Summary: The Kansas automobile injury reparations act requires the owner of every self-propelled vehicle that must be registered in the state (including trailers, semi-trailers, and pole trailers designed to be used with such vehicles) to provide no-fault coverage on the vehicle. Personal injury protection endorsement PP 05 64 09 98 provides the prescribed coverage on vehicles insured under the personal auto policy. This article discusses the endorsement, its offered benefits and exclusions.

Topics covered:
Who is insured; definitions
Exclusions
Benefits
Other information
Tort liability

Who Is Insured; Definitions

PP 05 64, the personal injury protection coverage endorsement for Kansas, offers basic personal injury protection benefits to or for an insured who sustains bodily injury caused by an accident arising out of the ownership, operation, maintenance, or use of a motor vehicle. The term “insured” includes the named insured (the individual named in the declarations, resident spouse, or the owner of “your covered auto”) or any “family member.” “Family member” means any person related to the named insured by blood, marriage, or adoption, including a ward or foster child, who is a resident of the named insured's household or usually resides there but temporarily lives elsewhere (a student away at school, for example). Coverage applies to injury sustained by the named insured or a family member while occupying or through direct physical contact with, while not occupying, any motor vehicle. The term “insured” also includes any other person who sustains bodily injury while occupying the named insured's covered auto or who is injured through direct physical contact with the named insured's covered auto while not occupying any motor vehicle.

There are some terms used throughout the endorsement that are defined terms. “Monthly earnings” means with respect to an insured who is regularly employed or self-employed, one-twelfth of that insured's annual earnings at the time bodily injury is sustained; if the insured is not employed, the amount is one-twelfth of the anticipated annual earnings from the time the insured would reasonably have expected to be regularly employed. The insurer averages the annual anticipated compensation for the unemployed insured based on the five years prior to the injury. With regard to a survivor's loss for an insured who received either or both social security and retirement or pension benefits, “monthly earnings” means one-twelfth of the annual amount of the difference between the benefits the deceased insured was receiving at the time of death and the annual amount of the benefits the survivor receives after the death.

“Motor vehicle” means a self-propelled vehicle (including a trailer, semi-trailer, or pole-trailer designed for use with a self-propelled vehicle) of a kind that is required to be registered in Kansas, but does not include a motorized bicycle.

“Survivor” means a deceased insured's spouse or child under the age of eighteen years. The insured's death must have resulted from bodily injury sustained in the auto accident.

The policy territory under this endorsement is Kansas and, with respect to the named insured and any family member while occupying or when struck by any motor vehicle, the United States and its territories and possessions and Canada.

Exclusions

Coverage with respect to the named insured and family members does not apply while occupying any motor vehicle, other than the named insured's “covered auto,” that is owned by the named insured. A “covered auto” means a motor vehicle owned by the named insured to which the bodily injury liability coverage of the policy applies and for which a specific premium is charged, and for which the security required under the Kansas reparations act is maintained. Persons other than the named insured who themselves own vehicles on which Kansas no-fault insurance is required are not covered under the named insured's policy; these persons claim coverage under their own policies. Basic personal injury protection benefits are not available for anyone other than the named insured injured while occupying or when struck by a motor vehicle—other than the named insured's covered auto—on which Kansas no-fault insurance is required. (The endorsement lays out the priorities for coverage for these sorts of situations—described later in this article.) There is no coverage on any person, other than the named insured or any family member, when the person is neither a resident of Kansas nor occupying the named insured's covered auto.

Injury sustained as a result of conduct in the course of a motor vehicle repair, servicing, or maintenance business is not covered if it occurs on the business premises. Injury in connection with the loading or unloading of a motor vehicle is not covered unless the injured person is occupying the vehicle when the injury occurs. “Occupying” means in or upon, entering into or alighting from. For example, an insured might be unloading a box from a truck and carrying it into his or her house. If he or she trips and falls on the way and is injured, the PIP coverage will not respond. Intentionally self-caused injury is excluded, as is injury suffered by an intentional converter of a motor vehicle. Finally, the coverage does not apply to bodily injury sustained by any person operating the named insured's covered auto without the named insured's express or implied consent.

Benefits

Endorsement PP 05 64 offers medical expenses, rehabilitation expenses, work loss, essential services, funeral expenses, and survivors' loss benefits.

Medical expenses consists of all reasonable expenses incurred for necessary medical, psychological, dental, x-ray, ambulance, hospital, and professional nursing services; prosthetic devices are also included. Medical expenses include services recognized and permitted under Kansas laws for an insured who relies upon spiritual means through prayer alone for healing in accordance with that insured's religious beliefs. However, medical expenses do not include rehabilitation expenses; those expenses are included in the coverage for rehabilitation expenses. The limit of liability is $4,500 per person.

Rehabilitation expenses are offered separately from medical expenses. This benefit consists of the reasonable expense of necessary psychiatric or psychological services, occupational therapy, and occupational training and retraining to enable the injured person to obtain suitable employment. The limit of liability under this particular benefit is $4,500 per person.

Work loss benefits, which compensate the insured for loss of monthly earnings due to inability to engage in “available and appropriate gainful activity,” are payable up to $900 per month. Work loss is paid for a period of no more than one year after the inability to work begins. The work loss is equal to 100 percent of monthly earnings; however, if work loss is not included in gross income for federal income tax purposes, work loss will be limited to 85 percent of monthly earnings.

Essential services are paid at the rate of $25 per day for a maximum of 365 days. This benefit includes the appropriate and reasonable costs of obtaining ordinary and necessary services as replacement for those an insured would have performed for his or his family's benefit. Housecleaning, yard work—even “handyman” activities can be reimbursed.

Funeral expenses are covered for an amount of $2,000 per person and this includes burial or cremation.

A survivors' loss benefit is also offered. Total allowances to all survivors for loss, after an insured's death, of that insured's monthly earnings are included in this benefit as well as allowances for essential services incurred after an insured's death (reduced to whatever degree the death of the insured makes such expense unnecessary). These benefits are payable subject to the same limits (combined) that govern work loss and essential services expenses—up to $900 per month and $25 per day respectively. If the schedule or declarations on the endorsement indicates that basic personal injury protection benefits apply, survivors' loss is paid for a period of not longer than one year after the date of the insured's death; if the deceased received work loss payments before he or she died, the number of months for which such payments were made is subtracted from the survivors' loss benefit period.

Other Information

No-fault benefits are reduced by amounts payable under any workers compensation law, but are primary in relation to any available medical payments coverage. When more than one insurer is liable for no-fault payments because of a single injury, the injured person may not recover benefits in an amount greater than the highest limit of any applicable policy. Priority of payment among multiple policies is prescribed in endorsement PP 05 64 as follows: (1) the policy insuring any motor vehicle owned by the insured; (2) the policy insuring the motor vehicle that struck the insured or that the insured was occupying at the time of the accident; (3) the policy providing coverage for the named insured's covered auto for bodily injury sustained by any family member who was occupying or struck by a motor vehicle outside the state of Kansas and who is not a named insured under another policy.

Kansas personal injury protection benefits may be increased, with respect to the named insured and family members only, by indicating on PP 05 64 that this option has been chosen. The current options are: medical expenses, $12,500 or $27,500 per person; rehabilitation expenses, $12,500 or $27,500 per person; work loss, $1050 or $1250 per month, and the one year benefit period may be increased; the $25 per day limit for essential services expenses may not be increased, but the 365 day benefit period may be expanded. The limit for funeral expenses is $2,000 (in other words, it is not increased) or $2,500 per person, and survivors' loss up to $1050 or $1250 per month. The amount for essential services cannot be increased, but the benefit period can be extended.

Personal injury protection benefits payable under the coverage are considered overdue if not paid within thirty days after the insurer receives written notice of a covered loss, including the amount of the loss. Work loss will be paid not less than every two weeks after the notice. In some instances it might not be possible to provide the total amount to the insurer; in that case, partial amounts may be given by written notice and are considered overdue if not paid within thirty days after receipt of the notice. Overdue payments bear simple interest at 18 percent per year.

If a person to whom benefits are being paid takes legal action to recover damages for bodily injury against a person or organization that might be liable, a copy of the complaint and summons must be forwarded to the insurer. No claim for personal injury protection benefits can be made after two years from the date of the bodily injury.

Tort Liability

Under the Kansas automobile injury reparations act, damages in tort for pain and suffering and other noneconomic loss may be recovered only when the injury results in medical expenses with a reasonable value of at least $2,000, or in the case of permanent disfigurement, injury, or loss of a body function; compound, comminuted, displaced, or compressed fracture, or a fracture of a weight-bearing bone; the loss of a body member; or death.

See No-Fault Automobile Insurance for a general discussion of tort liability exemption in connection with no-fault coverage.