Accidental Death and Dismemberment Details
to a mortuary. The Repatriation Benefit is separate from any Accidental Death and Dismemberment Benefit which may be payable. For the Repatriation Benefit to be paid, the Insured's Accidental Death Benefit must be paid first. Benefit Duration This benefit is payable once per Insured. Benefit Description This benefit may be payable if, due to Injuries sustained in an Accident, an Insured dies while driving or riding in a Private Passenger Car, provided: - the Private Passenger Car is equipped with seatbelt(s); - the seatbelt(s) were in actual use and properly fastened at the time of the Accident; and - the position of the seatbelt(s) are certified in the official report of the Accident, or by the investigating officer. A copy of the police Accident report must be submitted with the claim. If certification is not available, and it is clear that an Insured was properly wearing seatbelt(s), then we will pay an amount equal to 10% of the Insured's AD&D Benefit Amount to a maximum of $25,000. However, if such certification is not available, and it is unclear whether an Insured was properly wearing seatbelt(s), then we will pay a fixed benefit of $1,000. We will only pay the Seatbelt Benefit for the death of a minor Child if the Child is correctly strapped and fastened in the appropriate seat for the Child's age and weight as defined by state or federal guidelines. The seatbelt device must also be approved by the state or federal government for the Child's age and weight. An automatic harness seatbelt will not be considered properly fastened unless a lap belt is also used. No benefit will be paid if the Insured is the driver of the Private Passenger Car and does not hold a current and valid driver's license. The Seatbelt(s) Benefit is separate from any Accidental Death and Dismemberment Benefit which may be payable. For the Seatbelt(s) Benefit to be paid, the Insured's Accidental Death Benefit must be paid first. Benefit Duration This benefit is payable once per Insured. Benefit Description This benefit may be payable in addition to the Seatbelt Benefit if, due to Injuries sustained in an Accident, an Insured dies while driving or riding in a Private Passenger Car, provided: - the Private Passenger Car is equipped with an airbag for the seat in which the Insured is seated; and - the seatbelt(s) must be in actual use and properly fastened at the time of the Accident. This benefit will pay an amount equal to 5% of the Insured's AD&D Benefit Amount to a maximum of $5,000. However, if we can verify that the airbag(s) had been disengaged prior to the Accident, no benefit will be payable. The Air Bag Benefit is separate from any Accidental Death and Dismemberment Benefit which may be payable. For the Air Bag Benefit to be paid, the Insured's Seatbelt(s) Benefit and Accidental Death Benefit must be paid first. Benefit Duration
Seatbelt(s) Benefit
Air Bag Benefit
UA-GTLC21-1
Group Life and Accidental Death and Dismemberment Certificate
(1/1/2025) 17
Unum Life Insurance Company of America
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