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HomeMy WebLinkAbout09-45940 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA KEVIN P. SNYDER 131 Whispering Pine Road Loysville, PA 17047 Plaintiff(s)& Address(es) NO. 69- 41s9Y Ct-v:i ft?? CIVIL ACTION - LAW NATIONWIDE INSURANCE 1000 Nationwide Drive Harrisburg, PA 17110 Defendant(s) Address(es) JURY TRIAL DEMANDED PRAECIPE FOR WRIT OF SUMMONS TO THE PROTHONOTARY: Kindly issue a Writ of Summons against Defendant Nationwide Insurance. The Writ of Summons should be time-stamped and returned to Plaintiff's counsel. & ERB, P.C. By Date: July 9, 2009 Franci/ J. Laffert ,r, EsAu I.D. No. 84009 3211 North Front Street P.O. Box 5300 Harrisburg, PA 17110-0300 (717) 238-8187 Attorney for Plaintiff 422493-! D-5? 2069 -9 Pal 2, v?l'rl, f P- k . aIs-v9 METZGER, WICKERSHAM, P.C. By: Francis J. Lafferty, IV, Esquire Attorney I.D. No. 84009 3211 North Front Street P.O. Box 5300 Harrisburg, PA 17110-0300 (717) 238-8187 KEVIN P. SNYDER, Plaintiff V. NATIONWIDE INSURANCE Defendant Attorneys for Plaintiff Kevin P. Snyder IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW No. 0 9 - y5_9 y c / -le-1--, JURY TRIAL DEMANDED WRIT OF SUMMONS TO: Nationwide Insurance 1000 Nationwide Drive Harrisburg, PA 17110 You are hereby notified that Plaintiff Kevin P. Snyder has commenced an action against you. Dated: d--669 // 19 P othonota 422493-1 Request for Service R. Thomas Kline, Sheriff Cumberland County Office of the Sheriff One Courthouse Square Carlisle, PA 17013 Ph: 717.240.639o Fx:717.240.6397 Plaintiff/s: Court Number: ?- Kevin P. Snyder Expiration Date: Type of Action: Civil Defendant/s: Nationwide Insurance S U erve pon: Nationwide Insurance Address for Service: 1000 Nationwide Drive Harrisburg State PA 17110 Alternate Address for for Service: State AR Type of Service: r Adult in Charge r Personal Fx- Deputize (-' Certified Mail (- Posting **Copy of Court Order Required with Posting** Special Service Instructions: Deputize Dauphin County Sheriff *If service is to be made by deputized service to another county please specify which county* Filing Attorney: Name: Francis J. Lafferty, IV Address: P.O. Box 5300 Harrisburg State PA 17110 Phone Number: +1 (717) 238-8187 Sheriffs Office of Cumberland County ~I~C)_.~~=i~l;~ R Thomas Kline {~c YHC ~'~',1!,::_~;,~~ ir~~~3Y Sheri ~4~„tp of ~ambrr,~~b Ronny R Anderson 2~~~ ~~L 22 ~~~ Lam: Chief Deputy ~ :,''~ f t ,f Jody S Smith '`~' CUl~~~~~. ~=~, ,~ t,;+~~ '~~ ~' .,°; ~ ~ Civil Process Sergeant ~~tcE'~ `'''~ ~"~~~~~ pla`~i~iu`i`~.,~rA,~~lj~i, Edward L Schorpp Solicitor Kevin P. Snyder vs. Nationwide Insurance Case Number 2009-4594 SHERIFF'S RETURN OF SERVICE 07/13/2009 R. Thomas Kline, Sheriff who being duly sworn according to law states that he made a diligent search and inquiry for the within named defendant, to wit: Nationwide Insurance, but was unable to locate him in his bailiwick. He therefore deputized the Sheriff of Dauphin County, PA to serve the within Writ of Summons according to law. 07/16/2009 01:57 PM -Dauphin County Return: And now July 16, 2009 at 1357 hours I, Jack Lotwick, Sheriff of Dauphin County, Pennsylvania, do herby certify and return that I served a true copy of the within Writ of Summons, upon the within named defendant, to wit: Nationwide Insurance by making known unto Megan Sites, Human Resource Coordinator at 1000 Nationwide Drive Harrisburg, PA 17110 its contents and at the same time handing to her personally the said true and correct copy of the same. SHERIFF COST: $37.00 July 21, 2009 SO ANSWERS, ,l- ~,/~~ ~~-~° ~. ' R THOMAS KLINE, SHERIFF (~f~.ue ~a# #I2~= a~~exiff Mary Jane Snyder Real Estate Depu William T. Tully solicitor .~.. Dauphin County Harrisburg, Pennsylvania 17101 ph: (717) 780-6590 fax: (717) 255-2889 Jack Lotwick sheriff Commonwealth of Pennsylvania County of Dauphin Charles E. Sheaffer Chief Deputy Michael W. Rinehart Assistant Chief Deputy KEVIN P SNYDER VS NATIONWIDE INSURANCE Sheriffs Return No. 2009-T-1988 OTHER COUNTY N0.20094594 And now: JULY 16, 2009 at 1:57:00 PM served the within WRIT OF'SUMMONS upon NATIONWIDE INSURANCE by personally handing to MEGAN SITES 1 true attested copy of the original WRIT OF SUMMONS and making known to him/her the contents thereof at 1000 NATIONWIDE DRIVE HARRISBURG PA 17110 HR COORD. Sworn and subscribed to before me this 17TH day of July, 2009 NOTARIAL SEAL ARY JANE SNYDER, No'ary Publi Highspire, Dauphin Co;,uty M Commission Ex ices Se t l 2010 So Answers, ~~i~''`KC_._. Deputy: W CONWAY Sheriffs Costs: $47.25 7/15/2009 In The Court of Common Pleas of Cumberland County, Pennsylvania Kevin P. Snyder vs. Nationwide Insurance 1000 Nationwide Drive Harrisburg, PA 17110 Civil No. 2009-4594 Now, July 13, 2009, I, SHERIFF OF CUMBERLAND COUNTY, PA, do hereby deputize the Sheriff of Dauphin County to execute this Writ, this deputation being made at the request and risk of the Plaintiff. Sheriff of Cumberland County, PA Affidavit of Service Now, , 20 , at o'clock 1VI, served the within upon at by handing to a and made known to Sworn and subscribed before me this day of ,20 copy of the original So answers, Sheriff of COST5 SERVICE- MILEAGE_ AFFIDAVIT the contents thereof. County, PA Peter J. Speaker, Esquire 1. D. 42834 THOMAS, THOMAS &HAFER, LLP 305 North Front Street P.O. Box 999 Harrisburg, PA 17108 (717) 255-7644 pspeaker@tthlaw. com IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PA KEVIN P. SNYDER, Plaintiff NO. 09-4594 v. NATIONWIDE INSURANCE, Defendant CIVIL ACTION -LAW JURY TRIAL DEMANDED Attorneys for Defendant PRAECIPE FOR .ENTRY DF APPEARANCE To: Prothonotary Please enter the appearance of the undersigned as counsel of record for Nationwide Insurance, Defendant, in the above matter. Date: ~ ~ G ~ o & HAFER, LLP Peter J. esker, Esquire I.D. 4 8 4 305 rth Front Street P.O. Box 999 Harrisburg, PA 17108-0999 (717) 255-7644 pspeaker@tthlaw.com CERTIFICATE OF SERVICE I, Peter J. Speaker, Esquire, of the law firm of Thomas, Thomas & Hafer, LLP, attorney for Defendant, hereby certify that a true and correct copy of the foregoing document was sent to the following counsel of record by placing a copy of same in the United States mail, postage prepaid, at Harrisburg, Pennsylvania addressed as follows: Francis J. Lafferty IV, Esquire Metzger Wickersham P. O. Box 5300 Harrisburg, PA 17110-0300 Date: 0 ~ ~O . ~ 722604.1 THOM~, T,fjiO~A~4S & HAFER, LLP Peter J peaker, Esquire I.D. 4 34 305 orth Front Street P.O. Box 999 Harrisburg, PA 17108-0999 (717) 255-7644 pspeaker@tthlaw.com ~CO~ 1~;i~vi -1 iii 2~ } ~: ~u~~y r , ', 4o Peter J. Speaker, Esquire I.D. 42834 THOMAS, THOMAS & HAFER, LLP 305 North Front Street P.O. Box 999 Harrisburg, PA 17108 (717) 255-7644 pspeaker@tthlaw.com Attorneys for Defendant KEVIN P. SNYDER, IN THE COURT OF COMMON PLEAS Plaintiff OF CUMBERLAND COUNTY, PA ' C } C= r J c- s C:L' -11 V. NO. 09-4594 CIVIL ACTION - LAW ?? - ~= r''r=- NATIONWIDE INSURANCE, cor ; 'S Defendant JURY TRIAL DEMANDED` co -? PRAFCIPE AND RULE TO FILE COMPLAINT N `r To: Curt Long, Prothonotary V Please issue a Rule on Plaintiff, Kevin P. Snyder, to file a Co plaint in the above case within twenty (20) days after service of the Ry"o??suffer a j?ent of non pros. THOMAS, THJ0MAA j9XAFER, LLP J. Spjbdker, Esquire 305 North Front Street P.O. Box 999 Harrisburg, PA 17108-0999 (717) 255-7644 Dates- '10 pspeakera@tthlaw.com RULE TO FILE COMPLAINT AND NOW, , 2011, a Rule is hereby issued upon Plaintiff, Kevin P. Snyder, to file a C plaint herein within twenty (20) days after service hereof or suffer the entry of a Judgment of Non Pros. % r CERTIFICATE OF SERVICE I, Peter J. Speaker, Esquire, of the law firm of Thomas, Thomas & Hafer, LLP, attorney for Defendant, hereby certify that a true and correct copy of the foregoing document was sent to the following counsel of record by placing a copy of same in the United States mail, postage prepaid, at Harrisburg, Pennsylvania addressed as follows: Francis J. Lafferty IV, Esquire Metzger Wickersham P. O. Box 5300 Harrisburg, PA 17110-0300 THgW, Y-IOMAS & HAFER, LLP Peter J. Speaker, Esquire I. D. 2834 305 North Front Street P.O. Box 999 Harrisburg, PA 17108-0999 (717) 255-7644 pspeaker@tthlaw.com Date: 975840.1 FILED-OF El?E i.P THE PRO T HONOTARY 1011 FEB 17 PM 3. 14 METZGER, WICKERSHAM, P.C. By: Amy E. Bauccio, Esquire Attorney I.D. No. 307216 Zachary D. Campbell, Esquire Attorney I.D. No. 93177 3211 North Front Street P.O. Box 5300 Harrisburg, PA 17110-0300 (717) 238-8187 CUMBERLAND COUNTY Attorneys for Plaintiff Kevin P. Snyder KEVIN P. SNYDER, Plaintiff V. NATIONWIDE INSURANCE, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 09-4594 JURY TRIAL DEMANDED PRAECIPE FOR ENTRY OF APPEARANCE TO THE PROTHONOTARY: Please enter the appearance of Amy E. Bauccio, Esquire and Zachary D. Campbell, Esquire as attorneys for the Plaintiff in the above-captioned action. METZGER, WICKERSHAM, KNAUSS & ERB, P.C. By: Amy auccio, Esquire Attorney I.D. No. 307216 Zachary D. Campbell, Esquire Attorney I.D. No. 93177 3211 North Front Street P.O. Box 5300 Harrisburg, PA 17110 Dated: 211 CA/201 2 (717) 238-8187 479933-! PRAECIPE FOR WITHDRAWAL OF APPEARANCE Please withdraw the appearance of Francis J. Lafferty, IV, Esquire as attorney for the Plaintiff in the above captioned action. NORFLEET AND LAFFERTY, LLC By: Dated: , Jr31`} is J ferty, IV, Esquire D. No. 84009 1300 Market Street Suite 202B Lemoyne, PA 17043 479933-1 CERTIFICATE OF SERVICE I, Amy E. Bauccio, Esquire, of the law firm of Metzger, Wickersham, Knauss & Erb, P.C., hereby certify that I served a true and correct copy of a Praecipe for Entry of Appearance and Withdrawal of Appearance with reference to the foregoing action by first class mail, postage prepaid, this / V4-day of (_ , 2012, on the following: FIRST CLASS MAIL Peter J. Speaker, Esquire Michele J. Thorp, Esquire Thomas, Thomas & Hafer, LLP P.O. Box 999 Harrisburg, PA 17101 METZGER, WICKERSHAM, KNAUSS & ERB, P.C. Amy E. B cio, Esquire 479933-1 Amy E. Bauccio, Esquire Attorney I.D. No. 307216 Zachary D. Campbell Attorney I.D. No. 93199 Metzger, Wickersham, Knauss & Erb, PC 3211 North Front Street P.O. Box 5300 Harrisburg, PA 17110-0300 (717) 238-8187 KEVIN P. SNYDER, Plaintiff V. NATIONWIDE INSURANCE, Defendant TO: Nationwide Insurance c/o Peter J. Speaker, Esquire Michele J. Thorp, Esquire Thomas, Thomas & Hafer, LLP P.O. Box 999 Harrisburg, PA 17101 F!?FTn-OFFTE OF THE Fig; iIfcgioiARY 2 E F-? 17 P11 3: If CU 8ER! ANN) C U` TY i''ENS ` ' VANIA Attorneys for Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 09-4594 JURY TRIAL DEMANDED NOTICE TO DEFEND YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the following pages, you must take action within Twenty (20) days after this Complaint and Notice are served, by entering a written appearance personally or by attorney and filing in writing with the Court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the Court without further notice for any money claimed in the Complaint or for any other claim or relief requested by the Plaintiffs. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. Cumberland County Lawyer Referral Service 32 S. Bedford Street Carlisle, PA 17013 (800) 990-9108 475745-I NOTICIA LE 1 AN DEMANDADO A USTED EN LA CORTE. Si usted quiere defenderse de estas demandas expuestas en las paginas siguientes, usted tiene viente (20) dias de plazo al partir de la fecha de la demanda y la notificacion. Usted debe presentar una apariencia escrita o en persona o por abogado y archivar en la corte en forma escrita sus defensas o sus objeciones a las demandas en contra de su persona. Sea avisado que si usted no se defiende, la corte tomara medidas y puede entrar una orden contra usted sin previo aviso a notificacion y por cualquier queja o alivio que es pedido en la peticion de demanda. Usted puede perder dinero o sus propiedades o otros derechos importantes para usted. LLEVE ESTA DEMANDA A UN ABODAGO IMMEDIATAMENTE. SI NO TIENE ABOGADO O SI NO TIENE EL DINERO SUFICIENTE DE PAGAR TAL SERVICIO, VAYA EN PERSONA O LLAME POR TELEFONO A LA OFICINA CUYA DIRECCION SE ENCUENTRA ESCRITA ABAJO PARA AVERIGUAR DONDE SE PUEDE CONSEGUIR ASISTENCIA LEGAL. Cumberland County Lawyer Referral Service 32 S. Bedford Street Carlisle, PA 17013 (800) 990-9108 475745-1 Amy E. Bauccio, Esquire Attorney I.D. No. 307216 Zachary D. Campbell Attorney I.D. No. 93199 Metzger, Wickersham, Knauss & Erb, PC 3211 North Front Street P.O. Box 5300 Attorneys for Plaintiff Harrisburg, PA 17110-0300 (717) 238-8187 KEVIN P. SNYDER, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 09-4594 NATIONWIDE INSURANCE, JURY TRIAL DEMANDED Defendant COMPLAINT AND NOW, comes the Plaintiff, Kevin P. Snyder, by and through his counsel, Metzger, Wickersham, Knauss & Erb, P.C., and complains against the Defendant, Nationwide Insurance, and avers as follows: 1. Plaintiff, Kevin P. Snyder, is an adult individual currently residing at 131 Whispering Pine Lane, Loysville, Perry County, Pennsylvania 1.7047. 2. Defendant, Nationwide Insurance (hereinafter referred to as "Nationwide"), is a corporation with offices for the transaction of business located at 1000 Nationwide Drive, Harrisburg, Dauphin County, Pennsylvania 17110. Defendant is licensed and authorized to conduct business as an insurer in the Commonwealth of Pennsylvania. 3. At all times material hereto, Plaintiff, Kevin P. Snyder, was a named insured under an automobile insurance policy issued by Defendant, Nationwide, insurance policy number 8937355019 (hereinafter referred to as "the Policy"). A true and correct copy of the 475745-1 Auto Policy Declarations sheet is attached hereto as Exhibit "A.." A true and correct copy of the Policy is attached hereto as Exhibit "B." 4. On or about July 11, 2005, at approximately 1:00 p.m., Plaintiff, Kevin P. Snyder, was operating a 2001 Chevrolet 6500, bearing Pennsylvania License Plate No. YNM9503 and owned by Harrisburg Auto Auction. 5. At the aforesaid time, Plaintiff, Kevin P. Snyder, was operating the aforementioned vehicle westbound on West Trindle Road, in Monroe Township, Cumberland County Pennsylvania. 6. At approximately the same time and place, tortfeasor, Rose Hosterman, was the owner and operator of a 1993 Dodge Shadow bearing Pennsylvania License Plate No. EVM9932. 7. At approximately the same time and place, tortfeasor, Rose Hosterman, was traveling eastbound on West Trindle Road, in Monroe "Township, Cumberland County Pennsylvania. 8. Suddenly and without warning, Ms. Hosterman crossed over the double yellow line and into the westbound lane, directly into the path of Plaintiff Kevin P. Snyder's vehicle causing Plaintiff to impact the front bumper of Ms. Hosterman's vehicle with the left front bumper of Plaintiff's vehicle. 9. The injuries sustained by Plaintiff, Kevin P. Snyder, in the aforementioned motor vehicle accident include, but are not limited to, the following: a. Neck pain/injury; (b) Bilateral shoulder pain/injury; (c) Low back pain/injury; (d) Cervical strain/sprain; (e) Lumbar strain/sprain; (f) Displacement of cervical intervertebral disc; 475745-1 (g) Displacement of lumbar intervertebral disc; (h) Headaches; (i) Left leg pain/injury; 0) HPN left C6-C7; (k) HPN left L5-Sl; (1) Recurrent HPN left L5-S1; and (m) Other serious and permanent injuries. 10. Due to the injuries that Plaintiff, Kevin P. Snyder, received in the July 11, 2005 motor vehicle accident, Plaintiff underwent medical treatment including, but not limited to, a microdiscectomy at L5-S1 on the left. 11. The damages sustained by the Plaintiff, Kevin P. Snyder, in the aforesaid motor vehicle accident include, but are not limited to, the following: a. Plaintiff, Kevin P. Snyder, has suffered and will continue to suffer great physical pain, discomfort, distress, suffering, inconvenience, embarrassment, humiliation, and mental anguish; b. Plaintiff, Kevin P. Snyder, has suffered and will continue to suffer loss of his ability to enjoy the pleasures of life and limitations in his pursuit of his daily activities all to his great loss and detriment; C. Plaintiff, Kevin P. Snyder, has been and will be required to spend money for medication attention, medical treatment, hospitalization, surgery, rehabilitation, medical supplies, and other medically necessary items; d. Plaintiff, Kevin P. Snyder, has been and will be required to spend money for incidental costs and expenses and losses to include, but not limited to, past and future medicine costs and medical appliances, and travel to and from medical appointments; e. Plaintiff, Kevin P. Snyder, has suffered and will continue to suffer loss of household services and other economic damages; 475745-1 f. Plaintiff, Kevin P. Snyder, has suffered and will continue to suffer permanent scarring and/or disfigurement; g. Plaintiff, Kevin P. Snyder, has been and will be deprived of his earnings; h. Plaintiff Kevin P. Snyder's earning capacity has been reduced and permanently impaired; and i. Plaintiff Kevin P. Snyder's general health, strength, and vitality have been impaired. 12. At the time of the collision, the tortfeasor, Rose Hosterman, was issued a motor vehicle insurance policy through Nationwide Insurance with bodily injury liability limits in the amount of $50,000.00. 13. A settlement agreement was reached whereby the insurance carrier for the tortfeasor, Rose Hosterman, Nationwide Insurance, agreed to make payment of the available insurance liability limits of $50,000.00, in settlement of the Plaintiff Kevin P. Snyder's personal injury claims. 14. The Defendant herein, Nationwide, consented to the settlement of the claim against Rose Hosterman for payment of the available liability insurance limits. 15. At the time of the collision, Plaintiff, Kevin P. Snyder, was driving an employer owned vehicle, which was insured with Empire Fire & Casualty, policy number CK06807346, with underinsured policy limits of $50,000.00. 16. A settlement agreement was reached whereby Empire Fire & Casualty agreed to make payment of the available underinsured limits of $50,000.00, in settlement of the Plaintiff Kevin P. Snyder's personal injury claims. 475745-1 17. Plaintiff, Kevin P. Snyder, was an underinsured motorist because the combined liability coverage and underinsured motorist coverage through Plaintiff's employer of $100,000.00 paid to Plaintiff was less than Plaintiff's damages. 18. Plaintiff, Kevin P. Snyder, elected to purchase underinsured motorist coverage with the Defendant, Nationwide. 19. Defendant, Nationwide, has no documentation requesting underinsured limits lower than the limits of the liability portion of the Policy. 20. It is believed and therefore averred that the underinsured limits of the Policy are $100,000.00 per person and $300,000.00 per accident because there is no documentation and/or evidence requesting lower limits for that Policy. Said coverage was in full force and effect on July 11, 2005. 21. The above referenced Policy with Defendant, Nationwide, provided for underinsured motorist coverage, which became applicable to the Plaintiff, Kevin P. Snyder, since the combined liability coverage and underinsured motorist coverage through Plaintiff's employer of $100,000.00, which was paid to the Plaintiff, was inadequate to compensate the Plaintiff for injuries, loses and damages he suffered as a result of the motor vehicle accident. 22. Plaintiff, Kevin P. Snyder, elected to purchase underinsured motorist coverage with the Defendant, Nationwide, and as a result of Plaintiff's election of this coverage, he paid and Defendant accepted, additional increased premium payments. 23. After settlement of the liability claim and employer's underinsured motorist claim for the available insurance liability and underinsured limits, a demand for payment of the available underinsured motorist coverage was made to the Defendant, Nationwide. 475745-1 24. The Defendant, Nationwide, has refused to make payment of the available limits of the underinsured motorist coverage and instead has extended an offer of $35,000.00 to settle Plaintiff Kevin P. Snyder's claim. 25. At all times relevant hereto, Plaintiff, Kevin R Snyder, fully complied with the terms and conditions of the Policy with Defendant, Nationwide, and all terms and conditions precedent and subsequent to his right to recover under the Policy. 26. Plaintiff, Kevin P. Snyder, was considered full tort at the time of this accident because he was injured while an occupant of a motor vehicle other than a private passenger motor vehicle. Therefore, Plaintiff remains eligible to claim compensation for non economic loss and economic loss in this collision pursuant to applicable tort law. COUNT I - BREACH OF CONTRACT PLAINTIFF KEVIN P. SNYDER v. DEFENDANT NATIONWIDE INSURANCE 2T Paragraphs 1 through 26 are incorporated herein by reference as if fully set forth. 28. Plaintiff Kevin P. Snyder's medical records clearly establish that he suffered significant personal injuries as a direct result of the motor vehicle accident on July 11, 2005. 29. Plaintiff, Kevin P. Snyder, has fully complied with all of the terms, conditions and duties required under the Policy with Defendant, Nationwide. 30. Defendant, Nationwide, has failed to timely, objectively and reasonably evaluate Plaintiff Kevin P. Snyder's claim. 31. Defendant, Nationwide, has failed to promptly offer payment of the reasonable and fair value of the underinsured motorist claim to the Plaintiff, Kevin P. Snyder. 475745-1 32. Defendant, Nationwide, failed to reasonably investigate Plaintiff Kevin P. Snyder's claim, inasmuch as a thorough and proper inquiry would have revealed that the Plaintiff sustained injuries, damages and losses which reasonable compensation would have required an offer of the available limits. 31 Defendant, Nationwide, owes a fiduciary, contractual and statutory obligation to investigate, evaluate and negotiate the underinsured motorist claim in good faith and to arrive at a prompt, fair and equitable settlement as the insurer of Plaintiff, Kevin P. Snyder. 34. For the reasons set forth above, Defendant, Nationwide, has violated its obligation under the Policy. WHEREFORE, the Plaintiff, Kevin P. Snyder, seeks damages from Defendant, Nationwide Insurance, in an amount in excess of the compulsory arbitration limits of Cumberland County, exclusive of interest and costs. COUNT II - BAD FAITH PLAINTIFF, KEVIN P. SNYDER, V. DEFENDANT, NATIONWIDE INSURANCE 35. Paragraphs 1 through 34 are incorporated herein by reference as if fully set forth. 36. The actions of Defendant, Nationwide, in handling Plaintiff Kevin P. Snyder's underinsurance motorist claim constitute bad faith as defined under 42 Pa. C.S.A. Section 8371, include the following reasons: a. Engaging in dilatory claims handling; b. Acting unreasonably and unfairly in response to the underinsured motorist claim; 475745-1 c. Not attempting in good faith to effectuate a fair, prompt and equitable settlement of the underinsured motorist claim in which the Defendant's liability under the Policy is reasonably clear; d. Subordinating the interests of its insured to its own financial monetary interest; e. Failing promptly to offer payment of the underinsured motorist claim; f. Failing reasonably and adequately to investigate the underinsured motorist claim; g. Failing reasonably to evaluate or review the medical documents and other supporting documentation in Nationwide's possession; h. Violating the fiduciary duty owed to the Plaintiff, i. Otherwise unreasonably and unfairly withholding underinsured motorist benefits justly due and owing to the Plaintiff; j. Compelling its insured to file suit and engage in litigation when a reasonable evaluation of the claim would have avoided suit; k. Compelling Plaintiff to litigate his claim to recover amounts due under the Policy; 1. Failing to make an honest and objective settlement offer; in. Otherwise unreasonably and unfairly withholding underinsured motorist benefits justly due and owing to the Plaintiff, and n. Failing to allow its own manual with regards to the evaluation and payment of underinsured motorist claims. 475745-1 WHEREFORE, the Plaintiff, Kevin P. Snyder, seeks damages from the Defendant, Nationwide Insurance, in an amount in excess of the compulsory arbitration limits of Cumberland County, exclusive of interests and costs. METZGER, WICKERSHAM, KNAUSS & ERB, P.C. By: Amy . Bauccio, Esquire Attorn y I.D. No. 307216 Zachary D. Campbell, Esquire Attorney I.D. No. 93199 P.O. Box 5300 3211 North Front Street Harrisburg, PA 17110-0300 (717) 238-8187 Attorney for Plaintiff Dated:2 11 ID j2-0) 2- 475745-1 VERIFICATION I, Kevin P. Snyder, do hereby verify that the facts set forth in the foregoing Complaint are true and correct to the best of my personal knowledge or information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904, relating to unsworn falsification to authorities. Date: Kevin P. Snyder 475745--].[X)(' CERTIFICATE OF SERVICE I, Amy E. Bauccio, Esquire, of the law firm of Metzger, Wickersham, Knauss & Erb, P.C., hereby certify that I served a true and exact copy of the foregoing document with reference to the foregoing action by first class mail, postage prepaid, this ? day of Et- 2y? , 2012, on the following: Peter J. Speaker, Esquire Michele J. Thorp, Esquire Thomas, Thomas & Hafer, LLP P.O. Box 999 Harrisburg, PA 17101 Amy E. B cio, Esquire 475745-1 \??? ??? \ _/ CENTURY 21 AUTO POLICY DECLARATIONS Page 1 of 3 These Declarations are a part of the policy narked above and Identltled by policy number below. They supersede any Declarations Issued earlier. Your policy provides the coverages and limits shown in the schedule of coverages. They apply to each Insured vehicle as Indicated. Your policy complies with the motorists' financial responslbllRy aws of your state only for vehicles for which Property Damage and Bodly Injury Ltabllhy coverages are provided. Policyholder: Number: (Named Insured) 89 37 355019 KEVIN SNYDER RR 1 BOX 266 Issued: LOYSVILLE, PA 17047 MAR 31, 2005 0 8 Policy Period From: APR 25 , 2005 to OCT 25, 2005 but only If the required premium for thls ppeeriod has been paid and only for six month renewal periods If renewal premiums have been paid as required. This policy Is Initially effective at (1) the time the application for insurance Is completed, or (2) 12:01• a.m. on the first day of the policy period, whichever is later. Each renewal period begins and ends at 12:01 a.m. standard time at the address of the named Insured stated herein. This policy cancels at 12:01 a.m. at the address of the named Insured stated herein. INSURED VEHICLE(S) & SCHEDULE OF COVERAGES 1. 1994 SUBA IMPREZA Coverages PROPERTY DAMAGE LIABILITY BODILY INJURY LIABILITY UNINSURED MOTORISTS, -BODILY INJURY UNDERINSURED MOTORISTS -BODILY INJURY FIRST PARTY BENEFITS OPTION 1 OMMEEDICAL BENEFIT ION 2 INCOME LOSS BENEFIT OPTION 3 ACCIDENTAL DEATH BENEFIT OPTION 4 FUNERAL BENEFIT FULL TORT ID #JF1GC2245RB535401 Six Month Limits Of Liability Premium . ENDORSEMENT 779 100,000 EACH OCCURRENCE $ 38.00 100,000 EACH PERSON 300,000 EACH OCCURRENCE $ 56.30 ENDO 2357 S 15,000 EACH PERSON $ 6.50 S 30,000 EACH OCCURRENCE ENDORSEMENT 2358 15,000 EACH PERSON 30,000 EACH OCCURRENCE $ 20.60 10,000 20.10 5,000 TOTAL 7.20 1,000 MONTHLY $ 101000 $ 2.30 $ 1,500 $ .30 TOTAL $ 151.30 AUTO 7100-A FR A MF.- R 22 Pape 2 of 3 VEHICLE •C LASS I FICATIONS Premium Is Based On: 1994 SUBA USE OF VEHICLE RATED DRIVER FARM MALE ADULT AGE 34 PRINCIPAL UNMARRIED APPLIED DISCOUNTS PASSIVE RESTRAINT •AIR BAG DRIVER ANNUAL MILEAGE MULTI CAR LONG TERM HOME & CAR SPECIAL RATING SAFE DRIVER FULL TORT RATING SYMBOLS 014.015 00 Policy Form 6 Endorsements: NGN 0388B 809A 2391 3208 Office Use: PR344954 D 549406 NOV 12, 2004 TERR: 099 $ 0.00 Issued By, NATIONWIDE GENERAL INSURANCE COMPANY Countersigned At: HARR I SBURG, PA By: ROBERT C Home Office - Columbus, Ohio GROVE MEMBER, LOSS PAYABLE CLAUSE ENDORSEMENT This endorsement applies to the Comprehensive and Collision coverages provided by this policy. It protects the Ilenholder named In the policy Declarations. Payment for loss will be made accordln to the Interest of the policyholder and Penholder. Payment may be made to both Jointly, or to either separately. Either way, the company will protect the Interests of both. The Ilenholder's Interest will be protected, except from fraud or omissions by the policyholder or the policyholder's representative. If the company cancels or refuses to renew the policy, the Ilenholder will receive notice at least 10 days before protection of its Interest will end. The Ilenholder shall notify the company upon learning of any change in ownership of the vehicle. To the extent of payment to the Ilenholder, the company will be entitled to the llenholder's rights of recovery. The endorsement is Issued by the Nationwide Mutual Insurance Company or Nationwide Mutual Fire Insurance Company, whichever has Issued the policy to which it Is attached. NATIONWIDE GENERAL INSURANCE COMPANY HOME OFFICE: COLUMBUS, OHIO 43215-2220 • - I ' ' Pnsldant Secretary FRAME: C 22 CENTURY 21 AUTO POLICY DECLARATIONS Page 3 of 3 Policy Number: Policyholder. u ed 89 37 355019 KEVIN SNYDER Issued: Policy Period From: MAR 31, 2005 APR 25, 2006 to OCT 25, 2005 IMPORTANT PHONE NUMBERS Nationwide 24-Hour Claims Number. 1.800-421-3535 For QUESTIONS About Your Policy, Cali Your NATIONWIDE AGENT : REBECCA A REISINGER 717.763-8514 For Hearing Impaired, TTY 1-3007022.2421 Nationwide Regional Office: 717-M-6400 0 a F MON r. r!• r. afar a>• r! atew rr? l? r FRAME: D 22 /?,1? ?? ?? ?k ?