Source: http://docplayer.net/2604302-Automobile-claims-procedures.html
Timestamp: 2018-12-16 07:11:04
Document Index: 237174998

Matched Legal Cases: ['ART 1', 'ART 2', 'ART 3', 'ART 4', 'ART 5', 'art 1', 'art 2', 'art 3', 'art 4', 'art 4', 'art 5', 'ART 1', 'art 2', 'ART 2', 'ART 3', 'art 4', 'ART 4', 'art 2', 'art 3', 'art 5', 'art 4', 'art 3', 'art 5']

AUTOMOBILE CLAIMS PROCEDURES - PDF
Download "AUTOMOBILE CLAIMS PROCEDURES"
2 AUTOMOBILE CLAIMS PROCEDURES A. AUTO GLASS CLAIMS 1. Report the claim to our Claims Dispatcher in Saskatoon at or use our toll-free number at for coverage confirmation and instructions. 2. Proceed to a glass shop of your choice for repair or replacement. 3. If the windshield can be repaired rather than replaced, we will waive the $50 or $100 Road Hazard Glass deductible. We will pay up to a maximum of three stone bruise repairs. B. AUTO PHYSICAL DAMAGE CLAIMS 1. IF DAMAGE IS LESS THAN $700 PLATE DEDUCTIBLE There are two options: a. Report the claim to our Claims Dispatcher in Saskatoon at or use our toll-free number at for coverage confirmation and instructions. OR b. Report the claim to your broker who will complete an Auto Loss Report Form on your behalf and submit it to SMI Claims. THEN - Obtain two written estimates and provide them to either your broker or SMI Claims. - Proceed with repairs according to the lowest estimate. - Pay your extension policy deductible directly to the repair facility. - The repair facility will submit their invoice directly to SMI Claims. - The invoice must be billed in your name, not SMI. The invoice should be sent to SMI for payment. - Payment will be made by SMI directly to the repair facility. 2. IF DAMAGE IS OVER THE $700 PLATE DEDUCTIBLE There are two options: a. Report the claim to our Claims Dispatcher in Saskatoon at or use our toll-free number at for coverage confirmation and instructions. OR b. Report the claim to your broker who will complete an Auto Loss Report Form on your behalf and submit it to SMI Claims. THEN - Report loss to SGI and proceed with repairs as authorized by SGI. - Pay your Extension deductible directly to the repair facility. - Submit a copy of SGI Damage Appraisal Form to either your broker or SMI Claims. - Repair facility will submit the repair invoice directly to SMI Claims. - If you are receiving a cash settlement from SGI, submit a copy of the SGI signed Proof of Loss Form to either your broker or SMI Claims. - Payment will be issued directly from SMI and forwarded directly to the repair facility or to you in case of a cash settlement. - The invoice must be billed in your name, not SMI. The invoice should be sent to SMI Claims for payment.
3 As a Saskatchewan Mutual policyholder, you have the right to attend meetings of the policyholders of the Company, and to vote in person or by proxy at these meetings. If you wish to appoint someone to attend and vote at meetings on your behalf, you may request a Proxy Form by writing to: Saskatchewan Mutual Insurance Company, rd Avenue North, Saskatoon, Sask. S7K 2H8. If you wish to receive a notice of all policyholders meetings within the next three years, please complete and return the Request for Notice of Meetings form below. REQUEST FOR NOTICE OF MEETINGS The undersigned, a policyholder of Saskatchewan Mutual Insurance Company, hereby requests that notice of each meeting of policyholders which may be held within three years from the date shown below, be sent to me at the address shown below. Dated: Policy Number: Signature: Please print name and address:
5 TABLE OF CONTENTS Page INTRODUCTION... 1 PART 1 - GENERAL DEFINITIONS... 2 PART 2 AUTOMOBILES TO WHICH THIS POLICY APPLIES... 2 PART 3 - GENERAL PROVISIONS AND EXCLUSIONS... 5 PART 4 - COVERAGES... 7 SECTION A - THIRD PARTY LIABILITY... 7 I. INSURED PERSONS... 7 II. INSURING AGREEMENTS... 7 III. EXCLUSIONS:... 8 IV. ADDITIONAL AGREEMENTS... 8 V. YOUR AGREEMENT...9 SECTION B ACCIDENT BENEFITS... 9 I. DEFINITIONS:... 9 II. INSURING AGREEMENTS III. INSURED BENEFITS A. Tort Coverage Extension B. No-Fault Coverage Extension IV. EXCLUSIONS V. LIMITATION OF LIABILITY VI. CLAIM SETTLEMENTS SECTION C - LOSS OR DAMAGE TO INSURED AUTOMOBILE I. INSURING AGREEMENTS II. LIMITATIONS AND DEDUCTIBLE III. EXCLUSIONS IV. ADDITIONAL AGREEMENTS V. YOUR AGREEMENT SECTION D - ENDORSEMENTS Cancellation/Deletion of Coverage Endorsement (Snowmobiles) Cancellation/Deletion of Coverage Endorsement (Motorcycles, Mopeds, Mini Bikes and Tricarts) E.E.F. 5 - Permission To Rent Or Lease E.E.F. 6a - Permission to Carry Passengers for Compensation E.E.F. 19 Limitation of Amount E.E.F. 19a - Stated Value E.E.F Loss of Use E.E.F. 21b - Blanket Basis Fleet E.E.F. 21d - Blanket Excess Value Cover E.E.F. 27 Legal Liability For Damage To Non-Owned Automobiles E.E.F. 27a Legal Liability For Damage To Non-Owned Automobiles E.E.F Excluding Named Person... 22
6 E.E.F. 32a - Snowmobile Underage Operator E.E.F. 32b - A.T.V. Underage Operator E.E.F. 32c - Motorcycle Underage Operator E.E.F Replacement Cost Coverage E.E.F. 44 Family Protection Coverage E.E.F. 46 Notice of Cancellation E.E.F Theft Coverage Limitation E.E.F Excess Value E.E.F Environmental Liability Limitation E.E.F. 111 Limited Waiver of Deductible E.E.F. 113 Approved Driver Warranty E.E.F. 114 Restoration Endorsement E.E.F. 115 Repair Endorsement PART 5 - STATUTORY CONDITIONS... 33
