LIBERTY LIFE ASSURANCE COMPANY OF BOSTON
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DISABILITY
WAIVER OF
MONTHLY
DEDUCTION
BENEFIT
AGREEMENT
WAIVER BENEFIT
We will provide a waiver benefit for this contract if the Insured becomes
Disabled while this Agreement is in force. If the Insured becomes Disabled, We
will waive the Monthly Deduction as defined in the Monthly Deduction provision
of this contract. Benefits under this Agreement will begin once the conditions
set forth in the Definition of Disability provision and the Waiting Period
provision have been satisfied and will cease when the disability ends.
DEFINITION OF DISABILITY
Disability means a condition, which results from either a bodily injury or
disease, that totally and continuously prevents the Insured from performing the
material and substantial duties of an occupation. For the first 24 months of the
Disability, the term "occupation" means the Insured's regular occupation.
Thereafter, it means any occupation for compensation or profit for which the
Insured is or becomes reasonably qualified by age, education, training and
experience.
Disability also means the total and irrecoverable loss of:
o the sight of both eyes;
o the use of both hands;
o the use of both feet; or
o the use of one hand and one foot;
occurring after this Agreement takes effect, even if the Insured engages in an
occupation.
WAITING PERIOD
The Disability must exist continuously for at least 6 months before We will
provide the waiver benefit. You should pay the premiums needed to prevent this
contract from terminating during this period since We will continue to make
Monthly Deductions.
EFFECT ON CONTRACT
Once the 6 month Waiting Period has been satisfied, We will begin waiving
Monthly Deductions under this Agreement. The amounts waived will not be treated
as premiums paid with regard to the Guaranteed Death Benefit provision. You must
make any premium payments necessary to satisfy the Limited Guaranteed Coverage
Monthly Premium and the Lifetime Guaranteed Coverage Monthly Premium
requirements.
If Death Benefit Option 1 is in effect on the date We begin to waive Monthly
Deductions, We will automatically change the option to Option 2. The new Face
Amount will be the Option 1 Death Benefit less the Account Value as of the
Monthly Date on or next following the date Disability began. When Disability
ends, the Death Benefit Option will be returned to the option in effect prior to
Disability. During a period of Disability, You may not:
o change to Death Benefit Option 1; or
o increase the Face Amount of this contract except as allowed under any
Additional Benefit Agreement attached to and made a part of this contract.
NOTICE OF DISABILITY
You must give Us written notice of the Disability of the Insured at Our Service
Center:
o while the Insured is alive and Disabled; and
o no later than 1 year after this Agreement terminates.
Failure to give Us this notice will not invalidate a claim if You furnish
evidence, which satisfies Us, that notice was given as soon as reasonably
possible. In no event will We waive the Monthly Deductions made for any period
more than 1 year before notice is received at Our Service Center.
PROOF OF DISABILITY
You must also furnish proof, which satisfies Us, that the Insured is Disabled
before We will waive any Monthly Deductions. We will, from time to time
thereafter, require additional proof that the Insured continues to be Disabled.
We may also require the Insured to submit to one or more physical examinations
by a physician of Our choice at Our expense. However, We will not require an
exam more often than once each year after the Disability has continued for 2
full years.
EXCLUSIONS
No Monthly Deductions will be waived if the Disability of the Insured results
directly or indirectly from:
o a bodily injury which occurred or a disease which first manifested itself
before this Agreement takes effect, unless the injury or disease was set forth
in the application;
o an intentionally self-inflicted injury or disease while sane or insane; or
o service in the armed forces of an international body or of any country at war,
declared or undeclared.
COST OF THE BENEFIT
A Monthly Deduction is made from the Account Value of this contract for the cost
of this Agreement. The Monthly Deduction for this Agreement is:
o the cost of Insurance for this contract plus the cost of any other Additional
Benefit Agreements, plus the Contract Fee; times
o the Waiver of Monthly Deductions Rate (WMD Rate), shown below, based on the
Insured's Attained Age; times
o the Rating Factor for this Agreement shown on the Contract Information page of
this contract.
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Attained Age Monthly WMD Rate Attained Age Monthly WMD Rate
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15 .030 40 .033
16 .030 41 .034
17 .030 42 .036
18 .030 43 .038
19 .030 44 .041
20 .030 45 .043
21 .030 46 .047
22 .030 47 .052
23 .030 48 .057
24 .030 49 .064
25 .030 50 .074
26 .030 51 .084
27 .030 52 .098
28 .030 53 .114
29 .030 54 .134
30 .030 55 .158
31 .030 56 .181
32 .030 57 .196
33 .030 58 .212
34 .030 59 .231
35 .030 60 .250
36 .030 61 .276
37 .030 62 .319
38 .030 63 .379
39 .031 64 .461
TERMINATION
This Agreement and all benefits under this Agreement will terminate on the
earliest of:
o the contract anniversary following the 65th birthday of the Insured;
o the Monthly Date on or next following the date We receive at Our Service
Center Your Written Request to cancel this Agreement; or
o the date this contract is surrendered or terminates for any reason.
THIS AGREEMENT AND THE CONTRACT
This Agreement is made a part of Your contract if We have listed it on the
Contract Information page. The values and benefits provided by any amount We pay
will be the same as if You had paid it.
INCONTESTABILITY
This Agreement is subject to the INCONTESTABILITY provision in this contract.
However, the contestable period for this Agreement will be measured from its
Effective Date.
EFFECTIVE DATE
This Agreement takes effect on the Date of Issue for this Agreement shown on the
Contract Information page of this contract.
/s/ Xxxxxx X. Xxxxx
PRESIDENT
