Representative Stephen G. Handy proposes the following substitute bill:




Chief Sponsor: Stephen G. Handy

Senate Sponsor: Lyle W. Hillyard


8     General Description:
9          This bill amends provisions related to motor vehicle insurance.
10     Highlighted Provisions:
11          This bill:
12          ▸     includes a bone fracture as an injury that allows a person who has or is required to
13     have direct benefit coverage under a policy that includes personal injury protection
14     to maintain an action for damages; and
15          ▸     makes technical changes.
16     Money Appropriated in this Bill:
17          None
18     Other Special Clauses:
19          This bill provides a special effective date.
20     Utah Code Sections Affected:
21     AMENDS:
22          31A-22-307, as last amended by Laws of Utah 2006, Chapter 197
23          31A-22-309, as last amended by Laws of Utah 2017, Chapter 363

25     Be it enacted by the Legislature of the state of Utah:

26          Section 1. Section 31A-22-307 is amended to read:
27          31A-22-307. Personal injury protection coverages and benefits.
28          (1) Personal injury protection coverages and benefits include:
29          (a) up to the minimum amount required coverage of not less than $3,000 per person,
30     the reasonable value of all expenses for necessary:
31          (i) medical services;
32          (ii) surgical services;
33          (iii) X-ray services;
34          (iv) dental services;
35          (v) rehabilitation services, including prosthetic devices;
36          (vi) ambulance services;
37          (vii) hospital services; and
38          (viii) nursing services;
39          (b) (i) the lesser of $250 per week or 85% of any loss of gross income and loss of
40     earning capacity per person from inability to work, for a maximum of 52 consecutive weeks
41     after the loss, except that this benefit need not be paid for the first three days of disability,
42     unless the disability continues for longer than two consecutive weeks after the date of injury;
43     and
44          (ii) a special damage allowance not exceeding $20 per day for a maximum of 365 days,
45     for services actually rendered or expenses reasonably incurred for services that, but for the
46     injury, the injured person would have performed for the injured person's household, except that
47     this benefit need not be paid for the first three days after the date of injury unless the person's
48     inability to perform these services continues for more than two consecutive weeks;
49          (c) funeral, burial, or cremation benefits not to exceed a total of $1,500 per person; and
50          (d) compensation on account of death of a person, payable to the person's heirs, in the
51     total of $3,000.
52          (2) (a) (i) To determine the reasonable value of the medical expenses provided for in
53     Subsection (1) and under Subsection 31A-22-309(1)(a)[(v)](vi), the commissioner shall
54     conduct a relative value study of services and accommodations for the diagnosis, care,
55     recovery, or rehabilitation of an injured person in the most populous county in the state to
56     assign a unit value and determine the 75th percentile charge for each type of service and

57     accommodation.
58          (ii) The relative value study shall be updated every other year.
59          (iii) In conducting the relative value study, the department may consult or contract with
60     appropriate public and private medical and health agencies or other technical experts.
61          (iv) The costs and expenses incurred in conducting, maintaining, and administering the
62     relative value study shall be funded by the tax created under Section 59-9-105.
63          (v) Upon completion of the relative value study, the department shall prepare and
64     publish a relative value study which sets forth the unit value and the 75th percentile charge
65     assigned to each type of service and accommodation.
66          (b) (i) The reasonable value of any service or accommodation is determined by
67     applying the unit value and the 75th percentile charge assigned to the service or
68     accommodation under the relative value study.
69          (ii) If a service or accommodation is not assigned a unit value or the 75th percentile
70     charge under the relative value study, the value of the service or accommodation shall equal the
71     reasonable cost of the same or similar service or accommodation in the most populous county
72     of this state.
73          (c) This Subsection (2) does not preclude the department from adopting a schedule
74     already established or a schedule prepared by persons outside the department, if it meets the
75     requirements of this Subsection (2).
76          (d) Every insurer shall report to the commissioner any pattern of overcharging,
77     excessive treatment, or other improper actions by a health provider within 30 days after the day
78     on which the insurer has knowledge of the pattern.
79          (e) (i) In disputed cases, a court on its own motion or on the motion of either party,
80     may designate an impartial medical panel of not more than three licensed physicians to
81     examine the claimant and testify on the issue of the reasonable value of the claimant's medical
82     services or expenses.
83          (ii) An impartial medical panel designated under Subsection (2)(e)(i) shall consist of a
84     majority of health care professionals within the same license classification and specialty as the
85     provider of the claimant's medical services or expenses.
86          (3) Medical expenses as provided for in Subsection (1)(a) and in Subsection
87     31A-22-309(1)(a)[(v)](vi) include expenses for any nonmedical remedial care and treatment

