AZ Regulatory Bulletin 2003-03: Revision of Form for Selection of Limits or Rejection of Uninsured Motorist or Underinsured Motorist Coverage

STATE OF ARIZONA DEPARTMENT OF INSURANCE JANET NAPOLITANO 2910 NORTH 44th STREET, 2ND FLOOR CHARLES R. COHEN Governor PHOENIX, ARIZONA 85018-7256 Director REGULATORY BULLETIN 2003-031 TO: All Insurance Industry Representatives, Insurance Trade Associations, Insurers That Sell Motor Vehicle Liability Insurance, And Interested Parties FROM: Charles R. Cohen Director of Insurance DATE: March 24, 2003 RE: Revision of Form for Selection of Limits or Rejection of Uninsured Motorist or Underinsured Motorist Coverage This regulatory bulletin amends Circular Letter 1998-5, dated August 11, 1998. Circular letter 1998-5 addressed Laws 1998, Ch. 288 (SB1273, effective August 21, 1998), a bill that amended A.R.S. § 20-259.01 and reinstated the requirement that every insurer writing automobile liability or motor vehicle liability polices in Arizona make available and offer, by written notice, uninsured motorist and underinsured motorist coverage, for all persons insured under the policy in limits not less than the policy’s liability limits for bodily injury or death. A.R.S. § 20-259.01, as amended by SB1273, further requires an insurer to provide an applicant with a selection form containing written notice and an offer of uninsured and underinsured motorist coverage. The Department of Insurance must approve the offer form used by an insurer. With Circular Letter 1998-5, the Department provided forms, in English and Spanish, that insurers could use to satisfy the requirements of A.R.S. § 20-259.01. Recently, the Department has been made aware that discrepancies exist between the English and Spanish versions of the forms previously provided. Therefore, the purpose of this Bulletin is to correct the discrepancies and to provide revised forms. 1 This Substantive Policy Statement is advisory only. A Substantive Policy Statement does not include internal procedural documents that only affect the internal procedures of the Agency, and does not impose additional requirements or penalties on regulated parties or include confidential information or rules made in accordance with the Arizona Administrative Procedure Act. If you believe that this Substantive Policy Statement does impose additional requirements or penalties on regulated parties, you may petition the agency under Arizona Revised Statutes Section 41-1033 for a review of the Statement. Regulatory Bulletin 2003-03 March 24, 2003 Page 2 Those insurers electing to use the revised forms must complete the blank provided for the name of their insurance company on the attached forms and file them with the Department. The Department will consider for approval forms submitted by insurers which contain essentially the same information as the attached forms and which also include the insurer’s name. Please direct any questions regarding this bulletin to Deloris Williamson, Assistant Director for the Division of Rates and Regulations, 602-912-8466. COMPANY NAME: _______________________________________ UNINSURED AND UNDERINSURED MOTORIST COVERAGE SELECTION FORM DO NOT SIGN UNTIL YOU READ You have a legal right to purchase both Uninsured and Underinsured Motorist coverages with the proposed automobile liability policy. THESE COVERAGES PROTECT YOU, YOUR FAMILY AND YOUR PASSENGERS. LIABILITY COVERAGE DOES NOT IN MOST CASES. Uninsured motorist insurance provides protection for bodily injuries caused by a negligent motorist who has no insurance. Underinsured motorist coverage provides protection if the negligent motorist does not have enough liability insurance to pay for the injuries caused. For a more detailed explanation of these coverages, refer to your policy. This policy will provide Uninsured/Underinsured coverage in the same amount as the policy's Bodily Injury Liability Limit, unless you select a lower amount or no coverage, as stated in this notice. You have a right to purchase both Uninsured Motorist coverage and Underinsured Motorist coverage in any amount from $30,000 single limit (or $15,000/$30,000 split limits) up to your policy's liability limit, or you may reject the coverage entirely. Neither limit may exceed your liability coverage limits for Bodily Injury. Your Bodily Injury Limit on the policy: ________________________ Options available for Uninsured and Underinsured Motorist