79285938.2-2201Virginia Decodedhttps://vacode.org2016InsuranceLiability Insurance PoliciesProvisions for payment of medical expense and loss of income benefits; assignment of certain benefits1972, 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; 2013, c. 75; 2014, cc. 157, 417; 2015, cc. 502, 503.State Farm Mut. Auto. Ins. Co. v. GandyRecord No. 880554383 S.E.2d 7171989-09-22https://www.courtlistener.com/opinion/1366258/state-farm-mut-auto-ins-co-v-gandy/ . . . language of exclusion. The court relied on Code § 38.2-2201 ("[u]pon request of an insured," . . . <abbr title="Supreme Court of Virginia">SCV</abbr>Cotchan v. State Farm Fire & Cas. Co.941858462 S.E.2d 781995-09-15https://www.courtlistener.com/opinion/1060263/cotchan-v-state-farm-fire-cas-co/ . . . mandated by Code § 38.2-2201. . . . <abbr title="Supreme Court of Virginia">SCV</abbr>State Farm Mut. Auto. Ins. Co. v. SeayRecord No. 870763373 S.E.2d 9101988-11-18https://www.courtlistener.com/opinion/1344385/state-farm-mut-auto-ins-co-v-seay/ . . . Code § 38.1-380.1 (Cum.Supp.1983) (now Code § 38.2-2201) when read with Code § 38.1-343 . . . <abbr title="Supreme Court of Virginia">SCV</abbr>Allstate Ins. Co. v. EatonRecord No. 931468448 S.E.2d 6521994-09-16https://www.courtlistener.com/opinion/1399518/allstate-ins-co-v-eaton/ . . . notes that the medical payments statutes, Code §§ 38.2-2201 and 38.2-2202(A), do not contain any . . . <abbr title="Supreme Court of Virginia">SCV</abbr>Scarbrow v. State Farm Mut. Auto. Ins. Co.9724351998-09-18https://www.courtlistener.com/opinion/1059854/scarbrow-v-state-farm-mut-auto-ins-co/ . . . such an exclusion does not conflict . . . <abbr title="Supreme Court of Virginia">SCV</abbr>VIRGINIA FARM BUREAU MUT. INS. v. JerrellRecord Nos. 860149, 860840 and 870049373 S.E.2d 9131988-11-18https://www.courtlistener.com/opinion/1344118/virginia-farm-bureau-mut-ins-v-jerrell/ . . . Code § 38.1-380.1 (Cum.Supp.1983) (now Code § 38.2-2201) provided them with coverage. This Code . . . <abbr title="Supreme Court of Virginia">SCV</abbr>Jones v. State Farm Mutual Auto. Ins. Co.0326322004-09-17https://www.courtlistener.com/opinion/1059044/jones-v-state-farm-mutual-auto-ins-co/ . . . under certain . . . <abbr title="Supreme Court of Virginia">SCV</abbr>Pauley v. State Farm Mutual Auto. Insurance9923662000-05-12https://www.courtlistener.com/opinion/1059607/pauley-v-state-farm-mutual-auto-insurance/ . . . was not . . . <abbr title="Supreme Court of Virginia">SCV</abbr>Acuar v. Letourneau992228531 S.E.2d 3162000-06-09https://www.courtlistener.com/opinion/1059606/acuar-v-letourneau/ . . . defined the term "incurred" in Code § 38.2-2201(A)(3), it did so only in the context of provisions . . . <abbr title="Supreme Court of Virginia">SCV</abbr>State Farm Mut. Auto. Ins. Co. v. Bowers971257500 S.E.2d 2121998-04-17https://www.courtlistener.com/opinion/1059898/state-farm-mut-auto-ins-co-v-bowers/ . . . Assembly defined "incurred" in Code § 38.2-2201(A)(3), which addresses medical payments in . . . <abbr title="Supreme Court of Virginia">SCV</abbr>State Farm Mut. Auto. Ins. Co. v. GandyRecord No. 880554383 S.E.2d 7171989-09-22https://www.courtlistener.com/opinion/1366258/state-farm-mut-auto-ins-co-v-gandy/ . . . language of exclusion. The court relied on Code § 38.2-2201 ("[u]pon request of an insured," . . . <abbr title="Supreme Court of Virginia">SCV</abbr>Cotchan v. State Farm Fire & Cas. Co.941858462 S.E.2d 781995-09-15https://www.courtlistener.com/opinion/1060263/cotchan-v-state-farm-fire-cas-co/ . . . mandated by Code § 38.2-2201. . . . <abbr title="Supreme Court of Virginia">SCV</abbr>State Farm Mut. Auto. Ins. Co. v. SeayRecord No. 870763373 S.E.2d 9101988-11-18https://www.courtlistener.com/opinion/1344385/state-farm-mut-auto-ins-co-v-seay/ . . . Code § 38.1-380.1 (Cum.Supp.1983) (now Code § 38.2-2201) when read with Code § 38.1-343 . . . <abbr title="Supreme Court of Virginia">SCV</abbr>Allstate Ins. Co. v. EatonRecord No. 931468448 S.E.2d 6521994-09-16https://www.courtlistener.com/opinion/1399518/allstate-ins-co-v-eaton/ . . . notes that the medical payments statutes, Code §§ 38.2-2201 and 38.2-2202(A), do not contain any . . . <abbr title="Supreme Court of Virginia">SCV</abbr>Scarbrow v. State Farm Mut. Auto. Ins. Co.9724351998-09-18https://www.courtlistener.com/opinion/1059854/scarbrow-v-state-farm-mut-auto-ins-co/ . . . such an exclusion does not conflict . . . <abbr title="Supreme Court of Virginia">SCV</abbr>VIRGINIA FARM BUREAU MUT. INS. v. JerrellRecord Nos. 860149, 860840 and 870049373 S.E.2d 9131988-11-18https://www.courtlistener.com/opinion/1344118/virginia-farm-bureau-mut-ins-v-jerrell/ . . . Code § 38.1-380.1 (Cum.Supp.1983) (now Code § 38.2-2201) provided them with coverage. This Code . . . <abbr title="Supreme Court of Virginia">SCV</abbr>Jones v. State Farm Mutual Auto. Ins. Co.0326322004-09-17https://www.courtlistener.com/opinion/1059044/jones-v-state-farm-mutual-auto-ins-co/ . . . under certain . . . <abbr title="Supreme Court of Virginia">SCV</abbr>Pauley v. State Farm Mutual Auto. Insurance9923662000-05-12https://www.courtlistener.com/opinion/1059607/pauley-v-state-farm-mutual-auto-insurance/ . . . was not . . . <abbr title="Supreme Court of Virginia">SCV</abbr>Acuar v. Letourneau992228531 S.E.2d 3162000-06-09https://www.courtlistener.com/opinion/1059606/acuar-v-letourneau/ . . . defined the term "incurred" in Code § 38.2-2201(A)(3), it did so only in the context of provisions . . . <abbr title="Supreme Court of Virginia">SCV</abbr>State Farm Mut. Auto. Ins. Co. v. Bowers971257500 S.E.2d 2121998-04-17https://www.courtlistener.com/opinion/1059898/state-farm-mut-auto-ins-co-v-bowers/ . . . Assembly defined "incurred" in Code § 38.2-2201(A)(3), which addresses medical payments in . . . <abbr title="Supreme Court of Virginia">SCV</abbr>http://law.lis.virginia.gov/vacode/38.2-2201/2.2-1204Health insurance program for employees of local governments, local officers, teachers, etc.; definitions/2.2-1204/2.2-2800Disability to hold state office/2.2-2800/38.2-3717Scope/38.2-3717/38.2-4300Definitions/38.2-4300/38.2-4500Applicability of chapter/38.2-4500/38.2-5200Definitions/38.2-5200/8.01-581.1Definitions/8.01-581.1//38.2-2201/38.2/22/38.2-220138.2-1248.01-27.58.01-413.01 All reasonable and necessary expenses for medical, chiropractic, hospital, dental, surgical, prosthetic and rehabilitation services, services provided by an emergency medical services vehicle as defined in § 32.1-111.1, and funeral expenses, resulting from the accident and incurred within three years after the date of the accident, up to $ 2,000 per person; however, if the insured does not elect to purchase such limit the insurer and insured may agree to any other limit;sectionA1A12 If the person is usually engaged in a remunerative occupation, an amount equal to the loss of income incurred after the date of the accident resulting from injuries received in the accident up to $ 100 per week during the period from the first workday lost as a result of the accident up to the date the person is able to return to his usual occupation. However, the period shall not extend beyond one year from the date of the accident; andsectionA2A22 An expense described in subdivision 1 shall be deemed to have been incurred:
sectionA3A32 If the insured is directly responsible for payment of the expense;sectionA3aA3a3 If no medical bill is rendered or specific charge made by a health care provider to the insured, an insurer, or any other person, in the amount of the usual and customary fee charged in that community for the service rendered.sectionA3cA3c3The insured has the option of purchasing either or both of the coverages set forth in subdivisions A 1 and A 2. Either or both of the coverages, as well as any other medical expense or loss of income coverage under any policy of automobile liability insurance, shall be payable to the covered injured person or pursuant to an assignment of benefits in accordance with subsection D, notwithstanding the failure or refusal of the named insured or other person entitled to the coverage to give notice to the insurer of an accident as soon as practicable under the terms of the policy, except where the failure or refusal prejudices the insurer in establishing the validity of the claim.sectionBB1In any policy of personal automobile insurance in which the insured has purchased coverage under subsection A, every insurer providing such coverage arising from the ownership, maintenance or use of no more than four motor vehicles shall be liable to pay up to the maximum policy limit available on every motor vehicle insured under that coverage if the health care or disability expenses and costs mentioned in subsection A exceed the limits of coverage for any one motor vehicle so insured.sectionCC1Any attempt to assign medical expense benefits shall be subject to the following:sectionDD1 An assignment of medical expense benefits shall be valid only if:
