Auto Accident, PIP & Medical Billing State Guides
Kentucky Auto Accident, PIP & Medical Billing Laws
Kentucky operates a Choice No-Fault automobile insurance framework under the Kentucky Motor Vehicle Reparations Act (KMVRA), KRS 304.39-010 et seq. Every auto policy automatically includes $10,000 in Basic Reparations Benefits (BRB / PIP) unless the insured executes a formal written rejection filed with the Department of Insurance. Unpaid benefits are subject to 12% to 18% statutory penalty interest under KRS 304.39-210.
Plain-language overview
Choice No-Fault (Basic Reparations Benefits under KRS 304.39-020)
Under Kentucky law, drivers and passengers automatically receive up to $10,000 in no-fault BRB/PIP coverage for accident-related medical expenses and wage losses, unless they have opted out by filing a written rejection (Form P-12) with the Kentucky Department of Insurance. Individuals who remain under the no-fault system are subject to a $1,000 medical expense tort threshold before they can maintain a claim for non-economic damages (pain and suffering) against an at-fault driver under KRS 304.39-060.
PIP and MedPay coverage
Basic Reparations Limit
$10,000 statutory minimum per person for reasonable medical expenses, lost wages (up to $200 weekly), and replacement services (KRS 304.39-020(2))
Optional Added Benefits
Insurers must offer optional Added Reparations Benefits (ARB) up to policy limits chosen by the insured (KRS 304.39-140)
Rejection Of No Fault
Drivers who file a written rejection with the Department of Insurance waive no-fault benefits and tort threshold immunities
Assignment Of Benefits
Medical providers may bill carriers directly under an executed Assignment of Basic Reparations Benefits
Medical fee schedule and reimbursement rules
Name
Reasonable Medical Charges Standard (KRS 304.39-020(5)(a))
Rules
Kentucky does not establish a statutory auto fee schedule table. Reimbursement is based on reasonable charges incurred for reasonably needed products, services, and accommodations, not to exceed the provider's usual charge.
Cpt Basis
CPT/HCPCS itemized coding on standard CMS-1500 or UB-04 billing claims
Appeals and dispute resolution
Thirty Day Prompt Pay Rule
Under KRS 304.39-210, benefits become overdue if not paid within 30 days after the insurer receives reasonable proof of the fact and amount of loss. Overdue benefits bear interest at 12% per year.
Eighteen Percent Penalty
If the court finds that the delay or denial was without reasonable foundation, the interest penalty increases to 18% per year under KRS 304.39-210(2).
Attorney Fees
Under KRS 304.39-220, courts award reasonable attorney fees to a claimant or healthcare provider if the insurer's denial of benefits was without reasonable foundation.
Dispute Forum
Kentucky District Court (claims up to $5,000) or Circuit Court (claims exceeding $5,000) for civil breach of contract actions.
Claim and dispute deadlines
Deadlines can depend on the trigger event and may be affected by agency relief notices. Confirm the live rule before filing.
| Event | Timeframe |
|---|---|
| Accident Notice | Notice to insurer as soon as reasonably practicable |
| Medical Bill Submission | Prompt submission on CMS-1500 or UB-04 with supporting treatment records |
| Carrier 30-Day Pay Window | 30 calendar days from receipt of proof of loss (KRS 304.39-210) |
| Medical Tort Threshold | $1,000 in medical expenses to maintain non-economic tort action (KRS 304.39-060) |
| Statute of Limitations | 2 years from accident date or 2 years from last no-fault benefit payment (KRS 304.39-230) |
Documentation checklist
- Kentucky Application for Basic Reparations Benefits
- Executed Assignment of Benefits (AOB) and HIPAA release form
- Itemized CMS-1500 or UB-04 billing form with appropriate CPT/HCPCS codes and modifiers
- Contemporaneous medical records, initial evaluation notes, and objective diagnostic reports
- Insurer Explanation of Review (EOR) or formal denial letter detailing reasons for reduction
Responsible agencies
- Kentucky Department of InsuranceRegulation of Auto Insurers, Market Conduct & No-Fault Rejection Registry
Primary legal and regulatory sources
- Kentucky Revised Statutes Chapter 304, Subtitle 39 (Motor Vehicle Reparations Act)Kentucky Legislative Research Commission · 2024
- Kentucky Revised Statutes Section 304.39-210 (Overdue Benefits; Interest)Kentucky Legislative Research Commission · 2024
This operational reference is educational, is not legal advice, and does not create an attorney-client relationship.
Common questions
- What rules govern auto accident, pip & medical billing state guides in Kentucky?
- Kentucky operates a Choice No-Fault automobile insurance framework under the Kentucky Motor Vehicle Reparations Act (KMVRA), KRS 304.39-010 et seq. Every auto policy automatically includes $10,000 in Basic Reparations Benefits (BRB / PIP) unless the insured executes a formal written rejection filed with the Department of Insurance. Unpaid benefits are subject to 12% to 18% statutory penalty interest under KRS 304.39-210.
- What dispute deadlines should providers track in Kentucky?
- Accident Notice: Notice to insurer as soon as reasonably practicable; Medical Bill Submission: Prompt submission on CMS-1500 or UB-04 with supporting treatment records; Carrier 30-Day Pay Window: 30 calendar days from receipt of proof of loss (KRS 304.39-210). Verify the trigger date, current agency notices, and any extension before acting.
- Which agencies administer these rules in Kentucky?
- The guide identifies Kentucky Department of Insurance. The correct agency depends on the plan and claim jurisdiction.