State Comparisons

Summary: The state no-fault plans outlined on these pages provide no-fault benefits in the form of additional first-party coverage, but, unlike in true no-fault states, do not strongly restrict the right to sue. They are often referred to as add-on no-fault plans. Because the use of tort liability is not fully impaired, these plans, for purposes of this discussion, are classed as expanded medical payments and disability benefits rather than modified no-fault plans. The modified no-fault plans are discussed elsewhere in this section. New Hampshire, Virginia, and Wisconsin are also add-on states, although there are no specific add-on endorsements for these states.

States covered:
Arkansas
Delaware
Maryland
Oregon
Pennsylvania
South Dakota
Texas
Washington

Arkansas

The Arkansas no-fault law became effective on July 1, 1974 and applies to any private passenger motor vehicle in the state. Form PP 05 82 10 07 provides no-fault coverage. On that form, “private passenger motor vehicle” is defined as private passenger vehicles, station wagons, jeeps, pickups or vans not used for business purposes (other than farming or ranching), and motorcycles. The term does not include a vehicle used as a public or livery conveyance. The no-fault coverage is for the named insured or any family member who sustains bodily injury while occupying, or as a pedestrian when struck by, a motor vehicle. Also covered as an insured is any other person who sustains bodily injury while occupying, or as a pedestrian when struck by, the named insured's covered auto. Any other person is also considered an insured (though not for work loss or accidental death benefits) if he sustains bodily injury while occupying a motor vehicle other than the named insured's covered auto if the injury results from the use of the motor vehicle by the named insured, operation of the motor vehicle by the named insured's private chauffeur or domestic servant on behalf of the named insured, or from the use of the motor vehicle by a family member (if the motor vehicle is a private passenger auto or trailer).

No coverage is provided for bodily injury sustained by any insured while operating the named insured's covered auto without express or implied consent or while not in lawful possession of the covered auto. The form also excludes duplicate payments for medical payments or work loss benefits. And, the form contains the standard furnished or available for the regular use of exclusions, as well as the war and nuclear material exclusions.

The basic benefits offered under PP 05 82, subject to the limits shown in the schedule, are medical payments, work loss, and accidental death benefits. Medical payments benefits apply to reasonable and necessary medical and hospital expenses incurred within two years from the date of the accident (a hospital room charge is limited to the semiprivate room rate). Loss of income is covered for 70 percent of the loss of gross income for an income earner, not to exceed $140 a week for a period not to exceed fifty-two weeks and is subject to an eight-day waiting period before payments can begin. Also subject to this eight-day waiting period is a $70 a week payment to a nonincome earner for essential services, which are ordinary and necessary services in lieu of those that the injured person would have performed, not for income but for the benefit of himself or his family had he not sustained the injury. This payment is not to exceed a fifty-two week period. The accidental death benefit is $5,000 per person paid if bodily injury resulting from the accident causes the death of an insured within one year from the date of the accident.

If a duly licensed auto dealer provides a motor vehicle to the named insured for use as a temporary substitute while the covered auto is out of use because of a breakdown or repair, the personal injury benefits extend to that loaned vehicle. The extent of the coverage is equal to that which exists for the covered auto.

A few definitions on PP 05 82 warrant mention. “Your covered auto” means a motor vehicle shown in the schedule of the endorsement, including a private passenger auto not owned by the named insured while used as a temporary substitute and a trailer designed for use with a private passenger auto. A “motor vehicle” means a land motor vehicle, trailer, or semitrailer, but does not include a farm tractor or other equipment designed for use mainly off public roads, vehicles operated upon rails or crawler treads, or vehicles located for use as a residence or premises.

Delaware

The no-fault law in Delaware became effective on January 1, 1972 and applies to all motor vehicles registered in the state. No-fault coverage can be arranged through the use of PP 05 56 09 97. Coverage applies to any person injured while occupying the named insured's covered auto and to any other person injured in an accident involving the covered auto, other than an occupant of another motor vehicle. The coverage is also applicable to the named insured and any family member injured while a pedestrian or while occupying any motor vehicle. With respect to personal injury protection coverage, the “named insured's covered auto” means a motor vehicle owned by the named insured to which the bodily injury liability coverage of the auto policy applies and that is registered in Delaware.

Medical expense benefits under the no-fault law are payable to insureds for reasonable and necessary expenses incurred within two years from the date of the accident. Medical expenses, funeral expenses, income loss, and substitute service expenses sustained by an insured as the result of any one accident are paid on the basis of no more than $15,000 each person and $30,000 each accident if split limits are chosen by the named insured. If the named insured chooses coverage under a combined single limit, the maximum amount is $30,000 each accident. The limit of liability for funeral expenses is $5,000 each person. Compensation under property protection benefits is a maximum of $10,000 each accident. The personal injury protection coverages are subject to a deductible chosen by the named insured and applicable to the named insured or to the named insured and family members.

If, within two years from the date of an accident causing bodily injury, a qualified doctor verifies in writing that surgical or dental procedures are necessary but impossible or impractical to perform within the two year period, the insurer pledges to view costs and expenses for the medical treatment as being incurred within two years from the date of the accident. Furthermore, income loss resulting from the medical procedures is treated the same way.

Endorsement PP 05 56 contains some exclusions that should be noted. Personal injury protection coverage is not provided for bodily injury sustained by any insured if that insured's conduct contributed to the injury either intentionally or while committing a felony. Coverage is not provided for any insured, other than the named insured or any family member, while a pedestrian if the accident occurs outside Delaware. Coverage is not provided for bodily injury sustained by any insured while a motor vehicle is used as a public or livery conveyance to the extent that the limits of liability exceed the limits of liability required by Delaware law unless such use is specifically declared and described in the auto policy.

Endorsement PP 05 56 offers property protection coverage for accidental damage to property resulting from an accident involving the named insured's covered auto. The coverage is not for any property owned by, rented to, or leased by the named insured or any family member. The coverage is also not for damage to any motor vehicle (as defined on the endorsement), or any aircraft or watercraft. Property protection coverage is not provided if there is other valid and collectible property insurance unless the owner or operator of the named insured's covered auto would be legally liable for the damage under tort law. The policy territory with respect to property protection coverage is Delaware.

Added personal injury protection coverage is available through endorsement PP 05 57 06 94.

Maryland

Under the Maryland no-fault law, effective July 1, 1973, every insurer proposing to issue or sell any motor vehicle insurance policy in the state will provide coverage for the medical, hospital, and disability benefits set forth in the no-fault law. The first named insured may opt to waive the benefits. This waiver is applicable to all named insureds, any family members age sixteen or older, and any other person listed in the policy as a permissive user of the named insured's auto. Also, the waiver must explain clearly and concisely the coverages involved and what is being waived by the insureds.

Endorsement PP 05 81 01 02 provides personal injury protection coverage in Maryland. Coverage under the endorsement applies to the named insured or any family member who sustains bodily injury in any motor vehicle accident. Also insured is any other person who sustains bodily injury while occupying the named insured's covered auto as a guest or passenger, or while using the covered auto with the express or implied consent of the named insured, or while a pedestrian when struck by the covered auto. “Pedestrian” is defined as any person not occupying a motor vehicle, including any person in, on, or alighting from any vehicle operated by animal or muscular power, or any person on or alighting from an animal.

The form does not specify a maximum limit for the total of all personal injury protection benefits. The medical expenses covered are the reasonable expenses arising from the accident and incurred within three years from the date of the accident. Medical expenses include not only the medical and dental services, but also funeral and burial services. Also encompassed are the payment of benefits for loss of income in the case of an injured income producer, and in the case where the injured person is not the income producer, payments made in reimbursement of necessary and reasonable expenses incurred for essential services ordinarily performed by the injured insured. The income continuation benefit pays 85 percent of the loss of gross income incurred during the lifetime of the insured and within three years from the date of the accident.

Where the insured has coverage under the endorsement and under some collateral source, the insurer may coordinate the policies for nonduplication of the benefits. For example, benefits payable under PP 05 81 are reduced to the extent that the recipient has recovered benefits under the state workers compensation law. Furthermore, an insurer paying benefits has no right of subrogation and no claim against any other person or the insurer of that other person by reason of the alleged fault of such other person in causing or contributing to the accident.

Under the PP 05 81, any person who intentionally causes the accident, who is injured while operating or voluntarily riding in a vehicle known to be stolen, or who is injured while committing a felony or fleeing or attempting to elude a police officer is excluded. The endorsement also excludes bodily injury sustained by any insured arising out of the ownership, maintenance, or use of a motorcycle by that insured, or for any insured if that insured is not a Maryland resident or is a pedestrian injured in an accident outside of Maryland.

Oregon

Every motor vehicle liability policy issued in Oregon that covers any private passenger motor vehicle is to provide personal injury protection benefits to the persons insured under the policy. Endorsement PP 05 58 01 10 provides the personal injury protection coverage in Oregon.

The term “insured” includes the named insured or any family member residing in the household of the named insured who sustains bodily injury while occupying a private passenger motor vehicle or while a pedestrian when struck by a motor vehicle. Also considered as insureds are any other persons who sustain bodily injury while occupying or using the named insured's covered auto with permission, or while a pedestrian when struck by the named insured's covered auto. If a named insured or a family member is injured as a pedestrian, the named insured's coverage under PP 05 58 and not the policy of the driver who struck him is primary. This endorsement's coverage is excess for any pedestrian other than the named insured or a family member. The definition of “pedestrian” includes any person who is occupying a wheelchair or other mechanically propelled vehicle designed specifically for use by a physically disabled person who has a medical necessity for such a vehicle.

A named insured or family member injured while occupying a vehicle other than the named insured's covered auto is primarily covered under the policy of the other vehicle owner—the named insured's own policy is excess. However, the named insured's policy will be primary if the named insured or any family member occupies any motor vehicle owned by a person who is in the business of selling, renting, leasing, or repairing motor vehicles. The vehicle owner must receive a written agreement that the insured is liable for injury, death, or damage arising out of the use of the vehicle and that does not state that coverage is provided on a primary basis.

The basic coverage provided under PP 05 58 consists of payments of all reasonable and necessary medical, hospital, and dental expenses. The expenses must be incurred within one year of the date of the accident. Deductibles are available under this coverage, but they apply only to the named insured and family members. Coverage also consists of payment of 70 percent of the loss of income for the insured who is disabled if the disability continues for at least fourteen days. This benefit is subject to a maximum payment of $3,000 per month and a maximum payment period in the aggregate of fifty-two weeks. If the injured person is not the income producer, the coverage provides up to a maximum of $30 per day for expenses necessary to replace essential services usually performed by the injured person. Reasonable and necessary funeral expenses incurred within one year after the date of the injury are covered, but the total amount paid cannot exceed $5,000. The final basic coverage is a child care benefit. If the insured is a parent of a minor and is required to be hospitalized for a minimum of twenty-four hours, $25 per day for child care is provided. This payment is supposed to be made for as long as the person is unable to return to work, but the maximum amount to be paid is $750.

The personal injury protection benefits may be reduced or eliminated if the insured also receives workers compensation benefits or other similar medical or disability benefits. Every insurer whose insured is or would be held legally liable for damages for injuries sustained in a motor vehicle accident by a person for whom personal injury protection benefits have been paid shall reimburse the personal injury insurer for the benefits that insurer furnished to the injured person. Arbitration proceedings are to settle any disputes over payments, that is, whether the insured is entitled to payment or what the amount of payment should be. Both sides must agree to the arbitration.

Under PP 05 58, the insurer providing coverage can exclude benefits for any person who intentionally causes self-injury, who participates in any prearranged or organized race, and who is injured as a pedestrian in an accident outside of Oregon. This last exclusion does not apply to the named insured or any family member and applies only to the income loss and essential services benefits.

A “motor vehicle” is defined in the endorsement as a self-propelled land motor vehicle or trailer that does not include a farm type tractor or a vehicle used as a residence. A “private passenger motor vehicle” means a four-wheel passenger or station wagon type motor vehicle not used as a public or livery conveyance. It also means any other four-wheeled motor vehicle of the utility, pickup body, sedan delivery, or panel truck type not used for delivery other than farming. Self-propelled mobile homes and farm trucks are also considered private passenger motor vehicles.

Pennsylvania

The Pennsylvania no-fault law became effective on October 1, 1984 and has been revised several times since that date. Form PP 05 51 06 94 provides no-fault coverage in Pennsylvania, and Form PP 05 53 11 92 provides extraordinary medical benefits coverage. Another form, PP 03 38 12 98, simply notifies the named insured of the alternative tort options that can be chosen under the law.

Under PP 05 51, first party benefits coverage is for an insured who sustains bodily injury caused by an accident arising out of the use or maintenance of a motor vehicle. “Insureds” are defined as the named insured and family members. Also considered as insureds are any other persons while occupying the named insured's covered auto, or not occupying a motor vehicle if injured as a result of an accident in Pennsylvania involving the named insured's covered auto. The endorsement also notes that if the named insured's covered auto is parked and unoccupied, it is not a motor vehicle involved in an accident unless it is parked in a manner that creates an unreasonable risk of injury. A “motor vehicle” is defined as a self-propelled vehicle operated or designed for use upon public roads but does not include a vehicle operated by muscular power or on rails or tracks.

The no-fault coverages include medical expenses, income loss benefits, accidental death benefits, and funeral expenses. Medical benefits in the amount of at least $5,000 are to be provided, payable regardless of fault, to cover reasonable and necessary medical and rehabilitative services. Benefits under this part of the endorsement may include any nonmedical remedial care and treatment rendered in accordance with a recognized religious method of healing. These medical expenses are considered basic first party benefits.

In addition to this basic coverage, PP 05 51 offers the following first party benefits: 1) an income loss benefit that includes 80 percent of actual loss of gross income and reasonable expenses actually incurred for hiring a substitute to perform services the injured insured cannot do; 2) accidental death benefits that are paid if bodily injury causes the death of the named insured or any family member within twenty-four months from the date of the accident; and 3) expenses that are directly related to the funeral, burial, or cremation of the deceased insured and that are covered up to twenty-four months from the date of the accident in which the deceased was injured.

PP 05 51 also offers a combined first party benefits program wherein no specific dollar amount is shown on the schedule for medical expenses and work loss benefits. Under this combined benefits plan, funeral expenses are limited to $2,500, but the accidental death benefit limit can be scheduled. The combination plan further allows the scheduling of a maximum limit of liability for the total of all combination first party benefits.

It should be noted that if added first party benefits or combination first party benefits are not shown as applicable in the schedule of the endorsement, only the basic first party benefit of medical expenses (with a limit of $5,000) applies.

An insurer may exclude from benefits any insured or personal representative when the conduct of that person contributed to the injury sustained in any of the following ways: while intentionally injuring himself, while committing a felony, or while seeking to elude arrest by the police. Also excluded from coverage are persons injured while occupying a recreational vehicle designed for use off public roads or a motorcycle, moped, or similar type vehicle.

The extraordinary medical benefits coverage endorsement, PP 05 53, offers coverage for medical expenses beyond the first $100,000 of medical expenses incurred by an insured. An insured can cover that first $100,000 by purchasing added first party benefits coverage under PP 05 51 with a $100,000 limit of liability scheduled for medical expenses.

South Dakota

The South Dakota no-fault law became effective January 1, 1972. It states that no application for any automobile liability policy may be taken with respect to any auto registered or principally garaged in South Dakota unless the no-fault benefits are offered to the named insured. The named insured has the right to reject in writing all or any of the benefits. The benefits called for by the no-fault law in the state of South Dakota can be provided by use of the ISO endorsement, PP 03 63 11 98.

The endorsement defines “auto” as a land motor vehicle or trailer not operated on rails or treads; the term does not include a farm type tractor or other equipment designed for use principally off public roads, except while actually upon public roads. Coverage under PP 03 63 is afforded only to the named insured, that is, the person named in the schedule of the endorsement.

The benefits offered under the endorsement include death benefits and disability benefits. Death benefits are offered in the amount scheduled on the endorsement in the event of the death of the named insured. The death must result directly and independently of all other causes from bodily injury caused by accident and sustained by the named insured while occupying or through being struck by an auto. The death must occur within ninety days after the date of the accident or within fifty-two weeks after the date of the accident and during a period of disability.

Disability benefits are paid on a weekly indemnity basis at the rate of $60 per week for the period of disability. There are several provisions that affect this benefit. The disability must commence within and extend beyond fourteen days from the date of the accident. The disability must prevent the named insured from performing the usual duties of his or her regular occupation. The weekly indemnity for disability shall not extend beyond a period of fifty-two consecutive weeks. If the named insured is not gainfully employed at the time of the accident, the amount paid is $30 per week. And, the disability benefits are to be paid in full without reduction because of any benefits available under any workers compensation law or from any other source.

The coverage under this endorsement does not apply to bodily injury or death sustained in the following instances: while the person is engaged in duties incident to the operation, loading, or unloading of a public or livery conveyance; while repairing or servicing an auto; through loss caused by or resulting from disease; suicide or any attempt thereat; or injury due to war.

Texas

No-fault coverage was enacted in Texas in 1973. Coverage is required to be provided on every automobile liability insurance policy, but any insured named in the policy may reject coverage in writing.

Coverage is available on Personal Injury Protection Coverage—Texas form, PP 05 98 04 08. Coverage is for bodily injury to insureds as a result of an accident with a motor vehicle and arising out of the ownership, maintenance, or use of a motor vehicle as a vehicle. Benefits include the following: medical and funeral expenses incurred within three years from the date of the accident; 80 percent of the insured's lost income if the insured was an income producer and was in an occupational status; and replacement services for those services an insured would normally perform, if the insured was not an income producer and was not in an occupational status.

“Insureds,” as used in the endorsement, means the named insured or any family member when struck by or when operating a motor vehicle or any other person while occupying the named insured's covered auto, with the insured's permission. “Family member” is defined as “a person related to the 'named insured' by blood, marriage or adoption who is a resident of the 'named insured's household. This includes a ward or foster child.” A “motor vehicle” includes the following: “a. Self-propelled vehicle designed for use on a highway; b. A trailer or semi-trailer designed for use with a self-propelled vehicle; or c. Vehicle propelled by electric power obtained from overhead wires, but not operated on rails.”

The endorsement does not provide coverage to any insured for bodily injury sustained in accidents that the insured intentionally causes, in the commission of a felony, or in an attempt by the insured to elude arrest by a law enforcement official. The endorsement also excludes coverage to any insureds or family members for bodily injury sustained as a result of use or operation of any motor vehicles other than the covered auto owned by the named insured. Family members are not covered for bodily injury resulting from the family member's motor vehicle and for which Texas law requires financial responsibility. Bodily injury due to war, civil war, insurrection, rebellion or revolution, or any act or incident to any of the foregoing, or resulting from radioactive, toxic, explosive or other hazardous properties of nuclear material is also excluded.

The limit of liability shown in the declarations for Personal Injury Protection is the maximum for each insured injured in any one accident, “regardless of the number of: 1.'Insureds'; 2. Claims made; 3. 'Your covered autos' or premiums shown in the Declarations; or 4. 'Your covered autos' involved in the accident.” The carrier pays only its share when there is other personal injury insurance, which is the portion the insurer's liability bears to the total of all applicable limits. Coverage provided for vehicles not owned by the insured is excess. In the event of an accident or loss, a proof of loss must be submitted within six months after the date of the accident. Benefits are payable every two weeks, but not more frequently, and within thirty days after proof of claim is received.

Washington

Washington made no-fault coverage effective July 1, 1994. The coverage is on an optional basis for insureds even though the law requires that no new auto liability policy or renewal of an existing policy be issued unless personal injury protection benefits are offered. The law contains minimum limits and increased limits that must be offered to insureds.

Coverage for no-fault benefits is available in Washington through the use of PP 05 69 07 04. Coverage is for insureds who sustain bodily injury caused by an accident arising out of the ownership, maintenance, or use of a motor vehicle. “Insureds” are the named insured or any family member while occupying or using a motor vehicle or while a pedestrian when struck by a motor vehicle. The “named insured” includes the person named in the declarations and that person's spouse. Any other person is an insured while occupying or using, or while a pedestrian when struck by the named insured's covered auto. A “motor vehicle” is a self-propelled land motor vehicle or trailer, but does not include a farm tractor, a vehicle operated on rails or crawler treads, a vehicle used as a residence, a motor home, a motorcycle, or a moped.

The endorsement offers basic limits coverage and increased limits coverage. Basic limits are medical and hospital benefits with a limit of $10,000; funeral expenses with a $2,000 limit; income continuation with a limit of $10,000, subject to a maximum of $200 per week; and loss of services with a $5,000 limit, subject to a sublimit of $40 per day, not to exceed $200 per week. The increased limits coverage offers the same benefits but with the following limits: $35,000 for medical and hospital expenses; $2,000 for funeral expenses; $35,000 for income continuation, subject to a maximum of $700 per week; and $14,600 for loss of services with a $40 per day limit but no maximum.

The endorsement does not provide personal injury protection coverage for bodily injury sustained by any insured who intentionally causes injury to himself, who is injured while participating in any prearranged racing or speed contest, or if the injury results from the insured's use of a motor vehicle in the commission of a felony. The endorsement also contains the war and nuclear material exclusions.

Any amounts payable under PP 05 69 are reduced by any amount paid or payable under any workers compensation law or similar medical or disability benefits law. Any insurance provided under PP 05 69 with respect to an insured while occupying or while a pedestrian when struck by a temporary substitute or nonowned auto is excess over any other valid and collectible auto medical payments coverage or personal injury protection coverage. In contrast, when applied to owned autos, any medical payments coverage provided is excess over any payment made under PP 05 69.

The endorsement also contains an arbitration clause in the event both parties do not agree on the amount of benefits payable. Both parties must agree on a single arbitrator. The arbitration will take place either in the county in which the insured lives or where the insured lived at the time of the accident. A decision by any two arbitrators is binding.