A Quick Guide to this Package

1. Additional Definitions Applicable to Liability Coverage

a. Bodily Injury means bodily injury, sickness or disease, including death resulting therefrom.

b. Property Damage means damage to, or destruction of, tangible property including its loss of use.

2. Coverage

a. You have this coverage only if a premium for it appears on the Policy Declarations.

b. We will

(1) pay damages that an insured becomes legally liable to pay because of

(a) bodily injury to others, and

(b) property damage

caused by accident resulting from the ownership, maintenance, or use of your private passenger auto;

(2) defend any suit against an insured for such damages with attorneys hired and paid by us. We will not defend any suit after we have paid the applicable limit of our liability for the accident that is the basis of the lawsuit;

(3) have the right to investigate, negotiate, and settle any claim or suit.

c. In addition to the limits of liability, we will pay for an insured the costs listed below resulting from such accident:

(1) all defense costs we incur;

(2) interest accruing after a judgment is entered in any suit we defend on behalf of an insured. Our duty to pay interest ends when we pay, offer, or deposit in court the amount due under this coverage;

(3) premiums or costs of bonds

(a) to secure the release of an insured’s property attached under a court order in any suit that we defend on behalf of an insured. The amount of the bond we pay for shall not be more than our limit of liability;

(b) required to appeal a decision in a suit for damages that we defend on behalf of an insured if we have not paid our limit of liability that applies to the suit;

(c) up to $250 for each bail bond needed because of an accident resulting in liability covered under this Policy or a traffic violation related to such accident.

We have no duty to furnish or apply for any bonds.

(4) expense incurred by an insured

(a) for loss of wages or salary up to $50 per day if we ask the insured to attend the trial of a civil suit. We will not pay for loss of other income;

(b) at our request.

d. Other Autos

The Liability Coverage extends to the use, by an insured, of a newly acquired private passenger auto, a temporary substitute private passenger auto, or a nonowned auto.

e. Trailer Coverage

The Liability Coverage extends to a trailer while owned by, leased to, or used by you or your relative.

3. Who Is an Insured

a. For your private passenger auto, a newly acquired private passenger auto, or a temporary substitute private passenger auto, including any trailers attached to such auto, insured means

(1) you;

(2) your relatives;

(3) any other person while using such an auto if its use is with your consent;

(4) any other person or organization legally responsible for the use of such an auto by a person for whom Liability Coverage is afforded.

b. For a nonowned auto, insured means:

(1) you;

(2) your relatives;

(3) any person or organization that does not own or hire the auto but is legally responsible for its use by a person for whom Liability Coverage is afforded.

4. Limits of Liability

a. The amount of Bodily Injury Liability Coverage is shown on the Policy Declarations under Limits of Liability—Bodily Injury, Each Person, Each Accident. The limit stated for Each Person is the maximum amount of coverage for all damages due to bodily injury to one person in any one auto accident. "Bodily injury to one person" includes all injury and damages to others, including but not limited to damages for care, loss of services, or death resulting from this bodily injury. The limit stated for Each Accident is the total amount of coverage, subject to the amount shown under Each Person, for all damages due to bodily injury to two or more persons in the same accident. The amount of Property Damage Liability Coverage is shown on the Policy Declarations under Limits of Liability—Property Damage, Each Accident. The limit stated for Property Damage, Each Accident is the maximum amount of coverage for all property damage resulting from any one auto accident. We will pay damages for which an insured is legally liable up to these bodily injury and property damage limits.

b. The limits of liability are not increased because more than one person or organization may be an insured.

c. An auto and attached trailer are one vehicle. Therefore, the limits are not increased.

5. Exclusions—What Is Not Covered

There is no Liability Coverage for

a. any person for liability arising out of the ownership or operation of any auto while being used as a public or livery conveyance. This exclusion (5.a) does not apply to shared-expense car pools;

b. any person who intentionally causes bodily injury or property damage;

c. any person while using a vehicle without reasonable belief that he or she has a right to do so;

d. any person for property damage to property owned by or being transported by that person;

e. any person for property damage to property rented to, used by, or in the care or custody of that person. However, coverage applies to a residence or private garage damaged by an auto we insure;

f. any person while employed or engaged in any way in the selling, leasing, repairing, servicing, transporting, storing, or parking of land motor vehicles or trailers. For your private passenger auto, a newly acquired private passenger auto, or a temporary private passenger substitute auto, this exclusion (5.f) does not apply to

(1) you or your relatives;

(2) any partner, agent, or employee of you or any relative;

g. any person maintaining or using a nonowned auto in any business, occupation, or profession other than farming or ranching and not described in exclusion 5.f. This exclusion (5.g) does not apply to a private passenger auto or a trailer used with a private passenger auto driven or occupied by you or your relatives;

h. any person for bodily injury to any employee of that person arising out of his or her employment. This exclusion (5.h) does not apply to a household employee who is not covered or required to be covered under any workers’ compensation insurance;

i. any person for bodily injury or property damage for which that person would also be covered under nuclear energy liability insurance issued by American Nuclear Insurers, Mutual Atomic Energy Liability Underwriters, Nuclear Insurance Association of Canada, or their successors. This exclusion (5.i) applies even if the limits of that insurance are exhausted;

j. any person who is a named insured under the terms of a Basic Automobile Insurance Policy issued pursuant to N.J.S.A. 39:6A-3.1 and N.J.A.C.11:3-3. This exclusion (5.j) does not apply to you if you are occupying your private passenger auto, a newly acquired private passenger auto, a temporary substitute private passenger auto, or a nonowned auto.

k. any person for any trailer used for business, occupational, or professional purposes with other than a private passenger auto;

l. any person for any trailer used with an auto that

(1) is owned by or hired by you; and

(2) we do not insure for Liability Coverage.

6. If There Is Other Liability Coverage

a. Basic Automobile Insurance Policies

This Policy provides no Liability Coverage for any person other than you who is a named insured under a Basic Automobile Insurance Policy issued pursuant to N.J.S.A. 39:6A-3.1 and N.J.A.C.11:3-3.

b. Other Liability Coverage Available from Other Sources

If other motor vehicle Liability Coverage applies, we are liable only for our share of the damages. Our share is the percent that the limit of liability of this Policy bears to the total of all motor vehicle Liability Coverage applicable to the accident.

c. Other Liability Coverage Including Temporary Substitute Private Passenger Auto, Nonowned Auto, or Trailer

If a temporary substitute private passenger auto, a nonowned auto, or a trailer designed for use with a private passenger auto

(1) has other vehicle liability coverage on it; or

(2) is self-insured under any motor vehicle financial responsibility law, motor carrier law, or any similar law,

then Liability Coverage under this Policy is excess over such insurance or self‑insurance.

d. Newly Acquired Private Passenger Auto

This coverage does not apply if there is other auto Liability Coverage on a newly acquired private passenger auto that is a pickup, panel truck, van, delivery sedan, or utility automobile.

7. Motor Vehicle Compulsory Insurance Law or Financial Responsibility Law

a. Out‑of‑State Coverage

If an insured under the Liability Coverage is in another state or Canada and, as a nonresident, becomes subject to higher limits than are shown on the Policy Declarations as a result of motor vehicle compulsory insurance, financial responsibility, or similar law

(1) this Policy will be interpreted to give the coverage required by the law; and

(2) the coverage so given replaces any coverage in this Policy to the extent required by the law for the insured’s operation, maintenance, or use of an auto insured under this Policy.

Any coverage so extended shall be reduced to the extent other coverage applies to the accident. In no event shall a person collect for the same elements of loss more than once.

b. Financial Responsibility Law

When certified under any law as proof of future financial responsibility and while required during the policy period, this Policy shall comply with such law to the extent required.

1. Personal Injury Protection Coverage

a. Additional Definitions Applicable to Personal Injury Protection Coverage

For Personal Injury Protection Coverage

(1) Actual Benefits means those benefits determined to be payable for allowable expenses.

(2) Allowable Expenses means medically necessary, reasonable, and customary items of expense covered by the named insured’s or relative’s health insurance benefit plan(s) or by Personal Injury Protection Coverage as an eligible charge. The reasonable monetary value of benefits provided in the form of services shall be considered as both an allowable expense and a paid benefit.

(3) Bodily Injury means bodily injury, sickness or disease, including an identified injury or death resulting therefrom.

