Title 31A Chapter 22 Section 309

Insurance Code
Contracts in Specific Lines
Section 309
Limitations, exclusions, and conditions to personal injury protection.

            

31A-22-309.   Limitations, exclusions, and conditions to personal injury protection.

            (1) (a) A person who has or is required to have direct benefit coverage under a policy which includes personal injury protection may not maintain a cause of action for general damages arising out of personal injuries alleged to have been caused by an automobile accident, except where the person has sustained one or more of the following:

            (i) death;

            (ii) dismemberment;

            (iii) permanent disability or permanent impairment based upon objective findings;

            (iv) permanent disfigurement; or

            (v) medical expenses to a person in excess of $3,000.

            (b) Subsection (1)(a) does not apply to a person making an uninsured motorist claim.

            (2) (a) Any insurer issuing personal injury protection coverage under this part may only exclude from this coverage benefits:

            (i) for any injury sustained by the insured while occupying another motor vehicle owned by or furnished for the regular use of the insured or a resident family member of the insured and not insured under the policy;

            (ii) for any injury sustained by any person while operating the insured motor vehicle without the express or implied consent of the insured or while not in lawful possession of the insured motor vehicle;

            (iii) to any injured person, if the person's conduct contributed to his injury:

            (A) by intentionally causing injury to himself; or

            (B) while committing a felony;

            (iv) for any injury sustained by any person arising out of the use of any motor vehicle while located for use as a residence or premises;

            (v) for any injury due to war, whether or not declared, civil war, insurrection, rebellion or revolution, or to any act or condition incident to any of the foregoing; or

            (vi) for any injury resulting from the radioactive, toxic, explosive, or other hazardous properties of nuclear materials.

            (b) The provisions of this subsection do not limit the exclusions which may be contained in other types of coverage.

            (3) The benefits payable to any injured person under Section 31A-22-307 are reduced by:

            (a) any benefits which that person receives or is entitled to receive as a result of an accident covered in this code under any workers' compensation or similar statutory plan; and

            (b) any amounts which that person receives or is entitled to receive from the United States or any of its agencies because that person is on active duty in the military service.

            (4) When a person injured is also an insured party under any other policy, including those policies complying with this part, primary coverage is given by the policy insuring the motor vehicle in use during the accident.

            (5) (a) Payment of the benefits provided for in Section 31A-22-307 shall be made on a monthly basis as expenses are incurred.

            (b) Benefits for any period are overdue if they are not paid within 30 days after the insurer receives reasonable proof of the fact and amount of expenses incurred during the period. If reasonable proof is not supplied as to the entire claim, the amount supported by reasonable proof is overdue if not paid within 30 days after that proof is received by the insurer. Any part or all of the remainder of the claim that is later supported by reasonable proof is also overdue if not paid within 30 days after the proof is received by the insurer.

            (c) If the insurer fails to pay the expenses when due, these expenses shall bear interest at the rate of 1-1/2% per month after the due date.

            (d) The person entitled to the benefits may bring an action in contract to recover the expenses plus the applicable interest. If the insurer is required by the action to pay any overdue benefits and interest, the insurer is also required to pay a reasonable attorney's fee to the claimant.

            (6) (a) Except as provided in Subsection (6)(b), every policy providing personal injury protection coverage is subject to the following:

            (i) that where the insured under the policy is or would be held legally liable for the personal injuries sustained by any person to whom benefits required under personal injury protection have been paid by another insurer, including the Workers' Compensation Fund created under Chapter 33, the insurer of the person who would be held legally liable shall reimburse the other insurer for the payment, but not in excess of the amount of damages recoverable; and

            (ii) that the issue of liability for that reimbursement and its amount shall be decided by mandatory, binding arbitration between the insurers.

            (b) There shall be no right of reimbursement between insurers under Subsection (6)(a) if the insurer of the person who would be held legally liable for the personal injuries sustained has tendered its policy limit.

            (c) (i) If the insurer of the person who would be held legally liable for the personal injuries sustained reimburses a no-fault insurer prior to settling a third party liability claim with an injured person and subsequently determines that some or all of the reimbursed amount is needed to settle a third party claim, the insurer of the person who would be held legally liable for the personal injuries sustained shall provide written notice to the no-fault insurer that some or all of the reimbursed amount is needed to settle a third party liability claim.

            (ii) The written notice described under Subsection (6)(c)(i) shall:

            (A) identify the amount of the reimbursement that is needed to settle a third party liability claim;

            (B) provide notice to the no-fault insurer that the no-fault insurer has 15 days to return the amount described in Subsection (6)(c)(ii)(A); and

            (C) identify the third party liability insurer that the returned amount shall be paid to.

            (iii) A no-fault insurer that receives a notice under this Subsection (6)(c) shall return the portion of the reimbursement identified under Subsection (6)(c)(ii) to the third party liability insurer identified under Subsection (6)(c)(ii)(C) within 15 business days from receipt of a notice under this Subsection (6)(c).


Amended by Chapter 162, 2008 General Session