7 SASKATCHEWAN EXTENSION AUTOMOBILE POLICY THIS POLICY CONTAINS A PARTIAL PAYMENT OF LOSS CLAUSE INTRODUCTION On the understanding that the information you have given us in your application for this policy is correct, we provide the insurance described in this booklet, subject to the limits, terms, conditions, provisions and exclusions stated herein, in return for payment of the premium. This policy is a contract between you and us. It consists of this booklet and the Coverage Summary page. The Coverage Summary page shows your name and/or "organization", particulars of your "automobile(s)" as well as the coverages, deductibles, endorsements and policy limits that apply. This booklet describes the various coverages and sets out the terms, exclusions and conditions that apply to your insurance. It is divided into 5 parts as follows: Part 1 General Definitions: defines certain words and terms used throughout the policy. Part 2 Automobiles to Which this Policy Applies: tells what coverages apply to your own "automobile(s)" described in this policy and to certain "automobiles" you do not own but for which you are responsible. Part 3 General Provisions and Exclusions: sets out certain provisions and exclusions that apply to all policy coverages. Part 4 Coverages: describes the coverages that are available. There are four coverage sections, as follows: Section A (Third Party Liability) - describes insurance for your legal liability and the legal liability of certain other persons for bodily injury, death or property damage caused by an "automobile" you own or use. Section B (Accident Benefits) - describes benefits payable to certain persons who are injured or killed in an "automobile" accident. Section C (Loss or Damage to Insured Automobile) - describes the insurance for loss of or damage to your "automobile". Section D (Endorsements) consists of endorsements which apply if shown on the Coverage Summary page. An endorsement may extend or limit a particular coverage, or add new coverage. You may not have insurance for all the coverages described in Part 4. You are insured only for the coverages for which a premium is shown on the Coverage Summary page. All limits and amounts shown in this policy are in Canadian funds. Part 5 Statutory Conditions: lists the conditions required by The Saskatchewan Insurance Act for all "automobile" insurance policies written in Saskatchewan. In providing the insurance set out in this policy, we rely on the accuracy and truth of any information you give us at our request. Misrepresentation or violation of conditions of this policy renders claims invalid. The Saskatchewan Insurance Act includes the following provision: Where: a) an applicant for a contract: i) gives false particulars of the described "automobile" to be insured to the prejudice of the Insurer; or ii) knowingly misrepresents or fails to disclose in the application any fact required to be stated therein; 1
8 b) the Insured contravenes a term of the contract or commits a fraud; or c) the Insured willfully makes a false statement in respect of a claim under the contract; a claim by the Insured is invalid and the right of the Insured to recover indemnity is forfeited. PART 1 - GENERAL DEFINITIONS The following definitions apply to all parts of this policy unless the word or term is otherwise defined in the policy. Words and terms which are defined here, other than the words "you", "your", "we", "our" or "us", appear in quotation marks throughout the rest of this booklet, except in the Statutory Conditions. When used in this policy: "all terrain vehicle" means a vehicle defined as an all terrain vehicle in The All Terrain Vehicles Act (Saskatchewan). "insured" means a person insured by this policy, whether named as an insured or not. "licence insurance" means insurance as provided by The Automobile Accident Insurance Act (Saskatchewan) and the Regulations under that Act. "nuclear energy hazards" means radioactive, toxic, explosive or other hazardous properties of substances described in Regulations made under the Atomic Energy Control Act (Canada). "occupant" means the driver and any passenger while in, on or getting into or out of an "automobile" or other vehicle. "organization" means a corporation, unincorporated association or partnership. "policy period" means the period from the date and time this policy becomes effective until the date and time it expires. The "policy period" is shown on the Coverage Summary page. "private passenger/farm truck type" means a private passenger car, station wagon, private van, private truck, sport utility vehicle, motorhome or farm truck, excluding any "automobile" licenced for commercial use. "properly registered in Saskatchewan" means properly registered in accordance with all the requirements of The Vehicle Administration Act (Saskatchewan). "snowmobile" means a vehicle defined as a "snowmobile" in The Snowmobile Act (Saskatchewan). "spouse" means your legal husband or wife. It also means someone who has been living with you as your husband or wife for a period of at least two years or, if you are parents of a child, a period of at least one year. "we", "our", "us" or "Insurer" means Saskatchewan Mutual Insurance Company. "you", "your", or "Named Insured" means the person or persons named as Insured on the Coverage Summary page. For the definition of automobile", please refer to Part 2. PART 2 AUTOMOBILES TO WHICH THIS POLICY APPLIES In this Part we explain what is meant by the word "automobile" as used in the various coverages of this policy. Under Coverage Sections A (Third Party Liability), B (Accident Benefits) and C (Loss or Damage to Insured Automobile), "automobile" means: 1. the "described automobile". a) an "automobile", trailer, or semi-trailer specifically described on the Coverage Summary page, or within the description of insured "automobile(s)" set out in this policy. 2
