§ 67.1. Purpose.

 The purpose of this subchapter is to provide procedures for the establishment and administration of the Fund, which continues the Catastrophic Loss Trust Fund eligibility determinations for certain individuals suffering catastrophic losses on or after October 1, 1984, but prior to June 1, 1989, or who may have suffered a catastrophic loss during the December 1988 to December 1989 vehicle registration year for which payment for Catastrophic Loss Trust Fund coverage was made in accordance with former section 1762 of the act (repealed).

 The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:

   Act—75 Pa.C.S. § §  1701—1798 (relating to the Motor Vehicle Financial Responsibility Law).

   Administrator—The person or entity designated by the Fund to review claims for catastrophic loss benefits, determine the eligibility of the claimant and make payment where appropriate.

   Benefits—Payments by the Fund for reasonable, necessary and accident-related expenses for medical treatment and rehabilitative services which exceed $100,000, subject to limitations provided in sections 1761 and 1766 of the act (now repealed). Reference may be made to sections 1761, 1762 and 1766, in Appendix A.

   Claims manager—The Department employe designated by the Commissioner to manage the daily activities of the Fund.

   Department—The Insurance Department of the Commonwealth.

   Eligible claimant—An individual who meets the requirements of §  67.16 (relating to eligible claimant for fund benefits).

   Fund—The Catastrophic Loss Benefits Continuation Fund established to provide benefits required by the act.

   Surcharge—The amount to be paid by drivers upon conviction of any traffic violation, exclusive of parking offenses, to fund the Fund.

 The Fund shall be financed by surcharges for motor vehicle violations pursuant to 75 Pa.C.S. §  6506(a) and (b).

   The provisions of this §  67.3 issued and amended under 75 Pa.C.S. § §  1762 and 1765.

 (a)  A person who seeks benefits from the Fund shall file a claim for benefits with the Fund. The Fund will review the claim for benefits and advise the claimant in writing as to whether the claimant is an eligible claimant. The insurer shall assist the insured in filing the claim for benefits.

 (b)  A claim submitted to the Fund which is erroneously completed or contains inadequate information may be returned to the claimant for correction and resubmission.

 (c)  The Fund may employ an Administrator to review the claim for benefits and advise the claimant of eligibility.

 The Administrator and Fund are authorized to obtain from claimants, insurers and self-insurers data or information which is necessary to permit review of claims for Fund benefits.

   The provisions of this §  67.5 amended October 30, 1998, effective October 31, 1998, 28 Pa.B. 5482. Immediately preceding text appears at serial page (131437).

   Records of Activities

 (a)  A claimant who disputes a determination by the Administrator or Fund concerning eligibility for or allowance of benefits, may file a written complaint with the claims manager. The written determination by the Fund or Administrator shall advise the claimant how to file a complaint with the claims manager. A complaint is timely filed by the claimant if received by the claims manager no later than 33 days after the date of the written determination from the Administrator or the Fund denying eligibility for or allowance of benefits.

 (b)  The claims manager will issue a written determination notifying the claimant of the results of the claims manager’s review. If the claimant is not satisfied with the results of the claims manager’s review, the claimant may request in writing a formal administrative hearing before the Commissioner. The written determination by the claims manager will advise the claimant how to request a hearing. A request for hearing is timely if received by the Department no later than 33 days after the date of the written determination from the claims manager.

 (c)  Appeals are conducted in accordance with 1 Pa. Code Part II (relating to the General Rules of Administrative Practice and Procedure) as applicable to the Department and in accordance with Chapter 56 (relating to special rules of administrative practice and procedure).

 An individual who has suffered injuries in a motor vehicle accident is an eligible claimant for Fund benefits if the individual meets the following criteria:

   (1)  The individual was a resident of this Commonwealth at the time of the accident.

   (2)  The injury arose out of the maintenance or use of a motor vehicle after October 1, 1984, and prior to June 1, 1989, or during the December 1988 to December 1989 vehicle registration year for which payment for Catastrophic Loss Trust Fund coverage was made in accordance with former section 1762 of the act (Repealed).

   (3)  The auto accident occurred in the United States, its territories or possessions or Canada.

   (4)  The injured person was not the driver or occupant of a recreational vehicle not intended for highway use, a motorcycle, a motorized pedal cycle, a motor-driven cycle or any vehicle required to be registered under 75 Pa.C.S. (relating to the Vehicle Code) but not subject to the Fund charge.

   (5)  As a result of the accident, the individual incurred reasonable and necessary medical and rehabilitative expenses exceeding $100,000.

   (6)  The individual’s medical and rehabilitative expenses were not covered by workers’ compensation.

