Subchapter A. CATASTROPHIC LOSS TRUST FUND
Sec.
67.1. Purpose.
67.2. Definitions.
67.3. Fund financing.
67.4. Claim filing and review.
67.5. Collection of data.
67.6. Appeals.
67.7. [Reserved].
67.8. [Reserved].
67.9. [Reserved].
67.10. [Reserved].
67.11. [Reserved].
67.12. [Reserved].
67.13. [Reserved].
67.14. [Reserved].
67.15. [Reserved].
67.16. Eligible claimant for Fund benefits.
67.17. Extraordinary medical benefits coverage.
67.18. Coordination of benefits.§ 67.1. Purpose.
The purpose of this subchapter is to provide procedures for the establishment and administration of the Fund, which continues the Catastrophic Loss Trust Fund eligibility determinations for certain individuals suffering catastrophic losses on or after October 1, 1984, but prior to June 1, 1989, or who may have suffered a catastrophic loss during the December 1988 to December 1989 vehicle registration year for which payment for Catastrophic Loss Trust Fund coverage was made in accordance with former section 1762 of the act (repealed).
Source The provisions of this § 67.1 amended October 30, 1998, effective October 31, 1998, 28 Pa.B. 5482. Immediately preceding text appears at serial page (137019).
§ 67.2. Definitions.
The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:
Act—75 Pa.C.S. § § 1701—1798 (relating to the Motor Vehicle Financial Responsibility Law).
Administrator—The person or entity designated by the Fund to review claims for catastrophic loss benefits, determine the eligibility of the claimant and make payment where appropriate.
Benefits—Payments by the Fund for reasonable, necessary and accident-related expenses for medical treatment and rehabilitative services which exceed $100,000, subject to limitations provided in sections 1761 and 1766 of the act (now repealed). Reference may be made to sections 1761, 1762 and 1766, in Appendix A.
Claims manager—The Department employe designated by the Commissioner to manage the daily activities of the Fund.
Department—The Insurance Department of the Commonwealth.
Eligible claimant—An individual who meets the requirements of § 67.16 (relating to eligible claimant for fund benefits).
Fund—The Catastrophic Loss Benefits Continuation Fund established to provide benefits required by the act.
Surcharge—The amount to be paid by drivers upon conviction of any traffic violation, exclusive of parking offenses, to fund the Fund.
Source The provisions of this § 67.2 amended October 30, 1998, effective October 31, 1998, 28 Pa.B. 5482. Immediately preceding text appears at serial page (137020).
§ 67.3. Fund financing.
The Fund shall be financed by surcharges for motor vehicle violations pursuant to 75 Pa.C.S. § 6506(a) and (b).
Authority The provisions of this § 67.3 issued and amended under 75 Pa.C.S. § § 1762 and 1765.
Source The provisions of this § 67.3 amended September 19, 1986, effective September 20, 1986, 16 Pa.B. 3510; amended September 4, 1987, effective September 5, 1987, 17 Pa.B. 3608; amended September 16, 1988, effective September 17, 1988, 18 Pa.B. 4243; amended October 30, 1998, effective October 31, 1998, 28 Pa.B. 5482. Immediately preceding text appears at serial pages (137020) and (131437).
§ 67.4. Claim filing and review.
(a) A person who seeks benefits from the Fund shall file a claim for benefits with the Fund. The Fund will review the claim for benefits and advise the claimant in writing as to whether the claimant is an eligible claimant. The insurer shall assist the insured in filing the claim for benefits.
(b) A claim submitted to the Fund which is erroneously completed or contains inadequate information may be returned to the claimant for correction and resubmission.
(c) The Fund may employ an Administrator to review the claim for benefits and advise the claimant of eligibility.
Source The provisions of this § 67.4 amended October 30, 1998, effective October 31, 1998, 28 Pa.B. 5482. Immediately preceding text appears at serial page (131437).
§ 67.5. Collection of data.
The Administrator and Fund are authorized to obtain from claimants, insurers and self-insurers data or information which is necessary to permit review of claims for Fund benefits.
Source The provisions of this § 67.5 amended October 30, 1998, effective October 31, 1998, 28 Pa.B. 5482. Immediately preceding text appears at serial page (131437).
Notes of Decisions Records of Activities
The third-party claims administrator was authorized, under § 67.5, to require the caretaker to provide details of her activities and the services she provides to her injured husband, the recipient of CAT Fund Benefits. Bickerton v. Insurance Commissioner, 808 A.2d 971 (Pa. Cmwlth. 2002), appeal denied 822 A.2d 705 (Pa. 2003).
§ 67.6. Appeals.
(a) A claimant who disputes a determination by the Administrator or Fund concerning eligibility for or allowance of benefits, may file a written complaint with the claims manager. The written determination by the Fund or Administrator shall advise the claimant how to file a complaint with the claims manager. A complaint is timely filed by the claimant if received by the claims manager no later than 33 days after the date of the written determination from the Administrator or the Fund denying eligibility for or allowance of benefits.
(b) The claims manager will issue a written determination notifying the claimant of the results of the claims manager’s review. If the claimant is not satisfied with the results of the claims manager’s review, the claimant may request in writing a formal administrative hearing before the Commissioner. The written determination by the claims manager will advise the claimant how to request a hearing. A request for hearing is timely if received by the Department no later than 33 days after the date of the written determination from the claims manager.
