Health Care Availability Act

C.R.S. tit. 13, art. 64
in effect

C.R.S. § 13-64-101 Short title

13-64-101. Short title. This article shall be known and may be cited as the "Health Care Availability Act".

C.R.S. § 13-64-102 Legislative declaration

13-64-102. Legislative declaration. (1) The general assembly determines and declares that it is in the best interests of the citizens of this state to assure the continued availability of adequate health-care services to the people of this state by containing the significantly increasing costs of malpractice insurance for medical care institutions and licensed medical care professionals, and that such is rationally related to a legitimate state interest. To attain this goal and in recognition of the exodus of professionals from health-care practice or from certain portions or specialties thereof, the general assembly finds it necessary to enact this article limited to the area of medical malpractice to preserve the public peace, health, and welfare. (2) The general assembly further determines and declares: (a) The purpose of enacting the "Health Care Availability Act" and amendments thereto is to clearly and unequivocally state the intent of the general assembly that, in order to promote the purposes set forth in subsection (1) of this section, the limitations of liability set forth in section 13-64-302 are hereby reaffirmed; and (b) All noneconomic damages of any kind whatsoever, whether direct or derivative, including but not limited to grief, loss of companionship, pain and suffering, inconvenience, emotional stress, impairment of quality of life, physical impairment, disfigurement, and damages for any other nonpecuniary harm awarded in a medical malpractice action, shall not exceed the limitations on noneconomic loss or injury specified in section 13-64-302.

C.R.S. § 13-64-201 Legislative declaration

13-64-201. Legislative declaration. (1) The general assembly declares the purposes of enacting this part 2 are to: (a) Alleviate the practical problems incident to the unpredictability of future losses; (b) Effectuate more precise awards of damages for actual losses; (c) Pay damages as the losses are found to accrue; (d) Assure that payments of damages more nearly serve the purposes for which they are awarded; (e) Reduce the burden on public assistance costs created by the dissipation of lump-sum payments; and (f) Conform to the income tax policies in the federal "Internal Revenue Code of 1986" and the laws of this state with respect to compensation for personal injuries.

C.R.S. § 13-64-202 Definitions

13-64-202. Definitions. As used in this part 2, unless the context otherwise requires: (1) "Economic loss" means pecuniary harm for which damages are recoverable under the laws of this state. (2) "Future damages" means damages of any kind arising from personal injuries which the trier of fact finds will accrue after the damages findings are made. (3) "Health-care institution" means any licensed or certified hospital, health-care facility, dispensary, other institution for the treatment or care of the sick or injured, or a laboratory certified under the federal "Clinical Laboratories Improvement Act of 1967", as amended, 42 U.S.C. sec. 263a, to perform high complexity testing. (4) (a) "Health-care professional" means any person licensed in this state or any other state to practice medicine, chiropractic, nursing, physical therapy, podiatry, dentistry, pharmacy, optometry, or other healing arts. The term includes any professional corporation or other professional entity comprised of such health-care providers as permitted by the laws of this state. (b) Repealed. (c) Nothing in this subsection (4) shall be construed to create an exception to the corporate practice of medicine doctrine. (5) "Noneconomic loss" means nonpecuniary harm for which damages are recoverable under the laws of this state, but the term does not include punitive or exemplary damages. (6) "Past damages" means damages that have accrued before the damages findings are made, including any punitive or exemplary damages allowed by the laws of this state. (7) "Present value" means the amount as of a date certain of one or more sums payable in the future, discounted to the date certain. The discount is determined by a commercially reasonable rate that takes into account the facts and circumstances of each case at the time the judgment is entered. (8) "Qualified insurer" means an insurance company licensed to do business in this state or any self-insurer, assignee, plan, or arrangement approved by the court.

C.R.S. § 13-64-203 Periodic payments

13-64-203. Periodic payments. (1) In any civil action for damages in tort brought against a health-care professional or a health-care institution, the trial judge shall enter a judgment ordering that awards for future damages be paid by periodic payments rather than by a lump-sum payment if the award for future damages exceeds the present value of one hundred fifty thousand dollars, as determined by the court. (2) In any such action in which the award for future damages is one hundred fifty thousand dollars or less, present value, the trial judge may order that awards for future damages be paid by periodic payments.

C.R.S. § 13-64-204 Special damages findings required

13-64-204. Special damages findings required. (1) If liability is found in a trial under this part 2, the trier of fact, in addition to other appropriate findings, shall make separate findings for each claimant specifying the amount of: (a) Any past damages for each of the following types: (I) Medical and other costs of health care; (II) Other economic loss except loss of earnings; (III) Loss of earnings; and (IV) Noneconomic loss; (b) Any future damages and the period of time over which they will be paid, for each of the following types: (I) Medical and other costs of health care; (II) Other economic loss except loss of future earnings which would be incurred for the life of the claimant or any lesser period; (III) Loss of future earnings which would be incurred for the work life expectancy of the claimant or a lesser period; and (IV) Noneconomic loss which would be incurred for the life of the claimant or any lesser period. (2) The calculation of all future damages under subparagraphs (I), (II), and (IV) of paragraph (b) of subsection (1) of this section shall reflect the costs and losses during the period of time, including life expectancy, if appropriate, that the claimant will sustain those costs and losses. The calculation of loss under subparagraph (III) of paragraph (b) of subsection (1) of this section shall be based on loss during the period of time the claimant would have earned income but for the injury upon which the claim is based. (3) The fact that payment of any judgment will be paid by periodic payments shall not be disclosed to a jury.

