PENNSYLVANIA N0-FAULT MOTOR VEHICLE INSURANCE ACT - REPEALED — 1974 Pa. Act 176 (historical enacted text)

Historical Act text

SENATE AMENDED
PRIOR PRINTER'S NOS. 2621, 3068, 3277, PRINTER'S NO. 3566
3300, 3495
INTRODUCED BY MESSRS. GEESEY, LEHR, MRS. GILLETTE, MRS. TOLL,
MESSRS. TAYOUN, FOOR, DAGER, KATZ, KNEPPER, L. E. SMITH,
ZELLER, W. W. WILT, SHUMAN, RITTER, GRIECO, TADDONIO, WILSON,
IRVIS, ANDERSON, ZWIKL, CESSAR, WEIDNER, RUANE, TRUSIO,
O'CONNELL, C. S. SMITH, WRIGHT, SALVATORE, PERRI, HILL,
M. E. MILLER, JR., POLITE, VOLPE, E. H. SMITH, FRYER, STAHL,
HARRIER, SHANE, MRS. KELLY, MESSRS. KAHLE, MORRIS, KELLY,
W. W. FOSTER, McCLATCHY, McGINNIS, KOLTER, FEE, NOVAK,
MALADY, SALOOM, KLINGAMAN, NOYE, BIXLER, PERRY AND JONES,
MARCH 4, 1974
AS AMENDED ON THIRD CONSIDERATION, IN SENATE, JULY 11, 1974
AN ACT
1 Providing for a compensation system for persons injured in motor
2 vehicle accidents; requiring insurance for all motor vehicles
3 required to be registered in Pennsylvania; defining
4 compensable damage in motor vehicle accident cases; providing <--
5 for comparative negligence; establishing an assigned claims
6 plan; providing for arbitration; imposing powers and duties
7 on courts, the Department of Transportation and the Insurance
8 Commissioner; prohibiting certain discrimination; and
9 providing penalties.
10 TABLE OF CONTENTS <--
11 ARTICLE I. SHORT TITLE, PURPOSE AND DEFINITIONS
12 § 101. SHORT TITLE.
13 § 102. FINDINGS AND PURPOSES.
14 (A) FINDINGS.
15 (B) PURPOSES.
16 § 103. DEFINITIONS.
17 § 104. REQUIRED MOTOR VEHICLE INSURANCE.
18 (A) SECURITY COVERING A MOTOR VEHICLE.
19 (B) SELF-INSURANCE.
20 (C) OBLIGATED GOVERNMENT.
21 (D) OBLIGATIONS UPON TERMINATION OF SECURITY.
22 § 105. AVAILABILITY OF INSURANCE.
23 (A) PLAN.
24 (B) CANCELLATION, REFUSAL TO RENEW, OR OTHER
1 TERMINATION OF INSURANCE.
2 § 106. PAYMENT OF CLAIMS FOR NO-FAULT BENEFITS.
3 (A) IN GENERAL.
4 (B) RELEASE OR SETTLEMENT OF CLAIM.
5 (C) TIME LIMITATIONS ON ACTIONS TO RECOVER BENEFITS.
6 (D) ASSIGNMENT OF BENEFITS.
7 (E) DEDUCTION AND SETOFF.
8 (F) EXEMPTION OF BENEFITS.
9 § 107. ATTORNEY'S FEES AND COSTS.
10 § 108. ASSIGNED CLAIMS PLAN.
11 (A) GENERAL.
12 (B) ASSIGNED CLAIMS PLAN.
13 (C) TIME FOR PRESENTING CLAIMS UNDER ASSIGNED CLAIMS
14 PLAN.
15 § 109. RATES.
16 (A) RATES AND RATING.
17 (B) PUBLIC INFORMATION.
18 (C) ACCOUNTABILITY PROGRAM.
19 (D) AVAILABILITY OF SERVICES.
20 § 110. MOTOR VEHICLES IN INTERSTATE TRAVEL.
21 (A) GENERAL.
22 (B) CONFORMING COVERAGE.
23 (C) APPLICABLE LAW.
24 § 111. RIGHTS AND DUTIES OF OBLIGORS.
25 (A) REIMBURSEMENT AND SUBROGATION.
26 (B) DUTY TO PAY BASIC LOSS BENEFITS.
27 (C) INDEMNITY.
28 (D) REFERRAL FOR REHABILITATION SERVICES.
29 ARTICLE II. RIGHT TO BENEFITS
30 § 201. RIGHT TO BASIC LOSS BENEFITS; LIMITATION ON BENEFITS.
31 (A) ACCIDENT WITHIN THIS STATE.
32 (B) ACCIDENT OUTSIDE THIS STATE.
33 § 202. BASIC LOSS BENEFITS.
34 (A) ALLOWABLE EXPENSE LIMITS.
35 (B) WORK LOSS LIMITS.
36 (C) REPLACEMENT SERVICES LOSSES.
37 (D) SURVIVORS LOSSES.
38 (E) DEDUCTIBLES; WAITING PERIOD.
39 § 203. COLLATERAL BENEFITS.
40 § 204. SOURCE OF BASIC RESTORATION BENEFITS.
41 (A) APPLICABLE SECURITY.
42 (B) MULTIPLE SOURCES OF EQUAL PROPERTY.
43 § 205. WORK LOSS.
44 (A) REGULARLY EMPLOYED.
45 (B) SEASONALLY EMPLOYED.
46 (C) NOT EMPLOYED.
47 (D) DEFINITIONS.
48 § 206. NET LOSS.
49 (A) GENERAL.
50 (B) TAX DEDUCTION.
51 § 207. ADDED LOSS BENEFITS.
52 (A) MANDATORY OFFERING.
53 (B) ADDITIONAL LOSS COVERAGE.
54 § 208. INELIGIBLE CLAIMANTS.
55 (A) CONVERTER.
56 (B) INTENTIONAL INJURIES.
57 § 209. OTHER PROVISIONS.
58 (A) INCLUDED COVERAGE.
59 (B) APPROVAL OF TERMS AND FORMS.
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1 ARTICLE III. TORT LIABILITY
2 § 301. TORT LIABILITY.
3 (A) PARTIAL ABOLITION.
4 (B) NONREIMBURSABLE TORT FINE.
5 ARTICLE IV. EXAMINATION, TREATMENT AND REHABILITATION OF
6 INJURED PERSONS; DISCOVERY
7 § 401. EXAMINATION.
8 § 402. REPORT OF EXAMINATION.
9 § 403. REFUSAL TO COMPLY.
10 § 404. COURT ORDER; OBLIGOR RESPONSIBILITY.
11 (A) COURT ORDER.
12 (B) FINDINGS.
13 § 405. COURT ORDER; REHABILITATIVE TRAINING.
14 (A) COURT ORDER.
15 (B) FINDINGS.
16 § 406. COMPLIANCE WITH COURT ORDER.
17 (A) ORDER OF COMPLIANCE.
18 (B) REFUSAL TO COMPLY.
19 (C) SANCTIONS.
20 § 407. CUSTOMARY CHARGES FOR TREATMENT.
21 § 408. EARNINGS STATEMENT.
22 (A) STATEMENT FROM EMPLOYER.
23 (B) MEDICAL RECORDS.
24 (C) COST OF REPORTS.
25 (D) DISCOVERY.
26 ARTICLE V. UNINSURED MOTORISTS, ANTI-DISCRIMINATION, SECURITY
27 REQUIRED CANCELLATION, SUBROGATION, RATE REDUCTION,
28 SELF INSURANCE, TERMINATION OF SECURITY, CONSUMER
29 INFORMATION, SEVERABILITY
30 § 501. UNINSURED MOTORISTS.
31 § 502. ANTI-DISCRIMINATION.
32 § 503. SEPARABILITY.
33 § 504. POLICY REQUIREMENTS AND PREMIUM CHANGES.
34 (A) REQUIREMENTS FOR WRITING INSURANCE.
35 (B) INITIAL PREMIUM CHARGES.
36 § 505. ROLL ON BENEFITS.
37 ARTICLE VI. PENALTIES
38 § 601. OPERATION OF A VEHICLE WITHOUT SECURITY.
39 § 602. EXCESSIVE CHARGES.
40 § 603. VIOLATIONS BY OBLIGOR.
41 ARTICLE VII. EFFECTIVE DATE
42 § 701. EFFECTIVE DATE.
43 The General Assembly of the Commonwealth of Pennsylvania hereby
44 enacts as follows:
45 ARTICLE I
46 SHORT TITLE, PURPOSE AND DEFINITIONS
47 § 101. Short title.
48 This act may be cited as the "Pennsylvania No-fault Motor
49 Vehicle Insurance Act."
50 § 102. Findings and purposes.
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1 (a) Findings.--The General Assembly hereby finds and
2 declares that--
3 (1) motor vehicles are the primary instrumentality for
4 the transportation of individuals;
5 (2) the transportation of individuals by motor vehicle
6 over Commonwealth highways and other highways significantly
7 affects intrastate commerce, particularly in metropolitan
8 areas;
9 (3) the maximum feasible restoration of all individuals
10 injured and compensation of the economic losses of the
11 survivors of all individuals killed in motor vehicle
12 accidents on Commonwealth highways, in intrastate commerce,
13 and in activity affecting intrastate commerce is essential to
14 the humane and purposeful functioning of commerce;
15 (4) to avoid any undue burden on commerce during the
16 intrastate transportation of individuals, it is necessary and
17 proper to have a Statewide low-cost, comprehensive, and fair
18 system of compensating and restoring motor vehicle accident
19 victims and the survivors of deceased victims;
20 (5) exhaustive studies by the United States Department
21 of Transportation, the Congress of the United States and the
22 General Assembly have determined that the present basic
23 system of motor vehicle accident and insurance law, which
24 makes compensation and restoration contingent upon--
25 (A) every victim first showing that someone else was
26 at fault;
27 (B) every victim first showing that he was without
28 fault; and
29 (C) the person at fault having sufficient liability
30 insurance and other available financial resources to pay
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1 for all the losses,
2 is not such a low-cost, comprehensive, and fair system;
3 (6) Careful studies, intensive hearings, and some State
4 experiments have demonstrated that a basic system of motor
5 vehicle accident and insurance law which--
6 (A) assures every victim payment of all his basic
7 medical and rehabilitation costs, and recovery of a
8 reasonable amount of work loss, replacement services and
9 survivor's loss; and
10 (B) eliminates the need to determine fault except
11 when a victim is very seriously injured,
12 is such a low-cost, comprehensive, and fair system;
13 (7) adoption of the system described in paragraph (6) in
14 place of the system described in paragraph (5) would remove
15 an undue burden on commerce;
16 (8) throughout the Commonwealth there should be
17 uniformity as to the essential elements of the system of
18 motor vehicle accident and insurance law to avoid confusion,
19 complexity, uncertainty, and chaos which would be engendered
20 by a multiplicity of noncomplementary systems, but the need
21 for a basic system does not require that the Commonwealth
22 itself directly administer, operate, or direct the
23 administration or operation of such system; and
24 (9) a Statewide low-cost, comprehensive, and fair system
25 of compensating and restoring motor vehicle accident victims
26 can save and restore the lives of countless victims by
27 providing and paying the cost of services so that every
28 victim has the opportunity to--
29 (A) receive prompt and comprehensive professional
30 treatment; and
19740H1973B3566 - 5 -
1 (B) be rehabilitated to the point where he can
2 return as a useful member of society and a self-
3 respecting and self-supporting citizen.