   (7)  The individual’s medical and rehabilitative expenses were not covered by a policy issued under the Pennsylvania No-fault Motor Vehicle Insurance Act (repealed).

   The provisions of this §  67.16 adopted October 30, 1998, effective October 31, 1998, 28 Pa.B. 5482.

 An eligible claimant receiving Fund benefits for accidents occurring between June 1, 1989, through December 31, 1989, may also be insured for extraordinary medical benefits coverage. If the Administrator or the Fund determines that extraordinary medical benefits are applicable, the insurer providing these benefits is the primary payor and the Fund has no obligation to pay until the benefits payable by the insurer providing the extraordinary medical benefits have been exhausted. No duplicate recovery is available. The total lifetime aggregate to one eligible claimant under both Extraordinary Medical Benefits coverage and the Fund may not exceed $1 million dollars.

 An eligible claimant shall cooperate in providing coordination of benefit information to the Administrator and the Fund.

   The provisions of this §  67.18 adopted October 30, 1998, effective October 31, 1998, 28 Pa.B. 5482.

Subchapter B. EVIDENCE OF FINANCIAL RESPONSIBILITY

Sec.

 (a)  Insurers. On or after October 1, 1984, at the inception or renewal of a policy, the insurer shall issue to each named insured one I. D. card as specified in this subchapter for each vehicle which it insures. Upon the addition or substitution of a vehicle covered in the policy, the insurer shall issue an I. D. card for that vehicle. Replacement of I. D. cards for the purpose of change of address shall be optional at the discretion of the insurer.

 (b)  Self-insurers. On or after October 1, 1984, the self-insurer shall issue an I. D. card as specified in this subchapter for each vehicle for which satisfaction of the requirements of the act is accomplished through self-insurance. Upon the addition or substitution of a vehicle, the self-insurer shall issue an I. D. card for that vehicle. Replacement of I. D. cards for the purpose of change of address shall be optional at the discretion of the self-insurer.

 (a)  Form of financial responsibility cards. The insurer and self-insurer may in their discretion choose to satisfy the requirements of this subchapter by continuing to use the existing no-fault identification card until January 1, 1985. After January 1, 1985, the insurer and self-insurer shall use a new card containing information required in this section or another card as may be approved by the Department.

 (b)  Contents. Each I. D. card shall contain the following information on the front of the card:

   (1)  Title of card, ‘‘Financial Responsibility Identification Card’’.

   (2)  NAIC company code number of the insurer or self-insurance certificate number.

   (3)  Name of the insurer or self-insurer.

   (4)  Name and address of the named insured or motor vehicle registrant where the vehicle is self-insured.

   (5)  Description of vehicle: year, make, and vehicle identification number (VIN). The model of the vehicle may be used as the make. All digits of the vehicle identification number shall appear on the I. D. card.

   (6)  Policy number where applicable.

   (7)  Effective date: month, day, and year of the policy must be shown.

   (8)  The following inscription below the effective date: NOT VALID MORE THAN 1 YEAR FROM EFFECTIVE DATE.

 (c)  Statement. Each I. D. card shall contain the following statement on the back of the card:

 This card must be carried for production upon demand. It is suggested that you carry this card in the insured vehicle.

 WARNING: Any owner or registrant of a motor vehicle who drives or permits a motor vehicle to be driven in this State without the required financial responsibility may have his registration suspended or revoked.

 NOTE: THIS CARD IS REQUIRED WHEN:

   (1)  You are involved in an auto accident.

   (2)  Your are convicted of a traffic offense other than a parking offense that requires a court appearance.

   (3)  You are stopped for violating any provision of 75 Pa.C.S (relating to the Vehicle Code) and requested to produce it by a police officer.

 You must provide a copy of this card to the Department of Transportation when you request restoration of your operating privilege and/or registration privilege which has been previously suspended or revoked.

 At the time the insurer issues an I. D. card to a policyholder, it shall also issue a statement explaining I. D. card requirements, including display to law enforcement officers, use for registering vehicles, and action that must be taken in the event a card is lost or a card is in error. The following language will be acceptable to the Department in satisfaction of this requirement:

 IMPORTANT NOTICE Regarding your Financial Responsibility Insurance Identification Card.

 The

 If you lose the card, contact your insurance company or agent for a replacement.

 The I. D. card information may be used for vehicle registration and replacing license plates. If your liability insurance policy is not in effect, the I. D. card is no longer valid.

 (a)  When a policyholder or self-insurer has five or more vehicles registered in this Commonwealth, the insurer or self-insurer may use the statement ‘‘all owned vehicles’’ or ‘‘all owned and leased vehicles’’ instead of a specific vehicle description on each I. D. card. However, each vehicle must have an I. D. card for it.