9 Or, b) a trailer specifically described on the Coverage Summary page, while licenced with a perpetual plate. Coverage will apply only when a value for the trailer is indicated on the Coverage Summary page. Under Coverage Sections A (Third Party Liability), B (Accident Benefits), and C (Loss or Damage to Insured Automobile), "automobile" also means: 2. a "newly acquired automobile" This can be either of the following: a) a "replacement automobile": This is an "automobile" you acquire as owner (or as lessee, if the lease is more than 30 days) which has no other insurance except "licence insurance" and which replaces an "automobile" specifically described on the Coverage Summary page. The replacement "automobile" will have the same coverages as the "described automobile" it replaces. You must, however, tell us about the replacement "automobile" within 14 days from the day you take possession of it and pay us any additional premium we may require, otherwise, the insurance under this policy will not apply to it after the 14 days have expired. Or, b) an "additional automobile" This is an "automobile" you acquire as owner or as lessee, if the lease is for more than 30 days, which is in addition to and does not replace a "described automobile". All the following conditions must be met before the insurance under this policy will apply: i) you must tell us about this "automobile" within 14 days from the day you take possession of it and pay us the additional premium we require; ii) you must properly register the "automobile" in Saskatchewan; iii) you must register the vehicle in your own name; iv) all other "automobile(s)" you own must be insured by us under an "automobile" insurance policy for the coverage for which claim is made; v) you must have no other insurance on the "newly acquired (additional) automobile", other than "licence insurance"; and vi) you must not be in the business of selling "automobile(s)". The word "automobile(s)" as used in part (b) of this definition does not apply to an "all terrain vehicle" or a "snowmobile". Under Coverage Sections A (Third Party Liability) and B (Accident Benefits) only, "automobile" also means: 3a) a "temporary substitute automobile" This is an "automobile" not owned by you or by anyone living in your home, while temporarily used as a substitute for the "described automobile" while the "described automobile" is not in use by any person insured by this policy because of its breakdown, repair, servicing, loss, destruction or sale. [Please refer also to paragraph 2(c) of the Additional Agreements of Section C that describes insurance under Section C that applies to a "temporary substitute automobile".] b) a "rented automobile", meaning an "automobile" of the "private passenger/farm truck type" which has been rented to you for a period not exceeding one year and for which you are contractually liable under a written agreement. This does not apply to an "automobile" that is: i) owned, hired or leased by or registered in the name of your employer or the employer of anyone living in your home; 3
10 ii) used in connection with the business of selling, repairing, maintaining, servicing, storing or parking automobiles; or iii) used to carry people or goods for any kind of payment. If the "Named Insured" is an "organization", the words "you" and "your" in this definition of "rented automobile" shall apply to the employee or partner of the "Named Insured" for whose regular use the "described automobile is furnished, provided that neither such employee or partner nor anyone living in his or her home owns or leases an "automobile" of the "private passenger/farm truck type". And under Coverage Section A (Third Party Liability) only, "automobile" also means: 4. a "temporary non-owned automobile". a) If the "Named Insured" is an individual or husband and wife, "temporary non-owned automobile" means any other "automobile" of the "private passenger/farm truck type", other than the "described automobile", or a "rented automobile" while personally driven by or in the care, custody or control of you or your "spouse", if your "spouse" is living with you, provided that such other "automobile" is not: i) owned, leased or regularly or frequently used by you or by anyone living in your home; ii) owned, hired or leased by or registered in the name of your employer or an employer of anyone living in your home; iii) being driven by you or anyone living in your home in connection with the business of selling, repairing, maintaining, servicing, storing or parking "automobile(s)"; nor iv) being used to carry passengers or goods for any kind of payment. b) If the "Named Insured" is an "organization", a "temporary nonowned automobile" means any other "automobile" of the "private passenger/farm truck type", other than the "described automobile", or a "rented automobile" while personally driven by or in the care, custody or control of the employee or partner of the "Named Insured" for whose regular use the "described automobile" is furnished, or by his or her "spouse", if living with such employee or partner, provided that: i) neither such employee or partner or his or her "spouse" owns or leases an "automobile" of the "private passenger /farm truck type"; and ii) such other "automobile" is not owned, leased or regularly or frequently used by the "Named Insured" or by such employee or partner or by anyone living in the home of such employee or partner; and iii) such employee or partner or his or her "spouse" is not driving such other "automobile" in connection with the business of selling, repairing, maintaining, servicing, storing or parking "automobile(s)"; and iv) such other "automobile" is not being used to carry people or goods for any kind of payment. c) only if the "described automobile" is registered under The Vehicle Administration Act (Saskatchewan) as a Private Passenger Vehicle or Farm Vehicle and is of the "private passenger/farm truck type", "temporary non-owned automobile" also includes any other "automobile" of the "private passenger/farm truck type", other than the "described automobile" or a "rented automobile", while personally driven by or in the care, custody or control of any child living in your care and in your home, provided that such other "automobile" is not: 4
