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AN ACT relating to basic and added reparation benefits. 1
Be it enacted by the General Assembly of the Commonwealth of Kentucky: 2
Section 1. KRS 304.39-020 is amended to read as follows: 3
As used in this subtitle: 4
(1) "Added reparation benefits" mean benefits provided by optional added reparation 5
insurance. 6
(2) "Basic reparation benefits" mean benefits providing reimbursement for net loss 7
suffered through injury arising out of the operation, maintenance, or use of a motor 8
vehicle, subject, where applicable, to the limits, deductibles, exclusions, 9
disqualifications, and other conditions provided in this subtitle. The maximum 10
amount of basic reparation benefits payable for all economic loss resulting from 11
injury to any one (1) person as the result of one (1) accident shall be ten thousand 12
dollars ($10,000), regardless of the number of persons entitled to such benefits or 13
the number of providers of security obligated to pay such benefits. Basic reparation 14
benefits consist of one (1) or more of the elements defined as "loss." 15
(3) "Basic reparation insured" means: 16
(a) A person identified by name as an insured in a contract of basic reparation 17
insurance complying with this subtitle; and 18
(b) While residing in the same household with a named insured, the following 19
persons not identified by name as an insured in any other contract of basic 20
reparation insurance complying with this subtitle: a spouse or other relative of 21
a named insured; and a minor in the custody of a named insured or of a 22
relative residing in the same household with the named insured if he usually 23
makes his home in the same family unit, even though he temporarily lives 24
elsewhere. 25
(4) "Injury" and "injury to person" mean bodily harm, sickness, disease, or death. 26
(5) "Loss" means accrued economic loss consisting only of medical expense, work 27 UNOFFICIAL COPY 25 RS BR 840
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loss, replacement services loss, and, if injury causes death, survivor's economic loss 1
and survivor's replacement services loss. Noneconomic detriment is not loss. 2
However, economic loss is loss although caused by pain and suffering or physical 3
impairment. 4
(a) 1. "Medical expense" means reasonable charges incurred for reasonably 5
needed products, services, and accommodations, including those for 6
medical care, physical rehabilitation, rehabilitative occupational 7
training, licensed ambulance services, and other remedial treatment and 8
care. "Medical expense" may include non-medical remedial treatment 9
rendered in accordance with a recognized religious method of healing. 10
The term includes a total charge not in excess of one thousand dollars 11
($1,000) per person for expenses in any way related to funeral, 12
cremation, and burial. It does not include that portion of a charge for a 13
room in a hospital, clinic, convalescent or nursing home, or any other 14
institution engaged in providing nursing care and related services, in 15
excess of a reasonable and customary charge for semi-private 16
accommodations, unless intensive care is medically required. Medical 17
expense shall include all healing arts professions licensed by the 18
Commonwealth of Kentucky. 19
2. A medical expense, other than care provided in a hospital or hospital-20
owned outpatient facility, submitted pursuant to this subtitle shall not 21
exceed the maximum fee allowed or listed for that expense on the 22
relevant workers' compensation schedule of fees established pursuant 23
to KRS 342.035 that is in effect at the time the medical expense is 24
incurred. 25
3. There shall be a presumption that any medical expense[bill] submitted 26
in accordance with this paragraph is reasonable. 27 UNOFFICIAL COPY 25 RS BR 840
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(b) "Work loss" means loss of income from work the injured person would 1
probably have performed if he had not been injured, and expenses reasonably 2
incurred by him in obtaining services in lieu of those he would have 3
performed for income, reduced by any income from substitute work actually 4
performed by him. 5
(c) "Replacement services loss" means expenses reasonably incurred in obtaining 6
ordinary and necessary services in lieu of those the injured person would have 7
performed, not for income but for the benefit of himself or his family, if he 8
had not been injured. 9
(d) "Survivor's economic loss" means loss after decedent's death of contributions 10
