General Provisions
the event of non-payment of premium, we can take legal or other action at any time as permitted by applicable law. To confirm the accuracy of an Insured's signed application, we may require additional information, including but not limited to completion of a medical treatment form and medical records. If we receive information about an Insured that is incorrect, we will: - review the information to decide whether the Insured has coverage and in what amounts; and - if necessary, make the applicable premium adjustments. We want to make sure you and your Employer do not incur additional insurance costs as a result of the effects of insurance fraud. We promise to focus on all means necessary to support fraud detection, investigation, and prosecution. It is a crime to defraud or attempt to defraud us into issuing coverage or paying benefits that we would otherwise not have issued or paid. This includes filing a claim or providing information that contains any false, incomplete, or misleading information. Fraudulent and deceptive actions may result in denial of a claim, and may be subject to prosecution and punishment under state and federal law. We will pursue all appropriate legal remedies in the event of insurance fraud. For purposes of the policy, your Employer acts on its own behalf or as your agent. Under no circumstances will your Employer be deemed our agent. This certificate does not provide coverage under any workers' compensation or state disability insurance law.
Misstatement of Information
Fraud
Agency
Workers' Compensation or State Disability Insurance Communicating with you or your Employer Privacy and Data Protection
We may communicate verbally or in Writing with you or your Employer.
We will abide by all applicable privacy and data protection laws and regulations.
Discretionary Acts
The Plan grants to itself the discretionary authority to make all benefit determinations under the Plan. The Plan, acting through the Plan Administrator, delegates to Unum Life Insurance Company of America ("Unum") and its parents and affiliates the discretionary authority to make all benefit determinations pursuant to Plan documents, which include insurance policies and other documents evidencing funding for benefits provided under the Plan. Unum may act directly or through its parents, employees and agents, or further delegate its authority through contracts, letters or other documentation or procedures to other affiliates or entities. Benefit determinations include determining eligibility for benefits and the amount of any benefits, resolving factual disputes, and interpreting and applying Plan terms and conditions. Exercising discretionary authority requires that a benefit determination must be made on a principled and reasoned basis, consistent with a reasonable interpretation of the terms of the Plan or insurance policy and supported by the facts and circumstances of each claim.
UA-GTLC21-1
Group Life and Accidental Death and Dismemberment Certificate
(1/1/2025) 36
Unum Life Insurance Company of America
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