(c) Appeals are conducted in accordance with 1 Pa. Code Part II (relating to the General Rules of Administrative Practice and Procedure) as applicable to the Department and in accordance with Chapter 56 (relating to special rules of administrative practice and procedure).
Source The provisions of this § 67.6 amended October 30, 1998, effective October 31, 1998, 28 Pa.B. 5482. Immediately preceding text appears at serial page (131438).
§ 67.7. [Reserved].
Source The provisions of this § 67.7 adopted September 28, 1984, effective September 29, 1984, 14 Pa.B. 3520; reserved February 15, 1985, effective February 16, 1985, 15 Pa.B. 558. Immediately preceding text appears at serial page (94062).
§ 67.8. [Reserved].
Source The provisions of this § 67.8 adopted September 28, 1984, effective September 29, 1984, 14 Pa.B. 3520; reserved February 15, 1985, effective February 16, 1985, 15 Pa.B. 558. Immediately preceding text appears at serial page (94063).
§ 67.9. [Reserved].
Source The provisions of this § 67.9 adopted September 28, 1984, effective September 29, 1984, 14 Pa.B. 3520; reserved February 15, 1985, effective February 16, 1985, 15 Pa.B. 558. Immediately preceding text appears at serial page (94063).
§ 67.10. [Reserved].
Source The provisions of this § 67.10 adopted September 28, 1984, effective September 29, 1984, 14 Pa.B. 3520; reserved February 15, 1985, effective February 16, 1985, 15 Pa.B. 558. Immediately preceding text appears at serial page (94064).
§ 67.11. [Reserved].
Source The provisions of this § 67.11 adopted September 28, 1984, effective September 29, 1984, 14 Pa.B. 3520; reserved February 15, 1985, effective February 16, 1985, 15 Pa.B. 558. Immediately preceding text appears at serial page (94064).
§ 67.12. [Reserved].
Source The provisions of this § 67.12 adopted September 28, 1984, effective September 29, 1984, 14 Pa.B. 3520; reserved February 15, 1985, effective February 16, 1985, 15 Pa.B. 558. Immediately preceding text appears at serial pages (94064) and (94065).
§ 67.13. [Reserved].
Source The provisions of this § 67.13 adopted September 28, 1984, effective September 29, 1984, 14 Pa.B. 3520; reserved February 15, 1985, effective February 16, 1985, 15 Pa.B. 558. Immediately preceding text appears at serial page (94065).
§ 67.14. [Reserved].
Source The provisions of this § 67.14 adopted September 28, 1984, effective September 29, 1984, 14 Pa.B. 3520; reserved February 15, 1985, effective February 16, 1985, 15 Pa.B. 558. Immediately preceding text appears at serial page (94065).
§ 67.15. [Reserved].
Source The provisions of this § 67.15 adopted September 28, 1984, effective September 29, 1984, 14 Pa.B. 3520; reserved February 15, 1985, effective February 16, 1985, 15 Pa.B. 558. Immediately preceding text appears at serial page (94065).
§ 67.16. Eligible claimant for Fund benefits.
An individual who has suffered injuries in a motor vehicle accident is an eligible claimant for Fund benefits if the individual meets the following criteria:
(1) The individual was a resident of this Commonwealth at the time of the accident.
(2) The injury arose out of the maintenance or use of a motor vehicle after October 1, 1984, and prior to June 1, 1989, or during the December 1988 to December 1989 vehicle registration year for which payment for Catastrophic Loss Trust Fund coverage was made in accordance with former section 1762 of the act (Repealed).
(3) The auto accident occurred in the United States, its territories or possessions or Canada.
(4) The injured person was not the driver or occupant of a recreational vehicle not intended for highway use, a motorcycle, a motorized pedal cycle, a motor-driven cycle or any vehicle required to be registered under 75 Pa.C.S. (relating to the Vehicle Code) but not subject to the Fund charge.
(5) As a result of the accident, the individual incurred reasonable and necessary medical and rehabilitative expenses exceeding $100,000.
(6) The individual’s medical and rehabilitative expenses were not covered by workers’ compensation.
(7) The individual’s medical and rehabilitative expenses were not covered by a policy issued under the Pennsylvania No-fault Motor Vehicle Insurance Act (repealed).
Source The provisions of this § 67.16 adopted October 30, 1998, effective October 31, 1998, 28 Pa.B. 5482.
Cross References This section cited in 31 Pa. Code § 67.2 (relating to definitions).
§ 67.17. Extraordinary medical benefits coverage.
An eligible claimant receiving Fund benefits for accidents occurring between June 1, 1989, through December 31, 1989, may also be insured for extraordinary medical benefits coverage. If the Administrator or the Fund determines that extraordinary medical benefits are applicable, the insurer providing these benefits is the primary payor and the Fund has no obligation to pay until the benefits payable by the insurer providing the extraordinary medical benefits have been exhausted. No duplicate recovery is available. The total lifetime aggregate to one eligible claimant under both Extraordinary Medical Benefits coverage and the Fund may not exceed $1 million dollars.
Source The provisions of this § 67.17 adopted October 30, 1998, effective October 31, 1998, 28 Pa.B. 5482.
§ 67.18. Coordination of benefits.
An eligible claimant shall cooperate in providing coordination of benefit information to the Administrator and the Fund.
Source The provisions of this § 67.18 adopted October 30, 1998, effective October 31, 1998, 28 Pa.B. 5482.
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