(4) Catastrophic Injury Treatment means medically necessary treatment of permanent or significant brain injury, spinal cord injury or disfigurement, or other permanent or significant injuries rendered at a trauma center or acute care hospital immediately following the accident and until the eligible injured person is stable, no longer requires critical care, and can be safely discharged or transferred to another facility in the judgment of the attending physician.

(5) Clinically Supported means that a health care provider, prior to selecting, performing or ordering the administration of a treatment or diagnostic test, has satisfied all of the following requirements:

(a) personally examined the eligible injured person to ensure that the proper medical indications exist to justify ordering the treatment or test;

(b) physically examined the eligible injured person including making an assessment of any current and/or historical subjective complaints, observations, objective findings, neurologic indications, and physical test;

(c) considered any and all previously performed tests that relate to the injury and the results and which are relevant to the proposed treatment or test;

(d) recorded and documented these observations, positive and negative findings, and conclusions on the patient’s medical records.

(6)Death Benefits means the amount or amounts payable in the event of the death of an eligible injured person as determined in subdivision (a) or (b) hereof, as appropriate:

(a) if the eligible injured person was an income producer at the time of the accident, an amount equal to the difference between $5,200 and all income continuation benefits paid for any loss of income resulting from his or her injury prior to his or her death;

(b) if the eligible injured person ordinarily performed essential services for the care and maintenance of himself or herself, his or her family, or family household, an amount not to exceed the difference between $4,380 and all essential services benefits paid with respect to his or her injury prior to death.

(7)Diagnostic Test means a medical service or procedure utilizing biomechanical, neurological, neurodiagnostic, radiological, vascular or any means, other than bioanalysis, intended to assist in establishing a medical, dental, physical therapy, chiropractic or psychological diagnosis, for the purpose of recommending or developing a course of treatment for the tested patient to be implemented by the treating practitioner or by the consultant.

(8) Eligible Charges means that portion of the medical expenses incurred for treatment of bodily injury that, without considering any deductible or copayment, does not exceed

(a) the percent or dollar amounts specified on the medical fee schedules promulgated by the New Jersey Department of Banking and Insurance, or the treating health care provider’s usual, customary and reasonable charge, whichever is less; or

(b) the reasonable amount, as determined by us, considering the medical fee schedules promulgated by the New Jersey Department of Banking and Insurance for similar services or equipment in the region where the service or equipment was provided, when an incurred medical expense is not included on the medical fee schedules promulgated by the New Jersey Department of Banking and Insurance.

(9) Eligible Injured Person means

(a) the named insured or any relative of the named insured, if the named insured or relative sustains bodily injury

(i) as a result of any accident while occupying, using, entering into, or alighting from a private passenger auto; or

(ii) while a pedestrian, caused by a private passenger auto or by an object propelled by or from a private passenger auto; or

(b) any other person who sustains bodily injury while, with the permission of the named insured, occupying, using, entering into, or alighting from the insured automobile.

(10)Emergency Care means all medically necessary treatment of a traumatic injury or a medical condition manifesting itself by acute symptoms of sufficient severity such that absence of immediate attention could reasonably be expected to result in death, serious impairment to bodily functions, or serious dysfunction of a bodily organ or part.

Emergency Care shall include all medically necessary care immediately following an automobile accident, including, but not limited to, immediate pre-hospitalization care, transportation to a hospital or trauma center, emergency room care, surgery, critical and acute care. Emergency care extends during the period of initial hospitalization until the patient is discharged from acute care by the attending physician. Emergency care shall be presumed when medical care is initiated at a hospital within 120 hours of the accident.

(11)Essential Services Benefits means an amount not exceeding a limit of $12 per day and a total limit of $4,380 payable to an eligible injured person as reimbursement for payments made to others for substitute essential services of the type actually rendered during his or her lifetime and that he or she would ordinarily have performed not for income but for the care and maintenance of himself or herself and his or her relatives.

(12)Funeral Expense Benefits means an amount not exceeding $1,000 for reasonable funeral, burial, and cremation expenses incurred.

(13)Health Care Provider means those persons licensed or certified to perform health care treatment or services compensable as medical expenses and shall include, but not be limited to

(a) a hospital or health care facility that is maintained by state or any political subdivision;

(b) a hospital or health care facility licensed by the Department of Health and Senior Services;

(c) other hospitals or health care facilities designated by the Department of Health and Senior Services to provide health care services, or other facilities, including facilities for radiological and diagnostic testing, free-standing emergency clinics or offices, and private treatment centers;

(d) a nonprofit voluntary visiting nurse organization providing health care services other than a hospital;

(e) hospitals or other health care facilities or treatment centers located in other states or nations;

(f) physicians licensed to practice medicine and surgery;

(g) licensed chiropractors;

(h) licensed dentists;

(i) licensed optometrists;

(j) licensed pharmacists;

(k) licensed chiropodists (podiatrists);

(l) registered bioanalytical laboratories;

(m) licensed psychologists;

(n) licensed physical therapists;

(o) certified nurse midwives;

(p) certified nurse practitioners/clinical nurse-specialist;

(q) licensed health maintenance organizations;

(r) licensed orthotists and prosthetists;

(s) licensed professional nurses;

(t) licensed occupational therapists;

(u) licensed speech-language pathologists;

(v) licensed audiologists;

(w) licensed physicians assistants;

(x) licensed physical therapy assistants;

(y) licensed occupational therapy assistants;

(z) providers of other health care services or supplies including durable medical goods.

(14)Identified Injury means those injuries identified by the New Jersey Department of Banking and Insurance as being subject to medical treatment protocols in accordance with N.J.S.A. 39:6A-3.1a and 39:6A-4a.

(15)Income means salary, wages, tips, commissions, fees, and other earnings derived from work or employment.

(16)Income Continuation Benefits means an amount not exceeding a limit of $100 per week and a total limit of $5,200 payable for the loss of income of an income producer during his or her lifetime, as a result of bodily injury disability. In no case shall income continuation benefits exceed the net income normally earned during the period in which the benefits are payable.

(17)Income Producer means a person who, at the time of the accident, was in an occupational status, earning or producing income.

(18)Insured Automobile means an automobile with respect to which the named insured is required to maintain automobile liability insurance coverage under New Jersey statutes, to which the bodily injury liability insurance of this Policy applies and for which a specific premium is charged.

(19)Medical Expense Benefits means the reasonable and necessary expenses for

(a) treatment or services rendered by a provider, including medical, surgical, rehabilitative, and diagnostic services and hospital expenses;

(b) ambulance services or other transportation;

(c) medication;

(d) clinically supported necessary non-medical expenses that are prescribed by a treating medical provider for a permanent or significant brain, spinal cord, or disfiguring injury.

Necessary nonmedical expense means charges for

(i) products and devices, not exclusively used for medical purposes or as durable medical equipment, such as any vehicles, durable goods, equipment, appurtenances, improvements to real or personal property, fixtures;

(ii) services and activities such as recreational activities, trips, and leisure activities.

Medical expenses include any nonmedical remedial treatment rendered in accordance with a recognized religious method of healing.

Medical expense benefits are subject to the limitations set forth in the Policy and as approved by the Commissioner of Banking and Insurance.

(20)Medically Necessary or Medical Necessity means that the medical treatment or diagnostic test is consistent with the clinically supported symptoms, diagnosis, or indications of the injured person, and

(a) the treatment is the most appropriate standard or level of service that is in accordance with standards of good practice and standard professional treatment protocols, as such protocols may be recognized or designated by the Commissioner of Banking and Insurance;

(b) the treatment of the injury is not primarily for the convenience of the injured person or provider;

(c) does not include unnecessary or inappropriate testing or treatment.

(21)Named Insured means the person or organization named as the insured on the Policy Declarations, and if an individual, named insured includes his or her spouse if the spouse is a resident of the household of the named insured. If the spouse ceases to be a resident of the named insured’s household, Personal Injury Protection Coverage will continue for the spouse until the end of the policy period in effect at the time he or she ceased to be a resident of such household.

If the insured automobile is owned by a farm family copartnership or corporation, the term named insured also includes the head of the household of each family designated in this Policy as having a working interest in the farm.

(22)Pedestrian means any person who is not occupying, entering into, or alighting from a vehicle propelled by other than muscular power and designed primarily for use on highways, rails, and tracks.

b. Insuring Agreement

(1) You have this coverage only if a premium for it appears on the Policy Declarations.