4 (10) IT IS NECESSARY TO AFFORD REQUIRED COVERAGES FOR <--
5 MOTOR VEHICLES TO ECONOMICALLY DISADVANTAGED INDIVIDUALS AT
6 RATES NOT SO GREAT AS TO DENY SUCH INDIVIDUALS ACCESS TO
7 INSURANCE WHICH IT IS NECESSARY FOR THEM TO HAVE IN ORDER TO
8 EARN INCOME AND TO BE OR REMAIN GAINFULLY EMPLOYED.
9 (b) Purposes.--Therefore, it is hereby declared to be the
10 policy of the General Assembly to establish at reasonable cost
11 to the purchaser of insurance, a Statewide system of prompt and
12 adequate basic loss benefits for motor vehicle accident victims
13 and the survivors of deceased victims.
14 § 103. Definitions.
15 As used in this act--
16 "Added loss benefits" means benefits provided by added loss
17 insurance in accordance with section 207 of this act.
18 "Allowable expense" means reasonable charges incurred for, or
19 the reasonable value of (where no charges are incurred),
20 reasonably needed and used products, services, and
21 accommodations for--
22 (A) professional medical treatment and care;
23 (B) emergency health services;
24 (C) medical and vocational rehabilitation services;
25 (D) expenses directly related to the funeral,
26 burial, cremation, or other form of disposition of the
27 remains of a deceased victim, not to exceed one thousand
28 five hundred dollars ($1,500); and
29 (E) any nonmedical remedial care and treatment <--
30 rendered in accordance with a recognized religious method
19740H1973B3566 - 6 -
1 of healing.
2 The term does not include that portion of a charge for a room
3 in a hospital, clinic, convalescent, or nursing home, or any
4 other institution engaged in providing nursing care and related
5 services, in excess of a reasonable and customary charge for
6 semiprivate accommodations, unless more intensive care is
7 medically required; or any amount includable in work loss,
8 replacement services loss, or survivor's loss.
9 "Basic loss benefits" means benefits provided in accordance
10 with this act for the net loss sustained by a victim, subject to
11 any applicable limitations, exclusions, deductibles, waiting
12 periods, disqualifications, or other terms and conditions
13 provided or authorized in accordance with this act. Basic loss
14 benefits do not include benefits for damage to property. NOR DO <--
15 BASIC LOSS BENEFITS INCLUDE BENEFITS FOR NET LOSS SUSTAINED BY
16 AN OPERATOR OR PASSENGER OF A MOTORCYCLE.
17 "Commissioner" means the Insurance Commissioner.
18 "Department" means the Pennsylvania Department of
19 Transportation.
20 "Emergency health services" means services necessary to
21 mitigate injury to any victim during the period immediately and
22 proximately following an accident including, but not limited to,
23 communications, transportation, and treatment by medical and
24 paramedical personnel, and which are supplied or provided by any
25 person accredited or certified by an emergency health services
26 system.
27 "Emergency health services system" means a system which
28 provides for the arrangement of personnel, facilities, and
29 equipment for the effective and coordinated delivery in an
30 appropriate geographical area of health care services under
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1 emergency conditions arising out of the maintenance or use of a
2 motor vehicle, which is administered by a public or nonprofit
3 private entity which has the authority and the resources to
4 provide effective administration, and which is operating in
5 accordance with applicable requirements, conditions, and
6 regulations.
7 "Government" means the government of the United States, any
8 state, any political subdivision of a state, any instrumentality
9 of two or more states, or any agency, subdivision, or department
10 of any such government, including any corporation or other
11 association organized by a government for the execution of a
12 government program and subject to control by a government, or
13 any corporation or agency established under an interstate
14 compact or international treaty.
15 "Injury" means accidentally sustained bodily harm to an
16 individual and that individual's illness, disease, or death
17 resulting therefrom.
18 "Insurance" means a contract, self-insurance, or any other
19 legally binding obligation to pay or provide no-fault benefits
20 or any required tort liability.
21 "Insured" means--
22 (A) an individual identified by name as an insured
23 in a contract of basic loss insurance complying with this
24 act; and
25 (B) a spouse or other relative of a named insured, a
26 minor in the custody of a named insured, and a minor in
27 the custody of a relative of a named insured if--
28 (i) not identified by name as an insured in any
29 other contract of basic restoration insurance
30 complying with this act; and
19740H1973B3566 - 8 -
1 (ii) in residence in the same household with a
2 named insured.
3 An individual is in residence in the same household if he
4 usually makes his home in the same family unit, even though he
5 temporarily lives elsewhere.
6 "Insurer" means a legally constituted entity, other than a
7 self-insurer or an obligated government, which is authorized
8 under state law to provide security covering a motor vehicle in
9 such state.
10 "Loss" means accrued economic detriment resulting from injury
11 arising out of the maintenance or use of a motor vehicle
12 consisting of, and limited to, allowable expense, work loss,
13 replacement services loss, and survivor's loss.
14 "Loss of income" means gross income actually lost by a victim
15 or that would have been lost but for any income continuation
16 plan, reduced by--
17 (A) eighty per cent (80%) of any income which such
18 individual earns from substitute work;
19 (B) income which such individual would have earned
20 in available substitute work he was capable of performing
21 but unreasonably failed to undertake; or
22 (C) any income which such individual would have
23 earned by hiring an available substitute to perform self-
24 employment services but unreasonably failed to do.
25 "Maintenance or use of a motor vehicle" means maintenance or
26 use of a motor vehicle as a vehicle, including, incident to its
27 maintenance or use as a vehicle, occupying, entering into, or
28 alighting from it. Maintenance or use of a motor vehicle does
29 not include--
30 (A) conduct within the course of a business of
19740H1973B3566 - 9 -
1 repairing, servicing, or otherwise maintaining motor
2 vehicles unless the conduct occurs off the business
3 premises; or
4 (B) conduct in the course of loading or unloading a
5 motor vehicle unless the conduct occurs while occupying,
6 entering into, or alighting from it.
7 "Medical and vocational rehabilitation services" means
8 services necessary to reduce disability and to restore the
9 physical, psychological, social, and vocational functioning of a
10 victim. Such services may include, but are not limited to,
11 medical care, diagnostic and evaluation procedures, physical and
12 occupational therapy, other necessary therapies, speech
13 pathology and audiology, optometric services, nursing care under
14 the supervision of a registered nurse, medical social services,
15 vocational rehabilitation and training services, occupational
16 licenses and tools, and transportation where necessary to secure
17 medical and vocational rehabilitation services. A basic loss
18 obligor is not obligated to provide basic loss benefits for
19 allowable expense for medical and vocational rehabilitation
20 services unless the facility in which or through which such
21 services are provided has been accredited by the Department of
22 Health, the equivalent governmental agency responsible for
23 health programs, or the accrediting designee of such department
24 or agency of the State in which such services are provided, as
25 being in accordance with applicable requirements and
26 regulations.
27 "Motor vehicle" means a vehicle of a kind required to be
28 registered under the act of April 29, 1959 (P.L.58, No.32),
29 known as The Vehicle Code.
30 "Net loss" means loss less benefits or advantages required to
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1 be subtracted from loss in calculating net loss pursuant to this
2 act.
3 "Noneconomic detriment" means pain, suffering, inconvenience,
4 physical impairment, and other nonpecuniary damage recoverable
5 under the tort law applicable to injury arising out of the
6 maintenance or use of a motor vehicle. The term does not include
7 punitive or exemplary damages.
8 "No-fault benefits" means basic loss benefits, added loss
9 benefits, or both.
10 "No-fault insurance" means basic loss insurance, added loss
11 insurance, or both.
12 "Obligor" means an insurer, self-insurer, or obligated
13 government providing no-fault benefits in accordance with this
14 act.
15 "Owner" means an individual, government, corporation,
16 company, association, firm, partnership, joint stock company,
17 foundation, institution, society, union, club, church, or any
18 other group of persons organized for any purpose, other than a
19 lienholder or secured party, that owns or has title to a motor
20 vehicle or is entitled to the use and possession of a motor
21 vehicle subject to a security interest held by another. The term
22 includes a lessee of a motor vehicle having the right to
23 possession under a lease with option to purchase.
24 "Replacement services loss" means expenses reasonably
25 incurred in obtaining ordinary and necessary services in lieu of
26 those the victim would have performed, not for income, but for
27 the benefit of himself or his family, if he had not been
28 injured.
29 "Secretary" means the Pennsylvania Secretary of
30 Transportation.
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1 "Secured vehicle" means a motor vehicle for which security is
2 provided in accordance with section 104 of this act.
3 "Security covering a motor vehicle," "security covering the
4 vehicle," and "security" means the security which is provided in
5 accordance with section 104 of this act.
6 "Self-insurer" means an owner or any person providing
7 security pursuant to subsections (b) or (c) of section 104 of
8 this act.
9 "State" means a state of the United States, the District of
10 Columbia, Guam, and the Virgin Islands.
11 "State vocational rehabilitation agency" means the agency in
12 the Commonwealth which administers the Commonwealth plan for
13 vocational rehabilitation services under the Federal Vocational
14 Rehabilitation Act (29 U.S.C.35).
15 "Survivor" means--
16 (A) spouse; or
17 (B) child, parent, brother, sister or relative
18 dependent upon the deceased for support.
19 "Survivor's loss" means the--
20 (A) loss of income of a deceased victim which would
21 probably have been contributed to a survivor or
22 survivors, if such victim had not sustained the fatal
23 injury; and
24 (B) expenses reasonably incurred by a survivor or
25 survivors, after a victim's death resulting from injury,
26 in obtaining ordinary and necessary services in lieu of
27 those which the victim would have performed, not for
28 income, but for their benefit, if he had not sustained
29 the fatal injury,
30 reduced by expenses which the survivor or survivors would
19740H1973B3566 - 12 -
1 probably have incurred but avoided by reason of the victim's
2 death resulting from injury.
3 "Victim" means an individual who suffers injury arising out
4 of the maintenance or use of a motor vehicle; "deceased victim"
5 means a victim suffering death resulting from injury.
6 "Without regard to fault" means irrespective of fault as a
7 cause of injury.
8 "Work loss" means
9 (A) loss of gross income of a victim, as calculated
10 pursuant to the provisions of section 205 of this act;
11 and
12 (B) reasonable expenses of a victim for hiring a
13 substitute to perform self-employment services, thereby
14 mitigating loss of income, or for hiring special help,
15 thereby enabling a victim to work and mitigate loss of
16 income.
17 § 104. Required motor vehicle insurance.
