Personal Auto Policy

Transcription

1 NEW YORK Personal Auto Policy For questions about your policy, please call: Esurance Property and Casualty Insurance Company 650 Davis Street San Francisco, CA Fraud Statement: Any person who knowingly and with intent to defraud any insurance company or other person files an application for commercial insurance or a statement of claim for any commercial or personal insurance benefits containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, and any person who, in connection with such application or claim, knowingly makes or knowingly assists, abets, solicits or conspires with another to make a false report of the theft, destruction, damage or conversion of any motor vehicle to a law enforcement agency, the department of motor vehicles or an insurance company commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the value of the subject motor vehicle or stated claim for each violation. WHEN THIS POLICY IS ISSUED, AND WHEN THIS POLICY IS RENEWED, WE RELY UPON THE TRUTH AND ACCURACY OF THE REPRESENTATIONS MADE IN THE APPLICATION FOR THIS INSURANCE. ANY ENDORSEMENTS ISSUED BY US ARE PART OF, AND FORM, YOUR POLICY NY 06 13

2 CONTENTS NEW YORK PERSONAL AUTOMOBILE POLICY... 1 INSURING AGREEMENT... 1 GENERAL DEFINITIONS... 1 PART I: LIABILITY COVERAGE... 3 INSURING AGREEMENT... 3 ADDITIONAL DEFINITIONS FOR PART I: LIABILITY COVERAGE... 4 SUPPLEMENTARY PAYMENTS... 4 EXCLUSIONS FOR PART I: LIABILITY COVERAGE... 5 LIMIT OF LIABILITY... 6 OUT OF STATE COVERAGE... 7 OTHER INSURANCE... 7 PART II-A: PERSONAL INJURY PROTECTION... 8 MANDATORY PERSONAL INJURY PROTECTION ENDORSEMENT... 8 OPTIONAL BASIC ECONOMIC LOSS COVERAGE ENDORSEMENT ADDITIONAL PERSONAL INJURY PROTECTION ENDORSEMENT EXCLUSION OF MEDICAL EXPENSE FROM MANDATORY PERSONAL INJURY PROTECTION ENDORSEMENT PART II-B: MEDICAL AND FUNERAL SERVICES PAYMENTS COVERAGE INSURING AGREEMENT ADDITIONAL DEFINITION FOR PART II-B: MEDICAL AND FUNERAL SERVICES PAYMENTS COVERAGE EXCLUSIONS FOR PART II-B: MEDICAL AND FUNERAL SERVICES PAYMENTS COVERAGE LIMIT OF LIABILITY OTHER INSURANCE PART III: UNINSURED AND UNDERINSURED MOTORISTS COVERAGE INSURING AGREEMENTS EXCLUSIONS CONDITIONS SUPPLEMENTARY UNINSURED/UNDERINSURED MOTORISTS ENDORSEMENT--NEW YORK INSURING AGREEMENTS EXCLUSIONS CONDITIONS PART IV: COVERAGE FOR PHYSICAL DAMAGE TO AN AUTO INSURING AGREEMENT: COLLISION COVERAGE INSURING AGREEMENT: COMPREHENSIVE COVERAGE ADDITIONAL DEFINITIONS FOR PART IV: COVERAGE FOR PHYSICAL DAMAGE TO AN AUTO RENTAL REIMBURSEMENT COVERAGE CUSTOM PARTS AND EQUIPMENT COVERAGE TOWING AND LABOR COVERAGE NY i

3 FULL COVERAGE WINDOW GLASS EXCLUSIONS FOR PART IV: COVERAGE FOR PHYSICAL DAMAGE TO AN AUTO LIMIT OF LIABILITY PAYMENT OF LOSS LOSS PAYABLE CLAUSE NO BENEFIT TO BAILEE OTHER SOURCES OF RECOVERY APPRAISAL PART V: INSURED S DUTIES AFTER AN ACCIDENT OR LOSS PART VI: GENERAL PROVISIONS BANKRUPTCY CHANGES FRAUD OR MISREPRESENTATION LEGAL ACTION AGAINST US OUR RIGHT TO RECOVER PAYMENT SUBROGATION POLICY PERIOD AND TERRITORY TERMINATION Cancellation Nonrenewal Automatic Termination Other Termination Provisions PAYMENT OF PREMIUM AND CONDITION PERFORMANCE TRANSFER OF YOUR INTEREST IN THIS POLICY CONFORMITY WITH STATUTE TWO OR MORE AUTO POLICIES RENTAL VEHICLE COVERAGE ENDORSEMENT Definitions: Priority of payment Exclusions: Subrogation: NY ii

4 NEW YORK PERSONAL AUTOMOBILE POLICY INSURING AGREEMENT When we agree to issue this policy, and when we agree to renew this policy, we rely upon the truth and accuracy of the information you provide to us and the representations made by you in your Application for this insurance and at the time of each renewal. Any Endorsements issued by us are part of, and form, your policy. The duties and obligations imposed by this policy shall be binding upon you, family members, and all other persons seeking coverage or benefits under this policy. In return for your premium payment, we agree to insure you subject to all of the terms of this policy as follows: GENERAL DEFINITIONS The following definitions, in their singular, plural, and possessive forms, apply throughout this policy when printed in boldface italics within quotation marks. 1. You and your refer to: A. The named insured(s) shown on the Declarations page; B. The spouse of the named insured if that spouse is a resident of the named insured s household during the policy period. If the spouse ceases to be a resident of the named insured s household during the policy period or prior to the inception of this policy, that spouse will be considered you and your under this policy but only until the earliest of: A. 30 days after the spouse ceases to reside with the named insured; B. The effective date of another policy listing that spouse as an insured; C. The end of the policy period; or D. Cancellation of this policy. 2. We, us, and our refer to the Company providing this insurance, as shown on the Declarations page. 3. Accident means a sudden, unexpected, and unintended event. 4. Auto means a land motor vehicle: A. Registered under the applicable motor vehicle laws; B. Designed principally for operation upon public roads; and C. With more than three load-bearing wheels. 5. Bodily injury means bodily harm, sickness, or disease, including death that results from bodily harm, sickness, or disease. 6. Business includes trade, profession, or occupation. 7. Covered auto means the following "autos" used predominantly for non-business purposes: A. Any vehicle identified on your Declarations page; B. A newly acquired auto ; 1001 NY Page 1 of 43

