C.R.S. Section 10-4-635
Medical payments coverage

  • exceptions
  • definitions

(1)

Intentionally left blank —Ed.

(a)

Except as otherwise provided in this subsection (1), no automobile liability or motor vehicle liability policy insuring against loss resulting from liability imposed by law for bodily injury or death suffered by any person arising out of the ownership, maintenance, or use of a motor vehicle shall be delivered or issued for delivery in this state unless coverage is provided in the policy or in a supplemental policy for medical payments with benefits of five thousand dollars for bodily injury, sickness, or disease resulting from the ownership, maintenance, or use of the motor vehicle.

(b)

A policy may be issued without medical payments coverage only if the named insured rejects medical payments coverage in writing or in the same medium in which the application for the policy was taken. The insurer shall maintain proof that a named insured rejected medical payments coverage for at least three years after the date of the rejection, and such proof of rejection shall be presumed valid for all insureds under the policy, including resident relatives of the named insured and permissive users of the motor vehicle. An agent or insurer that obtains a rejection of medical payments coverage from the named insured or applicant pursuant to this section shall not be liable to the insured or any other person seeking benefits under the named insured’s policy for claims arising out of or relating to the rejection of medical payments coverage.

(c)

If the insurer fails to offer medical payments coverage or fails to maintain or provide proof that the named insured rejected medical payments coverage in the manner required by this section, the insured’s policy shall be presumed to include medical payments coverage with benefits of five thousand dollars.

(d)

If an insured selects limits for medical payments coverage or exercises the option not to purchase the coverages described in this section, an insurer or affiliated insurer shall not be required to notify any policyholder in any renewal or replacement policy of the availability of medical payments coverage. However, the insured may make a request for additional coverage or coverage more extensive than that provided on a prior policy.

(e)

Nothing in this section shall be construed to limit any other coverage amounts being made available by an insurer.

(2)

Intentionally left blank —Ed.

(a)

If a policy contains medical payments coverage, medical payments benefits shall be paid to persons providing medically necessary and accident-related trauma care or medical care. Except as provided in paragraphs (b), (c), and (d) of this subsection (2), payments of claims for medical payments coverage shall be made in accordance with section 10-4-642.

(b)

Upon receiving notice, either from a provider or the insured, of an accident for which the medical payments coverage specified in this section or medical payments coverage in a greater amount may apply, the insurer shall reserve five thousand dollars of the medical payments coverage for the payment of trauma care provided by a licensed air ambulance, licensed ambulance, trauma physician, or trauma center in the following priority, as applicable:

(I)

Benefits shall be paid first to licensed ambulances or air ambulances that provide trauma care at the scene of or immediately after the motor vehicle accident, including transport to or from a trauma center.

(II)

After payments to providers described in subparagraph (I) of this paragraph (b), benefits shall be paid next to trauma physicians that provide trauma care to stabilize or provide the first episode of care to the injured person.

(III)

After payments to providers described in subparagraphs (I) and (II) of this paragraph (b), benefits shall be paid next to trauma centers designated as level IV or V pursuant to section 25-3.5-703 (4), C.R.S., that provide trauma care to stabilize or provide the first episode of care to the injured person.

(IV)

After payments to providers described in subparagraphs (I), (II), and (III) of this paragraph (b), benefits shall be paid next to trauma centers designated as level I, II, or III or as a regional pediatric trauma center pursuant to section 25-3.5-703 (4), C.R.S., that provide trauma care to stabilize or provide the first episode of care to the injured person.

(c)

The reserve shall be held and used to pay claims of trauma care providers described in this subsection (2) for no more than thirty days after receipt of the accident notice. After the thirty-day period, any amount of the reserve for which the insurer has not received a claim for reimbursement from a trauma care provider described in this subsection (2) may be used to pay any other claims for reimbursement submitted by other providers.

(d)

The periods specified in section 10-4-642 for the prompt payment of medical payments coverage benefits shall be tolled for the period that an insurer is required under this subsection (2) to hold payment of a claim from a provider that did not provide trauma care, but only to the extent the medical payments coverage benefits not held in reserve are insufficient to pay the claim.

(3)

Intentionally left blank —Ed.

(a)

An insurer providing benefits under medical payments coverage in the amount specified in this section or in a greater amount than the amount specified in this section shall not have a right to recover against an owner, user, or operator of a motor vehicle, or against any person or organization legally responsible for the acts or omissions of such person, in any action for damages for benefits paid under such medical payments coverage. An insurer shall not have a direct cause of action against an alleged tortfeasor for benefits paid under medical payments coverage.

