except in respect of any excess beyond the amount payable or provided under such Other Coverage...

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Cowrie

Senior Member
Japanese
Hi everyone!

The following paragraph is from a Certificate of Insurance (of health insurance). I just want to see if what I understand from the bold part is the same as what a more skilled/native English speaker would understand.

(10) OTHER INSURANCE - The Company shall not be liable or obligated to provide any coverage or benefits or to pay or reimburse any claim under this insurance if there is any other insurance, membership benefit, workers’ or workplace compensation coverage program or other government program, reimbursement or indemnification coverage, right of contribution, recoupment or recovery, contract, or any other third-party obligation or liability for provision of benefits (“Other Coverage”) which would, or would but for the existence of this insurance, be available or obligated to provide such benefit or to pay or reimburse or provide indemnity for such claim, except in respect of any excess beyond the amount payable or provided under such Other Coverage had this insurance not been effected. Notwithstanding the foregoing, the Company shall not be liable or obligated to provide any benefit or to pay or reimburse any claim for any Insured Person in respect to Treatment or supplies furnished by any program or agency funded by any government or governmental authority.

What I understand from the bold part:
If Other Coverage does not pay the full amount, the Company will provide coverage for the amount that is left over.

Say, you are charged $300,000 and Other Coverage paid $200,000, then the Company will provide coverage for the remaining $100,000. Do you read it that way, too?
 
  • owlman5

    Senior Member
    English-US
    Hi, Cowrie.

    What I understand from the bold part:
    If Other Coverage does not pay the full amount, the Company will provide coverage for the amount that is left over.
    This interpretation seems reasonable to me. However, the language of contracts is notoriously tricky, and it's easy for fluent English-speakers to misunderstand what they read in contracts if they don't have any legal training. I'd be very reluctant to sign this contract before I had some attorney explain to me in plain English exactly what it said.
     
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