 (a)  Prior to receiving an I. D. card from an insurer, a copy of a valid binder which contains the information required in §  67.24(b)(1)—(7) (relating to form and content of I. D. cards) excluding the policy number can be used as evidence of financial responsibility.

 Where the I. D. card is not held sufficient by the court, the Department of Transportation or other law enforcement agency to demonstrate financial responsibility, an insurer shall provide in writing other evidence that the policyholder is financially responsible.

Subchapter C. SURCHARGE DISCLOSURE PLAN

Sec.

§ 67.31. Purpose.

 (a)  Circumstances where a premium surcharge can be assessed on a named insured.

   (1)  Insurers may assess a premium surcharge on policies where payment for at-fault accidents exceeds their approved dollar threshold. An at-fault accident is one where the insured was at fault in causing or contributing to the accident, and the claim resulting from that accident was paid in part or in whole by the insurer.

   (2)  Insurers may assess a premium surcharge on policies where an insured has been convicted of at least two violations of an offense enumerated in 75 Pa.C.S. §  1535 (relating to schedule of convictions and points).

     (i)   To impose a surcharge the two violations must have occurred in a period of time no more than 36 months in duration.

     (ii)   To impose a surcharge the accumulation of two violations must have been committed by one individual insured in the household covered by the policy.

   (3)  Where an insurer imposes a surcharge for an at-fault accident, the amount of the surcharge may be increased if the same accident also resulted in two 75 Pa.C.S. §  1535 convictions.

   (4)  Offenses that occur while operating a motor vehicle other than those listed in 75 Pa.C.S. §  1535 may be used in a premium surcharge plan.

 (b)  Circumstances under which a surcharge cannot be assessed.

   (1)  An insurer may not assess a premium surcharge for the payment of a claim arising from one or more accidents where the insured was not at fault in causing or contributing to the accident.

   (2)  An insured shall be deemed not at fault for an accident which occurs under the following circumstances:

     (i)   The motor vehicle is lawfully parked and is struck by another vehicle. If the parked vehicle rolls from the parked position, then the accident is charged to the person who parked the vehicle.

     (ii)   The insured, or owner of the motor vehicle, is reimbursed by, or on behalf of, a person who is responsible for the accident, or the insurer is able to subrogate its entire payment to the insured.

     (iii)   The insured, or owner of the motor vehicle, has a judgment against a person who is responsible for the accident.

     (iv)   The motor vehicle is struck in the rear by another vehicle and the insured has not been convicted of a traffic violation in connection with the accident.

     (v)   The driver of the other motor vehicle involved in the accident was convicted of a moving traffic violation and the insured was not convicted of a moving traffic violation in connection with the accident.

     (vi)   The motor vehicle driven by the insured is struck by a hit-and-run vehicle, if the accident is reported to the proper authority within 24 hours by the insured.

     (vii)   The accident involves damage by contact with animals or fowl.

     (viii)   The accident involves physical damage, limited to and caused by flying gravel, missiles, or falling objects.

     (ix)   The accident occurs when the insured is using the motor vehicle in response to an emergency if the insured was a paid or voluntary member of a police or fire department, first-aid squad, or a law enforcement agency at the time of the accident. This exception does not include an accident occurring after the motor vehicle ceases to be used in response to the emergency.

   (3)  An insurer may not assess a premium surcharge for the payment of a claim made under the comprehensive portion of the policy unless the loss was intentionally caused by the insured.

 (a)  A surcharge disclosure plan shall describe the circumstances and conditions when a surcharge would be applied, the estimated increase of the surcharge per policy period per policyholder and the number of years a surcharge will be in effect. The estimated increase of the surcharge may be stated as a percent or dollar amount of premium increase. The estimated increase may also be stated as a percentage of the base premium if the insurer describes the manner in which the prospective or named insured’s premium relates to the base premium.

 (b)  The insurer shall disclose the approved dollar threshold in the surcharge disclosure plan.

 (a)  Prospective insured. Beginning on October 1, 1984, the insurer shall give the surcharge disclosure plan to each prospective insured at the time application is made for motor vehicle insurance coverage.

 (b)  Named insured. Beginning on October 1, 1984, the insurer shall deliver the surcharge disclosure plan to each named insured at least once every year.

Subchapter D. STATEMENTS OF POLICY

Sec.

§ 67.41. Eligibility guidelines for the Catastrophic Loss Trust Fund for accidents on and after June 1, 1989.

 (a)  Section 1798.2(a) of the act (relating to transition), added by the act of April 26, 1989 (P. L.

 (b)  Natural persons who suffer catastrophic losses on or after 12:01 a.m., June 1, 1989, may be eligible for benefits from the CAT Fund if the following apply:

   (1)  They are injured in an accident arising out of the maintenance or use of a motor vehicle.

