KRS 304.39-210: Obligor's duty to respond to claims.

(1) (a) Basic and added reparation benefits are payable monthly as loss accrues.

(b) Loss accrues not when injury occurs, but as work loss, replacement services

loss, or medical expense is incurred.

(c) Benefits are overdue if not paid within thirty (30) days afte r the reparation

obligor receives reasonable proof of the fact and amount of loss realized,

unless the reparation obligor elects to accumulate claims for periods not

exceeding thirty-one (31) days after the reparation obligor receives reasonable

proof of t he fact and amount of loss realized, and pays them within fifteen

(15) days after the period of accumulation.

(d) Notwithstanding any provision of this chapter to the contrary, benefits are not

overdue if a reparation obligor has not made payment to a provider of services

due to the request of a secured person when the secured person is directing the

payment of benefits among the different elements of loss.

(e) If reasonable proof is supplied as to only part of a claim, and the part totals

one hundred dollars ($100) or more, the part is overdue if not paid within the

time provided by this section.

(f) Medical expense benefits may be paid by the reparation obligor directly to

persons supplying products, services, or accommodations to the claimant, if

the claimant so designates.

(g) A reparation obligor shall not, in any event, pay a charge for a medical

expense that exceeds the maximum fee permitted under KRS 304.39 -

020(5)(a)2.

(h) 1. Except as provided in subparagraph 2. of this paragraph, a person

providing a product, service, or accommodation shall submit a statement

of the charge for the medical expense within one hundred eighty (180)

days of the date the product, service, or accommodation is rendered.

2. Subparagraph 1. of this paragraph shall not apply to charges submitted

pursuant to KRS 304.39-241.

(i) A person providing a product, service, or accommodation shall not:

1. Knowingly collect, attempt to collect, coerce, or attempt to coerce,

directly or in directly, the payment of any charge for a medical expense

covered by a reparation obligor that exceeds the maximum fee permitted

under KRS 304.39-020(5)(a)2.; or

2. Cause the credit of any basic or added reparation insured to be impaired

by reason of the i nsured's failure or refusal to pay the balance of any

charge for a medical expense covered by a reparation obligor that

exceeds the maximum fee permitted under KRS 304.39-020(5)(a)2.

(2) Overdue payments bear interest at the rate of twelve percent (12%) pe r annum,

except that if delay was without reasonable foundation, the rate of interest shall be

eighteen percent (18%) per annum.

(3) (a) A claim for basic or added reparation benefits shall be paid without deduction

for the benefits which are to be subtrac ted pursuant to the provisions on

calculation of net loss if these benefits have not been paid to the claimant

before the reparation benefits are overdue or the claim is paid.

(b) The reparation obligor is entitled to reimbursement from the person obligate d

to make the payments or from the claimant who actually receives the

payments.

(4) (a) A reparation obligor may bring an action to recover benefits which are not

payable, but are in fact paid, because of an intentional misrepresentation of a

material fact, upon which the reparation obligor relies, by the insured or by a

person providing an item of medical expense.

(b) The action may be brought only against the person providing the item of

medical expense, unless the insured has intentionally misrepresented the facts

or knows of the misrepresentation.

(c) An insurer may offset amounts he is entitled to recover from the insured under

this subsection against any basic or added reparation benefits otherwise due.

(5) (a) A reparation obligor who rejects a claim for basic reparation benefits shall

give to the claimant prompt written notice of the rejection, specifying the

reason.

(b) If a claim is rejected for a reason other than that the person is not entitled to

the basic reparation benefits claimed, the written notice shall inform the

claimant that he may file his claim with the assigned claims bureau and shall

give the name and address of the bureau.