11 i) owned, leased or regularly or frequently used by you or by anyone living in your home; ii) owned, hired or leased by or registered in the name of your employer or an employer of anyone living in your home; iii) being driven in connection with the business of selling, repairing, maintaining, servicing, storing or parking "automobile(s)"; nor iv) being used to carry passengers or goods for any kind of payment. If the "Named Insured" is an "organization", the word "child" as used in this clause 4(c) refers to a child living in the care and in the home of the employee or partner of the "Named Insured" for whose regular use the "described automobile" is furnished, but only if: i) neither such employee or partner or anyone living in his or her home is the owner or lessee of an "automobile" of the "private passenger/farm truck type" and ii) such other "automobile" is not owned, leased or regularly or frequently used by the "Named Insured" or by the employee or partner of the "Named Insured" for whose regular use the "described automobile" is furnished, or anyone living in the home of such employee or partner. "Lease" used in definitions 3 and 4 refers to an "automobile" leased for a period of more than 30 days. And under Coverage Section A (Third Party Liability) only, the "automobile" also means: 5. "Trailer": any "trailer" used in connection with the "automobile". However, if the "automobile" with which the "trailer" is used is registered under The Vehicle Administration Act (Saskatchewan) as a Private Passenger Vehicle or a Farm Vehicle, this definition 5, does not apply to a trailer designed or used: i) to carry passengers, or ii) for demonstration purposes, or iii) to carry goods for a fee. PART 3 - GENERAL PROVISIONS AND EXCLUSIONS I. PROVISIONS: The following provisions apply to all coverages. 1. Territory: The insurance provided by this policy applies only while the "automobile" is in Canada or the United States of America or while on a ship sailing between the ports of these two countries. 2. Two or More Automobile(s): a) When two or more "described automobiles" are insured under this policy, each "automobile" is considered to be insured under a separate policy. With respect to the use or operation of an "automobile" you do not own, the limit of our liability will not exceed the highest limit applicable to any one "described automobile". b) If two or more "automobile(s)" are insured in your name as "described automobile(s)" under two or more policies, either with us or another insurance company, and loss or damage arises from the use or operation of an "automobile" you do not own, we will pay our share of the amount of the loss or damage for which you are insured. Our share under this policy will be the proportion that the highest limit applicable to any one "described automobile" in this policy bears to the total of the highest limits applicable under each policy. In no event will we pay more than this proportion of 5
12 the highest limit applicable to any "automobile" described in this or any other policy. c) A "motor vehicle" with one or more trailers or semi-trailers attached will be considered to be one "automobile" with respect to the limit(s) of liability under Coverage Section A (Third Party Liability) and Coverage Section B (Accident Benefits), and separate "automobile(s)" with respect to the limit(s) of liability, including any deductible amount, under Coverage Section C (Loss or Damage to Insured Automobile). II. EXCLUSIONS - Losses we do not insure: The following exclusions apply to all coverages. Other exclusions applying to each coverage section are set out in Part 4. l. Excluded Uses: Unless we expressly give coverage by endorsement, there is no insurance under this policy while the "automobile": a) is rented or leased to someone else, but if you let your employee use the "automobile" for your business purposes, we do not consider this to be renting or leasing; or b) is used to carry explosives or to carry radio-active material for research, education, development or industrial purposes, or for purposes incidental to any of these; or c) is being used as a taxicab, public bus or otherwise being used to carry passengers for which you receive any kind of payment. We do not consider the following to be carrying passengers for payment: i) a private car pool arrangement where members take turns using their "automobile(s)" or share driving expenses; ii) the occasional and infrequent use of the "automobile" for driving another person who shares the cost of the trip; iii) when you use the "automobile" for the transportation of your own employees; iv) when you use the "automobile" for the transportation of clients or customers or prospective clients or customers. Also, where the "automobile" is registered under The Vehicle Administration Act (Saskatchewan) as a Private Passenger Vehicle or a Farm Vehicle and is of the "private passenger/farm truck type", we do not consider the following to be carrying passengers for payment: v) when you use the "automobile" for the transportation of co-workers for your employer's business purposes; vi) when you use the "automobile" to drive others to or from their place of business or school, but only while you are also driving yourself to or from your place of business or school; vii) when the "automobile" is used for the transportation of teachers, students or others to or from school or events connected with a school program; or viii) when the "automobile" is used for the transportation of passengers in connection with activities of religious or voluntary service "organization(s)". 2. Consent of Owner: The insurance provided by this policy does not apply to any person, whether named as "Insured" or not, who is an "occupant" of any "automobile" which is being used without the consent of its owner. Where an "automobile" is owned by an "organization", consent given by a person for 6