   (2)  The accident giving rise to the claim for CAT Fund benefits occurred during the registration year for which the CAT Fund charge had been paid on one or more of the motor vehicles involved in the accident.

   (3)  They otherwise are ‘‘eligible claimants’’ as defined in 75 Pa.C.S. §  1761 (repealed).

   The provisions of this §  67.41 adopted May 19, 1989, effective May 8, 1989, 19 Pa.B. 2178.

 (a)  Mandatory offering. The act of April 26, 1989 (P. L.

 (b)  Notice to policyholders. By May 24, 1989, insurers should send a notice to policyholders in the form required by section 1798.2(c) of the act (relating to transition), except that if the insurer is utilizing the interim rate specified in subsection (e), appropriate revisions may be made in the interest of fully and accurately informing the policyholder. Insurers that have sent a notice to policyholders regarding an approved catastrophic loss filing by May 8, 1989 will be deemed to have satisfied the requirement of this subsection.

 (c)  Rate filing. Insurers are required by section 1798.2(b) of the act to make an EMB rate filing with the Department by May 26, 1989, that date being 30 days from the effective date of section 1798.2 of the act. This filing requirement includes those insurers which had obtained Departmental approval of catastrophic loss rates by April 26, 1989—the effective date of section 1798.2 of the act. However, those insurers may file amendments to their approved catastrophic loss filings with the changes necessary to comply with Act 4. No initial EMB rate filing or amendment to an approved catastrophic loss filing may be deemed into effect.

 (d)  Insurers with approved catastrophic loss rates and forms. Insurers which have obtained Departmental approval for catastrophic loss rates and forms by April 26, 1989 shall utilize those rates and forms for EMB endorsements issued effective on or after June 1, 1989 until the Department approves a new EMB rate or form. The insurer shall pro-rate the catastrophic loss premium to the next policy renewal. Insurers which are subscribers to a licensed rating organization that had obtained Departmental approval of catastrophic loss rates by April 26, 1989 may elect to utilize the rating organization’s approved rates and forms for EMB coverage until the rating organization receives approval of a revised filing under subsection (c). With approval of the Department, subscribers may utilize deviations from the rate and form approved for a rating organization if the deviation provides for a rate reduction and the form provides more liberal coverage. Insurers planning to utilize the rating organization’s rates and forms or deviations shall inform the Department of their intent by May 26, 1989.

 (e)  Interim rate and forms. Insurers are obligated by Act 4 to offer to bind EMB coverage as of June 1, 1989. However, Act 4 does not relieve insurers that had not obtained Departmental approval for catastrophic loss rates and forms by April 26, 1989 from the requirements under section 4(h) of the Casualty and Surety Rate Regulatory Act (40 P. S. §  1184(h)) and section 354 of the Insurance Company Law of 1921 (40 P. S. §  477b) that rates and forms be approved by the Department prior to use. Under the Commissioner’s authority under the Casualty and Surety Rate Regulatory Act (40 P. S. § §  1181—1199), the requirement of preapproved rates for EMB coverage is temporarily suspended if an insurer utilizes the interim Statewide rate of $38 per motor vehicle, per year. The interim rate is to be utilized for EMB endorsements issued effective on or after June 1, 1989, until the Department approves the insurer’s EMB rate filing. The interim EMB rate shall be prorated to the next policy renewal. Insurers not having approved EMB forms may utilize the form in Appendix A.

 (f)  Enforcement action. The Department may take enforcement action against insurers failing to offer to bind EMB coverage as of June 1, 1989. However, the Department will not take enforcement action against insurers utilizing the interim rates and forms specified in subsection (e) prior to the Department’s approval of n insurer’s EMB rates and forms.

 An individual eligible for CAT Fund benefits under §  67.41 (relating to eligibility guidelines for the Catastrophic Loss Trust Fund for accidents on and after June 1, 1989) may also be insured for EMB coverage. In these instances, the EMB carrier is primary and the CAT Fund secondary. No duplicate recovery may be available. The total lifetime aggregate to one individual under both EMB coverage and the CAT Fund may not exceed $1 million dollars.

 Section 1715(e) of the act (relating to availability of adequate limits), added by the act of April 26, 1989 (P. L.

 Insurers shall make available to an applicant or policyholder all levels of extraordinary medical benefit coverage approved for use by the Department.

   The provisions of this §  67.45 adopted May 19, 1989, effective May 8, 1989, 19 Pa.B. 2178.

   The provisions of this Appendix A adopted May 19, 1989, effective May 8, 1989, 19 Pa.B. 2178.

   This section cited in 31 Pa. Code §  67.42 (relating to phase-in extraordinary medical benefit coverage).

APPENDIX B

Section