18 (a) Security covering a motor vehicle.--Every owner of a
19 motor vehicle which is registered or which is operated in this
20 Commonwealth by the owner or with his permission, shall
21 continuously provide security covering such motor vehicle while
22 such vehicle is either present or registered in the
23 Commonwealth. Security shall be provided for the payment of
24 basic loss benefits, and for the payment of other benefits and <--
25 tort liability for bodily injury or death of not less than
26 fifteen thousand dollars ($15,000) to one person in any one
27 accident and not less than thirty thousand dollars ($30,000) to
28 two or more persons in any one accident. SUMS UP TO A TOTAL <--
29 LIMIT OF THIRTY THOUSAND DOLLARS ($30,000) WHICH THE OWNER OR
30 ANY PERSON OPERATING THE VEHICLE WITH THE EXPRESS OR IMPLIED
19740H1973B3566 - 13 -
1 PERMISSION OF THE OWNER MAY BECOME LIABLE TO PAY AS DAMAGES
2 BECAUSE OF BODILY INJURY OR DEATH ARISING OUT OF ANY ONE
3 ACCIDENT (SUBJECT TO A SUBLIMIT OF FIFTEEN THOUSAND DOLLARS
4 ($15,000) FOR DAMAGES ARISING OUT OF THE BODILY INJURY OR DEATH
5 OF ANY ONE PERSON) AND FOR THE PAYMENT OF DAMAGES FOR INJURY TO
6 OR DESTRUCTION OF PROPERTY IN ANY ONE ACCIDENT OF AMOUNTS UP TO
7 A TOTAL LIMIT OF FIVE THOUSAND DOLLARS ($5,000). The owner or
8 any other person may provide security covering a motor vehicle
9 by a contract of insurance with an insurer or by qualifying as a
10 self-insurer or as an obligated government. Obligors shall, upon <--
11 the request of the registered owner of a motorcycle, waive no-
12 fault benefits or provide no-fault benefits at reduced no-fault
13 benefit levels with respect only to the operator, owner or
14 passenger of a motorcycle.
15 (b) Self-insurance.--Self-insurance, subject to approval of
16 the commissioner and department, is effected by filing with the
17 department in satisfactory form:
18 (1) a continuing undertaking by the owner or other
19 appropriate person to pay basic restoration benefits and any
20 tort liability required in amounts not less than those
21 required, by Article XIV of the act of April 29, 1959 <--
22 (P.L.58, No.32), known as The Vehicle Code SUBSECTION (A) OF <--
23 THIS SECTION, to perform all obligations imposed in
24 accordance with this act, and to elect to pay such added
25 restoration benefits as are specified in the undertaking;
26 (2) evidence that appropriate provision exists for
27 prompt and efficient administration of all claims, benefits,
28 and obligations provided in accordance with this act; and
29 (3) evidence that reliable financial arrangements,
30 deposits, resources, or commitments exist providing assurance
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1 substantially equivalent to that afforded by a contract of
2 insurance complying with this act for payment of no-fault
3 benefits, any required tort liability, and performance of all
4 other obligations imposed in accordance with this act.
5 (c) Obligated government.--A government may provide security
6 with respect to any motor vehicle owned or operated by it by
7 lawfully obligating itself to pay basic restoration benefits in
8 accordance with this act, and such added restoration benefits as
9 are specified in the undertaking.
10 (d) Obligations upon termination of security.--An owner of a
11 motor vehicle who ceases to maintain the security required in
12 accordance with this act shall immediately surrender the
13 registration certificate and license plates for the vehicle to
14 the department and may not operate or permit operation of the
15 vehicle in this Commonwealth until security has again been
16 furnished as required in accordance with this act. A person
17 other than the owner who ceases to maintain such security shall
18 immediately notify the owner and the department, who may not
19 operate or permit operation of the vehicle until security has
20 again been furnished. An insurer who has issued a contract of
21 insurance and knows or has reason to believe the contract is for
22 the purpose of providing security shall immediately give notice
23 to the department of the termination of the insurance. If the
24 commissioner or department withdraws approval of security
25 provided by a self-insurer or knows that the conditions for
26 self-insurance have ceased to exist, he shall immediately give
27 notice thereof to the department. These requirements may be
28 modified or waived by the department.
29 § 105. Availability of insurance.
30 (a) Plan.--
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1 (1) The commissioner shall establish and implement or
2 approve and supervise a plan assuring that any required no-
3 fault benefits and tort liability coverages for motor
4 vehicles will be conveniently and expeditiously available,
5 subject only to payment or provisions for payment of the
6 premium, to each individual who cannot conveniently obtain
7 insurance through ordinary methods at rates not in excess of
8 those applicable to similarly situated individuals under the
9 plan. The plan may provide reasonable means for the transfer
10 of individuals insured thereunder into the ordinary market,
11 at the same or lower rates, pursuant to regulations
12 established by the commissioner. The plan may be implemented
13 by assignment of applicants among insurers, pooling, any
14 joint insuring or reinsuring arrangement, or any other
15 method, that results in all applicants being conveniently
16 afforded the insurance coverages on reasonable and not
17 unfairly discriminatory terms.
18 (2) The plan shall make available added loss benefits
19 and tort liability coverage together with other contract
20 provisions which the commissioner determines are reasonably
21 needed by applicants and are commonly afforded in voluntary
22 markets. The plan must also assure that there is available
23 through the private sector or otherwise to all applicants
24 adequate premium financing or provision for the installment
25 payment of premiums subject to customary terms and
26 conditions.
27 (3) All insurers writing no-fault benefits and tort
28 liability coverages in this Commonwealth shall participate in
29 the plan. The plan shall provide for equitable apportionment,
30 among all participating insurers writing any insurance
19740H1973B3566 - 16 -
1 coverage required under the plan, of the financial burdens of
2 insurance provided to applicants under the plan and the costs
3 of operation of the plan.
4 (4) Subject to the supervision and approval of the
5 commissioner, insurers may consult and agree with each other
6 and with other appropriate persons as to the organization,
7 administration, and operation of the plan and as to rates and
8 rate modifications for insurance coverages provided under the
9 plan. Rates and rate modifications adopted or charged for
10 insurance coverages provided under the plan shall:
11 (A) be first adopted or approved by the commissioner;
12 and
13 (B) be reasonable and not unfairly discriminatory
14 among similarly situated applicants for insurance
15 pursuant to regulations established by the commissioner.
16 (5) Subject to the supervision and approval of the <--
17 commissioner, the plan shall afford required coverages for
18 motor vehicles to any economically disadvantaged individual,
19 at rates as determined by this Commonwealth, which shall not
20 be so great as to deny such individual access to insurance
21 which it is necessary for him to have in order to earn income
22 and to be or remain gainfully employed.
23 (6) (5) To carry out the objectives of this subsection,
24 the commissioner may adopt rules, make orders, enter into
25 agreements with other governmental and private entities and
26 individuals, and form and operate or authorize the formation
27 and operation of bureaus and other legal entities.
28 (b) Cancellation, refusal to renew, or other termination of
29 insurance.-- Cancellation, refusal to renew and other
30 termination of insurance shall be provided for in accordance
19740H1973B3566 - 17 -
1 with the provisions of the act of June 5, 1968 (P.L.140, No.78),
2 entitled "An act regulating the writing, cancellation of or
3 refusal to renew policies of automobile insurance; and imposing
4 powers and duties on the Insurance Commissioner therefor."
5 § 106. Payment of claims for no-fault benefits.
6 (a) In general.--
7 (1) No-fault benefits are payable monthly as loss
8 accrues. Loss accrues not when injury occurs, but as
9 allowable expense, work loss, replacement services loss, or
10 survivor's loss is sustained.
11 (2) No-fault benefits are overdue if not paid within
12 thirty days after the receipt by the obligor of each
13 submission of reasonable proof of the fact and amount of loss
14 sustained, unless the obligor designates, upon receipt of an
15 initial claim for no-fault benefits, periods not to exceed
16 thirty-one days each for accumulating all such claims
17 received within each such period, in which case such benefits
18 are overdue if not paid within fifteen days after the close
19 of each such period. If reasonable proof is supplied as to
20 only part of a claim, but the part amounts to one hundred
21 dollars ($100) or more, benefits for such part are overdue if
22 not paid within the time mandated by this paragraph. An
23 obligation for basic loss benefits for an item of allowable
24 expense may be discharged by the obligor by reimbursing the
25 victim or by making direct payment to the supplier or
26 provider of products, services, or accommodations within the
27 time mandated by this paragraph. Overdue payments bear
28 interest at the rate of eighteen per cent (18%) per annum.
29 (3) A claim for no-fault benefits shall be paid without
30 deduction for the benefits or advantages which are to be
19740H1973B3566 - 18 -
1 subtracted from loss in calculating net loss if such benefits
2 or advantages have not been paid or provided to such claimant
3 prior to the date the no-fault benefits are overdue or the
4 no-fault benefits claim is paid. The obligor is thereupon
5 entitled to recover reimbursement from the person obligated
6 to pay or provide such benefits or advantages or from the
7 claimant who actually receives them.
8 (4) An obligor may bring an action to recover
9 reimbursement for no-fault benefits which are paid upon the
10 basis of an intentional misrepresentation of a material fact
11 by a claimant or a supplier or provider of an item of
12 allowable expense, if such obligor reasonably relied upon
13 such misrepresentation. The action may be brought only
14 against such supplier or provider, unless the claimant has
15 intentionally misrepresented the facts or knew of the
16 misrepresentation. An obligor may offset amounts he is
17 entitled to recover from the claimant under this paragraph
18 against any no-fault benefits otherwise due.
19 (5) An obligor who rejects a claim for basic loss
20 benefits shall give to the claimant written notice of the
21 rejection promptly, but in no event more than thirty days
22 after the receipt of reasonable proof of the loss. Such
23 notice shall specify the reason for such rejection and inform
24 the claimant of the terms and conditions of his right to
25 obtain an attorney. If a claim is rejected for a reason other
26 than that the person is not entitled to basic loss benefits
27 claimed, the written notice shall inform the claimant that he
28 may file his claim with the assigned claims bureau and shall
29 give the name and address of the bureau.
30 (b) Release or settlement of claim.--
19740H1973B3566 - 19 -
1 (1) Except as otherwise provided in this subsection, no-
2 fault benefits shall not be denied or terminated because the
3 victim executed a release or other settlement agreement. A
4 claim for no-fault benefits may be discharged by a settlement
5 agreement for an agreed amount payable in installments or in
6 a lump sum, if the reasonably anticipated net loss does not
7 exceed two thousand five hundred dollars ($2,500). In all
8 other cases, a claim may be discharged by a settlement to the
9 extent authorized by law and upon a finding, by a court of
10 competent jurisdiction, that the settlement is in the best
11 interest of the claimant and any beneficiaries of the
12 settlement, and that the claimant understands and consents to
13 such settlement, and upon payment by the restoration obligor
14 of the costs of such proceeding including a reasonable
15 attorney's fee (based upon actual time expended) to the
16 attorney selected by or appointed for the claimant. Such
17 costs may not be charged to or deducted from the proceeds of
18 the settlement. Upon approval of the settlement, the court
19 may make appropriate orders concerning the safeguarding and
20 disposing of the proceeds of the settlement and may direct as
21 a condition of the settlement agreement, that the restoration
22 obligor pay the reasonable cost of appropriate future medical
23 and vocational rehabilitation services.