`?,. AUTO :1 L* POLICY Auto insurance protection you can count on In a policy you can understand This is a different kind of insurance policy-one that's readable, understandable, straightforward. We believe you have purchased the best in auto insurance protection-backed by the best in policyholder service, We intend to keep it that way. Please take a few minutes to read and see what's inside your new Century 21 policy. Should you have an accident or loss-and we hope you don't- just call us at once. Our claims service starts then. The telephone number to call is listed on your Nationwide identification card, or you may get in touch with any local claims office. If you have any questions about this policy, or any part of your insurance program, your sales representative will welcome your call any time. Thank you for relying on Nationwide, RENTED AUTO NOTICE IF THE DECLARATIONS AT- TACHED TO THIS POLICY SHOW THAT COLLISION COVERAGE APPLIES TO YOUR AUTO, THERE IS ALSO COLLISION COVERAGE FOR DAMAGE TO A RENTED AUTO. COVERAGE IS SUBJECT TO CONDITIONS AND LIMITA- TIONS LISTED ON PAGE S AND ELSEWHERE IN THE POLICY OR ATTACHED ENDORSEMENTS. YOUR GUIDE TO PROTECTION ID1+FINITIONS Key Policy Words ............................................................... 2 TERRITORY Where Your Protection Applies .................................................... 3 COVERAGES Comprehensive .................................................................. Collision.... .................................................................... Towing and Labor. . .. ... .................... ...................... Auto Liability ............................... ................................... First Party Benefits ................. . ............. Uninsured Motorists ..................................... Underinsured Motorists ........................................................... GENERAL CONDITIONS Your Duties After an Accident or Loss ........ . .. . ............... . .. . . . . Use of Other Motor Vehicles .................................. How Your Policy May Be Changed ................................................ Our Right to Recover from Others (Subrogation) .... . Policy Renewal/Nonrenewal ....................................................... Your Right and Our Right to Cancel ............................................... Our Installment Premium Plan ................. . ............ . . . . .... Nationwide General Insurance Company I Home Office- Columbus, Ohio 43215-2220 3 4 4 7 10 13 17 21 21 21 21 22 22 23 NCAN 388-9 (K-110) Nationwide's Century 21 Auto Policy INSURING AGREEMENT For the poliieyholder's payment of premiums in amounts we require and subject to all of the terms and conditions of this policy, we agree to provide the coverages the policyholder has selected. These selections are shown in the Declarations, which are a part of this policy contract. Subsequent premiums for renewal terms of six months each must be paid in advance. DEFINITIONS This policy uses certain common words for easy reading. They are defined as follows: 1. "YOU" and "YOUR" mean or refer to the policyholder as defined, and include the policyholder's spouse if living in the same household. 2. "WE," "US," "OUR," and "THE COMPANY" means the Nationwide General Insurance Company. 3. "INSURED" means one who is described as entitled to protection under each coverage. 4. "YOUR AUTO" means the vehicle(s) described in the Declarations. 5. "DEDUCTIBLE" means the amount of loss to be paid by the insured. We pay for covered loss above the deductible amount. 6. "MOTOR VEHICLE" means a land motor vehicle designed primarily to be driven on public roads. This does not include vehicles operated on rails or crawler-treads. Other motor vehicles designed for use mainly off public roads shall be included within the definition of motor vehicle when used on public roads. 7. "PRIVATE PASSENGER AUTO" means a four-wheel: a) private passenger auto; b) station wagon; c) van; d) jeep-type vehicle; or c) pickup truck. 8. "OCCUPYING" means in, upon, entering, or alighting from. 9. "RELATIVE." means one who regularly lives in your household, related to you by blood, marriage or adoption (including a ward or foster child). A relative may live temporarily outside your household. 10. "BODILY INJURY" means: a) bodily injury; c) disease; or b) sickness; d) death; of any person. 11. "PROPERTY DAMAGE" means: a) destruction of property; b) damage or injury to it; or c) loss if its use. 2 (Attach Declarations and Endorsements Here) definitions 12. "POLICYHOLDER" means the first person named in the Declarations. The policyholder is the Ili named insured under this policy and does not include the polleyhoWer% spouse. If the first named insured is an organization, that organization is the policyholder. 13. "NONECONOMIC LOSS" means pain and suffering and other nonmonetary detriment. Other words are also defined. All defined words are in bold print. TERRITORY All coverages in this policy apply only to occurrences while the policy is in force. All coverages apply in Canada, the United States of America and its territories or possessions, or between their ports. All coverages except Uninsured Motorists and Underinsured Motorists apply to occurrences in Mexico, if within 50 miles of the United States boundary. We will base the amount of any Comprehensive or Collision loss in Mexico on cost at the nearest United States point. NOTE: You will need to buy auto insurance from a Mexican insurance company-regardless of coverage provided by this policy-before driving in Mexico. Otherwise, you may be subject to jail detention, auto impoundment, and other legal complications in case of an accident. physical Additional Definitions Applicable to These Coverages damage 1. "LOSS" means direct and accidental loss or damage to your auto. Your auto includes its equipment. 2 " IPM N " . EQU E T means anything usual and incidental to the use of a motor vehicle as a motor coverages vehicle. A trailer is not equipment. (damage to your auto) COVERAGE AGREEMENT COMPREHENSIVE COVERAGE 1. We will pay for loss to your auto not caused by collision or upset. We will pay for the loss less your deductible. Coverage is included for: a) damage from contact with: (1) animals; or (2) falling or flying objects; b) broken glass: (1) even if caused by collision or upset; and (2) if you do not have Collision coverage. If your Comprehensive and Collision coverages have different deductibles, the smaller deductible will apply to broken glass. 2. Also, if your auto has a loss under this coverage we will: a) pay for resulting damage to your clothing and luggage or that of any relative. Maximum payment is $200. We will pay for stolen clothing or luggage only if your auto is stolen. physical damage b) repay your travel costs after your auto is stolen. Maximum payment is $15 per day-not to exceed $450 per occurrence. These costs must be incurred within a certain time. It starts 48 hours after you report the theft to us and the police. It ends when your auto is returned to you or we pay for its loss. c) repay you for the cost of travel from where your auto was disabled to where you were going. Maximum payment is $10. COLLISION COVERAGE 1. We will pay for loss to your auto caused by collision or upset. This includes broken glass. We will pay for the loss less your deductible. However, we will not subtract the deductible amount: a) if your auto collides with another motor vehicle insured by us; or b) for broken glass if you have full (no deductible) Comprehensive coverage in force. 2. Also if your auto has a loss under this coverage, we will: a) pay for resulting damage to your clothing and luggage or that or any relative. Maximum payment is $200. b) repay you for the travel cost to where you were going. Maximum payment is $10. TOWING AND LABOR COSTS COVERAGE We will pay towing and labor costs if your auto is disabled. We will pay only for labor costs at the place where your auto is disabled. Our maximum payment per disablement is shown in the Declarations. COVERAGE EXTENSIONS USE OF TRAILERS The insurance on your auto covers a trailer used by you or a relative. 1. The trailer must be: a) designed for use with a private passenger auto; and b) used with a vehicle that is insured under these coverages. 2. The trailer must not be: a) otherwise insured; b) owned by you or a relative; or c) used for business purposes with a vehicle that's not a private passenger auto. 3. The maximum amount payable is $500. USE OF OTHER MOTOR VEHICLES The insurance on your auto also covers other motor vehicles as follows: 1. a motor vehicle you do not own, while it is used in place of your auto for short time. Your auto must be out of use because of: a) breakdown; c) servicing; or b) repair; d) loss. 2. a four-wheel motor vehicle newly acquired by you. The coverage applies only during the first 30 days you own the vehicle, unless it replaces your auto. We provide this coverage only if you do not have other collectible insurance. You must pay any added premium resulting from this coverage extension. 3. a private passenger auto owned by a non-member of your household and not covered in item 1. of this section. 4 physical damage a) This applies only: ' i06i'1lol1 rfl) (1) to the policies issued to persons (not organizations). (2) while such auto is being used by yon or a relative. b) We will not pay for loss: (I) that results from the operation of an auto: (a) repair shop; (c) sales agency; or (b) public garage or parking place; (d) service or maintenance facility (2) involving a private passenger auto owned by an employer of an insured. (3) involving a private passenger auto furnished to you or a relative for regular use. (4) to any rented motor vehicle. 4. a rented private passenger auto, including its loss of income. a) This applies only: (1) while such auto is rented by you or a relative; (2) to policies issued to persons (not organizations); (3) if such auto is rented from a rental company for less than 28 days; and (4) for loss of income that is: (a) verifiable by us; and (b) owed to a rental company because: (1) the rental company has a customer willing to rent a private passenger auto; and (2) there was no other vehicle available for rental in place of the damaged rented auto, b) We will not pay for loss involving a private passenger auto rented or leased by anyone for or on behalf of the employer of an insured. COVERAGE EXCLUSIONS We will not pay for loss: I. to more than one: a) stereo tape; b) cassette; or c) cartridge. 2. to a container to be used for storing or carrying: a) stereo tapes; b) cassettes; or c) cartridges. 3. to any: a) citizens band radio; b) two-way mobile radio; c) telephone; or d) other device which receives and transmits sound. This exclusion (3) does not apply if the device is a permanent part of your auto. Permanent part means installed in a location planned by the auto maker for a radio. If the device is not covered, its antenna and other parts are not covered. 5 physical damage 4. to a camper or living quarters unit which can be mounted on or attached to a vehicle, We will pay ;, > the loss if: a) the unit is reported to us; and b) the required premium is paid; before the loss. 5. due to: a) wear and tear; b) freezing; c) mechanical or electrical breakdown or failure. This exclusion (5) does not apply to damage which is the result of other loss covered by this policy. This exclusion does not apply to Towing and Labor coverage. 6. while any motor vehicle is used to carry persons or property for a fee. Motor vehicles used in shared- expense czar pools are not considered as carrying persons for a fee. 7. to any auto due to an act of war. 8. to scanning monitor receivers used for radar detection. LIMITS OF PAYMENT ACTUAL CASH VALUE The limit of our coverage is the cash value of your auto or its damaged parts at the time of loss. To determine cash value, we will consider: 1. fair market value; 2. age; and 3. condition of the property; at the time of loss. We may: 1. pay you directly for a loss; 2. repair or replace your auto or its damaged parts; 3. return stolen property at our expense and pay for any damage. OTHER INSURANCE If you have other insurance that covers any loss, we will pay only our share of the loss. Our share is our proportion of the total insurance collectible for the loss. For loss to motor vehicles other than your auto, we will pay only the insured loss not covered by other insurance. COVERAGE CONDITION AUTO RECOVERY When an insured auto which has been stolen or abandoned is located, we have the right to take it into our care to keep it safe. ASSIGNABILITY No interest in these coverages can be transferred without our written consent. However, if the policyholder dies, they will stay in force for the rest of the policy period. They will apply for anyone having proper temporary custody of your auto. 6 auto COVERAGiE AGREEMENT liability PROPERTY DAMAGE AND BODILY INJURY LIABILITY COVERAGE (for damage or injury to 1. We will pay for damages for which you are legally liable as a result of an accident arising out of the: others caused by your auto) a) ownership; b) maintenance or use; or c) loading or unloading; of your auto. A relative also has this protection. So does any person or organization who is liable for the use of your auto while used with your permission. 2. Damages must involve: a) property damage; or b) bodily injury. 3. We will pay such liability losses up to the limits stated in the Declarations, In addition to these limits and as to any covered damages, we will: a) defend at our expense, with attorneys of our choice, any suit against the insured. We may settle or defend any claim or suit as we think proper. b) pay: (1) all expense incurred by us; and (2) all costs levied against the insured; in any such suit. c) pay: (1) all premiums on appeal bonds in defended suits. (2) a premium of not more than $250 for bail bond required because of an accident or traffic violation. Although paying such premiums, we are not required to apply for or furnish such bonds. (3) all premiums on bonds to release attached property. d) pay post-judgment interest on all damages awarded. We will not pay interest that accrues after such time as we have: (1) paid; (2) formally offered; or (3) deposited in court the amount for which we are liable under this policy. e) pay expenses incurred by an insured for emergency medical aid to others at the time of accident. f) pay all reasonable expenses incurred by an insured at our request, but not more than $50 per day for loss of earnings. 4. After the limits of this coverage have been paid, we will not defend any suit or pay any claim or judgment. COVERAGE EXTENSIONS USE OF TRAILERS 1. This coverage applies to the use of a trailer by: a) you; b) a relative; or c) someone else with your permission. 7 auto liability 2. The trailer must be: ?conunuedl a) designed for use with a private passenger auto; and b) used with a vehicle that is insured under this coverage. 3_ The trailer must not be used for business purposes with a vehicle that's not a private passenger auto. USE OF OTHER MOTOR VEHICLES This insurance also applies to certain other motor vehicles as follows; 1. a motor vehicle you do not own, while it is used in place of your auto for a short time. Your auto must be out of use because of; a) breakdown; c) servicing; or b) repair; d) loss. 2. a four-wheel motor vehicle newly acquired by you. It applies only: a) during the first 30 days you own the vehicle unless it replaces your auto; and b) if you do not have other insurance. You must pay any premiums resulting from this coverage. 3. a motor vehicle owned by a non-member of your household and not covered in item 1 of this section. a) This applies only to policies issued to individual persons (not organizations) and while the vehicle is being used by you or a relative. It protects the user, and any person or organization, except as noted below in b), who does not own the vehicle but is legally responsible for its use. b) This does not apply to losses involving a motor vehicle: (1) used in the business or occupation of you or a relative except a private passenger auto used by you, your chauffeur, or your household employee; (2) owned, rented or leased by an employer of an insured; (3) rented or leased by anyone for or on behalf of an insured; or (4) furnished to you or a relative for regular use. Furnished for regular use does not include a motor vehicle rented from a rental company for less than 28 days. FINANCIAL RESPONSIBILITY We will adjust this policy to comply: 1. with the financial responsibility law of any state or province which requires higher liability limits than those provided by this policy. 2. with the kinds and limits of coverage required of non-residents by any compulsory motor vehicle insurance law, or similar law. However, any loss payment under this extension of limits or coverage will be made only over and above any other collectible motor vehicle insurance. In no case will anyone be entitled to dublicate payments for the same loss. COVERAGE EXCLUSIONS This coverage does not apply to: 1. property damage or bodily injury caused intentionally by or at the direction of an insured. 2. any motor vehicle while used to carry persons or property for a fee. Motor vehicles used in shared- expense car pools are not considered as carrying persons for a fee. 3. any person for any occurrence arising out of the operation of an auto: a) repair shop; b) public garage or parking place; c) sales agency; or d) service or maintenance facility. 8 auto liability However, this exclusion does not apply to: a) you; b) a relative; or c) a partner, employee or agent of you or a relative; with regard to the use of your auto. 4. damage to any property you own or have in your care; except a rented home or rented private garage. The same applies to any insured. 5. bodily injury to others for which any insured may be liable under a: a) workers' compensation; c) disability benefits; or b) unemployment compensation; d) similar law. 6, bodily injury to an employee of any insured, while engaged in his employment. However, it does cover an employee at your home who is not, or is not required to be, covered by any workers' compensation law. 7. any obligation for which the government may be held liable under the Federal Tort Claims Act. 8. any person protected under nuclear energy liability insurance. This exclusion applies even if the liability benefit. of that insurance has been exhausted. 9. noneconomic loss of or for any person who has elected "Limited Tort" in accordance with the Pennsylvania Motor Vehicle Financial Responsibility Law. LIMITS OF PAYMENT AMOUNTS PAYABLE: FOR LIABILITY LOSSES Our obligation to pay Liability losses is limited to the amount per occurrence stated in the Declarations. The following conditions apply to this limit; 1. This limit will first be applied to provide the separate bodily injury and property damage limits required to satisfy the financial responsibility law. Any amount remaining within the total limit will then be used as needed. 2. Limits apply as stated in the Declarations. Insuring more than one person or vehicle under this policy does not increase our limits. 3. In any loss covered under items (2) and (3) of "USE OF OTHER MOTOR VEHICLES," the highest liability limit applicable to any one vehicle in this policy will apply. 4. A motor vehicle and attached trailer are considered one vehicle for Auto Liability coverage. OTHER INSURANCE In any loss involving the use of your auto, we will be liable for only our share of the loss if there is other collectible liability insurance. Our share is our proportion of the total insurance limits for the loss. For losses involving the use of other motor vehicles, we will pay the insured loss not covered by other insurance. You may have more than one Nationwide policy; we will pay only up to the highest limit of any one of them. ASSIGNABILITY No interest in this coverage can be transferred without our written consent. However, if the policyholder dies, the Liability coverage will continue in force for the rest of the policy period for: 1. Anyone having proper temporary custody of your auto until a legal representative is appointed; and 2. The appointed legal representative. 9 first party COVERAGE AGREEMENT This coverage provides First Party Benefit options in accordance with the Pennsylvania Motor Vehicle benefits Financial Responsibility Law. The options and limits which the policyholder has selected are shown on the Declarations. We will pay First Party Benefits for bodily injury of an insured as a result of an accident that arises out of the maintenance or use of a motor vehicle as a motor vehicle. We will pay these benefits regardless of who is at fault in the accident. Additional Definitions Applicable to This Coverage For purposes of this coverage: 1. "RELATIVE" means the following residents of the policyholder's household; a) spouse; b) anyone related to the policyholder or spouse by blood, marriage or adoption; and c) a minor in the legal custody of the policyholder or such relative. A relative may live temporarily outside the household. 2. "MOTOR VEHICLE" means any vehicle which is self-propelled, except one which is propelled: a) solely by human power; b) by electric power obtained from overhead trolley wires; or c) upon rails. 3. "NECESSARY MEDICAL TREATMENT AND REHABILITATIVE SERVICES" means treatment, accommodations, products or services which are determined to be necessary by a licensed health care provider unless they shall have been found or determined to be unnecessary by a State- approved Peer Review Organization (PRO). 4. "CATASTROPHIC LOSS TRUST FUND" means the fund established by the Pennsylvania Motor Vehicle Financial Responsibility Law in 1984 and repealed in 1988. INSUREDS The policyholder and relatives are covered while occupying or injured by any motor vehicle. Persons other than the policyholder and relatives are covered: 1. while occupying your auto. 2. as non-occupants of a motor vehicle if injured as the result of an accident in Pennsylvania involving your auto. OPTIONS OPTION 1-MEDICAL BENEFIT We will pay all reasonable expenses for necessary medical treatment and rehabilitative services. We will pay such expenses up to the limit shown on the Declarations. Applicable Medical Benefit limits greater than $100,000 shall be excess over any sums paid or payable by the Catastrophic Loss Trust Fund. We will not pay any medical benefit expenses described which are paid or payable by the Catastrophic Loss Trust Fund. There is no time limitation for this benefit, provided that, within 18 months after the date of the accident, it is determined with reasonable medical probability that further expenses may be incurred as a result of the injury. OPTION 2-INCOME LOSS BENEFIT If this option is selected by payment of premium, we will pay for loss of income from work the insured was unable to do because of bodily injury. We will not pay under this benefit until five working days have been lost. We will not pay for these five days of lost income, to first party benefits "LOSS OF INCOME" means: a) 80 percent of actual loss of gross income. Gross income is income received from work performed while normally employed in gainful activity. b) reasonable expenses actually incurred for hiring a substitute to perform self-employment services in order to reduce loss of gross income or for hiring special help which permits a person to work and reduce loss of gross income. We will pay such benefit up to the limit shown on the Declarations. However, the total limit of this benefit is subject to the monthly maximum shown on the Declarations. Income loss benefits do not continue after a person dies. OPTION 3-ACCIDENTAL DEATH BENEFIT If this option is selected by payment of premium, we will pay the Accidental Death Benefit for the policyholder or a relative who suffers accidental bodily injury causing death from a covered accident. We will pay the Accidental Death Benefit limit shown on the Declarations, We will increase this limit $10,000 for an insured using an approved motor vehicle seat belt or child restraint system at the time of the accident. Death must occur within two years of, and as a direct result of, the accident. Payment will be made to the executor or administrator of the estate. OPTION 4-FUNERAL BENEFIT If this option is selected by payment of premium, we will pay reasonable expenses directly related to the funeral, burial, cremation, or other form of disposition of the remains of a deceased insured. These expenses must be the direct result of death from a covered accident within two years of the date of the accident. Payment will be made to any person presenting bills for qualified expenses incurred. We will pay such expenses up to the limit shown on the Declarations. OPTION 5-COMBINED LOSS BENEFITS If this option is selected by payment of premium, we will pay the benefits described in Options 1, 2, 3 and 4 above. However, total benefits payable under this option are limited to: a) the aggregate limit shown on the Declarations for this option; or b) three years from the date of the accident; whichever occurs first. Option 5 is subject to the following conditions: a) Except for the 18 month determination of further expenses to be paid under the Medical Benefit, the "no time limitation" provision does not apply. b) There is no monthly dollar maximum for Income Loss Benefits. c) The maximum Accidental Death Benefit payable is $25,000. d) The maximum Funeral Benefit payable is $2,500. e) Benefits under c) and d) are payable if death occurs within two years of the date of the accident. OPTION 6-EXCESS MEDICAL BENEFITS if this option is selected by payment of premium, we will pay Excess Medical Benefits for an insured who suffers accidental bodily injury from a covered accident. Excess Medical Benefits are all reasonable expenses for necessary medical treatment and rehabilitative services. We will pay such expenses in excess of $100,000 but not to exceed one million dollars. We will not pay Excess Medical Benefits to an insured who is not eligible for Option 1-Medical Benefits under this policy. Our liability to one person in one accident is $50,000 per year. Subject to this limit for any one person in any one year, our aggregate limit for any one person is one million dollars for any one accident. During the first 18 months of eligibility, we shall approve payments for an insured without regard to the $50,000 per year limit. For purposes of this option, the first 18 months of eligibility begins when the Insured has incurred $100,000 of eligible necessary medical treatment and rehabilitative services expenses. first party benefits If the insured is covered by Option 5-Combined Loss Benefits package (or a similar auto benefits continued) package with another insurer), applicable Medical Benefit limits greater than $100,000 in such package shall be excess over any sums paid or payable under Excess Medical Benefits. COVERAGE EXCLUSIONS We will not pay First Party Benefits in certain circumstances, as follows: 1. The policyholder and relatives are not covered for bodily injury arising out of the maintenance or use of a motor vehicle that the policyholder owns that is not an insured motor vehicle. An insured motor vehicle is one on which there are First Party Benefits, and to which the auto Bodily Injury Liability coverage in this policy applies. 2. There is no coverage for bodily injury to a relative arising out of the maintenance or use of a motor vehicle owned by such relative which is not insured for First Party Benefits and auto Bodily Injury Liability coverage under this or any other policy. 3. There is no coverage for anyone while occupying a motorcycle, motor-driven cycle, motorized pedalcycle, or similar type vehicles or a recreational vehicle not intended for highway use, 4. There is no coverage for anyone, other than the policyholder or a relative, who knowingly converts a motor vehicle if the injury arises out of the maintenance or use of the converted vehicle. 5. There is no coverage for anyone injured by your auto while it is unoccupied and parked so as not to cause unreasonable risk of injury. 6. There is no coverage for use by any insured of any vehicic to carry persons or property for a fee. However, .shared-expense car pools will not be considered carrying persons for a fee. 7. There is no coverage for anyone, other than the policyholder, who is the owner of a currently registered motor vehicle and who does not have Financial Responsibility. Financial Responsibility means the type of financial responsibility that was self-certified to the Department of Transportation ro obtain the registration. 8. We will not pay any benefits to or for anyone who injures themselves: a) or another intentionally, including an attempt to intentionally injure themselves or another; b) while committing a felony; or c) while seeking to elude lawful apprehension or arrest by a law enforcement official. 9. There is no coverage for any person for any occurrence arising out of the operation of a motor vehicle: a) repair shop; c) sales agency; or b) public garage or parking place; d) service or maintenance facility. However, this exclusion does not apply with regard to the use of your auto to: a) the policyholder; or b) a relative. 10. There is no coverage for any loss sustained by any person as a direct result of loading or unloading any motor vehicle, except while occupying the motor vehicle. 