5 C. Any trailer titled to you ; or D. Any auto or trailer while used as a temporary substitute for any other auto or trailer described in this definition which is out of normal use due to: (1) Breakdown; (2) Repair; (3) Loss; or (4) Destruction. 8. Depreciation means the decline in value due to wear and tear and/or obsolescence. 9. Family member means: A. Any person related to you by blood, marriage, or adoption who is a resident of your household ; and B. Your ward or foster child who resides in your household. 10. Household consists of you, a family member, unrelated roomers, boarders, live-in employees, and other people who are not related to you who live together in the same housing unit. A housing unit includes a house, apartment, condominium, mobile home, trailer, a group of rooms, or a single room that is self-contained and located at the address listed in your Declarations page. 11. Loss means: A. Sudden, direct, and unintended physical damage; or B. Theft. 12. Minimum limits refers to the minimum amounts of liability insurance required to be provided under the automobile financial responsibility and insurance laws of New York. 13. Newly acquired auto means an auto that you become the owner of during the policy period: A. If you pay any applicable additional premium due for coverage under this policy; and B. Subject to the following conditions: (1) If the auto you acquire replaces an auto shown on the Declarations page, that acquired auto will have the same coverage as the auto it replaces. Coverage will begin when you become the owner of the acquired auto. You must ask us to insure a replacement auto within 30 days after you become the owner if you want to continue any coverage you had under Part IV: Coverage for Physical Damage to an Auto after those initial 30 days. (2) If the auto you acquire replaces an auto shown on the Declarations page, and the replaced auto did not have coverage under Part IV: Coverage for Physical Damage to an Auto, you may add this coverage for the replacement auto. The added coverage will not be effective until after we receive your request and we agree to add the coverage. (3) If the auto you acquire is in addition to the autos shown on the Declarations page, for any coverage as described below to apply: (a) We must insure all other autos you own ; and (b) No other valid and collectible insurance policy provides coverage for the auto. (4) If the auto you acquire is in addition to the autos shown on the Declarations page, that added auto will have the same coverage as the auto on the Declarations page with the broadest coverage if you ask us to insure the additional auto within 30 days after you become the owner. If you ask us to insure the additional auto within 30 days after you became the owner, coverage will begin when you became the owner of the auto. (5) If the auto you acquire is in addition to the autos shown on the Declarations page, and you do not ask us to insure the additional auto within 30 days after you become the owner, no 1001 NY Page 2 of 43

6 coverage will be provided for the additionally acquired auto until after you ask us to insure the additional auto and we agree to insure the auto. (6) If no auto on the policy has coverage under Part IV: Coverage for Physical Damage to an Auto, you may add this coverage for the acquired auto. The added coverage will not be effective until after we receive your request and we agree to add the coverage. (7) If you ask us to increase any of your limits, the increase will not be effective until after we receive your request and we agree to increase the limits. 14. Occupying means: A. In; B. Upon; or C. Getting in, on, out, or off. 15. Own and owned, with respect to a motor vehicle means: A. Titled to that person under motor vehicle laws; B. Leased under a written agreement for a continuous period greater than 30 days; or C. That person has primary legal possession, subject to a lien or written security agreement with an original term greater than 30 days. 16. Owner means a person: A. To whom a motor vehicle is titled under motor vehicle laws; B. To whom a motor vehicle is leased under a written agreement for a continuous period greater than 30 days; or C. Who has primary legal possession of a motor vehicle, subject to a lien or written security agreement with an original term greater than 30 days. 17. Property damage means the physical damage of, destruction of, or loss of use of, property. 18. Trailer means a vehicle designed to be pulled by a private passenger auto that is not used: A. For a business or commercial purpose; B. As an office, store, or for commercial display purposes; C. To transport passengers; or D. As a primary residence. INSURING AGREEMENT PART I: LIABILITY COVERAGE Subject to the Limits of Liability, we will pay damages for bodily injury and property damage for which any insured becomes legally responsible because of an auto accident. Damages include prejudgment interest awarded against the insured. We will settle or defend as we deem appropriate, any claim or lawsuit asking for these damages. However, we will not pay for punitive or exemplary damages under Part I. A defense will be provided even if the claim or lawsuit is or proves to be groundless. In addition to our limit of liability, we will pay costs we incur when we defend an insured. Our duty to settle or defend ends when our limit of liability for this coverage has been exhausted by payment of judgments or settlements, or the limit is paid into a court that has jurisdiction. We have no duty to defend any lawsuit or settle any claim for bodily injury or property damage not covered under this policy NY Page 3 of 43

