Other common policy provisions are those concerning accidental death benefits, the guaranteed purchase option (also known as the guaranteed insurability option), and the waiver of premium in the event of the insured�s disability.

This optional policy provision is added to some insurance contracts in the form of a rider, or amendment, to the policy. It is also known as the double indemnity provision because it normally doubles the standard death benefit if the insured dies accidentally.

Since this benefit is payable only in the event of the insured�s accidental death, that term requires definition. In the absence of a specific definition in the rider, the word accident means an unintentional event that is sudden and unexpected. An accidental death is one that is caused by an accident. This statement seems quite clear, but it is not always easy to apply. There have been cases where an insured has been mortally injured in an accident, but the actual cause of death is a disease. Is the accidental death benefit payable? The answer is yes only if the accident was the cause of death. If the insured is in an automobile accident but dies from a heart attack, the accidental death benefit will be payable only if the accident can be proven to have triggered the heart attack.

The problems caused by cases in which there is potentially more than one cause of death are mitigated somewhat by the standard practice of putting a time limit in the accidental death benefit provision. In the most common type the death must occur within 90 days of the accident that is said to have caused the injury.

These basic definitions preclude coverage for any death that is the natural and probable result of a voluntary act. It is an unchallenged principle of law that people are presumed to expect and intend the probable or foreseeable consequences of their actions. This concept is sometimes described by the term assumption of the risk. If one plays Russian roulette, jumps off buildings, or runs with the bulls in Pamplona, Spain, his or her death as a result of those activities cannot be described as accidental.

There are two types of accidental death clauses: (1) the accidental result type and (2) the accidental means type. A sample accidental result death benefit provision is as follows:

An accidental means death benefit provision would be only slightly different:

The most common type of provision that insurers use is the accidental result type. This is because the accidental result clause is more favorable to the consumer. It is also because most courts have recognized that the difference between the two clauses is too difficult for many consumers to understand and have therefore ceased to recognize a distinction between the two types of clauses.

The distinction can be explained as follows: Under an accidental means clause both the cause (means) of the death and the result must be unintentional. Under an accidental result clause, only the result must be unintentional. For example, assume that an insured is participating in an obstacle course race at a family reunion, and the race requires the racers to dive over a barrel, do a somersault, and run to the next event. The insured breaks her neck and is killed doing the somersault. Since she was doing exactly what she intended to do, the means was not accidental although the result was certainly an accident. The accidental means clause would not require the payment of the benefit, but the accidental result clause would.

There is another factor that has made accidental means clauses less attractive to insureds and thus less frequently used by insurers. This is the provision requiring that, in addition to being accidental, the means (cause) of death must also be violent and caused by an external agency. Courts have been liberal in their interpretation of these limitations in favor of the public.

Most accidental death benefit clauses do not provide coverage in the event of the insured�s death by suicide. If suicide of the insured (whether sane or insane) is excluded, then an examination of the insured�s mental state at the time of the suicide is avoided. If the insured is sane at the time of the suicide, then it is an intentional act that would not qualify as an accident. If the insured is insane, the suicide might be classified as unintentional because the insured may be presumed not to have been able to intend the consequences of his or her act.

Another popular policy provision is the guaranteed purchase option, which is also called the guaranteed insurability option. Although it is quite common now, this is a relatively new option for insureds. It was developed during the 1950s, but it did not become widely available for many years.

This provision helps policyowners protect themselves against the possibility that they might become uninsurable. Under the typical provision, the insured may purchase the right to acquire additional insurance in specified amounts at specified times or ages. Typically this provision allows additional purchases every 3 years and after the birth of a child, provided the events occur before the insured reaches the specified maximum age (often 45). This right to purchase additional insurance may be very valuable because the insured does not have to provide evidence of insurability in order to exercise the option. Another benefit of the guaranteed purchase option is that the new coverage is normally not subject to a new suicide provision or a new incontestability clause.

There is a ceiling on the maximum amount of insurance available under the guaranteed purchase option and a maximum age at which the option may be exercised. Once the insured passes an age or event that triggers the right to purchase additional insurance but he or she does not exercise that option, the option lapses.

A waiver-of-premium provision in the event of the insured�s disability is another extremely valuable coverage.

According to a typical waiver-of-premium provision, if the insured becomes totally disabled as defined in the life insurance contract, the insurance company will waive payment of premiums on the policy during the continuance of the insured�s disability.

The disability waiver of premium has some limitations. For example, the waiver will not be granted if the insured�s disability begins after a specified age. In addition, the provision in the sample below will not waive premiums if the disability is self-inflicted or the result of an act of war. As with all contracts, it is important to pay close attention to the language used. Seemingly small differences in the language of the provision can make large differences in the obligations the insurer incurs.

The following is a sample disability waiver-of-premium rider:

It is the rule that if a policy is sold in a state but does not include a required provision or has not been filed with the state for approval, the courts will treat the policy as if it did include all the required provisions under the law of that jurisdiction. The policyowner or beneficiary will be permitted to enforce the policy against the insurer as if it complied in all respects with the applicable state law. The state insurance commissioners are charged with the responsibility to see that the insurance companies doing business in their state are complying with that state�s law regarding the permitted and prohibited policy provisions. To enable the insurance department to do its job, a policy may not be issued or delivered in a state until it has been approved by the department. In some states, the insurer may assume that the policy has been approved if it has not been advised otherwise within a fixed period of time, such as 30 days, after it has been submitted to the state insurance department. In other states, the insurer may not issue the policy until it has received notice of approval from the department.

If an insurer issues a policy that has not been approved by the insurance department, the policyowner may seek a refund of premiums paid or seek to enforce the policy. If suit is brought, the courts will enforce the unapproved contract against the insurer on behalf of the beneficiary. If the unapproved policy does not include a provision that would have been required for approval, the policy will be treated by the courts as if it does contain such a provision. Furthermore, if a required provision is more favorable to the policyowner than one actually included in the contract, the courts will treat the contract as if it included the more favorable provision. The insurer that violates the laws requiring filing of the policy and approval of its provisions by the state will also be subject to fines or other penalties (such as revocation of the insurer�s right to do business in that state).