13 whose regular use such "automobile" is provided will be considered as consent given by its owner. 3. Garage Personnel Excluded: We will not make any payment for any loss, damage, injury or death sustained by any "garage personnel" while using, operating or working on the "automobile" in the course of their business or while an "occupant" of the "automobile" in the course of their business, unless the person sustaining the loss, damage, injury or death is the owner of the "automobile". "Garage personnel" means people in the business of selling, repairing, maintaining, storing, servicing or parking "automobile(s)". PART 4 - COVERAGES SECTION A - THIRD PARTY LIABILITY We provide the insurance described in this section only if a premium is shown for Section A on the Coverage Summary page. I. INSURED PERSONS Under Section A, we insure: 1. the "Named Insured" and any other person who, with the "Named Insured's" consent, personally drives or operates any part of or who has care, custody or control of the "described automobile", a "newly acquired automobile", a "temporary substitute automobile", a "rented automobile", and 2. you, your "spouse" (if your "spouse" is living with you) and any child living in your care and in your home while personally driving or operating any part of or have care, custody or control of a "temporary non-owned automobile" as provided for in Part 2 of this policy. The persons referred to in 1. and 2. above are "Insured Persons". The words "you" and "your" as used in Section A refer to these "Insured Persons". If the "Named Insured" is an "organization" and the "described automobile" is of the "private passenger/farm truck type" and is furnished for the regular use of an employee or partner of the "Named Insured", permission given by such employee or partner to another person to drive a "rented automobile" shall be considered to be the "Named Insured s" consent, for the purposes of Paragraph 1 above. II. INSURING AGREEMENTS We agree to pay on your behalf those amounts which you become legally obligated to pay because of liability imposed by law for loss or damage arising from the ownership, use or operation of the "automobile" and resulting from bodily injury to or death of any person or damage to property, subject always to the following: 1. We will pay only that portion, if any, of the amounts you are legally obligated to pay which is in excess of the amount payable under the "licence insurance" for such bodily injury, death or property damage. 2. The limit shown for Section A on the Coverage Summary page is the most we will pay for bodily injury, death or property damage arising out of any one accident or occurrence regardless of the number of: a) "Insured Persons, b) claims made or actions brought, or c) persons or "organization(s)" making claims or bringing actions. 7
14 III. EXCLUSIONS: We will not make any payment under Section A for: 1. any liability imposed by any Workers' Compensation law or plan upon any person insured by this section; or 2. bodily injury to or death of any of your employees while they are operating or repairing the "automobile"; or 3. loss or damage to property carried in or on the "automobile" or to any property you own or rent or have in your care, custody or control; or 4. bodily injury, death or property damage arising out of the ownership, use or operation of the "described automobile" or a "newly acquired automobile" if, at the time of the occurrence causing the bodily injury, death or damage, such "automobile" is not "properly registered in Saskatchewan" or does not have valid "licence insurance", unless you establish that for the whole time during the "policy period" while such "automobile" was not so registered or was without valid "licence insurance", it was in continuous storage and not used. Nor will we make any payment under Section A for: 5. bodily injury, death or property damage caused intentionally by or at the direction of any person insured by this policy; or 6. bodily injury, death or property damage caused by "nuclear energy hazards", except as provided for by The Saskatchewan Insurance Act; or 7. bodily injury or death for which insurance is payable under Part VIII of The Automobile Accident Insurance Act (Saskatchewan); or 8. bodily injury, death or property damage arising from the ownership, use or operation of any machinery or apparatus, including its equipment, mounted on or attached to the "automobile" while at the site where it is being used, but this exclusion does not apply to an "automobile" registered under The Vehicle Administration Act (Saskatchewan) as a Private Passenger Vehicle or a Farm Vehicle. Please refer also to the General Provisions and Exclusions (Part 3) and the Statutory Conditions (Part 5) of this policy. IV. ADDITIONAL AGREEMENTS We will defend you against any suit which makes claims against you for which you are insured under Section A of this policy and which alleges bodily injury or property damage and seeks damages, even if it is groundless, false or fraudulent. We agree to investigate, negotiate and settle any such claim or suit as we consider appropriate. In addition to any amount for which we may be liable under the Insuring Agreements of Section A, we will pay: 1. all expenses we incur in such investigation and defense; 2. all costs charged against you in any suit insured under Section A; 3. any interest occurring after judgment on that part of the judgment which is within the limit of insurance payable under Section A; and 4. your reasonable costs for giving first aid to others at the time of the accident. If an accident giving rise to a claim under Section A occurs in a province or territory of Canada where the minimum limit(s) required by law is higher than the limit insured under Section A of this policy, we will increase the Section A limit of insurance to meet the minimum limit(s) required by the law of such province or territory. We will not set up any defence to a claim insured under Section A that might not be set up if the policy were a motor vehicle liability 8