7 ADDITIONAL DEFINITIONS FOR PART I: LIABILITY COVERAGE 1. Insured as used in Part I means: A. You or any family member for the ownership, maintenance, or use of any auto or trailer provided there is permission from the owner for any such use; B. Any person using a covered auto with permission from you or a family member ; C. For a covered auto, any person or organization but only with respect to legal responsibility for acts or omissions of an insured person described in 1.A or 1.B above; or D. For any auto or trailer other than a covered auto, any other person or organization but only with respect to legal responsibility for the acts or omissions of you or a family member. This Provision 1.D. applies only if the person or organization does not own or hire the auto or trailer. However, the following are not insureds under Part I: A. If the provisions of Section 2679 of Title 28, United States Code, as amended, require the Attorney General of the United States to defend that person or organization in any civil action for bodily injury or property damage arising out of the accident : (1) The United States of America or any of its agencies. (2) Any person with respect to bodily injury or property damage resulting from the operation of an auto by that person as an employee of the United States Government. B. Any person, including you or a family member, with respect to an accident arising out of that person's ownership, maintenance or use of an auto, other than a covered auto, that is: (1) Owned by you, a family member, or a person who resides with you ; or (2) Furnished or available for regular use to you, a family member, or a person who resides with you. This does not apply to you while you are maintaining or occupying any vehicle which is: (1) Owned by any family member or a person who resides with you ; or (2) Furnished or available for the regular use of any family member or a person who resides with you. SUPPLEMENTARY PAYMENTS In addition to our limit of liability, we will pay on behalf of the insured : 1. Up to $250 for the cost of bail bonds required because of an accident or traffic law violation resulting from an accident. The accident must result in bodily injury or property damage covered under this policy. We have no duty to apply for or furnish this bond. 2. Premiums on appeal bonds and bonds to release attachments in any lawsuit we defend. We are not required to apply for or provide these bonds. 3. Interest accruing after a judgment is entered in any lawsuit we defend. Our duty to pay interest ends when we offer to pay, or have deposited with the court, that part of the judgment which does not exceed our limit of liability for this coverage. This does not apply if we have not been given notice of the lawsuit or the opportunity to defend an insured. 4. Up to $200 a day for loss of earnings, but not other income, because of attendance at hearings or trials at our request. 5. All costs taxed against the insured in any lawsuit we defend and other reasonable expenses incurred at our request. 6. Expenses incurred by the insured for first aid to others at the time of the accident involving an auto insured under Part I. 7. All expenses incurred by us NY Page 4 of 43

8 EXCLUSIONS FOR PART I: LIABILITY COVERAGE (Read carefully. If any of the exclusions below apply, coverage will not be afforded under Part I.) We have no duty to defend and do not provide Liability Coverage for any insured : 1. Who intentionally causes, or directs another to cause, bodily injury or property damage. 2. For property damage to property owned or being transported by that insured. 3. For property damage to property: A. Rented to; or B. In the care of; that insured, or to property as to which the insured is for any purpose exercising physical control. This Exclusion 3. does not apply to property damage to a residence or private garage unless that residence or garage is owned by you or another insured. 4. For bodily injury to an employee of that insured during the course of employment. This Exclusion 4. does not apply to bodily injury to a domestic employee unless workers compensation benefits are required or available for that domestic employee. 5. For that insured s liability arising out of the ownership or operation of any vehicle while it is used as a public or livery conveyance. However, this Exclusion 5 does not apply to shared-expense car pools. 6. Who is a person or organization, or any agent or employee thereof, while employed or otherwise engaged in operating an automobile sales agency, repair shop, service station, storage garage or public parking place, with respect to any accident arising out of the maintenance or use of a motor vehicle in connection therewith. This Exclusion 6. does not apply to the ownership, maintenance, or use of a covered auto by: A. You ; B. Any family member ; or C. Any partner, agent, or employee of you or any family member. 7. For bodily injury or property damage resulting from the operation of a vehicle as an employee of the United States government and acting within the scope of that employment. This Exclusion 7. applies when the provisions of the Federal Tort Claims Act apply. 8. Any liability assumed by an insured under any contract or agreement. 9. For bodily injury sustained by the spouse of any insured. This Exclusion 9. does not apply if: A. You have purchased Supplemental Spousal Liability Coverage from us ; or B. An insured is named as a third-party defendant for contribution in a lawsuit brought by his or her spouse against another party. 10. Bodily injury or property damage arising out of an accident while: A. The auto is used for the towing of any trailer or semi trailer: (1) Owned or hired by the insured ; and (2) Not covered under Part I of this policy; or B. Any trailer covered by the policy is used with any motor vehicle: (1) Owned or hired by the insured ; and (2) Not covered under Part I of this policy NY Page 5 of 43

9 11. Bodily injury or property damage due to: A. War, whether or not declared; B. Civil war; C. Insurrection; D. Rebellion; E. Revolution; or F. To any act or condition incident to any of the foregoing. LIMIT OF LIABILITY 1. Subject to Clause 2 below of this Part I Limit of Liability, the limit of liability shown on the Declarations page for each person for Bodily Injury Liability is our maximum limit of liability for all damages which may arise as a result of bodily injury sustained by or bodily injury resulting in the death of any one person in any one auto accident. Subject to this limit for each person, the limit of liability shown on the Declarations page for each accident for Bodily Injury Liability is our maximum limit of liability for all damages for bodily injury or bodily injury resulting in the death resulting from any one auto accident. 2. If the limit shown on the Declarations page for bodily injury is: A. $25,000 for each person and $50,000 for each accident, the following additional coverage will apply in the event of bodily injury that results in death, to the extent required by New York law: (1) Our limit of liability for damages due to bodily injury that results in the death of one person in any one accident is $50,000; or (2) If two or more persons sustain bodily injury that results in death, our limit of liability for bodily injury that results in the death of two or more persons in any one accident is $100,000. B. $50,000 for each person and $100,000 for each accident, our limit of liability, to the extent required by New York law, will be as follows: (1) For any accident that causes bodily injury that results in the death of one person: (a) The most we will pay for all damages due to the bodily injury that results in death is $50,000; (b) If only one person sustains a bodily injury that does not result in death, our limit of liability for damages due to the bodily injury to the one person is $50,000; and (c) Subject to the each person limit, if two or more persons sustain bodily injury that does not result in death, our limit of liability for all damages due to bodily injury that does not result in death is $100,000; or (2) For any accident that causes bodily injury that results in the death of two or more persons: (a) The most we will pay for all damages due to bodily injury that results in death is $100,000; (b) If only one person sustains a bodily injury that does not result in death, our limit of liability for damages due to the bodily injury to the one person is $50,000; and (c) Subject to the each person limit, if two or more persons sustain bodily injury that does not result in death, our limit of liability for all damages due to bodily injury that does not result in death is $100,000. These Limits of Liability for bodily injury that results in death are subject to the following reductions: A. In the event of the death of one person in any accident, the $50,000 limit of liability will be reduced by any amounts paid to or on behalf of that person for bodily injury under Part I; and B. In the event of the death of two or more persons in any accident, the $100,000 limit of liability will be reduced by any amounts paid to or on behalf of those persons for bodily injury under Part I NY Page 6 of 43