11. There is no coverage for bodily injury arising out of any act of war, or as a result of any hazardous quality of nuclear material. LIMITS AND CONDITIONS OF PAYMENT Limits apply as stated in the attached Declarations. However, the insuring of more than one person or vehicle under this First Party Benefits coverage does not increase the limit of coverage to any one 12 first party benefits person in any one accident. In no event will any insured be entitled to more than the highest limit ?c , clnuFdj applicable to any one motor vehicle under this or any other policy. The following conditions apply to the relationship of this coverage to other insurance or benefits that may be available: uninsured motorists (tor bodily injury caused by uninsured motorists) PRIORITIES OF POLICIES We will pay First Party Benefits in accordance with the order of priorities set forth by law. We will not pay if there is other insurance at a higher level of priority, even if the limits of that insurance have been paid. The highest priority level listed below is the FIRST level which provides benefits for a named insured. The priority order is: FIRST -For a named insured on any policy, the policy on which that person is the named insured. SECOND -For a relative, the policy covering the relative as an insured. THIRD -For the occupants of an insured motor vehicle, the policy on that motor vehicle. FOURTH -For a person who is not the occupant of a motor vehicle, the policy on any motor vehicle involved in the accident. NO DUPLICATION OF BENEFITS; OTHER INSURANCE In any occurrence where other similar auto insurance or self-insurance of equal priority to that provided in this coverage is available and the claim is first presented to us, we will process and pay the claim as if wholly responsible up to the limits of our policy. The total limits available from all such insurance will be considered not to exceed the highest limits available from any one source of coverage. In no instance may an Insured or legal representative recover duplicate benefits from the same elements of loss under this and other similar auto insurance or self-insurance. WORKERS' COMPENSATION REDUCTION We will reduce any amount payable to anyone under this coverage by any benefits received or available under workers' compensation. No reduction will be made if such benefits have not been paid by the time benefits under this coverage are due. However, we will be entitled to reimbursement from whomever is obligated to pay the benefits, or from anyone who ultimately receives them. INSURED PERSONS' DUTIES The insured, or someone on the insured's behalf, will report any accident to us in writing as soon as practicable. This report will identify the injured and give reasonably obtainable information about the time, place and circumstances of the accident. As soon as practicable, the insured or someone on the insumd's behalf will submit written proof of claim to us, under oath if required. This proof will include detailed information about the nature and extent of bodily injury, treatment and rehabilitation received and contemplated, and anything else that may help us determine what benefits are payable in what amounts. The injured person must grant us authorization, if we request it, to obtain copies of medical, income and income tax reports and records. Injured persons must submit to examinations by company-selected physicians as often as the company reasonably requires. Additional Definitions Applicable to This Coverage "Arbitration" means resolving questions in dispute. "Arbitrator" means the party conducting the arbitration. "Uninsured motor vehicle"-See definition in "COVERAGE AGREEMENT" section. 13 uninsured COVERAGE AGREEMENT motorists YOU AND A RELATIVE We will pay compensatory damages as a result of bodily injury suffered by you or a relative and due by law from the owner or driver of an uninsured motor vehicle. Damages must result from an accident arising out of the: 1. ownership; 2. maintenance; or 3. use; of the uninsured motor vehicle. OTHER PERSONS Anyone else is protected who suffers bodily injury while occupying: 1. Your auto. 2. A motor vehicle you do not own, while it is used in place of your auto for a short time. Your auto must be out of use because of: a) breakdown; b) repair; c) servicing; or d) loss. 3. A four-wheel motor vehicle newly acquired by you. This applies only during the first 30 days you own the vehicle, unless it replaces your auto. 4. Any other motor vehicle while it is being driven by you or a relative. This extension applies only in policies issued to persons (not organizations). However, the vehicle must not be: a) owned by you or a relative; or b) furnished to you or a relative for regular use. DERIVATIVE CLAIMS This coverage also protects others for compensatory damages due them, as a derivative claim, by law because of bodily injury to you or a relative. A derivative claim is included within the limit payable per person and per occurrence as described in the Limits of Payment section. RECOVERY 1. We will jointly determine with the insured whether: a) there is legal right to recover damages; and b) if so, the amount of such damages. If you and we can't agree, the matter will go to arbitration. 2. The limits of coverage as shown in the Declarations are not subject to arbitration. 3. Any judgment against the uninsured will be binding on us only if it has our written consent. DEFINITION 1. An uninsured motor vehicle is: a) one for which there is no bodily injury liability bond or insurance or self-insurance at the time of the accident. b) one for which the insuring company denies coverage or becomes insolvent. 14 uninsured c) an unidentified motor vehicle which causes bodily injury to an insured by physical contact with: Motmist% (1) such person; or (2) a vehicle the Insured is occupying. The driver and the owner of the unidentified vehicle must be unknown. A report must be made to the police as soon as practicable. We must have a sworn statement within 30 days. It must state that the insured has a legal action due to the accident. It must include facts to support the action. We may inspect any vehicle the insured was occupying. 2. We will not consider as an uninsured motor vehicle: a) a motor vehicle that is "self-insured" under any law; b) any motor vehicle owned by a government unit or agency; c) any vehicle in use as a residence or premises; d) any equipment or vehicle designed for use mainly off public roads except while on public roads; e) any motor vehicle insured under the liability coverage of this or any other policy; nor f) any motor vehicle furnished for the regular use of you or a relative. "OVERAGE EXCLUSIONS This coverage does not apply to. 1. Use of any motor vehicle by an insured to carry persons or property for a fee. Shared-expense car pools are not considered carrying persons for a fee. 2. Use of any motor vehicle by an insured without the owner's permission. 3. Bodily injury of any insured if the insured settles, without our written consent, with a liable party. 4. Bodily injury suffered while occupying a motor vehicle owned by you or a relative but not insured for Uninsured Motorists coverage under this policy; not to bodily Injury from being hit by any such motor vehicle. 5. Punitive or exemplary damages. 6. Noneconomic loss of any insured who has elected "Limited Tort" in accordance with the Pennsylvania Motor Vehicle Financial Responsibility Law. 7. Directly or indirectly benefit any workers' compensation carrier or any person qualified as a self- insurer under any workers' compensation law. !NSUREG PEMSCNS' DUTIES 1. The insured must: a) submit written proof of the claim to us. It must be under oath, if required. It must include: (1) the nature and extent of injuries; (2) treatment; and (3) any other details which could affect the amount of payment. b) provide all facts of the accident and the name of all witnesses, c) answer questions under oath as often as we require with good reason. d) be examined by doctors chosen by us as often as we require with good reason. At our request, the injured person must promptly authorize us to: (l) speak with any doctor who has treated him; (2) read all medical history and reports of the injury; 15 uninsured (3) obtain copies of wage and medical reports and records; and motorists (4) obtain copies of all medical bills as they are incurred. k' Ml (uiektl 2. After notice of claim, we require the insured to take legal action against any liable party. 3. An insured may bring legal action against the other party for bodily injury. A copy of any paper served in this action must be sent to us at once. 4. The insured must: a) obtain our written consent to: (1) settle any legal action brought against any liable party; or (2) release any liable party. b) preserve and protect our right to subrogate against any liable party. ARBITRATION If we and the insured disagree about the right to recover damages, or the amount of such damages: 1. After written demand for arbitration by either party, each will select a competent arbitrator. The two so selected will select a third. 2. If the third arbitrator is not agreed upon within 30 days, the insured or we may request a judge of a court of record to name one. The court must be in the county and state where arbitration is pending. 3. Each party will pay its chosen arbitrator. Each will pay half of all other expenses. 4. Arbitration shall be conducted in accordance with the provisions of the Pennsylvania Arbitration Act of 1927. 5. Unless the insured and we agree otherwise, arbitration will take place in the county and state where the insured lives. The insured will submit to examination under oath as often as reasonably requested by as. The insured will grant us authority, at our request, to obtain copies of wage and medical records. The arbitrators will resolve the issues. Questions in dispute will be decided when two arbitrators agree. 6. Any demand for arbitration must be made within two years after the date of the accident. TRUST AGREEMENT This applies to the extent of any payment we make under this coverage. We will have first right to any amount the Insured receives from any liable party. The insured will: 1. Hold in trust for us his right to recover against any such party; and 2. Furnish us all papers in any suit the insured files. Our payment of a claim may result from the insolvency of an insurer. If so, we have the right to recover from the insurer, but not its insured. LIMITS OF PAYMENT AMOUNTS PAYABLE FOR UNINSURED MOTORISTS LOSSES We agree to pay losses up to the limits stated in the attached Declarations. Any change to those limits must be requested by the policyholder in writing. The following applies to these limits: 1. Bodily injury limits shown for any one person are for all legal damages, including all derivative claims, claimed by anyone I'or bodily injury to one person as a result of one occurrence. Subject to this limit for any one person, the total limit of our liability shown for each occurrence is for all damages, including all derivative claims, due to bodily injury to two or more persons in any one occurrence. 16 uninsured 2. Limits apply as stated in the Declarations. The insuring of more than one person or vehicle under motorists this policy does not increase our payment limits for this coverage, In no event will any insured be ;)orilJnued) entitled to more than the highest per person limit applicable to any one motor vehicle under this policy or any other policy issued by us. However, with regards to you (not organizations) or a relative, the sum of limits of your autos apply as stated in the Declarations. 3. Any damages payable, under this coverage, will be reduced by any sums paid by or for any liable parties, This includes all sums paid under the Auto Liability coverage of this policy. 4. Any payment under this coverage to or for an insured will reduce the amount of damages the insured may be entitled to recover under the Auto Liability coverage of this policy. 5. No payment will be made until the limits of all other liability insurance and bonds that apply have been exhausted by payments. OTHER INSURANCE If there is other insurance. 1. For bodily injury suffered by an Insured while occupying a motor vehicle you do not own, we will pay the insured loss not covered by other insurance. 2. Except as stated above, if you have other insurance similar to this coverage under another policy, we will be liable for only our share of the loss. Our share is our proportion of the total insurance limits for the loss. 3. In any event, if more than one policy applies to an insured other than you or a relative, total limits applicable will be considered not to exceed the highest limits of any one of them. DUPLICATE PAYMENT We will make no duplicate payment to or for any Insured for the same element of loss. ASSIGNABILITY No interest in this coverage can be transferred without our written consent. However, if the policyholder dies, this coverage will continue in force for the rest of the policy period. It will apply to anyone having proper custody of your auto. under' Additional Definitions Applicable to This Coverage "Arbitration" means resolving questions in dispute. insured "Arbitrator" means the party conducting the arbitration. motorists "Underinsured motor vehicle"-Sec definition in "COVERAGE AGREEMENT" section. (for bodily injury caused by underinsured motorists) COVERAGE AGREEMENT YOU AND A RELATIVE We will pay compensatory damages as a result of bodily injury suffered by you or a relative and due by law from the owner or driver of an underinsured motor vehicle. Damages must result from an accident arising out of the: 1. ownership; 2. maintenance; or 3. use; of the underinsured motor vehicle. 17 underinsured OTHER PERSONS motorists Anyone else is protected who suffers bodily injury while occupying: is urn a ,n:ri 1. Your auto. 2. A motor vehicle you do not own, while it is used in place of your auto for a short time. Your auto must be out of use because of: a) breakdown; b) repair; C) servicing; or d) loss. 3. A four-wheel motor vehicle newly acquired by you. This applies only during the first 30 days you own the vehicle, unless it replaces your auto. d. Any other motor vehicle while it is being driven by you or a relative. This extension applies only in policies issued to persons (not organizations). However, the vehicle must not be; a) owned by you or a relative; or b) furnished to you or a relative for regular use. DERIVATIVE CLAIMS This coverage also protects others for compensatory damages due them, as a derivative claim, by law because of bodily injury to you or a relative. A derivative claim is included within the limit payable per person and per occurrence as described in the Limits of Payment section. RECOVERY 1. We will jointly determine with the insured whether: a) there is legal right to recover damages; and b) if so, the amount of such damages. if you and we can't agree, the matter will go to arbitration. 2. The limits of coverage as shown in the Declarations are not subject to arbitration. 3. Any judgment against the underinsured will be binding on us only if it has our written consent. DEFINITION t. An underinsured motor vehicle is: a motor vehicle for which bodily injury liability coverage, bonds of self-insurance are in effect. However, their total amount is insufficient to pay the damages an insured is entitled to recover. We will pay damages that exceed such total amount. 2. We will not consider as an underinsured motor vehicle: a) a motor vehicle that is "self-insured" under any taw; b) any motor vehicle owned by a government unit or agency; c) any vehicle in use as a residence or premises; d) any equipment or vehicle designed for use mainly off public roads except while on public roads; e) any motor vehicle insured under the liability coverage of this policy; nor f) any motor vehicle furnished for the regular use of you or a relative. 7FIAGF EX.CI.0SIONS This coverage does not apply to: 1. Use of any motor vehicle by an insured to carry persons or property for a fee. Shared-expense car pools are not considered carrying persons for a fee. 18 underinsured 2. Use of any motor vehicle by an insured without the owner's permission. motorists 3. Bodily injury suffered while occupying a motor vehicle owned by you or a relative but not insured for Underinsured Motorists coverage under this policy; nor to bodily injury from being hit by any such motor vehicle. 5. Punitive or exemplary damages. 6. Noneconomic loss of any insured who has elected "Limited Tort" in accordance with the Pennsylvania Motor Vehicle Financial Responsibility Law. INSURED PERSONS' DUTIES 1. The insured must: a) submit written proof of the claim to us. It must be under oath, if required. It must include: (1) the nature and extent of injuries; (2) treatment; and (3) any other details which could affect the amount of payment. b) provide all facts of the accident and the name of all witnesses. c) answer questions under oath as often as we require with good reason. d) be examined by doctors chosen by us as often as we require with good reason. At our request, the injured person must promptly authorize us to: (1) speak with any doctor who has treated him; (2) read all medical history and reports of the injury; (3) obtain copies of wage and medical reports and records; and (4) obtain copies of all medical bills as they are incurred. 2. After notice of claim, we require the insured to take legal action against any liable party. 3. An insured may bring legal action against the other party for bodily injury. A copy of any paper served in this action must be sent to us at once. 4. The insured must: a) obtain our written consent to: (1) settle any legal action brought against any liable party; or (2) release any liable party. b) preserve and protect our right to subrogate against any liable party. ARBITRATION If we and the insured disagree about the right to recover damages, or the amount of such damages: 1. After written demand for arbitration by either party, each will select a competent arbitrator. The two so selected will select a third. 2. If the third arbitrator is not agreed upon within 30 days, the insured or we may request a judge of a court of record to name one. The court must be in the county and state where arbitration is pending. 1 Each party will pay its chosen arbitrator. Each will pay half of all other expenses. 4. Arbitration shall be conducted in accordance with the provisions of the Pennsylvania Arbitration Act of 1927. 5. Unless the insured and we agree otherwise, arbitration will take place in the county and state where the insured lives. The insured will submit to examination under oath as often as reasonably requested by us. The insured must grant as authority, at our request, to obtain copies of wage and medical records. The arbitrators will resolve the issues. Questions in dispute will be decided when two arbitrators agree. 19 underinsured 6. Any demand for arbitration must be made within two years after the date of the accident. motorists .;nV??n?nr?lj TRUST AGREEMENT This applies to the extent of any payment we make under this coverage. We will have first right to any amount the insured receives from any liable party. The insured will: 1. Hold in trust for us his right to recover against any such party; and 2. Furnish us all papers in any suit the insured files, Our payment of a claim may result from the insolvency of an insurer. If so, we have the right to recover from the insurer, but not its insured. LIMITS OF PAYMENT AMOUNTS PAYARLE: FOR UNDERINSURED MOTORISTS LOSSES We agree to pay losses up to the limits stated in the attached Declarations. Any change to those limits must be requested by the policyholder in writing. The following applies to these limits: I . Bodily injury limits shown for any one person are for all legal damages, including all derivative claims, claimed by anyone for bodily injury to one person as a result of one occurrence. Subject to this limit for any one person, the total limit of our liability shown for each occurrence is for all damages, including all derivative claims, due to bodily injury to two or more persons in any one occurrence. 2, Limits apply as stated in the Declarations. The insuring of more than one person or vehicle under this policy does not increase our payment limits for this coverage. In no event will any insured be entitled to more than the highest per person limit applicable to any one motor vehicle under this policy or any other policy issued by us. However, with regards to you (not organizations) or a relative, the sum of limits of your autos apply as stated in the Declarations. 3. Any damages payable, under this coverage, will be reduced by any sums paid by or for any liable parties. 4. Any payment under this coverage to or for an insured will reduce the amount of damages the insured may be entitled to recover under the Auto Liability coverage of this policy. 5. No payment will be made until the limits of al) other liability insurance and bonds that apply have been exhausted by payments. 6. An insured who recovers damages for an uninsured motorists claim cannot recover damages for an underinsured motorists claim for the same accident. OTHER INSURANCE': If there is other insurance: 1. For bodily injury suffered by an insured while occupying a motor vehicle you do not own, we will pay the insured loss not covered by other insurance, 2. Except as stated above, if you have other insurance similar to this coverage under another policy, we will be liable for only our share of the loss. Our share is our proportion of the total insurance limits for the loss. 3. In any event, if more than one policy applies to an insured other than you or a relative, total limits applicable will be considered not to exceed the highest limits of any one of them. DUPLICATE PAYMENT We will make no duplicate payment to or for any insured for the same element of loss. 20 underinsured ASSIGNABILITY irotoriStS No interest in this coverage can be transferred without our written consent. However, if the policyholder dies, this coverage will continue in force for the rest of the policy period. It will apply to anyone having proper custody of your auto. general We, you, and anyone insured by this policy must do certain things in order for the provisions or the policy to apply. The following are policy conditions: policy 1. INSURED PERSONS' DUTIES conditions The insured will: a) give us or our agent prompt notice of all losses and provide written proof of claim if required. b) notify the police of all theft losses as soon as practicable. c) promptly deliver to us all papers dealing with any claims or suits. d) submit to examination under oath as often as reasonably requested by its. e) assist us with any claim or suit. f) if injured, submit to examinations by company-selected physicians as often as the company reasonably requires. The injured person must grant us authority, at our request, to obtain copies of wage and medical records. g) protect damaged property insured under this policy and make it available to its for inspection before its repair or disposal. 2. UNAUTHORIZED USE OF OTHER MO" VEHICLES Protection in this policy does not apply to any motor vehicle any insured: a) uses without a reasonable belief that the insured is entitled to do so. b) has stolen. c) knows to have been stolen. 3. HOW YOUR POLICY MAY BE CHANGED a) Any terms of this policy which may be in conflict with statutes of the state in which the policy is issued are hereby amended to conform, b) Any insured will automatically have the benefit of any extension or broadening of coverage in this policy, as of the effective date of the change, provided it does not require more premium, c) No other changes may be made in the terms of this policy except by policy endorsement, d) The premium for each coverage is based on information in our possession. Any change(s) in this information will allow us to make an adjustment of the prernium on a pro rata basis. 4. IF YOU BECOME BANKRUPT Bankruptcy or insolvency of any insured will not relieve us of any obligation under the terms of this policy. 5. SUBROGATION We have the right of subrogation under the; a) Physical Damage; b) Auto Liability; and c) Medical Payments; coverages in this policy. This means that after paying a loss to you or others tinder this policy, we will have the insured's right to sue for or otherwise recover such loss from anyone else who may be liable. Also, we may require reimbursement from the insured out of' any settlement or judgment that duplicates our payments. 21 ,,:?rteral poliCy 6. RENEWAL/NONR NEWAL (_andilions This policy is written for a six-month policy period. We will renew it for successive policy periods, subject to the following conditions: a) renewal will be in accordance with policy forms, rules, rates and rating plans in use by us at the time. b) prior to the expiration date of a policy term for which premium has been paid, we will mail a notice to the policyholder for the premium required to renew or maintain the policy in effect. We will mail this notice to the address last known to us. c) all premiums nr premium installment payments must be paid when due, whether payable directly to us or through any premium finance plan. d) at the end of each 12-month period after the first date of the policy or any coverage, we will have the right to refuse to renew any coverage or the entire policy. If we elect not to renew, we will mail notice to the policyholder 60 days in advance of the date when coverage will terminate. Such mailing to the last known address will be considered proof of notice. 7. CANCELLATION DURING POLICY PERIOD The policyholder may cancel this policy or any of its coverages by mailing notice to us of the future date of cancellation desired. Premium refund, if any due, will be made as soon as practicable after the date of cancellation. We will retain premium for the days covered. If this policy or any coverage has been in effect less than 60 days, we have unlimited right of cancellation. We may cancel by mailing notice to the policyholder. a) 15 days in advance of termination for nonpayment of premium. b) 10 days in advance of termination for all other reasons. Except for nonpayment, the date of termination must be within the first 60 days of coverage. After any coverage of this policy has been in force 60 days, our right to cancel such coverage during the policy period is limited. We may cancel during an annual policy period: a) if premiums or premium installment payments are not paid when due, whether payable directly to us or through any premium finance plan. b) if the driver's license or motor vehicle registration of any named insured has been suspended or revoked during the policy term. c) if it is determined that any insured has concealed a material fact, has made a material allegation Contrary to fact, or has made a misrepresentation of a material fact and that such concealment, allegation or misrepresentation was material to the acceptance of the risk by us. We must mail notice to the policyholder: a) 15 days in advance of termination for nonpayment of premium. b) 15 days in advance of termination for loss of license or of motor vehicle registration, c) 60 days in advance of termination for concealment or misrepresentation. In any case of cancellation by us, our mailing of notice to the last known address or delivery of it to the policyholder will be considered proof of notice. We will retain premium for days covered during the policy period. Premium refund, if any due, will be made as soon as practicable. Mailing or delivery of our check will constitite tender of refund. 8. LEGAL ACTION LIMITATIONS No legal action may be brought against us concerning this policy until the insured has fully complied with all its terms. Under the liability coverages of this policy, no legal action may be brought against us until judgment against the insured has been finally determined after trial. This policy does not give anyone the right to make us a party to any liability action against an insured. 22 general policy 9. PREMIUM RECOMPUTATION conditions Premiums and coverages of this policy conform to the Motor Vehicle Financial Responsibility Law. It 'a court of jurisdiction effectively renders any or all provisions of the act invalid Or unenforceable, we may recompute premiums payable and revise the coverage. Changes, however, will be made- as required by law--only upon approval by the Pennsylvania Insurance Commissioner. If we fail to act within a reasonable time, the Commissioner may direct fair and reasonable adjustments. 10. OPTIONAL PAYMENT OF PREMIUM IN INSTALLMENTS The policyholder may pay the premium for this policy in installmeents, under terms and conditions approved where required by the Department of Insurance. For each separate installment payment there is an installment service charge. Your agent can provide additional information about installment payment. IN WITNESS WHEREOF: Nationwide General Insurance Company has caused this policy to be signed by its President and Secretary at Columhus, Ohio, and countersigned as may be required by a duly authorized representative of the company. )940914- _441e? 044_1?? .ti'.r rrgrt ry! 1'r,.idr a7 Nationwide General Insurance Company I Home Office Columbus. Ohio 43215-2220 23 Endorsement 809A amendatory endorsement (Pennsylvania) Please attach this important addition to your auto policy. It is agreed that the policy is amended as follows: DEFINITIONS Definitions 7 and 9 are replaced to read: 7. "PRIVATE PASSENGER AUTO" means a four-wheel: a) private passenger auto; b) van; or c) pickup truck. 