Summary: The District of Columbia has an optional no-fault automobile insurance plan. Motorists have the option of choosing one of a series of medical and rehabilitation benefit limits up to $50,000 ($100,000 if increased limits are chosen), work loss benefit limits up to $12,000 ($24,000 under increased limits), and funeral benefits up to $4,000; or, they can choose not to buy personal injury protection (PIP) coverage at all. Personal injury protection coverage endorsement PP 05 74 06 94 to the personal auto policy provides no-fault coverage as prescribed by the District of Columbia no-fault act.

 Topics covered:

 Who is insured

Exclusions

Benefits

Relation of no-fault to other coverage

Tort liability exemption

Who Is Insured

 No-fault benefits as provided under endorsement PP 05 74 are payable to two categories of "insureds": the named insured and any other person while occupying the named insured's covered auto or a vehicle operated by the named insured. A "covered auto" in the context of endorsement PP 05 74 is a motor vehicle shown in the declarations as one to which both personal injury protection coverage and liability coverage apply.

 The endorsement's applicability to any insured is determined in light of a set of priorities as stated in the no-fault act involving all applicable policies under which the insured is covered. First, the endorsement will not pay no-fault benefits if benefits are available under a policy at a higher priority level. If this is not the case, the system of priorities requires payment as follows: first, the insurer providing benefits to the insured as a named insured pays; second in line is the insurer of the motor vehicle occupied by the insured; and finally, the insurer providing benefits to an insured who is occupying an uninsured motor vehicle operated by a named insured pays. If two or more policies have equal priority, the insurer against whom the claim is first made handles the claim, subject to a subsequent pro rata contribution by the other companies. And note that the maximum recovery under all policies will not exceed the amount payable under the policy with the highest dollar limits.

 Exclusions

 There is no coverage for bodily injury sustained by the named insured while occupying or operating any vehicle owned by the named insured and on which the no-fault coverage is not in effect. There is no coverage for bodily injury sustained by any person injured while intentionally causing or attempting to cause injury. Also excluded is the owner or operator of a vehicle involved in an accident in which no motor vehicle is involved. This particular exclusion brings out the point that there is a distinction made in PP 05 74 between a motor vehicle and a vehicle. A motor vehicle is defined as any device propelled by an internal combustion engine, electricity, or steam (the term does not include a traction engine used exclusively for drawing vehicles in fields or a road roller or a vehicle propelled only upon rails and tracks). The term "vehicle" denotes a trailer, or an appliance designed for use over a publicly maintained way on wheels or traction tread, that is operated by other than muscular power or drawn by a draft animal or beast of burden. Thus, for example, if the owner of a trailer is injured in a collision with a trolley that runs on rails in the District of Columbia , this endorsement will not apply; a motor vehicle as defined on the endorsement must be involved.

 Injury sustained by any person resulting from conduct in the course of a motor vehicle or vehicle repair, service, or maintenance business is not covered unless the conduct is off the business premises or in the course of loading or unloading a vehicle or motor vehicle. Bodily injury sustained by any person while occupying a motor vehicle or a vehicle located for use as a residence or premises is also excluded. Endorsement PP 05 74 also contains the standard war and nuclear exclusions.

 Note that if the schedule indicates that certain benefits are excluded, the insurer will not pay these items. The benefits that can be excluded are: medical expense benefits to or for any insured, work loss benefits to or for any insured, or funeral expense benefits.

 Benefits

 The District of Columbia no-fault plan provides for three categories of benefits (payable to or for an insured who sustains bodily injury caused by an accident and that arises out of the maintenance or use of a motor vehicle as a vehicle).

 Medical expense benefits cover reasonable charges for reasonably necessary products, services, and accommodations for an insured's care, recovery, or rehabilitation. Hospital room charges are limited to the cost of a semiprivate room unless more specialized care is required and the insurer will pay only if the provider is licensed or approved and complies with any applicable laws or regulations.

 Work loss benefits apply to two subcategories of loss: loss of income, consisting of up to 80 percent of the loss of gross income from work an insured would have performed except for the injury; and replacement services, consisting of the reasonable expense to obtain ordinary and necessary services replacing those the insured would have performed without pay for himself or his family had there been no injury. A higher percentage of gross income is recoverable if the insured can demonstrate that he or she is subject to an income tax of less than 20 percent of gross income. With respect to replacement services coverage, the services for which no-fault insurance will pay must be performed within three years after the accident and the services can not be obtained to produce income for the insured.

 The District of Columbia no-fault plan does not provide for any survivors' benefits category of recovery. Work loss benefits do not continue after an insured's death.

 The funeral expense benefits pay for the actual cost of an insured's funeral or funeral-related expenses, up to a limit of $4,000.

 Recovery in each category of personal injury protection benefits under the District of Columbia plan is reduced by the amount of a deductible that may be chosen by the named insured. The deductible affects recovery only by the named insured and does not apply to emergency medical services rendered during the first 72 hours after the accident.

 Relation of No-Fault to Other Coverage

 Endorsement PP 05 74 prohibits the recovery of duplicate personal injury protection benefits for a single loss. If no-fault benefits are available with respect to the same injury under more than one policy, the maximum recovery under all policies is limited to the amount recoverable under the single policy with the highest limit of liability. The endorsement also contains an anti-stacking provision, specifying that the scheduled limits of liability represent the maximum amounts to be paid to or for any one person for any one accident, regardless of the number of claims made, vehicles covered by the policy or involved in the accident, or insurers providing no-fault coverage.

 Endorsement PP 05 74 designates its coverage as excess in relation to workers compensation or state or District of Columbia temporary nonoccupational disability insurance. This excess provision does not operate when the law authorizing benefits under any of these other plans makes them secondary to (as in the case of Medicare) or duplicative of no-fault benefits.

 Tort Liability Exemption

 The District of Columbia no-fault act creates an exemption from tort liability for bodily injury with respect to the owners of vehicles involved in accidents to the extent that no-fault coverage is in effect on those vehicles at the time of the accident. This exemption, however, does not operate with respect to liability to the survivors of an insured killed in an automobile accident or to liability arising out of the use of a motor vehicle with intent to injure oneself or another person. Also, suits alleging noneconomic loss are allowed in connection with injuries that result in scarring or disfigurement or other substantial or permanent injuries as defined in the law, permanent impairment that prevents the injured person from performing professional or customary daily activities, or impairment that prevents the injured person from performing substantially all customary daily activities for more than 180 consecutive days. Liability for noneconomic loss may also exist in connection with injuries entailing medical expenses or work loss in excess of the amount of the available PIP benefits.

 Vehicle damage remains under the tort system.

 Personal injury protection benefits will not be provided to any insured unless the insurer is notified within sixty days of an accident of that insured's election to receive such benefits. The insurer and the insured may agree in writing to extend this sixty day period.