(2) We will pay Personal Injury Protection Coverage benefits consisting of

(a) medical expense benefits,

(b) income continuation benefits,

(c) essential services benefits,

(d) death benefits,

(e) funeral expense benefits,

with respect to bodily injury sustained by an eligible injured person, caused by an accident and arising out of the ownership, maintenance, or use, including loading or unloading, of a private passenger auto as an automobile.

c. Limit of Liability

(1) Medical Expense Benefits

(a) Limit

The following per person, per accident limit of liability for medical expense benefits applies:

(i) For the named insured and relatives, who are not named insureds under another policy, the limit is shown on the Policy Declarations. However, for a catastrophic injury treatment, the available limit of coverage will be an amount not to exceed $250,000.

(ii) For all other eligible injured persons, the limit is $250,000.

(iii)Under no circumstances will more than $250,000 in medical expense benefits be paid for any one person for any accident involving catastrophic injury treatment.

(b) Limitation Set by Medical Fee Schedule

Payments of medical expense benefits shall not exceed the applicable amount set forth in any medical fee schedule promulgated by the New Jersey Department of Banking and Insurance for specific injuries or services. If a claimed eligible charge is not included on the medical fee schedule, payment will be determined by us, on a reasonable basis, considering the medical fee schedules for similar services or equipment in the region where the service or equipment was provided.

(c) Co-payment

Our payment of medical expense benefits is subject on a per accident basis to a co-payment of 20% of the medical expense benefits between the deductible amount and $5,000.

(d) Deductible

The amount shown in the Medical Expense Benefits Deductible section on the Policy Declarations is the deductible amount that applies to medical expense benefits payable to the named insured and relatives, who are not named insureds under another policy. A $250 deductible applies for medical expense benefits payable to any other eligible injured person. Only one deductible amount applies to each accident.

(e) Primary Health Insurance Option

(i) If the Policy Declarations indicate that the Primary Health Insurance Option has been elected

a) any health insurance coverage or benefits applying to the named insured and relatives shall be the primary coverage for medical expense benefits for allowable expenses. Personal Injury Protection Coverage will apply as secondary coverage for medical expense benefits that remain uncovered. An explanation of benefit payment calculations when Personal Injury Protection Coverage is secondary is given below in the Coordination of Benefits provision.

b) However, if it is determined that the health insurance certified by the named insured, or another comparable plan, was not in effect at the time of the accident then

1) the terms and conditions applicable if the Primary Health Insurance Option had not been elected on the Policy Declarations will apply;

2) an additional $750 deductible per accident will apply to the medical expense benefits;

3) we will be entitled to recover as additional premium the total amount of any reduction applied to the premium for the policy period in which the accident occurred, due to the insured’s election of the Primary Health Insurance Option.

(ii) If the Policy Declarations indicate that the Primary Health Insurance Option has not been elected to provide primary coverage, Personal Injury Protection Coverage shall be the primary coverage for medical expense benefits payable to the named insured and relatives, who are not named insureds under another policy.

(iii) Health insurance includes individual, blanket, or group accident insurance; medical or surgical reimbursement plans; health care services provided by a health maintenance organization; or any coverage or benefits provided under any federal or state program.

(iv) Coordination of Benefits

a) When this coverage applies as primary, we will pay medical expense benefits without reduction for amounts collected from health insurance coverage.

b) When this coverage applies as secondary, we will pay actual benefits to be calculated as follows:

1) We will first determine the amount of eligible charges which would have been paid under this coverage after application of the deductible and co-payment requirements, if this coverage applied as primary.

2) If the allowable expenses that remain unpaid by the health insurance that applies as primary are less than the benefits calculated in 1) above, we will pay actual benefits equal to the allowable expenses that remain unpaid, without reducing the remaining allowable expenses by the deductible or co-payment amounts of Personal Injury Protection Coverage.

In determining the allowable expenses that remain unpaid, we shall not consider any amount for items of expense which exceed the dollar or percent amounts recognized by the medical fee schedules promulgated by the New Jersey Department of Banking and Insurance.

3) If the allowable expenses that remain unpaid by the health insurance that applies as primary are greater than the amount calculated in 1) above, without reducing the remaining allowable expenses by the deductible or co-payment amounts of this coverage, we will pay the amount calculated in 1) above.

c) The total amount of medical expense benefits for the named insured or any relative per accident shall not exceed the maximum amount payable for medical expense benefits under this Policy.

(2) Income Continuation Benefits

The applicable limit on income continuation benefits applies separately to each full regular and customary work week of an eligible injured person. We will prorate the limit of liability shown in the Policy Declarations for weekly income continuation benefits for any period of bodily injury disability shorter than one week.

(3) Medical Expense Benefits Only Option

If the Policy Declarations indicate that the Medical Expense Benefits Only Option has been elected, there is no coverage for the named insured and relatives for any benefit provided by Personal Injury Protection Coverage except medical expense benefits.

(4) Reduction of Personal Injury Protection Coverage Benefits

Any amount payable by us as Personal Injury Protection Coverage benefits with respect to bodily injury shall be reduced by all amounts

(a) paid, payable, or required to be provided under any workers’ compensation or employees’ temporary disability law; or

(b) paid, payable, or required to be provided under Medicare provided under federal law; or

(c) actually paid as benefits provided under federal law to active and retired military personnel.

d. Exclusions

(1) Personal Injury Protection Coverage does not apply

(a) to bodily injury to a person whose conduct contributed to the injury in any of the following ways:

(i) while committing a high misdemeanor or felony or seeking to avoid lawful apprehension or arrest by a police officer; or

(ii) while acting with specific intent to cause injury or damage to himself or herself or others.

(b) to bodily injury to the named insured or any relative of the named insured sustained while occupying, using, entering into, or alighting from a private passenger auto which is not an insured automobile under this Policy, if he or she is required to maintain automobile liability insurance coverage with respect to the automobile under New Jersey statutes.

(c) to bodily injury to any person who at the time of the accident

(i) was the owner or registrant of a private passenger auto registered or principally garaged in New Jersey that was being operated without Personal Injury Protection Coverage; or

(ii) was operating or occupying a private passenger auto without the permission of the owner or other named insured.

(d) to bodily injury to any person who is not occupying an insured automobile if the accident occurs outside of New Jersey. This exclusion (d(1)(d)) does not apply to

(i) the named insured; or

(ii) a relative of the named insured; or

(iii) a resident of New Jersey.

(e) to bodily injury arising out of the ownership, maintenance, or use, including loading or unloading, of any vehicle while located for use as a residence or premises other than for transitory recreational purposes.

(f) to bodily injury due to war, whether or not declared, civil war, insurrection, rebellion, or revolution, or to any act or condition incident to any of the foregoing.

(g) to bodily injury resulting from the radioactive, toxic, explosive, or other hazardous properties of nuclear material.

(h) to bodily injury to any person who is entitled to New Jersey Personal Injury Protection Coverage as a named insured or relative under the terms of any other policy. This exclusion (d.(1)(h)) does not apply to the named insured under this Policy.

(i) to bodily injury to any relative who is entitled to New Jersey Personal Injury Protection Coverage as a named insured under the terms of another policy.

(j) to bodily injury to any person who is a named insured under the terms of a Basic Automobile Insurance Policy issued pursuant to N.J.S.A. 39:6A-3.1 and N.J.A.C. 11:3-3.

(2) We do not provide Personal Injury Protection Coverage with respect to those diagnostic tests prohibited by the New Jersey Department of Banking and Insurance or by statute or regulation.

e. Mandated Medical Expense Conditions

(1) Voluntary Networks

(a) Upon receiving notification of bodily injury covered under this Policy, we will make available to the named insured and the treating health care provider information about our approved voluntary network providers for certain types of testing, durable medical equipment, or prescription drugs.

(b) If an eligible injured person does not use a voluntary network provider, we will impose a co-payment not to exceed 30% of the eligible charges for medically necessary diagnostic tests, durable medical equipment, or prescriptions.

(2) Care Paths for Identified Injuries

(a) The New Jersey Department of Banking and Insurance has established standard courses of medically necessary treatment including diagnostic tests for identified injuries that are reimbursable by medical expense benefits. These standard treatments and practices are based on the diagnosed injury and are known as care paths.

Care paths do not apply to treatment administered during emergency care.

(b) We will advise an eligible injured person of the care path requirements established by the New Jersey Department of Banking and Insurance upon receiving notice of a bodily injury covered under this Policy.

(c) Within the care paths, certain treatments and diagnostic tests are subject to the Decision Point Review Plan and precertification requirements. The administration of any test listed in N.J.A.C. 11:3-4.5(b) 1-10 also requires decision point review, regardless of the diagnosis.