(b)

Nothing in this subsection (3) shall be construed to:

(I)

Modify the requirements of section 13-21-111.6, C.R.S., or any requirements under the “Workers’ Compensation Act of Colorado”, articles 40 to 47 of title 8, C.R.S.;

(II)

Prevent a person to whom benefits are paid under medical payments coverage from obtaining recovery of benefits available under uninsured motorist coverage pursuant to section 10-4-609; or

(III)

Afford an insurer a cause of action against a person to whom or for whom the medical payments coverage benefits specified in this section were paid except in a case where the benefits were paid by reason of fraud.

(4)

This section does not apply to:

(a)

A person obtaining an automobile liability or motor vehicle policy insuring against loss resulting from the ownership, maintenance, or use of a motorcycle, autocycle, low-power scooter, or toy vehicle, as defined in section 42-1-102; a snowmobile, as defined in section 33-14-101; or any vehicle designed primarily for use off the road or on rails;

(b)

A person that has obtained a certificate of self-insurance from the commissioner pursuant to section 10-4-624.

(5)

As used in this section:

(a)

“Injured person” means the insured, or a passenger who is authorized by the insured to occupy the insured’s motor vehicle, who sustains bodily injury arising out of the use of the insured’s motor vehicle.

(b)

“Licensed air ambulance” means an air ambulance, as defined in section 25-3.5-103 (1), C.R.S., that is licensed by the department of public health and environment pursuant to section 25-3.5-307, C.R.S.

(c)

“Licensed ambulance” means an ambulance, as defined in section 25-3.5-103 (1.5), C.R.S., that is licensed pursuant to section 25-3.5-301, C.R.S.

(d)

“Licensed health-care provider” has the same meaning as set forth in section 10-4-601, and also includes an occupational therapist, as defined in section 12-270-104 (9), and an occupational therapy assistant, as defined in section 12-270-104 (11).

(e)

“Medical care” means all medically necessary and accident-related health-care and rehabilitation services provided by a licensed health-care provider to a person injured in an automobile accident for which benefits under the terms of the medical payments coverage in the policy are payable.

(f)

“Provider” means a licensed health-care provider, licensed air ambulance, licensed ambulance, trauma physician, or trauma center.

(g)

“Stabilize” means, with respect to a medical condition resulting from a trauma, to provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result or occur during the transfer of the individual to or from a trauma center.

(h)

“Trauma” means an injury or wound to a living person caused by the application of an external physical force. Trauma includes any event that threatens life, limb, or the well-being of an individual in such a manner that a prudent lay person would believe that immediate medical care is needed.

(i)

“Trauma care” means care provided by a licensed ambulance or air ambulance, trauma physician, or trauma center to a person injured in a motor vehicle accident from the time the administration of care begins to the time the patient is fully stabilized or through the first episode of care, not to exceed seventy-two hours after the administration of care begins. The term includes a trauma care system, trauma transport protocols, and triage, as defined in section 25-3.5-703, C.R.S.

(j)

“Trauma center” means the emergency department in a licensed or certified hospital or a health-care facility that is designated by the department of public health and environment as a level I, II, III, IV, or V facility or as a regional pediatric trauma center.

(k)

“Trauma physician” means a trauma surgeon, orthopedic surgeon, neurosurgeon, intensive care unit physician, anesthesiologist, or physician who provides care in a trauma center to a trauma patient injured in a motor vehicle accident.

Source: Section 10-4-635 — Medical payments coverage - exceptions - definitions, https://leg.­colorado.­gov/sites/default/files/images/olls/crs2023-title-10.­pdf (accessed Oct. 20, 2023).