9. "RELATIVE" means one who regularly lives in your household and who is related to you by blood, marriage or adoption (including a ward or foster child). A relative may live temporarily outside your household. PHYSICAL DAMAGE COVERAGE AGREEMENT COMPREHENSIVE COVERAGE The following is added to item 1. b) (2): For damage to your windshield, we may offer to have it repaired in lieu of replacement. We will not apply a deductible for the repair of the windshield. However, if the repair is not satisfactory, we will replace the windshield subject to your deductible. COLLISION COVERAGE Item 1, is amended to read: 1. We will pay for loss to your auto caused by collision or upset. We will pay for the loss less your deductible. We will not subtract the deductible amount for broken glass if you have full (no deductible) Comprehensive coverage in force. COVERAGE EXTENSIONS USE OF OTHER MOTOR VEHICLES Item 2. is amended to read: 2. A four-wheel motor vehicle newly acquired by you. You must report the acquisition of the vehicle to us during the first 30 days you own the vehicle. Also, if the newly acquired vehicle does not replace your auto, all household vehicles owned by you must be insured by us or an affiliate for this extension of coverage to apply. We provide this coverage only if you do not have other collectible insurance. You must pay any added premium resulting from this coverage extension. COVERAGE EXCLUSIONS Exclusions L, 2., 3., and 8. are replaced to read: We will not pay for loss: 1. To more than one: a) recording tape; b) compact disc; or c) other recording media. 2. To a container to be used for storing or carrying: a) recording tapes; NGN 809-A (6-97) Page 1 of 5 b) compact discs; or c) other recording media. 3. To any device which is a: a) tape player; b) compact disc player; c) citizens band radio; d) two-way mobile radio; e) telephone; or f) any other device which records, emits, receives and/or transmits sound. This exclusion (3.) does not apply if the device is a permanent part of your auto. Permanent part means installed in a location used by an auto maker for such a device. If the device is not covered, its antenna and other parts are not covered. 8. To scanning monitor receivers used for radar detection, or any other device designed to detect the monitoring of speed. LIMITS OF PAYMENT ACTUAL CASH VALUE The Actual Cash Value provisions are replaced to read: The limit of our coverage is the cash value of your auto or its damaged parts at the time of loss. To determine cash value, we will consider: 1. fair market value; 2, age; and 3. condition of the property; at the time of loss. In addition to our payment of the loss, necessary and reasonable towing and storage will be paid to protect the auto from further damage. The following provisions apply under the heading Loss Settlement: LOSS SETTLEMENT At our option, we may: 1. pay you directly for a loss; 2. repair or replace your auto or its damaged parts with parts furnished either by original equipment manufacturers or non-original equipment manufacturers; 3. return stolen property at our expense and pay for any damage. COVERAGE CONDITIONS The following Condition is added: CONTROLLING STORAGE COSTS When an insured is involved in a Collision or Comprehensive loss, we have the right to move the vehicle from any impound lot, storage site, towing yard or any other facility to control storage costs, towing costs or other fees. The insured will be promptly notified whenever any such action is undertaken. AUTO LIABILITY COVERAGE AGREEMENT PROPERTY DAMAGE AND BODILY INJURY LIABILITY COVERAGE Item 3. c) is replaced to read: 3. c) pay premiums: (1) of not more than $250 per insured for bail bonds required because of an accident or traffic violation. Page 2 of 5 NGN 809-A (6-97) (2) for appeal bonds in defended suits and for bonds to release attached property. The amount of such bonds shall not be more than the limits of liability shown in the Declarations. Although paying such premiums, we are not required to apply for or furnish such bonds. COVERAGE EXTENSIONS USE OF OTHER MOTOR VEHICLES Item 2. is amended to read: A four-wheel motor vehicle newly acquired by you. This coverage applies only during the first 30 days you own the vehicle unless it replaces your auto. If the newly acquired vehicle does not replace your auto, all household vehicles owned by you must be insured by us or an affiliate for this extension of coverage to apply. We provide this coverage only if you do not have other insurance. You must pay any added premium resulting from this coverage extension. COVERAGE EXCLUSIONS Exclusions 1., 4., 5., and 7. are replaced to read: 1. Property damage or bodily injury caused by an act intending to cause any harm done by or at the direction of any insured. 4. Property damage caused by any insured: a) to a motor vehicle that is owned or operated by, or in the custody of, that insured; or b) to any other property that is owned by or in the custody of any insured or anyone occupying your auto. This exclusion does not apply to a: (1) rented home; or (2) rented private garage. Bodily injury to any person eligible to receive any benefits required to be provided or voluntarily provided by any insured under a: a) workers' compensation; b) unemployment compensation; c) non-occupational or occupational disease; d) disability benefits; or any similar law. 7. The United States of America or any of its agencies. It also does not apply to any employee of the United States of America or any of its agencies while such person is acting within the scope of his or her office or employment and the provisions of the Federal Tort Claims Act apply. LIMITS OF PAYMENT The Other Insurance provisions are replaced to read: OTHERINSURANCE In any losses involving the use of your auto or any other motor vehicle covered under this policy, we will be liable for only our share of the loss if there is other collectible liability insurance available to you or an insured. Our share is our proportion of the total insurance policies applicable to you or any insured for the loss. You may have more than one Nationwide policy; we will pay only up to the highest limit of any one of them. FIRST PARTY BENEFITS OPTIONS OPTION 3-ACCIDENTAL DEATH BENEFIT The following sentence is added: In the alternative, payment will be made to the surviving spouse. NGN 809-A (6-97) Page 3 of 5 OPTION 5-COMBINED LOSS BENEFITS The second paragraph is replaced to read: Option 5 is subject to the following conditions: a) Within 18 months after the date of the accident, it must be determined with reasonable medical probability that future medical expenses will be incurred as a result of the injury. b) In no event will benefits be paid beyond three years from the date of the accident. c) There is no monthly dollar maximum for Income Loss Benefits. d) The maximum Accidental Death Benefit payable is $25,000. e) The maximum Funeral Benefit payable is $2,500. f) Benefits under d) and e) are only payable if death occurs within two years of the date of the accident. INSURED PERSONS' DUTIES The following paragraph is added: The injured person must submit to examination under oath as often as reasonably requested by us. GENERAL POLICY CONDITIONS 1. INSURED PERSONS' DUTIES Item h) is added to read: h) provide all records and documents we reasonably request and permit us to make copies. 3. HOW YOUR POLICY MAYBE CHANGED Items c) and d) are replaced and item e) is added to read: c) no other changes may be made in the terms of this policy except by endorsement or policy revision. d) the premium for each coverage is based on information in our possession. Any change or correction in this information will allow us to make an adjustment of the premium as of the date the change is effective. e) the policyholder has a duty to notify us as soon as possible of any change which may affect the premium or the risk under this policy. This includes, but is not limited to, changes in: (1) the principal garaging address of the insured vehicle(s), which must be reported to us within 30 days of the date the address change becomes effective; (2) drivers; (3) use of the insured vehicle(s); or (4) desired coverages, deductibles, or limits. 5. SUBROGATION Items d) and e) are added to read: d) Uninsured Motorists; and e) Underinsured Motorists; General Policy Condition 7 is replaced to read: 7. CANCELLATION DURING POLICY PERIOD The policyholder may cancel this policy or any of its coverages by mailing notice to us of the future date of cancellation desired. Premium refund, if any due, will be made as soon as practicable after the date of cancellation. We will retain premium for the days covered. If this policy or any coverage has been in effect less than 60 days, we have unlimited right of cancellation. We may cancel by mailing notice to the policyholder 15 days in advance of termination. Page 4 of 5 NGN 809-A (6-97) After any coverage of this policy has been in force 60 days, our right to cancel such coverage during the policy period is limited. We may cancel during an annual policy period: a) if premiums or premium installment payments are not paid when due, whether payable directly to us or through any premium finance plan. b) if the driver's license or motor vehicle registration of any named insured has been suspended or revoked during the policy term. c) if it is determined that any insured has concealed a material fact, has made a material allegation contrary to fact, or has made a misrepresentation of a material fact and that such concealment, allegation or misrepresentation was material to the acceptance of the risk by us. We must mail notice to the policyholder: a) 15 days in advance of termination for nonpayment of premium, b) 15 days in advance of termination for loss of license or of motor vehicle registration. c) 60 days in advance of termination for concealment or misrepresentation. In any case of cancellation by us, our mailing of notice to the policyholder's last known address or delivery of it to the policyholder will constitute proof of notice. We will retain premium for days covered during the policy period. Premium refund, if any due, will be made as soon as practicable. Mailing or delivery of our check will constitute tender of refund. Conditions 11., 12., and 13, are added to read: 11. DIVIDENDS The policyholder is entitled to any dividends which are declared by the Board of Directors and are applicable to coverages in this policy. 12. NON-SUFFICIENT FUNDS CHARGE The company reserves the right to impose a fee for any premium payment that is unable to be processed due to non-sufficient funds, or if there are non-sufficient funds in an account that is being utilized for electronic funds transfer (EFT) payments. This is under the terms and conditions approved where required by the Department of Insurance. 13. FRAUD a) this policy does not cover any loss to or by any insured if any element of fraud or fraudulent action is engaged in by that insured in connection with the loss. b) this policy does not provide Physical Damage coverage if you or a relative, either before or after a loss has: (1) intentionally concealed or misrepresented any material fact or circumstance; or (2) committed any fraud or made false statements relating to such loss. This endorsement applies as stated in the policy Declarations. This endorsement supersedes any prior endorsement numbered 809. NATIONWIDE GENERAL INSURANCE COMPANY Columbus, Ohio NGN 809-A (6-97) Page 5 of 5 i. - pia 2-2 P;V.Fe ett?_i tZl3 irrp -t::r.t ti'our cu. 1 c'.°}'. _ .S IIL2:.CI'e .i1CC1. 3: _ in5 1:C3 _II _::IIS'1rCt, ii2t .:5:. CCYC_-,IC _,- ut;a?i C4 tc :he RECOVERY :.em 4. of Recovery is reFiaced to read: 4. The injured party shall provide notice of an uainsured'underinsured motorists clai= within ttivo years after the date of the accident, if the injured parry fails to provide sucl, ant:ce, and this failure precludes our ability to subrogate against liable parties, coverage may t: denied as provided in Insured Persons' Duties No. 2 below, INSURED PERSONS' DUTIES Items 1. c) and 1, d) are replaced to read: 1. '.he Insured must: c) submit to oral examination under oath as often as we require with good reasoa. d) be examined by doctors, including doctors examining the insured for r:habilitatiaa purposes, chosen by us as often as tine require with good reason. At our r.ues:, the injured person must promptly authorize us to: (1) speak with any doctor who has treated him; (2) read all medical history and reports of the injury; (3) obtain copies of wage and medical reports and records; and (4) obtain copies of all medical bills as they are incurred, This endorsement applies as stated in the policy Declarations. This endorsement is issued by the company shown in the Declarations as the issuic_ company. h;;'--h*iV:?EI"1E Fi„NCEC;?GF,AN'ES Endorsement 2358 underinsured motorists coverage (Pennsylvania) Please attach this important addition to your auto policy, This endorsement replaces the policy's Underinsured Motorists coverage section. Coverage is subject to all terms and conditions of the policy, except as changed by this endorsement. ADDITIONAL DEFINITIONS APPLICABLE TO THIS COVERAGE 1. "ARBITRATION" means a forum for resolving questions subject to arbitration. 2. "ARBITRATOR" means the person conducting the arbitration. 3 An "UNDERINSURED MOTOR VEHICLE" is a motor vehicle for which bodily injury liability coverage, bonds or insurance are in effect. However, their total amount is insufficient to pay the damages an insured is entitled to recover. We will pay damages that exceed such total amount. We will not consider as an underinsured motor vehicle: a) a motor vehicle that is "self-insured" under any law; b) any motor vehicle owned by any government unit or agency-, c) any vehicle in use as a residence or premises; d) any equipment or vehicle designed for use mainly off public roads except while on public roads; e) any motor vehicle insured under the Auto Liability coverage of this policy; nor f) any motor vehicle furnished for the regular use of you or a relative. COVERAGE AGREEMENT YOU AND A RELATIVE We will pay compensatory damages, including derivative claims, which are due by law to you or a relative from the owner or driver of an underinsured motor vehicle because of bodily injury suffered by you or a relative. Damages must result from an accident arising out of the: 1. ownership; 2. maintenance; or 3, use; of the underinsured motor vehicle. OTHER PERSONS We will also pay compensatory damages, including derivative claims, which are due by taw to other persons who: 1. Are not a named insured or an insured household member for similar coverage under another policy; and 2. Suffer bodily injury while occupying: a) your auto. b) a motor vehicle you do not own, while it is used in place of your auto for a short time. Your auto must be out of use because of. (1) breakdown; (3) servicing; or (2) repair; (4) loss. c) a four-wheel motor vehicle newly acquired by you. This applies enly during the lust 30 days you own the vehicle, unless it replaces your auto. V-23!2 i3-C%; d) any other motor vehicle while it is being driven by you or a relative. This extension applies only in policies issued to persons (not organizations). However, the vehicle must not be: (1) owned by you or a relative; or (2) furnished to you or a relative for regular use. RECOVERY 1. Before recovery, we and any injured party seeking protection under this coverage must agree on two points: a) whether there is legal right to recover damages from the owner or driver of an underinsured motor vehicle; and if so, b) the amount of such damages. If agreement can't be reached, the matter will go to arbitration. 2. Questions between the injured party and us regarding whether the injured party is an insured under this coverage, or the Emits of such coverage, are not subject to arbitration and shall be decided by a court of law. 3. Any judgment against the underinsured will be binding on us only if it has our written consent. 4. Any demand for Underinsured Motorists Coverage benefits must be made within two years after the date of the accident. COVERAGE EXCLUSIONS This coverage does not apply to: 1. Use of any motor ivehide by an insured to carry persons or property for a fee. Motor vehicles used in shared-expense car pools are not considered as carrying persons for a fee. 2. Use of any motor vehicle by an insured without the owner's permission. 3. Punitive or exemplary damages. 4. Directly or indirectly benefit any workers' compensation or disability benefits carrier, or any person or organization qualifying as a "self-insurer" under a workers' compensation, disability benefits, or similar law. 5. Bodily injury suffered while occupying or struck by a motor vehicle owned by you or a relative, but not insured for auto liability coverage under this or any other policy. 6. Bodily injury suffered while occupying a motor vehicle owned by you or a relative but not insured for 1jllnderinsured Motorists coverage under this policy, nor to bodily injury from being hit by any such motor vehicle. 7. Noneconomic loss of any insured who has elected "L'united Tort" in accordance with the Pennsylvania Motor Vehicle Financial Responsibility Law. 8. Bodily injury of any insured if the insured settles, without our written consent, with a liable party. INSURED PERSONS' DUTIES 1. The insured must: a) submit written proof of the claim to us. It must be under oath, if required. It must include dotails of: (1) the nature and extent of injuries; (2) treatment; and (3) any other facts which could affect the amount of payment. b) provide all facts of the accident and the name of all witnesses. c) submit to oral examination under oath as often as we require. d) be examined by doctors, including doctors exam iaing the insured for rehabilitation purposes, chosen by us as often as we require. At our request, the injured person must promptly authorize us to: (1) speak with any doctor who has treated him; (2) read all medical history and reports of the injury; 01) c` twin cerics of wage and medical reports and records; and (4) obtain copies of 0 medical b'i is as they are incurred. • 2; We require the insured to file suit against any and all liable parties to preserve and protect our subrogation rights. Failure to do so precludes recovery under this coverage. 3. The insured must obtain our written consent to: a) settle any legal action brought against any liable party, or b) release any party. ARBITRATION If we and the Insured disagree about the right to recover damages from the owner or driver of an underinsured motor vehicle or the amount of such damages: 1. After written demand for arbitration by either party, each will select a competent arbitrator. The two so selected will select a third competent arbitrator. Unless the insured and we agree otherwise, arbitration will take place in the county and state where the Insured lived at the time of the accident. 2. If the third arbitrator is not selected within 30 days, the insured or we may request a judge of a court of record to name one. The court must be in the county and state in which arbitration is pending. 3. Each party will pay its chosen arbitrator. Each will pay half of the neutral arbitrator's expenses. Fees to lawyers and expert witnesses are to be paid by the party hiring them. 4. Arbitration shall be conducted in accordance with the provisions of the Pennsylvania Arbitration Act of 1927. OUR RIGHT TO RECOVERY This applies to the extent of any payment we make under this coverage. We will have fast right to any amount the insured receives from any liable party. The insured will: 1. Hold in trust for us his right to recover against any such party, and 2. Furnish us all papers in any suit the Insured files. Our payment of a claim may result from the insolvency of an insurer. If so, we have the right to recover from the insurer, but not its insured. LIMITS OF PAYMENT AMOUNTS PAYABLE FOR UNDERINSURED MOTORISTS LOSSES We agree to pay losses up to the limits stated in the policy Declarations. The following applies to these limits: 1. The Underinsured Motorists bodily injury limit shown for any one person is for all legal damages, including all derivative claims, claimed by anyone due to bodily Injury to one person as a result of one occtwence. The per-person limit is the total amount available when one person sustains bodily injury, including death, as a result of one occurrence. No separate limits are available to anyone for derivative claims, statutgty claims, or any other claims made by anyone arising out of bodily injury, including death, to one person as o result of one occurrence. The total limit of our liability shown for each occurrence is the total amount available when two or more persons sustain bodily Injury, including death, as a result of one occurrence. In no event shall any one person recover more than the per-person limit shown. 2. Coverage applies as stated in the Declarations. The insuring of more than one person or vehicle under this policy does not increase our Underinsured Motorists payment limits. In no event will any Insured be entitled to more than the higbest per person limit applicable to any one motor vehicle under this policy or any other policy issued by us. However, with regards to you (not organizations) or a relative, the sum of limits of your autos apply as stated in the Declarations. 3. Damages payable under this coverage sball be reduced by any amount paid by or for any liable parties. 4. The insured may recover for bodily injury under the Auto Liability coverage or the Underinsured :Motorists a;vcrage of this policy, but not under both coverages. 5. No payment will be made unti! the limits of 0 other auto liability insurance and bonds that apply have been exhausted by payments. 6. An insured who recov-.rs da=ges for an uninsured motc.rists claim cannot recover damages for ap underinsured m :)torists claims for the same accident. M OTHER INSURANCE If there is other insurance: 1. For bodily Injury suffered by an insured while occupying a motor vehicle you do not own, we will pay the insured loss not covered by other insurance. 2. Except as stated above, if there is other insurance similar to this coverage under any other policy, we will be liable for only our share of the loss. Our share is our proportion of the total insurance limits for the loss. 3. In any event, if more than one policy applies to an insured other than you or a relative, total limits applicable will be considered not to exceed the highest limits amount of any one of them. DL'PLICA7'E PAYMENT We will make no duplicate payment to or for any insured for the same element of loss. ASSIGNABILITY No interest in this coverage can be transferred without our written consent. However, if the policyholder dies, this coverage will continue in force for the rest of the policy period. It will apply to the following having proper custody of your auto: 1. your relatives; 2. your heirs; 3. an appointed legal representative; or 4. anyone else using your auto with the express permission of the legal representative. This endorsement applies as stated in the policy Declarations. This endorsement is issued by the company shown in the Declarations as the issuing company. NATIONWIDE INSURANCE COMPANIES Home Office: Columbus, Ohio 43215-2220 4 Endorsement 2357 uninsured motorists coverage (Pennsylvania) Please attach this important addition to your auto policy. This endorsement replaces the policy's Uninsured Motorists coverage section. Coverage is subject to all terms and conditions of the policy, except as changed by this endorsement. ADDITIONAL DEFINITIONS APPLICABLE TO THIS COVERAGE 1. "ARBITRATION" means a forum for resolving questions subject to arbitration. 2. "ARBITRATOR" means the person conducting the arbitration. 3. An "UNINSURED MOTOR VEHICLE" is: a) one for which there is no bodily injury liability bond or insurance at the time of the accident. b) one for which the insuring company denies coverage or becomes insolvent. c) an unidentified motor vehicle which causes bodily injury to an insured by physical contact with: (1) such insured; or (2) a vehicle the insured is occupying. The driver and the owner of the unidentified vehicle must be unknown. A report must be made to the police and us within 30 days, or as soon as practicable. It must state that the insured has a legal action due to the accident. It must include facts to support the action. If there was no physical contact with the unidentified vehicle, there must be corroborating evidence from a source other than any insured. We may inspect any vehicle the insured was occupying. We will not consider as an uninsured motor vehicle: a) a motor vehicle that is "self-insured" under any law; b) any motor vehicle owned by any government unit or agency; c) any vehicle in use as a residence or premises; d) any equipment or vehicle designed for use mainly off public roads except while on public roads; e) any motor vehicle insured under the Auto Liability coverage of this policy or any other policy; nor f) any motor vehicle furnished for the regular use of you or a relative. COVERAGE AGREEMENT YOU AND A RELATIVE We will pay compensatory damages, including derivative claims, which are due by law to you or a relative from the owner or driver of an uninsured motor vehicle because of bodily injury suffered by you or a relative. Damages must result from an accident arising out of the: 1. ownership; 2. maintenance; or 3. use; of the uninsured motor vehicle. OTHER PERSONS We will also pay compensatory damages. including derivative claims, which are due by law to other persons who: 1. Are not a named insured or an insured household member for similar coverage under another policy; and 2. Suffer bodily injury while occupying: a) your auto. V-2357 (10/(X); b) a motor vehicle you do not own, while it is used in place of your auto for a short time. Your auto must be out of use because of: (1) breakdown; (3) servicing; or (2) repair; (4) loss. c) a four-wheel motor vehicle newly acquired by you. This applies only during the first 30 days you own the vehicle, unless it replaces your auto. d) any other motor vehicle while it is being driven by you or a relative. This extension applies only in policies issued to persons (not organizations). However, the vehicle must not be: (1) owned by you or a relative; or (2) furnished to you or a relative for regular use. RECOVERY 1. Before recovery, we and any injured party seeking protection under this coverage must agree on two points: a) whether there is legal right to recover damages from the owner or driver of an uninsured motor vehicle; and if so, b) the amount of such damages. If agreement can't be reached, the matter will go to arbitration. 2. Questions between the injured party and as regarding whether the injured party is an insured under this coverage, or the limits of such coverage, are not subject to arbitration and shall be decided by a court of law. 3. Any judgment against the uninsured will be binding on us only if it has our written consent. 4. Any demand for Uninsured Motorists Coverage benefits must be made within two years after the date of the accident. COVERAGE EXCLUSIONS This coverage does not apply to: 1. Use of any motor vehicle by an insured to carry persons or property for a fee_ Motor vehicles used in shared- expense car pools are not considered as carrying persons for a fee. 2. Use of any motor vehicle by an insured without the owner's permission. 3. Punitive or exemplary damages. 4. Directly or indirectly benefit any workers' compensation or disability benefits carrier, or any person or organization qualifying as a "self-insurer" under a workers' compensation, disability benefits, or similar law. 5. Bodily injury suffered while occupying or struck by a motor vehicle owned by you or a relative, but not insured for auto liability coverage under this or any other policy. 6. Bodily injury suffered while occupying a motor vehicle owned by you or a relative but not insured for Uninsured Motorists coverage under this policy; nor to bodily injury from being hit by any such motor vehicle. 7. Noneconomic loss of any insured who has elected "Limited Tort" in accordance with the Pennsylvania Motor Vehicle Financial Responsibility Law. 8. Bodily injury of any insured if the insured settles, without our written consent, with a liable party. INSURED PERSONS' DUTIES 1. The insured must: a) submit written proof of the claim to us. It must be under oath, if required. It must include details of: ( I ) the nature and extent of injuries; (2) treatment; and (3) any other facts which could affect the amount of payment. b) provide all facts of the accident and the name of all witnesses. c) submit to oral examination under oath as often as we require. 2 d) be examined by doctors, including doctors examining the insured for rehabilitation purposes, chosen by as as often as we require. At our request, the injured person must promptly authorize us to: (1) speak with any doctor who has treated him; (2) read all medical history and reports of the injury; 13) obtain copies of wage and medical reports and records: and (4) obtain copies of all medical bills as they are incurred. 2. We require the insured to file suit against any and all liable parties to preserve and protect our subrogation rights. Failure to do so precludes recovery under this coverage. 3. The insured must obtain our written consent to: a) settle any legal action brought against any liable party; or b) release any party. ARBITRATION If we and the insured disagree about the right to recover damages from the owner or driver of an uninsured motor vehicle or the amount of such damages: 1. After written demand for arbitration by either party, each will select a competent arbitrator. The two so selected will select a third competent arbitrator. Unless the insured and we agree otherwise, arbitration will take place in the county and state where the insured lived at the time of the accident. 