CAIC EXCESS LIABILITY TERMS AND CONDITIONS

Transcription

1 NON-RESIDENT EXCESS VEHICLE LIABILITY POLICY (WITH MEDICAL PAYMENT COVERAGE) Commercial Alliance Insurance Company (CAIC) 415 Lockhaven Drive Houston, Texas THIS IS A NON-RESIDENT EXCESS VEHICLE LIABILITY POLICY ( Excess Policy ) intended to cover Mexican Nationals entering Texas and/or the U.S.A. The primary residence for both the applicant (you) and vehicle(s) listed on the Certificate of Insurance (Certificate) must be from Mexico and/or a country other than the U.S.A. THIS INSURANCE DOES NOT APPLY TO AUTO ACCIDENTS AND LOSSES THAT OCCUR IN MEXICO. This is NOT an insurance policy sold for use while your principal location and base of operations is in the U.S.A. If your principal location and operations are in the U.S.A., please consult an Insurance Agent in the U.S.A. for your insurance needs. A U.S.A. titled and/or registered auto is not eligible for this insurance. Various provisions in this Excess Policy restrict coverage. Read the entire Excess Policy carefully to determine your rights and duties. THIS EXCESS POLICY PROVIDES NO CARGO, COLLISION AND/OR COMPENSABLE COVERAGE OF ANY TYPE. THIS IS AN EXCESS VEHICLE LIABILITY POLICY ONLY. SIMILARLY, THIS EXCESS POLICY DOES NOT CONTAIN ANY UM OR UIM BENEFITS. This Excess Policy is only sold in Mexico. CAIC, in consideration of the payment of your premium and the information you provided as set out in the Certificate, hereby provides Excess Vehicle Liability insurance to you based upon the following Terms, Conditions and Exclusions: CAIC EXCESS LIABILITY TERMS AND CONDITIONS PART I - LIABILITY COVERAGE A. INSURING AGREEMENT This Excess Policy will apply if you become legally obligated in the U.S.A. to pay either bodily injury and/or property damage as a result of an auto accident arising out of the ownership or use of the covered vehicle. Our obligation to pay for any loss which occurs as a direct result of an auto accident, only arises when either: 1. There is an exhaustion of any and all primary or underlying insurance available to the covered vehicle for such auto accident; and/or 2. If you do not have underlying or primary insurance for the covered vehicle, this Excess Policy s coverage only begins from the first dollar above the minimal levels of required motor vehicle insurance in the State in the U.S.A. where the auto accident occurred. This Excess Vehicle Liability Policy will not cover or provide the benefits of any mandatory primary policy as may be required in the specific State where the auto accident occurred. B. YOU OR AN INSURED AS USED IN THIS EXCESS POLICY MEANS: FORM CAIC PAGE 1 of 9

2 1. Any person operating the covered vehicle with your permission while in the U.S.A. is an insured; and/or 2. If You are an individual or partnership, you and each partner is covered for the use of the covered vehicle(s). Also, You if an individual or partners in a partnership, are covered under this Excess Policy while operating other vehicles. However, this Excess Policy only provides excess liability insurance above the liability insurance coverage on the other vehicle. This Excess Policy will not drop down to provide primary coverage to you or on your behalf if the other vehicle is without liability insurance. 3. If You are a corporation, You means all employees and officers of the company for use of the covered vehicle provided such use of the covered vehicle is with the permission of the corporation listed on the Certificate. There is no other excess liability coverage available to a corporation. The use or operation of other vehicles by the corporation employees and/or officers is not covered under this Excess Policy. For covered vehicles this Excess Liability Policy will not drop down to provide primary coverage. C. TIME OF AUTO ACCIDENT This Excess Policy only applies to auto accidents which occur within or during the time frame set out in the Policy Period. The Excess Policy Period is set out on your Certificate of Insurance for the covered vehicle. D. POLICY TERRITORY - U.S.A. ONLY This Excess Policy only applies to auto accident(s) which occur within the U.S.A. Auto accident(s) which occur in Mexico, Canada or other Countries are not covered under this Excess Policy. E. DEFENSE OF SUIT We will defend you or an insured in any suit arising out of an auto accident which falls within the terms of the Excess Vehicle Liability Policy, if: 1. You or the covered person are not being defended by the primary policy of insurance; or 2. You or the covered person have no primary or underlying coverage, or the insurance carrier for the primary or underlying policy has declined to defend you; or 3. The primary or underlying policy has been exhausted by payment of claims and such insurer(s) has withdrawn a defense to you. We will provide this legal defense, with counsel of our choice, even if the suit is groundless or fraudulent. We may investigate, negotiate and settle any such claim or suit against you or an insured at our discretion. Our duty to defend ends whenever we have paid out the limits of this Excess Policy. This defense will include: 1. All expenses incurred by us in the defense including the cost of any attorney we retain to defend you. 2. All court cost taxes against you or an insured person. 