10 3. The applicable limit of liability described above for each person is our maximum limit of liability for all damages, including, but not limited to, damages for: A. Loss of society; B. Loss of companionship; C. Loss of services; D. Loss of consortium; and E. Wrongful death; which may arise as a result of bodily injury sustained by or bodily injury resulting in the death of any one person in any one auto accident. 4. The limit of liability shown on the Declarations page for each accident for Property Damage Liability is our maximum limit of liability for all property damage resulting from any one auto accident. 5. The applicable limit of liability is the most we will pay regardless of the number of: A. Insureds ; B. Claimants; C. Claims; D. Claims made; E. Lawsuits filed; F. Vehicles or premiums shown on the Declarations page; or G. Vehicles involved in the accident. 6. No one will be entitled to receive duplicate payments for the same elements of damages under this policy or any other source. 7. An auto and attached trailer are considered one auto. The limit of liability for Part I will not be increased for an accident involving an auto that has an attached trailer. OUT OF STATE COVERAGE If an accident to which this policy applies occurs in any state or province other than the one in which a covered auto is principally garaged, we will interpret your policy for that accident as follows: 1. If the state or province has: A. A financial responsibility or similar law requiring limits of liability for bodily injury or property damage higher than the limit shown in the Declarations page, your policy will provide the higher specified limit. B. A compulsory insurance or similar law requiring a nonresident to maintain insurance whenever the nonresident uses an auto in that state or province, your policy will provide at least the required minimum amounts and types of coverage. 2. No one will be entitled to duplicate payments for the same elements of damages. OTHER INSURANCE If there is other valid and collectible liability insurance available under one or more policies or provisions of coverage that applies to the accident, we will pay only our share of the damages. Our share is the proportion that our limit of liability bears to the total of all valid and collectible limits. However, any insurance we provide for a vehicle you do not own, including any temporary substitutes, shall be excess over any other valid and collectible insurance, self-insurance, or bond NY Page 7 of 43

11 PART II-A: PERSONAL INJURY PROTECTION MANDATORY PERSONAL INJURY PROTECTION ENDORSEMENT (New York) The Company agrees with the named insured, as follows: Mandatory Personal Injury Protection Section I The company will pay first-party benefits to reimburse for basic economic loss sustained by an eligible injured person on account of personal injuries caused by an accident arising out of the use or operation of a motor vehicle or a motorcycle during the policy period and within the United States of America, its territories or possessions, or Canada. First-party Benefits First-party benefits, other than death benefits, are payments equal to basic economic loss, reduced by the following: (a) 20 percent of the eligible injured person's loss of earnings from work to the extent that an eligible injured person's basic economic loss consists of such loss of earnings; (b) amounts recovered or recoverable on account of personal injury to an eligible injured person under State or Federal laws providing social security disability or workers' compensation benefits, or disability benefits under article 9 of the New York Workers' Compensation Law; (c) the amount of any applicable deductible, provided that such deductible shall apply to each accident, but only to the total of first-party benefits otherwise payable to the named insured and any relative as a result of that accident. Basic Economic Loss Basic economic loss shall consist of medical expense, work loss, other expense and, when death occurs, a death benefit as herein provided. Except for such death benefit, basic economic loss shall not include any loss sustained on account of death. Basic economic loss of each eligible injured person on account of any single accident shall not exceed $50,000, except that any death benefit hereunder shall be in addition thereto. Medical Expense Medical expense shall consist of necessary expenses for: (a) medical, hospital (including services rendered in compliance with Article 41 of the Public Health Law, whether or not such services are rendered directly by a hospital), surgical, nursing, dental, ambulance, X- ray, prescription drug and prosthetic services; (b) psychiatric, physical and occupational therapy and rehabilitation; (c) any nonmedical remedial care and treatment rendered in accordance with a religious method of healing recognized by the laws of New York; and (d) any other professional health services. These medical expenses will not be subject to a time limitation, provided that, within one year after the date of the accident, it is ascertainable that further medical expenses may be sustained as a result of the injury. Payments hereunder for necessary medical expenses shall be subject to the limitations and requirements of section 5108 of the New York Insurance Law NY Page 8 of 43