15 policy issued in any province or territory in Canada where the accident occurred. V. YOUR AGREEMENT By accepting this insurance, you agree: 1. to appoint us as your irrevocable attorney to appear on your behalf and defend in any province or territory of Canada or any state of the United States of America any action brought against you arising out of the ownership, use or operation of the "automobile"; and 2. to repay us the amount we have been required to pay because of a law relating to "automobile" insurance and which we would not otherwise have been liable to pay under this policy. SECTION B ACCIDENT BENEFITS We provide the insurance described in this section only if a premium is shown for Section B on the Coverage Summary page. I. DEFINITIONS: Words or terms defined here will appear in quotation marks throughout Section B. As used in Section B: "Act" means The Automobile Accident Insurance Act (Saskatchewan) and regulations thereunder as may be amended from time to time. "Insured Person" means: 1.a) any person insured by Part II or Part VIII of the "Act" while an "occupant" of the "described automobile", a "newly acquired automobile" or a "temporary substitute automobile"; b) any person insured by Part II or Part VIII of the "Act" while an "occupant" of a "rented automobile" being driven by you or by someone else with your permission; 2. you, your "spouse", if your "spouse" is living with you, and any dependent relative of either who is a Saskatchewan resident and living in your care, while an "occupant" of any other "automobile" of the "private passenger/farm truck type", provided that such person is not engaged in the business of selling, repairing, maintaining, servicing, storing or parking "automobile(s)" at the time of the accident for which claim is made under this section, and also provided that such other "automobile" is not: a) owned, hired, leased or regularly used by you or by anyone living in your home; b) owned, hired or leased by your employer or by the employer of anyone living in your home; nor c) used to carry people or goods for any kind of payment; 3. any other person insured by Part II or Part VIII of the "Act" while an "occupant" of an "automobile" of the "private passenger/farm truck type" that you do not own or lease (meaning leased from another for a period in excess of 30 days) but which you are using, with permission, provided that: a) you are not an "organization"; b) the "described automobile" is registered under The Vehicle Administration Act (Saskatchewan) as a Private Passenger Vehicle or a Farm Vehicle and is of the "private passenger/ farm truck type"; and c) the "automobile" you are using is not: i) owned, leased or regularly used by you or by anyone living in your home; 9
16 ii) owned, hired or leased by your employer or by the employer of anyone living in your home; iii) being used in the business of selling, repairing, maintaining, servicing, storing or parking "automobile(s)"; or iv) used to carry people or goods for any kind of payment; 4. you, your "spouse", if your "spouse" is living with you, and any dependent relative of either who is a Saskatchewan resident and living in your care, if hit by an "automobile" while not the "occupant" of an "automobile" or railway rolling stock that runs on rails, provided that: a) the "automobile" that hits such person is not rented by that person's employer or by the employer of anyone living in that person's home; and b) such person is not engaged in the business of selling, repairing, maintaining, servicing, storing or parking "automobile(s)" when hit by an "automobile". If this policy has been endorsed to grant permission to rent or lease the "described automobile" for more than 30 days, any reference to you and your in this definition of "Insured Person" will refer to the person named as the lessee on the Coverage Summary page, provided that the lessee is an individual (not an "organization") or two "spouses" in the same household. "net income" means "net income" as defined in Part VIII of the "Act", but without taking into account the "maximum yearly insurable earnings". "surviving spouse" means the surviving "spouse" of a deceased "Insured Person", to whom death benefits are payable under Part II or Part VIII of the "Act". "weekly net income" means weekly "net income" calculated in the same manner as prescribed in the "Act" for calculating "weekly net income" to determine death benefits payable under Part II of the "Act", subject to the "maximum yearly employment income" as provided for in the "Act". "maximum yearly insurable earnings" and "maximum yearly employment income" have the same meaning as set out in the "Act". II. INSURING AGREEMENTS If a premium is shown for Section B on the Coverage Summary page, we agree to pay the benefits described in this section to, or on behalf of, each "Insured Person" who sustains bodily injury or death directly and independently of all other causes by an accident arising out of the use or operation of an "automobile". III. INSURED BENEFITS A. TORT COVERAGE EXTENSION Applicable where benefits are payable to or on behalf of an "Insured Person" pursuant to Part II of the "Act": 1. Disability Benefits When an "Insured Person" is paid a Weekly Benefit for disability under Part II of the "Act", we will pay the "Insured Person" a Weekly Benefit equal to 25% of the Weekly Benefit paid under the "Act". We will pay this benefit only during such time as the "Insured Person" is being paid Weekly Benefits for disability under Part II of the "Act". 10
