State Farm® Car Policy Booklet

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Please read the policy carefully. If there is an accident, contact your State Farm agent or one of our Claim Offices at once. (See “INSURED’S DUTIES” in this policy booklet.)

Maine Policy Form 9819B

MktReg - ME DC – 2019 Produced pursuant to data call from Maine Bureau of Insurance regarding automobile insurance dated July 30, 2019 and homeowners insurance dated August 7, 2019 MEDC201900000001PROD CONTENTS THIS POLICY ...... 3 Supplementary Payments – Comprehensive Coverage and Collision DEFINITIONS ...... 4 Coverage ...... 22 Limits and Loss Settlement – LIABILITY COVERAGE ...... 6 Comprehensive Coverage and Collision Additional Definition ...... 6 Coverage ...... 22 Insuring Agreement ...... 6 Limits – Car Rental and Travel Expenses Coverage ...... 24 Supplementary Payments ...... 7 Nonduplication ...... 24 Limits ...... 7 Exclusions ...... 24 Nonduplication ...... 8 If Other Physical Damage Coverage or Exclusions ...... 8 Similar Coverage Applies ...... 26 If Other Liability Coverage Applies ...... 9 Financed Vehicle ...... 27 Required Out-of-State Liability Coverage .. 10 Our Payment Options ...... 27 Financial Responsibility Certification ...... 10 Maine Rental Vehicle Coverage ...... 27 MEDICAL PAYMENTS COVERAGE .... 11 DEATH, DISMEMBERMENT AND Additional Definitions ...... 11 LOSS OF SIGHT COVERAGE ...... 28 Insuring Agreement ...... 11 Additional Definition ...... 28 Determining Medical Expenses ...... 12 Insuring Agreement ...... 28 Limit ...... 12 Benefit ...... 29 Nonduplication ...... 12 Exclusions – Death, Dismemberment and Exclusions ...... 12 Loss of Sight Coverage and Loss of If Other Medical Payments Coverage or Earnings Coverage ...... 30 Similar Vehicle Insurance Applies ...... 13 Our Payment Options– Death, Dismember- Our Payment Options ...... 15 ment and Loss of Sight Coverage and Loss of Earnings Coverage ...... 31 UNINSURED MOTOR VEHICLE COVERAGE ...... 15 LOSS OF EARNINGS COVERAGE...... 29 Additional Definitions ...... 29 Additional Definitions ...... 15 Insuring Agreement ...... 30 Insuring Agreement ...... 16 Limit ...... 30 Consent to Settlement ...... 16 Exclusions – Death, Dismemberment and Deciding Fault and Amount ...... 16 Loss of Sight Coverage and Loss of Limits ...... 17 Earnings Coverage ...... 30 Nonduplication ...... 17 Our Payment Options – Death, Dismember- Exclusions ...... 17 ment and Loss of Sight Coverage and Loss If Other Uninsured Motor Vehicle of Earnings Coverage ...... 31 Coverage Applies ...... 18 INSURED’S DUTIES ...... 31 Our Payment Options ...... 19 Notice to Us of an Accident or Loss ...... 31 PHYSICAL DAMAGE COVERAGES .... 19 Notice to Us of a Claim or Lawsuit ...... 31 Additional Definitions ...... 19 Insured’s Duty to Cooperate With Us ...... 31 Insuring Agreements ...... 20 Questioning Under Oath ...... 32 2 9819B

Other Duties Under the Physical Changes to This Policy ...... 35 Damage Coverages ...... 32 Premium ...... 35 Other Duties Under Medical Payments Renewal ...... 36 Coverage, Uninsured Motor Vehicle Nonrenewal ...... 36 Coverage, Death, Dismemberment and Cancellation ...... 36 Loss of Sight Coverage, and Loss of Earnings Coverage ...... 32 Assignment ...... 37 Bankruptcy or Insolvency of the Insured .. 37 GENERAL TERMS ...... 33 Concealment or Fraud ...... 37 When Coverage Applies ...... 33 Our Right to Recover Our Payments ...... 37 Where Coverage Applies ...... 33 Legal Action Against Us ...... 38 Limited Coverage in Mexico ...... 33 Choice of Law ...... 39 Newly Owned or Newly Leased Car ...... 34 Severability...... 39

THIS POLICY 1. This policy consists of: Page, in reliance on the following a. the most recently issued Declarations statements: Page; (1) The named insured shown on the b. the policy booklet version shown on Declarations Page is the sole own- that Declarations Page; and er of your car. c. any endorsements that apply, including (2) Neither you nor any member of those listed on that Declarations Page your household has, within the as well as those issued in connection past three years, had either: with any subsequent renewal of this policy. (a) a license to drive; or 2. This policy contains all of the agreements (b) a vehicle registration between all named insureds who are suspended, revoked, or refused. shown on the Declarations Page and all applicants and: (3) Your car is used for pleasure and a. us; and business. b. any of our agents. 4. All named insureds shown on the Declara- tions Page and all applicants agree by ac- 3. We agree to provide insurance according to ceptance of this policy that: the terms of this policy: a. based on payment of premium for the a. the statements in 3.b. above are made coverages chosen; and by such named insured or applicant and are true; and b. unless otherwise stated in “EXCEP- TIONS, POLICY BOOKLET, & EN- b. we provide this insurance on the basis DORSEMENTS” on the Declarations those statements are true.

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5. Your purchase of this policy may allow: non-insurance products or services, to a. you to purchase or obtain certain cover- vary. Such other products or services ages, coverage options, coverage de- must be provided by the State Farm ductibles, coverage limits, or coverage Companies or by an organization that terms on other products from the State has entered into an agreement or con- Farm Companies, subject to their ap- tract with the State Farm Companies. plicable eligibility rules; or The State Farm Companies do not warrant the merchantability, fitness, or b. the premium or price for other products quality of any product or service of- or services purchased by you, including fered or provided by that organization.

DEFINITIONS We define certain words and phrases below for 2. the end of the 14th calendar day imme- use throughout the policy. Each coverage in- diately following the date the car is de- cludes additional definitions only for use with livered to you. that coverage. These definitions apply to the If a newly acquired car is not otherwise af- singular, plural, possessive, and any other form forded comprehensive coverage or collision of these words and phrases. Defined words coverage by this or any other policy, then this and phrases are printed in boldface italics. policy will provide Comprehensive Coverage Bodily Injury means bodily injury to a person or Collision Coverage for that newly acquired and sickness, disease, or death that results from car, subject to a deductible of $500. Any cov- it. erage provided as a result of this paragraph Car means a land motor vehicle with four or will apply only until the end of the 5th calen- more wheels, designed for use primarily on dar day immediately following the date the public roads. Car does not include: newly acquired car is delivered to you. 1. Any vehicle while located for use as a Non-Owned Car means a car that is in the dwelling or other premises; or lawful possession of you or any resident relative and that neither: 2. A truck-tractor designed to pull any type of trailer. 1. is owned by: Car Business means a business or job where a. you; the purpose is to sell, lease, rent, repair, serv- b. any resident relative; ice, modify, transport, store, or park land motor c. any other person who resides primari- vehicles or any type of trailer. ly in your household; or Newly Acquired Car means a car newly d. an employer of any person described owned by you. A car ceases to be a newly ac- in a., b., or c. above; nor quired car on the earlier of: 2. has been operated by, rented by, or in the 1. the effective date and time of a policy, in- possession of: cluding any binder, issued by us or any other company that describes the car as an a. you; or insured vehicle; or b. any resident relative 4 9819B

during any part of each of the 31 or more 2. a ward or a foster child of that named in- consecutive days immediately prior to the sured, his or her spouse, or a person de- date of the accident or loss. scribed in 1. above. Occupying means in, on, entering, or exiting. State Farm Companies means one or more of the following: Our means the Company issuing this policy as shown on the Declarations Page. 1. State Farm Mutual Automobile Insurance Company; Owned By means: 2. State Farm Fire and Casualty Company; 1. owned by; and 2. registered to; or 3. Subsidiaries or affiliates of either 1. or 2. 3. leased, if the lease is written for a period of above. 31 or more consecutive days, to. Temporary Substitute Car means a car that is Pedestrian means a person who is not occupy- in the lawful possession of the person operating: ing it and that: 1. a motorized vehicle; or 1. replaces your car for a short time while your car is out of use due to its: 2. a vehicle designed to be pulled by a motor- a. breakdown; ized vehicle. b. repair; Person means a human being. c. servicing; Private Passenger Car means: d. damage; or 1. a car of the private passenger type, other than a pickup truck, van, minivan, or sport e. theft; and utility vehicle, designed primarily to carry 2. neither you nor the person operating it persons and their luggage; or own or have registered. 2. a pickup truck, van, minivan, or sport util- If a car qualifies as both a non-owned car and ity vehicle: a temporary substitute car, then it is considered a temporary substitute car only. a. while not used for: Trailer means: (1) wholesale; or 1. a trailer: (2) retail a. designed to be pulled by a private pas- pickup or delivery; and senger car; b. that has a Gross Vehicle Weight Rating b. not designed to carry persons; and of 10,000 pounds or less. c. while not used as premises for office, Resident Relative means a person, other than store, or display purposes; or you, who resides primarily with the first per- 2. a farm implement or farm wagon while son shown as a named insured on the Declara- being pulled on public roads by a car. tions Page and who is: Us means the Company issuing this policy as 1. related to that named insured or his or her shown on the Declarations Page. spouse by blood, marriage, or adoption, including an unmarried and unemancipated We means the Company issuing this policy as child of either who is away at school and shown on the Declarations Page. otherwise maintains his or her primary res- You or Your means the named insured or idence with that named insured; or named insureds shown on the Declarations 5 9819B

Page. If a named insured shown on the Decla- with a car newly owned by you, then the car rations Page is a person, then “you” or “your” being replaced will continue to be considered includes the spouse of the first person shown your car until the earliest of: as a named insured if the spouse resides pri- 1. the end of the 30th calendar day imme- marily with that named insured. diately following the date the car newly Your Car means the vehicle shown under owned by you is delivered to you; “YOUR CAR” on the Declarations Page. Your Car does not include a vehicle that you no 2. the date this policy is no longer in force; longer own or lease. or If a car is shown on the Declarations Page un- 3. the date you no longer own or lease the car der “YOUR CAR”, and you ask us to replace it being replaced.

LIABILITY COVERAGE This policy provides Liability Coverage if “A” a. your car; is shown under “SYMBOLS” on the Declara- b. a newly acquired car; tions Page. c. a temporary substitute car; or Additional Definition d. a trailer while attached to a car de- Insured means: scribed in a., b., or c. above. 1. you and resident relatives for: Such vehicle must be used within the a. the ownership, maintenance, or use of: scope of your consent; and (1) your car; 4. any other person or organization vicarious- (2) a newly acquired car; or ly liable for the use of a vehicle by an insured as defined in 1., 2., or 3. above, but (3) a trailer; and only for such vicarious liability. This pro- b. the maintenance or use of: vision applies only if the vehicle is neither owned by, nor hired by, that other person (1) a non-owned car; or or organization. (2) a temporary substitute car; Insured does not include the United States of 2. the first person shown as a named insured America or any of its agencies. on the Declarations Page and that named Insuring Agreement insured’s spouse who resides primarily with that named insured for the mainte- 1. We will pay damages an insured becomes nance or use of a car that is owned by, or legally liable to pay because of: furnished by an employer to, a person who a. bodily injury to others; and resides primarily in your household, but only if such car is neither owned by, nor b. damage to property furnished by an employer to, the first per- caused by an accident that involves a ve- son shown as a named insured on the Dec- hicle for which that insured is provided larations Page or that person’s spouse; Liability Coverage by this policy. 3. any other person for his or her use of: 2. We have the right to:

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a. investigate, negotiate, and settle any Insuring Agreement of this policy’s Lia- claim or lawsuit; bility Coverage. We also have no duty to b. defend an insured in any claim or law- pay interest that accrues on any damages suit, with attorneys chosen by us; and paid or payable by a party other than the insured or us; c. appeal any award or legal decision 4. Premiums for bonds, provided by a com- for damages payable under this policy’s pany chosen by us, required to appeal a Liability Coverage. decision in a lawsuit against an insured. Supplementary Payments We have no duty to: We will pay, in addition to the damages de- a. pay for any bond with a face amount scribed in the Insuring Agreement of this pol- that exceeds this policy’s applicable icy’s Liability Coverage, those items listed Liability Coverage limit; below that result from such accident: b. furnish or apply for any bonds; or 1. Attorney fees for attorneys chosen by us to c. pay premiums for bonds purchased af- defend an insured who is sued for such ter we deposit in court, pay, or offer to damages. We have no duty to pay attorney pay, the amount due under the Insur- fees incurred after we deposit in court or ing Agreement of this policy’s Liabili- pay the amount due under the Insuring ty Coverage; and Agreement of this policy’s Liability Cov- erage; 5. The following costs and expenses if related to and incurred after a lawsuit has been 2. Court costs awarded by the court against filed against an insured: an insured and resulting from that part of the lawsuit: a. Loss of wages or salary, but not other income, up to $200 for each day an in- a. that seeks damages payable under this sured attends, at our request: policy’s Liability Coverage; and (1) an arbitration; b. against which we defend an insured with attorneys chosen by us. (2) a mediation; or We have no duty to pay court costs in- (3) a trial of a lawsuit; and curred after we deposit in court or pay the b. Reasonable expenses incurred by an amount due under the Insuring Agree- insured at our request other than loss ment of this policy’s Liability Coverage; of wages, salary, or other income. 3. Interest the insured is legally liable to pay The amount of any of the costs or expenses on damages payable under the Insuring listed above that are incurred by an in- Agreement of this policy’s Liability Cov- sured must be reported to us before we erage: will pay such incurred costs or expenses. a. before a judgment, but only the inter- Limits est on the lesser of: The Liability Coverage limits for bodily injury (1) that part of the damages we pay; or are shown on the Declarations Page under (2) this policy’s applicable Liability “Liability Coverage – Bodily Injury Limits – Coverage limit; and Each Person, Each Accident.” b. after a judgment. The limit shown under “Each Person” is the most we will pay for all damages resulting We have no duty to pay interest that ac- from bodily injury to any one person injured crues after we deposit in court, pay, or of- in any one accident, including all damages fer to pay, the amount due under the sustained by other persons as a result of that 7 9819B

bodily injury. The limit shown under “Each who is neither covered, nor required to be Accident” is the most we will pay, subject to covered, under workers’ compensation in- the limit for “Each Person”, for all damages surance; resulting from bodily injury to two or more 4. FOR BODILY INJURY TO THAT IN- persons injured in the same accident. SURED’S FELLOW EMPLOYEE The Liability Coverage limit for damage to WHILE THE FELLOW EMPLOYEE IS property is shown on the Declarations Page IN THE COURSE AND SCOPE OF HIS under “Liability Coverage – Property Damage OR HER EMPLOYMENT. This exclusion Limit – Each Accident”. The limit shown is does not apply to you and resident rela- the most we will pay for all damages resulting tives who are legally liable for bodily in- from damage to property in any one accident. jury to fellow employees; These Liability Coverage limits are the most 5. FOR DAMAGES ARISING OUT OF we will pay regardless of the number of: THE OWNERSHIP, MAINTENANCE, 1. insureds; OR USE OF A VEHICLE WHILE IT IS RENTED TO OR LEASED TO OTHERS 2. claims made; BY AN INSURED; 3. vehicles insured; or 6. FOR DAMAGES ARISING OUT OF 4. vehicles involved in the accident. THE OWNERSHIP, MAINTENANCE, Nonduplication OR USE OF A VEHICLE WHILE IT IS BEING USED TO CARRY PERSONS We will not pay any damages or expenses un- FOR A CHARGE. This exclusion does not der Liability Coverage: apply to the use of a private passenger car 1. that have already been paid as expenses on a share-the-expense basis; under Medical Payments Coverage of any 7. WHILE MAINTAINING OR USING A policy issued by the State Farm Compa- VEHICLE IN CONNECTION WITH nies to you or any resident relative; or THAT INSURED’S EMPLOYMENT IN 2. that have already been paid under Unin- OR ENGAGEMENT OF ANY KIND IN A sured Motor Vehicle Coverage of any poli- CAR BUSINESS. This exclusion does not cy issued by the State Farm Companies to apply to: you or any resident relative. a. you; Exclusions b. any resident relative; or THERE IS NO COVERAGE FOR AN IN- c. any agent, employee, or business part- SURED: ner of a. or b. above 1. WHO INTENTIONALLY CAUSES BOD- while maintaining or using your car, a ILY INJURY OR DAMAGE TO PROP- newly acquired car, a temporary substi- ERTY; tute car, or a trailer owned by you; 2. OR FOR THAT INSURED’S INSURER 8. WHILE THAT INSURED IS VALET FOR ANY OBLIGATION UNDER ANY PARKING A VEHICLE; TYPE OF WORKERS’ COMPENSA- 9. WHILE MAINTAINING OR USING TION, DISABILITY, OR SIMILAR LAW; ANY VEHICLE OTHER THAN YOUR 3. FOR BODILY INJURY TO THAT IN- CAR, A NEWLY ACQUIRED CAR, A SURED’S EMPLOYEE WHICH ARISES TEMPORARY SUBSTITUTE CAR, OR OUT OF THAT EMPLOYEE’S EM- A TRAILER IN ANY BUSINESS OR PLOYMENT. This exclusion does not ap- OCCUPATION OTHER THAN A CAR ply to that insured’s household employee BUSINESS OR VALET PARKING. This 8 9819B

exclusion does not apply to the mainte- DRIVING. This exclusion (14.b.) does nance or use of a private passenger car; not apply if the vehicle is being used in 10. FOR DAMAGE TO PROPERTY WHILE connection with an activity other than IT IS: racing, high-speed driving, or any type of competitive driving; OR a. OWNED BY; 15. WHO IS AN EMPLOYEE OF THE b. RENTED TO; UNITED STATES OF AMERICA OR c. USED BY; ANY OF ITS AGENCIES, IF THE PRO- d. IN THE CARE OF; OR VISIONS OF THE FEDERAL TORT e. TRANSPORTED BY CLAIMS ACT APP LY. YOU, A RESIDENT RELATIVE, OR If Other Liability Coverage Applies THE PERSON WHO IS LEGALLY LIA- 1. If Liability Coverage provided by this pol- BLE FOR THE DAMAGE. This exclu- icy and one or more other Car Policies is- sion does not apply to damage to a: sued to you or any resident relative by the a. motor vehicle owned by the employer State Farm Companies apply to the same of you or any resident relative if such accident, then: damage is caused by an insured while a. the Liability Coverage limits of such operating another motor vehicle; policies will not be added together to b. residence while rented to or leased to determine the most that may be paid; an insured; or and c. private garage while rented to or b. the maximum amount that may be paid leased to an insured; from all such policies combined is the 11. FOR LIABILITY ASSUMED UNDER single highest applicable limit pro- ANY CONTRACT OR AGREEMENT; vided by any one of the policies. We 12. FOR ANY ORDER OF RESTITUTION may choose one or more policies from ISSUED BY A COURT IN A CRIMINAL which to make payment. PROCEEDING OR EQUITABLE AC- 2. The Liability Coverage provided by this TION; policy applies as primary coverage for the 13. WHILE USING A TRAILER WITH A ownership, maintenance, or use of your MOTOR VEHICLE IF THAT INSURED car or a trailer attached to it. IS NOT PROVIDED LIABILITY COV- a. If: ERAGE BY THIS POLICY FOR THE USE OF THAT MOTOR VEHICLE; (1) this is the only Car Policy issued to you or any resident relative by 14. FOR THE OWNERSHIP, MAINTE- the State Farm Companies that NANCE, OR USE OF ANY VEHICLE WHILE IT IS: provides Liability Coverage which applies to the accident as primary a. OFF PUBLIC ROADS AND BEING coverage; and PREPARED FOR, USED IN PRAC- TICE FOR, OR OPERATED IN ANY (2) liability coverage provided by one RACING CONTEST, SPEED CON- or more sources other than the TEST, HILL-CLIMBING CONTEST, State Farm Companies also ap- JUMPING CONTEST, OR ANY SIM- plies as primary coverage for the ILAR CONTEST; OR same accident, b. ON A TRACK DESIGNED PRIMAR- then we will pay the proportion of ILY FOR RACING OR HIGH-SPEED damages payable as primary that our 9 9819B

applicable limit bears to the sum of b. If: our applicable limit and the limits of (1) more than one Car Policy issued to all other liability coverage that apply you or any resident relative by the as primary coverage. State Farm Companies provides b. If: Liability Coverage which applies (1) more than one Car Policy issued to to the accident as excess coverage; you or any resident relative by the and State Farm Companies provides (2) liability coverage provided by one Liability Coverage which applies or more sources other than the to the accident as primary cover- State Farm Companies also ap- age; and plies as excess coverage for the (2) liability coverage provided by one same accident, or more sources other than the then the State Farm Companies will State Farm Companies also ap- pay the proportion of damages payable plies as primary coverage for the as excess that the maximum amount same accident, that may be paid by the State Farm then the State Farm Companies will Companies as determined in 1. above pay the proportion of damages payable bears to the sum of such amount and as primary that the maximum amount the limits of all other liability coverage that may be paid by the State Farm that apply as excess coverage. Companies as determined in 1. above Required Out-of-State Liability Coverage bears to the sum of such amount and If: the limits of all other liability coverage that apply as primary coverage. 1. an insured is in another state of the United States of America, a territory or possession 3. Except as provided in 2. above, the Liabil- of the United States of America, the Dis- ity Coverage provided by this policy ap- trict of Columbia, or any province or terri- plies as excess coverage. tory of Canada, and as a nonresident a. If: becomes subject to its motor vehicle com- pulsory insurance law, financial responsi- (1) this is the only Car Policy issued bility law, or similar law; and to you or any resident relative by the State Farm Companies that 2. this policy does not provide at least the provides Liability Coverage which minimum liability coverage required by applies to the accident as excess such law for such nonresident, coverage; and then this policy will be interpreted to provide (2) liability coverage provided by one the minimum liability coverage required by or more sources other than the such law. State Farm Companies also ap- This provision does not apply to liability cov- plies as excess coverage for the erage required by law for motor carriers of same accident, passengers or motor carriers of property. then we will pay the proportion of Financial Responsibility Certification damages payable as excess that our When this policy is certified under any law as applicable limit bears to the sum of proof of future financial responsibility, and our applicable limit and the limits of while required during the policy period, this all other liability coverage that apply policy will comply with such law to the extent as excess coverage. required. 10 9819B

MEDICAL PAYMENTS COVERAGE This policy provides Medical Payments Cov- within the United States of America as ap- erage if “C” is shown under “SYMBOLS” on propriate for the treatment of the bodily in- the Declarations Page. jury; Additional Definitions 4. primarily designed to serve a medical pur- Insured means: pose; 1. you and resident relatives: 5. not experimental; and a. while occupying: 6. not for research purposes. (1) your car; Reasonable Expenses mean the lowest one of the following charges: (2) a newly acquired car; 1. The usual and customary fees charged by a (3) a temporary substitute car; majority of healthcare providers who pro- (4) a non-owned car; or vide similar medical services in the geo- (5) a trailer while attached to a car graphical area in which the charges were described in (1), (2), (3), or (4) incurred; above; or 2. The fee specified in any fee schedule: b. if struck as a pedestrian by a land mo- a. applicable to medical payments cover- tor vehicle or any type of trailer; and age, no-fault coverage, or personal in- 2. any other person while occupying: jury protection coverage included in motor vehicle liability policies issued a. your car; in the state where medical services are b. a newly acquired car; provided; and c. a temporary substitute car; or b. as prescribed or authorized by the law of the state where medical services are d. a trailer while attached to a car de- provided; scribed in a., b., or c. above. 3. The fees agreed to by both the insured’s Such vehicle must be used within the healthcare provider and us; or scope of your consent. 4. The fees agreed upon between the in- Medical Expenses mean reasonable expenses sured’s healthcare provider and a third par- for medical services. ty when we have a contract with such third Medical Services mean treatments, procedures, party. products, and other services that are: Insuring Agreement 1. necessary to achieve maximum medical We will pay: improvement for the bodily injury; 1. medical expenses incurred because of bod- 2. rendered by a healthcare provider: ily injury that is sustained by an insured a. who is licensed as a healthcare provid- and caused by a motor vehicle accident if: er if a license is required by law; and a. that insured is first provided medical b. within the legally authorized scope of services within one year immediately that healthcare provider’s practice; following the date of the accident; and 3. commonly and customarily recognized b. such medical expenses are for medical throughout the medical profession and services that are provided within three 11 9819B