12 Work Loss Work loss shall consist of the sum of the following losses and expenses, up to a maximum payment of $2,000 per month for a maximum period of three years from the date of the accident: (a) loss of earnings from work which the eligible injured person would have performed had such person not been injured, except that an employee who is entitled to receive monetary payments, pursuant to statute or contract with the employer, or who receives voluntary monetary benefits paid for by the employer, by reason of such employee's inability to work because of personal injury arising out of the use or operation of a motor vehicle or a motorcycle, shall not be entitled to receive first-party benefits for loss of earnings from work to the extent that such monetary payments or benefits from the employer do not result in the employee suffering a reduction in income or a reduction in such employee's level of future benefits arising from a subsequent illness or injury; and (b) reasonable and necessary expenses sustained by the eligible injured person in obtaining services in lieu of those which such person would have performed for income. Other Expenses Other expenses shall consist of all reasonable and necessary expenses, other than medical expense and work loss, up to $25 per day for a period of one year from the date of the accident causing injury. Death Benefit Upon the death of any eligible injured person, caused by an accident to which this coverage applies, the company will pay to the estate of such person a death benefit of $2,000. Eligible Injured Person Subject to the exclusions and conditions set forth below, an eligible injured person is: (a) the named insured and any relative who sustains personal injury arising out of the use or operation of any motor vehicle; (b) the named insured and any relative who sustains personal injury arising out of the use or operation of any motorcycle, while not occupying a motorcycle; (c) any other person who sustains personal injury arising out of the use or operation of the insured motor vehicle in the State of New York while not occupying another motor vehicle; or (d) any New York State resident who sustains personal injury arising out of the use or operation of the insured motor vehicle outside of New York while not occupying another motor vehicle. Exclusions This coverage does not apply to personal injury sustained by: (a) the named insured while occupying, or while a pedestrian through being struck by, any motor vehicle owned by the named insured with respect to which the coverage required by the New York Comprehensive Motor Vehicle Insurance Reparations Act is not in effect; (b) any relative while occupying, or while a pedestrian through being struck by, any motor vehicle owned by the relative with respect to which the coverage required by the New York Comprehensive Motor Vehicle Insurance Reparations Act is not in effect; (c) the named insured or relative while occupying, or while a pedestrian through being struck by, a motor vehicle in New York State, other than the insured motor vehicle, with respect to which the coverage required by the New York Comprehensive Motor Vehicle Insurance Reparations Act is in effect; however, this exclusion does not apply to personal injury sustained in New York State by the named insured or relative while occupying a bus or school bus, as defined in sections 104 and 142 of the New 1001 NY Page 9 of 43

13 York Vehicle and Traffic Law, unless that person is the operator, an owner, or an employee of the owner or operator, of such bus or school bus; (d) any person while occupying a motorcycle; (e) any person who intentionally causes his or her own personal injury; (f) any person as a result of operating a motor vehicle while in an intoxicated condition or while his or her ability to operate the vehicle is impaired by the use of a drug (within the meaning of section 1192 of the New York Vehicle and Traffic Law) except that coverage shall apply to necessary emergency health services rendered in a general hospital, as defined in section 2801(10) of the New York Public Health Law, including ambulance services attendant thereto and related medical screening. However, where the person has been convicted of violating section 1192 of the New York Vehicle and Traffic Law while operating a motor vehicle in an intoxicated condition or while his or her ability to operate such vehicle is impaired by the use of a drug, and the conviction is a final determination, the Company has a cause of action against such person for the amount of first party benefits that are paid or payable; or (g) any person while: (1) committing an act which would constitute a felony, or seeking to avoid lawful apprehension or arrest by a law enforcement officer; (2) operating a motor vehicle in a race or speed test; (3) operating or occupying a motor vehicle known to that person to be stolen; or (4) repairing, servicing or otherwise maintaining a motor vehicle if the conduct is within the course of a business of repairing, servicing or otherwise maintaining a motor vehicle and the injury occurs on the business premises; (h) the named insured or relative while not occupying a motor vehicle or a motorcycle when struck by a motorcycle in New York State with respect to which the coverage required by the New York Comprehensive Motor Vehicle Insurance Reparations Act is in effect; (i) any New York State resident other than the named insured or relative injured through the use or operation of the insured motor vehicle outside of New York State if such resident is the owner or a relative of the owner of a motor vehicle insured under another policy providing the coverage required by the New York Comprehensive Motor Vehicle Insurance Reparations Act; (j) any New York State resident other than the named insured or relative injured through the use or operation of the insured motor vehicle outside of New York State if such resident is the owner of a motor vehicle for which the coverage required by the New York Comprehensive Motor Vehicle Insurance Reparations Act is not in effect. Other Definitions When used in reference to this coverage: (a) the "insured motor vehicle" means a motor vehicle owned by the named insured and to which the bodily injury liability insurance of this policy applies and for which a specific premium is charged; (b) "motorcycle" means a vehicle as defined in section 123 of the New York Vehicle and Traffic Law and which is required to carry financial security pursuant to article 6, 8 or 48-A of the Vehicle and Traffic Law; (c) "motor vehicle" means a motor vehicle, as defined in section 311 of the New York Vehicle and Traffic Law, and also includes fire and police vehicles, but shall not include any motor vehicle not required to carry financial security pursuant to article 6, 8 or 48-A of the Vehicle and Traffic Law, or a motorcycle as defined above; (d) "named insured" means the person or organization named in the Declarations page; (e) "occupying" means in or upon or entering into or alighting from; (f) "personal injury" means bodily injury, sickness or disease; (g) "relative" means a spouse, child, or other person related to the named insured by blood, marriage, or adoption (including a ward or foster child), who regularly resides in the insured's household, including any such person who regularly resides in the household, but is temporarily living elsewhere; and 1001 NY Page 10 of 43

