# AUTOMOBILE MEDICAL PAYMENTS INSURANCE COVERAGE PART

## POLICY NO.
CA 8596100

## EFFECTIVE DATE
[Not specified]

## AGENCY NO.
[Not specified]

### SCHEDULE
- **Designation of Automobiles - Division 1** (Check appropriate box)
  - [ ] Any owned automobile
  - [ ] Any hired automobile
  - [X] Any licensed owned private passenger automobile
  - [ ] Any automobile described in the automobile schedule and designated "M.P."
  - [ ] Any non-owned automobile
  - [ ] Other: $______

- **Designated Person Insured - Division 2**
  - [ ] Any person designated as insured in the schedule.

### ADVANCE PREMIUM
- [ ] $______

### Total Advance Premium
- [ ] $______

## IV. ADDITIONAL DEFINITIONS
The additional definitions applicable to automobile bodily injury liability insurance also apply to this insurance, except as modified in reference to this insurance (including endorsements forming a part of the policy).

- **"Designated automobile"** means an automobile designated in the schedule and includes:
  - (a) An automobile not owned by the named insured while temporarily used as a substitute for an owned automobile designated in the schedule when withdrawn from normal use for servicing or repair or because of its breakdown, loss, or destruction; and
  - (b) A trailer designed for use with a private passenger automobile, if not being used for business purposes with another type automobile and if not a home office, store, display or passenger trailer;
  - (c) A highway vehicle means a land motor vehicle or trailer other than a farm type tractor or other equipment designed for use principally off public roads, while not upon public roads;
  - (d) A vehicle operated on rails or crawler-tracks; or
  - (e) A vehicle while located for use as a residence or premises;

- **"Medical expenses"** mean expenses for necessary medical, surgical, x-ray and dental services, including diagnostic devices, and necessary ambulance, hospital professional nursing and funeral services;

- **"Occupying"** means in or upon or entering into or alighting from.

## V. POLICY PERIOD: TERRITORY
This insurance applies only to accidents which occur during the policy period within the territory described in paragraph (1) or (2) of the definition of "public territory."

## VI. ADDITIONAL CONDITIONS
A. Medical Reports; Proof and Payment of Claim
As soon as practicable the injured person or someone on his behalf shall give the company written proof of the accident, with it required, and shall, after execution of any necessary authority, execute authorization to enable the company to obtain medical reports and copies of records. The injured person shall submit physical examination by physicians selected by the company when and as soon as requested by the company. The company may pay the reasonable charges of any person or organization rendering the services and such payment shall reduce the amount payable hereunder for such injury. Payment hereunder shall not constitute an admission of liability of any person or, except hereunder, the company.

B. Excess Insurance
Except with respect to an owned automobile, the insurance under Division shall be excess insurance over any other valid and collectible automobile medical payments or automobile medical expense insurance.

The insurance under Division 2 shall be excess insurance over any other valid and collectible automobile medical expense insurance available to the insured under any other policy.