years immediately following the date Nonduplication of the accident; and We will not pay any medical expenses or fu- 2. funeral expenses incurred for an insured neral expenses under Medical Payments Cov- who dies within three years immediately erage that have already been paid: following the date of a motor vehicle accident if the death is a direct result of bodily 1. as damages under Liability Coverage or injury sustained in such accident. Uninsured Motor Vehicle Coverage of any policy issued by the State Farm Compa- Determining Medical Expenses nies to you or any resident relative; or We have the right to: 2. by or on behalf of a party who is legally 1. obtain and use: liable for the insured’s bodily injury. a. utilization reviews; Exclusions b. peer reviews; and THERE IS NO COVERAGE FOR AN IN- c. medical bill reviews SURED: to determine if the incurred charges are 1. WHO IS STRUCK AS A PEDESTRIAN medical expenses; BY A MOTOR VEHICLE, OWNED BY THAT INSURED OR YOU, IF IT IS NOT 2. use a medical examination of the insured YOUR CAR OR A NEWLY ACQUIRED to determine if: CAR; a. the bodily injury was caused by a mo- 2. IF ANY WORKERS’ COMPENSATION tor vehicle accident; and LAW OR ANY SIMILAR LAW APPLIES b. the expenses incurred are medical ex- TO THAT INSURED’S BODILY IN- penses; and JURY; 3. enter into a contract with a third party that 3. WHO IS OCCUPYING A VEHICLE has an agreement with the insured’s WHILE IT IS RENTED TO OR LEASED healthcare provider to charge fees as de- TO OTHERS BY AN INSURED; termined by that agreement. 4. WHO IS OCCUPYING A VEHICLE WHILE IT IS BEING USED TO CARRY Limit PERSONS FOR A CHARGE. This exclu- The Medical Payments Coverage limit is sion does not apply to: shown on the Declarations Page under “Medi- a. the use of a private passenger car on a cal Payments Coverage – Limit – Each Per- share-the-expense basis; or son”. This limit is the most we will pay for the medical expenses and funeral expenses com- b. an insured while occupying a non- bined, incurred by or on behalf of any one in- owned car as a passenger; sured as a result of any one accident, 5. WHILE MAINTAINING OR USING A regardless of the number of: VEHICLE IN CONNECTION WITH 1. insureds; THAT INSURED’S EMPLOYMENT IN OR ENGAGEMENT OF ANY KIND IN A 2. claims made; CAR BUSINESS. This exclusion does not 3. vehicles insured; or apply to: 4. vehicles involved in the accident. a. you; Subject to the limit shown on the Declarations b. any resident relative; or Page, the most we will pay for funeral ex- c. any agent, employee, or business part- penses incurred for any one insured is $3,000. ner of a. or b. above 12 9819B

while maintaining or using your car, a a. BEING PREPARED FOR, USED IN newly acquired car, a temporary substi- PRACTICE FOR, OR OPERATED IN tute car, or a trailer owned by you; ANY RACING CONTEST, SPEED 6. WHILE THAT INSURED IS VALET CONTEST, HILL-CLIMBING CON- PARKING A VEHICLE; TEST, JUMPING CONTEST, OR ANY SIMILAR CONTEST; OR 7. WHILE MAINTAINING OR USING A b. ON A TRACK DESIGNED PRIMAR- NON-OWNED CAR IN ANY BUSINESS ILY FOR RACING OR HIGH-SPEED OR OCCUPATION OTHER THAN A DRIVING. This exclusion (13.b.) CAR BUSINESS OR VALET PARKING. does not apply if the vehicle is being This exclusion does not apply to the used in connection with an activity maintenance or use of a private passenger other than racing, high-speed driving, car; or any type of competitive driving. 8. WHO IS EITHER OCCUPYING OR If Other Medical Payments Coverage or STRUCK AS A PEDESTRIAN BY A Similar Vehicle Insurance Applies VEHICLE THAT IS LOCATED FOR USE 1. An insured shall not recover for the same AS A DWELLING OR OTHER medical expenses or funeral expenses un- PREMISES; der both this coverage and other medical payments coverage or similar vehicle in- 9. WHO IS STRUCK AS A PEDESTRIAN surance. BY A VEHICLE THAT: 2. If Medical Payments Coverage provided a. IS DESIGNED FOR USE PRIMARI- by this policy and one or more other ve- LY OFF PUBLIC ROADS WHILE hicle policies issued to you or any resident OFF PUBLIC ROADS; OR relative by the State Farm Companies ap- b. RUNS ON RAILS OR CRAWLER- ply to the same bodily injury, then: TREADS; a. the Medical Payments Coverage limits 10. WHOSE BODILY INJURY RESULTS of such policies shall not be added to- FROM WAR OF ANY KIND; gether to determine the most that may 11. WHOSE BODILY INJURY RESULTS be paid; and FROM: b. the maximum amount that may be paid from all such policies combined is the a. NUCLEAR REACTION; single highest applicable limit pro- b. RADIATION OR RADIOACTIVE vided by any one of the policies. We CONTAMINATION FROM ANY may choose one or more policies from SOURCE; OR which to make payment. c. THE ACCIDENTAL OR INTEN- 3. The Medical Payments Coverage provided TIONAL DETONATION OF, OR by this policy applies as primary coverage RELEASE OF RADIATION FROM, for an insured who sustains bodily injury ANY NUCLEAR OR RADIOAC- while occupying your car or a trailer at- TIVE DEVICE; tached to it. 12. WHOSE BODILY INJURY RESULTS a. If: FROM THE DISCHARGE OF A FIRE- (1) this is the only vehicle policy is- ARM; sued to you or any resident rela- 13. WHO IS OCCUPYING A VEHICLE tive by the State Farm Companies WHILE IT IS: that provides Medical Payments 13 9819B

Coverage or other similar vehicle a. If: insurance which applies to the ac- (1) this is the only vehicle policy is- cident as primary coverage; and sued to you or any resident rela- (2) medical payments coverage or tive by the State Farm Companies other similar vehicle insurance that provides Medical Payments provided by one or more sources Coverage or other similar vehicle other than the State Farm Com- insurance which applies to the ac- panies also applies as primary cident as excess coverage; and coverage for the same accident, (2) medical payments coverage or then we will pay the proportion of other similar vehicle insurance medical expenses and funeral ex- provided by one or more sources penses payable as primary that our ap- other than the State Farm Com- plicable limit bears to the sum of our panies also applies as excess cov- applicable limit and the limits of all erage for the same accident, other medical payments coverage or then we will pay the proportion of similar vehicle insurance that apply as medical expenses and funeral ex- primary coverage. penses payable as excess that our ap- b. If: plicable limit bears to the sum of our applicable limit and the limits of all (1) more than one vehicle policy is- other medical payments coverage or sued to you or any resident rela- similar vehicle insurance that apply as tive by the State Farm Companies excess coverage. provides Medical Payments Cov- b. If: erage or other similar vehicle insurance which applies to the (1) more than one vehicle policy is- accident as primary coverage; and sued to you or any resident relative by the State Farm Companies (2) medical payments coverage or provides Medical Payments Cov- other similar vehicle insurance erage or other similar vehicle in- provided by one or more sources surance which applies to the other than the State Farm Com- accident as excess coverage; and panies also applies as primary coverage for the same accident, (2) medical payments coverage or other similar vehicle insurance then the State Farm Companies will provided by one or more sources pay the proportion of medical expenses other than the State Farm Com- and funeral expenses payable as prima- panies also applies as excess cov- ry that the maximum amount that may erage for the same accident, be paid by the State Farm Companies then the State Farm Companies will as determined in 2. above bears to the pay the proportion of medical ex- sum of such amount and the limits of penses and funeral expenses payable all other medical payments coverage or as excess that the maximum amount similar vehicle insurance that apply as that may be paid by the State Farm primary coverage. Companies as determined in 2. above bears to the sum of such amount and 4. Except as provided in 3. above, the Medi- the limits of all other medical pay- cal Payments Coverage provided by this ments coverage or similar vehicle in- policy applies as excess coverage. surance that apply as excess coverage. 14 9819B

Our Payment Options 3. A parent or guardian of the insured, if the insured is a minor or an incompetent person; We may, at our option, make payment to one or more of the following: 4. A person authorized by law to receive such payment; or 1. The insured; 5. Any person or organization that provides 2. The insured’s surviving spouse; the medical services or funeral services.

UNINSURED MOTOR VEHICLE COVERAGE This policy provides Uninsured Motor Vehicle (2) the insuring company: Coverage if “U” is shown under “SYMBOLS” (a) denies that its policy provides on the Declarations Page. liability coverage for compensatory damages that result Additional Definitions from the accident; or Insured means: (b) is or becomes insolvent; or 1. you; (3) the limits of liability are less than the limits you carry for uninsured 2. resident relatives; motor vehicle coverage under this 3. any other person while occupying: policy; or a. your car; 2. the owner and driver of which remain unknown and which causes bodily injury to b. a newly acquired car; or the insured. If there is no physical contact c. a temporary substitute car. between that land motor vehicle and the Such vehicle must be used within the insured or the vehicle the insured is occu- scope of your consent. Such other person pying, then the facts of the accident must occupying a vehicle used to carry persons be corroborated by a disinterested person for a charge is not an insured; and who witnessed the accident. You, resident relatives, and persons occupying the same 4. any person entitled to recover compensa- vehicle as the insured are not disinterested tory damages as a result of bodily injury to persons. an insured as defined in 1., 2., or 3. above. Uninsured Motor Vehicle does not include a Uninsured Motor Vehicle means a land motor land motor vehicle: vehicle: 1. whose ownership, maintenance, or use is 1. the ownership, maintenance, and use of provided Liability Coverage by this policy; which is: 2. owned by, rented to, or furnished or avail- a. not insured or bonded for bodily injury able for the regular use of you; liability at the time of the accident; or 3. owned by, rented to, or operated by a self- b. insured or bonded for bodily injury insurer under any motor vehicle financial liability at the time of the accident; but responsibility law, any motor carrier law, (1) the limits are less than required by or any similar law; the financial responsibility re- 4. designed for use primarily off public roads quirements of Maine; or except while on public roads; or 15 9819B

5. while located for use as a dwelling or other (2) If the insured and we agree that premises. the answer to 1.a.(1) above is yes, Insuring Agreement then what is the amount of the compensatory damages that the in- We will pay compensatory damages for bodily sured is legally entitled to recover injury an insured is legally entitled to recover from the owner or driver of the from the owner or driver of an uninsured mo- uninsured motor vehicle? tor vehicle. The bodily injury must be: b. If there is no agreement on the answer 1. sustained by an insured; and to either question in 1.a. above, then 2. caused by an accident that involves the the insured shall: operation, maintenance, or use of an unin- (1) file a lawsuit, in a state or federal sured motor vehicle as a motor vehicle. court that has jurisdiction, against: Consent to Settlement (a) us; The insured must inform us of a settlement offer, if any, proposed by or on behalf of the (b) the owner and driver of the owner or driver of the uninsured motor ve- uninsured motor vehicle un- hicle, and the insured must request our written less we have consented to a consent to accept such settlement offer. settlement offer proposed by or on behalf of such owner or If we: driver; and 1. consent in writing, then the insured may (c) any other party or parties who accept such settlement offer. may be legally liable for the 2. inform the insured in writing that we do insured’s damages; not consent, then the insured may not accept such settlement offer and: (2) consent to a jury trial if requested by us; a. we will make payment to the insured in an amount equal to such settlement (3) agree that we may contest the is- offer. This payment is considered a sues of liability and the amount of payment made by or on behalf of the damages; and owner or driver of the uninsured mo- (4) secure a judgment in that action. tor vehicle; and The judgment must be the final re- b. any recovery from or on behalf of the sult of an actual trial and any ap- owner or driver of the uninsured mo- peals, if any appeals are taken. tor vehicle shall first be used to repay 2. We are not bound by any: us. a. judgment obtained without our written Deciding Fault and Amount consent; and 1. a. The insured and we must agree to the b. default judgment against any person or answers to the following two ques- organization other than us. tions: 3. Regardless of the amount of any award, (1) Is the insured legally entitled to including any judgment or default judg- recover compensatory damages ment, we are not obligated to pay any from the owner or driver of the amount in excess of the available limits uninsured motor vehicle? under this coverage of this policy. 16 9819B

