Texas Insurance Code - Not Codified - Article 5.06-3. Personal Injury Protection Coverage
Legal Research Home >
Texas Lawyer > Insurance Code - Not Codified > Texas Insurance Code - Not Codified - Article 5.06-3. Personal Injury Protection Coverage
Art. 5.06-3. PERSONAL INJURY PROTECTION COVERAGE.
Article repealed effective April 1, 2007
(a) No automobile liability insurance policy, including
insurance issued pursuant to an assigned risk plan established
under authority of Section 35 of the Texas Motor Vehicle
Safety-Responsibility Act, covering liability arising out of the
ownership, maintenance, or use of any motor vehicle shall be
delivered or issued for delivery in this state unless personal
injury protection coverage is provided therein or supplemental
thereto. The coverage required by this article shall not be
applicable if any insured named in the policy shall reject the
coverage in writing; provided, unless the named insured thereafter
requests such coverage in writing, such coverage need not be
provided in or supplemental to a reinstated policy or renewal
policy if the named insured has rejected the coverage in connection
with that policy or a policy previously issued to him by the same
insurer or by an affiliated insurer.
(b) "Personal injury protection" consists of provisions of
a motor vehicle liability policy which provide for payment to the
named insured in the motor vehicle liability policy and members of
the insured's household, any authorized operator or passenger of
the named insured's motor vehicle including a guest occupant, up to
an amount of $2,500 for each such person for payment of all
reasonable expenses arising from the accident and incurred within
three years from the date thereof for necessary medical, surgical,
X-ray and dental services, including prosthetic devices, and
necessary ambulance, hospital, professional nursing and funeral
services, and in the case of an income producer, payment of benefits
for loss of income as the result of the accident; and where the
person injured in the accident was not an income or wage producer at
the time of the accident, payments of benefits must be made in
reimbursement of necessary and reasonable expenses incurred for
essential services ordinarily performed by the injured person for
care and maintenance of the family or family household. The insurer
providing loss of income benefits may require, as a condition of
receiving such benefits, that the insured person furnish the
insurer reasonable medical proof of his injury causing loss of
income. The personal injury protection in this paragraph specified
shall not exceed $2,500 for all benefits, in the aggregate, for each
person.
(c) The benefits required by this Act shall be payable
without regard to the fault or non-fault of the named insured or the
recipient in causing or contributing to the accident, and without
regard to any collateral source of medical, hospital, or wage
continuation benefits. Except as provided by Subsection (i) of
this article, an insurer paying benefits pursuant to this Act shall
have no right of subrogation and no claim against any other person
or insurer to recover any such benefits by reason of the alleged
fault of such other person in causing or contributing to the
accident.
(d) All payments of benefits prescribed under this Act shall
be made periodically as the claims therefor arise and within thirty
(30) days after satisfactory proof thereof is received by the
insurer subject to the following limitations:
(1) The coverage described in this Act may prescribe a
period of not less than six months after the date of accident within
which the original proof of loss with respect to a claim for
benefits must be presented to the insurer.
(2) The coverage described in this Act may provide that in
any instance where a lapse occurs in the period of total disability
or in the medical treatment of an injured person who has received
benefits under such coverage and such person subsequently claims
additional benefits based upon an alleged recurrence of the injury
for which the original claim for benefits was made, the insurer may
require reasonable medical proof of such alleged recurrence;
provided, that in no event shall the aggregate benefits payable to
any person exceed the maximum limits prescribed in the policy.
(3) In the event the insurer fails to pay such benefits when
due, the person entitled to such benefits may bring an action in
contract to recover the same; and, in the event the insurer is
required to pay such benefits, the person entitled to such benefits
shall be entitled to recover reasonable attorneys fees plus 12%
penalty, plus interest thereon at the legal rate from the date such
sums became overdue.
(e) An insurer shall exclude benefits to any insured, or his
personal representative, under a policy required by Section 1, when
the insured's conduct contributed to the injury he sustained in any
of the following ways:
(1) Causing injury to himself intentionally.
(2) While in the commission of a felony, or while seeking to
elude lawful apprehension or arrest by a law enforcement official.
(f) This article applies only to motor vehicle insurance
policies subject to this subchapter and does not apply to other
accident or health policies even though they promise indemnity
against automobile-connected injuries.
(g) Nothing contained in this Act shall affect the offering
of medical payments coverage, disability benefits, and accidental
death benefits, as presently prescribed by the State Board of
Insurance; and nothing contained in this Act shall be construed to
prevent an insurer from providing broader benefits than the minimum
benefits enumerated in this Act subject to the rules and forms
prescribed by the State Board of Insurance.
(h) When any liability claim is made by any guest or
passenger described in paragraph (b) hereof against the owner or
operator of the motor vehicle in which he was riding or the owner's
or operator's liability insurance carrier, the owner or operator of
such motor vehicle or his liability insurance carrier shall be
entitled to an offset, credit or deduction against any award made to
such guest or passenger in an amount of money equal to the amounts
paid by the owner, operator or his automobile liability insurance
carrier under "personal injury protection" as defined in this Act
to such guests or passengers; provided, however, that nothing
herein shall be construed to authorize a direct action against a
liability insurance company if such right does not presently exist
at law.
(i) An insurer paying benefits pursuant to this Act,
including a county mutual insurance company, shall have a right of
subrogation and a claim against a person causing or contributing to
the accident if, on the date of loss, financial responsibility as
required by Chapter 601, Transportation Code, has not been
established for a motor vehicle involved in the accident and
operated by that person.
Added by Acts 1973, 63rd Leg., p. 90, ch. 52, Sec. 1, eff. Aug. 27,
1973. Amended by Acts 1981, 67th Leg., p. 100, ch. 51, Sec. 1, eff.
Aug. 31, 1981.
Sec. (f) amended by Acts 1991, 72nd Leg., ch. 242, Sec. 2.09, eff.
Sept. 1, 1991; Sec. (c) amended by and (i) added by Acts 2005, 79th
Leg., ch. 1074, Sec. 2, eff. Sept. 1, 2005; Sec. (a) amended by Acts
2005, 79th Leg., ch. 1159, Sec. 4, eff. June 18, 2005.
Article: 5.03-1 5.04 5.04-1 5.05 5.06 5.06-1 5.06-2 5.06-3 5.06-4 5.06-5 5.06-6 5.07 5.07-1 5.08 5.09
Last modified: August 11, 2007
|