2. If the third arbitrator is not selected within 30 days, the insured or we may request a judge of a court of record to name one. The court must be in the county and state in which arbitration is pending. 3. Each party will pay its chosen arbitrator. Each will pay half of the neutral arbitrator's expenses. Fees to lawyers and expert witnesses are to be paid by the party hiring them. 4. Arbitration shall be conducted in accordance with the provisions of the Pennsylvania Arbitration Act of 1927. OUR RIGHT TO RECOVERY This applies to the extent of any payment we make under this coverage. We will have first right to any amount the insured receives from any liable party. The insured will: 1. Hold in trust for us his right to recover against any such party; and 2. Furnish us all papers in any suit the insured files. Our payment of a claim may result from the insolvency of an insurer. If so, we have the right to recover from the insurer, but not its insured. LIMITS OF PAYMENT AMOUNTS PAYABLE FOR UNINSURED MOTORISTS LOSSES We agree to pay losses up to the limits stated in the policy Declarations. The following applies to these limits: I. The Uninsured Motorists bodily injury limit shown for any one person is for all legal damages, including all derivative claims, claimed by anyone due to bodily injury to one person as a result of one occurrence. The per-person limit is the total amount available when one person sustains bodily injury. including death, as a result of one occurrence. No separate limits are available to anyone for derivative claims, statutory claims, or any other claims made by anyone arising out of bodily injury, including death, to one person as a result of one occurrence. The total limit of our liability shown for each occurrence is the total amount available when two or more persons sustain bodily injury, including death, as a result of one occurrence. In no event shall anv one person recover more than the per-person limit shown. 2. Coverage applies as stated in the Declarations. The insuring of more than one person or vehicle under this policy does not increase our Uninsured Motorists payment limits. In no event will any insured be entitled to? more than the highest per person limit applicable to any one motor vehicle under this policy or any other policy issued by as. However, with regards to you (not organizations) or a relative, the sum of limits of your autos apply as stated in the Declarations. I , 3. Damages payable under this coverage shall be reduced by any amount paid by or for any liable parties. 4. The insured may recover for bodily injury under the Auto Liability coverage or the Uninsured Motorists coverage of this policy. but not under both coverages. OTHER INSURANCE If there is other insurance: I. For bodily injury suffered by an insured while occupying a motor vehicle you do not own, we will pay the insured loss not covered by other insurance. 2. Except as stated above, if there is other insurance similar to this coverage under any other policy, we will be liable for only our share of the loss. Our share is our proportion of the total insurance limits for the loss. 3. In any event, if more than one policy applies to an insured other than you or a relative, total limits applicable will be considered not to exceed the highest limits amount of any one of them. DUPLICATE PAYMENT We will make no duplicate payment to or for any insured for the same element of loss. ASSIGNABILITY No interest in this coverage can be transferred without our written consent. However, if the policyholder dies, this coverage will continue in force for the rest of the policy period. It will apply to the following having proper custody of your auto: 1. your relatives; 2. your heirs; 3. an appointed legal representative; or 4. anyone else using your auto with the express permission of the legal representative. This endorsement applies as stated in the policy Declarations. This endorsement is issued by the company shown in the Declarations as the issuing company. NATIONWIDE INSURANCE COMPANIES Home Office: Columbus, Ohio 43215-2220 4 i I Endorsement 3208 Amendatory Endorsement Physical Damage Coverage Please attach this important addition to your auto policy. With this endorsement, it Is agreed that the PHYSICAL DAMAGE coverage provided by this policy Is amended as follows: The following exclusion Is added: We will not pay for loss: • to your auto or any other motor vehicle for diminution In value or depreciation. The following provision Is added: APPRAISAL If we and the insured fall to agree on the amount payable under the Comprehensive or Collision Coverage, either party may demand appraisal for the loss. Each will: 1. appoint and pay a competent and disinterested appraiser; and 2. equally share other appraisal expenses. Any fees of expert witnesses or attorneys will be paid by the party who hires them. The appraisers, or a judge of a court having jurisdiction, will select an umpire to decide any differences. Each appraiser will state separately the actual cash value and the amount of loss. An award In writing by any two appraisers will determine the amount payable. This endorsement applies as stated In the policy Declarations. This endorsement Is Issued by the company shown in the Declarations as the issuing company NATIONWIDE INSURANCE COMPANIES Home Office: Columbus, Ohio 43215-2220 V-3208 Amy E. Bauccio, Esquire Attorney I.D. No. 307216 Zachary D. Campbell Attorney I.D. No. 93199 Metzger, Wickersham, Knauss & Erb, PC `? ? --yam 3211 North Front Stree t t c;` P.O. Box 5300 Attorneys for Plaintiff e ` n C Harrisburg, PA 17110-0300 J ?z „r -J (717) 238-8187 , CD KEVIN P. SNYDER, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 09-4594 NATIONWIDE INSURANCE, JURY TRIAL DEMANDED Defendant NOTICE TO DEFEND TO: Nationwide Insurance c/o Peter J. Speaker, Esquire Michele J. Thorp, Esquire Thomas, Thomas & Hafer, LLP P.O. Box 999 Harrisburg, PA 17101 YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the following pages, you must take action within Twenty (20) days after this Complaint and Notice are served, by entering a written appearance personally or by attorney and filing in writing with the Court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the Court without further notice for any money claimed in the Complaint or for any other claim or relief requested by the Plaintiffs. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. Cumberland County Lawyer Referral Service 32 S. Bedford Street Carlisle, PA 17013 (800) 990-9108 490827-1 NOTICIA LE IRAN DEMANDADO A USTED EN LA CORTE. Si usted quiere defenderse de estas demandas expuestas en las paginas siguientes, usted tiene viente (20) dias de plazo al partir de la fecha de la demanda y la notificacion. Usted debe presentar una apariencia escrita o en persona o por abogado y archivar en la corte en forma escrita sus defensas o sus objeciones a las demandas en contra de su persona. Sea avisado que si usted no se defiende, la corte tomara medidas y puede entrar una orden contra usted sin previo aviso a notificacion y por cualquier queja o alivio que es pedido en la peticion de demanda. Usted puede perder dinero o sus propiedades o otros derechos importantes para usted. LLEVE ESTA DEMANDA A UN ABODAGO IMMEDIATAMENTE. SI NO TIENE ABOGADO O SI NO TIENE EL DINERO SUFICIENTE DE PAGAR TAL SERVICIO, VAYA EN PERSONA O LLAME POR TELEFONO A LA OFICINA CUYA DIRECCION SE ENCUENTRA ESCRITA ABAJO PARA AVERIGUAR DONDE SE PUEDE CONSEGUIR ASISTENCIA LEGAL. Cumberland County Lawyer Referral Service 32 S. Bedford Street Carlisle, PA 17013 (800) 990-9108 490827-1 Amy E. Bauccio, Esquire Attorney I.D. No. 307216 Zachary D. Campbell Attorney I.D. No. 93199 Metzger, Wickersham, Knauss & Erb, PC 3211 North Front Street P.O. Box 5300 Attorneys for Plaintiff Harrisburg, PA 17110-0300 (717) 238-8187 KEVIN P. SNYDER, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 09-4594 NATIONWIDE INSURANCE, JURY TRIAL DEMANDED Defendant AMENDED COMPLAINT AND NOW, comes the Plaintiff, Kevin P. Snyder, by and through his counsel, Metzger, Wickersham., Knauss & Erb, P.C., and complains against the Defendant, Nationwide Insurance, and avers as follows: 1. Plaintiff, Kevin P. Snyder, is an adult individual currently residing at 131 Whispering Pine Lane, Loysville, Perry County, Pennsylvania 17047. 2. Defendant, Nationwide Insurance (hereinafter referred to as "Nationwide"), is a corporation with offices for the transaction of business located at 1000 Nationwide Drive, Harrisburg, Dauphin County, Pennsylvania 17110. Defendant is licensed and authorized to conduct business as an insurer in the Commonwealth of Pennsylvania. 3. At all times material hereto, Plaintiff, Kevin P. Snyder, was a named insured under an automobile insurance policy issued by Defendant, Nationwide, insurance policy number 8937355019 (hereinafter referred to as "the Policy"). A true and correct copy of the 490827-1 Auto Policy Declarations sheet is attached hereto as Exhibit "A." A true and correct copy of the Policy is attached hereto as Exhibit "B." 4. On or about July 11, 2005, at approximately 1:00 p.m., Plaintiff, Kevin P. Snyder, was operating a 2001 Chevrolet 6500, bearing Pennsylvania License Plate No. YNM9503 and owned by Harrisburg Auto Auction. 5. At the aforesaid time, Plaintiff, Kevin P. Snyder, was operating the aforementioned vehicle westbound on West Trindle Road, in Monroe Township, Cumberland County Pennsylvania. 6. At approximately the same time and place, tortfeasor, Rose Posterman, was the owner and operator of a 1993 Dodge Shadow bearing Pennsylvania License Plate No. EVM9932. 7. At approximately the same time and place, tortfeasor, Rose Hosterman, was traveling eastbound on West Trindle Road, in Monroe Township, Cumberland County Pennsylvania. 8. Suddenly and without warning, Ms. Hosterman crossed over the double yellow line and into the westbound lane, directly into the path of Plaintiff Kevin P. Snyder's vehicle causing Plaintiff to impact the front bumper of Ms. Hosterman's vehicle with the left front bumper of Plaintiff's vehicle. 9. The injuries sustained by Plaintiff, Kevin P. Snyder, in the aforementioned motor vehicle accident include, but are not limited to, the following: a. Neck pain/injury; (b) Bilateral shoulder pain/injury; (c) Low back pain/injury; (d) Cervical strain/sprain; (e) Lumbar strain/sprain; (f) Displacement of cervical intervertebral disc; 490827-1 (g) Displacement of lumbar intervertebral disc; (h) Headaches; (i) Left leg pain/injury; 0) HPN left C6-C7; (k) HPN left L5-S1; (1) Recurrent HPN left L5-S1; and (m) Other serious and permanent injuries. 10. Due to the injuries that Plaintiff, Kevin P. Snyder, received in the July 11, 2005 motor vehicle accident, Plaintiff underwent medical treatment including, but not limited to, a microdiscectomy at L5-S 1 on the left. 11. The damages sustained by the Plaintiff, Kevin P. Snyder, in the aforesaid motor vehicle accident include, but are not limited to, the following: a. Plaintiff, Kevin P. Snyder, has suffered and will continue to suffer great physical pain, discomfort, distress, suffering, inconvenience, embarrassment, humiliation, and mental anguish; b. Plaintiff, Kevin P. Snyder, has suffered and will continue to suffer loss of his ability to enjoy the pleasures of life and limitations in his pursuit of his daily activities all to his great loss and detriment; C. Plaintiff, Kevin P. Snyder, has been and will be required to spend money for medication attention, medical treatment, hospitalization, surgery, rehabilitation, medical supplies, and other medically necessary items; d. Plaintiff, Kevin P. Snyder, has been and will be required to spend money for incidental costs and expenses and losses to include, but not limited to, past and future medicine costs and medical appliances, and travel to and from medical appointments; e. Plaintiff, Kevin P. Snyder, has suffered and will continue to suffer loss of household services and other economic damages; 490827-1 f. Plaintiff, Kevin P. Snyder, has suffered and will continue to suffer permanent scarring and/or disfigurement; g. Plaintiff, Kevin P. Snyder, has been and will be deprived of his earnings; h. Plaintiff Kevin P. Snyder's earning capacity has been reduced and permanently impaired; and i. Plaintiff Kevin P. Snyder's general health, strength, and vitality have been impaired. 12. At the time of the collision, the tortfeasor, Rose Hosterman, was issued a motor vehicle insurance policy through Nationwide Insurance with bodily injury liability limits in the amount of $50,000.00. 13. A settlement agreement was reached whereby the insurance carrier for the tortfeasor, Rose Hosterman, Nationwide Insurance, agreed to make payment of the available insurance liability limits of $50,000.00, in settlement of the Plaintiff Kevin P. Snyder's personal injury claims. 14. The Defendant herein, Nationwide, consented to the settlement of the claim against Rose Hosterman for payment of the available liability insurance limits. 15. At the time of the collision, Plaintiff, Kevin P. Snyder, was driving an employer owned vehicle, which was insured with Empire Fire & Casualty, policy number CK06807346, with underinsured policy limits of $50,000.00. 16. A settlement agreement was reached whereby Empire Fire & Casualty agreed to make payment of the available underinsured limits of $50,000.00, in settlement of the Plaintiff Kevin P. Snyder's personal injury claims. 490827-1 17. Plaintiff, Kevin P. Snyder, was an underinsured motorist because the combined liability coverage and underinsured motorist coverage through Plaintiff's employer of $100,000.00 paid to Plaintiff was less than Plaintiff's damages. 18. Plaintiff, Kevin P. Snyder, elected to purchase underinsured motorist coverage with the Defendant, Nationwide. 19. Defendant, Nationwide, has no documentation requesting underinsured limits lower than the limits of the liability portion of the Policy. 20. It is believed and therefore averred that the underinsured limits of the Policy are $100,000.00 per person and $300,000.00 per accident because there is no documentation and/or evidence requesting lower limits for that Policy. Said coverage was in full force and effect on July 11, 2005. 21. The above referenced Policy with Defendant, Nationwide, provided for underinsured motorist coverage, which became applicable to the Plaintiff, Kevin P. Snyder, since the combined liability coverage and underinsured motorist coverage through Plaintiff's employer of $100,000.00, which was paid to the Plaintiff, was inadequate to compensate the Plaintiff for injuries, loses and damages he suffered as a result of the motor vehicle accident. 22. Plaintiff, Kevin P. Snyder, elected to purchase underinsured motorist coverage with the Defendant, Nationwide, and as a result of Plaintiff's election of this coverage, he paid and Defendant accepted, additional increased premium payments. 23. After settlement of the liability claim and employer's underinsured motorist claim for the available insurance liability and underinsured limits, a demand for payment of the available underinsured motorist coverage was made to the Defendant, Nationwide. 490827-1 24. The Defendant, Nationwide, has refused to make payment of the available limits of the underinsured motorist coverage and instead has extended an offer of $35,000.00 to settle Plaintiff Kevin P. Snyder's claim. 25. At all times relevant hereto, Plaintiff, Kevin P. Snyder, fully complied with the terms and conditions of the Policy with Defendant, Nationwide, and all terms and conditions precedent and subsequent to his right to recover under the Policy. 26. Plaintiff, Kevin P. Snyder, was considered full tort at the time of this accident because he was injured while an occupant of a motor vehicle other than a private passenger motor vehicle. Therefore, Plaintiff remains eligible to claim compensation for non economic loss and economic loss in this collision pursuant to applicable tort law. COUNT I - BREACH OF CONTRACT PLAINTIFF, KEVIN P SNYDER, v. DEFENDANT, NATIONWIDE INSURANCE 27. Paragraphs 1 through 26 are incorporated herein by reference as if fully set forth. 28. Plaintiff Kevin P. Snyder's medical records clearly establish that he suffered significant personal injuries as a direct result of the motor vehicle accident on July 11, 2005. 29. Plaintiff, Kevin P. Snyder, has fully complied with all of the terms, conditions and duties required under the Policy with Defendant, Nationwide. 30. Defendant, Nationwide, has failed to timely, objectively and reasonably evaluate Plaintiff Kevin P. Snyder's claim. 31. Defendant, Nationwide, has failed to promptly offer payment of the reasonable and fair value of the underinsured motorist claim to the Plaintiff, Kevin P. Snyder. 490827-1 32. Defendant, Nationwide, failed to reasonably investigate Plaintiff Kevin P. Snyder's claim, inasmuch as a thorough and proper inquiry would have revealed that the Plaintiff sustained injuries, damages and losses which reasonable compensation would have required an offer of the available limits. 33. Defendant, Nationwide, owes a fiduciary, contractual and statutory obligation to investigate, evaluate and negotiate the underinsured motorist claim in good faith and to arrive at a prompt, fair and equitable settlement as the insurer of Plaintiff, Kevin P. Snyder. 34. For the reasons set forth above, Defendant, Nationwide, has violated its obligation under the Policy. WHEREFORE, the Plaintiff, Kevin P. Snyder, seeks damages from Defendant, Nationwide Insurance, in an amount in excess of the compulsory arbitration limits of Cumberland County, exclusive of interest and costs. METZGER, WICKERSHAM, KNAUSS & ERB, P.C. By: dZt,4 &Izz&4-z? Amy . Bauccio, Esquire Attorney I.D. No. 307216 Zachary D. Campbell, Esquire Attorney I.D. No. 93199 P.O. Box 5300 3211 North Front Street Harrisburg, PA 17110-0300 (717) 238-8187 Attorney for Plaintiff Dated: 3 /11 12012 490827-1 VERIFICATION I, Kevin P. Snyder, do hereby verify that the facts set forth in the foregoing Amended Complaint are true and correct to the best of my personal knowledge or information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904, relating to unsworn falsification to authorities. Date: evin P. Snyder 490827-1 CERTIFICATE OF SERVICE I, Amy E. Bauccio, Esquire, of the law firm of Metzger, Wickersham, Knauss & Erb, P.C., hereby certify that I served a true and exact copy of the foregoing document with reference to the foregoing action by first class mail, postage prepaid, this C) day of V?Ql(.fv? , 2012, on the following: Peter J. Speaker, Esquire Michele J. Thorp, Esquire Thomas, Thomas & Hafer, LLP P.O. Box 999 Harrisburg, PA 17101 Amy E. Ba io, Esquire 490827-1 . ?\ ?? ?? Endorsement 3208 Amendatory Endorsement-- Physical Damage Coverage Please attach this important addition to your auto policy. With this endorsement, it is agreed that the PHYSICAL DAMAGE coverage provided by this policy Is amended as follows: The following exclusion Is added: We will not pay for loss: • to your auto or any other motor vehicle for diminution in value or depreciation. The following provision is added: APPRAISAL If we and the Insured fall to agree on the amount payable under the Comprehensive or Collision Coverage, either party may demand appraisal for the loss. Each will: 1. appoint and pay a competent and disinterested appraiser; and 2. equally share other appraisal expenses. Any fees of expert witnesses or attorneys will be paid by the party who hires them. The appraisers, or a judge of a court having jurisdiction, will select an umpire to decide any differences. Each appraiser will state separately the actual cash value and the amount of loss. An award in writing by any two appraisers will determine the amount payable. This endorsement applies as stated in the policy Declarations. This endorsement Is Issued by the company shown In the Declarations as the issuing company. NATIONWIDE INSURANCE COMPANIES Home Office: Columbus, Ohio 43215-2220 V-3208 AUTO L 3: POLICY Auto insurance protection you can count on in a policy you can understand This is a different kind of insurance policy-one that's readable, understandable, straightforward. We believe you have purchased the best in auto insurance protection-backed by the best in policyholder servicc. We intend to keep it that way, Please take a few minutes to read and see what's inside your new Century 21 policy. Should you have an accident or loss-and we hope you don't- just call us at once. Our claims service starts then. The telephone number to call is listed on your Nationwide identification card, or you may get in touch with any local claims office. If you have any questions about this policy, or any part of your insurance program, your sales representative will welcome your call any time. Thank you for relying on Nationwide. RENTED AUTO NOTICE IF THE DECLARATIONS AT- TACHED TO THIS POLICY SHOW THAT COLLISION COVERAGE APPLIES TO YOUR AUTO, THERE tS ALSO COLLISION COVERAGE FOR DAMAGE TO A RENTED AUTO. COVERAGE IS SUBJECT TO CONDITIONS AND LI MITA• TIOW LISTED ON PAGE S AND ELSEWHW IN THE POLICY OR ATTACHED ENDORSEMENTS. YOUR GUIDE TO PROTECTION 11IF '1NITIONS Key Policy Words ............................................................... 2 TERRITORY Where Your Protection Applies ........................................... ...... 3 CO'VERAGFS Comprehensivc .................................................................. Collision....... ....................................... ......................... Towing and Labor ..................................... ......................... Auto Liability ................................................................... First Party Benefits .................................... ......................... Uninsured Motorists ................................... .. ...................... Underinsured Motorists ........................................................... GENERAL COND111ONS Your Duties After an Accident or Loss .......................... . ................. . Use of Other Motor Vehicles ................................... ............... How Your Policy May Be Changed ...................... . ........................ . Our Right to Recover from Others (Subrogation) .................................... Policy Renewal/Nonrenewal .................................................. . Your Right and Our Right to Cancel..... .......................................... Our Installment Premium Plan ............................. Nationwide General Insurance Company / Home Offtce. Columbus, Ohio 43215-2220 3 4 4 7 10 13 17 21 21 21 21 22 22 23 N GN 188-3 (8410) Nationwide's Century 21 Auto Policy INSURING AGREEMENT For the policyholder's payment of premiums in amounts we require and subject to all of the terms and conditions of this policy, we agree to provide the coverages the policyholder has selected. These selections are shown in the Declarations, which are a part of this policy contract. Subsequent premiums for renewal terms of six months each must be paid in advance. DEFINITIONS This policy uses certain common words for easy reading. They are defined as follows: 1. "YOU" and "YOUR" mean or refer to the policyholder as defined, and include the policyholder's spouse if living in the same household. 2. "WE," "US," "OUR," and "THE COMPANY" means the Nationwide General Insurance Company. 3. "INSURED" means one who is described as entitled to protection under each coverage. 4. "YOUR AUTO" means the vehicle(s) described in the Declarations. 5. "DEDUCTIBLE" means the amount of loss to be paid by the insured. We pay for covered loss above the deductible amount. b. "MOTOR VEHICLE" means a land motor vehicle designed primarily to be driven on public roads. This does not include vehicles operated on rails or crawler-treads. Other motor vehicles designed for use mainly off public roads shall be included within the definition of motor vehicle when used on public roads. 7. "PRIVATE PASSENGER AUTO" means a four-wheel: a) private passenger auto; b) station wagon; c) van; d) jeep-type vehicle; or e) pickup truck. 8. "OCCUPYING" means in, upon, entering, or alighting from. 9. "RELATIVE" means one who regularly lives in your household, related to you by blood, marriage or adoption (including a ward or foster child). A relative may live temporarily outside your household. 10. "BODILY INJURY" means: a) bodily injury; c) disease; or b) sickness; d) death; of any person. 11. "PROPERTY DAMAGE" means: a) destruction of property; b) damage or injury to it; or c) loss if its use. 2 (Attach Declarations and Endorsements Here) definitions 12. "POLICYHOLDER" means the first person named in the Declarations. The pdieyholder is the nrrin dl named insured under this policy and does not include the poleyholder's spouse. If the first named insured is an organization, that organization is the policyholder. 13. "NONECONOMIC LOSS" means pain and suffering and other nonmonetary detriment. Other words are also defined. All defined words are in bold print. TERRITORY All coverages in this policy apply only to occurrences while the policy is in force. All coverages apply in Canada, the United States of America and its territories or possessions, or between their ports. All coverages except Uninsured Motorists and Underinsured Motorists apply to occurrences in Mexico, if within 50 miles of the United States boundary. We will base the amount of any Comprehensive or Collision loss in Mexico on cost at the nearest United States point. NOFE: You will need to buy auto insurance from a Mexican insurance company-regardless of coverage provided by this policy-before driving in Mexico. Otherwise, )rw may be subject to jail detention, auto impoundment, and other legal complications in case of an accident. physical Additional Definitions Applicable to These Coverages 1. "LOSS" means direct and accidental loss or damage to your auto. Your auto includes its equipment. damage 2. "EQUIPMF,NT" means anything usual and incidental to the use of a motor vehicle as a motor coverages vehicle. A trailer is not equipment. (damage to your autol COVERAGE AGREEMENT COMPREHENSIVE. COVERAGE 1. We will pay for loss to your auto not caused by collision or upset, We will pay for the loss less your deductible. Coverage is included for: a) damage from contact with: (1) animals; or (2) falling or flying objects; b) broken glass: (1) even if caused by collision or upset; and (2) if you do not have Collision coverage. If your Comprehensive and Collision coverages have different deductibles, the smaller deductible will apply to broken glass. 2. Also, if your auto has a loss under this coverage we will: a) pay for resulting damage to your clothing and luggage or that of any relative. Maximum payment is $200. We will pay for stolen clothing or luggage only if your auto is stolen. 3 physical damage b) repay your travel costs after your auto is stolen. Maximum payment is $15 per day-riot to exceed $450 per occurrence, These costs must be incurred within a certain time. It starts 48 hours after you report the theft to us and the police, It ends when your auto is returned to you or we pay for its loss. c) repay you for the cost of travel from where your auto was disabled to where you were going. Maximum payment is $10. COLLISION COVERAGE 1. We will pay for loss to your auto caused by collision or upset. This includes broken glass. We will pay for the loss less your deductible. However, we will not subtract the deductible amount: a) if your auto collides with another motor vehicle insured by us; or b) for broken glass if you have full (no deductible) Comprehensive coverage in force. 2. Also if your auto has a loss under this coverage, we will: a) pay for resulting damage to your clothing and luggage or that or any relative. Maximum payment is $200, b) repay you for the travel cost to where you were going. Maximum payment is $10. TOWING AND LABOR COSTS COVERAGE We will pay towing and labor costs if your auto is disabled. We will pay only for labor costs at the place where your auto is disabled. Our maximum payment per disablement is shown in the Declarations. COVERAGE EXTENSIONS USE OF TRAILERS The insurance on your auto covers a trailer used by you or a relative. 1. The trailer must be: a) designed for use with a private passenger auto; and b) used with a vehicle that is insured under these coverages. 2. The trailer must not be: a) otherwise insured; b) owned by you or a relative; or c) used for business purposes with a vehicle that's not a private passenger auto. 3. The maximum amount payable is $500. USE OF OTHER MOTOR VEHICLES The insurance on your auto also covers other motor vehicles as follows: I . a motor vehicle you do not own, while it is used in place of your auto for short time. Your auto must be out of use because of: a) breakdown; c) servicing; or b) repair; d) loss. 2. a four-wheel motor vehicle newly acquired by you. The coverage applies only during the first 30 days you own the vehicle, unless it replaces your auto. We provide this coverage only if you do not have other collectible insurance. You must pay any added premium resulting from this coverage extension. 3. a private passenger auto owned by a non-member of your household and not covered in item 1. of this section. 4 physical damage a) This applies only: (1) to the policies issued to persons (not organizations). (2) while such auto is being used by you or a relative. b) We will not pay for loss: (1) that results from the operation of an auto: (a) repair shop; (c) sales agency; or (b) public garage or parking place; (d) service or maintenance facility (2) involving a private passenger auto owned by an employer of an insured. (3) involving a private passenger auto furnished to you or a relative for regular use. (4) to any rented nwtor vehicle. 