24 (2) A settlement agreement for an amount payable in
25 installments shall be modified as to amounts to be paid in
26 the future, if it is shown that a material and substantial
27 change of circumstances has occurred or that there is newly-
28 discovered evidence concerning the claimant's physical
29 condition, loss, or rehabilitation which could not have been
30 known previously or discovered in the exercise of reasonable
19740H1973B3566 - 20 -
1 diligence.
2 (3) A settlement agreement may be set aside if it is
3 procured by fraud or if its terms are unconscionable.
4 (c) Time limitations on actions to recover benefits.--
5 (1) If no-fault benefits have not been paid for loss
6 arising otherwise than from death, an action therefor may be
7 commenced not later than two years after the victim suffers
8 the loss and either knows, or in the exercise of reasonable
9 diligence should have known, that the loss was caused by the
10 accident, or not later than four years after the accident,
11 whichever is earlier. If no-fault benefits have been paid for
12 loss arising otherwise than from death, an action for further
13 benefits, other than survivor's benefits, by either the same
14 or another claimant; may be commenced not later than two
15 years after the last payment of benefits.
16 (2) If no-fault benefits have not been paid to the
17 deceased victim or his survivor or survivors, an action for
18 survivor's benefits may be commenced not later than one year
19 after the death or four years after the accident from which
20 death results, whichever is earlier. If survivor's benefits
21 have been paid to any survivor, an action for further
22 survivor's benefits by either the same or another claimant
23 may be commenced not later than two years after the last
24 payment of benefits. If no-fault benefits have been paid for
25 loss suffered by a victim before his death resulting from the
26 injury, an action for survivor's benefits may be commenced
27 not later than one year after the death or six years after
28 the last payment of benefits, whichever is earlier.
29 (3) If timely action for basic restoration benefits is
30 commenced against an obligor and benefits are denied because
19740H1973B3566 - 21 -
1 of a determination that the obligor's coverage is not
2 applicable to the claimant under the provisions of section
3 204 of this act, an action against the applicable obligor or
4 the obligor to whom a claim is assigned under an assigned
5 claims plan may be commenced not later than sixty days after
6 the determination becomes final or the last date on which the
7 action could otherwise have been commenced, whichever is
8 later.
9 (4) Except as paragraph (1), (2), or (3) prescribes a
10 longer period, an action by a claimant on an assigned claim
11 which has been timely presented in accordance with the
12 provisions of section 108(c) of this act may not be commenced
13 more than sixty days after the claimant receives written
14 notice of rejection of the claim by the restoration obligor
15 to which it was assigned.
16 (5) If a person entitled to no-fault benefits is under a
17 legal disability when the right to bring an action for the
18 benefits first accrues, the period of his disability is not a
19 part of the time limited for commencement of the action.
20 (d) Assignment of benefits.--An assignment of or an
21 agreement to assign any right in accordance with this act for
22 loss accruing in the future is unenforceable except as to
23 benefits for:
24 (1) work loss to secure payment of alimony, maintenance,
25 or child support; or
26 (2) allowable expense to the extent the benefits are for
27 the cost of products, services, or accommodations provided or
28 to be provided by the assignee.
29 (e) Deduction and setoff.--Except as otherwise provided in
30 this act, basic loss benefits shall be paid without deduction or
19740H1973B3566 - 22 -
1 setoff.
2 (f) Exemption of benefits.--
3 (1) No-fault benefits for allowable expense are exempt
4 from garnishment, attachment, execution, and any other
5 process or claim, except upon the claim of a creditor who has
6 provided products, services, or accommodations to the extent
7 benefits are for allowable expense for those products,
8 services, or accommodations.
9 (2) Basic loss benefits other than those for allowable
10 expense are exempt from garnishment, attachment, execution,
11 and any other process or claim for benefits attributable to
12 loss sustained within the first sixty days following the
13 accident resulting in injury. Other basic loss benefits
14 (except for items of allowable expense) are exempt to the
15 extent that wages or earnings are exempt under any applicable
16 law exempting wages or earnings from such process or claims.
17 § 107. Attorney's fees and costs.
18 Fees of claimant's attorney.--
19 (1) If any overdue no-fault benefits are paid by the
20 obligor after receipt by the obligor of notice of
21 representation of a claimant in connection with a claim or
22 action for the payment of no-fault benefits, a reasonable
23 attorney's fee (based on actual time expended) shall be paid
24 by the obligor to such attorney. No part of the attorney's
25 fee for representing the claimant in connection with such
26 claim or action for no-fault benefits shall be charged or
27 deducted from benefits otherwise due to such claimant and no
28 part of such benefits may be applied to such fee.
29 (2) If, in any action by a claimant to recover no-fault
30 benefits from an obligor, the court determines that the claim
19740H1973B3566 - 23 -
1 or any significant part thereof is fraudulent or so excessive
2 as to have no reasonable foundation, the court may award the
3 claimant's OBLIGOR'S attorney a reasonable fee based upon <--
4 actual time expended. The court, in such case, may direct
5 that the fee shall be paid by the obligor CLAIMANT or that <--
6 the fee may be treated in whole or in part as an offset
7 against any benefits due or to become due to the claimant.
8 (3) IF, IN ANY ACTION BY A CLAIMANT TO RECOVER NO-FAULT <--
9 BENEFITS FROM AN OBLIGOR, THE COURT DETERMINES THAT THE
10 OBLIGOR HAS DENIED THE CLAIM OR ANY SIGNIFICANT PART THEREOF
11 WITHOUT REASONABLE FOUNDATION, THE COURT MAY AWARD THE
12 CLAIMANT'S ATTORNEY A REASONABLE FEE BASED UPON ACTUAL TIME
13 EXPENDED.
14 § 108. Assigned claims plan.
15 (a) General.--
16 (1) If this act is in effect on the date when the
17 accident resulting in injury occurs, a victim or the survivor
18 or survivors of a deceased victim may obtain basic benefits
19 through the assigned claims plan established pursuant to
20 subsection (b) of this section, if basic loss insurance:
21 (A) is not applicable to the injury for a reason
22 other than those specified in the provisions on
23 ineligible claimants;
24 (B) is not applicable to the injury because the
25 victim converted a motor vehicle while he was under
26 fifteen years of age;
27 (C) applicable to the injury cannot be identified;
28 (D) applicable to the injury is inadequate to
29 provide the contracted-for benefits because of financial
30 inability of an obligor to fulfill its obligations; or
19740H1973B3566 - 24 -
1 (E) benefits are refused by an obligor for a reason
2 other than that the individual is not entitled in
3 accordance with this act to be RECEIVE the basic loss <--
4 benefits claimed.
5 (2) If a claim qualifies for assignment under paragraph
6 (1)(C), (D), or (E) of this subsection, the assigned claims
7 bureau or any insurer to whom the claim is assigned is
8 subrogated to all rights of the claimant against the obligor
9 legally obligated to provide basic benefits to the claimant,
10 or against any successor in interest to or substitute for
11 such obligor for such benefits as are provided by the
12 assignee.
13 (3) If an individual receives basic loss benefits
14 through the assigned claims plan for any reason other than
15 because of the financial inability of an obligor to fulfill
16 its obligation, all benefits or advantages that such
17 individual receives or is entitled to receive as a result of
18 such injury, other than life insurance benefits or benefits
19 by way of succession at death or in discharge of familial
20 obligations of support, shall be subtracted from loss in
21 calculating net loss.
22 (4) An assigned claim of an individual who does not
23 comply with the requirement of providing security for the
24 payment of basic restoration benefits, or of an individual as
25 to whom the security is invalidated because of his fraud or
26 willful misconduct, is subject to:
27 (A) all the maximum optional deductibles and
28 exclusions required to be offered; and
29 (B) a deduction in the amount of five hundred
30 dollars ($500) for each year or part thereof of the
19740H1973B3566 - 25 -
1 period of his continuous failure to provide security,
2 applicable to any benefits otherwise payable except basic
3 benefits for allowable expense.
4 (b) Assigned claims plan.--
5 (1) Obligors other than self insurers and governments
6 providing basic loss insurance in this Commonwealth shall
7 organize and maintain, subject to approval and regulation by
8 the commissioner, an assigned claims bureau and an assigned
9 claims plan and adopt rules for their operation and for
10 assessment of costs on a fair and equitable basis consistent
11 with this act. If such bureau and plan are not organized and
12 maintained in a manner considered by the commissioner to be
13 consistent with this act, he shall organize and maintain an
14 assigned claims bureau and an assigned claims plan. Each
15 obligor insurer providing basic loss insurance in the
16 Commonwealth shall participate in the assigned claims bureau
17 and the assigned claims plan. Costs incurred shall be
18 allocated fairly and equitably among the obligors.
19 (2) The assigned claims bureau shall promptly:
20 (A) assign each claim for no-fault benefits to an
21 assignee who shall be a participating insurer; and
22 (B) notify the claimant of the identity and address
23 of such assignee.
24 Claims shall be assigned so as to minimize inconvenience to
25 claimants. The assignee thereafter has rights and obligations as
26 if he had issued a policy of basic loss insurance complying with
27 this act applicable to the injury or, in a case involving the
28 financial inability of a restoration obligor to perform its
29 obligations, as if the assignee had written the applicable basic
30 restoration insurance, undertaken the self-insurance, or
19740H1973B3566 - 26 -
1 lawfully obligated itself to pay basic loss benefits.
2 (c) Time for presenting claims under assigned claims plan.--
3 (1) Except as provided in paragraph (2) of this
4 subsection, an individual authorized to obtain basic loss
5 benefits through the assigned claims plan shall notify the
6 assigned claims bureau of his claim within the time that
7 would have been allowed pursuant to section 106(c) of this
8 act for commencing an action for basic loss benefits against
9 any obligor, other than an assigned claims bureau, in any
10 case in which identifiable no-fault insurance coverage was in
11 effect and applicable to the claim.
12 (2) If timely action for basic loss benefits is
13 commenced against an obligor who is unable to fulfill his
14 obligations because of financial inability, an individual
15 authorized to obtain basic loss benefits through the assigned
16 claims plan shall notify the bureau of his claim within six
17 months after his discovery of such financial inability.
18 § 109. Rates.
19 (a) Rates and rating.--The commissioner shall regulate
20 obligors providing security covering a motor vehicle in this
21 Commonwealth. The rates charged for security shall be
22 established, determined, and modified only in accordance with
23 the provisions of the applicable rating law of this
24 Commonwealth.
25 (b) Public information.--The commissioner shall provide the
26 means to inform purchasers of insurance, in a manner adequate to
27 permit them to compare prices, about rates being charged by
28 insurers for no-fault benefits and tort liability coverage.
