ACORD 67 MD (2011/01)

Section Name
Field Name
Field and/or Section Description
ACORD 67 MD (2011/01)
Maryland Personal Auto
Supplement - Mandatory Offer of
Increased Liability Coverage for
Claims of Family Members at an
Additional Premium (New
Business), Mandatory Personal
Injury Protection Waiver, and
Mandatory Uninsured Motorist
Coverage Waiver for Private
Passenger Motor Vehicle Liability
Insurance in the State of Maryland
ACORD 67 MD, Maryland Personal Auto Supplement, complies with
Maryland law and the Maryland Insurance Administration's Bulletin 10-34 (AMENDED),
which replaces Bulletin P/C 04-18-A. It must be provided to all applicants for personal
auto insurance.
The form consists of three (3) parts:
Part 1: Offer of Increased Liability Coverage for Claims of Family Members (New
Business) *
Part 2: Notice and Waiver of Personal Injury Protection (PIP) Coverage
Part 3: Notice and Waiver of Increased Limits of Uninsured Motorist Coverage
Part 1 *
does not need to be used by insurers who have modified their policy provisions to
provide all family members liability coverage up to the policy limits, or those policies
issued at minimum limits.
* IMPORTANT: A new Maryland Law effective January 1, 2006, allows that parent-
child actions arising out of the operation of a motor vehicle may not be restricted
by the doctrine of parent-child immunity up to the limits of motor vehicle liability or
uninsured motorist coverage. It does not expand coverage for claims of all family
members up to the policy limits.
Some insurers' policies may restrict liability coverage for claims made by family
members (other than those described in the new law) to the minimum liability limits
requires by 17-103 of the Transportation Article. Those insurers need to continue
to use the family liability offer in Part 1 of this form in order to comply with 19-504.1
of the Insurance Article.
ACORD 67 MD (2011/01)
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Section Name
Field Name
Field and/or Section Description
Parts 2 and 3 must be signed and dated whether the insured accepts or rejects them.
The executed original of this form or a reliable image thereof by way of photographic,
microprocessed, magnetic, mechanical, electronic, digital or any other media that the
company uses to maintain its records of insurance transactions should be kept with the
original application.
A copy of this form becomes a part of and must be attached to the policy if one or more
parts are waived or requested - unless an endorsement is attached to the policy reflecting
the insured's choices.
Use this form with ACORD 90 MD.
ACORD 67 MD (2011/01)
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