3. All premiums on bonds to release attachments up to the amount of our coverage (but we are not obligated to furnish or apply for any bond). 4. Pre-judgment (if any) and post-judgment interest after a judgment is entered in a suit we defend. Our obligation is limited to that part of any judgment we are obligated to pay for. Our obligation to pay interest stops once we have paid any judgment up to the limits of our coverage. 5. Reasonable expenses incurred by you or an insured based upon our request and/or defense counsel s need for your availability to assist in preparation for trial or deposition. Our duty to defend only arises when you and/or an insured have formally tendered a suit to us for a defense. Such tender or notice must be made in writing and sent or given to us at our address listed on the first page of this Excess Policy. Further, you must cooperate with attorneys selected to defend you. If you fail to cooperate in the defense and/or fail to make yourself available as requested, we can withdraw the defense. Our obligation to defend you ends upon your failure to cooperate with us and/or the assigned attorneys. FORM CAIC PAGE 2 of 9

3 F. NO COLLISION OR PHYSICAL DAMAGE COVERAGE This is an Excess Vehicle Liability Policy. This Excess Policy does not insure or protect the covered vehicle for Physical Damage. Specifically, Collision or Comprehensive type coverages are not included in this Excess Policy. G. NO PIP AND/OR UM OR UIM COVERAGE/BENEFITS PROVIDED Personal Injury Protection Benefits ( PIP ), Uninsured Motorist ( UM ) and/or Underinsured Motorist ( UIM ) coverages are not included in this Excess Policy. This Excess Policy provides no benefits or protection to the person operating the covered vehicle for any bodily injuries which the driver or operator may themselves receive as a result of an auto accident. H. LIMIT OF LIABILITY 1. Subject to the limit of liability shown in the Certificate for each auto accident, this amount is our maximum limit of liability we will pay for all damages for either bodily injury and/or property damage for any one (1) auto accident. This limit is the most we will pay regardless of the number of: a. Claimants; or b. Third-Party Property or bodily injury damages; or c. Vehicles or premiums shown in the Certificate; or d. Vehicles involved in the auto accident. 2. A vehicle and attached trailer are considered one vehicle. Therefore, the Limits of Liability will not be increased for auto accidents involving a covered vehicle with an attached trailer. 3. NO DROP DOWN COVERAGE: If you and/or the covered vehicle do not have primary coverage, this Excess Policy will not drop down and/or become responsible for whatever minimum coverage is required in the State in the U.S.A. where an auto accident occurs. This Excess Policy is not triggered or it s benefits activated until, at least, the minimum motor vehicle liability coverage in the State where the auto accident occurs has been either exhausted by payment and/or has been satisfied by you if no primary coverage is otherwise available. PART 1. - EXCLUSIONS Excess Liability Coverage under this PART 1., including our duty to defend, does NOT apply to: 1. Intentional Acts. An insured who intentionally causes bodily injury or property damage. (This exclusion does not apply to an insured who did not participate in such intentional or expected bodily injury or property damage). 2. Workers Compensation. Bodily injury to an employee of any insured during the course of employment. This Excess Policy excludes any obligation which you and/or an insured may be or is held liable for under any workers compensation laws. 3. Property Damage in Your Care, Custody and/or Control. This Excess Policy excludes property rented to, used by, or in the care, custody or control of an insured that is lost or damaged for any reason, including an auto accident. This includes personal items of you, an insured and/or occupant in the covered vehicle. This Excess Policy provided no coverage to you for any cargo or property you are hauling or carrying. This Excess Policy also provides no coverage for physical damage to the covered vehicle. 4. Handling of Property. Bodily Injury or Property damage resulting from the handling or movement of property by any mechanical device. 5. Commercial Use. Bodily injury or property damage arising out of the ownership, maintenance, or use of a covered vehicle while carrying persons and/or property for compensation. 6. The covered vehicle while employed or engaged in the business or occupation of selling, repairing, servicing, storing, parking, leasing, delivering, repossessing, or testing vehicles. 7. Racing. Bodily injury or property damage resulting from any pre-arranged or organized racing, speed or demolition contest, stunt activity, or in practice or preparation for such activity. 8. Nuclear Discharge. Bodily injury or property damage due to nuclear reaction or radiation. FORM CAIC PAGE 3 of 9

