(1) (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) (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) (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.