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Session Laws, 1963
Volume 671, Page 1203   View pdf image (33K)
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J. MILLARD TAWES, Governor                     1205

amount which would otherwise have been payable hereunder plus
the total of the like amounts under all such other valid coverages
for the same loss of which this insurer had notice bears to the total
like amounts under all valid coverages for such loss, and for the
return of such portion of the premiums paid as shall exceed the pro
rata portion for the amount so determined. For the purpose of apply-
ing this provision when other coverage is on a provision of service
basis, the 'like amount' of such other coverage shall be taken as the
amount which the services rendered would have cost in the absence
of such coverage."

(b) If the foregoing policy provision is included in a policy which
also contains the policy provision set out in section 457 of this sub-
title there shall be added to the caption of the foregoing provision
the phrase "—Expense Incurred Benefits". The insurer may, at its
option, include in this provision a definition of "other valid cover-
age", approved as to form by the Commissioner, which definition
shall be limited in subject matter to coverage provided by organiza-
tions subject to regulation by insurance law or by insurance authori-
ties of this or any other state of the United States or any province
of Canada, and by hospital or medical service organizations, and to
any other coverage the inclusion of which may be approved by the
Commissioner. In the absence of such definition such term shall not
include group insurance, automobile medical payments insurance, or
coverage provided by hospital or medical service organizations or
by union welfare plans or employer or employee benefit organiza-
tions. For the purpose of applying the foregoing policy provision
with respect to any insured, any amount of benefit provided for such
insured pursuant to any compulsory benefit statute (including any
workmen's compensation or employer's liability statute) whether
provided by a governmental agency or otherwise shall in all cases be
deemed to be "other valid coverage" of which the insurer has had
notice. In applying the foregoing policy provision no third party
liability coverage shall be included as "other valid coverage".

457. Insurance With Other Insurers—Other Benefits.

(a)   There may be a provision as follows:

"Insurance With Other Insurers: If there be other valid cover-
age, not with this insurer, providing benefits for the same loss on
other than an expense incurred basis and of which this insurer has
not been given written notice prior to the occurrence or commence-
ment of loss, the only liability for such benefits under this policy shall
be for such proportion of the indemnities otherwise provided here-
under for such loss as the like indemnities of which the insurer had
notice (including the indemnities under this policy) bear to the total
amount of all like indemnities for such loss, and for the return of
such portion of the premium paid as shall exceed the pro rata portion
for the indemnities thus determined."

(b)   If the foregoing policy provision is included in a policy which
also contains the policy provision set put in section 456 of this sub-
title, there shall be added to the caption of the foregoing provision
the phrase "—Other Benefits". The insurer may, at its option, include
in this provision a definition of "other valid coverage", approved as
to form by the Commissioner, which definition shall be limited in
subject matter to coverage provided by organizations subject to

 

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Session Laws, 1963
Volume 671, Page 1203   View pdf image (33K)
 Jump to  
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