(d) Medical care provided to persons injured in auto accidents that is consistent with the care paths will be reimbursable by the Personal Injury Protection Coverage medical expense benefits. Medical care that deviates from these care paths will not be reimbursable except by reason of specific medical necessity based upon adequate clinically supported findings in the particular case. Medical treatments, diagnostic tests, or durable medical equipment that are not medically necessary will not be reimbursable through Personal Injury Protection Coverage.

(3) Decision Point Review Plan and Precertification

The following Decision Point Review Plan and precertification requirements are applicable only after the tenth day following the accident, and do not apply to treatment administered in emergency care:

(a) Upon receipt of notice of bodily injury covered under this Policy, we will make available to the eligible injured person our Decision Point Review Plan and precertification requirements, if any.

(b) If the eligible injured person requests either

(i) a decision point review; or

(ii) precertification of certain diagnostic tests, specific proposed treatment, non-medical expenses, or durable medical equipment;

we will provide a written authorization, denial, or request for more information within three business days.

(c) We must be provided with the appropriate clinically supported findings, that the administration of a test allowable by the New Jersey Department of Banking and Insurance, proposed treatments, non-medical expenses, or durable medical equipment is medically necessary.

(d) During our review of the information required in paragraph (3)(c) above, we may

(i) approve the proposed treatment, test, nonmedical expense, or durable medical equipment;

(ii) request further information;

(iii) schedule a physical examination of the injured person in accordance with (g) below where the notice and supporting materials and other medical records, if requested, are not sufficient to authorize or deny reimbursement of further treatment, diagnostic tests or durable medical equipment; and/or

(iv) deny reimbursement of further treatment, diagnostic tests, nonmedical expense, or durable medical equipment pursuant to N.J.A.C. 11:3-4.7(b).

(e) After consideration of the further information and/or physical examination, we will then authorize or deny reimbursement for the treatment, tests, nonmedical expense, or durable medical equipment. Our authorization or denial will be based on medical necessity and will not encourage over or under utilization of benefits.

(f) Any denial of decision point review or precertification requests based on medical necessity will be the determination of a physician. If the treatment is prescribed by a dentist, any denial will be determined by a dentist.

(g) Physical Examination

(i) We will notify the eligible injured person or his or her designee if a physical examination is required for reimbursement of further treatment, diagnostic tests, or durable medical equipment.

(ii) The medical examination will be

a) scheduled within seven calendar days of receipt of the notice described above unless the eligible injured person agrees to extend the time period;

b) conducted by a health care provider similar to the treating health care provider;

c) conducted at a location reasonably convenient to the eligible injured person.

(iii)Upon our request, the treating health care provider or the eligible injured person will provide medical records and other pertinent information to the health care provider conducting the medical examination. The requested records will be provided no later than the time of the examination.

(iv) We may deny reimbursement of further treatment, testing or use of durable medical equipment for an eligible injured person’s or “insured person’s” repeated unexcused failure to appear for a physical examination required by us in accordance with our plan.

(v) We will notify the eligible injured person, his or her designee, and the treating health care provider whether reimbursement for further treatment, diagnostic tests, or durable medical equipment is authorized as promptly as possible but no later than three business days after the examination.

A copy of the health care provider’s report, if prepared, is available upon request.

(h) Penalty

If the eligible injured person fails to

(i) request a decision point review or precertification where required; or

(ii) provide clinically supported findings that support the treatment, diagnostic tests or durable medical equipment;

we will impose an additional co-payment not to exceed 50 percent of the eligible charges for medically necessary diagnostic tests, treatments, surgery, durable medical goods, and non-medical expenses that were provided between the time notification to us was required and the time that proper notification is made and we have an opportunity to respond in accordance with our Decision Point Review Plan.

We will not impose the additional co-payment where we received the required notice but failed to act in accordance with the Decision Point Review Plan to request further information, to modify or deny reimbursement of further treatment, diagnostic tests, or durable medical equipment.

f. Conditions

(1) Notice

In the event of an accident, written notice containing both particulars sufficient to identify the eligible injured person, and reasonably obtainable information respecting the time, place, and circumstances of the accident shall be given by or on behalf of each eligible injured person to us within 29 days following the accident.

If any eligible injured person, his or her legal representative, or survivors shall institute legal action to recover damages for injury against a person or organization who is or may be liable in tort therefore, a copy of the summons and complaint or other process served in connection with such legal action shall be forwarded to us promptly by such eligible injured person, his or her legal representative, or his or her survivors.

(2) Medical Reports; Proof of Claim

Within 29 days following the accident, the eligible injured person or someone on his or her behalf shall give to us written proof of claim, including full particulars of the nature and extent of the injuries and treatment received and contemplated, and such other information as may assist us in determining the amount due and payable. The eligible injured person shall submit to physical examination by physicians when and as often as we may reasonably require and a copy of the medical report will be forwarded to such eligible injured person if requested.

(3) Penalty

If an eligible injured person fails to provide us with notice, proof of claim and other reasonably obtainable information regarding an injury or claim, we may impose an additional co-payment as a penalty. The additional co-payment shall be an amount no greater than:

(a) 25 percent when notification is received 30 to 59 days after the accident; or

(b) 50 percent when notification is received 60 days or more after the accident.

Such co-payment will reduce the amount reimbursed for eligible charges that are incurred after notification to us is required and until we received notification.

Any reduction in the amount of reimbursement in eligible charges shall be in addition to any other deductible or co-payment requirement.

(4) Multiple Policies Applicable to One Accident; Nonduplication of Benefits; Priority of Complying Policies

This Policy provides no Personal Injury Protection Coverage benefits for a person who is a named insured under a Basic Automobile Insurance Policy issued pursuant to N.J.S.A. 39:6A-3.1 and N.J.A.C. 11:3-3.

Regardless of the number of automobiles insured for Personal Injury Protection Coverage pursuant to Section 4 of the New Jersey Automobile Reparation Reform Act, or the number of insurers or policies affording such coverage, there shall be no duplication of payment of Personal Injury Protection Coverage benefits and the aggregate maximum amount payable under this and all applicable policies with respect to bodily injury to any one person as the result of any one accident shall not exceed the applicable amounts or limits specified in Section 4 of said Act.

Personal Injury Protection Coverage applies on a primary basis to bodily injury to the named insured and his or her relative and on a secondary basis to all other eligible injured persons. Similarly, the Personal Injury Protection Coverage provided by other complying policies applies on a primary basis to bodily injury to those persons who are named insureds under such policies and their relatives. If an eligible injured person to whom Personal Injury Protection Coverage applies on a secondary basis has other Personal Injury Protection Coverage under another complying policy applicable to his or her bodily injury on a primary basis, all claims for Personal Injury Protection Coverage benefits shall first be made against the insurer issuing the other complying policy. No Personal Injury Protection Coverage benefits shall be due and payable under Personal Injury Protection Coverage unless the other insurer fails to pay such benefits by reason of insolvency and we have been given written notice by the claimant of such failure. “Complying Policy” means a policy of automobile liability insurance maintained pursuant to the requirements of Section 3 of the New Jersey Automobile Reparation Reform Act and providing Personal Injury Protection Coverage as approved by the Department of Banking and Insurance.

The eligible injured person shall not collect under more than one policy. If an eligible injured person under this Policy qualifies for payments under other policies providing Personal Injury Protection Coverage benefits, the insurer paying benefits to such person shall be entitled to recover from each of the other insurers an equitable pro rata share of the benefits paid. The pro rata share is the proportion that the insurer’s liability bears to the total of all applicable limits. Any deductible amounts applicable shall be taken into consideration in determining each insurer’s pro rata share.

(5) Reimbursement and Trust Agreement

Subject to any applicable limitations set forth in the New Jersey Automobile Reparation Reform Act, in the event of any payment to any person under Personal Injury Protection Coverage

(a) we shall be entitled to the extent of such payment to the proceeds of any settlement or judgment that may result from the exercise of any rights of recovery of such person against any person or organization legally responsible for the bodily injury because of which such payment is made; and we shall have a lien to the extent of such payment. Notice of our lien may be given to the person or organization causing such bodily injury, his or her producer of record, his or her insurer, or a court having jurisdiction in the matter;

(b) such person shall hold in trust for our benefit all rights of recovery that he or she shall have against such other person or organization because of such bodily injury;

(c) such person shall do whatever is proper to secure and shall do nothing after loss to prejudice such rights;

(d) such person shall execute and deliver to us such instruments and papers as may be appropriate to secure the rights and obligations of such person and us established by this provision.

