Sample Auto Deductible Reimbursement Policy

Virginia Surety Company, Inc.
175 W. Jackson Boulevard
Chicago, Illinois 60604

All Benefits are approved for the following States: CO, TX, SC, KY, NC, CA, LA, MI, MN, OH, VA, NE, KS, WI and NV. More States coming soon!

$500 Auto Deductible Reimbursement Insurance Policy*
This program and policy is included in your membership package as well as all the other benefits.

A. DEFINITIONS

Throughout this document, You and Your refer to the Policyholder indicated on the Declaration Page. We, Us, Our, and VSC refer to Virginia Surety Company, Inc. In addition, when in bold certain words and phrases are defined as follows:

Administrator means TWG Innovative Solutions. You may contact the Administrator if You have questions regarding this coverage or would like to make a claim. The Administrator can be reached by phone at 1-800-456-8894.

Auto Policy means the private passenger automobile insurance policy (or similar insurance policy) issued to You or Your Family Member by a licensed automobile insurance company.

Covered Auto Deductible means the amount of the deductible (including but not limited to, uninsured or underinsured deductible) in Your or Your Family Member’s Auto Policy.

Declaration Page means the attached document listing the named insured, benefit(s), term, and limit.

Domestic Partner means an unmarried person in an intimate, committed relationship of mutual caring. That person must share responsibility for basic living expenses with You. That person must also be at least eighteen (18) years old and not currently married or committed to another person.

Family Member means Your spouse or Domestic Partner. Family Member includes unmarried children (including children who You are a legal guardian) under nineteen (19) years of age or children with a documented disability. Family Member also includes unmarried children under twenty-three (23) years of age if a full-time student at an accredited college or university. Any Family Member who does not reside at Your home is not eligible for coverage. Coverage for Your spouse will continue during the period of separation until the completion of the divorce. Coverage for Your Family Member’s only applies if they are covered under Your Auto Policy.

Insured Vehicle means any vehicle(s) owned, rented, or leased by You or Your Family Member that is designed and licensed for use on public roads, not used commercially, and is insured under Your or Your Family Member’s Auto Policy. Insured Vehicles may include: a.) private passenger vehicles; b.) station wagons; c.) Jeeps/SUVs; and d.) pick-ups. (Non-eligible vehicles: motor homes, mobile homes, RVs, campers, trailers, ATVs, motorcycles, or vehicles designed to seat more than eight (8) passengers.)

Loss means an event for which Your or Your Family Member’s auto insurance company has approved and paid a claim which exceeds the Covered Auto Deductible for a collision or comprehensive claim as described by the Auto Policy.

Policy means this document, which describes the terms, conditions, and exclusions of this coverage. The Policy sets forth the entire agreement between You and Us. Representations or promises made by any person that are not contained in this document are not a part of this coverage.


B. INSURING AGREEMENT

If You or Your Family Member suffer a Loss which is covered by Your or Your Family Member Auto Policy, You may be entitled to reimbursement of the Covered Auto Deductible. Reimbursement will be equal to the Covered Auto Deductible on the Auto Policy, up to the limit per Loss indicated on the Declaration Page attached to this Policy.

C. EXCLUSIONS

We shall not be responsible for the following:
• If the claim under Your or Your Family Member’s Auto Policy has been denied.
• If Your or Your Family Member’s auto insurance company has waived the Covered Auto Deductible.
• If the claim on Your or Your Family Member’s Auto Policy does not exceed the Covered Auto Deductible.
• If the vehicle is used for commercial purposes or hire.
• If the vehicle is a commercial vehicle.

D. HOW TO FILE A CLAIM

Call the Administrator at 1-800-456-8894 to request a claim form. You must report the claim within twelve (12) months of the Loss.

The following required items, must be sent to the Administrator at TWGIS, PO Box 87719, Chicago, IL 60680.
1. The fully completed claim form.
2. A copy of the Auto Policy, showing Your or Your Family Member’s vehicle is insured.
3. A copy of the Insurance Company declaration page and the claim settlement.
4. Any other documents the Administrator may reasonably request to validate a claim.

Notice of Claim: We shall, not later than the fifteenth (15th) day after receipt of such notice of a claim:
1. Acknowledge receipt of the claim;
2. Commence any investigation of the claim; and
3. Request from You or Your Family Member all items, statements, and forms that We reasonably believe, at that time, will be required. Additional requests may be made if, during the investigation of the claim such additional information is necessary.

If the acknowledgement of the claim is not made in writing, We will make a record of the date and content of the acknowledgement.

We will notify You in writing of the acceptance or rejection of the claim not later than the fifteenth (15th) business day (which is other than a Saturday, Sunday or holiday) after the date We receive all items, statements and forms required in order to secure final proof of loss. If We reject the claim, We will inform You of the reasons for the rejection. If We are unable to accept or reject the claim within fifteen (15) business days after We receive all items, statements and forms required, We will notify You within such fifteen (15) business days. The notice provided must give the reasons that We need additional time. Not later than the forty fifth (45th) day after the date We notify You of the need for additional time to investigate a claim, We will accept or reject the claim.

Except as otherwise provided, if We delay payment of a claim following its receipt of all items, statements and forms reasonably requested and required for more than sixty (60) days, We will pay, in addition to the amount of the claim eighteen percent (18%) per annum of the amount of such claim as damages, together with reasonable attorney fees. If suit is filed, such attorney fees shall be taxed as part of the costs in the case.

Payment of Claim: If We notify You that We will pay a claim or part of a claim, We will pay the claim not later than the fifth (5th) business day after the notice has been made. If payment of the claim or part of the claim is conditioned on the performance of an act by You, We will pay the claim not later than the fifth (5th) business day after the date the act is performed.