17 2. Death Benefits a) When a Weekly Death Benefit is paid under Part II of the "Act" to a "surviving spouse", we will pay the "surviving spouse" the difference, if any, between the maximum amount of the Weekly Death Benefit paid under the "Act" and 50% of the applicable "weekly net income". Where, under Part II of the "Act", a Weekly Death Benefit is paid to a dependant child on the same basis as to a "surviving spouse", we will pay weekly death benefits to the dependent child on the same basis as we would to a "surviving spouse", as set out above. We are not liable for any payment unless the Weekly Death Benefit payable under the "Act" is less than 50% of the applicable "weekly net income". b) When a Weekly Death Benefit is payable under Part II of the "Act" to a "surviving spouse" for a child who is a dependent of the "surviving spouse" and who was a dependent of the deceased "Insured Person", we will pay, for the benefit of such dependent child, the difference, if any, between the maximum amount of the Weekly Death Benefit paid under the "Act" for the dependent child and 5% of the "weekly net income" that would apply in the particular circumstances if the "maximum yearly employment income" were not taken into account. We are not liable for any payment unless the Weekly Death Benefit payable under the "Act" is less than 5% of the "weekly net income" that would apply if the "maximum yearly employment income" were not taken into account. We will pay the death benefits described in (a) and (b) above only during such time as the "surviving spouse" or dependent child, as the case may be, is entitled to receive Weekly Death Benefit payments under Part II of the "Act". 3. Funeral Expenses In the case of the death of an "Insured Person", we will pay an amount of up to 50% of the amount payable under Part II the "Act" for the "Insured Person's" funeral. We will pay only to the extent the actual and reasonable funeral expenses incurred exceed the limit provided for such expense under Part II of the "Act". B. NO FAULT COVERAGE EXTENSION Applicable where benefits are payable to or on behalf of an "Insured Person" pursuant to Part VIII of the "Act": 1. Income Replacement When an Income Replacement Benefit is paid under Part VIII of the "Act" to an "Insured Person", we will pay the amount necessary to cover the difference, if any, between the maximum amount of the Income Replacement Benefit payable under Part VIII of the "Act" and the "Insured Person's" loss of "net income". We will pay this Benefit only during such time as the "Insured Person" is entitled to receive an Income Replacement Benefit under Part VIII of the "Act". We will not pay for any loss of "net income" that occurs during the first seven days from the date of the accident. The "Insured Person's" loss of "net income" must exceed the amount payable under Part VIII of the "Act" before we are liable for any payment. 11
18 2. Death Benefits a) When a Weekly Death Benefit is paid under Part VIII of the "Act" to a "surviving spouse", we will pay the "surviving spouse" the difference, if any, between the maximum amount of the Weekly Death Benefit payable under Part VIII of the "Act" and 50% of the deceased's weekly "net income". We will pay this Death Benefit only during such time as the "surviving spouse" is entitled to receive Weekly Death Benefit payments under Part VIII of the "Act". We are not liable for any payment unless the Weekly Death Benefit payable under the "Act" is less than 50% of the deceased's weekly "net income". b) When a Weekly Death Benefit is paid under Part VIII of the "Act" to a "surviving spouse" for a child who is a dependent of the "surviving spouse" and who was a dependent of the deceased "Insured Person", we will pay, for the benefit if such dependent child, the difference, if any, between the maximum amount of the Weekly Death Benefit payable for the dependent child under Part VIII of the "Act" and 5% of the deceased's weekly "net income". We will pay this Death Benefit only during such time as the dependent child is entitled to receive payment for Death Benefits under Part VIII of the "Act". We are not liable for any payment unless the Weekly Death Benefit payable under the "Act" is less than 5% of the deceased's weekly "net income". c) Where Part VIII of the "Act" pays Weekly Death Benefits to a dependent child on the same basis as to a surviving "spouse", we will pay Death Benefits to the dependant child on the same basis that we would pay a "surviving spouse", as set out in 2(a) above. 3. Education Benefits When an Education Benefit is paid to a "surviving spouse" under Part VIII of the "Act", we will pay an amount of up to 50% of the maximum Education Benefit payable under the "Act". We will pay such benefit only to the extent that the actual and reasonable costs incurred for the education of the "surviving spouse" exceed the maximum amount payable for this benefit under the "Act". 4. Funeral Expenses In the case of the death of an "Insured Person", we will pay an amount of up to 50% of the amount payable under Part VIII of the "Act" for the "Insured Person's" funeral. We will pay only to the extent that the actual and reasonable funeral expenses incurred exceed the limit provided for such expense under Part VIII of the "Act". IV. EXCLUSIONS 1. We will not make any payment under Section B for bodily injury to or death of any person: a) resulting from deliberate self-injury, suicide or attempted suicide; or b) who is entitled to receive benefits under a Workers' Compensation plan or law; or c) if the injury or death is caused by sickness or disease, unless the claimant can establish that the sickness or disease was a direct result of an "automobile" accident for which insurance is provided under this section; or 12