(6) Payment of Personal Injury Protection Coverage Benefits

Medical expense benefits and essential services benefits may be paid at our option to the eligible injured person or the person or organization furnishing the products or services for which such benefits are due. These benefits shall not be assignable except to providers of service benefits who comply with the care paths, precertification and decision point review requirements of this Policy. The first recourse for disputes regarding payment of Personal Injury Protection Coverage for assignees of benefits shall be the procedures specified in paragraph 3 of this Section.

In the event of the death of an eligible injured person, any amounts payable, but unpaid prior to death, for medical expense benefits are payable to the eligible injured person’s estate.

Benefits payable under subdivision (a) of the definition of death benefits are payable to the eligible injured person’s surviving spouse, or if there is no surviving spouse, to his or her surviving children, or if there are no surviving spouse or surviving children, to the eligible injured person’s estate.

Benefits payable under subdivision (b) of the definition of death benefits are payable to the person who has incurred the expense of providing essential services.

Funeral expense benefits are payable to the eligible injured person’s estate.

(7) Our Right to Apply for Employee Benefits

If an eligible injured person has not applied for workers’ compensation or employees’ temporary disability benefits, we may immediately apply directly to the provider of such benefits for reimbursement of benefits paid under this coverage.

(8) Proof of Health Benefits Plan Coverage

If you have elected the Medical Expense Benefits‑As‑Secondary option, you must provide proof that you and your relatives are insured by health insurance coverage or benefits in a manner and to an extent approved by the New Jersey Department of Banking and Insurance.

g. Policy Period; Territory

Personal Injury Protection Coverage applies only to accidents that occur during the policy period anywhere in the world.

2. Extended Medical Expense Benefits Coverage

a. Definitions

The definitions under Personal Injury Protection Coverage apply to Extended Medical Expense Benefits Coverage, and under Extended Medical Expense Benefits Coverage.

(1) Highway Vehicle means a land motor vehicle or trailer other than

(a) a private passenger auto;

(b) a farm type tractor or other equipment designed for use principally off public roads, while not upon public roads;

(c) a vehicle operated on rails or crawler‑treads; or

(d) a vehicle while located for use as a residence or premises.

(2) Insured Person means

(a) the named insured or any relative of the named insured, if the named insured or relative sustains bodily injury

(i) while occupying, using, entering into, or alighting from a highway vehicle; or

(ii) while a pedestrian, caused by a highway vehicle;

(b) any other person who sustains bodily injury while occupying a highway vehicle (other than a motorcycle or a vehicle while being used as a public or livery conveyance) if such highway vehicle is being operated by the named insured or a relative of the named insured or any other person using such highway vehicle with the permission of the named insured;

(c) any other person who sustains bodily injury while occupying an insured automobile if such insured automobile is being operated by the named insured or a relative of the named insured or any other person using such insured automobile with the permission of the named insured.

b. Insuring Agreement

(1) You have this coverage only if a premium for it appears on the Policy Declarations.

(2) We will pay medical expense benefits not to exceed the total aggregate amount stated on the Policy Declarations with respect to bodily injury sustained by an insured person, caused by an accident occurring during the policy period anywhere in the world and arising out of the ownership, maintenance, or use, including loading and unloading, of an insured automobile or of a highway vehicle not owned by or furnished or available for the regular use of the named insured or any relative of the named insured.

c. Limit of Liability

The limit of our liability under Extended Medical Expense Benefits for each person entitled to benefits who sustains bodily injury in any one accident shall not exceed the amount shown in the Extended Medical Expense Limit section on the Policy Declarations.

No eligible injured person will recover duplicate benefits for the same elements of loss under Personal Injury Protection Coverage.

d. Exclusions

(1) Extended Medical Expense Benefits Coverage is subject to all of the exclusions applicable to Personal Injury Protection Coverage except that the word “person” in exclusion 1.d.(1)(c) is replaced by the word pedestrian.

(2) The following exclusions also apply to Extended Medical Expense Benefits Coverage:

(a) Extended Medical Expense Benefits Coverage does not apply to any insured who would be entitled to benefits under Personal Injury Protection Coverage except for the application of the medical fee schedule promulgated by the New Jersey Department of Banking and Insurance.

(b) Extended Medical Expense Benefits Coverage does not apply to any person, other than the named insured or a relative of the named insured or a resident of New Jersey, if the accident occurs outside of New Jersey.

e. Conditions

Conditions (1), (2), (5), and (8) of Personal Injury Protection Coverage apply to Extended Medical Expense Benefits Coverage, substituting the term insured person for eligible injured person wherever it appears therein. The following additional condition applies under Extended Medical Expense Benefits Coverage:

Other Insurance or Benefits

Extended Medical Expense Benefits Coverage does not apply to loss or expense with respect to which an insured person is entitled to benefit under any Medicare provided under federal law, any workers’ compensation law, or under Section 4 of the New Jersey Automobile Reparation Reform Act.

Extended Medical Expense Benefits Coverage does not apply to loss or expense to the extent that benefits are payable or are required to be provided therefore under any other automobile no‑fault law or under any other automobile medical payments insurance.

Extended Medical Expense Benefits Coverage does not apply to amounts not paid under the New Jersey No‑Fault Law because of the application of the deductible or co-payment stated in the Limit of Liability provision for Personal Injury Protection Coverage.

3. Dispute Resolution

The New Jersey Department of Banking and Insurance established procedures for the resolution of disputes concerning the payment of medical expense and other benefits provided by Personal Injury Protection Coverage.

A request for dispute resolution for Personal Injury Protection Coverage may be submitted by the injured party, the insured, a provider of service benefits who is an assignee of Personal Injury Protection Coverage benefits, or the insurer in accordance with New Jersey Law. The request for dispute resolution may include a request for review by a medical review organization.

1. Additional Definitions Applicable to Uninsured and Underinsured Motorist Coverage

a. Bodily Injury means bodily injury, sickness or disease, including death resulting therefrom.

b. Underinsured Motor Vehicle means

(1) For you and any insured who is not insured as a named insured, spouse, or relative under any other policy providing Uninsured and Underinsured Motorist Coverage:

a land motor vehicle or trailer, the ownership, maintenance, or use of which is insured or bonded for bodily injury and property damage liability at the time of the accident, but the limits of liability are less than the limits you carry for Uninsured and Underinsured Motorist Coverage under this Policy.

(2) For any insured who is insured as a named insured, spouse, or relative under any other policy providing Uninsured and Underinsured Motorist Coverage:

a land motor vehicle or trailer, the ownership, maintenance, or use of which is insured or bonded for bodily injury and property damage liability at the time of the accident, but the limits of liability are less than the highest applicable limit of liability under any other policy providing Uninsured and Underinsured Motorist Coverage to that insured as a named insured, spouse, or relative.

An underinsured motor vehicle does not include

(1) an uninsured motor vehicle;

(2) a land motor vehicle or trailer that is owned by, or leased to, or furnished for the regular use of

(a) you; or

(b) any relative; or

(c) a resident of your household;

(3) a land motor vehicle or trailer

(a) owned or operated by a self-insurer under any motor vehicle financial responsibility law, motor carrier law, or any similar law;

(b) owned by any government or any of its political subdivisions or agencies;

(c) designed for use mainly off public roads except while on public roads;

(d) used as a residence or stationary structure;

(e) operated on rails or crawler treads.

c. Uninsured Motor Vehicle means

(1) a land motor vehicle or trailer, the ownership, operation, maintenance, or use of which is

(a) not insured or bonded for bodily injury and property damage liability at the time of the accident; or

(b) insured or bonded for bodily injury and property damage liability at the time of the accident, but the insuring company denies coverage or is or becomes insolvent, or the Commissioner of Banking and Insurance has undertaken control of the insurer for purposes of liquidation; or

(2) with respect to bodily injury, a hit-and-run land motor vehicle whose owner and driver remains unknown and

(a) that strikes

(i) the insured; or

(ii) the vehicle the insured is occupying;

and causes bodily injury to an insured; or

(b) that causes bodily injury to the insured without striking the insured or the vehicle the insured is occupying.

(3) an auto covered by a New Jersey Special Automobile Insurance Policy.