of things of economic value to his survivors, not including services they 11
would have received from the decedent if he had not suffered the fatal injury, 12
less expenses of the survivors avoided by reason of decedent's death. 13
(e) "Survivor's replacement services loss" means expenses reasonably incurred by 14
survivors after decedent's death in obtaining ordinary and necessary services 15
in lieu of those the decedent would have performed for their benefit if he had 16
not suffered the fatal injury, less expenses of the survivors avoided by reason 17
of the decedent's death and not subtracted in calculating survivor's economic 18
loss. 19
(6) "Use of a motor vehicle" means any utilization of the motor vehicle as a vehicle 20
including occupying, entering into, and alighting from it. It does not include: 21
(a) Conduct within the course of a business of repairing, servicing, or otherwise 22
maintaining motor vehicles unless the conduct occurs off the business 23
premises; or 24
(b) Conduct in the course of loading and unloading the vehicle unless the conduct 25
occurs while occupying, entering into, or alighting from it. 26
(7) "Motor vehicle" means any vehicle which transports persons or property upon the 27 UNOFFICIAL COPY 25 RS BR 840
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public highways of the Commonwealth, propelled by other than muscular power 1
except road rollers, road graders, farm tractors, vehicles on which power shovels 2
are mounted, such other construction equipment customarily used only on the site 3
of construction and which is not practical for the transportation of persons or 4
property upon the highways, such vehicles as travel exclusively upon rails, and such 5
vehicles as are propelled by electrical power obtained from overhead wires while 6
being operated within any municipality or where said vehicles do not travel more 7
than five (5) miles beyond the said limits of any municipality. Motor vehicle shall 8
not mean moped as defined in this section or an electric low-speed scooter as 9
defined in KRS 189.010. 10
(8) "Moped" means either a motorized bicycle whose frame design may include one (1) 11
or more horizontal crossbars supporting a fuel tank so long as it also has pedals, or 12
a motorized bicycle with a step-through type frame which may or may not have 13
pedals rated no more than two (2) brake horsepower, a cylinder capacity not 14
exceeding fifty (50) cubic centimeters, an automatic transmission not requiring 15
clutching or shifting by the operator after the drive system is engaged, and capable 16
of a maximum speed of not more than thirty (30) miles per hour. 17
(9) "Public roadway" means a way open to the use of the public for purposes of motor 18
vehicle travel. 19
(10) "Net loss" means loss less benefits or advantages, from sources other than basic and 20
added reparation insurance, required to be subtracted from loss in calculating net 21
loss. 22
(11) "Noneconomic detriment" means pain, suffering, inconvenience, physical 23
impairment, and other nonpecuniary damages recoverable under the tort law of this 24
Commonwealth. The term does not include punitive or exemplary damages. 25
(12) "Owner" means a person, other than a lienholder or secured party, who owns or has 26
title to a motor vehicle or is entitled to the use and possession of a motor vehicle 27 UNOFFICIAL COPY 25 RS BR 840
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subject to a security interest held by another person. The term does not include a 1
lessee under a lease not intended as security. 2
(13) "Reparation obligor" means an insurer, self-insurer, or obligated government 3
providing basic or added reparation benefits under this subtitle. 4
(14) "Survivor" means a person identified in KRS 411.130 as one entitled to receive 5
benefits by reason of the death of another person. 6
(15) A "user" means a person who resides in a household in which any person owns or 7
maintains a motor vehicle. 8
(16) "Maintaining a motor vehicle" means having legal custody, possession or 9
responsibility for a motor vehicle by one other than an owner or operator. 10
(17) "Security" means any continuing undertaking complying with this subtitle, for 11
payment of tort liabilities, basic reparation benefits, and all other obligations 12
imposed by this subtitle. 13
Section 2. KRS 304.39-210 is amended to read as follows: 14
(1) (a) Basic and added reparation benefits are payable monthly as loss accrues. 15
(b) Loss accrues not when injury occurs, but as work loss, replacement services 16
loss, or medical expense is incurred. 17