4 9. Carrying Hazardous Materials. Bodily injury or property damage arising out of the actual, alleged or threatened discharge, dispersal, release or escape of pollutants. (This exclusion does not apply to fuels, lubricants, fluids, or other similar pollutants which are normally needed to operate and use a vehicle, and the actual, alleged or threatened discharge, dispersal, release or escape is caused by an auto accident). Pollutants means any solid, liquid, gaseous, thermal irritant, or contaminant, including, but not limited to, smoke, vapor, soot, fumes, acids, alkalis, chemicals, waste. Waste includes materials to be recycled, reconditioned, or reclaimed. 10. War. Bodily injury or property damage due to war, whether or not declared, or any act or condition incident to war. War includes civil, insurrection rebellion, revolution or terrorist attacks. 11. Illegal Acts. Bodily injury or property damage arising out of the ownership or use of a covered vehicle while being used in any illegal transportation or trade. This specifically includes carrying illegal drugs or firearms across the U.S.A. border. 12. Leasing Covered Vehicle(s) To Others. Bodily injury or property damage arising out of the ownership or use of a covered vehicle while being rented, leased, sold, or under a conditional sales agreement by you to another. 13. Permissive Use Required. Bodily injury or property damage caused by a person using a vehicle without the reasonable belief that person is entitled to do so. 14. Watercraft/Aircraft. Damages for bodily injury or property damage arising out of the use, ownership maintenance or loading or unloading of a watercraft or aircraft of any kind. 15. Motorcycles. Bodily injury or property damage arising out of the use of the use, ownership, maintenance or loading or unloading a motorcycle of any kind. A motorcycle cannot be a covered vehicle. Similarly, a motorcycle cannot be an other vehicle for the purposes of this Excess liability coverage. 16. Punitive or Exemplary Damages. Damages awarded against you or an insured which are to punish or deter you and/or an insured for malicious, intentional, wanton, willful or gross negligence are not covered under this Excess Policy. 17. Negligent Entrustment. Legal liability to you and/or an insured person for your actual or alleged entrustment of any vehicle to others and/or your failure to supervise the use of any person or persons use of any vehicle. This Exclusion is not applicable if the vehicle at issue is the motor vehicle described in the Certificate of this Excess Liability Policy - the covered vehicle itself. OTHER EXCESS INSURANCE If there is other applicable excess liability insurance we will pay only our share of the loss for an auto accident covered under this Excess Policy. Our share is the proportion that our limit of liability bears to the total of all applicable limits. We do not provide any excess liability insurance of any kind to you for the operation or use of a vehicle you own unless it is the covered vehicle listed on the Certificate of Insurance for this Excess Policy. PART 2. - EXCESS MEDICAL PAYMENTS COVERAGE A. INSURING AGREEMENT A. We will pay reasonable and customary expenses incurred for necessary medical because of bodily injury. This coverage is in excess of any other applicable medical coverage. To be covered under this Excess Policy, all medical expenses must be: 1. Caused by auto accident which occurs in the U.S.A.; and 2. Sustained by an insured person; and 3. Incurred within one (1) year from the date of the auto accident. B. Insured person as used in this part of the Excess Policy means: 1. You : FORM CAIC PAGE 4 of 9

5 a. while occupying other vehicles and/or b. when struck by a motor vehicle. 2. Any other person while occupying the covered vehicle. 3. If you is a corporation, this coverage only applies to those persons operating or occupying the covered vehicle. EXCLUSIONS We do not provide Medical Expenses for any person for bodily injury: 1. Sustained while occupying or operating a motorcycle. A motorcycle is a two-wheeled motorized vehicle. 2. Sustained by persons occupying your covered vehicle when it is being used to carry persons/passengers for a fee. 3. Occurring during the course of employment if workers compensation benefits are required or otherwise available for the bodily injury incurred. 