Volume 146

FEBRUARY 2019

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PF&M ANALYSIS:

ISO '18 ED. PERSONAL AUTO POLICY ANALYSIS

(September, 2018)

PART A - LIABILITY COVERAGE

Insuring Agreement

A. The PAP covers both "bodily injury" and "property damage" for which a covered person is legally obligated to pay because of an auto accident. The agreement also obligates an insurer to defend a claim or lawsuit. However, once the policy's limit of liability has been exhausted, the insurer's obligation to continue paying to legally defend an insured ends.

 

Example: Phil Drivewrong is being sued for hitting a car at an intersection after running a red light. Phil’s insurer defends his suit and dutifully pays lawyer fees and court costs. Phil’s policy has a combined single liability limit of $100,000. The claimant is suing for $300,000 in damages and her claim is bolstered by a very credible group of expensive, expert witnesses. After a careful evaluation of the case, Phil’s insurer determines that it would take an equal number of expensive experts to refute the amount of damages being claimed. The insurer also believes that fighting expert with expert could not guarantee a victory. The insurer decides that, rather than pay astronomical defense costs, it would be in their best interest to pay out the full policy limits. The claimant accepts their payment but continues the suit for the additional damages. The cost of continuing any defense is now Phil’s responsibility.

 

The PAP gives the insurer discretion on defending and/or settling a given claim. The PAP contains the potential of an unlimited defense obligation since it does not contain a specific monetary limit on the amount that may be paid to defend a covered person. However, the policy does allow a company to have some control over their financial duty to protect a covered person in a given claim. Of course, a natural control against an insurer’s unlimited obligation to defend an insured is that a company does not have to provide a defense under ALL situations. An insurer doesn’t have to defend any "bodily injury" or "property damage" loss that isn't covered by the policy.

 

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Example: Billie Roadmaster is quite an aggressive driver and he’s usually in a big hurry. One morning he lost his “patience.” He was late for work and was enraged at a driver who slowed him down by traveling the posted limit. When he got a chance, Billie sped by the “slow” driver, made a U-turn and then rammed his antagonist head-on. Billie’s mood wasn’t helped when, later, his insurer tells him that his PAP will not pay for any claim NOR defend him in court.

 

Note: When prejudgment interest is awarded against an insured, this amount is part of the insurer’s obligation to pay, subject to applicable policy limits.

B. Under Part A - Liability Coverage, an insured includes:

1. The named insured, a resident spouse and  any "family member,"

Note: This is in regard to operating, owning, or maintaining either a car or trailer

2. Persons who use "your covered auto."

 

Example: Yannick Petrie’s ‘12 Toyota pickup is insured under a PAP. One day, his neighbor, Jeri, asks to use his truck to pick up some building materials for a wood deck. On the way back from Goodluk Builder’s Paradise, Jeri rear ends a car at a stoplight and the building material spills out of the pickup bed. The spilled materials not only damage the car in back of Jeri, they also fall onto the road, causing a chain collision. Since Jeri is a permissive operator of Yannick’s pickup, Yannick’s policy would cover the losses (up to its limit).

 

The PAP also considers other persons and organizations to be covered persons in certain circumstances.

3. Other persons or organizations are eligible for coverage against damage which they cause, but for which a named insured, a resident spouse or a "family member" is responsible because of their acts or omissions in providing the vehicle.

4. Other persons or organizations also are covered for their acts or omissions in providing a vehicle to a named insured, a resident spouse or a "family member" who causes damages with that vehicle (including a trailer). The same protection is available with regard to non-owned auto or trailer. However, this coverage does not apply in instances where such entities either own or hire the vehicle or trailer.

 

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Example: A member of your church asks you to drive some children to a church picnic using a van provided by another church member. On the way to the park (picnic site), the van hits an oil slick on the road, slams into a couple of parked cars, and one of the children suffers a broken leg. This policy provision allows the PAP to defend both you and the church as defendants in a claim involving the damages caused by a vehicle that is not owned or hired by either party.

 

Although this analysis does not attempt to discuss individual state differences, one important issue must be mentioned: no-fault insurance provisions. There are states with different methods of handling compensation of persons injured in automobile accidents. Instead of compensation based on tort liability (where payment of damages is based upon fault of the driver[s]), some states use various no-fault approaches.

