31A-22-309 - 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 policywhich includes personal injury protection may not maintain a cause of action for generaldamages 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 onlyexclude from this coverage benefits:
(i) for any injury sustained by the insured while occupying another motor vehicle ownedby or furnished for the regular use of the insured or a resident family member of the insured andnot insured under the policy;
(ii) for any injury sustained by any person while operating the insured motor vehiclewithout the express or implied consent of the insured or while not in lawful possession of theinsured 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 vehiclewhile located for use as a residence or premises;
(v) for any injury due to war, whether or not declared, civil war, insurrection, rebellion orrevolution, 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 hazardousproperties of nuclear materials.
(b) The provisions of this subsection do not limit the exclusions which may be containedin 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 anaccident 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 UnitedStates 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 thosepolicies complying with this part, primary coverage is given by the policy insuring the motorvehicle in use during the accident.
(5) (a) Payment of the benefits provided for in Section 31A-22-307 shall be made on amonthly basis as expenses are incurred.
(b) Benefits for any period are overdue if they are not paid within 30 days after theinsurer 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 reasonableproof is overdue if not paid within 30 days after that proof is received by the insurer. Any part orall 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 atthe 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 theexpenses plus the applicable interest. If the insurer is required by the action to pay any overduebenefits 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 injuryprotection coverage is subject to the following:
(i) that where the insured under the policy is or would be held legally liable for thepersonal injuries sustained by any person to whom benefits required under personal injuryprotection have been paid by another insurer, including the Workers' Compensation Fund createdunder Chapter 33, the insurer of the person who would be held legally liable shall reimburse theother 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 bymandatory, binding arbitration between the insurers.
(b) There shall be no right of reimbursement between insurers under Subsection (6)(a) ifthe insurer of the person who would be held legally liable for the personal injuries sustained hastendered its policy limit.
(c) (i) If the insurer of the person who would be held legally liable for the personalinjuries sustained reimburses a no-fault insurer prior to settling a third party liability claim withan injured person and subsequently determines that some or all of the reimbursed amount isneeded to settle a third party claim, the insurer of the person who would be held legally liable forthe personal injuries sustained shall provide written notice to the no-fault insurer that some or allof 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 partyliability claim;
(B) provide notice to the no-fault insurer that the no-fault insurer has 15 days to returnthe 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 theportion of the reimbursement identified under Subsection (6)(c)(ii) to the third party liabilityinsurer identified under Subsection (6)(c)(ii)(C) within 15 business days from receipt of a noticeunder this Subsection (6)(c).
Amended by Chapter 162, 2008 General Session