14 (h) "use or operation" of a motor vehicle or a motorcycle includes the loading or unloading of such vehicle. Conditions Action Against Company. No action shall lie against the Company unless, as a condition precedent thereto, there shall have been full compliance with the terms of this coverage. Notice. In the event of an accident, written notice setting forth details sufficient to identify the eligible injured person, along with reasonably obtainable information regarding the time, place and circumstances of the accident, shall be given by, or on behalf of, each eligible injured person, to the Company, or any of the Company's authorized agents, as soon as reasonably practicable, but in no event more than 30 days after the date of the accident, unless the eligible injured person submits written proof providing clear and reasonable justification for the failure to comply with such time limitation. If an eligible injured person or that person's legal representative institutes a proceeding to recover damages for personal injury under section 5104(b) of the New York Insurance Law, a copy of the summons and complaint or other process served in connection with such action shall be forwarded as soon as practicable to the Company or any of the Company's authorized agents by such eligible injured person or that person's legal representative. Proof of Claim; Medical, Work Loss, and Other Necessary Expenses. In the case of a claim for health service expenses, the eligible injured person or that person's assignee or representative shall submit written proof of claim to the Company, including full particulars of the nature and extent of the injuries and treatment received and contemplated, as soon as reasonably practicable but, in no event later than 45 days after the date services are rendered. The eligible injured person or that person's representative shall submit written proof of claim for work loss benefits and for other necessary expenses to the Company as soon as reasonably practicable but, in no event, later than 90 days after the work loss is incurred or the other necessary services are rendered. The foregoing time limitations for the submission of proof of claim shall apply unless the eligible injured person or that person's representative submits written proof providing clear and reasonable justification for the failure to comply with such time limitation. Upon request by the Company, the eligible injured person or that person's assignee or representative shall: (a) execute a written proof of claim under oath; (b) as may reasonably be required submit to examinations under oath by any person named by the Company and subscribe the same; (c) provide authorization that will enable the Company to obtain medical records; and (d) provide any other pertinent information that may assist the Company in determining the amount due and payable. The eligible injured person shall submit to medical examination by physicians selected by, or acceptable to, the Company, when, and as often as, the Company may reasonably require. Arbitration. In the event any person making a claim for first-party benefits and the Company do not agree regarding any matter relating to the claim, such person shall have the option of submitting such disagreement to arbitration pursuant to procedures promulgated or approved by the Superintendent of Financial Services. Reimbursement and Trust Agreement. To the extent that the Company pays first-party benefits, the Company is entitled to the proceeds of any settlement or judgment resulting from the exercise of any right of recovery for damages for personal injury under section 5104(b) of the New York Insurance Law. The Company shall have a lien upon any such settlement or judgment to the extent that the Company has paid first-party benefits. An eligible injured person shall: (a) hold in trust, for the benefit of the Company, all rights of recovery which that person shall have for personal injury under section 5104(b) of the New York Insurance Law; (b) do whatever is proper to secure, and shall do nothing to prejudice, such rights; and 1001 NY Page 11 of 43

15 (c) execute, and deliver to the Company, instruments and papers as may be appropriate to secure the rights and obligations of such person and the Company established by this provision. An eligible injured person shall not compromise an action to recover damages brought under section 5104(b) of the New York Insurance Law, except: (a) with the written consent of the Company; (b) with approval of the court; or (c) where the amount of the settlement exceeds $50,000. Other Coverage. Where more than one source of first-party benefits required by article 51 of the New York Insurance Law and article 6 or 8 of the New York Vehicle and Traffic Law is available and applicable to an eligible injured person in any one accident, this Company is liable to an eligible injured person only for an amount equal to the maximum amount that the eligible injured person is entitled to recover under this coverage, divided by the number of available and applicable sources of required first-party benefits. An eligible injured person shall not recover duplicate benefits for the same elements of loss under this coverage or any other mandatory first-party motor vehicle or no-fault motor vehicle insurance coverage issued in compliance with the laws of another state. If the eligible injured person is entitled to benefits under any such mandatory first-party motor vehicle or nofault motor vehicle insurance for the same elements of loss under this coverage, this Company shall be liable only for an amount equal to the proportion that the total amount available under this coverage bears to the sum of the amount available under this coverage and the amount available under such other mandatory insurance for the common elements of loss. However, where another state's mandatory first- party or no-fault motor vehicle insurance law provides unlimited coverage available to an eligible injured person for an element of loss under this coverage, the obligation of this Company is to share equally for that element of loss with such other mandatory insurance until the $50,000, or $75,000 if Optional Basic Economic Loss (OBEL) coverage is purchased, limit of this coverage is exhausted by the payment of that element of loss and any other elements of loss. Excess Coverage Section II If motor vehicle medical payments coverage or any disability coverages or uninsured motorists coverage are afforded under this policy, such coverages shall be excess insurance over any Mandatory PIP, OBEL or Additional PIP benefits paid or payable, or which would be paid or payable but for the application of a deductible, under this or any other motor vehicle No-Fault insurance policy. Section III Constitutionality If it is conclusively determined by a court of competent jurisdiction that the New York Comprehensive Motor Vehicle Insurance Reparations Act, or any amendment thereto, is invalid or unenforceable in whole or in part, then, subject to the approval of the Superintendent of Financial Services, the Company may amend this policy and may also recompute the premium for the existing or amended policy. These amendments and recomputations will be effective retroactively to the date that such act or any amendment is deemed to be invalid or unenforceable in whole or in part NY Page 12 of 43