4. Sustained while occupying, or when struck by, any vehicle (other than your covered vehicle), which is: a. owned by you; or b. furnished or available for your regular use. 5. Sustained while operating or occupying a vehicle without a reasonable belief that that person is entitled to do so. 6. From or as a consequence of any of the following events: a. nuclear reaction; b. radiation; or c. radioactive contamination. 7. Arising out of an auto accident involving the covered vehicle while being used by a person employed or otherwise engaged in the business or occupation of selling, repairing, servicing, storing, parking, leasing, delivering, repossessing, or testing vehicles. 8. Resulting from any pre-arranged or organized racing, speed or demolition contest, stunting activity, or in practice or preparation for any such contest or activity. LIMIT OF LIABILITY The limit of liability shown in the Certificate of Insurance for this coverage is the maximum limit of liability for each insured person injured in any one (1) auto accident. REIMBURSEMENT We shall have no right to be reimbursed those sums of money we pay to, or on behalf of, either you, and/or any other insured person, for medical services per PART 2. of this Excess Policy. ASSIGNMENT OF BENEFITS Payment for medical expenses will be paid directly to a physician or other health care provider if we receive a written assignment signed by the insured person to whom such benefits are payable. We also have the right to make direct payment to physician or health care provider or the insured person as we consider appropriate. B. EXCESS MEDICAL EXPENSE COVERAGE 1. When payable the medical payment coverage provided by this Excess Policy is excess over whatever other Underlying Insurance is applicable to the auto accident in which an insured person is injured. This excess insurance incepts or begins once the limits of any primary insurance has been exhausted by payment to or on behalf of an insured person. If there is no primary insurance, this excess coverage will pay for reasonable and customary medical and funeral expenses to or on behalf of an insured person up to the per person limits of medical coverage provided by this Excess Policy. 2. No duplication of medical or funeral payments are permitted. This coverage is not applicable if an injured person(s) has already received payment for and/or the insured person s medical bills have been paid by other primary vehicle coverage for any auto accident. If a primary vehicle insurer has paid its limits of medical benefits as a result of an auto accident, this Excess Policy will pay those medical expenses above the primary vehicle insurers coverage up to the per person FORM CAIC PAGE 5 of 9

6 limits of this excess medical coverage. C. BENEFITS PAYABLE For the purposes of this Excess Policy, reasonable medical expenses include the following health care provider and/or funeral services: - Ambulance and/or Emergency Room services. - Hospital charges. - Physician bills. - Physical or Occupational Therapy. - X-ray, CAT Scan and related diagnostic services. - Chiropractic expenses. - Home Health services. - FUNERAL EXPENSES. Benefits are only available if the medical expenses are incurred within the USA or Mexico. PART III - POLICY TERMS AND CONDITIONS A. DUTIES AFTER AN AUTO ACCIDENT OR LOSS 1. In the event of an auto accident, claim, suit or loss, we must be notified promptly of how, when and where the auto accident or loss happened. Notice should also include the names and addresses of any injured persons and witnesses. If we show that your failure to provide notice prejudices our defense, there is no liability coverage under this Excess Policy. Such notice should be given to us even if the auto accident, claim or suit is also reported to your primary insurer. 2. A persons seeking any liability coverage must: a. Cooperate with us in the investigation, settlement or defense of any claim or suit. b. Promptly send us copies of all demands, notices, summons, and legal papers received in connection with the auto accident or loss. c. Assume no obligation, make no payment and incur no expenses without our consent, except at your own cost. d. Fully cooperate with us in any investigation we undertake after you advise us of an auto accident. e. Fully cooperate with us if you are sued and/or a suit is brought against you. B. POLICY CHANGES This Excess Policy, your application for insurance and endorsements issued by us, contains all the agreements between you and us. Subject to the following, its terms may not be changed or waived except by an endorsement issued by us. The premium for each covered vehicle is based on information we received from you or other sources. You agree to cooperate with us in determining if this information is correct and complete, and you will notify us if it changes during the policy period. If this information is incorrect, incomplete, or changes during the policy period, we may adjust your premium during the policy period or take other appropriate action. To properly insure your covered vehicle, you must promptly notify us when: 1. Your address or phone number changes. 