sectionD1D12 A copy of the AOB form, executed by the assignor and in compliance with the other requirements of subdivision D 1 and a copy of the notice complying with subdivision g if such notice is provided in a separate document pursuant to subdivision e, is provided to the motor vehicle insurer;sectionD1aD1a3 The AOB form is (i) in writing, which includes any printed or electronic format, (ii) dated, and (iii) executed by the assignor;sectionD1bD1b3 The AOB form includes a conspicuous statement that the assignor is not required to execute the AOB form;sectionD1cD1c3 If the AOB form includes a notice that complies with the provisions of subdivision g, the AOB form is signed, initialed, or otherwise marked by the assignor, at or near the notice provision, to acknowledge that the assignor has read, or had the opportunity to read, the notice;sectionD1dD1d3 If the AOB form does not include a notice that complies with the provisions of subdivision g, (i) the assignor is given a separate document, in any printed or electronic format, that is delivered to the assignor at the same time as the AOB form and that contains a notice that complies with the provisions of subdivision g; (ii) the AOB form includes a conspicuous statement that a notice regarding the assignment of medical expense benefits is provided in a separate document; and (iii) the AOB form is signed, initialed, or otherwise marked by the assignor at or near the statement described in clause (ii) to acknowledge that the assignor has read, or had the opportunity to read, the separate document containing the notice;sectionD1eD1e3 The statements required by subdivision D 1 to be included in the AOB form or a separate document, including the notice prescribed by subdivision g, are in not less than eight-point type; andsectionD1fD1f3 Upon receipt of a copy of an AOB form that satisfies the requirements of subdivision D 1 and (i) an explanation of benefits or remittance advice or (ii) a bill, claim form, or documentation from the assignee advising that it has been represented to the assignee that the covered injured person does not have health insurance or is covered by a self-insured or self-funded employee welfare benefit plan subject to the Employee Retirement Income Security Act of 1974 which requires medical expense coverage to be primary, a motor vehicle insurer shall pay directly to the health care provider, from any medical expense benefits available to such person under a motor vehicle insurance policy:
sectionD2D22 If the covered injured person is covered under a health care policy, the health care provider is an in-network provider, and the health care provider has submitted its claim to the health insurer for the health care services, the amount of any copayments, coinsurance, or deductibles owed by the injured covered person to the health care provider, as evidenced by an explanation of benefits, remittance advice, or similar documentation provided to the motor vehicle insurer; orsectionD2aD2a3 If (i) the covered injured person is not covered under a health care policy, (ii) the covered injured person is covered by a self-insured or self-funded employee welfare benefit plan subject to the Employee Retirement Income Security Act of 1974 which requires medical expense coverage to be primary, or (iii) the health care provider is not an in-network provider, amounts to cover the cost of the health care services provided, in the amount of the usual and customary fee charged in that community for the health care services rendered;sectionD2bD2b3 A motor vehicle insurer shall in all respects be held harmless for making payments pursuant to subdivision D 2 to a health care provider in accordance with an assignment of benefits that satisfies the requirements of subdivision D 1;sectionD3D32 A covered injured person shall not be required to assign to any person any medical expense benefits he may have under this section, including any assignment of the proceeds of such coverages;sectionD4D42 An assignment of medical expense benefits shall be void and unenforceable as against public policy if the assignment does not comply with the requirements of subdivision D 1;sectionD5D52 Medical expense benefits may not be reduced because of any benefits paid, payable, or provided by any insurance contract providing hospital, medical, surgical, and similar or related benefits, or any subscription contract or health services plan delivered or issued for delivery or providing for the payment of benefits to or on behalf of persons residing in or employed in the Commonwealth, except as authorized by this section; andsectionD6D62 Nothing in this section shall prohibit the payment of medical expense benefits due to the covered injured person directly to any state or federal assistance program that has provided medical benefits to such injured person when the injury arose out of the ownership, maintenance, or use of any motor vehicle.sectionD7D72