16 The following OBEL endorsement applies only if this coverage is shown on your Declarations page and you have paid the premium due: OPTIONAL BASIC ECONOMIC LOSS COVERAGE ENDORSEMENT (New York) The Company agrees with the named insured, subject to all of the provisions, exclusions and conditions of the MANDATORY PERSONAL INJURY PROTECTION ENDORSEMENT (New York) not expressly modified in this Endorsement, as follows: The definition of Basic Economic Loss contained in the MANDATORY PERSONAL INJURY PROTECTION ENDORSEMENT (New York) is replaced by the following: Basic Economic Loss: Basic economic loss shall consist of medical expense, work loss, other expense and, when death occurs, a death benefit as herein provided. Except for such death benefit, basic economic loss shall not include any loss sustained on account of death. Basic economic loss of each eligible injured person on account of any single accident shall not exceed $75,000, the last $25,000 of which represents optional basic economic loss coverage, payable after the first $50,000 of basic economic loss has been exhausted, that the eligible injured person or that person's legal representative may specify will be applied to one of the following four options: (a) basic economic loss; (b) loss of earnings from work; (c) psychiatric, physical or occupational therapy and rehabilitation; or (d) a combination of options (b) and (c). Any death benefit hereunder shall be in addition thereto. Exclusion (c) set forth in the MANDATORY PERSONAL INJURY PROTECTION ENDORSEMENT (New York) is replaced by the following: (c) the named insured or relative while occupying, or while a pedestrian through being struck by, a motor vehicle in New York State, other than the insured motor vehicle, with respect to which the coverage required by the New York Comprehensive Motor Vehicle Insurance Reparations Act is in effect; however, this exclusion does not apply to: (1) the Optional Basic Economic Loss coverage provided under this endorsement, unless OBEL coverage is provided by the policy covering the other motor vehicle; or Election (2) to personal injury sustained in New York State by the named insured or relative while occupying a bus or school bus, as defined in sections 104 and 142 of the New York Vehicle and Traffic Law, unless that person is the operator, an owner, or an employee of the owner or operator, of such bus or school bus. Election of the OBEL option shall be made by the eligible injured person or that person's legal representative after such person has incurred expense aggregating $30,000 in basic economic loss and after receiving the required notices from the Company that an OBEL election may be made. Failure of the eligible injured person or that person's legal representative to respond to the second notice within 15 calendar days after its mailing shall be considered an election by the eligible injured person to apply OBEL coverage to all elements of basic economic loss. Once made by the eligible injured person or that person's legal representative, an OBEL election cannot be changed. However, if claims payable under OBEL coverage have not yet been 1001 NY Page 13 of 43

17 received by the Company, an eligible injured person who has failed to respond to the second notice in a timely manner may make an election. Notice If OBEL coverage is payable under this policy, but Mandatory PIP is being paid under a policy covering another motor vehicle, then the named insured or relative shall notify the Company no later than 90 days after Mandatory PIP benefits under that other policy have been exhausted. The Company shall then send its OBEL election notice. The following Additional PIP endorsement applies only if this coverage is shown on your Declarations page and you have paid the premium due: ADDITIONAL PERSONAL INJURY PROTECTION ENDORSEMENT (New York) The Company agrees with the named insured subject to all of the provisions, exclusions and conditions of the Mandatory Personal Injury Protection Endorsement (New York), not expressly modified in this Endorsement as follows: Additional Personal Injury Protection The Company will pay additional first-party benefits to reimburse for extended economic loss on account of personal injuries sustained by an eligible injured person and caused by an accident arising out of the use or operation of a motor vehicle or motorcycle during the policy period. This coverage only applies to motor vehicle accidents within the United States of America, its territories or possessions, or Canada. Eligible Injured Person Subject to the exclusions and conditions set forth below, an eligible injured person is: (a) the named insured and any relative who sustains personal injury arising out of the use or operation of any motor vehicle; (b) the named insured and any relative who sustains personal injury arising out of the use or operation of any motorcycle while not occupying a motorcycle; (c) any other person who sustains personal injury arising out of the use or operation of the insured motor vehicle while occupying the insured motor vehicle; or (d) any other person who sustains personal injury arising out of the use or operation of any other motor vehicle (other than a public or livery conveyance) while occupying such other motor vehicle, if such other motor vehicle is being operated by the named insured or any relative. Exclusions This coverage does not apply to personal injury sustained by: (a) any person while occupying a motor vehicle owned by such person with respect to which the coverage required by the New York Comprehensive Motor Vehicle Insurance Reparations Act is not in effect; (b) any person while occupying, or while a pedestrian through being struck by, a motor vehicle owned by the named insured with respect to which additional personal injury protection coverage is not provided under this policy; (c) any relative while occupying, or while a pedestrian through being struck by, a motor vehicle owned by such relative with respect to which additional personal injury protection coverage is not provided under this policy; 1001 NY Page 14 of 43

18 (d) any New York State resident other than the named insured or relative injured through the use or operation of a motor vehicle outside of New York State if such resident is the owner of a motor vehicle for which the coverage required by the New York Comprehensive Motor Vehicle Insurance Reparations Act is not in effect; (e) any person while occupying a motorcycle; (f) any person who intentionally causes his own personal injury; (g) any person as a result of operating a motor vehicle while in an intoxicated condition or while his or her ability to operate the vehicle is impaired by the use of a drug (within the meaning of section 1192 of the New York Vehicle and Traffic Law) except that coverage shall apply to necessary emergency health services rendered in a general hospital, as defined in section 2801(10) of the New York Public Health Law, including ambulance services attendant thereto and related medical screening. However, where the person has been convicted of violating section 1192 of the New York Vehicle and Traffic Law while operating a motor vehicle in an intoxicated condition or while his or her ability to operate such vehicle is impaired by the use of a drug, and the conviction is a final determination, the Company has a cause of action against such person for the amount of first party benefits that are paid or payable; or (h) any person while: (i) committing an act which would constitute a felony, or seeking to avoid lawful apprehension or arrest by a law enforcement officer; (ii) operating a motor vehicle in a race or speed test; (iii) operating or occupying a motor vehicle known to him to be stolen; or (iv) repairing, servicing, or otherwise maintaining a motor vehicle if such conduct is within the course of a business of repairing, servicing or otherwise maintaining a motor vehicle and the injury occurs on the business premises. Additional First-party Benefits Additional first-party benefits are payments equal to extended economic loss reduced by: (a) 20 percent of the eligible injured person's loss of earnings from work, to the extent that the extended economic loss covered by this Endorsement includes such loss of earnings; (b) amounts recovered or recoverable on account of personal injury to an eligible injured person under State or Federal laws providing social security disability or workers' compensation benefits or disability benefits under article 9 of the New York Workers' Compensation law, which amounts have not been applied to reduce first-party benefits recovered or recoverable under basic economic loss; (c) amounts recovered or recoverable by the eligible injured person for any element of extended economic loss covered by this Endorsement under any mandatory source of first-party automobile no-fault benefits required by the laws of any state (other than the State of New York) of the United States of America, its possessions or territories, or by the laws of any province of Canada. Extended Economic Loss Extended economic loss shall consist of the following: (a) basic economic loss sustained on account of an accident occurring within the United States of America, its possessions or territories, or Canada, which is not recovered or recoverable under a policy issued in satisfaction of the requirements of article 6 or 8 of the New York Vehicle and Traffic law and article 51 of the New York Insurance Law; (b) the difference between (i) basic economic loss; and (ii) basic economic loss recomputed in accordance with the time and dollar limits set out in the Declarations page; and (c) an additional death benefit in the amount set out in the declarations NY Page 15 of 43