4. a rented private passenger auto, including its loss of income. a) This applies only: (1) while such auto is rented by you or a relative; (2) to policies issued to persons (not organizations); (3) if such auto is rented from a rental company for less than 28 days; and (4) for loss of income that is: (a) verifiable by us; and (b) owed to a rental company because: (1) the rental company has a customer willing to rent a private passenger auto; and (2) there was no other vehicle available for rental in place of the damaged rented auto. b) We will not pay for loss involving a private passenger auto rented or leased by anyone for or on behalf of the employer of an insured. COVERAGE EXCLUSIONS We will not pay for Mss: 1. to more than one: a) stereo tape; b) cassette; or c) cartridge. 2. to a container to be used for storing or carrying: a) stereo tapes; b) cassettes; or c) cartridges. 3. to any: a) citizens band radio; b) two-way mobile radio; c) telephone; or d) other device which receives and transmits sound. This exclusion (3) does not apply if the device is a permanent pan of your auto. Permanent part means installed in a location planned by the auto maker for a radio, if the device is not covered, its antenna and other parts are not covered. 5 physical damage 4. to a camper or living quarters unit which can be mounted on or attached to a vehicle, We will pay (<i.i, 1? II(":the loss if: a) the unit is reported to us; and b) the required premium is paid; before the loss. 5, due to: a) wear and tear; b) freezing; c) mechanical or electrical breakdown or failure. This exclusion (5) does not apply to damage which is the result of other loss covered by this policy. This exclusion does not apply to Towing and Labor coverage, 6. while any motor vehicle is used to carry persons or property for a fee. Motor vehicles used in shared- expense car pools are not considered as carrying persons for a fee. 7. to any auto due to an act of war. 8. to scanning monitor receivers used for radar detection. LIMITS OF PAYMENT ACTUAL CASH VALUE The limit of our coverage is the cash value of your auto or its damaged parts at the time of loss. To determine cash value, we will consider: 1. fair market value; age; and 3. condition of the property; at the time of loss. We may: 1. pay you directly for a loss; 2, repair or replace your auto or its damaged parts; 3. return stolen property at our expense and pay for any damage. OTHER INSURANCE If you have other insurance that covers any loss, we will pay only our share of the loss. Our share is our proportion of the total insurance collectible for the loss. For loss to motor vehicles other than your auto, we will pay only the insured loss not covered by other insurance. COVERAGE CONDITION AUTO RECOVERY When an insured auto which has been stolen or abandoned is located, we have the right to take it into our care to keep it safe. ASSIGNABILITY No interest in these coverages can be transferred without our written consent. However, if the policyholder dies, they will stay in force for the rest of the policy period. They will apply for anyone having proper temporary custody of your auto. 6 auto COVERAGE AGREEMENT liability PROPERTY DAMAGE AND BODILY INJURY LIABILITY COVERAGE (for damage or injury to 1. We will pay for damages for which you are legally liable as a result of an accident arising out of the: 0*0mcou edbyyourWWI a) ownership; b) maintenance or use; or c) loading or unloading; of your auto. A relative also has this protection. So does any person or organization who is liable for the use of your auto while used with your permission. 2. Damages must involve: a) property damage; or b) bodily injury. 3. We will pay such liability losses up to the limits stated in the Declarations, In addition to these limits and as to any covered damages, we will: a) defend at our expense, with attorneys of our choice, any suit against the insured. We may settle or defend any claim or suit as we think proper. b) pay: (1) all expense incurred by us; and (2) all costs levied against the insured; in any such suit. c) pay: (1) all premiums on appeal bonds in defended suits. (2) a premium of not more than $250 for bail bond required because of an accident or traffic violation. Although paying such premiums, we are not required to apply for or furnish such bonds. (3) all premiums on bonds to release attached property. d) pay post-judgment interest on all damages awarded. We will not pay interest that accrues after such time as we have: (1) paid; (2) formally offered; or (3) deposited in court the amount for which we are liable under this policy. e) pay expenses incurred by an insured for emergency medical aid to others at the time of accident. f) pay all reasonable expenses incurred by an insured at our request, but not more than $50 per day for loss of earnings. 4. After the limits of this coverage have been paid, we will not defend any suit or pay any claim or judgment. COVERAGE EXTENSIONS USE OF TRAILERS 1. This coverage applies to the use of a trailer by: a) you; b) a relative; or c) someone else with your permission. 7 aulO liabiMy 2. The trailer must be: tcoomuc.d1 a) designed for use with a private passenger auto; and b) used with a vehicle that is insured under this coverage. 3. The trailer must not be used for business purposes with a vehicle that's not a private passenger auto. USE OF OTHER MOITUR VLHICLES This insurance also applies to certain other motor vehicles as follows. 1. a motor vehicle you do not own, while it is used in place of your auto for a short time. Your auto must be out of use because of: a) breakdown; c) servicing; or b) repair; d) loss. 2. a four-wheel motor vehicle newly acquired by you. It applies only: a) during the first 30 days you own the vehicle unless it replaces your auto; and b) if you do not have other insurance. You must pay any premiums resulting from this coverage. 3. a motor vehicle owned by a non-member of your household and not covered in item 1 of this section. a) This applies only to policies issued to individual persons (not organizations) and while the vehicle is being used by you or a relative. It protects the user, and any person or organization, except as noted below in b), who does not own the vehicle but is legally responsible for its use, b) This does not apply to losses involving a motor vehicle: (1) used in the business or occupation of you or a relative except a private passenger auto used by you, your chauffeur, or your household employee; (2) owned, rented or leased by an employer of an insured; (3) rented or leased by anyone for or on behalf of an insured; or (4) furnished to you or a relative for regular use. Furnished for regular use does not include a motor vehicle rented from a rental company for less than 28 days. FINANCIAL RESPONSIBILITY We will adjust this policy to comply: 1. with the financial responsibility law of any state or province which requires higher liability limits than those provided by this policy. 2. with the kinds and limits of coverage required of non-residents by any compulsory motor vehicle insurance law, or similar law. However, any loss payment under this extension of limits or coverage will be made only over and above any other collectible motor vehicle insurance. In no case will anyone be entitled to dublicate payments for the same loss. COVERAGE EXCLUSIONS This coverage does not apply to: 1. property damage or bodily injury caused intentionally by or at the direction of an Insured, 2. any motor vehicle while used to carry persons or property for a fee. Motor vehicles used in shared- expense car pools are not considered as carrying persons for a fee. 3. any person for any occurrence arising out of the operation of an auto: a) repair shop; b) public garage or parking place; c) sales agency; or d) service or maintenance facility. 8 auto 'tp?"'tlr"y 74owever, this exclusion does not apply to: a' you, h) a relative; or c) a partner, employee or agent of you or a relative; with regard to the use of your auto. 4. damage to any property you own or have in your care; except a rented home or rented private garage. The same applies to any insured. 5. bodily injury to others for which any insured may be liable under a: a) workers' compensation; c) disability benefits. or b) unemployment compensation; d) similar law. 6. bodily injury to an employee of any insured, while engaged in his employment. However, it does cover an employee at your home who is not, or is not required to be, covered by any workers' compensation law. 7, any obligation for which the government may be held liable under the Federal Tort Claims Act. 8. any person protected under nuclear energy liability insurance. This exclusion applies even if the liability benefit of that insurance has been exhausted. 9. noneconomic loss of or for any person who has elected "Limited Tort" in accordance with the Pennsylvania Motor Vehicle Financial Responsibility Law. LIMITS OF PAYMENT AMOUNTS PAYABLE FOR LIABILITY LOSSES Our obligation to pay Liability losses is limited to the amount per occurrence stated in the Declarations. The following conditions apply to this limit: 1. This limit will first be applied to provide the separate bodily injury and property damage limits required to satisfy the financial responsibility law. Any amount remaining within the total limit will then be used as needed. 2. Limits apply as stated in the Declarations. insuring more than one person or vehicle under this policy does not increase our limits. 3. In any loss covered under items (2) and (3) of "USE OF OTHER MOTOR VEHICLES," the highest liability limit applicable to any one vehicle in this policy will apply. 4. A motor vehicle and attached trailer are considered one vehicle for Auto Liability coverage. OTHER INSURANCE In any loss involving the use of your auto, we will be liable for only our share of the loss if there is other collectible liability insurance. Our share is our proportion of the total insurance limits for the loss. For losses involving the use of other motor vehicles, we will pay the insured loss not covered by other insurance. You may have more than one Nationwide policy; we will pay only up to the highest limit of any one of them. ASSIGNABILITY No interest in this coverage can be transferred without our written consent. However, if the policyholder dies, the Liability coverage will continue in force for the rest of the policy period for. 1. Anyone having proper temporary custody of your auto until a legal representative is appointed; and 2. The appointed legal representative. 9 first party COVERAGE AGREEMENT This coverage provides First Party Benefit options in accordance with the Pennsylvania Motor Vehicle benefits Financial Responsibility Law. The options and limits which the policyholder has selected are shown on the Declarations. We will pay First Party Benefits for bodily injury of an insured as a result of an accident that arises out of the maintenance or use of a motor vehicle as a motor vehicle. We will pay these benefits regardless of who is at fault in the accident. Additional Definitions Applicable to This Coverage For purposes of this coverage: I. "RELATIVE" means the following residents of the policyholder's household. a) spouse; b) anyone related to the policyholder or spouse by blood, marriage or adoption; and c) a minor in the legal custody of the policyholder or such relative. A relative may live temporarily outside the household. 2. "MOTOR VEHICLE" means any vehicle which is self-propelled, except one which is propelled: a) solely by human power; b) by electric power obtained from overhead trolley wires; or c) upon rails. 3. "NECESSARY MEDICAL TREATMENT AND REHABILITATIVE SERVICES" means treatment, accommodations, products or services which are determined to be necessary by a licensed health care provider unless they shall have been found or determined to be unnecessary by a State- approved Peer Review Organization (PRO). 4. "CATASTROPHIC LOSS TRUST FUND" means the fund established by the Pennsylvania Motor Vehicle Financial Responsibility Law in 1984 and repealed in 1988. INSUREDS The policyholder and relatives are covered while occupying or injured by any motor vehicle. Persons other than the policyholder and relatives are covered: 1. while occupying your auto. 2. as non-occupants of a motor vehicle if injured as the result of an accident in Pennsylvania involving your auto. OPTIONS OPTION 1-MEDICAL BENEFIT We will pay all reasonable expenses for necessary medical treatment and rehabilitative services. We will pay such expenses up to the limit shown on the Declarations. Applicable Medical Benefit limits greater than $100,000 shall be excess over any sums paid or payable by the Catastrophic Loss Trust Fund. We will not pay any medical benefit expenses described which are paid or payable by the Catastrophic Loss Trust Fund. There is no time limitation for this benefit, provided that, within 18 months after the date of the accident, it is determined with reasonable medical probability that further expenses may be incurred as a result of the injury. OPTION 2-INCOME LOSS BENEFIT If this option is selected by payment of premium, we will pay for loss of income from work the insured was unable to do because of bodily injury. We will not pay under this benefit until five working days have been lost. We will not pay for these five days of lost income, to first party benelits "LOSS OF INCOME" means: a) 80 percent of actual loss of gross income. Gross income is inc(>rne received from work performed while normally employed in gainful activity. b) reasonable expenses actually incurred for hiring a substitute to perform self-employment services in order to reduce loss of gross income or for hiring special help which permits a person to work and reduce loss of gross income. We will pay such benefit up to the limit shown on the Declarations. However, the total limit of this benefit is subject to the monthly maximum shown on the Declarations. Income loss benefits do not continue after a person dies. OPTION 3-ACCIDENTAL DEATH BENEFIT If this option is selected by payment of premium, we will pay the Accidental Death Benefit for the policyholder or a relative who suffers accidental bodily injury causing death from a covered accident. We will pay the Accidental Death Benefit limit shown on the Declarations. We will increase this limit $10,(00 for an insured using an approved motor vehicle seat belt or child restraint system at the time of the accident. Death must occur within two years of, and as a direct result of, the accident. Payment will be made to the executor or administrator of the estate. OPTION 4-FUNERAL BENEFIT If this option is selected by payment of premium, we will pay reasonable expenses directly related to the funeral, burial, cremation, or other form of disposition of the remains of a deceased insured. These expenses must be the direct result of death from a covered accident within two years of the date of the accident. Payment will be made to any person presenting bills for qualified expenses incurred. We will pay such expenses up to the limit shown on the Declarations. OPTION 5--COMBINED LOSS BENEFITS If this option is selected by payment of premium, we will pay the benefits described in Options 1, 2, 3 and 4 above. However, total benefits payable under this option are limited to: a) the aggregate limit shown on the Declarations for this option; or b) three years from the date of the accident; whichever occurs first. Option 5 is subject to the following conditions: a) Except for the 18 month determination of further expenses to be paid under the Medical Benefit, the "no time limitation" provision does not apply. b) There is no monthly dollar maximum for Income Loss Benefits. c) The maximum Accidental Death Benefit payable is $25,000. d) The maximum Funeral Benefit payable is $2,500. e) Benefits under c) and d) are payable if death occurs within two years of the date of the accident. OPTION 6-EXCESS MEDICAL BENEFITS If this option is selected by payment of premium, we will pay Excess Medical Benefits for an insured who suffers accidental bodily injury from a covered accident. Excess Medical Benefits are all reasonable expenses for necessary medical treatment and rebabilitative services. We will pay such expenses in excess of $100,000 but not to exceed one million dollars. We will not pay Excess Medical Benefits to an insured who is not eligible for Option 1--Medical Benefits under this policy. Our liability to one person in one accident is $50,000 per year. Subject to this limit for any one person in any one year, our aggregate limit for any one person is one million dollars for any one accident. During the first I8 months of eligibility, we shall approve payments for an Insured without regard to the $50,000 per year limit. For purposes of this option, the first 18 months of eligibility begins when the insured has incurred $100,0W of eligible necessary medical treatment and rehabilitative services expenses. first party benefits If the insured is covered by Option 5-Combined Loss Benefits package (or a similar auto benefits r,ntinuc=i package with another insurer), applicable Medical Benefit limits greater than $100,000 in such package shall be excess over any sums paid or payable under Excess Medical Benefits, COVERAGE EXCLUSIONS We will not pay First Party Benefits in certain circumstances, as follows: The policyholder and relatives are not covered for bodily injury arising out of the maintenance or use of a motor vehicle that the policyholder owns that is not an insured motor vehicle. An insured motor vehicle is one on which there are First Party Benefits, and to which the auto Bodily Injury Liability coverage in this policy applies. 2. There is no coverage for bodily injury to a relative arising out of the maintenance or use of a motor vehicle owned by such relative which is not insured for First Party Benefits and auto Bodily Injury Liability coverage under this or any other policy. 3. There is no coverage for anyone while occupying a motorcycle, motor-driven cycle, motorized pedalcycle, or similar type vehicles or a recreational vehicle not intended for highway use. 4. There is no coverage for anyone, other than the policyholder or a relative, who knowingly converts a motor vehicle if the injury arises out of the maintenance or use of the converted vehicle. 5. There is no coverage for anyone injured by your auto while it is unoccupied and parked so as not to cause unreasonable risk of injury. 6. There is no coverage for use by any insured of any vehicle to carry persons or property for a fee. However, .shared-expense car pools will not be considered carrying persons for a fee, 7. There is no coverage for anyone, other than the policyholder, who is the owner of a currently registered motor vehicle and who does not have Financial Responsibility. Financial Responsibility means the type of financial responsibility that was self-certified to the Department of Transportation to obtain the registration. 8. We will not pay any benefits to or for anyone who injures themselves: a) or another intentionally, including an attempt to intentionally injure themselves or another; b) while committing a felony; or c) while seeking to elude lawful apprehension or arrest by a law enforcement official. 9. There is no coverage for any person for any occurrence arising out of the operation of a motor vehicle: a) repair shop; c) sales agency; or b) public garage or parking place; d) service or maintenance facility. However, this exclusion does not apply with regard to the use of your auto to, a) the policyholder; or b) a relative. 10. There is no coverage for any loss sustained by any person as a direct result of loading or unloading any motor vehicle, except while occupying the motor vehicle. 11. There is no coverage for bodily injury arising out of any act of war, or as a result of any hazardous quality of nuclear material. LIMITS AND CONDITIONS OF PAYMENT Limits apply as stated in the attached Declarations. However, the insuring of more than one person or vehicle under this First Party Benefits coverage does not increase the limit of coverage to any one I i 12 first party benefits person in any one accident. In no event will any insured be entitled to more than the highest limit c ,, ;Hued applicable to any one motor vehicle under this or any other policy. The following conditions apply to the relationship of this coverage to other insurance or benefits that may be available: PRIORITIES OF POLICIES We will pay First Party Benefits in accordance with the order of priorities set forth by law. We will not pay if there is other insurance at a higher level of priority, even if the limits of that insurance have been paid. The highest priority level listed below is the FIRST level which provides benefits for a named insured. The priority order is: FIRST -For a named insured on any policy, the policy on which that person is the named insured. SECOND -For a relative, the policy covering the relative as an insured. THIRD -For the occupants of an insured motor vehicle, the policy on that motor vehicle. FOURTH -For a person who is not the occupant of a motor vehicle, the policy on any motor vehicle involved in the accident. NO DUPLICATION OF RF.NF:FITS; OTHLR INSURANCE In any occurrence where other similar auto insurance or self-insurance of equal priority to that provided in this coverage is available and the claim is first presented to us, we will process and pay the claim as if wholly responsible up to the limits of our policy, The total limits available from all such insurance will be considered not to exceed the highest limits available from any one source of coverage. In no instance may an insured or legal representative recover duplicate benefits from the same elements of loss under this and other similar auto insurance or self-insurance. WORKF;RS' COMPENSATION REDUCTION We will reduce any amount payable to anyone under this coverage by any benefits received or available under workers' compensation. No reduction will be made if such benefits have not been paid by the time benefits under this coverage are due. Rowever, we will be entitled to reimbursement from whomever is obligated to pay the benefits, or from anyone who ultimately receives them. INSURED PERSONS' DUTIES The insured, or someone on the insured's behalf, will report any accident to us in writing as soon as practicable. This report will identify the injured and give reasonably obtainable information about the time, place and circumstances of the accident. As soon as practicable, the insured or someone on the insured's behalf will submit written proof of claim to us, under oath if required. This proof will include detailed information about the nature and extent of bodily injury, treatment and rehabilitation received and contemplated, and anything else that may help us determine what benefits are payable in what amounts. The injured person must grant us authorization, if we request it, to obtain copies of medical, income and income tax reports and records. Injured persons must submit to examinations by company-selected physicians as often as the company reasonably requires. uninsured Additional Definitions Applicable to This Coverage "Arbitration" means resolving questions in dispute motorists "Arbitrator" means the party conducting the arbitra (tor bodily injury causad by uninsured motorists} "Uninsured motor vehicle"-See definition in "CO 13 Lion. VERAGE AGREEMENT" section. unirisured COVERAGE AGREEMENT motorists YOU AND A RELATIVE We will pay compensatory damages as a result of bodily injury suffered by you or a relative and due by law from the owner or driver of an uninsured motor vehicle. Damages must result from an accident arising out of the- L ownership; 2. maintenance; or 3. use; of the uninsured motor vehicle. OTHER PERSONS Anyone else is protected who suffers bodily injury while occupying: 1. Your auto. 2. A motor vehicle you do not own, while it is used in place of your auto for a short time. Your auto must be out of use because of: a) breakdown; b) repair; c) servicing; or d) loss. 3. A four-wheel motor vehicle newly acquired by you. This applies only during the first 30 days you own the vehicle, unless it replaces your auto. 4. Any other motor vehicle while it is being driven by you or a relative. This extension applies only in policies issued to persons (not organizations). However, the vehicle must not be: a) owned by you or a relative; or b) furnished to you or a relative for regular use. DERIVATIVE CLAIMS This coverage also protects others for compensatory damages due them, as a derivative claim, by law because of bodily injury to you or a relative. A derivative claim is included within the limit payable per person and per occurrence as described in the Limits of Payment section. RECOVERY 1. We will jointly determine with the insured whether: a) there is legal right to recover damages; and b) if so, the amount of such damages. If you and we can't agree, the matter will go to arbitration. 2. The limits of coverage as shown in the Declarations are not subject to arbitration. 3. Any judgment against the uninsured will be binding on as only if it has our written consent. DEFINITION 1. An uninsured motor vehicle is: a) one for which there is no bodily injury liability bond or insurance or self-insurance at the time of the accident. b) one for which the insuring company denies coverage or becomes insolvent. 14 ijnin;uted c) an unidentified motor vehicle which causes bodily injury to an insured by physical contact with: inotolists (1) such person: or i ,,,. (2) a vehicle the insured is occupying. The driver and the owner of the unidentified vehicle must be unknown. A report must be made to the police as soon as practicable. We must have a sworn statement within 30 days. It must state that the insured has a legal action due to the accident. It must include facts to support the action. We may inspect any vehicle the insured was occupying. 2. We will not consider as an uninsured motor vehicle: a) a motor vehicle that is "self-insured" under any law; b) any motor vehicle owned by a government unit or agency; c) any vehicle in use as a residence or premises; d) any equipment or vehicle designed for use mainly off public roads except while on public roads; e) any motor vehicle insured under the liability coverage of this or any other policy; nor f) any motor vehicle furnished for the regular use of you or a relative. :;OVERAGE EXCLUSIONS This coverage does not apply to: I . Use of any motor vehicle by an insured to carry persons or property for a fee. Shared-expense car pools are not considered carrying persons for a fee. 2. Use of any motor vehicle by an insured without the owner's permission. 3. Bodily injury of any insured if the insured settles, without our written consent, with a liable party. 4. Bodily injury suffered while occupying a motor vehicle owned by you or a relative but not insured for Uninsured Motorists coverage under this policy; nor to bodily injury from being hit by any such motor vehicle. 5. Punitive or exemplary damages. 6. Noneconomic loss of any insured who has elected "Limited Tort" in accordance with the Pennsylvania Motor Vehicle Financial Responsibility Law. 7. Directly or indirectly benefit any workers' compensation carrier or any person qualified as a self- insurer under any workers' compensation law. INSURED PERS()NS' 3UT117 1. The Insured must: a) submit written proof of the claim to us. It must be under oath, if required. It must include: (1) the nature and extent of injuries; (2) treatment; and (3) any other details which could affect the amount of payment. b) provide all facts of the accident and the name of all witnesses. c) answer questions under oath as often as we require with good reason. d) be examined by doctors chosen by us as often as we require with good reason. At our request, the injured person must promptly authorize us to: (1) speak with any doctor who has treated him; (2) read all medical history and reports of the injury; 15 uninsured motorists cordm.ltdt (3) obtain copies of wage and medical reports and records; and (4) obtain copies of all medical bills as they are incurred. 2. After notice of claim, we require the insured to take legal action against any liable party. 3. An insured may bring legal action against the other party for bodily injury. A copy of ally paper served in this action must be sent to us at once. 4. The insured must: a) obtain our written consent to: (1) settle any legal action brought against any liable party; or (2) release any liable party. b) preserve and protect our right to subrogate against any liable party. ARBITRATION If we and the insured disagree about the right to recover damages, or the amount of such damages: After written demand for arbitration by either party, each will select a competent arbitrator. The two so selected will select a third. 2. If the third arbitrator is not agreed upon within 34 days, the insured or we may request a judge of a court of record to name one. The court must be in the county and state where arbitration is pending. 3. Each party will pay its chosen arbitrator. Each will pay half of all other expenses. 4. Arbitration shall be conducted in accordance with the provisions of the Pennsylvania Arbitration Act of 1927. 5. Unless the insured and we agree otherwise, arbitration will take place in the county and state where the insured lives. The Insured will submit to examination under oath as often as reasonably requested by us. The insured will grant us authority, at our request, to obtain copies of wage and medical records. The arbitrators will resolve the issues. Questions in dispute will be decided when two arbitrators agree. 