# UNINSURED MOTORISTS INSURANCE COVERAGE PART

**POLICY NO:** GA 86-68-700  
**EFFECTIVE DATE:**  
**AGENCY NO.:**  
**ADVANCE PREMIUM:** $  

## SCHEDULE

**Designated Insured**

**Description of Insured Highway Vehicles (Check appropriate box):**

- ☐ Any automobile owned by the named insured
- ☑ Any private passenger automobile owned by the named insured
- ☐ Any highway vehicle to which are attached dealer's license plates issued to the named insured
- ☐ Any highway vehicle designated in the automobile schedules of the policy by the letters "UM" and a highway vehicle ownership of which is acquired during the policy period by the named insured as a replacement therefor
- ☐ Any mobile equipment owned or leased by and registered in the name of the named insured

## PROTECTION AGAINST UNINSURED MOTORISTS INSURANCE

### I. COVERAGE U—UNINSURED MOTORISTS (Damages for Bodily Injury)

The company will pay all sums which the insured or his legal representative shall be legally entitled to recover as damages from the owner or operator of an uninsured highway vehicle because of bodily injury sustained by the insured, caused by accident and arising out of the ownership, maintenance, or use of such uninsured highway vehicle. The company shall not be liable under this coverage for any contribution as to whether the insured or such representative is legally entitled to recover such damages, and if so the amount thereof, shall be made by agreement between the insured or such representative and the company or, if they fail to agree, by arbitration.

No judgment against any person or organization alleged to be legally responsible for the bodily injury shall be conclusive, as between the insured and the company, of the issues of liability of such person or organization or of the amount of damages to which the insured is legally entitled unless such judgment is entered pursuant to an action prosecuted by the insured with the written consent of the company.

### Exclusions

This insurance does not apply:

(a) to bodily injury to an insured with respect to which such insured, his legal representative, or any person entitled to payment under this insurance shall, without written consent of the company, make any settlement with any person or organization who may be legally liable therefor;

(b) to bodily injury to an insured while occupying a highway vehicle (other than an uninsured highway vehicle owned by the named insured and described as insured or as residing in the same household as the named or designated insured, or through being struck by such a vehicle, but this exclusion does not apply to the named insured or his relatives when occupying or if struck by a highway vehicle owned by a designated insured or his relatives;

(c) so as to be directly or indirectly to the benefit of any workmen's compensation or disability benefits carrier or any person or organization qualifying as a self-insurer under any workmen's compensation or disability benefits law of any similar law.

### II. PERSONS INSURED

Each of the following is an insured under this insurance to the extent set forth below:

(a) the named insured and any designated insured and, while residents of the same household, the spouse and relatives of either;

(b) any other person while occupying an insured highway vehicle; and

(c) any person, with respect to damages he is entitled to recover because of bodily injury to which this insurance applies sustained by an insured under (a) or (b) above.

The insurance applies separately with respect to each insured, except with respect to the limits of the company's liability.

### III. LIMITS OF LIABILITY

Regardless of the number of insureds under this policy, the company's liability is stated as follows:

(a) The limit of liability stated in the declarations as applicable to "each person" is the limit of the company's liability for all damages because of bodily injury sustained by one person as the result of any one accident and, subject to the above provision respecting "each person," the limit of liability stated in the declarations as applicable to "each person" is the total limit of the company's liability for all damages because of bodily injury sustained by two or more persons as the result of any one accident.

(b) Any amount payable under the terms of this insurance because of bodily injury sustained by a person who is an insured under this coverage shall be reduced by:

(1) all sums paid on account of such bodily injury by or on behalf of:
(i) the owner or operator of the uninsured highway vehicle and
(ii) any other person or organization jointly or severally liable together with such owner or operator of such bodily injury, including all sums paid under the bodily injury liability coverage of the policy, and
(2) the amount paid and the present value of all amounts payable on account of such bodily injury under any workmen's compensation law, disability benefit law, or any similar law.

(c) Any payment made under this insurance to or for any insured shall be applied in reduction of liability of damages which he may be entitled to recover from any person insured under the bodily injury liability coverage of the policy.

(d) The company shall not be obligated to pay under this insurance that part of the damages which the insured may be entitled to recover from the owner or operator of an uninsured highway vehicle which represents expenses for medical services paid or payable under the medical payments coverage of the policy.

### IV. POLICY PERIOD, TERRITORY

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

### V. ADDITIONAL DEFINITIONS

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

- "designated insured" means an individual named in the schedule under Designated Insured;
- "highway vehicle" means a land motor vehicle or trailer other than:
  (a) a farm type tractor or other equipment designed for use principally off public roads, while not upon public roads.
  (b) a vehicle operated on rails or crawler-treads, or
  (c) a vehicle while located for use as a residence or premises.

Form No. 420  
LOP: 02/07  
(over)  
Z 007099