An uninsured motor vehicle does not include

(1) an underinsured motor vehicle;

(2) a land motor vehicle or trailer that is owned by, or leased to, or furnished for the regular use of

(a) you; or

(b) any relative; or

(c) a resident of your household;

(3) a land motor vehicle or trailer

(a) owned or operated by a self-insurer under any motor vehicle financial responsibility law, motor carrier law, or any similar law;

(b) owned by any government or any of its political subdivisions or agencies;

(c) designed for use mainly off public roads except while on public roads;

(d) used as a residence or stationary structure;

(e) operated on rails or crawler treads;

(f) insured under the terms of a Basic Automobile Insurance Policy issued pursuant to N.J.S.A. 39:6A-3.1 and N.J.A.C. 11:3-3.

2. Coverage

a. You have this coverage only if a premium for it is shown on the Policy Declarations.

b. We will pay damages for bodily injury or property damage an insured person is legally entitled to collect from the owner or operator of an uninsured motor vehicle or underinsured motor vehicle because of

(1) bodily injury sustained by an insured person,

(2) damage to or destruction of

(a) your private passenger auto or your owned trailer;

(b) a newly acquired private passenger auto;

(c) a temporary substitute private passenger auto;

(d) property owned by

(i) you or any relative while in

a) your private passenger auto or your owned trailer;

b) a newly acquired private passenger auto;

c) a temporary substitute private passenger auto; or

(ii) any other insured while in your private passenger auto, a newly acquired private passenger auto, or temporary substitute private passenger auto.

The bodily injury or property damage must be caused by an accident arising out of the ownership, maintenance, or use of an uninsured motor vehicle or underinsured motor vehicle. This coverage does not apply to the first $500 of the total amount of all property damage as the result of any one accident.

c. We will pay any amount due

(1) to the insured;

(2) to a parent or guardian if the insured is a minor;

(3) to the surviving spouse;

(4) at our option, to a person authorized by law to receive such payment.

d. We are not bound by any judgment against any person or organization resulting from any suit brought without our written consent.

e. Any amount payable under this coverage shall be reduced by any outstanding premium that is owed by you to us for this Policy.

3. Who Is An Insured

The following are insureds:

a. you;

b. your relatives;

c. any other person while occupying your private passenger auto, a temporary substitute private passenger auto, a newly acquired private passenger auto or a trailer attached to such auto. Such vehicle has to be used with your consent.

d. any person entitled to recover damages because of bodily injury to an insured under paragraphs a through c above.

4. Determining Liability and Damages

a. Two questions must be decided by agreement between the insured and us:

(1) Is the insured legally entitled to collect damages from the owner or driver of the uninsured motor vehicle or underinsured motor vehicle?

(2) If so, in what amount?

b. If there is no agreement, these questions shall be decided by arbitration upon written request of the insured or us. Each party shall select a competent and impartial arbitrator. These two shall select a third one. If unable to agree on the third one within 30 days either party may request a judge of a court of record in the county in which the arbitration is pending to select a third one.

c. The cost of the arbitrator and any expert witness shall be paid by the party who hired them. The cost of the third arbitrator and other expenses of arbitration shall be shared equally by both parties.

d. The arbitration shall take place in the county in which the insured resides unless the parties agree to another place. Local rules of law as to procedure and evidence will apply.

e. The written decision of any two arbitrators as to the questions specified in paragraph 4.a above shall be binding on each party unless the amount of the damages awarded exceeds the minimum limit of liability specified by the financial responsibility law of New Jersey. If the amount of the damages exceeds that limit, either party may, within 60 days of the arbitrators’ decision, demand a trial. If the demand is not made, the decision of the arbitrators is binding on each party.

5. Limits of Liability

a. Bodily Injury

The limit shown on the Policy Declarations under Uninsured and Underinsured Motorist Coverage for bodily injury is the maximum amount of coverage for all damages due to bodily injury to one person in any one accident. Bodily injury to one person includes all injury and damages to others resulting from this bodily injury. The limit shown under Uninsured and Underinsured Motorist Coverage for Each Accident is the maximum amount of coverage, subject to the amount shown under each person, for all damages due to bodily injury to two or more persons in the same accident.

b. Property Damage

The limit shown on the Policy Declarations under Uninsured and Underinsured Motorist Coverage for Property Damage, Each Accident is the maximum amount of coverage for all property damage sustained by all insureds as the result of one accident.

c. However, subject to our maximum limit of liability for this coverage, for an insured other than you that is insured as a named insured, spouse, or relative under one or more policies providing Uninsured and Underinsured Motorist Coverage at a limit of liability less than our limit of liability, our limit of liability shall not exceed the highest applicable limit under any policy providing Uninsured and Underinsured Motorist Coverage to that insured as a named insured, spouse, or relative. For an insured other than you or your relative, who is not insured as a named insured, spouse or relative under a policy providing Uninsured and Underinsured Motorists Coverage, our limit of liability is $15,000 for all damages due to bodily injury to one person in any one accident, $30,000 for all damages due to bodily injury to two or more persons in the same accident, and $5,000, subject to a $500 deductible, for all property damage sustained as the result of one accident.

d. Any amount payable for economic loss under this coverage shall be reduced by the amount of any

(1) Personal Injury Protection benefits;

(2) additional Personal Injury Protection benefits;

paid or payable under this or any other motor vehicle insurance policy.

e. Any amount payable under this coverage as the result of an accident involving an uninsured motor vehicle shall be reduced by any amount paid to or for the insured

(1) by or for any person or organization who is or may be held legally liable for the bodily injury to the insured or the property damage; or

(2) under any Comprehensive or Collision Coverage of this Policy.

f. Any payment made to a person under this coverage as the result of an accident involving an uninsured motor vehicle shall reduce any amount payable to that person under the Liability Coverage.

g. The most we will pay as the result of an accident involving an underinsured motor vehicle will be the lesser of

(1) the difference between the applicable limit of liability of this coverage and the amount paid to the insured in damages by or for any person or organization who may be legally liable for the bodily injury or property damage; or

(2) the amount of damages for bodily injury or property damage sustained by but not recovered by the insured.

h. The limits of liability are not increased because

(1) more than one person is insured at the time of the accident;

(2) more than one auto is insured for this coverage under this Policy;

(3) more than one underinsured motor vehicle is involved in the same accident.

i. No injured person will recover duplicate benefits for the same elements of loss under this or any other uninsured motorists insurance, including approved plans of self-insurance.

6. Exclusions—What Is Not Covered

There is no coverage

a. for any person

(1) if that person or the legal representative without our written consent, settles a claim with the owner or operator of an uninsured motor vehicle or underinsured motor vehicle who may be liable for the bodily injury or property damage; or

(2) if that person or the legal representative without prior written notice to us, settles with any other person or organization who may be liable for the bodily injury or property damage;

b. for damages for pain, suffering, and non-economic damages resulting from bodily injury caused by an accident involving an uninsured motor vehicle, unless the injured person has a legal right to recover damages for such pain, suffering, and non-economic damages allowed under New Jersey law. The injured person’s legal right to recover non-economic damages allowed under New Jersey law will be determined by the liability tort limitation, if any, applicable to that person;

c. to the extent it benefits

(1) any workers’ compensation or disability benefits insurance company;

(2) a self-insurer under any workers’ compensation, disability benefits, or similar law;

(3) directly or indirectly any insurer of property;

d. for property damage arising out of the ownership, maintenance, or use of a hit-and-run vehicle;

e. for any person while using a vehicle without reasonable belief that he or she has a right to do so;

f. for punitive or exemplary damages;

g. for any person who is a named insured under the terms of a Basic Automobile Insurance Policy issued pursuant to N.J.S.A. 39:6A-3.1 and N.J.A.C. 11:3-3. This exclusion (6.g) does not apply to you if you are occupying your private passenger auto, a newly acquired private passenger auto, a temporary substitute private passenger auto, or a nonowned auto.

h. for any relative who is also insured as a relative under the terms of a Basic Automobile Insurance Policy issued pursuant to N.J.S.A. 39:6A-3.1 and N.J.A.C. 11:3-3. This exclusion (6.h) does not apply if your relative is occupying your private passenger auto, a newly acquired private passenger auto, or a temporary substitute private passenger auto.

i. for any person occupying a motor vehicle that he or she owns for which he or she has failed to maintain required insurance coverage under New Jersey statutes and regulations;

j. for bodily injury or property damage to any person occupying an auto while used as a public or livery conveyance. This exclusion (6.j) does not apply to shared-expense car pools.