Supplementary Payments

This section advises the insured of several, additional coverages that are available.

1. One supplemental coverage will pay for the cost of bail bonds, but this coverage is limited to a total of $250. However, the bond has to be connected with an accident. A bond that is due solely to a traffic violation isn't covered.

2. The policy pays for the costs of premiums on appeal bonds and attachment bonds, but only those involved in a suit that the insurance company is defending.

3. The PAP also pays for any interest on judgments that have been entered. However, any payment obligation ends if the policy's limit of insurance is reached.

4. The PAP pays for loss of earnings caused by hearings or trial attendance and other reasonable expenses caused by an insurance company's request.

 

Example: June Unlukki is asked to appear at a preliminary hearing involving her colliding with a family in a van while trying to merge onto a crowded interstate. June gets permission to take an unpaid day off from work to attend and testify at the trial. The insurer says that they will pay for her loss of a day’s wages.

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Concerning loss of pay, the latest edition PAP pays a maximum of $250 per day to reimburse a covered person for lost earnings. This supplemental coverage does not include loss of other sources of income. In the previous edition of the PAP, the maximum limit for loss of earnings was $200 per day. One thing remains the same: there is no other limitation regarding loss of earnings, so the limit could be paid for one or 100 daily occurrences of lost pay. (09 18 change)

5. Finally, under Supplementary Payments, the policy will pay any reasonable expenses that are due to activity requested of an insured by the insurer.

 

Example: Sammi Kollum’s insurer is defending a lawsuit filed against him for an intersection collision that occurred while Sammi was coming home from an out-of-state vacation. Sammi’s insurer has made arrangements for him to travel to a lawyer’s office in a neighboring state so that he can participate in a deposition. The insurance company assures Sammi that they will pay for all expenses including travel, meals, hotels, etc.

 

A very important point is that any supplemental payment does not reduce the PAP’s other, primary policy limits.

Exclusions

This coverage part's exclusions fall under category A, having to do with "insureds," and category B, which concerns vehicle ownership, maintenance and use.

A. There are a number of situations that fail to qualify for coverage under the PAP, such as the following:

1. The Personal Auto Policy doesn't provide liability protection to insureds that deliberately injure other persons or property. Because this point sometimes causes confusion, it's important to examine what is meant by intent.

 

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Example: Jimmy is on the way home from a really horrible day at the office. As he merges into freeway traffic, another driver swerves from behind and beats him onto the road. Jimmy is so mad that, after he merges, he races up to the other car, meaning to ride his bumper. Unfortunately, Jimmy ends up hitting the other car. In this case, the intent lies with Jimmy's frame of mind. Yes, he intentionally sped up and overtook the vehicle, but what he meant to do was to get on the other driver's case, not to put the other driver's car into a body shop. Certainly, one could argue that what happened was foreseeable, but in Jimmy's mind, it was still an accident.

 

If you think the fact that something is foreseeable should determine intent, how about the following?

 

Example: Pearl thinks that she is a world class driver and she is very proud of her expert ability to make it through intersections under “yellow” traffic lights. One day, Pearl is headed towards a very busy intersection where the light facing her has just turned yellow. Pearl knows that the street is slick because the area she’s traveling in just had a brief downpour. Pearl ignores this fact as she picks up speed. She then decides that she just won’t be able to beat the red light. Pearl quickly hits her brakes and, as anyone should expect since the street is wet, the tires can’t grip anything. Pearl slides into the intersection and also into two other cars. The accident under these circumstances was quite foreseeable, but this is easily a covered loss under the PAP.

 

Related Court Case: Unlicensed Driver "Borrows" Grandparents' Van.

2. The PAP excludes coverage for property damage to property that any insured owns or transports.

 

Example: Pete is a drummer for the "Xploding Eardrums." He jumps into his van and speeds toward a bowling alley on the other side of town. He's late for a gig being held there. Not only does he have his drums, but he's also carrying the other band members' instruments. None of the instruments survive his abrupt meeting with a city bus. While the PAP will dutifully respond to paying damages to the bus and his car, he and the other “Eardrums” won’t be collecting payment for their implements of noise under the car policy.

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3. Any property that an insured has rented, uses or is caring for is also without protection if damaged or destroyed. The good news is that an exception is made for damage involving an insured’s home or garage.