19 Two or More Motor Vehicles Insured Under This Policy The limit of liability under this Endorsement applicable to injuries sustained by an eligible injured person while occupying, or while a pedestrian through being struck by, the insured motor vehicle shall be as stated in the Declarations page for that insured motor vehicle. The limit of liability for injuries covered by this Endorsement and sustained by an eligible injured person while occupying, or while a pedestrian through being struck by, a motor vehicle, other than the insured motor vehicle, shall be the highest limit stated for this coverage in the declarations for any insured motor vehicle under this policy. Arbitration In the event any person making a claim for additional first-party benefits and the Company do not agree regarding any matter relating to the claim, such person shall have the option of submitting such disagreement to arbitration pursuant to procedures promulgated or approved by the Superintendent of Financial Services. Subrogation In the event of any payment for extended economic loss, the Company is subrogated to the extent of such payments to the rights of the person to whom, or for whose benefit, such payments were made. Such person must execute and deliver instruments and papers and do whatever else is necessary to secure such rights. Such person shall do nothing to prejudice such rights. Other Coverage; Nonduplication The eligible injured person shall not recover duplicate benefits for the same elements of loss covered by this Endorsement or any other optional first-party automobile or no-fault automobile insurance coverage. If an eligible injured person is entitled to New York mandatory and additional personal injury protection benefits under any other policy, and if such eligible injured person is not entitled to New York mandatory personal injury protection benefits under this policy, then the coverage provided under this Additional Personal Injury Protection Endorsement (New York) shall be excess over such other New York mandatory and additional personal injury protection benefits. When coverage provided under this Endorsement applies on an excess basis, it shall apply only in the amount by which the total limit of liability of New York mandatory and additional personal injury protection coverage available under this policy exceeds the total limit of liability for any other applicable New York mandatory and additional personal injury protection coverage. Subject to the provisions of the preceding three paragraphs, if the eligible injured person is entitled to benefits under any other optional first-party automobile or no-fault automobile insurance for the same elements of loss covered by this Endorsement this Company shall be liable only for an amount equal to the proportion that the total amount available under this Endorsement bears to the sum of the amounts available under this Endorsement and such other optional insurance, for the same element of loss NY Page 16 of 43

20 The following Exclusion of Medical Expenses from Mandatory PIP Endorsement applies only if shown on your Declarations page: EXCLUSION OF MEDICAL EXPENSE FROM MANDATORY PERSONAL INJURY PROTECTION ENDORSEMENT (New York) In consideration of a reduction in premium, it is agreed that: If the Medical Expense element of Basic Economic Loss is identified as not applicable in the Declarations page the Company shall not be liable for any items of such loss which would otherwise be covered under the Mandatory Personal Injury Protection Endorsement (New York) with respect to the named insured or named insured and any relative as specified in the Declarations page. Coverage for any such medical expense element of basic economic loss provided to such named insured, or such relative, by a company or corporation in accordance with the provisions of section 5103(g) of the New York Insurance Law shall reduce the $50,000 aggregate limit of liability for basic economic loss to such person under this policy. This endorsement shall be effective during the term of this policy so long as the medical expense coverage provided by such company or corporation remains in effect, notwithstanding any provisions in the Declarations page of this policy to the contrary, and in the event this endorsement shall no longer be in effect the premium may be adjusted accordingly. PART II-B: MEDICAL AND FUNERAL SERVICES PAYMENTS COVERAGE INSURING AGREEMENT In return for your premium payment for Medical and Funeral Services Payments Coverage, and subject to the limits of liability specified in your Declarations page: 1. We will pay reasonable expenses incurred by an insured for necessary medical and funeral services because of bodily injury : A. Caused by a motor vehicle accident ; and B. Sustained by an insured. We will pay only those expenses incurred for services rendered within three years from the date of the accident. 2. We reserve the right to review, or have another party review on our behalf, the expenses to determine if they are reasonable and necessary for diagnosis and treatment of the bodily injury. We may also use independent sources of information selected by us to determine if any medical expense is reasonable and necessary. These sources may include, but are not limited to: A. Physical exams paid for by us and conducted by physicians we select; B. Review of medical files; or C. Published sources of medical expense information including information available from computer databases. 3. We may refuse to pay for any medical expense that is unreasonable because the fee for the service is greater than the fee which is usual and customary for the geographic location in which the service is rendered. We may also refuse to pay for any medical expense because the service rendered is unnecessary for the treatment of the bodily injury sustained. If we refuse to pay for any medical expense because the fee is unreasonable or the service is unnecessary and the insured is sued for payment of this expense, we will defend the insured with an attorney of our choice. We will pay defense costs and any judgment against the insured up to our limit of liability. The insured must cooperate with us in the defense of the lawsuit and attend hearings or trials at 1001 NY Page 17 of 43