# AUTOMOBILE MEDICAL PAYMENTS INSURANCE

**Policy No:** 8826230

## COVERAGE PART

The insurance is issued only with respect to the following coverage as indicated to specific premium charge. 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.

### Schedule

| Coverage | Limit of Liability | Advance Premium |
|----------|--------------------|------------------|
| F - Automobile Medical Payments | $2,000 | $100 per each person | INCL. IN COMPOSITE |

### Form Numbers of Endorsements Attached at Issue

- [ ] Any owned automobile
- [ ] Any hired automobile
- [ ] Any licensed owned private passenger automobile
- [ ] Any automobile described in the schedule and designated "M.P."
- [ ] Any non-owned automobile

### Description of Automobiles—Division 1

- [ ] Any owned automobile
- [ ] Any hired automobile
- [ ] Any licensed owned private passenger automobile
- [ ] Any automobile described in the schedule and designated "M.P."
- [ ] Any non-owned automobile

## I. COVERAGE F – AUTOMOBILE MEDICAL PAYMENTS

The company will pay all reasonable medical expenses incurred within one year from the date of the accident:

### Division 1.
In or for any person who sustains bodily injury, caused by accident while occupying a designated automobile which is being used under this policy, or while being struck by a highway vehicle.

### Division 2.
In or for each insured who sustains bodily injury, caused by accident, while occupying or, while a pedestrian, through being struck by a highway vehicle.

### Exclusions
This insurance does not apply:
(a) to bodily injury to any person while employed or otherwise engaged in connection with an automobile business, if benefits therefor are wholly or in part either payable or required to be provided under any workmen’s compensation law;
(b) to bodily injury due to war, whether or not declared, civil war, insurrection, rebellion or revolution, or to any act or condition incidental to any of the foregoing;
(c) under Division 1, to bodily injury to any employee of the named insured arising out of and in the course of employment by the named insured, but this exclusion does not apply to any such bodily injury arising out of and in the course of domestic service performed by such employee in or about a dwelling house or vehicle or as part either payable or required to be provided under any workmen’s compensation law;
(d) under Division 2, to bodily injury sustained while occupying a highway vehicle owned, hired, leased, or furnished for the regular use of any insured other than the named insured.

## II. PERSONS INSURED—DIVISION 2

Each of the following is an insured under this insurance to the extent set forth below:
- All persons designated as insured in the schedule.
- All who reside in the same household as such designated person, his spouse, and the relatives of either; and
- If such designated person shall die, any person who was an insured at the time of such death shall continue to be an insured.

## III. LIMIT OF LIABILITY

The limit of liability for Automobile Medical Payments Coverage listed in the schedule is applicable to each person in the limit of the company’s liability for all bodily injuries sustained thereby, excepting any person, including any insured, as the result of any one 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.

## IV. ADDITIONAL DEFINITIONS

The additional definitions applicable to automobile bodily injury liability insurance are applicable to this insurance, and when used in reference to this insurance (including endorsements forming a part of the policy):
- "Designated automobile" means an automobile designated in the schedule and referred to in this policy.
- "Highway vehicle" means an automobile not owned by the named insured while temporarily used as a substitute for an owned automobile designated in the schedule when without power from its own source for servicing or repair or because of its breakdown, loss or destruction; and
- A trailer designed for use with a private passenger automobile, if not being used as a camper, camper shell, travel trailer, or similar type recreational vehicle and if not a "horse, mule, store, display or passenger trailer".
- "Highway" means a land motor vehicle or trailer other than a farm type vehicle or other equipment designed for use principally off public roads and not upon public roads.
- A vehicle operated on rails or crawler tracks, or
- A vehicle while located for use as a residence or premises.
- "Medical services" means services rendered for the purpose of medical, surgical, x-ray and dental services, including prosthetic devices, and necessary ambulance, hospital professional nursing and funeral services.
- "Pedestrian" means a person who is walking or entering into or leaving from.

## V. POLICY PERIOD, TERRITORY

This insurance applies only to accidents which occur during the policy period within the territory described in paragraph (i) or (ii) of the definition of policy territory.

## VI. ADDITIONAL CONDITIONS

A. Medical Reports, Proof and Payment of Claim
As soon as practicable after the injured person or someone of his legal age, if the injured person is a minor, has written notice of the accident, and if requested, and shall, after each request from the company, release authorization to enable the company to obtain medical reports and copies of records. The injured person shall submit all medical reports and copies of records furnished by the attending physician and as often as the company reasonably requests. The company may pay the injured person or any person or organization rendering the services, and may pay the person or organization furnishing the medical reports and copies of records. Payment hereunder shall not constitute an admission of liability of any person or, except hereinafter, of the company.

B. Subrogation
Except with respect to an owned automobile, the Insured under Division 1 who has excess insurance over any other valid and collectable automobile medical payments coverage shall not be entitled to subrogation.

The insurance under Division 7 shall be excess insurance over any other valid and collectible automobile medical payments of automobile medical expenses amounts under any other policy.

C. Non-Applicability of Subrogation Conditions
The Subrogation Condition does not apply to the Automobile Medical Payments Coverage.