4. This exclusion negates bodily injury coverage to any person who is hurt while working for an insured. However, an exception is made for domestic employees who aren’t covered by and are not required to be covered by workers compensation.

5. If an insured is using a covered auto to make money by transporting either people or property, that insured has just made the vehicle ineligible.

 

Example: Timmy was glad when he got his driver’s license. He was one of the first drivers at Gearhead H.S. Unfortunately; he wasn’t thrilled that, instead of a new ‘kickbutt’ car, he inherited his mom’s ‘07 minivan. But things are looking up. At first, he used it to take a friend or two back and forth to school. Now, Timmy’s van is known as the “Gearhead Taxi Service” and he makes nearly $100 a week by transporting kids to school/home, dances and sporting events. Let’s hope that Timmy doesn’t get into an accident because this use of the van won’t be covered by the PAP.

 

This exclusion has been revised to make coverage intent clearer. It now makes reference to the coverage ineligibility when any insured driver is actively using any vehicle in conjunction with a transportation network platform. Active use means providing such use as a driver. The exclusion applies both while seeking passenger contacts and during transporting passengers. (09 18 change)

 

Example: Mandi’s full-time job is a sous-chef for one of her town’s up and coming fusion Thai restaurants. Her job love doesn’t help as much with her bills, so she recently joined U-GO as a driver. So far, she’s making good money picking up on-demand driving jobs during the day. One day, she dropped off a passenger as she received another pick-up request. She strikes another car on the way to the pick-up site. When she turns in a claim, she’s told that the loss won’t be covered under her PAP. Her insurer points out that the use was excluded, even though, at the time, she was not carrying a passenger. The disqualifying event was that she was actively working under the U-Go application at the time of the accident.

 

Both the 01 05 and the 09 18 PAP editions maintain an important exception to this exclusion, with a difference.

a. Coverage is still permitted for vehicles used in traditional car pools (where the insured gets gas and maintenance money from car pool riders).

b. An additional exception is referenced, allowing coverage for a vehicle during its use in charity and volunteer situations. Protection extends to instances of both ownership and operation during such instances. (09 18 change)

The purpose of the next two exclusions  is to bar the PAP from responding to commercial auto exposures. These are best  written under a commercial auto policy.

Related Article: CA 00 01–Business Auto Coverage Form Analysis

6. No coverage is provided if the accident happens while an insured is in the business of selling, fixing, caring for, keeping or parking automobiles that are operated on public roads, including road testing or vehicle delivery. However, you don’t have to worry about this exclusion if the accident involves your covered car that’s being handled by “you” or any “family member,” partner, agent or employees of any of these insured parties.

Related Court Case: “Mechanic's Driving of Customer's Car Held Excluded”

7. This exclusion takes coverage away from any insured while involved in any “business” that is NOT described in exclusion 6, unless the business is ranching or farming. HOWEVER, the exclusion is voided if it involves a private-passenger auto, van or pickup that either is owned or is a temporary substitute for a covered auto that is inoperable because it is broken down, lost, destroyed, or being repaired or serviced. Further, any trailer used with an owned auto, van or pickup, or a temporary substitute, is covered.

 

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Examples:

Scenario 1: Chester owns a large farm outside of town. His pickup is in town having its brakes replaced. Chester needs to move a trailer loaded with bales of straw to the other end of his property, so his neighbor lets him use her pickup. While backing up onto a country road, the trailer gouges the side of a passing car. This loss is covered, since the “trailer” was attached to a temporary substitute for a covered vehicle. Further, the activity involved farming, which is permitted.

Scenario 2: Now suppose that, instead of farming, Chester repairs lawn equipment. His pickup is still unavailable because of the brakes. Chester borrows the same neighbor’s truck to deliver some mowers he fixed that are loaded on his trailer. Chester backs up the truck and the trailer hits the same passing car. Although the loss originated from use in Chester’s excluded business activity, this loss is covered, since the borrowed pickup is considered a temporary substitute for a covered auto.

