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04/16/02 TLTE 18:13 FAX <br />ZOOJ <br />SCCAlSCCA PRO Master Insurance Plan 2002 <br />Swmmarv of.SCCA/[TSRRC Psrticiannt Aceident Covers¢e <br />Written by Life Ynsnrance Company of Nort6 America <br />_ through Wxsenberg Insarance + Risk Management <br />This iosunnce provides coverage at variotus }imip for t6e fotlowing uteyoriee of pacticipanu that aee injured in eveo[-rolated accidmts u <br />SCCA pt USRRC evmts. <br />A. v e <br />Medicai Reimbuneme¢t <br />Accidenul Death <br />Dismemborment by sc6ednk up ro <br />Lo9s of Wwk <br />B. Tgr=LC~[fiM ud Euldirc <br />Non-SCCA/SCCA Pm Member <br />PuticiP3RLiln04 <br />510,000 <br />S 5,000 <br />S 5,000 <br />None <br />Thae ayply to p(1 participmt Accideqt covecasee and all rypes of eveata. <br />f 1,000,0p0 <br />5 23,000 <br />S 10.000 <br />$100 per wk foT 104 <br />wks with a 7 day wajtiag pajpd <br />BC9uinmmb: Muct 6ave cigaed yu auuwl Relase aod Waivc w 6avo siQtwd a Rekace and Waver frx the evmt; be is,cutd a vedmtiel <br />by SCCA or SCCA Pro, wd must coutact event mediwl or Satcry Steward beforc the wd of the evcm M ieport an accidmt w6ieh mig6t <br />give rife to a claim. <br />Cwditiooc: Ap eLims multing &om injmus a[ising et SCCA/SCCA Pm sene[iooed events mtat 6cst be wbmitlcd W tUc Puticipeot'c <br />yeteond mtdiml inturcr (if atry). T6e SCCA Excas Medial covaage will coord'maee benefits witA the pasonal medicd ipsurer, but will <br />not psy ip addidou b it. If there ia no persoasl medical inuurcr, the SCCA yrogram rvill bceome primary. Mediul traahnmt muat be <br />pceccribed by a MD a DO. <br />Filkigl2gnefit Peciod' Mmt submit evidence oFSrst medical tapeate witL'm !A dqys of itry'ury. BexSts an ppyoble foc mcdiral expenr.es <br />inaurted up to ] 56 weeks aftu tLe accideat. <br />P"cirmt ' m, Drivas, crews, ofticiale ofthe na, mwimeas, ambulane;e crews, bw truck crews, pit gale waukas, and eIl othv <br />Decsons bearin$ psues duly and afficioLy issued by t6e Namcd IawrW. (i.e. SCCA, SCCA Regions, SCCA PRO Raciag, Ltd„ USRRC <br />and, in some coeCe. We track). <br />E7~eLICi~[.imitations: l'hrilt ehowe. Wotlcas' Compemation reluod injuries, aloohoUmrcotic rolated 'mjmies, eye8lasralrnman Imees, <br />dendva, Crowns a ups, suicidc, intentimal self-intlicted inJu7, dlncss, unless developed ae o result of Uie rovercd iCCiAmt, pra' <br />aeisan; coaditioas, cbeopnttic care andlor wgni6ve therapy imlae epecificslly sathoriud by the aaeadiog MD or DO. Reimburxmant <br />is limited w ehatQe4 w6iah do mt acceed dw6e geoerollY cha*$ed fw simila medical or QenW eue. <br />SCCA/SCCA Pm Member <br />P.ttt'tC'twnt Lnnits (with Iicepse) <br />DwtB BmeSt Bmofmisv: Dnth hene6u m made payaMe ro rhw eswtc ofcl+e deaoccd. <br />