88     rendered in accordance with a recognized religious method of healing.
89          (4) The insured may waive for the named insured and the named insured's spouse only
90     the loss of gross income benefits of Subsection (1)(b)(i) if the insured states in writing that:
91          (a) within 31 days of applying for coverage, neither the insured nor the insured's spouse
92     received any earned income from regular employment; and
93          (b) for at least 180 days from the date of the writing and during the period of insurance,
94     neither the insured nor the insured's spouse will receive earned income from regular
95     employment.
96          (5) This section does not:
97          (a) prohibit the issuance of a policy of insurance providing coverages greater than the
98     minimum coverage required under this chapter; or
99          (b) require the segregation of those minimum coverages from other coverages in the
100     same policy.
101          (6) Deductibles are not permitted with respect to the insurance coverages required
102     under this section.
103          Section 2. Section 31A-22-309 is amended to read:
104          31A-22-309. Limitations, exclusions, and conditions to personal injury
105     protection.
106          (1) (a) A person who has or is required to have direct benefit coverage under a policy
107     which includes personal injury protection may not maintain a cause of action for general
108     damages arising out of personal injuries alleged to have been caused by an automobile
109     accident, except where the person has sustained one or more of the following:
110          (i) death;
111          (ii) dismemberment;
112          (iii) permanent disability or permanent impairment based upon objective findings;
113          (iv) permanent disfigurement; [or]
114          (v) a bone fracture; or
115          [(v)] (vi) medical expenses to a person in excess of $3,000.
116          (b) Subsection (1)(a) does not apply to a person making an uninsured motorist claim.
117          (2) (a) Any insurer issuing personal injury protection coverage under this part may only
118     exclude from this coverage benefits:

119          (i) for any injury sustained by the insured while occupying another motor vehicle
120     owned by or furnished for the regular use of the insured or a resident family member of the
121     insured and not insured under the policy;
122          (ii) for any injury sustained by any person while operating the insured motor vehicle
123     without the express or implied consent of the insured or while not in lawful possession of the
124     insured motor vehicle;
125          (iii) to any injured person, if the person's conduct contributed to the person's injury:
126          (A) by intentionally causing injury to the person; or
127          (B) while committing a felony;
128          (iv) for any injury sustained by any person arising out of the use of any motor vehicle
129     while located for use as a residence or premises;
130          (v) for any injury due to war, whether or not declared, civil war, insurrection, rebellion
131     or revolution, or to any act or condition incident to any of the foregoing; or
132          (vi) for any injury resulting from the radioactive, toxic, explosive, or other hazardous
133     properties of nuclear materials.
134          (b) This Subsection (2) does not limit the exclusions that may be contained in other
135     types of coverage.
136          (3) The benefits payable to any injured person under Section 31A-22-307 are reduced
137     by:
138          (a) any benefits which that person receives or is entitled to receive as a result of an
139     accident covered in this code under any workers' compensation or similar statutory plan; and
140          (b) any amounts which that person receives or is entitled to receive from the United
141     States or any of its agencies because that person is on active duty in the military service.
142          (4) When a person injured is also an insured party under any other policy, including
143     those policies complying with this part, primary coverage is given by the policy insuring the
144     motor vehicle in use during the accident.
145          (5) (a) Payment of the benefits provided for in Section 31A-22-307 shall be made on a
146     monthly basis as expenses are incurred.
147          (b) Benefits for any period are overdue if they are not paid within 30 days after the
148     insurer receives reasonable proof of the fact and amount of expenses incurred during the
149     period. If reasonable proof is not supplied as to the entire claim, the amount supported by

150     reasonable proof is overdue if not paid within 30 days after that proof is received by the
151     insurer. Any part or all of the remainder of the claim that is later supported by reasonable proof
152     is also overdue if not paid within 30 days after the proof is received by the insurer.
153          (c) If the insurer fails to pay the expenses when due, these expenses shall bear interest
154     at the rate of 1-1/2% per month after the due date.
155          (d) The person entitled to the benefits may bring an action in contract to recover the
156     expenses plus the applicable interest. If the insurer is required by the action to pay any overdue
157     benefits and interest, the insurer is also required to pay a reasonable attorney's fee to the
158     claimant.
159          (6) (a) Except as provided in Subsection (6)(b), every policy providing personal injury
160     protection coverage is subject to the following:
161          (i) that where the insured under the policy is or would be held legally liable for the
162     personal injuries sustained by any person to whom benefits required under personal injury
163     protection have been paid by another insurer, the insurer of the person who would be held
164     legally liable shall reimburse the other insurer for the payment, but not in excess of the amount
165     of damages recoverable; and
166          (ii) that the issue of liability for that reimbursement and its amount shall be decided by
167     mandatory, binding arbitration between the insurers.
168          (b) There shall be no right of reimbursement between insurers under Subsection (6)(a)
169     if the insurer of the person who would be held legally liable for the personal injuries sustained
170     has tendered its policy limit.
171          (c) (i) If the insurer of the person who would be held legally liable for the personal
172     injuries sustained reimburses a no-fault insurer prior to settling a third party liability claim with
173     an injured person and subsequently determines that some or all of the reimbursed amount is
174     needed to settle a third party claim, the insurer of the person who would be held legally liable
175     for the personal injuries sustained shall provide written notice to the no-fault insurer that some
176     or all of the reimbursed amount is needed to settle a third party liability claim.
177          (ii) The written notice described under Subsection (6)(c)(i) shall:
178          (A) identify the amount of the reimbursement that is needed to settle a third party
179     liability claim;
180          (B) provide notice to the no-fault insurer that the no-fault insurer has 15 days to return

181     the amount described in Subsection (6)(c)(ii)(A); and
182          (C) identify the third party liability insurer that the returned amount shall be paid to.
183          (iii) A no-fault insurer that receives a notice under this Subsection (6)(c) shall return
184     the portion of the reimbursement identified under Subsection (6)(c)(ii) to the third party
185     liability insurer identified under Subsection (6)(c)(ii)(C) within 15 business days from receipt
186     of a notice under this Subsection (6)(c).
187          Section 3. Effective date.
188          This bill takes effect on January 1, 2021.