Limits 3. that have already been paid as expenses The Uninsured Motor Vehicle Coverage limits under Medical Payments Coverage of this are shown on the Declarations Page under policy, the medical payments coverage of “Uninsured Motor Vehicle Coverage – Bodily any other policy, or other similar vehicle Injury Limits – Each Person, Each Accident”. insurance. The limit shown under “Each Person” is the Exclusions most we will pay for all damages resulting THERE IS NO COVERAGE: from bodily injury to any one insured injured in any one accident, including all damages sus- 1. FOR AN INSURED WHO, WITHOUT tained by other insureds as a result of that bod- OUR WRITTEN CONSENT, SETTLES ily injury. The limit shown under “Each WITH ANY PERSON OR ORGANIZA- Accident” is the most we will pay, subject to TION WHO MAY BE LIABLE FOR THE the limit for “Each Person”, for all damages BODILY INJURY; resulting from bodily injury to two or more 2. FOR AN INSURED WHO SUSTAINS insureds injured in the same accident. BODILY INJURY: These Uninsured Motor Vehicle Coverage lim- a. WHILE OCCUPYING A MOTOR its are the most we will pay regardless of the VEHICLE OWNED BY YOU OR number of: ANY RESIDENT RELATIVE IF IT 1. insureds; IS NOT YOUR CAR OR A NEWLY ACQUIRED CAR; OR 2. claims made; 3. vehicles insured; or b. THROUGH BEING STRUCK BY A MOTOR VEHICLE OWNED BY 4. vehicles involved in the accident. ANY RESIDENT RELATIVE. Nonduplication This exclusion does not apply to the first We will not pay under Uninsured Motor Ve- person shown as a named insured on the hicle Coverage any damages: Declarations Page and that named insured’s spouse who resides primarily with 1. that have already been paid to or for the that named insured, while occupying or insured: through being struck by a motor vehicle a. by or on behalf of any person or or- not owned by one or both of them; ganization who is or may be held le- 3. FOR AN INSURED WHOSE BODILY gally liable for the bodily injury to the INJURY RESULTS FROM THE DIS- insured; or CHARGE OF A FIREARM; b. for bodily injury under Liability Cov- 4. TO THE EXTENT IT BENEFITS: erage of any policy issued by the State Farm Companies to you or any resi- a. ANY WORKERS’ COMPENSATION dent relative; OR DISABILITY BENEFITS IN- SURANCE COMPANY; 2. that: a. have already been paid; b. A SELF-INSURER UNDER ANY WORKERS’ COMPENSATION LAW, b. could have been paid; or DISABILITY BENEFITS LAW, OR c. could be paid SIMILAR LAW; OR to or for the insured under any workers’ c. ANY GOVERNMENT OR ANY OF compensation law, disability benefits law, ITS POLITICAL SUBDIVISIONS OR or similar law; or AGENCIES; 17 9819B

5. FOR AN INSURED WHOSE BODILY the accident as primary coverage; INJURY RESULTS FROM: and a. NUCLEAR REACTION; (2) uninsured motor vehicle cover- b. RADIATION OR RADIOACTIVE age provided by one or more CONTAMINATION FROM ANY sources other than the State Farm SOURCE; OR Companies also applies as primary c. THE ACCIDENTAL OR INTEN- coverage for the same accident, TIONAL DETONATION OF, OR then we will pay the proportion of RELEASE OF RADIATION FROM, damages payable as primary that our ANY NUCLEAR OR RADIOAC- applicable limit bears to the sum of TIVE DEVICE; our applicable limit and the limits of 6. FOR PUNITIVE OR EXEMPLARY all other uninsured motor vehicle cov- DAMAGES; OR erage that apply as primary coverage. 7. FOR ANY ORDER OF RESTITUTION b. If: ISSUED BY A COURT IN A CRIMINAL (1) more than one vehicle policy is- PROCEEDING OR EQUITABLE AC- sued to you or any resident rela- TION. tive by the State Farm Companies If Other Uninsured Motor Vehicle Coverage provides Uninsured Motor Vehicle Applies Coverage which applies to the accident as primary coverage; and 1. If Uninsured Motor Vehicle Coverage provided by this policy and one or more other (2) uninsured motor vehicle coverage vehicle policies issued to you or any resi- provided by one or more sources other than the State Farm Com- dent relative by the State Farm Companies panies also applies as primary apply to the same bodily injury, then: coverage for the same accident, a. the Uninsured Motor Vehicle Coverage then the State Farm Companies will limits of such policies will not be add- pay the proportion of damages payable ed together to determine the most that as primary that the maximum amount may be paid; and that may be paid by the State Farm b. the maximum amount that may be paid Companies as determined in 1. above from all such policies combined is the bears to the sum of such amount and single highest applicable limit pro- the limits of all other uninsured motor vided by any one of the policies. We vehicle coverage that apply as primary may choose one or more policies from coverage. which to make payment. 3. Except as provided in 2. above, the Unin- 2. The Uninsured Motor Vehicle Coverage sured Motor Vehicle Coverage provided by provided by this policy applies as primary this policy applies as excess coverage. coverage for an insured who sustains bodi- a. If: ly injury while occupying your car. (1) this is the only vehicle policy is- a. If: sued to you or any resident rela- (1) this is the only vehicle policy is- tive by the State Farm Companies sued to you or any resident rela- that provides Uninsured Motor tive by the State Farm Companies Vehicle Coverage which applies to that provides Uninsured Motor the accident as excess coverage; Vehicle Coverage which applies to and 18 9819B

(2) uninsured motor vehicle coverage excess coverage for the same acci- provided by one or more sources dent, other than the State Farm Com- then the State Farm Companies will panies also applies as excess cov- pay the proportion of damages payable erage for the same accident, as excess that the maximum amount then we will pay the proportion of that may be paid by the State Farm damages payable as excess that our Companies as determined in 1. above applicable limit bears to the sum of bears to the sum of such amount and our applicable limit and the limits of the limits of all other uninsured motor all other uninsured motor vehicle cov- vehicle coverage that apply as excess erage that apply as excess coverage. coverage. b. If: Our Payment Options (1) more than one vehicle policy is- We may, at our option, make payment to one sued to you or any resident rela- or more of the following: tive by the State Farm Companies 1. The insured; provides Uninsured Motor Vehicle Coverage which applies to the ac- 2. The insured’s surviving spouse; cident as excess coverage; and 3. A parent or guardian of the insured, if the (2) uninsured motor vehicle cover- insured is a minor or an incompetent per- age provided by one or more son; or sources other than the State 4. A person authorized by law to receive such Farm Companies also applies as payment.

PHYSICAL DAMAGE COVERAGES The physical damage coverages are Compre- Page. The deductible that applies to Collision hensive Coverage, Collision Coverage, Emer- Coverage is shown on the Declarations Page. gency Road Service Coverage, and Car Rental Additional Definitions and Travel Expenses Coverage. Covered Vehicle means: This policy provides: 1. your car; 1. Comprehensive Coverage if “D”; 2. a newly acquired car; 2. Collision Coverage if “G”; 3. a temporary substitute car; 3. Emergency Road Service Coverage if “H”; 4. a camper that is designed to be mounted on 4. Car Rental and Travel Expenses Coverage a pickup truck and shown on the Declara- if “R1” tions Page; is shown under “SYMBOLS” on the Declara- 5. a non-owned car while it is: tions Page. a. being driven by an insured; or If a deductible applies to Comprehensive Cov- b. in the custody of an insured if at the erage, then it is shown on the Declarations time of the loss it is: 19 9819B

(1) not being driven; or 1. is owned by: (2) being driven by a person other a. an insured; than an insured and being occu- b. any other person who resides prima- pied by an insured; rily in your household; or 6. a non-owned trailer while it is being used c. an employer of any person described by an insured; and in a. or b. above; nor 7. a non-owned camper while it is being used 2. has been used by, rented by, or in the pos- by an insured; session of an insured during any part of including its parts and its equipment that are each of the 31 or more consecutive days common to the use of the vehicle as a vehicle. immediately prior to the date of the loss. However, parts and equipment of trailers and Non-Owned Trailer means a trailer that is in campers must be securely fixed as a permanent the lawful possession of an insured and that part of the trailer or camper. neither: Daily Rental Charge means the sum of: 1. is owned by: 1. the daily rental rate; a. an insured; 2. mileage charges; and b. any other person who resides prima- 3. related taxes. rily in your household; or Insured means you and resident relatives. c. an employer of any person described Loss means: in a. or b. above; nor 1. direct, sudden, and accidental damage to; or 2. has been used by, rented by, or in the possession of an insured during any part of 2. total or partial theft of each of the 31 or more consecutive days a covered vehicle. Loss does not include any immediately prior to the date of the loss. reduction in the value of any covered vehicle Insuring Agreements after it has been repaired, as compared to its value before it was damaged. 1. Comprehensive Coverage Loss Caused By Collision means a loss caused We will pay: by: a. for loss, except loss caused by colli- 1. a covered vehicle hitting or being hit by sion, to a covered vehicle; and another vehicle or another object; or b. transportation expenses incurred by an 2. the overturning of a covered vehicle. insured as a result of the total theft of your car or a newly acquired car. Any loss caused by missiles, falling objects, These transportation expenses are pay- windstorm, hail, fire, explosion, earthquake, able: water, flood, total or partial theft, malicious (1) during the period that: mischief, vandalism, riot, civil commotion, or hitting or being hit by a bird or an animal is not (a) starts on the date you report a Loss Caused By Collision. the theft to us; and Non-Owned Camper means a camper de- (b) ends on the earliest of: signed to be mounted on a pickup truck that is (i) the date the vehicle is re- in the lawful possession of an insured and that turned to your possession neither: in a drivable condition; 20 9819B

(ii) the date we offer to pay for its key is lost, stolen, or locked inside the loss if the vehicle has the vehicle. not yet been recovered; or 4. Car Rental and Travel Expenses Coverage (iii) the date we offer to pay for the loss if the vehicle is a. Car Rental Expense recovered, but is a total We will pay the daily rental charge in- loss as determined by us; curred when you rent a car from a car and business while your car or a newly (2) during the period that: acquired car is: (a) starts on the date the vehicle is (1) not drivable; or left at a repair facility if the (2) being repaired stolen vehicle is recovered, re- as a result of a loss which would be turned to your possession in a payable under Comprehensive Cover- drivable condition, and has un- age or Collision Coverage. repaired damage that resulted from the total theft; and We will pay this daily rental charge incurred during a period that: (b) ends on the date the vehicle is repaired. (1) starts on the date: These transportation expenses must be (a) the vehicle is not drivable as a reported to us before we will pay such result of the loss; or incurred expenses. (b) the vehicle is left at a repair 2. Collision Coverage facility if the vehicle is drivable; and We will pay for loss caused by collision to a covered vehicle. (2) ends on the earliest of: 3. Emergency Road Service Coverage (a) the date the vehicle has been repaired or replaced; We will pay the fair cost incurred by an insured for: (b) the date we offer to pay for the loss if the vehicle is repairable a. up to one hour of labor to repair a cov- but you choose to delay re- ered vehicle at the place of its break- pairs; or down; (c) five days after we offer to pay b. towing to the nearest repair facility for the loss if the vehicle is: where necessary repairs can be made if a covered vehicle is not drivable; (i) a total loss as determined c. towing a covered vehicle out of a loca- by us; or tion where it is stuck if the vehicle is (ii) stolen and not recovered. on or immediately next to a public road; The amount of any such daily rental charge incurred by you must be re- d. delivery of gas, oil, battery, or tire ne- ported to us before we will pay such cessary to return a covered vehicle to amount. driving condition. We do not pay the cost of the gas, oil, battery, or tire; and b. Travel Expenses e. up to one hour of labor for locksmith We will pay expenses for commercial services to unlock a covered vehicle if transportation, lodging, and meals if 21 9819B

your car or a newly acquired car is a. for a reasonable distance from the lo- not drivable as a result of a loss which cation of the loss to any one repair fa- would be payable under Comprehen- cility chosen by an insured or the sive Coverage or Collision Coverage. owner of the covered vehicle, if the The loss must occur more than 50 covered vehicle is not drivable; or miles from your home. We will only b. to any one repair facility or commer- pay these expenses if they are incurred cial storage facility, neither of which by: was chosen by an insured or the owner (1) an insured during the period that: of the covered vehicle. We will also (a) starts after the loss occurs; and pay reasonable expenses incurred to tow the covered vehicle for a reasona- (b) ends on the earlier of: ble distance from this facility to any (i) the insured’s arrival at his one repair facility chosen by an in- or her destination or home sured or the owner of the covered ve- if the vehicle is left behind hicle, if the covered vehicle is not for repairs; or drivable; (ii) the repair of the vehicle if 2. store the covered vehicle, if it is not driva- the insured waits for re- ble immediately after the loss, at: pairs before continuing on a. any one repair facility or commercial to his or her destination or storage facility, neither of which was returning home; and chosen by an insured or the owner of (2) you, or any person you choose, to the covered vehicle; and travel to retrieve the vehicle and b. any one repair facility chosen by the drive it to either the original desti- owner of the covered vehicle, and we nation or your home if the vehicle determine such vehicle is a total loss. was left behind for repairs. If the owner of the covered vehicle con- These expenses must be reported to us sents, then we may move the covered ve- before we will pay such incurred ex- hicle at our expense to reduce storage penses. costs. If the owner of the covered vehicle c. Rental Car – Repayment of Deduct- does not consent, then we will pay only the ible Expense storage costs that would have resulted if we had moved the damaged covered ve- We will pay the comprehensive cover- hicle; and age deductible or collision coverage deductible an insured is required to 3. clean up debris from the covered vehicle at pay the owner of a car rented from a the location of the loss. The most we will car business. pay to clean up the debris is $250 for any one loss. Supplementary Payments – Comprehensive Coverage and Collision Coverage Limits and Loss Settlement – Comprehen- sive Coverage and Collision Coverage If the covered vehicle sustains loss for which we make a payment under Comprehensive 1. We have the right to choose to settle with Coverage or Collision Coverage, then we will you or the owner of the covered vehicle in pay reasonable expenses incurred to: one of the following ways: 1. tow the covered vehicle immediately after a. Pay the cost to repair the covered ve- the loss: hicle minus any applicable deductible.

