2006 Code of Virginia § 38.2-2201 - Provisions for payment of medical expense and loss of income benefits

38.2-2201. Provisions for payment of medical expense and loss of incomebenefits.

A. Upon request of an insured, each insurer licensed in this Commonwealthissuing or delivering any policy or contract of bodily injury or propertydamage liability insurance covering liability arising from the ownership,maintenance or use of any motor vehicle shall provide on payment of thepremium, as a minimum coverage (i) to persons occupying the insured motorvehicle; and (ii) to the named insured and, while resident of the namedinsured's household, the spouse and relatives of the named insured while inor upon, entering or alighting from or through being struck by a motorvehicle while not occupying a motor vehicle, the following health care anddisability benefits for each accident:

1. All reasonable and necessary expenses for medical, chiropractic, hospital,dental, surgical, ambulance, prosthetic and rehabilitation services, andfuneral expenses, resulting from the accident and incurred within three yearsafter the date of the accident, up to $2,000 per person; however, if theinsured does not elect to purchase such limit the insurer and insured mayagree to any other limit;

2. If the person is usually engaged in a remunerative occupation, an amountequal to the loss of income incurred after the date of the accident resultingfrom injuries received in the accident up to $100 per week during the periodfrom the first workday lost as a result of the accident up to the date theperson is able to return to his usual occupation. However, the period shallnot extend beyond one year from the date of the accident; and

3. An expense described in subdivision 1 shall be deemed to have beenincurred:

a. If the insured is directly responsible for payment of the expense;

b. If the expense is paid by (i) a health care insurer pursuant to anegotiated contract with the health care provider or (ii) Medicaid orMedicare, where the actual payment with reference to the medical billrendered by the provider is less than or equal to the provider's usual andcustomary fee, in the amount of the actual payment; however, if the insuredis required to make a payment in addition to the actual payment by the healthcare insurer or Medicaid or Medicare, the amount shall be increased by thepayment made by the insured;

c. If no medical bill is rendered or specific charge made by a health careprovider to the insured, an insurer, or any other person, in the amount ofthe usual and customary fee charged in that community for the servicerendered.

B. The insured has the option of purchasing either or both of the coveragesset forth in subdivisions 1 and 2 of subsection A of this section. Either orboth of the coverages, as well as any other medical expense or loss of incomecoverage under any policy of automobile liability insurance, shall be payableto the covered injured person notwithstanding the failure or refusal of thenamed insured or other person entitled to the coverage to give notice to theinsurer of an accident as soon as practicable under the terms of the policy,except where the failure or refusal prejudices the insurer in establishingthe validity of the claim.

C. In any policy of personal automobile insurance in which the insured haspurchased coverage under subsection A of this section, every insurerproviding such coverage arising from the ownership, maintenance or use of nomore than four motor vehicles shall be liable to pay up to the maximum policylimit available on every motor vehicle insured under that coverage if thehealth care or disability expenses and costs mentioned in subsection A ofthis section exceed the limits of coverage for any one motor vehicle soinsured.

(1972, c. 859, 38.1-380.1; 1973, c. 294; 1977, c. 112; 1982, c. 450; 1983,cc. 197, 370; 1986, c. 562; 1987, c. 429; 1989, c. 243; 1991, c. 4; 1996, c.276; 1997, c. 503.)