29 (c) Accountability program.--
30 (1) The commissioner, through the State vocational
19740H1973B3566 - 27 -
1 rehabilitation agency, shall establish and maintain a program
2 for the regular and periodic evaluation of medical and
3 vocational rehabilitation services for which reimbursement or
4 payment is sought from an obligor as an item of allowable
5 expense to assure that:
6 (A) the services are medical and vocational
7 rehabilitation services, as defined in section 103 of
8 this act;
9 (B) the recipient of the services is making progress
10 toward a greater level of independent functioning and the
11 services are necessary to such progress and continued
12 progress; and
13 (C) the charges for the services for which
14 reimbursement or payment is sought are fair and
15 reasonable.
16 Progress reports shall be made periodically in writing on each
17 case for which reimbursement or payment is sought under security
18 for the payment of basic loss benefits. Such reports shall be
19 prepared by the supervising physician or rehabilitation
20 counselor and submitted to the State vocational rehabilitation
21 agency. The State vocational rehabilitation agency shall file
22 reports with the applicable obligor or obligors. Pursuant to
23 this program, there shall be provision for determinations to be
24 made in writing of the rehabilitation goals and needs of the
25 victim and for the periodic assessment of progress at reasonable
26 time intervals by the supervising physician or rehabilitation
27 counselor.
28 (2) The commissioner is authorized to establish and
29 maintain a program for the regular and periodic evaluation of
30 this Commonwealth's no-fault plan for motor vehicle
19740H1973B3566 - 28 -
1 insurance.
2 (d) Availability of services.--The commissioner is
3 authorized to coordinate with appropriate government agencies in
4 the creation and maintenance of an emergency health services
5 system or systems, and to take all steps necessary to assure
6 that emergency health services are available for each victim
7 suffering injury in the Commonwealth. The commissioner is
8 authorized to take all steps necessary to assure that medical
9 and vocational rehabilitation services are available for each
10 victim resident of the Commonwealth. Such steps may include, but
11 are not limited to, guarantees of loans or other obligations of
12 suppliers or providers of such services, and support for
13 training programs for personnel in programs and facilities
14 offering such services.
15 § 110. Motor vehicles in interstate travel.
16 (a) General.--An owner of a motor vehicle who has complied
17 with the requirements of security covering a motor vehicle in
18 this Commonwealth shall be deemed to have complied with the
19 requirements for such security in any state in which such
20 vehicle is operating.
21 (b) Conforming coverage.--
22 (1) An obligor providing security for the payment of
23 basic loss benefits shall be obligated to provide, and each
24 contract of insurance for the payment of basic loss benefits
25 shall be construed to contain, coverage sufficient to satisfy
26 the requirements for security covering a motor vehicle in any
27 state in which any victim who is a claimant or whose
28 survivors are claimants is domiciled or is injured.
29 (2) An obligor providing security for the payment of
30 basic loss benefits shall include in each contract of
19740H1973B3566 - 29 -
1 insurance for the payment of basic loss benefits, coverage to
2 protect the owner or operator of a motor vehicle from tort
3 liability to which he is exposed through application of the
4 law of any state in which the motor vehicle may be operated
5 and arising out of the ownership, maintenance or use of a
6 motor vehicle.
7 (c) Applicable law.--
8 (1) The basic loss benefits available to any victim or
9 to any survivor of a deceased victim shall be determined
10 pursuant to the provisions of the state no-fault plan for
11 motor vehicle insurance in effect in the state of domicile of
12 the victim on the date when the motor vehicle accident
13 resulting in injury occurs. If there is no such state no-
14 fault plan in effect or if the victim is not domiciled in any
15 state, then basic loss benefits available to any victim shall
16 be determined pursuant to the provisions of the state no-
17 fault plan for motor vehicle insurance, if any, in effect in
18 the state in which the accident resulting in injury occurs.
19 (2) The right of a victim or of a survivor of a deceased
20 victim to sue in tort shall be determined by the law of the
21 state of domicile of such victim. If a victim is not
22 domiciled in a state, such right to sue shall be determined
23 by the law of the state in which the accident resulting in
24 injury or damage to property occurs.
25 § 111. Rights and duties of obligors.
26 (a) Reimbursement and subrogation.--
27 (1) Except as provided in paragraphs (2) and (3) of this
28 subsection, an obligor:
29 (A) does not have and may not contract, directly or
30 indirectly, in whole or in part, for a right of
19740H1973B3566 - 30 -
1 reimbursement from or subrogation to the proceeds of a
2 victim's claim for relief or to a victim's cause of
3 action for noneconomic detriment; and
4 (B) may not directly or indirectly contract for any
5 right of reimbursement based upon a determination of
6 fault from any other obligor not acting as a reinsurer
7 for no-fault benefits which it has paid or is obligated
8 to pay as a result of injury to a victim.
9 (2) Whenever an individual who receives or is entitled
10 to receive no-fault benefits for an injury has a claim or
11 cause of action against any other person causing the injury
12 as based upon a determination of fault, the obligor is
13 subrogated to the rights of the claimant only for:
14 (A) elements of damage compensated for by security
15 for the payment of no-fault benefits in excess of the
16 minimum basic loss benefits required under this act are
17 recoverable; and
18 (B) the obligor has paid or become obligated to pay
19 accrued or future no-fault benefits in excess of the
20 minimum basic loss benefits required under this act.
21 (3) Nothing in this subsection shall preclude any person
22 supplying or providing products, services, or accommodations
23 from contracting or otherwise providing for a right of
24 reimbursement to any basic restoration benefits for allowable
25 expense.
26 (4) IN NO EVENT SHALL ANY ENTITY PROVIDING BENEFITS <--
27 OTHER THAN NO-FAULT BENEFITS TO AN INDIVIDUAL AS DESCRIBED IN
28 SECTION 203 OF THIS ACT, HAVE ANY RIGHT OF SUBROGATION WITH
29 RESPECT TO SAID BENEFITS.
30 (b) Duty to pay basic loss benefits.--An obligor providing
19740H1973B3566 - 31 -
1 security for the payment of basic loss benefits shall pay or
2 otherwise provide such benefits without regard to fault to each
3 individual entitled thereto, pursuant to the terms and
4 conditions of this act.
5 (c) Indemnity.--An obligor has a right of indemnity against
6 an individual who has converted a motor vehicle involved in an
7 accident, or against an individual who has intentionally injured
8 himself or another individual, for no-fault benefits paid for:
9 (1) the loss caused by the conduct of that individual;
10 (2) the cost of processing the claims for such benefits;
11 and
12 (3) the cost of enforcing this right of indemnity,
13 including reasonable attorney's fees.
14 (d) Referral for rehabilitation services.--The obligor shall
15 promptly refer each victim to whom basic benefits are expected
16 to be payable for more than two months to the State vocational
17 rehabilitation agency.
18 ARTICLE II
19 RIGHT TO BENEFITS
20 § 201. Right to basic loss benefits; limitation on benefits.
21 (a) Accident within this State.--If the accident resulting
22 in injury occurs in this Commonwealth, any victim or any
23 survivor of a deceased victim is entitled to receive basic loss
24 benefits in accordance with the provisions of this act.
25 (b) Accident outside this State.--If the accident resulting
26 in injury occurs outside of this Commonwealth, a victim or a
27 survivor of a deceased victim is entitled to receive basic loss
28 benefits if such victim was or is:
29 (1) an insured; or
30 (2) the driver or other occupant of a secured vehicle.
19740H1973B3566 - 32 -
1 § 202. Basic loss benefits.
2 (a) Allowable expense limits.--Allowable expense, as defined
3 in section 103 of this act shall be provided or the equivalent
4 in the form of a contract to provide for services required.
5 (b) Work loss limits.--Work loss, as defined in section 103
6 may be provided at the option of the insured on the following: <--
7 (1) A monthly amount not to be less than the smallest of
8 the following: SHALL BE PROVIDED: <--
9 (1) UP TO A MONTHLY MAXIMUM OF:
10 (A) one thousand dollars ($1,000) multiplied by a
11 fraction whose numerator is the average per capita income
12 in this Commonwealth and whose denominator is the average
13 per capita income in the United States, according to the
14 latest available United States Department of Commerce
15 figures; or
16 (B) the disclosed amount, in the case of a named
17 insured who, prior to the accident resulting in injury,
18 voluntarily discloses his actual monthly earnings to his
19 obligor and agrees in writing with such obligor that such
20 sum shall measure work loss; and
21 (2) Such total amount not to exceed fifteen thousand <--
22 dollars ($15,000) per annum as agreed upon between the named
23 insured and his obligor provided such amount does not exceed
24 eighty per cent (80%) of the anticipated annual income of the
25 named insured.
26 (2) UP TO A TOTAL AMOUNT OF FIFTEEN THOUSAND DOLLARS <--
27 ($15,000).
28 (c) Replacement services losses.--Replacement services loss,
29 as defined in section 103 shall be provided the named insured <--
30 but shall not exceed the sum of twenty-five dollars ($25) per
19740H1973B3566 - 33 -
1 diem for specified periods of time not to exceed one year as
2 agreed upon between the named insured and his obligor. UP TO A <--
3 DAILY MAXIMUM OF TWENTY-FIVE DOLLARS ($25) FOR AN AGGREGATE
4 PERIOD OF ONE YEAR.
5 (d) Survivors losses.--Survivors loss, as defined in section
6 103 shall be provided in an amount not to exceed five thousand
7 dollars ($5,000).
8 (e) Deductibles; waiting period.--Allowable expense, work
9 loss and replacement services loss may include provisions to
10 provide:
11 (1) a deductible not to exceed one hundred dollars
12 ($100) for each individual; or
13 (2) with respect to work loss or replacement services
14 only, a waiting period not to exceed one week.
15 SUCH DEDUCTIBLE OR WAITING PERIOD SHALL BE ELECTED IN <--
16 WRITING UPON A FORM APPROVED BY THE INSURANCE COMMISSIONER
17 AND, IF ELECTED, SHALL BE EFFECTIVE ONLY AS AGAINST THE NAMED
18 INSURED AND HIS OR HER IMMEDIATE FAMILY.
19 § 203. Collateral benefits.
20 (a) (A) If benefits other than no-fault benefits are <--
21 provided to an individual through a program, group, contract or
22 other arrangement for which some other person pays in whole or
23 in part that would inure to the benefit of a victim or the
24 survivor of a deceased victim injured as a result of an accident
25 in the absence of no-fault benefits, then any reduction or
26 savings in the direct or indirect cost to such person of such
27 benefits resulting from the existence of no-fault benefits shall
28 be returned to such individual or utilized for his benefit.