22 9819B

(1) We have the right to choose one of marking that was on the replaced the following to determine the cost glass. to repair the covered vehicle: (2) The cost to repair the covered ve- (a) The cost agreed to by both the hicle does not include any reduc- owner of the covered vehicle tion in the value of the covered and us; vehicle after it has been repaired, (b) A bid or repair estimate ap- as compared to its value before it proved by us; or was damaged. (c) A repair estimate that is writ- (3) If the repair or replacement of a ten based upon or adjusted to: part results in betterment of that part, then you or the owner of the (i) the prevailing competitive covered vehicle must pay for the price; amount of the betterment. (ii) the lower of paintless dent (4) If you and we agree, then wind- repair pricing established shield glass will be repaired in- by an agreement we have stead of replaced; with a third party or the paintless dent repair price b. Pay the actual cash value of the cov- that is competitive in the ered vehicle minus any applicable de- market; or ductible. (iii) a combination of (i) and (1) The owner of the covered vehicle (ii) above. and we must agree upon the actual The prevailing competitive cash value of the covered vehicle. price means prices charged by If there is disagreement as to the a majority of the repair market actual cash value of the covered in the area where the covered vehicle, then the disagreement will vehicle is to be repaired as de- be resolved by appraisal upon termined by a survey made by written request of the owner or us, us. If asked, we will identify using the following procedures: some facilities that will per- (a) The owner and we will each form the repairs at the prevail- select a competent appraiser. ing competitive price. The estimate will include parts suf- (b) The two appraisers will select ficient to restore the covered a third competent appraiser. If vehicle to its pre-loss condi- they are unable to agree on a tion. third appraiser within 30 days, then either the owner or we You agree with us that the repair may petition a court that has estimate may include new, used, jurisdiction to select the third recycled, and reconditioned parts. appraiser. Any of these parts may be either original equipment manufacturer (c) Each party will pay the cost of parts or non-original equipment its own appraiser, attorneys, manufacturer parts. and expert witnesses, as well as any other expenses incurred You also agree that replacement by that party. Both parties will glass need not have any insignia, share equally the cost of the logo, trademark, etching, or other third appraiser. 23 9819B

(d) The appraisers shall only de- Car Rental Expense – Each Day, Each termine the actual cash value Loss”. of the covered vehicle. Ap- a. The limit shown under “Each Day” is praisers shall have no author- the most we will pay for the daily rental ity to decide any other charge. If: questions of fact, decide any questions of law, or conduct (1) a dollar amount is shown, then we appraisal on a class-wide or will pay the daily rental charge up class-representative basis. to that dollar amount; or (e) A written appraisal that is (2) a percentage amount is shown, both agreed upon by and then we will pay that percentage of signed by any two appraisers, the daily rental charge. and that also contains an ex- b. Subject to the “Each Day” limit, the planation of how they arrived limit shown under “Each Loss” is the at their appraisal, will be most we will pay for Car Rental Ex- binding on the owner of the pense incurred as a result of any one covered vehicle and us. loss. (f) We do not waive any of our 2. Travel Expenses rights by submitting to an appraisal. The most we will pay for Travel Expenses incurred by all insureds as a result of any (2) The damaged covered vehicle one loss is $500. must be given to us in exchange for our payment, unless we agree 3. Rental Car – Repayment of Deductible that the owner may keep it. If the Expense owner keeps the covered vehicle, The most we will pay for Rental Car – Re- then our payment will be reduced payment of Deductible Expense incurred by the value of the covered vehicle as a result of any one loss is $500. after the loss; or Nonduplication c. Return the stolen covered vehicle to its owner and pay, as described in 1.a. We will not pay for any loss or expense under above, for any direct, sudden, and ac- the Physical Damage Coverages for which the cidental damage that resulted from the insured or owner of the covered vehicle has theft. already received payment from, or on behalf of, a party who is legally liable for the loss or 2. The most we will pay for transportation expense. expenses under Comprehensive Coverage is $25 per day subject to an aggregate limit Exclusions of $750 per loss. THERE IS NO COVERAGE FOR: 3. The most we will pay for loss to a non- 1. ANY COVERED VEHICLE THAT IS: owned trailer or a non-owned camper is a. INTENTIONALLY DAMAGED; OR $2,500. b. STOLEN Limits – Car Rental and Travel Expenses Coverage BY OR AT THE DIRECTION OF AN IN- SURED; 1. Car Rental Expense 2. ANY COVERED VEHICLE WHILE IT IS The limit for Car Rental Expense is shown RENTED TO OR LEASED TO OTHERS on the Declarations Page under “Limit – BY AN INSURED; 24 9819B

3. ANY COVERED VEHICLE WHILE IT VEHICLE BY ANY GOVERNMENTAL IS USED TO CARRY PERSONS FOR A AUTHORITY; CHARGE. This exclusion does not apply 9. LOSS TO ANY COVERED VEHICLE to the use of a private passenger car on a THAT RESULTS FROM WAR OF ANY share-the-expense basis; KIND; 4. ANY COVERED VEHICLE DUE TO: 10. YOUR CAR WHILE SUBJECT TO ANY: a. THEFT; a. LIEN AGREEMENT; b. CONVERSION; b. RENTAL AGREEMENT; c. EMBEZZLEMENT; OR c. LEASE AGREEMENT; OR d. SECRETION d. SALES AGREEMENT BY AN INSURED, A CONSIGNEE, AN NOT SHOWN ON THE DECLARA- AGENT OF A CONSIGNEE, OR A PER- TIONS PAGE; SON WHO OBTAINS POSSESSION OF THE COVERED VEHICLE WITH THE 11. ANY NON-OWNED CAR WHILE IT IS: PERMISSION OF A CONSIGNEE OR a. BEING MAINTAINED OR USED BY AGENT OF A CONSIGNEE; ANY PERSON WHILE THAT PER- 5. LOSS TO YOUR CAR OR A NEWLY SON IS EMPLOYED IN OR EN- ACQUIRED CAR IF AN INSURED VOL- GAGED IN ANY WAY IN A CAR UNTARILY RELINQUISHES POSSES- BUSINESS; OR SION OF THAT CAR TO A PERSON OR b. USED IN ANY BUSINESS OR OC- ORGANIZATION UNDER AN ACTUAL CUPATION OTHER THAN A CAR OR PRESUMED SALES AGREEMENT; BUSINESS. This exclusion (11.b.) does not apply to a private passenger 6. ANY COVERED VEHICLE TO THE car; EXTENT OUR PAYMENT WOULD BENEFIT ANY CARRIER OR OTHER 12. ANY PART OR EQUIPMENT OF A COVERED VEHICLE IF THAT PART BAILEE FOR HIRE THAT IS LIABLE OR EQUIPMENT: FOR LOSS TO SUCH COVERED VE- HICLE; a. FAILS OR IS DEFECTIVE; OR 7. LOSS TO ANY COVERED VEHICLE b. IS DAMAGED AS A DIRECT RE- THAT RESULTS FROM: SULT OF: a. NUCLEAR REACTION; (1) WEAR AND TEAR; b. RADIATION OR RADIOACTIVE (2) FREEZING; OR CONTAMINATION FROM ANY (3) MECHANICAL, ELECTRICAL, SOURCE; OR OR ELECTRONIC BREAK- c. THE ACCIDENTAL OR INTEN- DOWN OR MALFUNCTION TIONAL DETONATION OF, OR OF THAT PART OR EQUIPMENT. RELEASE OF RADIATION FROM, This exclusion does not apply if the loss is ANY NUCLEAR OR RADIOAC- the result of theft of the covered vehicle; TIVE DEVICE; 13. ANY PART OR EQUIPMENT: 8. LOSS TO ANY COVERED VEHICLE THAT RESULTS FROM THE TAKING a. THAT IS NOT LEGAL FOR USE IN OF OR SEIZURE OF THAT COVERED OR ON THE COVERED VEHICLE 25 9819B

IN THE JURISDICTION WHERE c. NOT SHOWN ON THE DECLARA- THE COVERED VEHICLE IS REG- TIONS PAGE; OR ISTERED; OR 18. ANY COVERED VEHICLE WHILE IT b. THE USE OF WHICH IS NOT LE- IS: GAL IN THE JURISDICTION a. BEING PREPARED FOR, USED IN WHERE THE COVERED VEHICLE PRACTICE FOR, OR OPERATED IN IS REGISTERED BECAUSE OF ANY RACING CONTEST, SPEED HOW OR WHERE THAT PART OR CONTEST, HILL-CLIMBING CON- EQUIPMENT IS INSTALLED IN OR TEST, JUMPING CONTEST, OR ON THE COVERED VEHICLE. ANY SIMILAR CONTEST; OR However, if there is a legal version of the part or equipment that is necessary for the b. ON A TRACK DESIGNED PRIMAR- safe operation of the covered vehicle, then ILY FOR RACING OR HIGH-SPEED we will pay the cost that we would other- DRIVING. This exclusion (18.b.) wise have paid to repair the vehicle with does not apply if the vehicle is being the legal version of the part or equipment. used in connection with an activity We will not pay any cost necessary to mod- other than racing, high-speed driving, ify the vehicle for installation of the legal or any type of competitive driving. version of the part or equipment; If Other Physical Damage Coverage or Sim- 14. TIRES. This exclusion does not apply if: ilar Coverage Applies a. loss is caused by missiles, falling ob- 1. If the same loss or expense is payable un- jects, windstorm, hail, fire, explosion, der more than one of the physical damage earthquake, water, flood, total or par- coverages provided by this policy, then on- tial theft, malicious mischief, vandal- ly the one coverage that pays the most for ism, riot, civil commotion, or hitting or that loss or expense applies. being hit by a bird or an animal; or 2. If any of the physical damage coverages b. loss caused by collision to another part provided by this policy and one or more of the covered vehicle causes loss to other policies issued to an insured by the tires; State Farm Companies apply to the same loss or expense, then only one policy ap- 15. REMOVABLE PRODUCTS USED FOR plies. We will select a policy that pays the STORAGE OF AUDIO, VIDEO, OR most for the loss or expense. OTHER DATA, INCLUDING BUT NOT LIMITED TO TAPES, DISCS, AND 3. The physical damage coverages provided MEMORY CARDS, NOR IS THERE by this policy apply as primary coverage COVERAGE FOR THE RECONSTRUC- for a loss to your car. TION OF DATA CONTAINED THERE- If similar coverage provided by one or IN; more sources other than the State Farm 16. ANY EQUIPMENT USED TO DETECT Companies also applies as primary cover- OR INTERFERE WITH SPEED MEAS- age for the same loss or expense, then the URING DEVICES; State Farm Companies will pay the pro- 17. A CAMPER, INCLUDING ITS PARTS portion of the loss or expense payable as AND ITS EQUIPMENT, THAT IS: primary coverage that the maximum amount that may be paid by the State a. DESIGNED TO BE MOUNTED ON Farm Companies bears to the sum of such A PICKUP TRUCK; amount and the limits of all other similar b. OWNED BY AN INSURED; AND coverage that applies as primary coverage. 26 9819B