coverages: Uninsured Motorist Liability Underinsured Motorist Liability Accept (Initial) Reject (Initial) Limit Of Liability Premium Accept (Initial) Reject (Initial) Limit Of Liability Premium ________ ________ $_______ $_________ ________ _________ $_________ $_______ ________ ________ $_______ $_________ ________ _________ $_________ $_______ I do not wish to purchase UNinsured motorist coverage: _________(initial) I do not wish to purchase UNDERinsured motorist coverage: _________ (initial) I understand and agree that selection of any of the above options applies to my liability insurance policy and future renewals or replacements of such policy which are issued at the same Bodily Injury Liability Limits. If I decide to select another option at some future time, I must let the Company know in writing. DO NOT SIGN UNTIL YOU READ Signed:________________________________________________ Date:_________________________ (Named Insured) Attached to application dated: ______________________ original - insurance company copy - insured/applicant copy - agent/broker file EDITION DATE 7/98 Edition: (1/03) FORMA DE SELECCIÓN DE SEGURO DE COBERTURA AUTOMOVILISTICA CONTRA CONDUCTORES NO ASEGURADOS Y SUBASEGURADOS NO FIRME ESTA FORMA HASTA QUE HAYA LEÍDO TODO CUIDADOSAMENTE Dentro de la póliza automovilística que se le propone aquí, usted tiene el derecho legal de comprar seguro que lo cubre contra conductores no asegurados o, subasegurados. LAS PÓLIZAS QUE CONTIENEN PROTECCIÓNES CONTRA CONDUCTORES NO ASEGURADOS O SUBASEGUADOS LO PROTEGEN A USTED, A SU FAMILIA Y A SUS PASAJEROS. EN LA MAYORÍA DE LOS CASOS LA COBERTURA DE RESPONSABILIDAD ÚNICAMENTE NO ES SUFICIENTE. Pólizas de seguro que contienen protección contra conductores no asegurados le disponen protección para Daños Corporales causados por un conductor negligente no asegurado. Pólizas de seguro que contienen protección contra conductores subasegurados le disponen protección si la póliza del el conductor negligente no contiene cobertura suficiente de responsabilidad para pagar los Daños Corporales que se causen. Para mayor información y detalles de estos tipos de coberturas, consulte su póliza. Esta póliza le proporciona seguro de protección contra conductores no asegurados o subasegurados en la misma cantidad del límite de responsabilidad de Daños Coporales notados dentro la póliza, a menos que usted elija una cantidad menor, o ninguna cobertura como está declarado en este aviso. Usted tiene el derecho de comprar ambas coberturas de protección contra conductores no asegurados y subasegurados en cualquier cantidad de protección empezando con $30,000 por límite sencillo, (o en cantidades de $15,000/$30,000 en límites partidos) hasta satisfacer los límites de responsabilidad de la póliza, o puede rechazar las coberturas por completo. Ninguno de esos límites puede sobrepasar su cobertura de responsabilidad de Daños Corporales. El límite de Daños Corporales de esta póliza es: ___________________________. Opciones disponibles de responsabilidad automovilística contra conductores no asegurados y subasegurados. Limitaciones de Responsabilidad Contra Personas No Asegurados Limitaciones de Responsabilidad Contra Personas Subasgurados Acepto Rechazo Límites Costo Acepto Rechazo Límites Costo ________ ________ $_______ $________ ________ ________ $_______ $________ ________ ________ $_______ $________ ________ ________ $_______ $________ No deseo comprar cobertura automovilística contra conductores no asegurados: ________ (iniciales) No deseo comprar cobertura automovilística contra conductores subasegurados: ________ (iniciales) Yo entiendo y estoy de acuerdo que la selección de cualquiera de las opciones ofrecidas se aplicarán a mi póliza de responsabilidad. También entiendo y estoy de acuerdo que renovaciones o reemplazos en el futuro de dicha póliza serán emitidos a los mismos límites de responabilidad de Daños Corporales. Si decido elejír otra opción en algún tiempo en el futuro, debo notificar a la compañía de seguros por forma escrita. NO FIRME ESTA FORMA HASTA QUE HAYA LEÍDO TODO CUIDADOSAMENTE Firma:__________________________________________ Fecha_______________________ (Nombre De Asegurado) Adjunto a esta solicitud en la fecha de: _________________ Original – de Seguros Copia – Asegurado/ Solicitante Copia – Agente de Seguros Edición 1/03 Edition: (1/03) NOMBRE DE COMPAÑÍA: _________________________________________________