10‑4‑101
Legislative declaration 10‑4‑102
Federal “voluntary fair access to insurance required, property insurance program” - state qualification 10‑4‑103
Voluntary partial payment of liability claims without admission of liability 10‑4‑104
Competency of minor to contract for insurance - nonavoidance 10‑4‑105
Valuation of bonds and policies other than life 10‑4‑106
Assigned risks 10‑4‑106.5
Medical malpractice insurers - requirement to provide information to the department of public health and environment 10‑4‑107
Cancellation of medical malpractice policies 10‑4‑108
Notice 10‑4‑109
Nonrenewal of medical malpractice policies 10‑4‑109.5
Notice of intent prior to unilateral increase in premium or decrease in coverage previously provided in medical malpractice policies 10‑4‑109.6
Medical malpractice insurers - protections relating to reproductive health care - definition 10‑4‑109.7
Notice of intent prior to cancellation of certain policies of insurance 10‑4‑110
Notice of intent prior to nonrenewal of certain policies of insurance 10‑4‑110.3
Exclusions where claim involves sexual misconduct - void 10‑4‑110.4
Exclusion - claims involving loss in progress not known to insured 10‑4‑110.5
Notice of intent prior to unilateral increase in premium or decrease in coverage previously provided in certain policies of insurance 10‑4‑110.6
Homeowner’s insurance - definition 10‑4‑110.7
Cancellation or nonrenewal - homeowner’s insurance policies 10‑4‑110.8
Homeowner’s insurance - prohibited and required practices - estimates of replacement value - additional living expense coverage - copies of policies - personal property contents coverage - inventory of personal property - requirements concerning total loss scenarios resulting from wildlife disasters - definitions - rules 10‑4‑110.9
Fire insurance - issuance and renewal of policies within federally designated disaster areas 10‑4‑111
Summary disclosure forms required 10‑4‑112
Property damage - time of payment 10‑4‑113
Exemptions 10‑4‑114
Requirements on hazard insurance coverage for loans secured by real property 10‑4‑115
Private utilization review 10‑4‑116
Use of credit information 10‑4‑117
Loss history information report - notice to insured - definition 10‑4‑118
Severability 10‑4‑119
Monthly and electronic payment of premiums 10‑4‑120
Unfair or discriminatory trade practices - legislative declaration 10‑4‑121
Authority of insurer to protect policyholders’ property - emergency 10‑4‑301
Bond executed by surety company 10‑4‑302
Release of surety - other security 10‑4‑303
Application for release of surety - refund 10‑4‑304
Place of deposit 10‑4‑305
Bond part of expense 10‑4‑401
Purpose - applicability 10‑4‑402
Definitions 10‑4‑403
Standards for rates - competition - procedure - requirement for independent actuarial opinions regarding 1991 legislation 10‑4‑404
Rate administration 10‑4‑404.5
Rating plans - property and casualty type II insurers - rules 10‑4‑405
Filing of rating information - certain coverages 10‑4‑406
Review of filings - certain coverages 10‑4‑407
Hearings 10‑4‑408
Rating organization - study of workers’ compensation rates - premium reductions - adoption of rules 10‑4‑409
Rates furnished - cooperation among organizations 10‑4‑410
Advisory organizations 10‑4‑411
Joint underwriting 10‑4‑412
Assigned risk motor vehicle insurance 10‑4‑413
Records required to be maintained 10‑4‑414
Examinations 10‑4‑415
Prohibition against anticompetitive behavior 10‑4‑416
Prohibiting changes in rates or coverages 10‑4‑417
False or misleading information 10‑4‑418
Enforcement procedures - penalties 10‑4‑419
Claims-made policy forms 10‑4‑419.5
Workers’ compensation form certification 10‑4‑420
Risk management procedures 10‑4‑421
Notice of rate increases and decreases 10‑4‑501
Short title 10‑4‑502
Legislative declaration 10‑4‑503
Definitions 10‑4‑504
Scope 10‑4‑505
Construction 10‑4‑506
Colorado insurance guaranty association 10‑4‑507
Board of directors 10‑4‑508
Powers and duties of association 10‑4‑508.5
Aggregate liability of association 10‑4‑509
Plan of operation 10‑4‑510
Duties and powers of commissioner 10‑4‑511
Effect of paid claims 10‑4‑512
Nonduplication of recovery 10‑4‑513
Prevention of insolvencies 10‑4‑514
Examination of association 10‑4‑515
Tax exemption 10‑4‑516
Recognition of assessments in rates 10‑4‑517
Immunity 10‑4‑518
Stay of proceedings 10‑4‑519
Termination - distribution of funds 10‑4‑520
Advertising 10‑4‑601
Definitions 10‑4‑601.5
Administrative authority 10‑4‑602
Basis for cancellation 10‑4‑603
Notice 10‑4‑604
Nonrenewal 10‑4‑604.5
Issuance or renewal of insurance policies - proof of insurance provided by certificate, card, or other media 10‑4‑605
Proof of notice 10‑4‑606
Further notice 10‑4‑607
Immunity 10‑4‑608
Exemptions 10‑4‑609
Insurance protection against uninsured motorists - applicability 10‑4‑610