Benefits payable under this Policy for any Loss will be paid upon receipt of proof of such loss and all required information necessary to support the claim.

All benefits will be payable to You or Your Family Member or, in the case of death, to Your or Your Family Member’s estate. No person or entity other than You or Your Family Member shall have any legal or equitable right, remedy or claim of insurance proceeds or damages under or arising out of this coverage.

E. CANCELLATION AND NON-RENEWAL

Coverage can be:
a. Cancelled by You at any time by sending written notification to the Administrator. If You cancel Your coverage, We will refund any unearned premium.
b. Cancelled by Us or Our designated representative for the following reasons:
i. Non payment of premium;
ii. Misrepresentation and Fraud (see below);
iii. The Department of Insurance determines that the Policy would result in a violation of their law.
If We cancel coverage, We will send You written notification and an explanation at least ten (10) days in advance of cancellation for non-payment of premium and at least thirty (30) days in advance of cancellation for any other reason.
iv. We will not cancel or refuse to renew coverage based solely on You being elected as an official in Texas.
c. Non-renewed by Us. We will send You written notification and an explanation at least thirty (30) days in advance of the expiration of coverage.

F. GENERAL PROVISIONS

Conformity of Statute: Any parts of this Policy that are in conflict with the state laws where this Policy is issued are automatically changed to conform to the minimum requirements of such laws.

Dispute Resolution – Arbitration: If there is an unresolved dispute between You and VSC concerning this Policy You and Us can enter into binding arbitration. Under this Arbitration provision, You give up your right to resolve any dispute arising from this Policy by a judge and/or a jury. You also agree not to participate as a class representative or class member in any class action litigation, any class arbitration or any consolidation of individual arbitrations. In arbitration, a group of three arbitrators (each of whom is an independent, neutral third party) will give a decision after hearing Your and Our positions. The decision of a majority of the arbitrators will determine the outcome of the arbitration and the decision of the arbitrators shall be final and binding and cannot be reviewed or changed by, or appealed to, a court of law.

To start arbitration, either You or VSC must make a written demand to the other party for arbitration. This demand must be made within two (2) years of the earlier of the date the loss occurred or the dispute arose. You and VSC will each separately select an arbitrator. The two (2) arbitrators will select a third arbitrator called an "umpire." You will pay the expense of the arbitrator You selected and We will pay the expense of the arbitrator We selected. The expense of the umpire will be shared equally by You and VSC. Arbitration will take place in Texas unless You and VSC both mutually agree on an alternate. The rules of the American Arbitration Association (www.adr.org) will apply to any arbitration under this Policy.

Legal Actions. No action at law or in equity shall be brought to recover under this Policy prior to the expiration of sixty (60) days after proof of Loss has been furnished in accordance with the requirements of this coverage.

Misrepresentation and Fraud. Coverage for You or Your Family Member may be cancelled if, whether before or after a Loss, You or Your Family Member have concealed or misrepresented any material fact or circumstance concerning this coverage or the subject thereof, or the interest of You or Your Family Member therein. Coverage may also be cancelled if You or Your Family Member commit fraud or false swearing in connection with any of the above.

ADR-IND-TX (6.08)
ADR-MEMF-COI (9.08)

* Membership is valid for Texas, Colorado, California, Nevada, South Carolina, Virginia, Ohio, Kansas, Michigan, Minnesota, Kentucky, Wisconsin, Nebraska, North Carolina and Louisiana. More states coming soon!

Your Membership Package includes your unique Member ID Card, insurance policies, and contact information for Logo Design, Keylogging, and Travel Programs. This benefits package is delivered by email or by USPS mail for those members lacking Internet connectivity. *Exclusions and limitations apply. See sample terms and conditions for details. Coverage may vary by state. Insurance product coverages underwritten by Virginia Surety Company, Inc., 175 W. Jackson Boulevard, Chicago, IL, 60604, ph: 800-456-8894, are administered by TWGIS via Form Numbers ADR-IND-TX (6.08), HB-IND-TX (6.08), ID-IND-TX (7.08), S002-TX VSC (01/08), and DDN-TX (05.11) coverage for TX. Form Numbers HB-DEC (9.08), HB-U-IND (9.08), END-IND-F (9.08) and END-IND-KS (6.10) coverage in Kansas. Form Numbers HB-DEC (9.08), HB-U-IND (9.08), END-IND-OH (9.08), ADR-DEC (9.08), ADR-IND-F (9.08), ID-DEC (9.08) and ID-IND-I (9.08) coverage in Ohio. Coverage for TX. Form numbers ADR-MEMF-COI (9.08), HB-MEM-U-COI (9.08), END-MI (5.11), END-MN (12.09) END-KY (9.08), NOT-KY (9.08), END-NC (9.08), END-ADR-NC (9.08) and ID-MEMF-COI (9.08) for group states CA, CO, NV, SC, VA, MI, MN, KY, NE, WI, NC and LA. Coverage available for Texas, Colorado, California, Nevada, South Carolina, Virginia, Ohio, Kansas, Michigan, Minnesota, Kentucky, Wisconsin, Nebraska, North Carolina and Louisiana.

Coverage offered by Southwest Business Insurance Agency, Inc. Texas License No. 7982.

For Insurance questions call 1-800-456-8894. All other information please contact 631-697-5902 or email: homeownersforhomelessveterans@sbcia.com

By acceptance of this membership I (we) understand that Southwest Business Insurance Agency, Inc. is receiving a fee for the insurance policy (or policies) being issued in conjunction with your membership for administrative purposes. Should you have any questions with regard to this policy fee please contact Southwest Business Insurance Agency, Inc. directly at homeownersforhomelessveterans@sbcia.com.

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- Tom