Personal injury protection benefits apply with respect to bodily injury sustained by an insured, caused by an accident arising out of the use or operation of a motor vehicle. An “insured” is a defined term that includes the named insured, any family member, or any other person while occupying the named insured's covered auto with the consent of the named insured or while a pedestrian if the accident involves the named insured's covered auto.

Within the definition of “insured” are several other terms that are also defined on the endorsement. “Family member” is defined as the spouse of the named insured, or any other person related to the named insured by blood, marriage, or adoption (including a ward or a foster child) who is a resident of the named insured's household or temporarily living elsewhere. “Occupying” means in or upon, entering into, or alighting from the named insured's covered auto. “Covered auto” means a motor vehicle owned by the named insured, and for which the bodily injury liability coverage of the policy applies and a specific premium is charged; and for which the named insured is required by Colorado law to maintain security. “Pedestrian” is defined as any person not occupying a motor vehicle or a machine operated by a motor or engine.

The endorsement contains some notable provisions concerning coverage for insureds. Persons other than the named insured and family members are eligible for benefits only if injured in an accident that involves the named insured's covered auto. The named insured and family members, on the other hand, are eligible with respect to the operation or use of any motor vehicle (as defined on the endorsement) unless the exclusion concerning owned autos applies (see the exclusions section of this article). Persons other than the named insured or a family member are eligible for personal injury coverage while occupying the named insured's covered auto, but that occupying must be with the consent of the named insured. If, for example, the named insured's son, while driving the named insured's auto, picks up a hitchhiker and has an accident injuring the hitchhiker, the insurer would be justified in claiming that the hitchhiker was not an insured under this endorsement since the named insured did not consent to his occupying the auto. Persons considered insureds as pedestrians cover the gamut from those who are walking through those riding a bike or being pushed in a wagon, as long as that person is not occupying a motor vehicle (as defined) or any machine operated by a motor or engine.

Personal injury protection benefits provided under endorsement PP 05 61 fall into five categories: medical expenses, rehabilitation expenses, work loss, essential services, and death compensation. Each category has limits of liability as specified in the Colorado Auto Accident Reparations Act.

Medical expenses covered are reasonable and necessary medical, chiropractic, hospital, dental, nursing, optometric, podiatric, x-ray, surgical, ambulance, and prosthetic services. Nonmedical remedial care and treatment in accordance with a recognized religious method of healing are also covered medical expenses. Benefits are payable for a period of five years from the date of the accident. However, if the schedule or declarations of the endorsement indicates that added medical expenses benefits apply, the five year time limitation does not apply. The limit of liability for medical expense benefits is $50,000 per person.

Treatment of neurologic or closed-head injuries and some related disorders are also covered medical or dental procedures. Medical expenses incurred that cannot be performed within five years of the accident will be covered if the insured is younger than thirteen years old when the accident occurred; surgery or reconstructive procedures cannot be performed because of the insured's juvenile status as confirmed in writing by a licensed physician or dentist; and the insured is notified in writing within ninety days that the surgery or procedure is to be performed.

Rehabilitation expenses are the costs of necessary rehabilitation procedures or treatment and reasonable and appropriate rehabilitative occupational training and are covered for up to ten years after the date of the accident. The treatment of neurologic or closed-head injuries and some associated disorders are covered rehabilitation expenses. The limit of liability is $50,000.

Work loss coverage applies to loss of income from work that an insured would have performed but for the injury. Payment is calculated as follows: 100 percent of the first $125 of loss of gross income per week, 70 percent of the next $125, and 60 percent of any loss of gross income per week in excess of $250. These payments are subject to a total maximum of $400 per week. The benefit period begins on the day after the date of the accident and extends for a period not exceeding 52 weeks from that date. If the schedule or declarations indicates that added work loss benefits apply, the 52 week time limitation does not apply.

Essential service expenses are expenses reasonably incurred during an insured's lifetime for essential services to replace those the insured would have performed without pay if he or she had not been injured. These expenses are covered up to $25 per day, payable from the day after the date of the accident for up to 52 weeks.

Death compensation has a limit of liability of $1,000, payable to an insured's estate due to that insured's death.

The amount of any benefits provided by workers compensation during any of the benefit periods outlined above is deducted from the payment of personal injury protection benefits. The endorsement reinforces this point by stating, “No one shall be entitled to receive, under more than one benefit, duplicate payment for the same expense.”

The coverage provided by PP 05 61 applies on a primary basis in most instances, with exceptions. If the accident arises out of the operation of the named insured's covered auto by a person who is neither the owner nor an employee of the owner acting within the course and scope of employment at the time of the accident, the coverage provided is excess over any coverage that is required by the Colorado Auto Accident Reparations Act and that is provided by a policy under which that person is a named insured or family member. PP 05 61 also responds as excess coverage if the accident involves the operation of a motor vehicle that is designed to seat twelve or more passengers and is owned by a nonprofit organization entitled to a tax exemption under the Internal Revenue Code, such as a church or the Salvation Army. This excess coverage provision does not apply to vehicles owned by or operated on behalf of a public school district. The personal injury protection is also excess coverage if the accident involves the operation of a motor vehicle in a ride sharing arrangement, a term defined on the endorsement.

Regardless of the number of similar policies that respond to a personal injury protection claim, an insured may not recover more than the amount that would have been payable under the policy with the highest limit of liability. When benefits are payable under more than one policy on the same basis, payment is prorated on terms of the policy limit's proportion to all applicable policy limits. These provisions do not affect optional benefits that may be purchased by the insured for an additional premium.