Property damage protection against uninsured motorists 10‑4‑611
Elimination of discounts - damage by uninsured motorist 10‑4‑613
Glass repair and replacement 10‑4‑614
Inflatable restraint systems - replacement - verification of claims - definition 10‑4‑615
Motorist insurance identification database program - reporting required - fine 10‑4‑616
Disclosure of credit reports 10‑4‑617
Insurers - biannual fee - auto theft prevention authority 10‑4‑619
Coverage compulsory 10‑4‑620
Required coverage 10‑4‑621
Required coverages are minimum 10‑4‑622
Required provision for intrastate and interstate operation 10‑4‑623
Conditions and exclusions 10‑4‑624
Self-insurers 10‑4‑625
Premium payments 10‑4‑626
Prohibited reasons for nonrenewal or refusal to write policy of automobile insurance applicable to this part 6 10‑4‑627
Discriminatory standards - premiums - surcharges - proof of financial responsibility requirements 10‑4‑628
Refusal to write - changes in - cancellation - nonrenewal of policies prohibited 10‑4‑629
Cancellation - renewal - reclassification 10‑4‑630
Exclusion of named driver 10‑4‑632
Reduction in rates for drivers aged fifty-five years or older who complete driver’s education course - legislative declaration 10‑4‑633
Certification of policy and notice forms 10‑4‑633.5
Automobile insurance policies - plain language required - rules 10‑4‑634
Assignment of payment for covered benefits 10‑4‑635
Medical payments coverage - exceptions - definitions 10‑4‑636
Disclosure requirements for automobile insurance products offered - rules 10‑4‑637
No discrimination by profession 10‑4‑638
Retroactive adjustment of health-care service claims 10‑4‑639
Claims practices for property damage 10‑4‑640
Operator’s policy of insurance 10‑4‑641
Rules - medical payments coverage 10‑4‑642
Prompt payment of direct benefits - legislative declaration - definitions 10‑4‑643
Electronic claim forms - rules 10‑4‑1001
Short title 10‑4‑1002
Definitions 10‑4‑1003
Disclosure of information 10‑4‑1004
Evidence - confidential 10‑4‑1005
Immunity 10‑4‑1006
Enforcement 10‑4‑1007
Penalty 10‑4‑1008
Municipal ordinances - concurrent jurisdiction - common law 10‑4‑1009
Continuing duties of insurers - unfair claim settlement practices 10‑4‑1201
Definitions 10‑4‑1202
Minimum standards 10‑4‑1203
Disclosure 10‑4‑1204
Penalties 10‑4‑1205
Applicability 10‑4‑1206
Effective date 10‑4‑1301
Legislative declaration 10‑4‑1302
Definitions 10‑4‑1303
Temporary joint underwriting association 10‑4‑1304
Board of directors - authority 10‑4‑1305
Plan of operation - annual certification 10‑4‑1306
Deficits - assessment - rebate of surplus 10‑4‑1307
Annual statements 10‑4‑1308
Examinations 10‑4‑1309
Legislative declaration - authority of commissioner - emergency rules - judicial review 10‑4‑1310
Privileged communications 10‑4‑1311
Tax exemption 10‑4‑1401
Legislative declaration 10‑4‑1402
Rules 10‑4‑1403
Exemption from rate filing, approval, and form certification requirements 10‑4‑1404
Multistate insurance risks - choice of law 10‑4‑1501
Definitions 10‑4‑1502
Licensure of vendors 10‑4‑1503
Requirements for sale of portable electronics insurance 10‑4‑1504
Authority of vendors of portable electronics 10‑4‑1505
Suspension or revocation of license 10‑4‑1506
Termination of portable electronics insurance 10‑4‑1507
Application for license - fees 10‑4‑1601
Definitions 10‑4‑1602
Exemptions 10‑4‑1603
Requirements for sale of consumer goods service contracts - definitions 10‑4‑1604
Obligations of reimbursement insurance companies 10‑4‑1605
Required disclosures - reimbursement insurance policy 10‑4‑1606
Required disclosures - service contracts 10‑4‑1607
Prohibited acts 10‑4‑1608
Required record keeping 10‑4‑1609
Enforcement provisions - rules 10‑4‑1701
Definitions 10‑4‑1702
Authority to issue license 10‑4‑1703
License - application - restrictions 10‑4‑1704
Disclosures to occupant 10‑4‑1705
Supervision of issuance - training 10‑4‑1706
Compensation 10‑4‑1707
Exemption from requirements 10‑4‑1708
Notification 10‑4‑1709
Enforcement 10‑4‑1801
Short title 10‑4‑1802
Legislative declaration 10‑4‑1803
Definitions 10‑4‑1804
Fair access to insurance requirements plan association - creation - participation required 10‑4‑1805
Fair access to insurance requirements plan association - board of directors - membership - duties 10‑4‑1806
FAIR plan - plan requirements - insurer requirements 10‑4‑1807
Plan of operation - mandatory components - amendments - revocation by commissioner - rules 10‑4‑1808
FAIR plans - requirements for licensed producers 10‑4‑1809
Assessment of fees 10‑4‑1810
Enforcement - suspension or revocation of certificate of authority - fines 10‑4‑1811
Appeals - judicial review 10‑4‑1812
Rules
Green check means up to date. Up to date

Current through Fall 2024

§ 10-4-635’s source at colorado​.gov