13. GENERAL PROVISIONS · examined by a Physician, other health professional or vocational expert of our choice; and/or · interviewed by an authorized representative. This right may be used as often as we determine necessary. Unless authorized by the examining Physician, the examination may not be recorded nor may another person be present during the examination. INCONTESTABILITY What is the Incontestability Provision? Except for non-payment of premium or any claims incurred within two years of the effective date of an Insured’s initial, increased, additional or reinstated insurance, no statement made by any Insured relating to insurability for such insurance will be used to contest the validity of that insurance after the insurance has been in force for a period of two years during that individual’s lifetime. The statement must be contained in a form Signed by that individual. This provision shall not preclude the assertion at any time of a defense to a claim based upon the Insured’s eligibility for insurance. INSURER’S AUTHORITY What is our authority? Sun Life has discretionary authority to make all final determinations regarding claims for benefits under the Policy. This discretionary authority includes, but is not limited to, the right to determine eligibility for benefits and the amount of any benefits due and to construe the terms of the Policy. Any decision made by us in the exercise of this authority, including review of denials of benefit, is conclusive and binding on all parties. Any court reviewing such a decision shall uphold it unless the claimant proves that it was arbitrary and capricious. This provision applies only where the interpretation of this policy is governed by the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq. LEGAL PROCEEDINGS What are the time limits for legal proceedings? No legal action may start: · until 60 days after Proof has been given; nor · more than 3 years after the time Proof of claim is required. For claims subject to ERISA, if a claimant files state law causes of action that are later determined by a court to be preempted by ERISA, we shall be entitled to legal fees in defense of those causes of action. LIMIT OF PREMIUM REFUNDS Is there a limit on premium refunds? Whether premiums were paid in error or otherwise, we will refund only that part of the excess premium that was paid during the 12-month period that preceded the date we learned of such overpayment. MISSTATEMENT OF FACTS What happens if there is a misstatement of facts in the administration of the Policy? If relevant facts about the Employer or Employee relating to this insurance are determined not to be accurate: 16-SD-C-01 Page38