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92-EK-V825-4 019284 <br />M 19279 <br />CMP-4260.1C <br />Page 2 of 3 <br />c. Arising out of oral or written publica- <br />tion of material, in any manner, <br />whose first publication took place <br />before the beginning of the policy <br />period; <br />c. Under SECTION II — MEDICAL EX- <br />PENSES, Paragraph 1.d.(2) under Cover- <br />age M — Medical Expenses is replaced by <br />the following: <br />(2) Executes authorization to allow us to <br />obtain copies of medical bills, medical <br />records, and any other information we <br />deem necessary to substantiate the <br />claim. <br />Such authorizations must not: <br />(a) Restrict us from performing our <br />business functions in: <br />I. Obtaining records, bills, infor- <br />mation, and data; or <br />ii. Using or retaining records, bills, <br />information, and data collected <br />or received by us; <br />(b) Require us to violate federal or <br />state laws or regulations, <br />(c) Prevent us from fulfilling our data <br />reporting and data retention obliga- <br />tions to insurance regulators; or <br />(d) Prevent us from disclosing claim in- <br />formation and data: <br />I. To enable performance of our <br />business functions; <br />ii. To meet our reporting obliga- <br />tions to insurance regulators, <br />iii. To meet our reporting obliga- <br />tions to insurance data consoli- <br />dators; and <br />iv. As otherwise permitted by law. <br />If the holder of the information re- <br />fuses to provide it to us despite the <br />authorization, then at our request <br />the person making claim or his or <br />her legal representative must ob- <br />tain the information and promptly <br />provide it to us; and <br />d. SECTION II — DEFINITIONS is amended <br />as follows: <br />(1) Paragraphs 18.f. and 18.g are replaced <br />by the following: <br />f. The use of another's advertising <br />idea in your "advertisement". or <br />g. Infringing upon another's copyright, <br />trade dress or slogan in your "ad- <br />vertisement'. <br />(2) Paragraph 18.h. is deleted <br />4. The following are added to SECTION I AND <br />SECTION II — COMMON POLICY CONDI- <br />TIONS: <br />Our Rights Regarding Claim Information <br />a. We will collect, receive, obtain, use, and re- <br />tain all the items described in Paragraph <br />b.(1) below and use and retain the infor- <br />mation described in Paragraph b.(3)(b) be- <br />low, in accordance with applicable federal <br />and state laws and regulations and con- <br />sistent with the performance of our busi- <br />ness functions. <br />b. Subject to Paragraph a. above, we will not <br />be restricted in or prohibited from: <br />(1) Collecting, receiving, or obtaining rec- <br />ords, receipts, invoices, medical bills, <br />medical records, wage information, sal- <br />ary information, employment information, <br />data, and any other information; <br />(2) Using any of the items described in Par- <br />agraph b.(1) above; or <br />(3) Retaining: <br />(a) Any of the items in Paragraph b.(1) <br />above; or <br />(b) Any other information we have in <br />our possession as a result of our <br />processing, handling, or otherwise <br />resolving claims submitted under <br />this policy. <br />c. We may disclose any of the items in Para- <br />graph b.(1) above and any of the infor- <br />mation described in Paragraph b.(3)(b) <br />above: <br />(1) To enable performance of our business <br />functions; <br />(2) To meet our reporting obligations to in- <br />surance regulators; <br />©, Copyright, State Farm Mutual Automobile Insurance Company, 2019 <br />Includes copyrighted material of Insurance Services Office, Inc., with its permission. <br />RAMwagemerd Division <br />REVIEWED & APPROVED BY. - <br />Risk Management Analyst <br />