19 d) caused directly or indirectly by "nuclear energy hazards", except as provided for by The Saskatchewan Insurance Act; or e) who, at the time of the accident causing the bodily injury or death: i) is an "occupant" of an "automobile" which is being used for any prohibited or unlawful trade or transportation or in any race or speed test, or ii) is operating an "automobile" while under the influence of or impaired by alcohol or drugs or driving with a blood-alcohol ratio that exceeds the legal limit (conviction for one of these offenses will be considered conclusive proof), or iii) is an "occupant" of a motorcycle, "snowmobile" or "all terrain vehicle". 2. We will not make any payment under Section B to any person who is not entitled to receive payment under Part II or Part VIII of the "Act" for the same type of benefit and for the same injury or death as that for which the claim is being made under this policy. 3. We will not make any payment under Section B for any injury or death caused directly or indirectly by war or warlike acts such as civil war, rebellion, revolution or insurrection. V. LIMITATION OF LIABILITY 1. Other Insurance Our liability under Section B Accident Benefits- shall be excess insurance to The Automobile Accident Insurance Act (Saskatchewan) and to any other valid or collectible insurance or plan that provides similar coverage as that provided under Section B of Part 4 of this policy. It is further understood and agreed that we shall not be liable for payment of any deductible or waiting period portion specified in any of the aforementioned "Act" or plans. 2. Maximum Amount Payable We will not pay more than the limit shown for Section B on the Coverage Summary page for any one accident or occurrence, regardless of the number of claims made or number of "Insured Persons". VI. CLAIM SETTLEMENTS 1. Notice and Proof of Claim The "Insured Person", or another person acting for the "Insured Person", must do the following things to claim under Section B: a) tell us about the claim by registered mail or in person. You must do this within 30 days after you make application for a Benefit under Part II or Part VIII of the "Act", but not later than two years from the date of the accident on which the claim is based; b) give us reasonable proof of the claim within 90 days after you make application for a Benefit under Part II or Part VIII the "Act", or such later date that we may agree to; and c) if we ask, provide us with a physician's statement giving information about the injuries arising from the accident and the expected length of the disability. 2. Medical Reports The "Insured Person" making the claim must agree to be examined by a physician of our choice whenever we require this to be done. In case of the death of an "Insured Person", we have 13
20 the right to have an autopsy performed within the limits of the law. Where we require these to be done, we agree: a) to pay the expenses of the "Insured Person" to attend any examination we may reasonably require; b) to pay for any autopsy that we require; c) to provide to the "Insured Person" or the "Insured Person's" representative, upon request, a copy of any examination we obtain; and d) to provide to a person making a claim under this Section or such person's representative, upon request, a copy of any autopsy report obtained by us relating to the claim. 3. Release As a condition of payment under Section B, we may require a release to be signed by the "Insured Person" or another person to whom the claim is payable, releasing you and us from any further payment. 4. When Claims are Payable a) We will make valid payments under Section B within 60 days after we receive proof of the claim. b) No one may bring legal action against us to recover the amount of a claim unless the requirements of "Notice and Proof of Claim" and "Medical Reports" as set out above are complied with and the amount of loss has been established. c) In respect to claims under Section B only, any legal action against us must be commenced within two years from the date on which the cause of action arose, and no later. Please refer also to the General Provisions and Exclusions (Part 3) and the Statutory Conditions (Part 5) of this policy. SECTION C - LOSS OR DAMAGE TO INSURED AUTOMOBILE I. INSURING AGREEMENTS We agree to insure you against direct and accidental loss of or damage to the "automobile", including its equipment, but only with respect to the following subsections of Section C for which a premium is shown on the Coverage Summary page. Subsection 1 - All perils - all perils of direct and accidental loss or damage, except as provided in Subsection 5. Subsection 2 - Collision or Upset - direct and accidental loss or damage caused by collision with another object or by upset. Subsection 3 - Comprehensive - all perils of direct and accidental loss or damage other than by collision with another object or by upset, and except as provided by Subsection 5 Road Hazard Glass. The words "another object" as used in this subsection include (a) a vehicle to which the "automobile" is attached and (b) the surface of the ground and any object on or in the ground. Except as provided by Subsection 5, loss or damage caused by any of the perils named in Subsection 4, as well as by missiles, falling or flying objects, malicious mischief, or vandalism, is considered loss or damage caused by perils for which insurance is provided under this Subsection 3. Subsection 4 - Specified Perils - direct and accidental loss or damage caused by fire, lightning, theft or attempted theft, windstorm, earthquake, hail, explosion, riot or civil commotion, falling or forced landing of aircraft or their parts, rising water, or the stranding, sinking, burning, derailment or collision of any conveyance in or upon which the "automobile" is being transported on land or water. 14