# Premises Medical Payments Insurance

**Coverage Part**

For attachment to Policy No. 89 06 923, to complete said policy.

## Schedule

The insurance afforded is only with respect to the following coverage indicated by specific premium charge or charges. The limit of the company's liability against such coverage shall be as stated herein, subject to all the terms of this policy having reference thereto.

| Coverage | Limits of Liability | Advance Premiums |
| --- | --- | --- |
| E—Premises Medical Payments | dollars each person | dollars each accident |
| (a) Premises and operations | $ INCL. IN | X X X |
| (b) Escalators | $ COMPOSITE | $ RATE |
| (c) Sports activities | $ | $ |

Form numbers of endorsements attached at issue

## Coverage E—Premises Medical Payments

The company will pay to or for each person who sustains bodily injury caused by accidental reason medical expense incurred within one year from the date of occurrence on account of such bodily injury, provided such bodily injury arises out of (a) a condition in the insured premises or (b) operations with respect to which the named insured is afforded coverage for bodily injury liability under this policy.

### Exclusions

This insurance does not apply:

1. To bodily injury:
   - Arising out of the ownership, maintenance, operation, use, loading or unloading of any automobile or aircraft owned or operated by or rented or loaned to any insured.
   - Arising out of the ownership, maintenance, operation, use, loading or unloading of any motor vehicle while being used in any prearranged or organized race, speed or demolition contest or in any stunting activity or in practice or preparation for any such contest or activity.
   - To the operation or use of any snowmobile or trailer designed for use thereon.
   - Arising out of the ownership, maintenance, operation, use, loading or unloading of any watercraft owned or operated by or rented or loaned to any insured.
   - To bodily injury arising out of the course of the transportation of mobile equipment owned or operated by or rented or loaned to any insured.

2. To bodily injury resulting from the selling, serving, giving away, or supplying of alcoholic beverage to a person under the influence of alcohol or who causes or contributes to the intoxication of any person, or to a person engaged in the business of manufacturing, distributing, selling or serving alcoholic beverages or, if not so engaged, is an owner or lessor of premises used for such purpose.

3. To bodily injury caused by war, whether or not declared, civil war, insurrection, rebellion or revolution, or to any act or condition incident to any of the foregoing.

4. To bodily injury to the named insured, any partner therein, any tenant or other person regularly residing on the insured premises or any employee of any of the insured premises.

## Limits of Liability

The limit of liability for Premises Medical Payments Coverage stated in the schedule as applicable to each person. The limit of the company's liability for medical expenses for bodily injury to any one person as the result of any one accident, but subject to the above provision respecting "each person", the total liability of the company under Premises Medical Payments Coverage for all medical expenses for bodily injury to any one or more persons as the result of any one accident shall not exceed the limit of liability stated in the schedule as applicable to "each accident".

When more than one medical payments coverage afforded by this policy applies to the loss, the company shall not be liable for more than the amount of the highest applicable limit of liability.

## Additional Definitions

When used in reference to this insurance (including endorsements forming a part of the policy):

- "Insured premises" means all premises owned by or rented to the named insured with respect to which the named insured is afforded coverage for bodily injury liability under this policy, and includes the ways immediately adjoining on land.
- "Medical expenses" means expenses for necessary medical, surgical, x-ray and dental services, including physical devices, and necessary ambulance, hospital, professional nursing and funeral services.

## Policy Period, Territory

This insurance applies only to accidents which occur during the policy period within the United States of America, its territories or possessions, or Canada.

## Additional Condition

Medical Reports; Proof and Payment of Claim

As soon as practicable the injured person or someone on his behalf shall give to the company written proof of claim, under oath if required, and shall after each request from the company execute an authorization to enable the company to obtain medical reports and copies of records. The injured person shall submit a medical examination by physicians selected by the company when and as often as the company may reasonably require. The company may reasonably require that any person or organization responsible for such injury. Payment hereunder shall not constitute an admission of liability of any person or, except hereunder, of the company.