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304.17-220 Insurance with other insurers -- Expense incurred benefits -- "Other
valid coverage."
(1)
(2)
(3)
There may be a provision as follows:
"Insurance with Other Insurers: If there be other valid coverage, not with this
insurer, providing benefits for the same loss on a provision of service basis or on an
expense incurred basis and of which this insurer has not been given written notice
prior to the occurrence or commencement of loss, the only liability under any
expense incurred coverage of this policy shall be for such proportion of the loss as
the amount which would otherwise have been payable hereunder plus the total of
the like amounts under all such other valid coverages for the same loss of which this
insurer had notice bears to the total like amounts under all valid coverages for such
loss, and for the return of such portion of the premiums paid as shall exceed the pro
rata portion for the amount so determined. For the purpose of applying this
provision when other coverage is on a provision of service basis, the like amount of
such other coverage shall be taken as the amount which the services rendered would
have cost in the absence of such coverage."
If the foregoing policy provision is included in a policy which also contains the
policy provision set out in subsection (1) of KRS 304.17-230, there shall be added
to the caption of the foregoing provision the phrase "... Expense Incurred Benefits."
The insurer may, at its option, include in the provision provided in subsection (1) of
this section, a definition of "other valid coverage" approved as to form by the
commissioner, which definition shall be limited in subject matter to coverage
provided by organizations subject to regulation by insurance law or by insurance
authorities of this or any other state of the United States or any province of Canada,
and by hospital or medical service organizations, and to any other coverage the
inclusion of which may be approved by the commissioner. In the absence of such
definition such term shall not include group insurance, automobile medical
payments insurance, or coverage provided by hospital or medical service
organizations or by union welfare plans or employer or employee benefit
organizations. For the purpose of applying such policy provision no third-party
liability coverage amount of benefit provided for such insured pursuant to any
compulsory benefit statute, including any workers' compensation or employer's
liability statute, whether provided by a governmental agency or otherwise, shall in
all cases be deemed to be "other valid coverage" of which the insurer has had
notice. In applying such policy provision no third-party liability coverage shall be
included as "other valid coverage."
Effective: July 15, 2010
History: Amended 2010 Ky. Acts ch. 24, sec. 1204, effective July 15, 2010. -- Created
1970 Ky. Acts ch. 301, subtit. 17, sec. 22, effective June 18, 1970.
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