7. If There Is Other Uninsured and Underinsured Motorist Coverage

a. If the insured sustains bodily injury and other Uninsured and Underinsured Motorist Coverage applies, the total limits of liability under all such coverages shall not exceed that of the coverage with the highest limit of liability for any one vehicle.

b. However, for an insured other than you that is insured as a named insured, spouse, or relative under one or more policies providing Uninsured and Underinsured Motorist Coverage, the total limits of liability under all such Uninsured and Underinsured Motorist Coverage for that insured shall not exceed the highest applicable limit under any policy providing Uninsured and Underinsured Motorist Coverage to that insured as a named insured, spouse, or relative.

c. We are liable only for our share. Our share is that percent of the damages that the limit of liability of this coverage bears to the total of all Uninsured and Underinsured Motorist Coverage applicable to the accident.

d. For a nonowned auto this coverage is excess over any other collectible insurance.

1. Additional Definitions Applicable to Comprehensive and Collision Coverages

a. Camper Body means a body designed for use as temporary living quarters and constructed as a detachable unit. A camper unit includes caps, toppers, canopies, and all equipment and accessories built into and forming a permanent part of the structure.

b. Collision means

(1) the upset of your private passenger auto or your trailer; or

(2) your private passenger auto or your trailer hit a vehicle or other object; or

(3) your private passenger auto or your trailer was hit by a vehicle.

c. Loss means each direct and accidental loss of or damage to

(1) your private passenger auto or your owned trailer; or

(2) its equipment that is common to the use of your private passenger auto as a vehicle; or

(3) a camper body attached to or removed from your private passenger auto for storage.

2. New Jersey Mandatory Inspection Provision

a. We or our authorized representative have the right to inspect any private passenger auto insured or intended to be insured under this Policy before Comprehensive or Collision Coverage shall be effective.

b. During the term of this Policy, coverage for an additional or replacement private passenger auto shall not become effective until you notify us and request coverage for the auto. However, this provision does not apply to a replacement private passenger auto for a period of three days, including the day on which the auto is acquired, if

(1) the auto is acquired during the policy period; and

(2) there was Comprehensive or Collision Coverages on the auto replaced for at least the 12-month period preceding the replacement date.

The three-day period shall be extended by one day for each Saturday, Sunday, or New Jersey State holiday falling within the three-day period.

c. When an inspection is required by us, you shall cooperate and make the auto available for inspection.

d. The mandatory insurance inspection report, completed by the authorized inspection site representative for your private passenger auto, shall not establish coverage for any equipment that is excluded by this Policy or that should be specifically insured by an endorsement to this Policy.

3. Comprehensive Coverage

a. You have this coverage only for your private passenger auto or your owned trailer for which a premium for this coverage appears on the Policy Declarations. The deductible amount is shown on the Policy Declarations for the private passenger auto or trailer to which it applies.

b. We will pay for loss to your private passenger auto or your owned trailer except loss by collision but only for the amount of each such loss in excess of the deductible amount, subject to our Limit of Liability, and minus any outstanding premium that is owed by you to us for this Policy. Breakage of glass, or loss caused by missiles, falling objects, fire, theft, larceny, explosion, earthquake, windstorm, hail, water, flood, malicious mischief or vandalism, riot, or civil commotion is payable under this coverage. Loss due to hitting or being hit by a bird or an animal is payable under this coverage. If breakage of glass is caused by a collision, at your option, we may cover it under Collision Coverage.

c. We will repay you for transportation costs if your private passenger auto is stolen. We will pay up to $15 per day for the period that begins 48 hours after the theft up to a maximum of $450. The period ends when your private passenger auto is returned to you or when we offer to pay for the loss. We will also pay for any loss-of-use expenses for which you are legally responsible because a nonowned auto or a temporary substitute private passenger auto is stolen. Payment for these transportation costs and loss-of-use expenses will not be subject to any deductible.

4. Collision Coverage

a. You have this coverage only for your private passenger auto or your owned trailer for which a premium for this coverage appears on the Policy Declarations. The deductible amount is shown on the Policy Declarations for the private passenger auto or trailer to which it applies.

b. We will pay for loss to your private passenger auto or your owned trailer caused by collision but only for the amount of each such loss in excess of the deductible amount, subject to our Limit of Liability and minus any outstanding premium that is owed by you to us for this Policy.

5. Coverage for the Use of Other Autos and Owned Trailers

a. The coverages in this section that you have on your private passenger auto extend to a newly acquired private passenger auto, a temporary substitute private passenger auto, or a nonowned auto. These coverages extend to a nonowned auto while it is driven by or in the custody of you or your relatives. If you have two or more private passenger autos insured on this Policy, we will provide the broadest coverage applicable to any of your private passenger autos to an additional private passenger auto, a temporary private passenger substitute auto, or a nonowned auto. A replacement private passenger auto will have the same coverage as the private passenger auto it replaced. This policy will only provide coverage for the replacement private passenger auto if you tell us about it within 30 days after its delivery to you.

b. If you acquire a trailer during the policy period, it is covered if you ask us to insure it within 30 days after you become the owner.

If the trailer you acquire is an additional trailer, we will provide the broadest coverage applicable to any of your private passenger autos or trailers. A replacement trailer will have the same coverage as the trailer it replaced.

6. Coverage for Owned Camper Bodies

Your camper body is covered in accordance with the terms and conditions of paragraphs D.1, 3, and 4 above

a. when it is described on the Policy Declarations of this Policy;

b. for the coverages shown as applying to it;

c. subject to any applicable deductible.

If you acquire a camper body during the policy period, it is covered if you ask us to insure it within 30 days after you become the owner.

7. Coverage for a Nonowned Trailer or Camper Body

a. Any Comprehensive and Collision Coverage in force on your private passenger auto applies to a nonowned

(1) trailer, if it is designed for use with a private passenger auto, or

(2) camper body,

used by you or your relatives.

b. A nonowned trailer or camper body is one that is not owned by or registered in the name of

(1) you or any relative;

(2) any other person residing in the same household as you or any relative;

(3) an employer of you or any relative.

c. The most we will pay under Comprehensive or Collision Coverage for a loss to such nonowned trailer or camper body is $500.

8. Limit of Liability—Comprehensive and Collision Coverages

a. The limit of our liability for loss to property or any part of it is the lesser of

(1) the actual cash value not to exceed $60,000; or

(2) the cost of repair or replacement not to exceed $60,000.

b. An adjustment for depreciation and physical condition will be made in determining actual cash value in the event of a total loss.

9. Settlement of Loss—Comprehensive and Collision Coverages

a. We have the right to settle a loss with you or the owner of the property in one of the following ways:

(1) pay the agreed upon actual cash value of the property at the time of the loss in exchange for the damaged property. If the owner and we cannot agree on the actual cash value, either party may demand an appraisal as described in paragraph 9.c. If the owner keeps the damaged property, we will deduct its value after the loss from our payment.

The damaged property cannot be abandoned to us.

(2) pay to

(a) repair the damaged property or part, or

(b) replace the property or part.

If the repair or replacement results in betterment, you must pay for the amount of betterment; or

(3) return the stolen property and pay for any damage due to the theft.

b. We may have a financial arrangement with one or more repair facilities or a network of facilities for repairing autos covered under Comprehensive and Collision coverages. You may select a repair facility of your choice. However, such repair facility must accept the same terms and conditions from us, including price, as the shop, facility, or network with which we have the most generous arrangement. The repair facility you choose must give you written notification that agreeing to such terms and conditions may jeopardize any manufacturer or dealer warranty or lease agreement. You must sign such notification form before any repair can begin.

c. Appraisal under item a.(1) above shall be conducted according to the following procedure. Each party shall select a competent appraiser. These two shall select a third appraiser. The written decision of any two appraisers shall be binding. The cost of the appraiser shall be paid by the party who hired him or her. The cost of the third appraiser and other appraisal expenses shall be shared equally by both parties. We do not waive any of our rights by any act relating to appraisal. If you give us your consent, we may move the damaged property, at our expense, to reduce storage costs during the appraisal process. If you do not give us your consent, we will pay only the storage costs that would have resulted if we had moved the damaged property.

d. The settlement of loss provision for Comprehensive and Collision Coverages incorporates the limit of liability stated in paragraph 8 above.

10. No Benefit to Bailee

These coverages shall not benefit any carrier or other bailee for hire liable for loss.