Scenario 3: Okay, before Chester’s neighbor and the passing motorist get too upset, let’s say that Chester once again hits a passing car while using his neighbor’s pickup truck to deliver some mowers he fixed that are loaded on his trailer. However, the reason he borrowed the truck was because his own pickup was being used by his daughter to go to tennis practice. There is no coverage in this situation. The loss is excluded because Chester is involved in a business activity while using a non-owned car that the policy does not define as an eligible temporary substitute. If he had used his own pickup, it would have been covered, since the definition of “your covered auto” (refer to definition J) allows the incidental business use of an owned vehicle in the insured’s business.

 

8. Don’t look for coverage under the PAP unless you’re operating a covered car in the belief that you have an insured’s permission.

Note: This standard is subjective. This means that evaluation of a loss must include consideration of the operator’s point of view, at least regarding his or her thoughts on whether the car was operated with an insured’s permission.

 

Example: A friend of an insured borrows a car a second time during a weekend that the insured is away from home. The insured gave permission for the first use, but not the second. However, since the friend can’t get in touch with the insured and as it was okay to use the car before, she assumes that a second use is okay. If the friend has an at-fault accident while using the borrowed car, her belief that she had permission should support coverage being extended to cover the loss.

 

However, a significant change in circumstances can render a different evaluation.

 

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Example: Again, let’s use the situation of an insured’s friend who borrows a car twice during the time that the insured was away for a weekend. Again, the first time, the friend received permission for the first use, which was to go on a downtown shopping trip. All of this was with the insured’s knowledge and permission. The second use is without the insured’s knowledge or permission but, as it was in the original situation, the friend can’t get in touch with the insured and as it was okay to use the car before, she assumes that a second use is okay. However, in this scenario, rather than using the insured’s SUV for personal use, the friend uses it to make deliveries for persons who bought furniture from her Second Hand Shop.

 

If the friend has an at-fault accident while using the borrowed car, her belief that she had permission might be challenged by an insurer. While the friend’s assumption that a second personal use might be okay, the assumption might not hold when the second use is for business. It is possible that coverage for this situation could be denied.

Related Court Case: Was Unlicensed Driver A Permissive Operator?

This exclusion does maintain its grip on reality. It DOES NOT apply to the use of a covered auto that is owned by an insured and being operated by a “family member.”

 

Example: Junior storms out of the house and uses his set of keys to the pickup immediately after his mom just said that he could not use the truck for a date - this is a covered situation.

 

Example: An insured borrows his neighbor’s dual axle pickup to help his mother-in-law move out of state. After he returns home from the move, the insured goes out in his own car to celebrate the fact that his mother-in-law is gone. While he is away, his son and a friend decide to go cruising in the borrowed truck - this is NOT a covered situation.

 

Example: A newly licensed daughter takes mom’s brand-new car for a short drive even though she was threatened under “penalty of being grounded forever” never to touch it. A mile away from her home, the daughter causes an intersection collision - this is a covered situation.

 

9. Next  under section A., no bodily injury or “property damage” is covered if separate coverage exists (or would exist except for exhausted limits) under a nuclear energy liability policy issued by three named sources (Nuclear Energy Liability Insurance Association, Mutual Atomic Energy Liability Underwriters and Nuclear Insurance Association of Canada) or their successors.

10. Finally, under section A., no liability protection extends to an insured for  incidents of vehicle ownership, maintenance or use during the period that both of the following apply to the vehicle:

a. There is a written contract under which the vehicle is part of a personal vehicle sharing program

b. That vehicle is being used by a  person other than the named insured or a family member (as defined) of the named insured who is participating in a program referenced in 10.a above (09 18 addition)

 

Example: Krista and her family live in a cul-de-sac with four other households that have been neighbors for more than a decade. They are all so close that they have a mini-sharing economy situation where there’s a high level of trade and assistance among the neighbor group. They all share a group-owned utility shed where all of the neighbors have keys for 24/7 access. All the families that have extra vehicles have copies of keys kept on a peg board in the shed. They also store mowers, tools and equipment in the shed that are owned by individual neighbors, but all neighbors can take out and use as needed. One neighbor who does not own a car, Perry, caused a serious accident with a car he had just borrowed from Krista. He advises Krista on the same day as the accident and Krista take the information and files a claim.

Scenario 1 Her insurance company investigates the claim and advises that, while the claim process will take a while to determine payments, the loss is covered. The neighbors’ property sharing agreement was an informal, verbal arrangement.

