31 Pa. Code § app B § 1766
Current through Register Vol. 54, No. 49, December 7, 2024
Section 1766 - Definitions [Repealed](a)General rule.-Subject to the limitations set forth in subsection (b), the Catastrophic Loss Trust Fund shall provide catastrophic loss benefits to eligible claimants only for the payment of expenses for medical treatment and rehabilitative services in excess of $100,000. No payment shall be made by the fund for the first $100,000 of expense for medical treatment and rehabilitative services incurred by an eligible claimant.(b)Maximum benefit.-The maximum catastrophic loss benefit which shall be paid by the fund on behalf of any one eligible claimant shall be $50,000 per year and $1,000,000 lifetime aggregate. During the first 18 months of eligibility, the administrator may approve payments on behalf of a claimant without regard to the $50,000 per year limit but subject to the $1,000,000 lifetime aggregate.(c)Effect of other benefits.-Except for workers' compensation, catastrophic loss benefits paid or payable by the fund shall be primary to any other available source of accident or health benefits including any program, group contract or other private or public source of benefits unless the law authorizing or providing those benefits makes the benefits primary to the benefits provided under this subchapter.(d)Structured settlements.-The administrator may enter into structured settlements to pay benefits under this subchapter. Where it appears the settlement will be both cost effective to the fund and in the best interest of the claimant, the restrictions in subsection (b) shall not apply to this subsection, but in no event shall the cost of the structured settlement exceed the present value of the future annual payments up to the maximum lifetime aggregate benefit remaining calculated at 6% simple interest.(e)Preclusion of pleading, proving and recovering benefits.-In any action for damages against a tortfeasor arising out of the maintenance or use of a motor vehicle, a person who is eligible to receive catastrophic loss benefits shall be precluded from pleading, introducing into evidence or recovering the amount of medical and rehabilitative expenses for which catastrophic loss benefits were paid or are payable. This preclusion applies only to catastrophic loss benefits.(f)Subrogation.-There shall be no subrogation or reimbursement from a claimant's tort recovery with respect to catastrophic loss benefits.31 Pa. Code § app B § 1766