6. Any demand for arbitration must be made within two years after the date of the accident. TRUST AGREEMENT This applies to the extent of any payment we make under this coverage. We will have first right to any amount the Insured receives from any liable party. The insured will: 1. Hold in trust for us his right to recover against any such party; and 2. Furnish us all papers in any suit the insured files. Our payment of a claim may result from the insolvency of an insurer. If so, we have the right to recover from the insurer, but not its insured. LIMITS OF PAYMENT AMOUNTS PAYABLE FOR UNINSURED MOTORISTS LOSSES We agree to pay losses up to the limits stated in the attached Declarations. Any change to those limits must be requested by the policyholder in writing. The following applies to these limits: 1. Bodily injury limits shown for any one person are for all legal damages, including all derivative claims, claimed by anyone I'or bodily injury to one person as a result of one occurrence. Subject to this limit for any one person, the total limit of our liability shown for each occurrence is for all damages, including all derivative claims, due to bodily Injury to two or more persons in any one occurrence. 16 uninsured 2. Limits apply as stated in the Declarations. The insuring of more than one person or vehicle under motorists this policy does not increase our payment limits for this coverage, In no event will any insured be (coy linuedl entitled to more than the highest pct person limit applicable to any one motor vehicle under this policy or any other policy issued by us. However, with regards to you (not organizations) or a relative, the sum of limits of your autos apply as stated in the Declarations. 3. Any damages payable, under this coverage, will be reduced by any sums paid by or for any liable parties. This includes all sums paid under the Auto Liability coverage of this policy. 4. Any payment under this coverage to or for an insured will reduce the amount of damages the insured may be entitled to recover under the Auto Liability coverage of this policy. 5. No payment will be made until the limits of all other liability insurance and bonds that apply have been exhausted by payments. OTHER INSURANCE: If there is other insurance: 1. For bodily injury suffered by an insured while occupying a motor vehicle you do not own, we will pay the insured loss not covered by other insurance. 2. Except as stated above, if you have other insurance similar to this coverage under another policy, we will be liable for only our share of the loss. Our share is our proportion of the total insurance limits for the loss. 3. In any event, if more than one policy applies to an insured other than you or a relative, total limits applicable will be considered not to exceed the highest limits of any one of them. DUPLICATE PAYMENT We will make no duplicate payment to or for any Insured for the same element of loss. ASSIGNABILITY No interest in this coverage can be transferred without nor written consent. However, if the policyholder dies, this coverage will continue in force for the rest of the policy period. It will apply to anyone having proper custody of your auto. under' Additional Definitions Applicable to This Coverage "Arbitration" means resolving questions in dispute. insured "Arbitrator" means the party conducting the arbitration. motorists "Underinsured motor vehicle"--Sec definition in "COVERAGE AGREEMENT" section. (for bodily injury caused by underinsured motorists) COVERAGE AGREEMENT YOU AND A RELATTVE We will pay compensatory damages as a result of bodily injury suffered by you or a relative and due by law from the owner or driver of an underinsured motor vehicle. Damages must result from an accident arising out of the: 1. ownership; 2. maintenance; or 3. use, of the underinsured motor vehicle. 17 underinsured OTHER PERSONS motorists Anyone else is protected who suffers bodily injury while occupying: 1. Your auto. 2. A motor vehicle you do not own, while it is used in place of your auto for a short time. Your auto must be out of use because of: a) breakdown; b) repair; c) servicing; or d) loss. 3. A four-wheel motor vehicle newly acquired by you. This applies only during the first 30 days you own the vehicle, unless it replaces your auto. 4. Any other motor vehicle while it is being driven by you or a relsttive. This extension applies only in policies issued to persons (not organizations). However, the vehicle must not be; a) owned by you or a relative, or b) furnished to you or a relative for regular use. DERIVATIVE CLAIMS This coverage also protects others for compensatory damages due them, as a derivative claim, by law because of bodily injury to you or a relative. A derivative claim is included within the limit payable per person and per occurrence as described in the Limits of Payment section. RECOVERY 1. We will jointly determine with the insured whether: a) there is legal right to recover damages; and b) if so, the amount of such damages. if you and we can't agree, the matter will go to arbitration. 2. The limits of coverage as shown in the Declarations are not subject to arbitration. 3. Any judgment against the underinsured will be binding on us only if it has our written consent. DEFINITION 1. An underinsured motor vehicle is: a motor vehicle for which bodily injury liability coverage, bonds of self-insurance are in effect. However, their total amount is insufficient to pay the damages an insured is entitled to recover, We will pay damages that exceed such total amount. 2. We will not consider as an underinsured motor vehicle: a) a motor vehicle that is "self-insured" under any law; b) any motor vehicle owned by a government unit or agency; c) any vehicle in use as a residence or premises; d) any equipment or vehicle designed for use mainly off public roads except while on public roads; e) any motor vehicle insured under the liability coverage of this policy; nor f) any motor vehicle furnished for the regular use of you or a relative. This coverage does not apply to: 1. Use of any motor vehicle by an insured to carry persons or property for a fee. Shared-expense car pools are not considered carrying persons for a fee. 18 Underinsured 2. Use of any motor vehicle by an insured without the owner's permission. motorists 3. Bodily injury u suffered while occupying a motor vehicle owned b y j ry g by you or a relative but not insured for Underinsured Motorists coverage under this policy; nor to bodily injury from being hit by any such motor vehicle. 5. Punitive or exemplary damages. 6. Noneconomic loss of any insured who has elected "Limited Tort" in accordance with the Pennsylvania Motor Vehicle Financial Responsibility Law. INSURED PERSONS' DUTIES 1. The insured must: a) submit written proof of the claim to us. It must be under oath, if required. It must include: (l) the nature and extent of injuries; (2) treatment; and (3) any other details which could affect the amount of payrrient. b) provide all facts of the accident and the name of all witnesses. c) answer questions under oath as often as we require with good reason. d) be examined by doctors chosen by us as often as we require with good reason. At our request, the injured person must promptly authorize us to: (t) speak with any doctor who has treated him; (2) read all medical history and reports of the injury; (3) obtain copies of wage and medical reports and records; and (4) obtain copies of all medical bills as they are incurred. 2. After notice of claim, we require the insured to take legal action against any liable party. 3. An insured may bring legal action against the other party for bodily injury. A copy of any paper served in this action must be sent to us at once. 4. The insured must: a) obtain our written consent to: (1) settle any legal action brought against any liable party; or (2) release any liable party. b) preserve and protect our right to subrogate against any liable party. ARBITRATION If we and the insured disagree about the right to recover damages, or the amount of such damages: 1. After written demand for arbitration by either party, each will select a competent arbitrator. The two so selected will select a third. 2. If the third arbitrator is not agreed upon within 34 days, the insured or we may request a judge of a court of record to name one. The court must be in the county and state where arbitration is pending. 3. Each party will pay its chosen arbitrator. Each will pay half of all other expenses. 4. Arbitration shall be conducted in accordance with the provisions of the Pennsylvania Arbitration Act of 1927. 5. Unless the insured and we agree otherwise, arbitration will take place in the county and state where the Insured lives. The insured will submit to examination under oath as often as reasonably requested by us. The insured must grant as authority, at our request, to obtain copies of wage and medical records. The arbitrators will resolve the issues. Questions in dispute will be decided when two arbitrators agree. 19 underinsured 6. Any demand for arbitration must be made within two years after the date of the accident. motorists TRUST AGREEMENT This applies to the extent of any payment we make under this coverage. We will have first right to any amount the insured receives from any liable party. The insured will: 1. Hold in trust for us his right to recover against any such party; and 2. Furnish us all papers in any suit the insured files. Our payment of a claim may result from the insolvency of an insurer. If so, we have the right to recover from the insurer, but not its insured. LIMITS OF PAYMENT AMOUNTS PAYABLE FOR UNDERINSURED MO'T'ORISTS LOSSES We agree to pay losses up to the limits stated in the attached Declarations. Any change to those limits must be requested by the policyholder in writing. The following applies to these limits: I . Bodily injury limits shown for any one person are for all legal damages, including all derivative claims, claimed by anyone for bodily injury to one person as a result of one occurrence. Subject to this limit for any one person, the total limit of our liability shown for each occurrence is for all damages, including all derivative claims, due to bodily injury to two or more persons in any one occurrence. 2, Limits apply as stated in the Declarations. The insuring of more than one person or vehicle under this policy does not increase our payment limits for this coverage. in no event will any insured be entitled to more than the highest per person limit applicable to any one motor vehicle under this policy or any other policy issued by us. However, with regards to you (not organizations) or a relative, the sum of limits of your autos apply as stated in the Declarations. 3. Any damages payable, under this coverage, will be reduced by any sums paid by or for any liable parties. 4. Any payment under this coverage to or for an insured will reduce the amount of damages the insured may be entitled to recover under the Auto Liability coverage of this policy. 5. No payment will be made tintil the limits of all other liability insurance and bonds that apply have been exhausted by payments. 6, An insured who recovers damages for an uninsured motorists claim cannot recover damages for an underinsured motorists claim for the same accident. OTHER INSURANCE If there is other insurance: 1. For bodily injury suffered by an insured while occupying a motor vehicle you do not own, we will pay the insured loss not covered by other insurance. 2. Except as stated above, if you have other insurance similar to this coverage under another policy, we will be liable for only our share of the loss. Our share is our proportion of the total insurance limits for the loss. 3. In any event, if more than one policy applies to an insured other than you or a relative, total limits applicable will be considered not to exceed the highest limits of any one of them. DUPLICATE PAYMENT We will make no duplicate payment to or for any insured for the same element of loss. 20 underinsured ASSIGNABILITY motorists No interest in this coverage can be transferred without our written consent. However, if the policyholder r. dies, this coverage will continue in force for the rest of the policy peri(:3d. It will apply to anyone having proper custody of your auto. general we, you, and anyone insured by this policy must do certain things in order for the provisions of the policy to apply. The following are policy conditions: policy 1. INSURED PERSONS' DUTIES eonditionS The insured will: a) give us or our agent prompt notice of all losses and provide written proof of claim if required, b) notify the police of all theft losses as soon as practicable. c) promptly deliver to us all papers dealing with any claims or suits. d) submit to examination under oath as often as reasonably requested by us. e) assist us with any claim or suit. f) if injured, submit to examinations by company-selected physicians as often as the company reasonably requires. The injured person must grant us authority, at our request, to obtain copies of wage and medical records. g) protect damaged property insured under this policy and make it available to us for inspection before its repair or disposal. 2. UNAUTHORIZED USF, OF O7'HVR MO" YEHICLF.S Protection in this policy does not apply to any rnolor vehicle any insured: a) uses without a reasonable belief that the insured is entitled to do so. b) has stolen. c) knows to have been stolen. 3. HOW YOUR POLICY MAY RE CHANGED a) Any terms of this policy which may be in conflict with statutes of the state in which the policy is issued are hereby amended to conform. b) Any insured will automatically have the benefit of any extension or broadening of coverage in this policy, as of the effective date of the change, provided it does not require more premium, c) No other changes may be made in the terms of this policy except by policy endorsement. d) The premium for each coverage is based on information in our possession. Any change(s) in this information will allow us to make an adjustment of the premium on a pro rata basis. 4. IF YOU UEC:OME BANKRUP'T' Bankruptcy or insolvency of any insured will not relieve us of any obligation under the terms of this policy. 5. SUBROGATION We have the right of subrogation under the, a) Physical Damage; b) Auto Liability; and c) Medical Payments; coverages in this policy. This means that after paying a loss to loll or others under this policy, we will have the irtsured's right to sue for or otherwise recover such loss from anyone else who may be liable. Also, we may require reimbursement from the irowred out of any settlement or judgment that duplicates our payments. 21 ,.erleral policy 6. RENEWAL/NONIRENEWAL Londiiions This policy is written for a six-month policy period. We will renew it for successive policy periods, ' I I 1d) subject to the following conditions: a) renewal will be in accordance with policy forms, rules, rates and rating plans in use by us at the time. b) prior to the expiration date of a policy term for which premium has been paid, we will mail a notice to the policyholder for the premium required to renew or maintain the policy in effect. We will mail this notice to the address last known to us. c) all premiums or premium installment payments must be paid when due, whether payable directly to us or through any premium finance plan. d) at the end of each 12-month period after the first date of the policy or any coverage, we will have the right to refuse to renew any coverage or the entire policy. If we elect not to renew, we will mail notice to the policyholder 60 days in advance of the date when coverage will terminate. Such mailing to the last known address will be considered proof of notice. 7, CANCELLATION DURING POLICY PERIOD The policyholder may cancel this policy or any of its coverages by mailing notice to its of the future date of cancellation desired. Premium refund, if any due, will be made as soon as practicable after the date of cancellation. We will retain premium for the days covered. if this policy or any coverage has been in effect less than 60 days, we have unlimited right of cancellation. We may cancel by mailing notice to the policyholder. a) 15 days in advance of termination for nonpayment of premium. b) 10 days in advance of termination for all other reasons. Except I-or nonpayment, the date of termination mutt be within the first 60 days of coverage. After any coverage of this policy has been in force 60 days, our right to cancel such coverage during the policy period is limited. We may cancel during an annual policy period: a) if premiums or premium installment payments are not paid when due, whether payable directly to us or through any premium finance plan. b) if the driver's license or motor vehicle registration of any named insured has been suspended or revoked during the policy term. c) if it is determined that any insured has concealed a material fact, has made a material allegation contrary to fact, or has made a misrepresentation of a material fact and that such concealment, allegation or misrepresentation was material to the acceptance of the risk by us. We must snail notice to the policyholder: a) 15 days in advance of termination for nonpayment of premium. b) 15 days in advance of termination for loss of license: or of motor vehicle registration. c) 60 days in advance of termination for concealment or misrepresentation. In any case of cancellation by us, our mailing of notice to the last known address or delivery of it to the policyholder will be considered proof of notice. We will retain premium for days covered during the policy period. Premium refund, if any due, will be made as soon as practicable. Mailing or delivery of our check will constitite tender of refund. 8. LEGAL ACTION LIMITATIONS No legal action may be brought against us concerning this policy until the insured has fully complied with all its terms. Under the liability coverages of this policy, no legal action may be brought against us until judgment against the insured has been finally determined after trial. This policy does not give anyone the right to make us a party to any liability action against an insured. 22 general policy 4. PREMIUM RECOMPUTATION condilions Premiums and coverages of this policy conform to the Motor Vehicle Financial Responsibility Law. If a court of jurisdiction effectively renders any or all provisions of the act invalid or unenforceable, we may recompute premiums payable and revise the coverage. Changes, however, will be made- as required by law-only upon approval by the Pennsylvania Insurance Commissioner. If we fail to act within a reasonable time, the Commissioner may direct fair and reasonable adjustments. 10. OPTIONAL PAYMENT OF PREMIUM IN INSTALLMENTS The policyholder may pay the premium for this policy in installmeents, under terms and conditions approved where required by the Department of Insurance. For each separate installment payment there is an installment service charge. Your agent can provide: additional information about installment payment. IN WITNESS WHEREOF: Nationwide General Insurance Company has cawed this policy to be signed by its President and Secretary at Columbus, Ohio, and countersigned as may be required by a duly authorized representative of the company. Nationwide General Insurance Company / Home Office. COiumbuS. Ohio 43215-2220 23 Endorsement 809A amendatory endorsement (Pennsylvania) Please attach this important addition to your auto policy. It is agreed that the policy is amended as follows: DEFINITIONS Definitions 7 and 9 are replaced to read: 7. "PRIVATE PASSENGER AUTO" means a four-wheel: a) private passenger auto; b) van; or c) pickup truck. "RELATIVE" means one who regularly lives in your household and who is related to you by blood, marriage or adoption (including a ward or foster child). A relative may live temporarily outside your household. PHYSICAL DAMAGE COVERAGE AGREEMENT COMPREHENSIVE COVERAGE The following is added to item 1. b) (2): For damage to your windshield, we may offer to have it repaired in lieu of replacement. We will not apply a deductible for the repair of the windshield. However, if the repair is not satisfactory, we will replace the windshield subject to your deductible. COLLISION COVERAGE Item 1. is amended to read: 1. We will pay for loss to your auto caused by collision or upset. We will pay for the loss less your deductible. We will not subtract the deductible amount for broken glass if you have full (no deductible) Comprehensive coverage in force. COVERAGE EXTENSIONS USE OF' OTHER MOTOR VEHICLES Item 2. is amended to read: 2. A four-wheel motor vehicle newly acquired by you. You must report the acquisition of the vehicle to us during the first 30 days you own the vehicle. Also, if the newly acquired vehicle does not replace your auto, all household vehicles owned by you must be insured by us or an affiliate for this extension of coverage to apply. We provide this coverage only if you do not have other collectible insurance. You must pay any added premium resulting from this coverage extension. COVERAGE EXCLUSIONS Exclusions 1., 2., 3., and 8. are replaced to read: We will not pay for loss: 1, To more than one: a) recording tape; b) compact disc; or c) other recording media. 2. To a container to be used for storing or carrying: a) recording tapes; NGN 809-A (6-97) Page 1 of 5 b) compact discs; or c) other recording media. 3. To any device which is a: a) tape player; b) compact disc player; c) citizens band radio; d) Iwo-way mobile radio; e) telephone; or f) any other device which records, emits, receives and/or transmits sound. This exclusion (3.) does not apply if the device is a permanent part of your auto, Permanent part means installed in a location used by an auto maker for such a device. If the device is not covered, its antenna and other parts are not covered. 8. To scanning monitor receivers used for radar detection, or any other device designed to detect the monitoring of speed. LIMITS OF PAYMENT ACTUAL CASH VALUE The Actual Cash Value provisions are replaced to read: The limit of our coverage is the cash value of your auto or its damaged parts at the time of loss. To determine cash value, we will consider: 1. fair market value; 2. age; and 3. condition of the property; at the time of loss. In addition to our payment of the loss, necessary and reasonable towing and storage will be paid to protect the auto from further damage. The following provisions apply under the heading Loss Settlement: LOSS SETTLEMENT At our option, we may: 1, pay you directly for a loss; 2. repair or replace your auto or its damaged parts with parts furnished either by original equipment manufacturers or non-original equipment manufacturers; 3. return stolen property at our expense and pay for any damage. COVERAGE CONDITIONS The following Condition is added: CONTROLLING STORAGE COSTS When an insured is involved in a Collision or Comprehensive loss, we have the right to move the vehicle from any impound lot, storage site, towing yard or any other facility to control storage costs, towing costs or other fees. The insured will be promptly notified whenever any such action is undertaken. AUTO LIABILITY COVERAGE AGREEMENT PROPERTY DAMAGE AND BODILY INJURY LIABILITY COVERAGE Item 3. c) is replaced to read: 3. c) pay premiums: (1) of not more than $250 per insured for bail bonds required because of an accident or traffic violation. Page 2 of 5 NGN 809-A (6-97) (2) for appeal bonds in defended suits and for bonds to release attached property. The amount of such bonds shall not be more than the limits of liability shown in the Declarations. Although paying such premiums, we are not required to apply for or furnish such bonds. COVERAGE EXTENSIONS USE OF OTHER MOTOR VEHICLES Item 2. is amended to read: 2. A four-wheel motor vehicle newly acquired by you. This coverage applies only during the first 30 days you own the vehicle unless it replaces your auto. If the newly acquired vehicle does not replace your auto, all household vehicles owned by you must be insured by us or an affiliate for this extension of coverage to apply. We provide this coverage only if you do not have other insurance. You must pay any added premium resulting from this coverage extension. COVERAGE EXCLUSIONS Exclusions 1., 4., 5., and 7, are replaced to read: 1. Property damage or bodily injury caused by an act intending to cause any harm done by or at the direction of any Insured. 4. Property damage caused by any Insured: a) to a motor vehicle that is owned or operated by, or in the custody of, that Insured; or b) to any other property that is owned by or in the custody of any Insured or anyone occupying your auto. This exclusion does not apply to a: (1) rented home; or (2) rented private garage. 5. Bodily injury to any person eligible to receive any benefits required to be provided or voluntarily provided by any insured under a: a) workers' compensation; b) unemployment compensation; c) non-occupational or occupational disease; d) disability benefits; or any similar law. 7. The United States of America or any of its agencies. It also does not apply to any employee of the United States of America or any of its agencies while such person is acting within the scope of his or her office or employment and the provisions of the Federal Tort Claims Act apply. LIMITS OF PAYMENT The Other Insurance provisions are replaced to read: OTHERINSURANCE In any losses involving the use of your auto or any other motor vehicle covered under this policy, we will be liable for only our share of the loss if there is other collectible liability insurance available to you or an insured. Our share is our proportion of the total insurance policies applicable to you or any insured for the loss. You may have more than one Nationwide policy; we will pay only up to the highest limit of any one of them. FIRST PARTY BENEFITS OPTIONS OPTION 3 -ACCIDENTAL DEATH BENEFIT The following sentence is added: In the alternative, payment will be made to the surviving spouse. NGN 804-A (6-47) Page 3 of 5 OPTION 5 -COMBINED LOSS BENEFITS The second paragraph is replaced to read: Option 5 is subject to the following conditions: a) Within 18 months after the date of the accident, it must be determined with reasonable medical probability that future medical expenses will be incurred as a result of the injury. b) In no event will benefits be paid beyond three years from the date of the accident, c) There is no monthly dollar maximum for Income Loss Benefits. d) The maximum Accidental Death Benefit payable is $25,000. e) The maximum Funeral Benefit payable is $2,500. f) Benefits under d) and e) are only payable if death occurs within two years of the date of the accident. INSURED PERSONS' DUTIES The following paragraph is added: The injured person must submit to examination under oath as often as reasonably requested by us. GENERAL POLICY CONDITIONS 1. INSURED PERSONS' DUTIES Item h) is added to read: h) provide all records and documents we reasonably request and permit us to make copies. 3. HOW YOUR POLICY MAYBE CHANGED Items c:) and d) are replaced and item e) is added to read: c) no other changes may be made in the terms of this policy except by endorsement or policy revision. d) the, premium for each coverage is based on information in our possession. Any change or correction in this information will allow us to make an adjustment of the premium as of the date the change is effective. e) the policyholder has a duty to notify us as soon as possible of any change which may affect the premium or the risk under this policy. This includes, but is not limited to, changes in: (1) the principal garaging address of the insured vehicle(s), which must be reported to us within 30 days of the date the address change becomes effective; (2) drivers; (3) use of the insured vehicle(s); or (4) desired coverages, deductibles, or limits. 5. SUBROGATION Items d) and e) are added to read: d) Uninsured Motorists; and e) Underinsured Motorists; General Policy Condition 7 is replaced to read: 7. CANCELLATION DURING POLICY PERIOD The policyholder may cancel this policy or any of its coverages by mailing notice to us of the future date of cancellation desired. Premium refund, if any due, will be made as soon as practicable after the date of cancellation. We will retain premium for the days covered. If this policy or any coverage has been in effect less than 60 days, we have unlimited right of cancellation. We may cancel by mailing notice to the policyholder 15 days in advance of termination. Page 4 of 5 NGN 809-A (6-97) After any coverage of this policy has been in force 60 days, our right to cancel such coverage during the policy period is limited. We may cancel during an annual policy period: a) if premiums or premium installment payments are not paid when due, whether payable directly to us or through any premium finance plan. b) if the driver's license or motor vehicle registration of any named insured has been suspended or revoked during the policy term. c) if it is determined that any insured has concealed a material fact, has made a material allegation contrary to fact, or has made a misrepresentation of a material fact and that such concealment, allegation or misrepresentation was material to the acceptance of the risk by us. We must mail notice to the policyholder: a) 15 days in advance of termination for nonpayment of premium. b) 15 days in advance of termination for loss of license or of motor vehicle registration, c) 60 days in advance of termination for concealment or misrepresentation. In any case of cancellation by us, our mailing of notice to the policyholder's last known address or delivery of it to the policyholder will constitute proof of notice. We will retain premium for days covered during the policy period. Premium refund, if any due, will be made as soon as practicable. Mailing or delivery of our check will constitute tender of refund. Conditions 11., 12., and 13. are added to read: 11, DIVIDENDS The policyholder is entitled to any dividends which are declared by the Board of Directors and are applicable to coverages in this policy. 