20-1361. Insurance with other insurers;
provision of service or expense incurred basis
A. 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."
B. If the policy provision set forth in subsection A of this section is included in
a policy which also contains the policy provision set out in section 20-1362 there shall
be added to the caption of the provision the phrase "--expense incurred benefits." The
insurer may, at its option, include in this provision a definition of "other valid
coverage," approved as to form by the director 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 director. In the absence of such
definition the 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
the policy provision with respect to any insured, any amount of benefit provided for the
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 the policy provision no third party liability coverage shall be
included as "other valid coverage."
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