29 (b) The owner or operator of a motor vehicle may elect to <--
30 provide for security in whole or in part for the payment of
19740H1973B3566 - 34 -
1 basic loss benefits through a program group, contract or other
2 arrangement that would pay to the victim or members of his
3 family residing with him or the survivor of a deceased victim,
4 allowable expense, loss of income, work loss, replacement
5 services loss and survivors loss. In all such instances, each
6 contract of insurance issued by an insurer shall be construed to
7 contain a provision that all basic loss benefits provided
8 therein shall be in excess of any valid and collectible benefits
9 otherwise provided through such program, group, contract or
10 other arrangement as designated at the election of the owner or
11 operator which shall be primary.
12 (c) An insurer providing basic loss benefits and tort
13 liability in accord with the provisions of subsection (b) above
14 shall reduce the cost of such contract of insurance to reflect
15 the anticipated reduction in basic loss benefits payable by the
16 insurer by reason of the election of the owner or operator to
17 provide substitute security.
18 (B) THE OWNER OR OPERATOR OF A MOTOR VEHICLE MAY ELECT TO <--
19 PROVIDE FOR SECURITY IN WHOLE OR IN PART FOR THE PAYMENT OF
20 BASIC LOSS BENEFITS THROUGH A PROGRAM, GROUP, CONTRACT OR OTHER
21 ARRANGEMENT THAT WOULD PAY TO OR ON BEHALF OF THE VICTIM OR
22 MEMBERS OF HIS FAMILY RESIDING WITH HIM OR THE SURVIVOR OF A
23 DECEASED VICTIM, ALLOWABLE EXPENSE, LOSS OF INCOME, WORK LOSS,
24 REPLACEMENT SERVICES LOSS AND SURVIVORS LOSS. IN ALL SUCH
25 INSTANCES, EACH CONTRACT OF INSURANCE ISSUED BY AN INSURER SHALL
26 BE CONSTRUED TO CONTAIN A PROVISION THAT ALL BASIC LOSS BENEFITS
27 PROVIDED THEREIN SHALL BE IN EXCESS OF ANY VALID AND COLLECTIBLE
28 BENEFITS OTHERWISE PROVIDED THROUGH SUCH PROGRAM, GROUP,
29 CONTRACT OR OTHER ARRANGEMENT AS DESIGNATED AT THE ELECTION OF
30 THE OWNER OR OPERATOR WHICH SHALL BE PRIMARY.
19740H1973B3566 - 35 -
1 (C) AN INSURER PROVIDING BASIC LOSS BENEFITS AND TORT
2 LIABILITY IN ACCORDANCE WITH THE PROVISIONS OF SUBSECTION (B)
3 ABOVE SHALL REDUCE THE COST OF SUCH CONTRACT OF INSURANCE TO
4 REFLECT THE ANTICIPATED REDUCTION IN BASIC LOSS BENEFITS PAYABLE
5 BY THE INSURER BY REASON OF THE ELECTION OF THE OWNER OR
6 OPERATOR TO PROVIDE SUBSTITUTE SECURITY.
7 § 204. Source of basic restoration benefits.
8 (a) Applicable security.--The security for the payment of
9 basic loss benefits applicable to an injury to:
10 (1) an employee, or to the spouse or other relative of
11 any employee residing in the same household as the employee,
12 if the accident resulting in injury occurs while the victim
13 or deceased victim is driving or occupying a motor vehicle
14 furnished by such employee's employer, is the security for
15 the payment of basic loss benefits covering such motor
16 vehicle or, if none, any other security applicable to such
17 victim;
18 (2) an insured is the security under which the victim or
19 deceased victim is insured;
20 (3) the driver or other occupant of a motor vehicle
21 involved in an accident resulting in injury who is not an
22 insured is the security covering such vehicle;
23 (4) an individual who is not an insured or the driver or
24 other occupant of a motor vehicle involved in an accident
25 resulting in injury is the security covering any motor
26 vehicle involved in such accident. For purposes of this
27 paragraph, a parked and unoccupied motor vehicle is not a
28 motor vehicle involved in an accident, unless it was parked
29 so as to cause unreasonable risk of injury; and
30 (5) any other individual is the applicable assigned
19740H1973B3566 - 36 -
1 claims plan.
2 (b) Multiple sources of equal property.--If two or more
3 obligations to pay basic loss benefits apply equally to an
4 injury under the priorities set forth in subsection (a) of this
5 section, the obligor against whom a claim is asserted first
6 shall process and pay the claim as if wholly responsible. Such
7 obligor is thereafter entitled to recover contribution pro rata
8 from any other such obligor for the basic loss benefits paid and
9 for the costs of processing the claim. If contribution is sought
10 among obligors responsible under paragraph (4) of subsection (a)
11 of this section proration shall be based on the number of
12 involved motor vehicles.
13 § 205. Work loss.
14 (a) Regularly employed.--The work loss of a victim whose
15 income prior to the injury was realized in regular increments
16 shall be calculated by:
17 (1) determining his probable weekly income by dividing
18 his probable annual income by fifty-two; and
19 (2) multiplying that quantity by the number of work
20 weeks, or fraction thereof, the victim sustains loss of
21 income during the accrual period.
22 (b) Seasonally employed.--The work loss of a victim whose
23 income is realized in irregular increments shall be calculated
24 by:
25 (1) determining his probable weekly income by dividing
26 his probable annual income by the number of weeks he normally
27 works; and
28 (2) multiplying that quantity by the number of work
29 weeks, or fraction thereof, the victim was unable to perform
30 and would have performed work during the accrual period but
19740H1973B3566 - 37 -
1 for the injury.
2 (c) Not employed.--The work loss of a victim who is not
3 employed when the accident resulting in injury occurs shall be
4 calculated by:
5 (1) determining his probable weekly income by dividing
6 his probable annual income by fifty-two; and
7 (2) multiplying that quantity by the number of work
8 weeks, or fraction thereof, if any, the victim would
9 reasonably have been expected to realize income during the
10 accrual period.
11 (d) Definitions.--As used in this section:
12 "Probable annual income" means, absent a showing that it is
13 or would be some other amount, the following:
14 (A) twelve times the monthly gross income earned by
15 the victim from work in the month preceding the month in
16 which the accident resulting in injury occurs, or the
17 average annual income earned by the victim from work
18 during the years, not to exceed three, preceding the year
19 in which the accident resulting in injury occurs,
20 whichever is greater, for a victim regularly employed at
21 the time of the accident;
22 (B) the average annual gross income earned by the
23 victim from work during the years in which he was
24 employed, not to exceed three, preceding the year in
25 which the accident resulting in injury occurs, for a
26 victim seasonally employed or not employed at the time of
27 the accident; or
28 (C) the average annual gross income of a production
29 or nonsupervisory worker in the private nonfarm economy
30 in the State in which the victim is domiciled for the
19740H1973B3566 - 38 -
1 year in which the accident resulting in injury occurs,
2 for a victim who has not previously earned income from
3 work.
4 "Work week" means the number of days an individual normally
5 works in a seven-day period; "weekly income" means income earned
6 during a work week.
7 § 206. Net loss.
8 (a) General.--Except as provided in section 108(a)(3) of
9 this act, all benefits or advantages (less reasonably incurred
10 collection costs) that an individual receives or is entitled to
11 receive from social security (except those benefits provided
12 under Title XIX of the Social Security Act AND EXCEPT THOSE <--
13 MEDICARE BENEFITS TO WHICH A PERSON'S ENTITLEMENT DEPENDS UPON
14 USE OF HIS SO-CALLED "LIFE-TIME RESERVE" OF BENEFIT DAYS)
15 workmen's compensation, any State-required temporary,
16 nonoccupational disability insurance, and all other benefits
17 (except the proceeds of life insurance) received by or available
18 to an individual because of the injury from any government,
19 unless the law authorizing or providing for such benefits or
20 advantages makes them excess or secondary to the benefits in
21 accordance with this act, shall be subtracted from loss in
22 calculating net loss.
23 (b) Tax deduction.--If a benefit or advantage received to
24 compensate for loss of income because of injury, whether from
25 no-fault benefits or from any source of benefits or advantages
26 subtracted under subsection (a) of this section, is not taxable
27 income, the income tax saving that is attributable to such loss
28 of income because of injury is subtracted in calculating net
29 loss for work loss. Subtraction may not exceed twenty per cent
30 (20%) of the loss of income and shall be in such lesser amount
19740H1973B3566 - 39 -
1 as the insurer reasonably determines is appropriate based on a
2 lower value of the income tax advantage.
3 § 207. Added loss benefits.
4 (a) Mandatory offering.--Obligors providing security for the
5 payment of basic loss benefits shall offer or obligate
6 themselves to provide added loss benefits for injury or damage
7 arising out of the ownership, maintenance, or use of a motor
8 vehicle, including:
9 (1) loss excluded from basis BASIC loss benefits by <--
10 limits on allowable expense, work loss, replacement services
11 loss, and survivor's loss;
12 (2) benefits for damage to property;
13 (3) benefits for loss of use of a motor vehicle;
14 (4) benefits for expense for remedial religious
15 treatment and care;
16 (5) for physical damage to a motor vehicle, a coverage
17 for all collision and upset damage, subject to an optional
18 deductible; and
19 (6) for economic detriment, a coverage for work loss
20 sustained by a victim in excess of limitations on basic loss
21 benefits for work loss.
22 (b) Additional loss coverage.--Subject to the approval of
23 terms and forms by the commissioner, obligors may offer or
24 obligate themselves to provide other added loss coverages.
25 The commissioner may adopt rules requiring that insurers
26 providing basic loss insurance offer, in accordance with this
27 act, any other specified added loss coverages and promulgate
28 regulations with respect thereto.
29 § 208. Ineligible claimants.
30 (a) Converter.
19740H1973B3566 - 40 -
1 (1) Except as provided for assigned claims, a converter
2 of a motor vehicle is ineligible to receive no-fault
3 benefits, including benefits otherwise due him as a survivor,
4 from any source other than a contract of insurance under
5 which he is an insured, for any injury arising out of the
6 maintenance or use of the converted vehicle. If a converter
7 dies from such injuries, his survivor or survivors are not
8 entitled to no-fault benefits for survivor's loss from any
9 source other than a contract of insurance under which the
10 converter is an insured.
11 (2) For purposes of this subsection and subsection (c)
12 of section 111 of this act, an individual is not a converter
13 of a motor vehicle if he used it in the good faith belief
14 that he was legally entitled to do so.
15 (b) Intentional injuries.
16 (1) An individual who intentionally injures himself or
17 another individual is ineligible to receive no-fault benefits
18 for injury arising out of his acts, including benefits
19 otherwise due him as a survivor. If an individual dies as a
20 result of intentionally injuring himself, his survivor or
21 survivors are not entitled to no-fault benefits for
22 survivor's loss. An individual intentionally injures himself
23 or another individual if he acts or fails to act for the
24 purpose of causing such injury or with knowledge that such
25 injury is substantially certain to follow. An individual does
26 not intentionally injure himself or another individual:
27 (A) merely because his act or failure to act is
28 intentional or done with his realization that it creates
29 a grave risk of causing injury; or
30 (B) if the act or omission causing the injury is for
19740H1973B3566 - 41 -
1 the purpose of averting bodily harm to himself or another
2 individual.
