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304.39-210 Obligor's duty to respond to claims.
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Basic and added reparation benefits are payable monthly as loss accrues.
Loss accrues not when injury occurs, but as work loss, replacement services
loss, or medical expense is incurred. Benefits are overdue if not paid within
thirty (30) days after the reparation obligor receives reasonable proof of the fact
and amount of loss realized, unless the reparation obligor elects to accumulate
claims for periods not exceeding thirty-one (31) days after the reparation
obligor receives reasonable proof of the fact and amount of loss realized, and
pays them within fifteen (15) days after the period of accumulation.
Notwithstanding any provision of this chapter to the contrary, benefits are not
overdue if a reparation obligor has not made payment to a provider of services
due to the request of a secured person when the secured person is directing
the payment of benefits among the different elements of loss. If reasonable
proof is supplied as to only part of a claim, and the part totals one hundred
dollars ($100) or more, the part is overdue if not paid within the time provided
by this section. Medical expense benefits may be paid by the reparation obligor
directly to persons supplying products, services, or accommodations to the
claimant, if the claimant so designates.
Overdue payments bear interest at the rate of twelve percent (12%) per
annum, except that if delay was without reasonable foundation the rate of
interest shall be eighteen percent (18%) per annum.
A claim for basic or added reparation benefits shall be paid without deduction
for the benefits which are to be subtracted pursuant to the provisions on
calculation of net loss if these benefits have not been paid to the claimant
before the reparation benefits are overdue or the claim is paid. The reparation
obligor is entitled to reimbursement from the person obligated to make the
payments or from the claimant who actually receives the payments.
A reparation obligor may bring an action to recover benefits which are not
payable, but are in fact paid, because of an intentional misrepresentation of a
material fact, upon which the reparation obligor relies, by the insured or by a
person providing an item of medical expense. The action may be brought only
against the person providing the item of medical expense, unless the insured
has intentionally misrepresented the facts or knows of the misrepresentation.
An insurer may offset amounts he is entitled to recover from the insured under
this subsection against any basic or added reparation benefits otherwise due.
A reparation obligor who rejects a claim for basic reparation benefits shall give
to the claimant prompt written notice of the rejection, specifying the reason. If a
claim is rejected for a reason other than that the person is not entitled to the
basic reparation benefits claimed, the written notice shall inform the claimant
that he may file his claim with the assigned claims bureau and shall give the
name and address of the bureau.
Effective:July 15, 1998
History: Amended 1998 Ky. Acts ch. 200, sec. 2, effective July 15, 1998. -Created 1974 Ky. Acts ch. 385, sec. 21, effective July 1, 1975.
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