4. Except as provided in 3. above, the physi- Our Payment Options cal damage coverages provided by this 1. Comprehensive Coverage and Collision policy apply as excess coverage. Coverage If similar coverage provided by one or a. We may, at our option, make payment more sources other than the State Farm to one or more of the following for loss Companies also applies as excess coverage to a covered vehicle owned by you: for the same loss or expense, then the State Farm Companies will pay the proportion (1) You; of the loss or expense payable as excess (2) The repairer; or that the maximum amount that may be paid by the State Farm Companies bears (3) A creditor shown on the Declara- to the sum of such amount and the limits of tions Page, to the extent of its in- all other similar coverage that applies as terest. excess coverage. b. We may, at our option, make payment to one or more of the following for loss Financed Vehicle to a covered vehicle not owned by you: 1. If a creditor is shown on the Declarations (1) You; Page, then any Comprehensive Coverage or Collision Coverage provided by this (2) The owner of such vehicle; policy applies to that creditor’s interest in (3) The repairer; or your car. Coverage for the creditor’s in- (4) A creditor, to the extent of its interest is only provided for a loss that is terest. payable to you. 2. Emergency Road Service Coverage and However, if this policy is cancelled or non- Car Rental and Travel Expenses Coverage renewed, then we will provide coverage for the creditor’s interest until we notify the We may, at our option, make payment to creditor of the termination of such cover- one or more of the following: age. This coverage for the creditor’s inter- a. You; est is only provided for a loss that would have been payable to you if this policy had b. The insured who incurred the expense; not been cancelled or nonrenewed. or c. Any party that provided the service for The date such termination is effective for: which payment is owed. a. cancellation of physical damage cov- Maine Rental Vehicle Coverage erage will be at least 10 days if nonpayment, otherwise at least 20 days; If this policy provides Liability Coverage, then and any Comprehensive Coverage or Collision Coverage provided by this policy extends to a b. nonrenewal of physical damage cover- covered rental vehicle. We will pay the obli- age will be at least 30 days gation of the insured for actual damage to a after the date we mail or electronically covered rental vehicle, including charges for transmit a notice of the termination to the verifiable and actual loss of use not to exceed creditor. 30 days, subject to other policy provisions and 2. If we pay such creditor, then we are entitled any Comprehensive Coverage deductible and to the creditor’s right of recovery against Collision Coverage deductible. you to the extent of our payment. Our right Any Comprehensive Coverage or Collision of recovery does not impair the creditor’s Coverage applying to a non-owned car or to a right to recover the full amount of its claim. temporary substitute car that is also a covered 27 9819B

rental vehicle shall be excess over and shall Covered Rental Agreement means a written not duplicate any loss or expense paid under agreement with a term of 45 continuous days Maine Rental Vehicle Coverage. or fewer setting forth the terms and conditions The following additional definitions apply to governing the use of a covered rental vehicle Maine Rental Vehicle Coverage. provided by a rental company. Additional Definitions Covered Rental Vehicle means a private pas- Authorized Driver means: senger motor vehicle rented by an insured in 1. the renter; the United States of America, its territories or 2. the renter’s spouse, if that person is a li- possessions, or Canada under a covered rental censed driver meeting the rental compa- agreement, regardless of where in the United ny’s minimum age requirement; States of America, its territories or possessions, 3. the renter’s employer or coworker, if that or Canada that rental vehicle is registered, person is engaged in business activity with rented, or operated. The rental vehicle must be the renter and is a licensed driver meeting operated by an authorized driver. the rental company’s minimum age re- Private Passenger Motor Vehicle means a quirement; motor vehicle of the private passenger, sedan, 4. a person who operates the vehicle during station wagon, or private passenger minivan an emergency or while parking the vehicle type. in the course of that person’s employment at a commercial establishment; or Rental Company means any person or organi- 5. a person listed by the rental company on zation, including franchisees, in the business of the covered rental agreement as an autho- providing private passenger motor vehicles to rized driver. the public.

DEATH, DISMEMBERMENT AND LOSS OF SIGHT COVERAGE AND LOSS OF EARNINGS COVERAGE DEATH, DISMEMBERMENT AND LOSS Insuring Agreement OF SIGHT COVERAGE We will pay the highest applicable benefit This policy provides Death, Dismember- shown in the following Death, Dismember- ment and Loss of Sight Coverage if “S” is ment and Loss of Sight Benefits Schedules if an insured: shown under “SYMBOLS” on the Declara- tions Page. 1. dies; or Additional Definition 2. suffers dismemberment or permanent loss of sight, as described in the schedule Insured means a person whose name is shown as the direct result of an accident that involves under “Death, Dismemberment and Loss of the use of a land motor vehicle or any type of Sight Coverage – Persons Insured” on the Dec- trailer as a vehicle and not due to any other larations Page. cause.

28 9819B

The insured must be occupying or be struck as If the amount shown on the Declarations Page a pedestrian by a land motor vehicle or any for the insured is $10,000, then we will pay type of trailer at the time of the accident. The the applicable benefit shown below for death death, dismemberment, or permanent loss of or for the described dismemberment or per- sight must occur within 90 days immediately manent loss of sight: following the date of the accident. Death $10,000 Benefit Loss of both hands; both feet; all $10,000 The applicable benefit shown in the schedule is sight of both eyes; one hand and the most we will pay for any one insured in one foot; or one hand or one foot any one accident. Any benefit paid or payable and all sight of one eye for dismemberment or permanent loss of sight Loss of one hand or one foot; or $5,000 reduces the death benefit. all sight of one eye The benefits shown in the schedules are Loss of the thumb and a finger on $3,000 doubled for an insured who at the time of the one hand; or any three fingers accident was occupying a private passenger Loss of any two fingers $2,000 car and using a seat belt in the manner recom- mended by the vehicle’s manufacturer. The hand must be cut off through or above the wrist. The foot must be cut off through or Death, Dismemberment and above the ankle. The whole thumb or finger Loss of Sight Benefits Schedules must be cut off. If the amount shown on the Declarations Page LOSS OF EARNINGS COVERAGE for the insured is $5,000, then we will pay the This policy provides Loss of Earnings Cover- applicable benefit shown below for death or age if “Z” is shown under “SYMBOLS” on the for the described dismemberment or perma- Declarations Page. nent loss of sight: Additional Definitions Death $5,000 Insured means a person whose name is shown Loss of both hands; both feet; all $5,000 under “Loss of Earnings Coverage – Persons sight of both eyes; one hand and Insured” on the Declarations Page. one foot; or one hand or one foot and all sight of one eye Total Disability means the insured’s inability to work, either full or part time, in his or her Loss of one hand or one foot; or $2,500 occupation or any other similar occupation for all sight of one eye which he or she is reasonably fitted by educa- Loss of the thumb and a finger on $1,500 tion, training, or experience. one hand; or any three fingers Weekly Earnings means 85% of all earnings Loss of any two fingers $1,000 for the insured’s services before any deduc- tions. When weekly earnings cannot be de- The hand must be cut off through or above the termined on a weekly basis an average will be wrist. The foot must be cut off through or used. The average is 85% of the total earnings above the ankle. The whole thumb or finger for the 52 weeks just prior to the accident di- must be cut off. vided by 52.

29 9819B

Insuring Agreement a. AN EMERGENCY VEHICLE IN THE COURSE AND SCOPE OF HIS We will pay the insured his or her loss of OR HER EMPLOYMENT; weekly earnings, which occur while the insured is living, due to continuous total disa- b. A VEHICLE, OTHER THAN AN bility that: EMERGENCY VEHICLE, WHILE USED IN THE: 1. is the direct result of bodily injury caused by an accident that involves the use of a (1) INSURED’S BUSINESS; OR land motor vehicle or any type of trailer as (2) COURSE AND SCOPE OF HIS a vehicle and not due to any other cause. OR HER EMPLOYMENT IN At the time of the accident, the insured OTHER THAN A CAR BUSI- must be occupying or be struck as a pedes- NESS. trian by a land motor vehicle or any type of trailer; and This exclusion (2.b.) does not apply if the vehicle is a private passenger car; 2. starts within 20 days immediately following the date of the accident and lasts for a c. A MILITARY VEHICLE; OR period of at least 30 consecutive days. We d. A VEHICLE WHILE IT IS: will not pay for the first seven days of the 30 day period. (1) BEING PREPARED FOR, USED IN PRACTICE FOR, OR OPER- Limit ATED IN ANY RACING CON- The most we will pay any one insured is: TEST, SPEED CONTEST, HILL-CLIMBING CONTEST, 1. $250 for each full workweek of total disa- JUMPING CONTEST, OR ANY bility; and SIMILAR CONTEST; OR 2. a pro rata portion of $250 for less than a (2) ON A TRACK DESIGNED PRI- full workweek of total disability. MARILY FOR RACING OR Subject to the workweek limit, the most we HIGH-SPEED DRIVING. This will pay any one insured for all loss of weekly exclusion (2.d.(2)) does not apply if the vehicle is being used in con- earnings due to any one accident is $15,000. nection with an activity other than We will pay once every two weeks the in- racing, high-speed driving, or any sured’s loss of weekly earnings owed. type of competitive driving; Exclusions – Death, Dismemberment and 3. WHILE OCCUPYING, LOADING, UN- Loss of Sight Coverage and Loss of Earn- LOADING, OR WHO IS STRUCK AS A ings Coverage PEDESTRIAN BY: a. A MOTOR VEHICLE THAT RUNS DEATH, DISMEMBERMENT AND LOSS ON RAILS OR CRAWLER- OF SIGHT COVERAGE AND LOSS OF TREADS; EARNINGS COVERAGE DO NOT APPLY TO AN INSURED: b. A MOTOR VEHICLE THAT IS DE- SIGNED FOR USE PRIMARILY OFF 1. WHILE IN THE COURSE AND SCOPE PUBLIC ROADS WHILE OFF PUB- OF HIS OR HER EMPLOYMENT IN A LIC ROADS; OR CAR BUSINESS; c. A MOTOR VEHICLE OR ANY TYPE 2. WHILE OCCUPYING, LOADING, OR OF TRAILER, EITHER OF WHICH UNLOADING: IS LOCATED FOR USE AS A 30 9819B

DWELLING OR OTHER PREMISES; THE INSURED WAS SANE OR IN- OR SANE; OR 4. FOR DEATH, DISMEMBERMENT, e. DISEASE except pus-forming infec- LOSS OF SIGHT, OR TOTAL DISABIL- tion due to bodily injury sustained in ITY THAT RESULTS FROM: the accident. Our Payment Options – Death, Dismem- a. WAR OF ANY KIND; berment and Loss of Sight Coverage and b. NUCLEAR REACTION, RADIATION Loss of Earnings Coverage OR RADIOACTIVE CONTAMI- We may, at our option, make payment to one NATION FROM ANY SOURCE, OR or more of the following: THE ACCIDENTAL OR INTEN- TIONAL DETONATION OF, OR 1. The insured; RELEASE OF RADIATION FROM, 2. The insured’s surviving spouse; ANY NUCLEAR OR RADIOACTIVE DEVICE; 3. A parent or guardian of the insured, if the insured is a minor or an incompetent per- c. THE DISCHARGE OF A FIREARM; son; or d. SUICIDE OR ATTEMPTED SUI- 4. A person or organization authorized by CIDE REGARDLESS OF WHETHER law to receive such payment.

INSURED’S DUTIES 1. Notice to Us of an Accident or Loss b. If a lawsuit is filed against an insured, The insured must give us or one of our then that insured must immediately agents notice of the accident or loss as send us every summons and legal soon as reasonably possible. The notice process received. must give us: 3. Insured’s Duty to Cooperate With Us a. your name; a. The insured must cooperate with us b. the names and addresses of all persons and, when asked, assist us in: involved in the accident or loss; (1) making settlements; c. the hour, date, place, and facts of the (2) securing and giving evidence; and accident or loss; and (3) attending, and getting witnesses to d. the names and addresses of witnesses attend, depositions, hearings, and to the accident or loss. trials. 2. Notice to Us of a Claim or Lawsuit b. The insured must not, except at his or a. If a claim is made against an insured, her own cost, voluntarily: then that insured must immediately (1) make any payment to others; or send us every demand, notice, and claim received. (2) assume any obligation to others 31 9819B

unless authorized by the terms of this c. allow us to: policy. (1) inspect any damaged property be- c. Any person or organization making fore its repair or disposal; claim under this policy must, when we (2) test any part or equipment before require, give us proof of loss on forms that part or equipment is removed we furnish. or repaired; and 4. Questioning Under Oath (3) move the covered vehicle at our Under: expense in order to conduct such a. Liability Coverage, each insured; inspection or testing; b. Medical Payments Coverage, Unin- d. provide us all: sured Motor Vehicle Coverage, Death, (1) records; Dismemberment and Loss of Sight (2) receipts; and Coverage, or Loss of Earnings Cover- age, each insured, or any other person (3) invoices or organization making claim or seek- that we request and allow us to make ing payment; and copies; and c. Physical Damage Coverages, each in- e. not abandon the covered vehicle to us. sured or owner of a covered vehicle, or any other person or organization 6. Other Duties Under Medical Payments making claim or seeking payment; Coverage, Uninsured Motor Vehicle Coverage, Death, Dismemberment and must, at our option, submit to an exami- Loss of Sight Coverage, and Loss of nation under oath, provide a statement Earnings Coverage under oath, or do both, as reasonably often as we require. Such person or organi- A person making claim under: zation must answer questions under oath, asked by anyone we name, and sign cop- a. Medical Payments Coverage, Unin- ies of the answers. We may require each sured Motor Vehicle Coverage, Death, person or organization answering ques- Dismemberment and Loss of Sight tions under oath to answer the questions Coverage, or Loss of Earnings Cover- with only that person’s or organization’s age must: legal representative, our representatives, (1) notify us of the claim and give us any person or persons designated by us to all the details about the death, in- record the questions and answers, and no jury, treatment, and other informa- other person present. tion that we may need as soon as 5. Other Duties Under the Physical Dam- reasonably possible after the in- age Coverages jured insured is first examined or treated for the injury. If the in- When there is a loss, you or the owner of sured is unable to give us notice, the covered vehicle must: then any other person may give us a. protect the covered vehicle from addi- the required notice; tional damage. We will pay any rea- (2) be examined as reasonably often sonable expense incurred to do so that as we may require by physicians is reported to us; chosen and paid by us. A copy of b. make a prompt report to the police the report will be sent to the per- when the loss is the result of theft; son upon written request; 32 9819B

(3) provide written authorization for b. Medical Payments Coverage must, us to obtain: when we request, execute a reim- (a) medical bills; bursement and subrogation agreement that we furnish and return that agree- (b) medical records; ment to us. We may withhold payment (c) wage, salary, and employment of medical expenses until we receive a information; and properly executed reimbursement and (d) any other information we subrogation agreement. deem necessary to substantiate c. Uninsured Motor Vehicle Coverage the claim. must report an accident, involving a If an injured insured is a minor, motor vehicle whose owner and driver unable to act, or dead, then his or remain unknown, to the police within her legal representative must pro- 24 hours and to us within 30 days; vide us with the written authoriza- d. Uninsured Motor Vehicle Coverage tion. must send us immediately a copy of all If the holder of the information re- lawsuit papers if the insured files a fuses to provide it to us despite the lawsuit against the party liable for the authorization, then at our request accident; and the person making claim or his or e. Loss of Earnings Coverage must: her legal representative must obtain the information and promptly (1) make a claim under this policy; provide it to us; and (2) report to us when that person has a (4) allow us to inspect the vehicle that total disability; and the insured occupied in the acci- (3) provide proof of continued total dent; disability when we ask for it.