11. Exclusions—What Is Not Covered

There is no coverage for

a. any auto or trailer used as a public or livery conveyance. This exclusion (11.a) does not apply to shared-expense car pools;

b. any loss to any auto or trailer arising out of or during its use for the transportation of any

(1) explosive substance;

(2) flammable liquid;

(3) similar hazardous materials;

except transportation incidental to your ordinary household or farm activities;

c. any customized equipment in or on a pickup, panel truck, van, delivery sedan, or utility automobile. Customized equipment includes but is not limited to

(1) television antennas;

(2) cooking and plumbing equipment;

(3) sleeping facilities;

(4) height-extending roofs;

(5) special carpeting and insulation, furniture, or bars;

(6) murals, paintings, or other decals or graphics;

d. awnings, cabanas, or equipment designed to create additional living facilities;

e. any nonowned auto while being repaired, serviced, or used by any person while that person is employed or engaged in any way in the selling, leasing, repairing, servicing, transporting, storing, or parking of land motor vehicles or trailers including road testing and delivery of such vehicle;

f. any person maintaining or using a nonowned auto in any business, occupation, or profession other than farming or ranching and not described in exclusion 11.e. This exclusion (11.f) does not apply to a private passenger auto or trailer used with a private passenger auto driven, maintained, or occupied by you or your relatives;

g. any auto or trailer while being operated in any prearranged or organized racing or speed contest or in practice or preparation for any such contest;

h. any sound reproduction system including, but not limited to, radios, stereos, tape decks, or compact disc players. Coverage under this Section also will not apply to any apparatus or accessories in or on the auto designed for use with that system. This exclusion (11.h) does not apply if the sound reproduction system is permanently installed in the auto;

i. any audio, visual, or data receiving and transmitting equipment including but not limited to

(1) citizens band or two-way mobile radios;

(2) telephones;

(3) scanning or television monitor receivers;

(4) video or audio cassette recorders; or

(5) personal computers.

This exclusion (11.i) does not apply if the electronic equipment is necessary for the normal operation of an auto.

Coverage under this Section also will not apply to any apparatus or accessories designed for use with that equipment;

j. any tapes, records, discs, or other media used with equipment described in exclusions h and i above for recording or reproducing sound;

k. any laser or radar detector;

l. loss to any vehicle due to war of any kind;

m. loss to any vehicle due to and limited to wear and tear, freezing, and mechanical or electrical breakdown or failure. This exclusion (11.m) does not apply when the loss is the result of a theft covered by this policy;

n. road damage to tires. This exclusion (11.n) does not apply if the damage results from the total theft of your private passenger auto, temporary substitute private passenger auto, newly acquired private passenger auto, or any nonowned auto or any trailer;

o. radioactive contamination;

p. any diminution in the value of any auto or trailer after it has been repaired as compared to its value before it was damaged.

12. If There Is Other Insurance

a. Coverage Available from Other Sources

If other insurance applies to the loss or expenses, we will pay only our share. Our share is the percent the limit of liability of this Policy bears to the total of all coverage that applies.

b. Temporary Substitute Private Passenger Auto, Nonowned Auto, or Trailer

If a temporary substitute private passenger auto, a nonowned auto, or trailer designed for use with a private passenger auto has other coverage on it, then this coverage is excess.

Section I. DEFINITIONS APPLICABLE TO ALL SECTIONS

B. Auto means a land motor vehicle with four or more wheels. It does not include

1. any vehicle while located for use as a dwelling or other premises; or

2. a truck‑tractor designed to pull a semitrailer.

C. Newly Acquired Private Passenger Auto means a replacement private passenger auto or an additional private passenger auto.

D. Nonowned Auto means an auto not owned by, registered to, leased to, or available or furnished for the regular use of

1. you;

2. any other person residing in the same household as you;

3. any relative. However, an auto owned by, registered to, leased to, or available or furnished for the regular use of a relative will be considered a nonowned auto for liability arising from your maintenance or use of such auto.

A nonowned auto must be an auto in the lawful possession of the person operating it.

E. Occupying means in, on, entering, or alighting from.

F. Private Passenger Auto means a self-propelled auto designed for use principally on public roads and that is one of the following types:

1. a private passenger or station wagon type automobile;

2. a pickup, panel truck, van, or delivery sedan;

3. a utility automobile designed for personal use as a camper or motor home or for family recreational purposes; but

G. Relative means a person who resides primarily with you in your household and is related to you by blood, marriage, adoption, or is a ward or foster child.

H. Replacement Private Passenger Auto means a private passenger auto newly owned by or leased to you to replace your private passenger auto.

J. Trailer means a trailer of the utility type or a trailer of the house, or camping type equipped or used as living quarters. Trailer is limited to a trailer designed for use with a private passenger auto.

Farm implements and farm wagons are considered trailers while pulled by an auto we insure for liability.

K. We, Us, or Our means the company providing this insurance as shown on the Policy Declarations.

L. You or Your means the person or persons named as the insured on the Policy Declarations and if an individual, includes his or her spouse if the spouse resides primarily in the same household.

M. The term Your Private Passenger Auto, when it appears in this Policy, means a private passenger auto that

1. is owned by or is leased for six months or longer to you;

2. is described on the Policy Declarations.

Section II. INSURING AGREEMENT

Section III. WHEN AND WHERE COVERAGE APPLIES

A. When Coverage Applies

The coverages you choose apply to accidents and losses that take place during the policy period.

The policy period is shown on the Policy Declarations. The policy period begins and ends at 12:01 A.M. standard time at the address shown on the Policy Declarations.

B. Where Coverage Applies

1. in the United States of America, its territories or possessions, Puerto Rico, or Canada; or

2. while the insured auto is being shipped between their ports.

Section IV. COVERAGES

A. LIABILITY COVERAGE

1. Additional Definitions Applicable to Liability Coverage

a. Bodily Injury means bodily injury, sickness or disease, including death resulting therefrom.

b. Property Damage means damage to, or destruction of, tangible property including its loss of use.

2. Coverage

a. You have this coverage only if a premium for it appears on the Policy Declarations.

b. We will

(1) pay damages that an insured becomes legally liable to pay because of

(a) bodily injury to others, and

(b) property damage

caused by accident resulting from the ownership, maintenance, or use of your private passenger auto;

(2) defend any suit against an insured for such damages with attorneys hired and paid by us. We will not defend any suit after we have paid the applicable limit of our liability for the accident that is the basis of the lawsuit;

(3) have the right to investigate, negotiate, and settle any claim or suit.

c. In addition to the limits of liability, we will pay for an insured the costs listed below resulting from such accident:

(1) all defense costs we incur;

(2) interest accruing after a judgment is entered in any suit we defend on behalf of an insured. Our duty to pay interest ends when we pay, offer, or deposit in court the amount due under this coverage;

(3) premiums or costs of bonds

(a) to secure the release of an insured’s property attached under a court order in any suit that we defend on behalf of an insured. The amount of the bond we pay for shall not be more than our limit of liability;

(b) required to appeal a decision in a suit for damages that we defend on behalf of an insured if we have not paid our limit of liability that applies to the suit;

(c) up to $250 for each bail bond needed because of an accident resulting in liability covered under this Policy or a traffic violation related to such accident.

We have no duty to furnish or apply for any bonds.

(4) expense incurred by an insured

(a) for loss of wages or salary up to $50 per day if we ask the insured to attend the trial of a civil suit. We will not pay for loss of other income;

(b) at our request.

d. Other Autos

The Liability Coverage extends to the use, by an insured, of a newly acquired private passenger auto, a temporary substitute private passenger auto, or a nonowned auto.

e. Trailer Coverage

The Liability Coverage extends to a trailer while owned by, leased to, or used by you or your relative.

3. Who Is an Insured

a. For your private passenger auto, a newly acquired private passenger auto, or a temporary substitute private passenger auto, including any trailers attached to such auto, insured means

(1) you;

(2) your relatives;

(3) any other person while using such an auto if its use is with your consent;

(4) any other person or organization legally responsible for the use of such an auto by a person for whom Liability Coverage is afforded.

b. For a nonowned auto, insured means:

(1) you;

(2) your relatives;

(3) any person or organization that does not own or hire the auto but is legally responsible for its use by a person for whom Liability Coverage is afforded.

4. Limits of Liability

b. The limits of liability are not increased because more than one person or organization may be an insured.

c. An auto and attached trailer are one vehicle. Therefore, the limits are not increased.

5. Exclusions—What Is Not Covered

There is no Liability Coverage for

a. any person for liability arising out of the ownership or operation of any auto while being used as a public or livery conveyance. This exclusion (5.a) does not apply to shared-expense car pools;

b. any person who intentionally causes bodily injury or property damage;

c. any person while using a vehicle without reasonable belief that he or she has a right to do so;

d. any person for property damage to property owned by or being transported by that person;