Kentucky law limits medical payments under auto injury insurance

Insurers must follow medical payment limits, and providers cannot knowingly seek payment of covered charges above those limits. These rules cover medical expenses paid through basic or optional added auto injury insurance benefits. Payments follow Kentucky's workers' compensation fee schedules, but cannot fall below the maximum fee listed when this law takes effect. Providers cannot damage patients' credit for refusing to pay covered charges above the allowed fee. Providers must submit charges within 180 days of providing care, except charges submitted under KRS 304.39-241. These rules apply to basic and added auto injury benefits issued or renewed on or after the law's effective date.

The law allows covered funeral expenses up to $5,000 and sets a $500 weekly limit for certain basic auto injury benefits. The funeral limit covers funeral, cremation, and burial costs counted as medical expenses under auto injury coverage. The weekly limit covers lost income and replacement household services, including related losses for survivors. The weekly limit is prorated for shorter periods and adjusted across the year for seasonal or irregular work. Total basic benefits cannot exceed $10,000 per injured person per accident. The weekly limit applies to the accident week and each following week. These provisions apply to benefits issued or renewed on or after the law's effective date.

Knowingly misrepresenting the extent of damage in an insurance claim, with intent to defraud or deceive, counts as insurance fraud. This rule covers property and casualty claims, including repair, towing, and storage costs. The rule also covers preparing a false statement with knowledge or belief that it will be submitted.

Kentucky's Attorney General shares authority with local prosecutors to investigate and prosecute insurance fraud. The shared authority covers offenses under the insurance fraud law described in Section 5. The Attorney General and local prosecutors must send fraud reports, investigations, or discoveries to the state insurance commissioner unless the fraud was already reported.

The state insurance commissioner must publish an annual insurance fraud report on the insurance department's website. The report must include fraud report counts, the number and total dollar amount of cases sent for prosecution, and prosecution counts and outcomes. Each annual report covers the previous calendar year.