3 (2) For purposes of section 111(c) and section 206 of
4 this act, an individual does not intentionally injure himself
5 or another individual merely because his act or failure to
6 act is intentional or done with his realization that it
7 creates a grave risk of harm.
8 § 209. Other provisions.
9 (a) Included coverage.--A contract of insurance covering
10 liability arising out of the ownership, maintenance, or use of a
11 motor vehicle registered in this Commonwealth, shall include
12 basic loss benefits and any other benefit coverages required by
13 the no-fault plan for motor vehicle insurance in effect in this
14 Commonwealth unless such contract provides tort liability
15 coverages only in excess of any of those required by the no-
16 fault plan.
17 (b) Approval of terms and forms.--Terms and conditions
18 (including forms used by insurers) of any contract, certificate,
19 or other evidence of insurance sold or issued pursuant to this
20 State's no-fault plan for motor vehicle insurance in accordance
21 with this act and providing no-fault benefits or any required
22 tort liability are subject to approval and regulation by the
23 commissioner. The commissioner shall approve only terms and
24 conditions which are consistent with the purposes of this act
25 and fair and equitable to all persons whose interests may be
26 affected. The commissioner may reasonably limit by rule the
27 variety of coverage available in order to give purchasers of
28 insurance a reasonable opportunity to compare the cost of
29 insuring with various insurers.
30 ARTICLE III
19740H1973B3566 - 42 -
1 TORT LIABILITY
2 § 301. Tort liability.
3 (a) Partial abolition.--Tort liability is abolished with
4 respect to any injury that takes place in this State in
5 accordance with the provisions of this act if such injury arises
6 out of the maintenance or use of a motor vehicle, except that--
7 (1) An owner of a motor vehicle involved in an accident
8 remains liable if, at the time of the accident, the vehicle
9 was not a secured vehicle.
10 (2) A person in the business of designing,
11 manufacturing, repairing, servicing, or otherwise maintaining
12 motor vehicles remains liable for injury arising out of a
13 defect in such motor vehicle which is caused or not corrected
14 by an act or omission in the course of such business, other
15 than a defect in a motor vehicle which is operated by such
16 business.
17 (3) An individual remains liable for intentionally
18 injuring himself or another individual.
19 (4) A person remains liable for loss which is not
20 compensated because of any limitation in accordance with
21 section 202 (a), (b), (c) or (d) of this act. A person is not
22 liable for loss which is not compensated because of
23 limitations in accordance with subsection (e) of section 202
24 of this act.
25 (5) A person remains liable for damages for non-economic
26 detriment if the accident results in:
27 (A) death or serious and permanent injury; or
28 (B) the reasonable value of reasonable and necessary
29 medical and dental services, any nonmedical remedial care <--
30 and treatment rendered in accordance with a recognized
19740H1973B3566 - 43 -
1 religious method of healing, including prosthetic devices
2 and necessary ambulance, hospital and professional
3 nursing expenses incurred in the diagnosis, care and
4 recovery of the victim, exclusive of diagnostic x-ray
5 costs and rehabilitation costs in excess of one hundred
6 dollars ($100) are determined to be IS in excess of seven <--
7 hundred fifty dollars ($750). or FOR PURPOSES OF THIS <--
8 SUBCLAUSE, THE REASONABLE VALUE OF HOSPITAL ROOM AND
9 BOARD SHALL BE THE AMOUNT DETERMINED BY THE DEPARTMENT OF
10 HEALTH TO BE THE AVERAGE DAILY RATE CHARGED FOR A SEMI-
11 PRIVATE HOSPITAL ROOM AND BOARD COMPUTED FROM SUCH
12 CHARGES BY ALL HOSPITALS IN THE COMMONWEALTH; OR
13 (C) medically determinable physical or mental
14 impairment which prevents the victim from performing all
15 or substantially all of the material acts and duties
16 which constitute his usual and customary daily activities
17 and which continues for more than sixty consecutive days;
18 or
19 (D) injury which in whole or in part consists of
20 cosmetic disfigurement which is permanent, irreparable
21 and severe.
22 (6) A PERSON REMAINS LIABLE FOR INJURY ARISING OUT OF A <--
23 MOTORCYCLE ACCIDENT TO THE EXTENT THAT SUCH INJURY IS NOT
24 COVERED BY BASIC LOSS BENEFITS PAYABLE UNDER THIS ACT, AS
25 DESCRIBED IN SECTION 103.
26 (b) Nonreimbursable tort fine.--Nothing in this section
27 shall be construed to immunize an individual from liability to
28 pay a fine on the basis of fault in any proceeding based upon
29 any act or omission arising out of the maintenance or use of a
30 motor vehicle: Provided, That such fine may not be paid or
19740H1973B3566 - 44 -
1 reimbursed by an insurer or other restoration obligor.
2 § 302. Comparative negligence rule. <--
3 (a) In general.--Contributory negligence shall not bar
4 recovery in any action by any person or his legal representative
5 to recover damages for negligence resulting in death or in
6 injury to person or property arising out of a motor vehicle
7 accident, if such negligence was not as great as the negligence
8 of the person against whom recovery is sought, but any damages
9 allowed shall be diminished in proportion to the amount of
10 negligence attributable to the person for whose injury, damage
11 or death recovery is made.
12 (b) Findings.--In any action to which subsection (a) of this
13 section applies, the court, in a nonjury trial, shall make
14 findings of fact or, in a jury trial, the jury shall return a
15 special verdict which shall state:
16 (1) The amount of the damages which would have been
17 recoverable if there had been no negligence on the part of
18 the party bringing the action; and
19 (2) The degree of negligence of each party, expressed as
20 a percentage.
21 (c) Reduction of verdict.--Upon the making of the findings
22 of fact or the return of a special verdict, as is contemplated
23 by subsection (b) above, the court shall reduce the amount of
24 the verdict in proportion to the amount of negligence
25 attributable to the person for whose injury, damage or death
26 recovery is made, however, if the said proportion is equal to or
27 greater than the negligence of the person against whom recovery
28 is sought, then, in such event, the court will enter a judgment
29 for the defendant.
30 ARTICLE IV
19740H1973B3566 - 45 -
1 EXAMINATION, TREATMENT AND REHABILITATION OF
2 INJURED PERSONS; DISCOVERY
3 § 401. Examination.
4 Whenever the mental or physical condition of a person is
5 material to any claim that has been or may be made for past or
6 future basic loss benefits, a court of competent jurisdiction
7 may order the person to submit to mental or physical examination
8 by a physician or physicians. The order may be made only on the
9 motion for good cause shown and upon notice to the person to be
10 examined and to all other persons having an interest and shall
11 specify the time, place, manner, conditions, and scope of the
12 examination and the person or persons by whom it is to be made.
13 § 402. Report of examination.
14 If requested by the person examined, a party causing an
15 examination to be made shall deliver to him a copy of every
16 written report concerning the examination rendered by an
17 examining physician, at least one of which reports must set out
18 his findings and conclusions in detail. After such request and
19 delivery, the party causing the examination to be made is
20 entitled upon request to receive from the person examined every
21 written report available to him (or his representative)
22 concerning any examination, previously or thereafter made, of
23 the same mental or physical condition. By requesting and
24 obtaining a report of the examination so ordered or by taking
25 the deposition of the examiner, the person examined waives any
26 privilege he may have, in relation to the claim for basic loss
27 benefits, regarding the testimony of every other person who has
28 examined or may thereafter examine him in respect of the same
29 mental or physical condition.
30 § 403. Refusal to comply.
19740H1973B3566 - 46 -
1 If any person refuses to comply with an order entered
2 pursuant to sections 401 and 402, the court may make such orders
3 in regard to the refusal as are just, except that no order shall
4 be entered directing the arrest of any person for disobeying an
5 order to submit to a physical or mental examination. The orders
6 that may be made in regard to such a refusal include, but are
7 not limited to, the following:
8 (1) An order that the mental or physical condition of
9 the disobedient person shall be taken to be established for
10 the purposes of the claim in accordance with the contention
11 of the party obtaining the order.
12 (2) An order refusing to allow the disobedient person to
13 support or oppose designated claims or defenses, or
14 prohibiting him from introducing evidence of mental or
15 physical condition.
16 (3) An order rendering judgment by default against the
17 disobedient person as to his entire claim or a designated
18 part of it.
19 (4) An order requiring the disobedient person to
20 reimburse the obligor for reasonable attorney's fees and
21 expenses incurred in defense against the claim.
22 (5) An order requiring delivery of a report, in
23 conformity with section 402 on such terms as are just, and if
24 a physician fails or refuses to make such a report a court
25 may exclude his testimony if offered at trial.
26 § 404. Court order; obligor reponsibility.
27 (a) Court order.--After a hearing upon application by any
28 interested person and reasonable notice to all other interested
29 persons, and upon findings supported by evidence, a court of
30 competent jurisdiction may enter an order determining that an
19740H1973B3566 - 47 -
1 obligor of basic loss benefits applicable to an injury is
2 responsible, subject to the limits and other terms and
3 conditions of the coverage, for the cost of a specified
4 procedure or treatment for rehabilitation to which the injured
5 person has submitted or does thereafter submit.
6 (b) Findings.--The findings required to support such an
7 order are:
8 (1) that the specified course of procedure or treatment,
9 whether or not involving surgery, is recognized and
10 acceptable medically or is acceptable nonmedical remedial
11 Christian Science treatment and care;
12 (2) that it has contributed or will contribute
13 substantially to rehabilitation; and
14 (3) that the cost of such procedure or treatment is
15 reasonable in relation to its probable rehabilitative
16 effects.
17 § 405. Court order; rehabilitative training.
18 (a) Court order.--After a hearing upon application by any
19 interested person and reasonable notice to all other interested
20 persons, and upon findings supported by evidence, a court of
21 competent jurisdiction may enter an order determining that an
22 obligor of basic loss benefits applicable to an injury is
23 responsible, subject to the limits and other terms and
24 conditions of the coverage, for the cost of a specified course
25 of rehabilitative occupational training that the injured person
26 has taken or does thereafter take.
27 (b) Findings.--The findings required to support such an
28 order are:
29 (1) that the specified course of occupational training
30 is a recognized form of training and is reasonable and
19740H1973B3566 - 48 -
1 appropriate for the particular case;
2 (2) that it has contributed or will contribute
3 substantially to rehabilitation; and
4 (3) that the cost of such training is reasonable in
5 relation to its probable rehabilitative effects.
6 § 406. Compliance with court order.
7 (a) Order of Compliance.--After a hearing upon application
8 by any interested person and reasonable notice to all other
9 interested persons, and upon findings, supported by evidence, as
10 stated in section 404 or section 405, and further findings:
11 (1) that the injured person has refused or has by his
12 conduct caused the obligor reasonably to believe that he may
13 refuse to submit to such procedure, treatment, or training;
14 and
15 (2) that he does not have reasonable grounds to continue
16 such refusal, a court of competent jurisdiction may enter an
17 order invoking reasonable sanctions against the injured
18 person and others whose claims are based on his injury.
