"Principal
Sum. Maximum Sum.
"$
1,000.00 "Great Western $ 2,000.00
"Accident
Insurance Company.
"Des
Moines, Iowa, U.S. A.
"Section
I.
"Insuring
Clause.
"In
consideration (1) of the payment of the policy fee of five
and no/100 Dollars, and (2) of all the agreements and
representations contained in the application herefor, a copy
of which is attached hereto and made a part hereof, and (3)
of the conditions and provisions contained
herein and indorsed hereon, the Great Western Accident
Insurance Company (hereinafter called the Company) hereby
insures Kathryn L. Breen (hereinafter called the insured), of
Chicago, state of Illinois, by occupation sales lady, office
or sales ladies' duties, handling light goods at counter,
under classification 'AA' from 12 o'clock, noon,
standard time, at the place of residence of insured on the
date of issuance hereof, and the payment herefor in cash or
its equivalent, until 12 o'clock noon, such standard
time, of the first day of May, 1919, and for such further
periods stated in the renewal agreements, as the renewal
premium of $ 1.75 per month, paid by the insured in advance,
will maintain this policy in force: (1) Against the effect of
personal bodily injury which produces disability from the
date of the accident, and which, exclusive of all other
causes, is caused solely and directly by external, violent
and accidental means (suicide, or any attempt thereat,
intentional self-inflicted injuries, or disappearance, while
either sane or insane, are excluded from benefits hereunder);
and (2) against disability resulting from sickness, the
infection, inoculation and cause of which is contracted not
less than thirty days after the issuance and acceptance of
this policy or not less than ten days after reinstatement of
same; said insurance to be paid in the amounts and under the
conditions herein provided.
"Section
II.
"Specific
Benefits.
"If
such accidental injury as defined in the insuring clause
hereof, shall produce immediate and continuous total
disability, and shall, within ninety days from the date of
accident, result in one of the losses specified in this
section, the company will pay to the insured or the
beneficiary, in lieu of all other indemnity, as follows, to
wit:
"1.
Life one thousand dollars. The principal sum.
"2.
Both hands (complete severance at or above wrists). The
principal sum.
"3.
Both feet (complete severance at or above ankles). The
principal sum.
"4.
Both eyes (entire and permanent destruction of sight). The
principal sum.
"5. One hand and one foot (complete severance
at or above wrist and ankle). The principal sum.
"6.
One hand (complete severance at or above wrist). One half the
principal sum.
"7.
One foot (complete severance at or above ankle). One half the
principal sum.
"8.
One eye (entire and permanent destruction of sight). One
fourth the principal sum.
"Section
III.
"Benefits
for Loss of Time.
"1.
Monthly Accident Payment. If such accidental injury
as defined in the insuring clause hereof (not including
injuries resulting in losses named in Section II hereof)
shall totally and continuously disable the insured from
performing any and every kind of duty pertaining to
insured's occupation, or to any occupation in which the
insured may engage, the company will pay sixty & no/100
dollars per month (but not to exceed the average salary or
earnings of the insured) during the period of such total
disability, but not exceeding twenty-four consecutive months;
or, in case such injury causes a material but not total loss
of time, or if total disability does not immediately follow
the accident, such disability indemnity shall accrue at a
rate, according to the actual loss of time, not less than one
fourth and not exceeding one half of the payment herein
provided for total disability, and for a period not exceeding
six consecutive months.
"2.
Monthly Sickness Payment. If the insured shall
suffer bodily disease or illness such as defined in the
insuring clause hereof, except as hereinafter stated, the
company will pay for the loss of time necessarily resulting
from such sickness at the rate of sixty & no/100 Dollars per
month (but not to exceed the average salary or earnings of
the insured) for a period not exceeding six consecutive
months, for the number of consecutive days that the insured
is totally disabled and wholly and continuously
confined within the house and prevented from performing any
and all duties pertaining to insured's occupation, and
while regularly visited
within the house by a licensed physician; or if the insured
shall be totally disabled although not confined to
the house and while under the care of a licensed physician by reason of such disease or illness, the
company will pay one half the amount provided herein for
confining sickness, not exceeding two consecutive months, but
such payment for both confining and nonconfining sickness
shall not exceed six consecutive months for any one sickness.
"3.
Covered as Sickness. Any disability or loss
hereinbefore defined, caused by or resulting wholly or in
part, directly or indirectly, in or from carbuncles, boils,
felons, abscesses, ulcers, infection (external infection of
accidental injuries such as defined in Section I, the
insuring clause hereof are construed as accidents), cancer,
gas, poison, anaesthetics, embolism, fits, vertigo, hernia,
sunstroke, freezing, lame or sprained back, strains,
sciatica, lumbago, over-exertion, dementia or insanity or any
injury complicated with disease, or any disability or loss
where there is no wound or contusion visible to the eye to
show a violent and external cause of such disability, then
and in every such case, said disability and any claim
therefor shall be classified and treated as sickness and
shall be subject to the provisions, conditions and
limitations governing sickness insurance as set forth in
Section III, Paragraph 2 hereof, the original cause of such
disability or loss notwithstanding.
"4.
Double Benefits. If such accidental injury as
defined in the insuring clause hereof results in one of the
losses specified in Section II or Paragraph 1 of Section III
hereof (1) while the insured is a passenger within the
inclosed part of any railway or street railway passenger car,
or (2) while a passenger on board a steam vessel licensed for
the regular transportation of passengers, and such injury
shall be the result of the wrecking of such car or vessel,
the company will pay double the amount provided in said
section or paragraph for such injury or loss."
