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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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