12. NON-SUFFICIENT FUNDS CHARGE The company reserves the right to impose a fee for any premium payment that is unable to be processed due to non-sufficient funds, or if there are non-sufficient funds in an account that is being utilized for electronic funds transfer (EFT) payments. This is under the terms and conditions approved where required by the Department of Insurance. 13. FRAUD a) this policy does not cover any loss to or by any insured if any element of fraud or fraudulent action is engaged in by that insured in connection with the loss. b) this policy does not provide Physical Damage coverage if you or a relative, either before or after a loss has: (1) intentionally concealed or misrepresented any material fact or circumstance; or (2) committed any fraud or made false statements relating to such loss. This endorsement applies as stated in the policy Declarations. This endorsement supersedes any prior endorsement numbered 809. NATIONWIDE GENERAL INSURANCE COMPANY Columbus, Ohio NGN 809-A (6-97) Page 5 of 5 y . r` - y = N U.-i1; iE:1, U"lDE"i"lEU,IM{{ i=e-1-sy,,, ar;a), le^,_ez ,. :h Calls Il"pJ...LtG1...?,.,,. I.- your nLi.1- -c': -%-. 7..5 -,IIL2r.Gr.Cu: antn?r ar, _zinsurcd .,'n1...:,IsurtL, i? _.:S:_ CCVC.'c1G a.`.:a i eu to :he pn,;?-V. RECOVERY item 4, of Recoveryis replaced to read: 4. The injured parry shall provide notice of as uninsured/underinsured motorists clai= within two years after the date of the accident, if the injured party fails to provide sucr notice, and this failure precludes our ability to subrogate agai.ast liable parties, coveraee may bt denied as provided in Insured Persons' Duties No. 2 below. INSURED PERSONS' DUTIES Items 1, e) and 1, d) are replaced to read: 1. The Insured must: c; submit to oral ertamina:ioa under oath as often as we require with good reazoa. d) be examined by doctors, including doctors examining the insured for r!habilitatioa purposes, chosen by us as cften as ire require with good reason. At our r: ;ues., the injured person must promptly authorize us to: (1) speak with any doctor who has treated him; (2) read aU medical history and reports of the injurr, (3) obtain copies of wage and medical reports and records; and (4) obtain copies of all medical bills as they are incurred. This -adorsement applies as stated in the policy Declarations. This endorsement is issued by the company shown in the Declarations as the issuicz company. f; ;' 3 hi N': E (NE;'?ANCE CC to, F,4 NIE5 IJ Endorsement 2358 underinsured motorists coverage (Pennsylvania) Please attach this important addition to your auto policy. This endorsement replaces the policy's Underinsured Motorists coverage section. Coverage is subject to all terms and conditions of the policy, except as changed by this endorsement. ADDITIONAL DEFINITIONS APPLICABLE TO THIS COVERAGE 1. "ARBITRATION" means a forum for resolving questions subject to arbitration. 2. "ARBITRATOR" means the person conducting the arbitration. 3 An "UNDERINSURED MOTOR VEHICLE" is a motor vehicle for which bodily injury h'abilit? coverage, bonds or insurance are in effect. However, their total amount is insufficient to pay the damages an idlsured is entitled to recover. We will pay damages that exceed such total amount. We will not consider as an underinsured motor vehicle: a) a motor vehicle that is "self.insured" under any law; b) any motor vehicle owned by any government unit or agency; c) any vehicle in use as a residence or premises; d) any equipment or vehicle designed for use mainly off public roads except while; on public roads; e) any motor vehicle insured under the Auto Liability coverage of this policy; nor f) any motor vehicle furnished for the regular use of you or a relative. COVERAGE AGREEMENT YOU AND A RELATIVE We wiU pay compensatory damages, including derivative claims, which are due by law to you or a relatlve;ftom the owner or driver of an underinsured motor vehicle because of bodily Injury suffered by you or a relative. Dam.*, Cs must result from an accident arising out of the: 1. ownership; 2. maintenance; or 3. use; of the underinsured motor vehicle. OTHER PERSONS We will also pay compensatory damages, including derivative claims, which are due by law to other petsons who: 1. Are not a named insured or an insured household member for similar coverage under another poicy; and 2. Suffer bodily Injury while occupying: a) your auto. b) a motor vehicle you do not own, while it is used in place of your auto for a short tune. Your auto must be out of use because of: (1) breakdown; (3) servicing; or (2) repair; (4) loss. c) a four-wheel motor vehicle newly acquired by you. This applies only during the first 30 days You own the chicle, unless it replaces your auto. i V-2352 it-CC; d) any other motor vehicle white it is being driven by you or a relative. This extension applies only: in policies issued to persons (not organizations), However, the vehicle must not be: (1) owned by you or a relative; or (2) furnished to you or a relative for regular use. RECOVERY 1. Before recovery, we and any injured party seeking protection under this coverage must agree on two!points: a) whether there is legal right to recover damages from the owner or driver of an underinsured motor vehicle; and if so, b) the amount of such damages. If agreement can't be reached, the matter will go to arbitration. 2. Questions between the injured party and us regarding whether the injured party is an Insured under this coverage, or the limits of such coverage, are not subject to arbitration and shall be decided by a court of law. 3. Any judgment against the underinsured will be binding on us only if it has our written consent. 4. Any demand for Underinsured Motorists Coverage benefits must be made within two years after the date of the accident. COVERAGE EXCLUSIONS This coverage does not apply to: 1. Use of any motor vehide by an insured to carry persons or property for a fee. Motor vehicles used in shslred-expense car pools are not considered as carrying persons for a fee. 2. Use of any motor vehicle by an insured without the owner's permission. 3, Punitive or exemplary damages. 4. Directly or indirectly benefit any workers' compensation or disability benefits carrier, or any person or.organization qualifying as a "self-insurer" under a workers' compensation, disability benefits, or similar law. 5. Bodily injury suffered while occupying or struck by a motor vehicle owned by you or a relative, but not insured for auto liability coverage under this or any other policy. 6. Bodily Injury suffered while occupying a motor vehicle owned by you or a relative but not insured for 012derinsured Motorists coverage under this polity; nor to bodily injury from being hit by any such motor vehicle: 7. Noneconomic loss of any Insured who has elected "Limited Tort" in accordance with the PenusyWania Motor Vehicle Financial Responsibility Law. 8. Bodily injury of any insured if the insured settles, without our written consent, with a liable party. INSURED PERSONS' DUTIES 1. The insured must: a) submit written proof of the claim to us. It must be under oath, if required. It must include details of: (1) the nature and extent of injuries; (2) treatment; and (3) any other facts which could affect the amount of payment. b) provide all facts of the accident and the name of all witnesses. c) submit to oral examination under oath as often as we require. d) be examined by doctors, including doctors examining the Insured for rehabilitation purposes, chosen by us as often as we require. At our request, the injured person must promptly authorize us to: (1) speak with any doctor who has treated him; (2) read al! medical history and reports of the injury, (3) obtain cc;Fics of wage and medical reports and records; and (4) obtain codes of 0 medical bits as they are incurred. r 2. We require the insured to file suit against any and all liable parties to preserve and protect oue subrogation rights. Failure to do so precludes recovery under this coverage. . 3. The insured must obtain our written consent to: a) settle any legal action brought against any liable party, or b) release any party. ARBITRATION If we and the Insured disagree about the right to recover damages from the owner or driver of an underinsured motor vehicle or the amount of such damages: 1. After written demand for arbitration by either party, each will select a competent arbitrator. T134 two so selected will select a third competent arbitrator. Unless the insured and we agree otherwise, arbitration will take place in the county and state where the Insured lived at the time of the accident. 2. If the thud arbitrator is not selected within 30 days, the insured or we may request a judge of 'a court of record to name one. The court must be in the county and state in which arbitration is pending. 3. Each party will pay its chosen arbitrator. Each will pay half of the neutral arbitrator's expenses, Fees to lawyers and expert witnesses are to be paid by the party hiring them. 4. Arbitration shall be conducted in accordance with the provisions of the Pennsylvania Arbitration Act of 1927. OUR RIGHT TO RECOVERY This applies to the extent of any payment we make under this coverage. We will have first right to any amount the insured receives from any liable party. The insured wilt: 1. Hold in trust for us his right to recover against any such party, and 2. Furnish us all papers in any suit the Insured files. Our payment of a claim may result from the insolvency of an insurer. If SO, We have the right to recover from the insurer, but not its insured. LIMITS OF PAYMENT AMOUNTS PAYABLE FOR UNDERINSURED MOTORISTS LOSSES We agree to pay losses up to the limits stated in the policy Declarations. The following applies to .ibese limits: 1. The Underinsured Motorists bodily injury limit shown for any one person is for all legal damsps, including all derivative claims, claimed by anyone due to bodily Injury to one person as a result of one occwrenee. The per-person limit is the total amount available when one person sustains bodily injury, inclytling death, as a result of one occurrence. No separate limits are available to anyone for derivative claims, statut* claims, or any other claims made by anyone arising out of bodily injury, including death, to one person as! a result of one occurrence. The total limit of our liability shown for each occurrence is the total amount available when two,or more persons sustain bodily injury, including death, as a result of one occurrence. In no event shall any one person recover more than the per-person limit shown. 2. Coverage applies as stated in the Declarations. The insuring of more than one person or vehicle winder this policy does not increase our Underinsured Motorists payment limits. In no event will any Insured be (entitled to more than the highest per person limit applicable to any one motor vehicle under this policy or any other policy issued by us. However, with regards to you (not organizations) or a relative, the sum of limits of yoO autos apply as stated in the Declarations. 1 Damages payable under this coverage shall be reduced by any amount paid by or for any bable;paties. 4. The insured may recover for bodily injury under the Auto Liability coverage or the Underinsured :Motorists average of this policy, but not under both coverages. 5. No payment Dili be made unci! the limits of al! other auto Liability insurance and bonds that apply have been cxhausted by payments. 6. An insured who reco%.rs damages for an uninsured motorists claim cannot recover damages for ab underinsured motorists claims for the same accident. i OTHER INSURA. CE If there is other insurance: 1. For bodily Injury suffered by an Insured while occupying a motor vehicle you do not own, we will pay the insured loss not covered by other insurance. 2. Except as stated above, if there is other insurance similar to this coverage under any other policy, we will be liable for only our share of the loss. Our share is our proportion of the total insurance limits for the loss. 3. In any event, if more than one policy applies to an Insured other than you or a relative, total limits applicable will be considered not to exceed the highest limits amount of any one of them. DUPLICATE PAYMENT N e will make no duplicate payment to or for any Insured for the same element of loss. ASSIGNABILITY No interest in this coverage can be transferred without our written consent. However, if the pollcyholder dies, this coverage will continue in force for the rest of the policy period. It will apply to the following having proper custody of your auto: 1. your relatives; 2. your heirs; 3. an appointed legal representative; or 4. anyone else using your auto with the express permission of the legal representative. This endorsement applies as stated in the policy Declarations. This endorsement is issued by the company shown in the Declarations as the issuing company. NATIONWIDE INSURANCE COMPANIES Home Office: Columbus, Ohio 43215-2220 4 Endorsement 2357 uninsured motorists coverage (Pennsylvania) Please attach this important addition to your auto policy. This endorsement replaces the policy's Uninsured Motorists coverage section. Coverage is subject to all terms and conditions of the policy, except as changed by this endorsement. ADDITIONAL DEFINITIONS APPLICABLE TO THIS COVERAGE 1. "ARBITRATION" means a forum for resolving questions subject to arbitration. 2. "ARBITRATOR" means the person conducting the arbitration. 3. An "UNINSURED MOTOR VEHICLE" is: a) one for which there is no bodily injury liability bond or insurance at the time of the accident. b) one for which the insuring company denies coverage or becomes insolvent. c) an unidentified motor vehicle which causes bodily injury to an insured by physical contact with: (1) such insured; or (2) a vehicle the insured is occupying. The driver and the owner of the unidentified vehicle must be unknown. A report must be made to the police and us within 30 days, or as soon as practicable. It must state that the insured has a legal action due to the accident. It must include facts to support the action. If there was no physical contact with the unidentified vehicle, there must be corroborating evidence from a source other than any insured. We may inspect any vehicle the insured was occupying. We will not consider as an uninsured motor vehicle: a) a motor vehicle that is "self-insured" under any law; b) any motor vehicle owned by any government unit or agency; c) any vehicle in use as a residence or premises; d) any equipment or vehicle designed for use mainly off public roads except while on public roads; e) any motor vehicle insured under the Auto Liability coverage of this policy or any other policy; nor f) any motor vehicle furnished for the regular use of you or a relative. COVERAGE AGREEMENT YOU AND A RELATIVE We will pay compensatory damages, including derivative claims, which are due by law to you or a relative from the owner or driver of an uninsured motor vehicle because of bodily injury suffered by you or a relative. Damages must result from an accident arising out of the: 1. ownership: 2. maintenance; or 3. use, of the uninsured motor vehicle. OTHER PERSONS We will also pay compensatory damages. including derivative claims, which are due by law to other persons who: 1. Are not a named insured or an insured household member for similar coverage under another policy; and 2. Suffer bodily injury while occupying: a) your auto. V-2357 00/00) b) a motor vehicle you do not own, while it is used in place of your auto for a short time. Your auto must be out of use because of: (1) breakdown; (3) servicing; or (2) repair; (4) loss. c) a four.-wheel motor vehicle newly acquired by you. This applies only during the first 30 days you own the vehicle, unless it replaces your auto. d) any other motor vehicle while it is being driven by you or a relative. This extension applies only in policies issued to persons (not organizations). However, the vehicle must not be: (1) owned by you or a relative; or (2) furnished to you or a relative for regular use. RECOVERY l . Before recovery, we and any injured party seeking protection under this coverage must agree on two points: a) whether there is legal right to recover damages from the owner or driver of an uninsured motor vehicle; and if so, b) the amount of such damages. If agreement can't be reached, the matter will go to arbitration. 2. Questions between the injured party and us regarding whether the injured party is an insured under this coverage, or the limits of such coverage, are not subject to arbitration and shall be decided by a court of law. 3. Any judgment against the uninsured will be binding on us only if it has our written consent. 4. Any demand for Uninsured Motorists Coverage benefits must be made within two years after the date of the accident. COVERAGE EXCLUSIONS This coverage does not apply to: 1. Use of any motor vehicle by an insured to carry persons or property for a fee. Motor vehicles used in shared- expense car pools are not considered as carrying persons for a fee. 2. Use of any, motor vehicle by an insured without the owner's permission. 3. Punitive or exemplary damages. 4. Directly or indirectly benefit any workers' compensation or disability benefits carrier, or any person or organization qualifying as a "self-insurer" under a workers' compensation, disability benefits, or similar law. 5. Bodily injury suffered while occupying or struck by a motor vehicle owned by you or a relative, but not insured for auto liability coverage under this or any other policy. b. Bodily injury suffered while occupying a motor vehicle owned by you or a relative but not insured for Uninsured Motorists coverage under this policy; nor to bodily injury from being hit by any such motor vehicle. 7. Noneconomic loss of any insured who has elected "Limited Tort" in accordance with the Pennsylvania Motor Vehicle Financial Responsibility Law. 8. Bodily injury of any insured if the insured settles, without our written consent, with a liable party. INSURED PERSONS' DUTIES 1. The insured must: a) submit written proof of the claim to us. It must be under oath, if required. It must include details of: (1) the nature and extent of injuries; (2) treatment, and (3) any other facts which could affect the amount of payment. b) provide all facts of the accident and the name of all witnesses. c) submit to oral examination under oath as often as we require. d) be examined by doctors, including doctors examining the insured for rehabilitation purposes, chosen by us as often as we require. At our request, the injured person must promptly authorize us to: (1) speak with any doctor who has treated him; (2) read all medical history and reports of the injury; (3) obtain copies of wage and medical reports and records: and (4) obtain copies of all medical bills as they are incurred. 2. We require the insured to file suit against any and all liable parties to preserve and protect our subrogation rights. Failure to do so precludes recovery under this coverage. 3. The insured must obtain our written consent to: a) settle any legal action brought against any liable party; or b) release any party. ARBITRATION if we and the insured disagree about the right to recover damages from the owner or driver of an uninsured motor vehicle or the amount of such damages: I. After written demand for arbitration by either party, each will select a competent arbitrator. The two so selected will select a third competent arbitrator. Unless the insured and we agree otherwise. arbitration will take place in the county and state where the insured lived at the time of the accident. 2, If the third arbitrator is not selected within 30 days, the insured or we may request a judge of a court of record to name one. The court must be in the county and state in which arbitration is pending. 3. Each party will pay its chosen arbitrator. Each will pay half of the neutral arbitrator's expenses. Fees to lawyers and expert witnesses are to be paid by the party hiring them. 4. Arbitration shall be conducted in accordance with the provisions of the Pennsylvania Arbitration Act of 1927. OUR RIGHT TO RECOVERY This applies to the extent of any payment we make under this coverage. We will have first right to any amount the insured receives from any liable party. The insured will: 1. Hold in trust for us his right to recover against any such party; and 2. Furnish us all papers in any suit the insured files. Our payment of a claim may result from the insolvency of an insurer. If so, we have the right to recover from the insurer, but not its insured. LIMITS OF PAYMENT AMOUNTS PAYABLE FOR UNINSURED MOTORISTS LOSSES We agree to pay losses up to the limits stated in the policy Declarations. The following applies to these limits: 1. The Uninsured Motorists bodily injury limit shown for any one person is for all legal damages, including all derivative claims, claimed by anyone due to bodily injury to one person as a result of one occurrence. The per-person limit is the total amount available when one person sustains bodily injury. including death, as a result of one occurrence. No separate limits are available to anyone for derivative claims, statutory claims, or any other claims made by anyone arising out of bodily injury, including death, to one person as a result of one occurrence. The total limit of our liability shown for each occurrence is the total amount available when two or more persons sustain bodily injury, including death, as a result of one occurrence. In no event shall any one person recover more than the per-person limit shown. 2. Coverage applies as stated in the Declarations. The insuring of more than one person or vehicle under this policy does not increase our Uninsured Motorists payment limits. In no event will any insured be entitled to more than the highest per person limit applicable to any one motor vehicle under this policy or any other policy issued by us. However. with regards to you (not organizations) or a relative, the sum of limits of your autos apply as stated in the Declarations. t ? 3. Damages payable under this coverage shall be reduced by any amount paid by or for any liable parties. 4. The insured may recover for bodily injury under the Auto Liability coverage or the Uninsured Motorists coverage of this policy, but not under both coverages. OTHER INSURANCE If there is other insurance: 1. For bodily injury suffered by an insured while occupying a motor vehicle you do not own. we will pay the insured loss not covered by other insurance. 2. Except as stated above. if there is other insurance similar to this coverage under any other policy, we will be liable for only our share of the loss. Our share is our proportion of the total insurance 1 imits for the loss. 3. In any event, if more than one policy applies to an insured other than you or a relative, total limits applicable will be considered not to exceed the highest limits amount of any one of them. DUPLICATE PAYMENT We will make no duplicate payment to or for any insured for the same element of loss. ASSIGNABILITY No interest in this coverage can be transferred without our written consent. However, if the policyholder dies, this coverage will continue in force for the rest of the policy period. It will apply to the following having proper custody of your auto: 1, your relatives; 2. your heirs; 3. an appointed legal representative: or 4_ anyone else using your auto with the express permission of the legal representative. This endorsement applies as stated in the policy Declarations. This endorsement is issued by the company shown in the Declarations as the issuing company. NATIONWIDE INSURANCE COMPANIES Home Office: Columbus, Ohio 43215-2220 4 Endorsement 3208 Amendatory Endorsement Physical Damage Coverage Please attach this important addition to your auto policy. With this endorsement, it is agreed that the PHYSICAL DAMAGE coverage provided by this policy Is amended as follows: The following exclusion is added: We will not pay for loss: • to your auto or any other motor vehicle for diminution In value or depreciation. The following provision is added: APPRAISAL If we and the Insured fall to agree on the amount payable under the Comprehensive or Collision Coverage, either party may demand appraisal for the loss. Each will: 1, appoint and pay a competent and disinterested appraiser; and 2. equally share other appraisal expenses. Any fees of expert witnesses or attorneys will be paid by the party who hires them. The appraisers, or a judge of a court having jurisdiction, will select an umpire to decide any differences. Each appraiser will state separately the actual cash value and the amount of loss. An award in writing by any two appraisers will determine the amount payable. This endorsement applies as stated in the policy Declarations. This endorsement is Issued by the company shown In the Declarations as the Issuing company. NATIONWIDE INSURANCE COMPANIES Home Office: Columbus, Ohio 43215-2220 V-3206 Qom' .'[`!1%A.`` LT_.. P% L.L. CENTURY 21 AUTO POLICY DECLARATIONS Page 1 of 3 These Declarations are a part of the policy narlted above and Identified by policy number below. They supersede any Declarations Issued earlier. Your policy provides the coverages and limits shown In the schedule of coverages. They apply to each Insured vehicle as Indicated. Your policy compiles with the motorists' financial responsibility laws of your state only for vehicles for which Property Damage and Bodily Injury Liability coverages are provided. Policy Number: Policyholder: (Named Insured) 89 37 355019 KEVIN SNYDER RR 1 BOX 266 Issued: LOYSVILLE, PA 17047 MAR 31, 2005 Policy Period From: APR 25, 2005 to OCT 25, 2005 but only if the required premium for this period has been paid and only for six month renewal periods If renewal premiums have been paid as required. This policy is Initially effective at (1) the time the application for Insurance Is completed, or (2) 12:01, a.m. on the first day of the policy period, whichever is later. Each renewal period begins and ends at 12:01 a.m. standard time at the address of the named Insured stated herein. This policy cancels at 12:01 a.m. at the address of the named Insured stated herein. 0 INSURED VEHICLE(S) & SCHEDULE OF COVERAGES $ 1. 1994 SUBA 1MPREZA ID #01GC2245RB535401 Coverages Limits Of Liability Premium PROPERTY DAMAGE LIABILITY . ENDORSEMENT 779 100,000 EACH pCWRRENCE $ 38 00 o BODILY INJURY LIABILITY 100,000 EACH PERSON . 300,000 EACH OCCURRENCE $ 56.30 UNINSURED MOTORISTS ENDORSEMENT 2357 -BODILY INJURY 1 15,000 EA PERSON 3 E O $ 6.50 0 000 A CCURRENCE UNDERINSURE BODILYIIN URY ENDORSEMENT P 000 2358 - M ERSON pp EACH 30, FIRST PARTY BENEFITS JCE $ 20.60 OPTION 1 MEDICAL BENEFIT 10,000 20 10 OPTION 2 6,000 TOTAL . 7 20 INCOME LOSS BENEFIT 1,000 MONTHLY . OPTION 3 ACCIDENTAL DEATH BENEFIT $ 10.000 $ 2 30 OPTION 4 . FUNERAL BENEFIT $ 11500 $ 30 FULL TORT . TOTAL $ 151.30 AUTO 7100-A FRAME: B 22 w Page 2 of 3 VEHICLE'CLASSIFICATIONS Premium Is Based On: 1984 SUBA USE OF VEHICLE FARM RATED DRIVER ADADUULT AGE 34 PRINCIPAL UNMARRIED APPLIED DISCOUNTS PASSIVE RESTRAINT ANNUALBMIILEAGEER MULTI CAR LONG TERM HOME & CAR SPECIAL RATING FULL DRIVER TORT RATING SYMBOLS 014-015 00 Policy Form & Endorsements: NGN 0388B 809A 2391 3208 Office Use: PR344954 D 549406 NOV 12, 2004 TERR: 099 S 0.00 Issued By: NATIONWIDE GENERAL INSURANCE COMPANY Home Office - Columbus, Ohio Countersigned At: HARR i SBURG, PA By: ROBERT C GROVE MEMBER, LOSS PAYABLE CLAUSE ENDORSEMENT This endorsement applles to the Comprehensive and Collision coverages provided by this policy. It protects the Ilenhoder named In the policy Declarations. Payment for loss will be made according to the Interest of the polcyhdder and Ilenhdder. Payment may be made to both jointly, or to eRher separately. Either way, the company will protect the Interests of both. The Penholder's Interest will be protected, except from fraud or omisslons by the policyholder or the policyholder's representative. If the company cancels or refuses to renew the policy, the Ilenhdder will receive notice at least 10 days before protection of its Interest will end. The Ilenhdder shall notify the company upon learning of any change In ownership of the vehicle. To the extent of payment to the Ilenhdder, the company will be entitled to the Ilenhoider's rights of recovery. The endorsement Is Issued by the Nationwide Mutual Insurance Company or Nationwide Mutual Fire Insurance Company, whichever has Issued the policy to which it Is attached. NATIONWIDE GENERAL INSURANCE COMPANY HOME OFFICE: COLUMBUS, OHIO 43215-2220 0'j, " • R 4, ? g, Pnsfdant Secretary FRAME: C 22 y CENTURY 21 AUTO POLICY DECLARATIONS Page 3 of 3 Policy Number: Policyholder. 89 37 355019 (Named Insured) KEVIN SNYDER Issued: Policy Period From: MAR 31, 2005 APR 25, 2005 to OCT 25, 2005 IMPORTANT PHONE NUMBERS Nationwide 24-Hour Claims Number. 1-000-421-3535 For GUESTIONS About Your Policy, Call Your NATIONWIDE AGENT : REBECCA A REISINGER 717463-0514 For Hearing impaired: TTY 1-000422-2421 Nationwide Regional Office: 717457.0400 0 o. 4 FRAME: D 22