PP 05 61 contains the standard exclusions relating to injury caused by war, radioactive or other hazardous properties of nuclear material, and an insured's own intentional acts. The endorsement also excludes injuries sustained by any insured while operating a vehicle without a good faith belief that insured is legally entitled to operate or use said vehicle. And, while the covered auto is being operated in any jurisdiction in which coverage is provided through a government agency or publicly financed auto accident reparations plan, the injuries that are sustained in an accident are not covered. The endorsement does not apply to bodily injury sustained by any insured arising out of the use or operation of a motor vehicle while located for use as a residence or premises.

Coverage is not applicable while an insured operates a motor vehicle as a converter unless the named insured or a family member operates or uses a covered auto owned by the named insured. A “converter” is defined as “a person who operates or uses a motor vehicle in a manner that a reasonable person would determine was unauthorized or beyond the scope of permission given by the 'named insured' or 'family member.'”

Coverage is also limited under the exclusions section to certain insureds. For example, only the named insured or any family members are covered if the accident occurs outside of Colorado . Also, the endorsement does not apply to injury sustained by an insured other than the named insured or family member arising out of conduct occurring within the course of a business of selling, repairing, storing, parking, or otherwise maintaining motor vehicles, but not if the conduct occurs off the business premises. Furthermore, the coverage does not apply for bodily injury sustained by the named insured or family member as a result of the use or operation of any motor vehicle, other than a covered auto, owned by the named insured if the security required by state law is not in effect or if coverage is also not available to any family member as a result of the use or operation of any motor vehicle owned by that family member. The coverage also does not apply for work loss for the named insured or any family member if rejection of work loss coverage is indicated on the schedule or declarations.

Colorado requires all insurers to offer certain cost containment options under the personal injury protection plan. PP 05 61 offers these options in the form of deductibles and copayments applicable to medical and rehabilitation expenses and a choice to reject work loss coverage. The named insured should read over these options as described on the schedule and check the ones desired. The medical expenses and rehabilitation expenses deductible applies separately to the named insured, each family member, and to any person operating the named insured's covered auto with the permission of the named insured or resident spouse.  The medical expenses and rehab expenses copayment option applies in the same manner. The rejection of work loss option applies to the named insured and any family member.

If the insured chooses the deductible option, the sum of all amounts payable for medical expenses and rehabilitation expenses is reduced by the amount of the deductible. However, the deductible does not apply to these expenses incurred either during the first twenty-four hours in which emergency treatment is provided or until the insured's emergency medical condition has stabilized, whichever is longer. If the copayment option is chosen, the insurer will pay 80 percent of any amount payable for medical expenses or rehabilitation expenses after the application of the deductible; the insurer will pay 100 percent of the expenses after the total out-of-pocket expenses exceed $2,500 (this includes any applicable deductible). The copayment also does not apply to expenses incurred during the emergency treatment period as described in the deductible discussion.

Colorado also requires insurers to offer a basic no-fault automobile insurance policy for those insureds wherein the named insured and resident spouse do not have a combined annual income, from all sources, of more than a certain stated amount. The Insurance Services Office offers an endorsement, PP 05 94 12 01, to fulfill this requirement. PP 05 94 is similar to PP 05 61 in most provisions, but there are some differences that should be recognized.

PP 05 94 offers personal injury protection benefits separately to the named insured, resident spouse, and resident child as one group (group A), and to any insured other than those three entities as another group (group B). To group A, the limit for medical expenses is $25,000 with no offer of rehabilitative expenses. A $50,000 limit is set for group B. PP 05 94 sets a maximum limit of liability of $5,000 under the work loss coverage for group A with no offer of coverage for essential services. Group A is also offered $5,000 in death compensation as opposed to the $1,000 limit offered to group B and those insured under PP 05 61. Group A has the rejection of work loss option, while both group A and group B have the deductible and copayment options available.

The law requiring coverage as found under PP 05 94 does not dictate that added personal injury protection benefits be offered; therefore, that protection (that can be found on PP 05 61) and all references to it are excluded from the form PP 05 94.

The endorsement entitles the insurer to subrogation rights, only after the injured party has been fully compensated for damages by another party. The policy territory for the endorsement encompasses the United States, its territories or possessions, and Canada .

An arbitration clause is also included. If a dispute over the benefits arises between the insurer and the injured person who is entitled to those benefits, such a dispute shall be submitted to arbitration if both parties agree to that course of action.

Personal injury protection benefits are assignable to licensed hospitals or other licensed health care providers if made in writing. Benefits assigned will be paid directly to the provider. Assignment may be revoked by the insured without the provider's consent, effective when both the insurer and the provider receive written notification.

Added personal injury protection can be found on PP 05 61 when the insured indicates in the schedule that the specified added benefits are to apply in place of the corresponding basic benefits. These added benefits are for the named insured or any family member.

This added coverage removes the $50,000 medical expenses limit of liability of the basic coverage and states that no specific dollar amount applies. Also, under the work loss section of the schedule, there is no specific dollar amount listed; rather, coverage is offered for 100 percent of the first $125 of loss of gross income per week and then 85 percent of any loss of gross income in excess of $125. The added protection section does set up a maximum limit of liability for the total of all basic and added personal injury protection benefits, to be specified in the schedule as agreed to by both the insured and the insurer.

The Colorado legislature extended its no-fault auto insurance law through July, 2003. The statute abolishes tort liability for those in compliance with the law except with respect to accidents that result in death, dismemberment, permanent disability, permanent disfigurement, medical and rehabilitation expense in excess of $2500, or loss of earnings and earning capacity extending beyond the 52-week no-fault benefit period and not covered by an applicable complying policy. (See No-Fault Automobile Insurance pages for a general discussion of tort liability exemption in connection with no-fault coverage).