2. Your covered vehicle is primarily garaged at an address other than the address shown on the Certificate of Insurance. 3. You make physical or mechanical modification to a covered vehicle. You may contact us at the address and phone number listed on the first page of this Excess Policy. C. FRAUD OR MISREPRESENTATION This Excess Policy was issued in reliance upon information you provided on your insurance application. We may deny coverage under this Excess Policy if you or an insured person knowingly concealed or misrepresented any material fact or circumstance, or engaged in fraudulent conduct in connection with this insurance at the time this Excess Policy was issued, or at any time during the policy period. We may deny coverage for any auto accident or loss if you or an insured person knowingly concealed or misrepresented any material fact or circumstance, or engaged in fraudulent conduct in connection with the presentation or settlement of a claim. D. PAYMENT OF PREMIUM If your initial premium payment is by check, draft or remittance other than cash, coverage under this Excess Policy is conditioned upon the check, draft, or FORM CAIC PAGE 6 of 9

7 remittance being honored upon presentment. If the check, draft or remittance is not honored upon presentment, this Excess Policy may, at our option, be deemed void from inception. This means that we will not be liable for any claim or damages which would otherwise be covered if the check, draft or remittance had been honored upon presentation. If you tender a check, draft or remittance to us for any full or partial payment of your premium, other than your initial payment, and the check, draft or remittance is returned to us due to insufficient funds, closed account or stop payment, this Excess Policy may be cancelled for non-payment of premiums. E. LEGAL ACTION AGAINST US 1. No legal action may be brought against us until there has been full compliance with all terms of this Excess Policy. In addition, under Liability Coverage, no legal action may be brought against us until we agree in writing that the insured person has an obligation to pay or the amount of that obligation has been finally determined by judgment after trial. 2. No person or organization has any right under this Excess Policy to bring us into any action to determine the liability of an insured person. F. TRANSFER OF YOUR INTEREST IN THIS EXCESS POLICY 1. Your rights and duties under this Excess Policy may not be assigned without our written consent. However, if the named insured shown in the Certificate of Insurance dies, coverage will be provided for: a. The surviving spouse if resident in the same household at the time of death. Coverage applies to the spouse as if a named insured shown in the Certificate of Insurance. b. The legal representative of the deceased person as if a named insured shown in the Certificate of Insurance. This applies only with respect to the representative s legal responsibility to maintain or use your covered vehicle. G. ENGLISH FORM This Excess Policy is on the CAIC web site in both Spanish and English. In the event of a dispute or suit in the U.S.A., the English version will control and be used for all purposes. The Spanish version is provided for your convenience and ease of reference only. H. REPORTING OF ALL CLAIMS In the event you and/or an insured person is involved in an auto accident and seek benefits under this Excess Policy, please contract CAIC at: Commercial Alliance Insurance Company ( CAIC ) 415 Lockhaven Drive Houston, Texas PART IV - DEFINITIONS The following definitions apply to the terms used in this Excess Policy: 1. AUTO ACCIDENT means a sudden, unexpected, and unintentional event involving one (1) or more vehicles. AUTO has the same meaning as Vehicle for the purposes of this Excess Policy. 2. Bodily injury means bodily harm, or injury to a person or persons, including death, that result directly from an auto accident. 3. Business includes trade, profession, or occupation. 4. Certificate of Insurance or Certificate means the report from us, listing one or more of the following: a. The term of the coverage or policy period; b. The liability excess limit; c. The cost or premium for each covered vehicle; d. The specified vehicle(s) covered by this Excess Policy; e. Other information applicable to this [certificate] Excess Policy. 5. Claimant(s) means those person or persons who make a liability claim for their loss against you and/or an insured as a result of an auto accident. A Claim is the notice to you and/or us of the Claimant s intent to proceed against you for a loss. 6. Collision Coverage is not afforded by this FORM CAIC PAGE 7 of 9

