaint: w xx.xxx.xxxxx.xxx Email: XxxxxxxxXxxxxxxxxx@xxx.xxxxx.xxx Mail: MC 111-1A, P.O. Box 149091, Austin, TX 78714-9091 To compare policies and prices To compare policies and prices: Visit XxxxXxxxxx.xxx to compare prices and coverages on home and auto insurance policiesus. The website is a service of the Texas Department of Insurance Application and the Office of Public Insurance Counsel. Attach this to your policy This notice is for information only and does not become a part or condition of the attached document. AVISO IMPORTANTE ¿Tiene una xxxxx o necesita ayuda? Si tiene un problema con una reclamación o con su prima de seguroDeclarations Page, llame primero a su compañía de seguros. Si no puede resolver el problema, es posible que el Departamento de Seguros de Texas (Texas Department of Insurance, por su nombre en inglés) pueda ayudar. Aun si usted presenta una queja ante el Departamento de Seguros de Texas, también debe presentar una xxxxx a través del proceso de quejas o de apelaciones de sucompañía de seguros. Si no lo hace, podría perder su derecho para apelar. AssuranceAmerica Insurance Company Para obtener información o para presentar una queja ante su compañía de seguros: Llame a: 000-000-0000 Teléfono gratuito: 0-000-000-0000 Correo electrónico: C xxxxxxx_Xxxxxxx@xxxxxxx.xxx Dirección postal: P.O. Box 723128, Atlanta, GA 31139 El Departamento de Seguros de Texas Para obtener ayuda con una pregunta relacionada con con los seguros o para presentar una queja ante el estado: Llame con sus preguntas al: 1-800-252-3439 Presente una xxxxx en: w xx.xxx.xxxxx.xxx Para comparar pólizas y precios Para comparar pólizas y precios: Visite XxxxXxxxxx.xxx para comparar precios y coberturas en pólizas de seguro para el hogar y automóvil. El sitio web es un servicio del Departamento de Seguros de Texas y de la Oficina del Asesor Público de Seguros (Office of Public Insurance Counsel, por su nombre en inglés w xx.xxxxxxxxxx.xxx Una este aviso a su poliza Este aviso es solo para proposito de informacion y no se convierte en parte o condicion del documento adjunto. w xx.xxxxxxxxxx.xxx Correo electrónico: XxxxxxxxXxxxxxxxxx@xxx.xxxxx.xxx Dirección postal: MC 111-1A, P.O. Box 149091, Austin, TX 78714-9091 INSURING AGREEMENT If you pay your premium when due, we agree to insure you, subject to the terms of this policy, for the coverage shown on the Declarations Page of this policy, up to the limits of liability. If you make your initial payment by check, this policy is void and there will be no coverage at any time if the check is not honored for any reason when first presented to your bank. The Declarations Page and any endorsements issued by us us, are part of the contract formed by this policy. This policy describes which vehicles and persons have coverage, and which vehicles and persons do not have coverage. It includes language that excludes, restricts and limits coverage. It also describes the duty to give us notice of an accident or loss, and to notify us about changes in vehicles or drivers in your household. IMPORTANT: Coverage does not apply under this policy contract. Please review your Declaration Page and policy contract immediately upon first receipt.for any person who does not comply with all: