Automobile No-Fault Endorsement

Summary: All residents of Utah who own motor vehicles are required by the Utah Motor Vehicle Act to maintain no-fault coverage (or another approved form of security) continuously during the motor vehicle registration period. Nonresidents are also required to maintain no-fault coverage on motor vehicles they own if the vehicle has been in Utah for more than 90 of the preceding 365 days. Coverage of the kind prescribed in the Utah no-fault statute is provided in the personal injury protection coverage endorsement, PP 05 79 08 14.

Topics covered:
Who is insured
Benefits
Exclusions
Relationship with other coverage
Tort Liability
Added personal injury protection
Definitions

Who Is Insured

Utah no-fault benefits under endorsement PP 05 79 are payable to or for an insured. The term “insured” includes two categories: the named insured and any family member (residents of the named insured's household or one that usually makes his home in the same household but temporarily lives elsewhere, like a student, related to the named insured by blood, marriage, or adoption) if injured in an accident involving the use of any motor vehicle; and, any other person injured (1) while occupying the named insured's covered auto with the named insured's consent, (2) while occupying any other motor vehicle that is operated by the named insured or a family member, or (3) as a pedestrian if the accident involves the named insured's covered auto and occurs in Utah.

Endorsement PP 05 79 lists those instances when a person is not included in the definition of “insured.” The term does not include the named insured who sustains bodily injury resulting from the use or operation of any motor vehicle, other than the named insured's covered auto, that is owned by the named insured; any family member who sustains bodily injury resulting from the use or operation of any motor vehicle, other than the named insured's covered auto, that is owned by that family member; and any person, other than the named insured or any family member, who sustains bodily injury while occupying any motor vehicle when it is being used as a public or livery conveyance.

Benefits

The Utah no-fault law requires, and endorsement PP 05 79 provides, four categories of benefits subject to the limits of liability specified below.

Medical expenses are reasonable expenses necessarily incurred for medical, surgical, x-ray, dental and rehabilitative services and prosthetic devices, ambulance, hospital and nursing services. This includes any non-medical remedial care and treatment rendered in accordance with a recognized religious method of healing. The limit of liability under this category is subject to a per person, per accident limit of $3,000. Medical expenses do not include expenses in excess of those for a semiprivate room,, unless more intensive care is medically required.

The work loss benefit covers two related types of loss: (1) loss of income and earning capacity by an insured during his lifetime because of inability to work, and (2) the expense of obtaining substitute household services to replace those the insured would have performed had there been no injury. The loss of income limit is 85 percent of lost gross income and earning capacity, up to a maximum of $250 per week, for a period of fifty-two consecutive weeks beginning three days after the date of loss of income and earning capacity. If, however, the disability continues for longer than two consecutive weeks following the date of loss of income and earning capacity, the three day waiting period does not apply. For replacement services expense, the limit of liability is $20 per day for 365 consecutive days beginning three days after the date of bodily injury. As with the coverage for income loss, the three day waiting period is waived if the insured's disability lasts longer than fourteen consecutive days after the injury.

The limit of liability for survivors' loss benefits is $3,000. Unlike other no-fault benefits collectible under the endorsement, survivors' loss benefits are not tied to any particular elements of economic loss or costs resulting from injury to an insured; they are defined simply as compensation because of an insured's death. Survivors' loss benefits are payable only to the insured's heirs.

Funeral expenses coverage has a limit of liability of $1,500 for funeral, burial, or cremation expenses.

Exclusions

Injury to anyone occupying a motor vehicle, other than the named insured's covered auto, that is owned by or furnished for the regular use of the named insured or any family member is not covered. Endorsement PP 05 79 does not provide coverage for anyone injured while operating the named insured's covered auto without the named insured's express or implied consent or anyone in unlawful possession of the covered auto. Intentionally self-inflicted injuries and injuries suffered while committing a felony are also excluded.

The insuring agreement requires that a motor vehicle be used as a motor vehicle and cause an accident in order for the insured's bodily injury to be covered. This condition of coverage is reinforced by an exclusion of injury that arises out of the use of a motor vehicle while located for use as a residence or premises. The endorsement also carries exclusions relating to war and nuclear risks.

Finally, under the basic personal injury protection coverage, the insurer does not provide for the loss of income coverage included in the work loss benefit for the named insured and spouse if the rejection of loss of income box is checked on the endorsement's schedule.

Relationship with Other Coverages

Benefit amounts payable under endorsement PP 05 79 are reduced by the amount of coverage available to the insured under any workers compensation law. No-fault benefits are likewise reduced by the amount of any coverage provided by the United States government to an insured on active duty in the military.

Any coverage provided through the endorsement is primary only for bodily injury sustained by an insured in an accident arising out of the use or operation of the named insured's covered auto. Any personal injury protection benefits paid or payable under the endorsement is primary over any coverage provided under part B (medical payments coverage) of the auto policy.

Duplicate recovery under more than one policy providing no-fault coverage is prohibited by the endorsement. For an insured entitled to similar benefits under more than one policy, the maximum amount payable under all the policies shall not exceed the amount payable under the single policy with the highest dollar limit. The contribution of each participating insurer is prorated on the basis of policy limits.

If the vehicle is a rental private passenger motor vehicle, the first priority is any source of recovery purchased by the named insured or a family member from the rental's owner. The second priority is any policy offering personal injury protection coverage to the insured as a named insured or family member.

Tort Liability

The Utah motor vehicle act abolished recovery in tort for automobile accident injuries to the extent that recovery is provided for in the act. A lawsuit seeking general damages (noneconomic elements of loss, such as pain and suffering or inconvenience) is allowed with respect to accidents that cause death, dismemberment, or fracture; permanent disability or disfigurement; or medical expenses to a person in excess of $3,000.

Added Personal Injury Protection

The named insured has an added benefits option and can choose that option on  the schedule or in the declarations. These added personal injury protection benefits apply instead of the basic benefits discussed above and are available to the named insured or any family member. The added benefits option still offers medical expenses, work loss, funeral expenses, and survivors' loss, just as the basic plan. However, the $3,000 limit of liability applicable to medical expenses and the $250 weekly maximum that governs the loss of income component of the work loss benefit and the $1500 limit for funeral expenses may be increased to whatever limits can be agreed upon by the named insured and the insurer. The survivors' loss benefit remains the same as under the basic plan.

Definitions

“Family member” includes a spouse or any other person related to the named insured by blood, marriage, or adoption. Wards and foster children are also considered family members. Family members must be residents of the named insured's household or usually make the named insured's household home, but temporarily lives somewhere else (for example, a student away at college).

“Motor vehicle” means any self-propelled vehicle (including trailers and semitrailers) that is designed for use upon a highway and any vehicle that is propelled by electric power obtained from overhead wires, but not operated on rails. The term does not include traction engines, road rollers, farm tractors, tractor cranes, power shovels, or well drillers.

“Pedestrian” means any person not occupying or riding upon a motor vehicle.

“Occupying” means being in or upon a motor vehicle as a passenger or operator or engaged in the immediate act of entering, boarding, or alighting from a motor vehicle.

“Your covered auto” means a motor vehicle to which the bodily injury liability coverage of this endorsement applies and for which a specific premium is charged, and for which the named insured is required by the Utah Motor vehicle Act to maintain security.