Scenario 2: Her insurance company investigates the claim and advises that, unfortunately, the accident is not covered. The neighbors’ property sharing agreement was a written document with signed and notarized sets of sharing contracts kept by every neighbor. The exclusion applies due to the loss meeting the terms of exclusion 10. a. and b.

 

B. These are other situations that are ineligible for coverage.

1. If your vehicle doesn’t have at least four wheels and/or is principally designed for off-road use, it isn’t protected under the PAP. An exception exists when such a vehicle is used by an insured in a medical emergency. Trailers are still covered and so are incidents involving golf carts as long as the golf cart is NOT owned by an insured.

 

Example: Jeri and her teen-aged twins are on their way to a weekend camping trip. She is towing a small trailer that has an all-terrain cycle (ATC) loaded on it. The trailer and ATC were lent to her by her ex-husband. A mile away from the campground, Jeri's car slips off the road and onto a soft shoulder. She loses controls and crashes. Her son is seriously hurt in the crash. Jeri tells her daughter to watch her brother while she goes for help. The car is inoperable, but Jeri is able to unload the ATC and drive it on the road into town. If Jeri is in another accident while using the ATC on the roadway, it would be covered.

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Related Article: Glossary of Basic Automotive Terms

2. A definite coverage problem exists for any car that’s not a “covered auto,” which an insured either owns or has available for her regular use. Why? Because such a vehicle should either be listed or rated on an insured’s policy, or coverage should exist under another party’s policy. If the PAP didn’t contain these exclusions, the country could play “six degrees of insurance protection” with only about 100 people being policyholders and the other 250 million people being related for coverage purposes.

Related Court Case: “Insured’s Use Is Not A Regularly Furnished Vehicle”

3. Similar to exclusion 2., the PAP disqualifies any car that’s not a “covered auto” that a “family member” either owns or has available for their regular use, unless such a vehicle is being either maintained or occupied by a named insured (and/or resident spouse).

Related Article: PP 03 06-Extended Non-Owned Coverage – Vehicles Furnished or Available for Regular Use

4. The intent of this exclusion  is to bar protection for otherwise covered vehicles for loss  related to organized vehicle competitions that take place   within a facility meant for racing. Traditionally this limitation applied to vehicles in such a facility while practicing, preparing or competing in races or speed contests. However, the latest edition of the PAP has been revised. Besides the activities just listed, exclusion 4. (a. and b.) also applies to driver skill training and driver skill events. In addition, the exclusion applies to those participating in any of the above instead of being limited to only those competing.(09 18 change)

 

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Example: Carl and Josie own a ‘16 Acura, which they’ve modified to perform at impressive speeds. One Saturday night, both are in their Acura that’s parked in the pit area of a local race track. They’re waiting to participate in a promotional “Amateur Couples Valentine’s Day” Race. While waiting, Carl’s foot slips off the brake and they ram into a pile of custom racing tires, damaging them and some other facility equipment. Such a loss, while not technically involving a race, is still excluded because Carl and Josie’s Acura was within a facility designed for racing AND they had the intent of participating in a race.

 

5. This exclusion is new. It bars coverage for loss involving flying vehicles, whether flight is their sole capability or is among their features. (09 18 change)

Limit of Liability

A. The monetary limit that appears on the policy declarations page is the maximum amount of coverage that applies to the damages from any single loss. This maximum is not affected by the number of vehicles, insureds, or claims involved, or the number of vehicles or premiums appearing on the declarations page. This arrangement is true of both bodily injury and property damage claims. The particulars of a given loss may well affect how payments may be distributed, but the maximum remains the maximum.


