Offer of Increased Liability Coverage for

Offer of Increased Liability Coverage for

Claims of Family Members at an Additional Premium

(New Business)

Offer of Increased Liability Coverage

for Claims of Family Members

Maryland law requires that a private passenger

motor vehicle liability insurance policy have at

least a minimum amount of coverage for both

liability and uninsured motorist coverage which

is $30,000 per person/$60,000 per accident for

bodily injury and $15,000 per accident for

property damage.

State law now requires that every insurer

writing private passenger motor vehicle liability

insurance offer to the first named insured,

under a binder or policy of private passenger

liability motor vehicle insurance, liability

coverage for claims made by a family member

in the same amount as the liability coverage

for claims made by a nonfamily member

under the policy or binder.

The insurance company may not refuse to

underwrite a first named insured because the

first named insured requests or elects the

liability coverage for claims made by family

members in an amount equal to the coverage

provided for nonfamily member claims.

Before making your decision, please read

the following carefully:

Liability coverage is an agreement of the

insurer to pay, in accordance with the terms

and conditions of the policy, for damages

arising out of bodily injury and/or property

damage for which an insured under your policy

becomes legally obligated to pay as a result of

a covered motor vehicle accident.

Bodily injury coverage - protects the insured

against claims made by others for bodily harm,

sickness, or disease, including death.

Property damage – protects the insured

against claims made by others for physical

injury to, destruction of, or loss of use of

tangible property.

PLEASE NOTE: The Family Member

Liability Coverage that you may elect to

purchase does not entitle you to coverage

for a claim for which liability does not

otherwise exist under the doctrine of parent-

child immunity.

The following limits of liability coverage

for family members are available to the

first named insured at the following

cost(s):

Limits of Coverage:

$__________________________________

(per person/per occurrence for bodily

injury and/for property damage or one

figure identifying it as a combined single

limit)

Cost(s) of Family Member Liability

Coverage (this amount is in addition to

your regular premium):

$__________________________________

I, the first named insured on the policy

described below, hereby ACCEPT the

Offer contained herein to increase the

limits of liability for the claims of family

members under the policy.

I, the first named insured on the policy

described below, hereby REJECT the

Offer contained herein to increase the

limits of liability for the claims of family

members under the policy.

I understand that this election, once

made, applies not only to the policy

described below, but to all future

renewals of the policy and on all

replacement policies, unless I notify the

company in writing of my desire to

increase the limits of liability for claims

of family members. Any such change will

be effective only as of the date that the

company receives my written

notification.

First Named Insured/Applicant

Signature of First Named Insured/Applicant

Date Policy/Binder #

Insurer

Liability Coverage

Claims of Family Members Form

Effective 1/1/2011

Liability Coverage

Claims of Family Members Form

Effective 1/1/2011

Producer Name Producer Code

(* Editorial note: These items are variable information

that must be provided by the insurer. The waiver must

be in 10 point boldface type per§19-504.1).