GENERAL TERMS 1. When Coverage Applies a. in the United States of America and its The coverages provided by this policy are territories and possessions; shown on the Declarations Page and apply b. in Canada; and to accidents and losses that occur during c. while a vehicle for which coverage is the policy period. The policy period is provided by this policy is being shipped shown on the Declarations Page and is for between the ports of the United States successive periods of six months each for of America, its territories, its posses- which the renewal premium is paid. The sions, and Canada. policy period begins and ends at 12:01 AM Standard Time at the address shown on the Death, Dismemberment and Loss of Sight Declarations Page. Coverage, and Loss of Earnings Coverage 2. Where Coverage Applies apply anywhere in the world. The coverages provided by this policy are 3. Limited Coverage in Mexico shown on the Declarations Page and apply This policy does not provide Mexican au- to accidents and losses that occur: to insurance and does not comply with 33 9819B

Mexican auto insurance requirements. If THE ACCIDENT OR LOSS HAD OC- you or any other insured plans to drive in CURRED IN THE STATE OF MAINE IN Mexico, then auto insurance providing THE UNITED STATES OF AMERICA. coverage in Mexico should be purchased All other policy provisions not in conflict from a Mexican insurance company. with the provisions in this Limited Cov- Subject to the above paragraph, the follow- erage in Mexico provision of this policy ing coverages apply in Mexico, but only for apply. accidents and losses that occur in Mexico If Other Coverage Applies within 50 miles of the United States of America border and only for insureds as de- Any coverage provided by this Limited fined under each of the following coverages: Coverage in Mexico provision is excess over any other applicable insurance. a. Liability Coverage Legal Action Against Us For claims brought against an insured Any legal action against us arising out of in Mexico, the Supplementary Pay- an accident or loss occurring in Mexico ments provision of this policy’s Lia- must be brought in a court that has juris- bility Coverage is changed to read: diction in the state of Maine in the United We may, in addition to the damages States of America. described in item 1 of the Insuring 4. Newly Owned or Newly Leased Car Agreement of this policy’s Liability Coverage, pay or reimburse, at our op- If you want to insure a car newly owned tion, reasonable attorney fees for an at- by you with the State Farm Companies af- torney licensed in Mexico to appear ter that car ceases to be a newly acquired for and provide advice to insureds as car, then you must either: defined under this policy’s Liability a. request we replace the car currently Coverage. The amount of such attor- shown on the Declarations Page of this ney fees incurred by an insured must policy with the car newly owned by be reported to us before we will make you and pay us any added amount due. payment. If you make such request while this b. Medical Payments Coverage policy is in force and: c. Physical Damage Coverages (1) before the car newly owned by you ceases to be a newly acquired Any amount payable for the repair or car, then that car newly owned by replacement of the covered vehicle you will be insured by this policy under the Limits and Loss Settlement as your car beginning on the date – Comprehensive Coverage and Col- the car newly owned by you is de- lision Coverage provision of this poli- livered to you. The added amount cy will be limited to the cost to repair due will be calculated based on or replace the covered vehicle in the that date; or United States of America. (2) after the car newly owned by you WE HAVE NO DUTY TO PROVIDE A ceases to be a newly acquired car, DEFENSE FOR YOU OR ANY OTHER then that car newly owned by you INSURED IN ANY CRIMINAL, CIVIL, will be insured by this policy as OR OTHER ACTION. your car beginning on the date and WE HAVE NO DUTY TO PAY ANY time you make the request. The CLAIM OR COST THAT WOULD NOT added amount due will be calcu- BE PAYABLE UNDER THIS POLICY IF lated based on that date; or 34 9819B

b. apply to the State Farm Companies car, a newly acquired car, or a for a separate policy to insure the car temporary substitute car. newly owned by you. Such policy will Policy notice requirements are met be issued only if both the applicant and by mailing the notice to the most the vehicle are eligible for coverage at recent policy address that we have the time of the application. on record for the deceased named 5. Changes to This Policy insured. a. Changes in Policy Provisions c. Joint and Individual Interests We may only change the provisions of If you consists of more than one per- this policy by: son or entity, then each acts for all to (1) issuing a revised policy booklet, a change or cancel the policy. revised Declarations Page, or an d. Change of Policy Address endorsement; or We may change the named insured’s (2) revising this policy to give broader policy address as shown on the Decla- coverage without an additional rations Page and in our records to the premium charge. If any coverage most recent address provided to us by: provided by this policy is changed to give broader coverage, then we (1) you; or will give you the broader coverage (2) the United States Postal Service. as of the date we make the change effective in the state of Maine 6. Premium without issuing a revised policy a. Unless as otherwise provided by an al- booklet, a revised Declarations ternative payment plan in effect with Page, or an endorsement. the State Farm Companies with re- b. Change of Interest spect to the premium for this policy, (1) No change of interest in this policy the premium is due and payable in full is effective unless we consent in on or before the first day of the policy writing. period shown on the most recently issued Declarations Page or Renewal (2) Except under Death, Dismember- Notice. ment and Loss of Sight Coverage and Loss of Earnings Coverage, if b. The renewal premium for this policy a named insured shown on the will be based upon the rates in effect, Declarations Page dies, then the the coverages carried, the applicable definition of insured under each of limits, deductibles, and other elements the coverages provided by this pol- that affect the premium that apply at icy is changed to include: the time of renewal. (a) any person with lawful custody c. The premium for this policy may vary of your car, a newly acquired based upon: car, or a temporary substitute (1) the purchase of other products or car until a legal representative services from the State Farm is qualified; and then Companies; (b) the legal representative of the (2) the purchase of products or services deceased named insured. from an organization that has en- This only applies while such per- tered into an agreement or contract son is maintaining or using your with the State Farm Companies. 35 9819B

The State Farm Companies do not deliver a nonrenewal notice or a cancella- warrant the merchantability, fitness, tion notice as set forth in 8. and 9. below. or quality of any product or service 8. Nonrenewal offered or provided by that organization; or If we decide not to renew this policy, then we will mail or deliver a nonrenewal notice (3) an agreement, concerning the in- to the most recent policy address that we surance provided by this policy, have on record for the named insured who that the State Farm Companies is shown on the Declarations Page. The has with an organization of which notice will be mailed or delivered so that it you are a member, employee, sub- is received at least 30 days before the end scriber, licensee, or franchisee. of the current policy period. A post-office d. The premium for this policy is based certificate of mailing to the named insured upon information we have received at the last known address is conclusive from you or other sources. You must proof of receipt of notice on the 3rd calen- inform us if any information regarding dar day after mailing. the following is incorrect or incom- 9. Cancellation plete, or changes during the policy period, and you must answer questions a. How You May Cancel we ask regarding the following: You may cancel this policy by provid- (1) Your car, or its use, including an- ing to us advance notice of the date nual mileage; cancellation is effective. We may con- (2) The persons who regularly drive firm the cancellation in writing. your car, including newly licensed b. How and When We May Cancel family members; We may cancel this policy by mailing (3) Your marital status; or or delivering a written notice to the (4) The location where your car is most recent policy address that we primarily garaged. have on record for the named insured who is shown on the Declarations If the above information or any other Page. The notice will provide the date information used to determine the pre- cancellation is effective. A post-office mium is incorrect, incomplete, changes certificate of mailing to the named in- during the policy period, or is not pro- sured at the last known address is con- vided to us when we ask, then we may clusive proof of receipt of notice on decrease or increase the premium dur- the 5th calendar day after mailing. ing the policy period. If we decrease the premium during the policy period, then (1) The notice will be mailed or de- we will provide a refund or a credit in livered so that it is received at least: the amount of the decrease. If we in- (a) 10 days before the cancellation crease the premium during the policy effective date if the cancella- period, then you must pay the amount tion is because of nonpayment of the increase. of premium; or 7. Renewal (b) 20 days before the cancellation We agree to renew this policy for the next effective date if the cancella- policy period upon payment of the renew- tion is because of any other al premium when due, unless we mail or reason.

36 9819B

(2) Unless you receive a notice of 12. Concealment or Fraud cancellation within 59 days of the There is no coverage under this policy if policy effective date, we will not you or any other person insured under this cancel your policy before the end policy has made false statements with the of the current policy period except intent to conceal or misrepresent any ma- for: terial fact or circumstance in connection (a) nonpayment of premium; with any claim under this policy. (b) fraud or material misrepresen- 13. Our Right to Recover Our Payments tation affecting the policy or a. Death, Dismemberment and Loss of the presentation of a claim; Sight Coverage and Loss of Earnings (c) violation of terms or condi- Coverage payments are not recovera- tions of the policy; or ble by us. (d) you, any resident relative, or b. Under Medical Payments Coverage any other person who usually when an insured's awarded or settled drives your car has had his or damages exceed $20,000: her driver’s license under sus- (1) Subrogation pension or revocation during If we are obligated under this pol- the policy period or, if the poli- icy to make payment to or for an cy is renewed, during the 180 insured or organization who has a days immediately before the ef- legal right to collect from another fective date of the renewal. person or organization, then we However, we will not cancel will be subrogated to that right to your policy for the first or the extent of our payment. Our second suspension of a provi- subrogation right is subject to sub- sional license for less than 90 traction to account for the pro rata days. share of that insured’s attorney c. Return of Unearned Premium fees incurred in obtaining the recovery of our payment from the If you cancel this policy, then premium responsible party. The insured or may be earned on a short rate basis. If organization to or for whom we we cancel this policy, then premium make payment must help us re- will be earned on a pro rata basis. cover our payment by: Any unearned premium may be re- (a) providing us written approval turned within a reasonable time after for us to recover our payment; cancellation. Delay in the return of any unearned premium does not affect (b) doing nothing to impair that le- the cancellation date. gal right; (c) executing any documents we 10. Assignment may need to assert that legal No assignment of benefits or other transfer right; and of rights is binding upon us unless ap- (d) taking legal action through our proved by us. representatives when we ask. 11. Bankruptcy or Insolvency of the Insured (2) Reimbursement Bankruptcy or insolvency of the insured or If we make payment under this his or her estate will not relieve us of our policy and the insured or organi- obligations under this policy. zation to or for whom we make 37 9819B

payment recovers or has recovered (b) reimburse us to the extent of from another person or organiza- our payment. tion, then the person or organization to or for whom we make 14. Legal Action Against Us payment must: Legal action may not be brought against us until there has been full compliance with (a) provide us written approval all the provisions of this policy. In addi- for us to recover our payment; tion, legal action may only be brought (b) hold in trust for us the against us regarding: proceeds of any recovery; and a. Liability Coverage after the amount of (c) reimburse us to the extent of damages an insured is legally liable to our payment. pay has been finally determined by: c. Under all other coverages the follow- (1) judgment after an actual trial, and ing apply: any appeals of that judgment if any appeals are taken; or (1) Subrogation (2) agreement between the claimant If we are obligated under this pol- and us. icy to make payment to or for a person or organization who has a b. Medical Payments Coverage if the le- legal right to collect from another gal action relating to this coverage is person or organization, then we brought against us within four years will be subrogated to that right to immediately following the date of the the extent of our payment. accident. The person or organization to or c. Uninsured Motor Vehicle Coverage if for whom we make payment must the insured or that insured’s legal rep- help us recover our payments by: resentative within two years immediately following the date of the (a) doing nothing to impair that accident: legal right; (1) presents an Uninsured Motor Ve- (b) executing any documents we hicle Coverage claim to us; and may need to assert that legal (2) files a lawsuit in accordance with right; and the Deciding Fault and Amount (c) taking legal action through our provision of the Uninsured Motor Vehicle Coverage. representatives when we ask. Except as provided in c.(2) above, no (2) Reimbursement other legal action may be brought If we make payment under this against us relating to Uninsured Motor policy and the person or organiza- Vehicle Coverage for any other causes tion to or for whom we make pay- of action that arise out of or are related ment recovers or has recovered to Uninsured Motor Vehicle Coverage from another person or organiza- until there has been full compliance tion, then the person or organiza- with the provisions titled Consent to tion to or for whom we make Settlement and Deciding Fault and payment must: Amount. (a) hold in trust for us the d. Physical Damage Coverages if the le- proceeds of any recovery; and gal action relating to these coverages is 38 9819B

brought against us within one year by the State Farm Mutual Automo- immediately following the date of the bile Insurance Company; or accident or loss. (2) Participating Policy provision 15. Choice of Law found on the most recently issued Declarations Page, if this policy Without regard to choice of law rules, the was issued by any subsidiary or af- law of the state of: filiate of the State Farm Mutual a. Maine will control, except as provided Automobile Insurance Company. in b. below, in the event of any disa- 16. Severability greement as to the interpretation and application of any provision in this If any provision of this policy is held policy; and invalid or unenforceable by a court that has jurisdiction, then: b. Illinois will control in the event of any disagreement as to the interpretation a. such provision will remain in full force and application of this policy’s: to the extent not held invalid or unenforceable; and (1) Mutual Conditions provision found on the most recently issued Declara- b. all other provisions of this policy will tions Page, if this policy was issued remain valid and enforceable.