 

Example: Tony and Kim have a PAP with the following limits:

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Bodily Injury

$100,000/$300,000

Property Damage

$100,000

Medical Payments

$10,000

Collision

$500 Deductible

Other Than Collision

$500 Deductible

Uninsured Motorist

$25,000/$50,000

Just before Kim could say “watch out,” Tony’s pickup slid out of control while trying to pass a car that slowed down to make a left turn at an intersection. Besides hitting the car waiting to turn, their truck also hit two other cars (both were car-pooling) and a local TV station’s van. Following are the resulting claims for damages:

BI Claims

Amount

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One

$43,000 (Severe burns)

Two

$12,000

Three

$51,500 (paralyzed)

Four

$24,000

Five

$17,800

Six

$8,500

Seven

$26,500

Total

$183,300

PD Claims

Amount

One

$23,000

These claims, all under a single accident, could be handled in a wide variety of ways. Under bodily injury, all of the individual claimants qualify under the per person insurance limits and the entire amount may also be paid under the per accident limit. Under property damage, all the cars individually qualify for coverage under the insurance limits, but the total amount exceeds the limits. Depending upon how the loss is settled, one or more of the claimants may only get partial settlement or could be squeezed out from any coverage at all, say if car four received total payment for its huge loss.

Two

$14,700

Three

$19,600

Four

$83,000

Total

$140,300

 

B. This section explains that, regardless of whether coverage exists under more than one coverage part (specifically parts A, B and/or C), no duplicate payments will be made under the PAP. This limitation means that, even if portions of a single claim qualify for coverage under Part A - Liability as well as Part B - Medical Payments and/or Part C - Uninsured Motorists coverage, an insured will not be paid more than once for any portion of his loss. This clarifies the purpose of the PAP to indemnify rather than enrich a claimant for their accidental loss.

Out-Of-State Coverage

The Personal Auto Policy emphasizes being able to perform in compliance with the legal realities of the environment that surrounds an eligible loss. Consistent with this objective, this provision allows the PAP to respond to a loss according to a given state’s requirements. Paragraph A.1. of this provision states that the policy will provide a higher limit for bodily injury or property damage liability coverage to meet whatever is minimally required by the state in which a covered loss occurs. Paragraph A.2. explains that the PAP will comply with the minimum amounts and types of coverages that may be required by a state’s compulsory insurance law while the covered auto is being operated in that state.

 

Example: The policy may be written in state A, which requires combined single limits, and the policy has a limit of $300,000. As it happens, a loss occurs while the insured is traveling in state B, which mandates the limit of liability to be applied in split limits for bodily injury and property damage liability. The PAP would respond to the accident by applying the $300,000 maximum consistent with the split limit requirement, but it would not increase the maximum available.

 

Paragraph B of this provision states that no one is eligible for duplicate payments.

This provision prevents technicalities to bar or limit coverage because of the different ways that states structure their coverage requirements. The provision allows travelers to cross state lines without having to worry about making specific adjustments to their form.

Financial Responsibility

The PAP, when considered as valid proof of financial responsibility, is to be interpreted as complying with the governing financial responsibility law. This is helpful and flexible since financial obligations required of drivers vary significantly by state.

Related Article: Financial Responsibility Limits

Other Insurance

In the event that other sources of liability insurance exist, Part A-Liability Coverage of the Personal Auto Policy will pay on a basis that equals its share of the total amount of insurance available to cover an eligible loss involving an owned auto. If the loss involves a non-owned auto, the PAP responds on an excess basis, paying only after the primary policy has paid its limit.

 

Example: Let us examine an auto loss that totals $10,000 in damages. The loss is covered by a PAP and some other source of coverage. Both sources have coverage limits greater than the loss amount.

Scenario 1: The loss involves an auto owned by the insured and the PAP and the other coverage source offer the same coverage limits. In this case, payment would be:

PAP - $5,000

Other Source - $5,000

Scenario 2: The loss involves an auto owned by the insured and the PAP and the other coverage source offer different coverage limits. Let us assume that the PAP’s limit represents 40% of the available coverage. In this case, payment would be:

PAP - $4,000

Other Source - $6,000

Scenario 3: The loss involves an auto that is NOT owned by the insured and the PAP and the other coverage source offer the same coverage limits. In this case, payment would be:

PAP - $0

Other Source - $10,000

 

Note: If a nonowned auto is involved, it would not matter if the PAP and the other source had different limits. The other source would have to pay out its complete limit before the PAP would contribute any payment.

Regarding other existing coverage, the policy reads that, even for autos that qualify as temporary substitutes for covered autos, this policy will respond as excess coverage over protection that may exist elsewhere. However, this policy’s application of limits is affected by one, different source of other insurance. When the other source of protection is intended to act as a higher layer of liability protection, then the PAP responds, per its applicable limits, ahead of that excess source. (09 18 Change)