8 Excess Policy. Collision coverage typically provides insurance for the covered vehicle for physical loss to the vehicle. A collision is typically considered an upset or overturn of the covered vehicle, and/or contact with another vehicle. 7. Comprehensive Coverage is not afforded by this Excess Policy. Comprehensive coverage typically covers you for physical damage to the covered vehicle due to such perils or events as falling objects, fire, theft or larceny, explosion/earthquake, windstorm, hail, water or flood, malicious mischief, riot, contact with an animal or bird and/or breakage or cracking of glass due to stones or debris. 8. Covered vehicle means the specifically described vehicle(s) for which a premium charge is shown in the Certificate of Insurance provided to you when this Excess Policy was purchased. To be a covered vehicle it must be either: a. A private passenger auto, or station wagon, registered in Mexico, Canada and/or any country other than the U.S.A.; or b. A pickup or van registered in a country other than the U.S.A. with a Gross Vehicle Weight of 10,000 lbs. or less not used for the delivery or transportation of people for a fee, goods, materials, supplies (other than samples), or any other business. c. Any trailer while drawn by or attached to a covered vehicle. No coverage will be provided for any vehicle not shown in the Certificate of Insurance. 9. Damages means the cost, or amount paid to resolve or settle a loss or the sum by us and/or set by a judicial procedure. 10. Exhaustion means payment by an insurer (usually the Primary Insurer) of its full or entire liability limits as a result of an auto accident. 11. Insured or Insured Person specifically means, unless otherwise defined in this Excess Policy, a permissive operator/driver of the covered vehicle. 12. Loss means sudden, direct, unexpected and unintentional damage from an auto accident, resulting in bodily injury or property damage. 13. Non-Resident means a citizen of a country other than the U.S.A. It also includes any vehicle registered/licensed in a country other than the U.S.A. 14. Occupying means in, on, entering or exiting a vehicle. An Occupant is a person who may also be termed a passenger in a vehicle. 15. Operating means the person who is controlling and/or driving a vehicle at the time of an auto accident. This person may also be called the driver for the purposes of this Excess Policy. 16. Other vehicles means vehicles other than your covered vehicle which you either operate and/or are occupying. An other vehicle cannot be another vehicle you own or lease and which is not otherwise listed in the Certificate. 17. Ownership means the titled or registered owner of a covered vehicle. The titled or registered owner of a vehicle is conclusively the owner for the purposes of this Excess Policy. 18. Primary Insurance means the policy which provides liability coverage to either you and/or the covered vehicle from the first dollar of coverage. Primary insurance also means the required insurance on a vehicle for its operation and use mandated by statute or law in any given State in the U.S.A. 19. Property damage means physical damage, destruction, or loss of use of tangible property due to an auto accident. There is no coverage for property damage to the covered vehicle itself. 20. State means any one (1) of the 50 governmental areas or regions which form the U.S.A. It includes, but is not limited to those states bordering Mexico, such as Texas, Arizona, California and New Mexico. 21. Suit means a civil proceeding in the U.S.A. in which losses for bodily injury or property damage are brought against you or an insured arising out of an auto accident which is covered by this Excess Vehicle Liability Policy. 22. Trailer means a vehicle designed to be pulled FORM CAIC PAGE 8 of 9

9 by a private passenger auto, pickup or van. It does not include a mobile or motorized home, travel trailer, or a commercial/business trailer used as an office, store, restaurant, display, or passenger conveyance. 23. Third-Party means a claimant and/or any other entity who seeks property damages against you and/or an insured as a result of an auto accident. 24. Underlying Insurance means either primary insurance and/or any other insurance which insures the covered vehicle and/or you/insured for an auto accident. 25. U.S.A. is an abbreviation for the United States of America. 26. USD as shown in the Certificate means United States Dollars. 27. Vehicle means a land motor vehicle designed and licensed for travel on public roads. 28. We, Us and Our refer to the company providing this insurance as shown on the Certificate of Insurance. 29. You and Your means the Applicant and/or those persons listed in the Schedule of Drivers shown on the Certificate. If You are Your is a corporation, employee and officers of the company are considered to be You for the operation of the covered vehicle only. There is no excess liability coverage for other vehicles if you is a corporation. In Witness whereof, the Company has caused this Excess Policy to be executed and attested. Secretary President FORM CAIC PAGE 9 of 9