39 9819B

6128AE AMENDATORY ENDORSEMENT

This endorsement is a part of the policy. Except for the changes this endorsement makes, all other provisions of the policy remain the same and apply to this endorsement. 1. DEFINITIONS b. neither available for, nor being Newly Acquired Car is changed to read: used for, carrying persons for a charge. Newly Acquired Car means a car newly owned by you or a resident relative. b. Exclusions A car ceases to be a newly acquired car (1) Exclusion 6. is changed to read: on the earlier of: THERE IS NO COVERAGE 1. the effective date and time of a pol- FOR AN INSURED FOR icy, including any binder, issued by DAMAGES ARISING OUT OF us or any other company that de- THE OWNERSHIP, MAINTE- car scribes the as an insured vehi- NANCE, OR USE OF A VEHI- cle; or CLE WHILE IT IS: 2. the end of the 14th calendar day a. MADE AVAILABLE; OR immediately following the date the car is delivered to you or a resident b. BEING USED relative. TO CARRY PERSONS FOR A If a newly acquired car is not otherwise CHARGE. This exclusion does afforded comprehensive coverage or not apply to the use of a private collision coverage by this or any other passenger car on a share-the- policy, then this policy will provide expense basis; Comprehensive Coverage or Collision Coverage for that newly acquired car, (2) The exception to exclusion 10. is subject to a deductible of $500. changed to read: 2. LIABILITY COVERAGE This exclusion does not apply a. Additional Definition to damage to a: Item 4. of Insured is changed to read: a. motor vehicle owned by the employer of you or the em- Insured means any other person or ployer of any resident rela- organization vicariously liable for tive if such damage is the use of a vehicle by an insured caused by an insured while as defined in 1., 2., or 3. above, but operating another motor only for such vicarious liability. vehicle; This provision applies only if the vehicle is: b. residence while rented to or leased to an insured; or a. neither owned by, nor hired by, that other person or organiza- c. private garage while rented tion; and to or leased to an insured;

MktReg - ME DC – 2019 Produced pursuant to data call from Maine Bureau of Insurance regarding automobile insurance dated July 30, 2019 and homeowners insurance dated August 7, 2019 MEDC201900000041PROD 3. MEDICAL PAYMENTS COVERAGE BY ANY RESIDENT RELA- TIVE YOUR Exclusions IF IT IS NOT CAR OR A NEWLY AC- Exclusion 4. is changed to read: QUIRED CAR. This exclusion THERE IS NO COVERAGE FOR AN (2.b.) does not apply to the first INSURED WHO IS OCCUPYING A person shown as a named in- VEHICLE WHILE IT IS: sured on the Declarations Page and that named insured’s spouse a. MADE AVAILABLE; OR who resides primarily with that b. BEING USED named insured, provided that the motor vehicle is owned by TO CARRY PERSONS FOR A neither that named insured nor CHARGE. This exclusion does not ap- that spouse; ply to: 5. PHYSICAL DAMAGE COVERAGES a. the use of a private passenger car on a share-the-expense basis; or a. The paragraph that reads: b. an insured while occupying a non- If a deductible applies to Compre- owned car as a passenger; hensive Coverage, then it is 4. UNINSURED MOTOR VEHICLE shown on the Declarations Page. COVERAGE The deductible that applies to Col- lision Coverage is shown on the a. Additional Definitions Declarations Page. Uninsured Motor Vehicle is changed to read: Item 2. of “Uninsured Motor Vehicle does not include a land motor vehicle” Deductible is changed to read: 1. If “D” is shown under “SYM- Uninsured Motor Vehicle does not BOLS” on the Declarations include a land motor vehicle owned Page, then the deductible that by, rented to, or furnished or avail- applies to Comprehensive Cov- able for the regular use of you or erage, if any, is the dollar any resident relative; amount shown on the Declara- tions Page next to the title of b. Exclusions this coverage. However, we Exclusion 2. is changed to read: will not deduct more than $500 for any loss to a newly ac- THERE IS NO COVERAGE FOR quired car. AN INSURED WHO SUSTAINS BODILY INJURY: 2. If “G” is shown under “SYM- BOLS” on the Declarations a. WHILE OCCUPYING A Page, then the deductible that MOTOR VEHICLE OWNED applies to Collision Coverage is BY YOU IF IT IS NOT YOUR the dollar amount shown on the CAR OR A NEWLY AC- Declarations Page next to the QUIRED CAR; OR title of this coverage. However, b. WHILE OCCUPYING A we will not deduct more than MOTOR VEHICLE OWNED $500 for any loss caused by Page 2 of 5 6128AE ©, Copyright, State Farm Mutual Automobile Insurance Company, 2015

MktReg - ME DC – 2019 Produced pursuant to data call from Maine Bureau of Insurance regarding automobile insurance dated July 30, 2019 and homeowners insurance dated August 7, 2019 MEDC201900000042PROD collision to a newly acquired (ii) stolen and not recov- car. ered. b. Insuring Agreements The amount of any such daily rental Car Rental and Travel Expenses charge incurred by an insured must Coverage be reported to us before we will pay Item 4.a. Car Rental Expenses is such amount. changed to read: c. Exclusions Car Rental Expense Exclusion 3. is changed to read: We will pay the daily rental charge incurred when an insured rents a THERE IS NO COVERAGE FOR car from a car business while your ANY COVERED VEHICLE car or a newly acquired car is: WHILE IT IS: (1) not drivable; or a. MADE AVAILABLE; OR (2) being repaired b. BEING USED loss as a result of a which would be TO CARRY PERSONS FOR A payable under Comprehensive Coverage or Collision Coverage. CHARGE. This exclusion does not apply to the use of a private pas- We will pay this daily rental senger car on a share-the-expense charge incurred during a period basis; that: (1) starts on the date: 6. INSURED’S DUTIES (a) the vehicle is not drivable a. Item 6.a.(3) is changed to read: as a result of the loss; or A person making claim under: (b) the vehicle is left at a repair facility if the vehicle is a. Medical Payments Coverage, drivable; and Uninsured Motor Vehicle Coverage, Death, Dismember- (2) ends on the earliest of: ment and Loss of Sight Cover- (a) the date the vehicle has age, or Loss of Earnings been repaired or replaced; Coverage must: (b) the date we offer to pay for (3) provide written authoriza- the loss if the vehicle is re- tion for us to obtain medi- pairable but you choose to cal bills, medical records, delay repairs; or wage information, salary (c) seven days after we offer to information, employment pay for the loss if the vehi- information, and any other cle is: information we deem nec- (i) a total loss as deter- essary to substantiate the mined by us; or claim.

MktReg - ME DC – 2019 Produced pursuant to data call from Maine Bureau of Insurance regarding automobile insurance dated July 30, 2019 and homeowners insurance dated August 7, 2019 MEDC201900000043PROD Such authorizations must us with the written authori- not: zation. (a) restrict us from per- If the holder of the infor- forming our business mation refuses to provide functions in: it to us despite the authorization, then at our request (i) obtaining records, person bills, information, the making claim or and data; nor his or her legal representative must obtain the information (ii) using or retaining and promptly provide it to records, bills, in- us; and formation, and data collected or re- b. The following is added to item 6.: ceived by us; A person making claim under Med- (b) require us to violate ical Payments Coverage, Uninsured federal or state laws or Motor Vehicle Coverage, Death, regulations; Dismemberment and Loss of Sight Coverage, or Loss of Earnings (c) prevent us from ful- Coverage must submit to us all in- filling our data report- formation we need to comply with ing and data retention federal and state laws and regula- obligations to insur- tions. ance regulators; or 7. GENERAL TERMS (d) prevent us from dis- a. The following is added to Newly closing claim infor- Owned or Newly Leased Car: mation and data: If a resident relative wants to in- (i) to enable perfor- sure a car newly owned by the res- mance of our busi- ident relative with the State Farm ness functions; Companies after that car ceases to be a newly acquired car, then the (ii) to meet our report- resident relative must apply to the ing obligations to State Farm Companies for a sepa- insurance regula- rate policy to insure the car newly tors; owned by the resident relative. our Such policy will be issued only if (iii) to meet report- both the applicant and the vehicle ing obligations to are eligible for coverage at the time insurance data con- of the application. solidators; and b. The following are added to GENERAL (iv) as otherwise per- TERMS: mitted by law. Electronic Delivery If an injured insured is a minor, unable to act, or With your consent, we may elec- dead, then his or her legal tronically deliver any document or representative must provide notice, including a notice to renew, Page 4 of 5 6128AE ©, Copyright, State Farm Mutual Automobile Insurance Company, 2015

MktReg - ME DC – 2019 Produced pursuant to data call from Maine Bureau of Insurance regarding automobile insurance dated July 30, 2019 and homeowners insurance dated August 7, 2019 MEDC201900000044PROD instead of mailing it or delivering it (b) any other information by other means. Proof of transmis- we have in our possession will be sufficient proof of no- sion as a result of our tice. This provision does not apply processing, handling, to any notice to nonrenew or can- or otherwise resolving cel. claims submitted under Our Rights Regarding Claim this policy. Information c. We may disclose any of the a. We will collect, receive, obtain, items in item b.(1) above and use, and retain all the items de- any of the information described in item b.(1) below and scribed in item b.(3)(b) above: use and retain the information described in item b.(3)(b) be- (1) to enable performance of low, in accordance with appli- our business functions; cable federal and state laws and (2) to meet our reporting obli- regulations and consistent with gations to insurance regula- the performance of our busi- tors; ness functions. (3) to meet our reporting obli- b. Subject to a. above, we will not gations to insurance data be restricted in or prohibited consolidators; from: (4) to meet other obligations (1) collecting, receiving, or obtaining records, receipts, required by law; and invoices, medical bills, med- (5) as otherwise permitted by ical records, wage infor- law. mation, salary information, d. Our rights under a., b., and c. employment information, above shall not be impaired by data, and any other infor- any: mation; (1) authorization related to any (2) using any of the items de- claim submitted under this scribed in item b.(1) above; policy; or or (2) act or omission of an in- (3) retaining: sured or a legal representa- (a) any of the items in item tive acting on an insured’s b.(1) above; or behalf.

6919B AMENDATORY ENDORSEMENT

This endorsement is a part of the policy. Except for the changes this endorsement makes, all other provisions of the policy remain the same and apply to this endorsement. GENERAL TERMS to or for whom we make payment Item b. under Our Right to Recover Our recovers or has recovered from an- Payments is changed to read: other person or organization, then the person or organization to or for b. Under Medical Payments Coverage the whom we make payment must: following apply: (1) Subrogation (a) provide us written approval for If we are obligated under this poli- us to recover our payment; cy to make payment to or for an in- (b) hold in trust for us the proceeds sured or organization who has a of any recovery; and legal right to collect from another person or organization, then we (c) reimburse us to the extent of will be subrogated to that right to our payment. the extent of our payment. The insured or organization to or for If the insured’s attorney has assisted us whom we make payment must help in successfully obtaining recovery of us recover our payment by: our payment from the legally responsi- our (a) providing us written approval ble party, then right of recovery is for us to recover our payment; subject to subtraction to account for the pro rata share of that insured’s attorney (b) doing nothing to impair that fees incurred in assisting us in success- legal right; fully obtaining recovery of our pay- (c) executing any documents we ment from the legally responsible party. may need to assert that legal In the event that we pursue our right to right; and subrogate directly against such legally (d) taking legal action through our responsible party without assistance representatives when we ask. from the insured’s attorney, our right of recovery is not subject to any subtrac- (2) Reimbursement tion to account for the insured’s attor- If we make payment under this pol- ney fees and we are entitled to our full icy and the insured or organization recovery.