(c) Benefits are overdue if not paid within thirty (30) days after the reparation 18
obligor receives reasonable proof of the fact and amount of loss realized, 19
unless the reparation obligor elects to accumulate claims for periods not 20
exceeding thirty-one (31) days after the reparation obligor receives reasonable 21
proof of the fact and amount of loss realized, and pays them within fifteen 22
(15) days after the period of accumulation. 23
(d) Notwithstanding any provision of this chapter to the contrary, benefits are not 24
overdue if a reparation obligor has not made payment to a provider of services 25
due to the request of a secured person when the secured person is directing the 26
payment of benefits among the different elements of loss. 27 UNOFFICIAL COPY 25 RS BR 840
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(e) If reasonable proof is supplied as to only part of a claim, and the part totals 1
one hundred dollars ($100) or more, the part is overdue if not paid within the 2
time provided by this section. 3
(f) Medical expense benefits may be paid by the reparation obligor directly to 4
persons supplying products, services, or accommodations to the claimant, if 5
the claimant so designates. 6
(g) A reparation obligor shall not, in any event, pay a charge for a medical 7
expense that exceeds the maximum fee permitted under subsection (5)(a)2. 8
of Section 1 of this Act. 9
(h) 1. Except as provided in subparagraph 2. of this paragraph, a person 10
supplying an item of medical expense shall submit a statement of the 11
charge for the medical expense within forty-five (45) days of the date 12
treatment is initiated and every forty-five (45) days thereafter, if 13
appropriate, as long as the products, services, or accommodations are 14
rendered. 15
2. Subparagraph 1. of this paragraph shall not apply to: 16
a. A hospital; or 17
b. Any other provider of emergency care or inpatient services 18
rendered to a basic or added reparation insured in a hospital. 19
(i) A person supplying products, services, or accommodations shall not: 20
1. Knowingly collect, attempt to collect, coerce, or attempt to coerce, 21
directly or indirectly, the payment of any charge for a medical expense 22
covered by a reparation obligor that exceeds the maximum fee 23
permitted under subsection (5)(a)2. of Section 1 of this Act; or 24
2. Cause the credit of any basic or added reparation insured to be 25
impaired by reason of the insured's failure or refusal to pay the 26
balance of any charge for a medical expense covered by a reparation 27 UNOFFICIAL COPY 25 RS BR 840
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obligor that exceeds the maximum fee permitted under subsection 1
(5)(a)2. of Section 1 of this Act. 2
(2) Overdue payments bear interest at the rate of twelve percent (12%) per annum, 3
except that if delay was without reasonable foundation, the rate of interest shall be 4
eighteen percent (18%) per annum. 5
(3) (a) A claim for basic or added reparation benefits shall be paid without deduction 6
for the benefits which are to be subtracted pursuant to the provisions on 7
calculation of net loss if these benefits have not been paid to the claimant 8
before the reparation benefits are overdue or the claim is paid. 9
(b) The reparation obligor is entitled to reimbursement from the person obligated 10
to make the payments or from the claimant who actually receives the 11
payments. 12
(4) (a) A reparation obligor may bring an action to recover benefits which are not 13
payable, but are in fact paid, because of an intentional misrepresentation of a 14
material fact, upon which the reparation obligor relies, by the insured or by a 15
person providing an item of medical expense. 16
(b) The action may be brought only against the person providing the item of 17
medical expense, unless the insured has intentionally misrepresented the facts 18
or knows of the misrepresentation. 19
(c) An insurer may offset amounts he is entitled to recover from the insured under 20
this subsection against any basic or added reparation benefits otherwise due. 21
(5) (a) A reparation obligor who rejects a claim for basic reparation benefits shall 22
give to the claimant prompt written notice of the rejection, specifying the 23
reason. 24
(b) If a claim is rejected for a reason other than that the person is not entitled to 25
the basic reparation benefits claimed, the written notice shall inform the 26
claimant that he may file his claim with the assigned claims bureau and shall 27 UNOFFICIAL COPY 25 RS BR 840
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give the name and address of the bureau. 1