19 (b) Refusal to comply.--In determining whether an injured
20 person has reasonable grounds for continuing refusal to submit
21 to the specified procedure, treatment, or training, the court
22 shall take into account, among all other relevant factors, the
23 extent of the probable benefit, the attendant risks, the extent
24 to which the procedure, treatment, or training is or is not
25 recognized as standard and customary, and whether the imposition
26 of sanctions because of the injured person's refusal would
27 abridge his constitutional rights.
28 (c) Sanctions.--The sanctions that may be invoked in such an
29 order include, but are not limited to, the following:
30 (1) An order that benefits be reduced or terminated at
19740H1973B3566 - 49 -
1 such time as necessary to limit recovery of benefits to an
2 amount equal to the benefits that in reasonable probability
3 would have been due had the injured person submitted to such
4 rehabilitative procedure, treatment, or training.
5 (2) An order that the physical or mental condition of
6 the injured person shall be taken to be established for the
7 purposes of the claim in accordance with the contention of
8 the insurer.
9 (3) An order that, if the insurer elects to pay a
10 specified lump sum (found to be fair and reasonable
11 compensation in lieu of benefits that in reasonable
12 probability would be due if the injured person submitted to
13 the specified procedure, treatment, or training) it shall be
14 fully discharged from all liability arising from the injury.
15 § 407. Customary charges for treatment.
16 Any physician, hospital, clinic, or other person or
17 institution lawfully rendering treatment to an injured person
18 for an injury covered by basic loss benefits, and any person or
19 institution providing rehabilitative occupational training
20 following such an injury, may charge a reasonable amount for the
21 products, services and accommodations rendered. In no event,
22 however, may a charge by any person or institution be in excess
23 of the amount the person or institution customarily charges for
24 like products, services, and accommodations in cases involving
25 no insurance.
26 § 408. Earnings statement.
27 (a) Statement from employer.--Every employer shall, if a
28 request is made by a basic loss obligor against whom a claim has
29 been made, furnish forthwith, in a form approved by the
30 commissioner, a sworn statement of earnings, since injury and
19740H1973B3566 - 50 -
1 for a reasonable period before injury, of the person upon whose
2 injury the claim is based.
3 (b) Medical records.--Every physician, hospital, clinic, or
4 other medical institution providing, before or after an injury
5 upon which a claim for basic or added loss benefits is based,
6 any products, services, or accommodations in relation to that or
7 any other injury, or in relation to a condition claimed to be
8 connected with that or any other injury, shall, if requested to
9 do so by the obligor against whom the claim has been made,
10 subject to conditions approved by the commissioner:
11 (1) furnish forthwith a written report of the history,
12 condition, treatment, and dates and costs of such treatment
13 of the injured person that are in connection with the injury
14 involved for which claim is being made; and
15 (2) produce forthwith and permit the inspection and
16 copying of his or its records regarding such history,
17 condition, treatment, and dates and costs of treatment that
18 are in connection with the injury involved for which claim is
19 being made.
20 (c) Cost of reports.--An employer, physician, hospital,
21 clinic, or other person or institution providing information in
22 response to a request under the terms of this section may charge
23 a reasonable amount in reimbursement for the time and cost of
24 providing the information.
25 (d) Discovery.--In the event of any dispute regarding an
26 insurer's right to discovery of facts about an injured person's
27 earnings or about his history, condition, treatment, and dates
28 and costs of such treatment, a court of competent jurisdiction
29 may enter an order for such discovery. The order may be made
30 only on motion for good cause shown and upon notice to all
19740H1973B3566 - 51 -
1 persons having an interest, and it shall specify the time,
2 place, manner, conditions, and scope of the discovery. A court
3 may, in order to protect against annoyance, embarrassment, or
4 oppression, as justice requires, enter an order refusing
5 discovery or specifying conditions of discovery and may order
6 payments of costs and expenses of the proceeding, including
7 reasonable fees for the appearance of attorneys at the
8 proceedings, as justice requires.
9 ARTICLE V
10 UNINSURED MOTORISTS, ANTI-DISCRIMINATION, SECURITY REQUIRED
11 CANCELLATION, SUBROGATION, DECLARATORY JUDGMENT, RATE <--
12 REDUCTION, SELF INSURANCE, TERMINATION OF SECURITY,
13 CONSUMER INFORMATION, SEVERABILITY, PRECLUSION OF PLEADING <--
14 § 501. Uninsured motorists.
15 The obligor obligated to pay basic loss benefits for
16 accidental bodily injury to a person occupying a motor vehicle,
17 the owner of which is uninsured pursuant to this act or to the
18 spouse or relative resident in the household of the owner or
19 registrant of such motor vehicle, shall be entitled to recover
20 all the benefits paid and appropriate loss adjustments costs
21 incurred from the owner or registrant of such motor vehicle or
22 from his estate. The failure of the person to make payment
23 within thirty days shall be grounds for suspension or revocation
24 of his motor vehicle registration and operator's license.
25 § 502. Anti-discrimination.
26 There shall be no unfair discrimination by insurers in
27 eligibility rules and underwriting practices by reason of race,
28 religion, nationality or ethnic group, age, sex, family size,
29 occupation, place of residence or marital status. The terms
30 "eligibility rules and underwriting practices" do not include
19740H1973B3566 - 52 -
1 the making or promulgation of rates if made and promulgated in
2 accordance with the appropriate rate regulatory act of this
3 Commonwealth and regulations pursuant thereto as promulgated by
4 the commissioner.
5 § 503. Declaratory judgments. <--
6 Because of the high costs involved in changing the existing
7 system and putting into operation the provisions of this act and
8 to eliminate uncertainties, the Supreme Court of Pennsylvania
9 shall render a declaratory judgment under the act of June 18,
10 1923 (P.L.840, No.321), known as the Uniform Declaratory
11 Judgments Act on petition of any interested party on the
12 constitutionality of this act and particularly as to the
13 provisions of section 301.
14 § 504 503. Separability. <--
15 If any provision in section 301 of this act, or any <--
16 application thereof to any individual or circumstance, is held
17 invalid, this act shall be interpreted as if such provision had
18 never been enacted. THE PROVISIONS OF THIS ACT ARE SEVERABLE, <--
19 EXCEPT THAT THE PROVISIONS OF SECTION 301(A) ARE EXPRESSLY MADE
20 INSEVERABLE.
21 § 505 504. Policy requirements and premium changes. <--
22 (a) Requirements for writing insurance.--All insurers
23 licensed in this Commonwealth and desiring to qualify to write
24 insurance applicable to motor vehicle accidents subsequent to
25 the effective date of this act, shall, as a condition of
26 qualifications, prepare and file policy forms and insurance
27 rates, for coverages effected by this act. Such policy forms and
28 rates shall be filed with the office of the Insurance
29 Commissioner of this Commonwealth within three months from
30 enactment hereof.
19740H1973B3566 - 53 -
1 (b) Initial premium charges.--The premiums charged by any
2 insurer during the first twelve-month period following the
3 effective date of this act for basic loss insurance benefits
4 together with security required for the payment of tort
5 judgments shall not exceed eighty-five per cent (85%) of the
6 combined premiums for:
7 (1) bodily injury liability insurance for the same
8 limits required in this act; and
9 (2) medical payments insurance in the amount of one
10 thousand dollars ($1,000) approved by the commissioner for
11 any insurer and in effect on the date this act becomes
12 effective.
13 (C) LIMITATION ON PREMIUM INCREASES.--NO INSURER SHALL <--
14 INCREASE THE PREMIUM RATE OF AN OWNER OF A POLICY SOLELY BECAUSE
15 ONE OR MORE OF THE NAMED INSUREDS UNDER THE POLICY MADE A CLAIM
16 UNDER THE POLICY AND WAS PAID THEREON UNLESS IT IS DETERMINED
17 THAT THE NAMED INSURED WAS AT FAULT IN CONTRIBUTING TO THE
18 ACCIDENT GIVING RISE TO THE CLAIM. THE INSURANCE COMMISSIONER
19 SHALL PROMULGATE RULES AND REGULATIONS ESTABLISHING GUIDELINES
20 AND PROCEDURES FOR DETERMINING FAULT OF AN INSURED FOR THE
21 PURPOSES OF THIS SUBSECTION.
22 § 506 505. Roll on benefits. <--
23 It is prohibited for any obligor, in effecting the renewal of
24 any automobile insurance policy or in amending any automobile
25 insurance policy to conform to the provisions of this act, to
26 add on any no-fault benefits in excess of the minimum benefits
27 required or to increase the limits of tort liability insurance
28 required under this act without the prior written consent of the
29 insured in agreement thereto.
30 ARTICLE VI
19740H1973B3566 - 54 -
1 PENALTIES
2 § 601. Operation of a vehicle without security.
3 Any owner of a passenger vehicle, for which the existence of
4 security for basic loss benefits and tort liability insurance is
5 a requirement for its legal operation upon the public highways
6 of this State, under either section 104 or 110 of this act or
7 sections 418, 419 or 420, act of April 29, 1959 (P.L.58, No.32),
8 known as The Vehicle Code, who operates such motor vehicle or
9 permits it to be operated upon a public highway in this State
10 without having in full force and effect security complying with
11 the terms of section 104 is guilty of a misdemeanor. And any
12 other person who operates such a motor vehicle upon a public
13 highway in this Commonwealth with the knowledge that the owner
14 does not have such security in full force and effect is guilty
15 of a misdemeanor. And each person convicted of a misdemeanor
16 under the terms of this section may be fined not less than one
17 hundred dollars ($100) or more than five hundred dollars ($500)
18 or may be imprisoned for not more than six months or both.
19 § 602. Excessive charges.
20 Any person who charges, demands, receives or collects for
21 hospital or medical products, services or accommodations
22 rendered in the treatment of an injured person or for
23 rehabilitative occupational training or for legal services
24 rendered in connection with a claim for basic loss benefits, any
25 amount in excess of that authorized by this act with awareness
26 that the charge is in excess of that authorized is guilty of a
27 misdemeanor and upon conviction may be fined not less than one
28 hundred dollars ($100) or more than five hundred dollars ($500)
29 or may be imprisoned for not more than six months or both.
30 § 603. Violations by obligor.
19740H1973B3566 - 55 -
1 Any obligor who shall advertise, offer or contract for, or
2 otherwise provide for no-fault benefits or tort liability
3 insurance coverages required by this act, and who, by a pattern
4 of business transactions violates any of the provisions of this
5 act, shall be guilty of a summary offense and upon conviction
6 thereof shall be sentenced to pay a fine of not more than one
7 thousand dollars ($1,000) for each violation.
8 ARTICLE VII
9 EFFECTIVE DATE
10 § 701. Effective date.
11 This act shall take effect in six TWELVE months: Provided, <--
12 however, That section 503 and subsection (a) of section 505 504 <--
13 shall take effect immediately.
B18L37RC/19740H1973B3566 - 56 -