C.R.S. § 13-64-205 Determination of judgment to be entered

13-64-205. Determination of judgment to be entered. (1) In order to determine what judgment is to be entered on a verdict requiring findings of special damages under this part 2, the court shall proceed as follows: (a) The court shall apply to the findings of past and future damages any applicable rules of law, including setoffs, credits, comparative fault, additurs, and remittiturs in calculating the respective amounts of past and future damages each claimant is entitled to recover and each party is obligated to pay. The court shall preserve the rights of any subrogee to be paid in a lump sum. (b) The court shall specify the payment of attorney fees and litigation expenses in a manner separate from the periodic installments payable to the claimant, either in a lump sum or by periodic installments, pursuant to any agreement entered into between the claimant or beneficiary and his attorney, computed in accordance with the applicable principles of law. (c) The court shall enter judgment in a lump sum for past damages and for any damages payable in lump sum or otherwise under paragraphs (a) and (b) of this subsection (1). (d) After hearing relevant expert testimony, the jury shall determine the present value of future damages and, except as provided in paragraphs (e) and (f) of this subsection (1), the court shall enter judgment for the periodic payment of future damages. The court, in considering evidence of the need for one or more future major medical proceedings or services, may enter judgment for lump-sum payment therefor, payable either immediately or at some designated date or dates in the future. (e) Upon petition of a party before entry of judgment and a finding of incapacity to fund the periodic payments, the court, at the election of the claimant or at the election of the beneficiaries in an action for wrongful death, shall enter a judgment for the present value of the periodic payments. (f) The plaintiff who meets the criteria set forth in this subsection (1) may elect to receive the immediate payment to the plaintiff of the present value of the future damage award in a lump-sum amount in lieu of periodic payments. In order to exercise this right, the plaintiff must either: (I) (A) Have reached his or her eighteenth birthday by the time the periodic payment order is entered; (B) Not be an incapacitated person, as defined in section 15-14-102 (5), C.R.S.; and (C) Have been provided financial counseling and must be making an informed decision; or (II) Be a person under disability who has a legal representative authorized to take action on his or her behalf, as described in section 13-81-102. (2) For purposes of paragraph (f) of subsection (1) of this section, "legal representative", "person under disability", and "take action" shall have the same meanings as provided in section 13-81-101.

C.R.S. § 13-64-206 Periodic installment obligations

13-64-206. Periodic installment obligations. (1) A judgment for periodic payments under this part 2 shall provide that: (a) Such periodic payments are fixed and determinable as to amount and time of payment; (b) Such periodic payments cannot be accelerated, deferred, increased, or decreased by the recipient of such payments; and (c) The recipient of such payments shall be a general creditor of the qualified insurer. (2) Unless the court directs otherwise and the parties otherwise agree, payments shall be scheduled at one-month intervals. Payments for damages accruing during the scheduled intervals are due at the beginning of the intervals. For good cause shown, the court may direct that periodic payments shall continue for an initial term of years notwithstanding the death of the judgment creditor during that term. (3) Money damages awarded for loss of future earnings shall not be reduced or payments terminated by reason of the death of the judgment creditor. Any such remaining periodic payments shall be paid to the heirs and devisees of the judgment creditor. Payments for future damages other than loss of future earnings shall cease at the death of the judgment creditor.

C.R.S. § 13-64-207 Form of funding

13-64-207. Form of funding. (1) A judgment for periodic payments entered in accordance with this part 2 shall provide for payments to be funded in one or more of the following forms approved by the court: (a) Annuity contract issued by a company licensed to do business as an insurance company under the laws of this state; (b) An obligation or obligations of the United States; (c) Evidence of applicable and collectible liability insurance from one or more qualified insurers; (d) An agreement by one or more personal injury liability assignees to assume the obligation of the judgment debtor; (e) An obligation of the state of Colorado or of a public entity other than the state which is self-insured as provided in section 24-10-115, 24-10-115.5, or 24-10-116, C.R.S.; or (f) Any other satisfactory form of funding. (2) The court shall require that the annuity contract or other form of funding permitted by subsection (1) of this section show that portion of each periodic payment which is attributable to loss of future earnings and that portion attributable to all other future damages.

C.R.S. § 13-64-208 Funding the obligation

13-64-208. Funding the obligation. (1) If the court enters a judgment for periodic payments under this part 2, then each party liable for all or a portion of the judgment, unless found to be incapable of doing so, shall separately or jointly with one or more others provide the funding for the periodic payments in a form prescribed in section 13-64-207, within sixty days after the date the judgment is entered. A liability insurer having a contractual obligation and any other person adjudged to have an obligation to pay all or part of a judgment for periodic payments on behalf of a judgment debtor is obligated to provide such funding to the extent of its contractual or adjudged obligation if the judgment debtor has not done so. (2) A judgment creditor or successor in interest and any party having rights under subsection (4) of this section may move that the court find that funding has not been provided with regard to a judgment obligation owing to the moving party. Upon so finding, the court shall order that funding complying with this article be provided within thirty days. If funding is not provided within that time and subsection (3) of this section does not apply, then the court shall calculate the present value of the periodic payment obligation and enter a judgment for that amount in favor of the moving party. (3) If a judgment debtor who is the only person liable for a portion of a judgment for periodic payments fails to provide funding, then the right to present value payment described in subsection (2) of this section applies only against that judgment debtor and the portion of the judgment so owed. (4) If more than one party is liable for all or a portion of a judgment requiring funding under this part 2 and the required funding is provided by one or more but fewer than all of the parties liable, the funding requirements are satisfied and those providing funding may proceed under subsection (2) of this section to enforce rights for funding or present value payment to satisfy or protect rights of reimbursement from a party not providing funding.

C.R.S. § 13-64-209 Assignment of periodic payments

13-64-209. Assignment of periodic payments. (1) An assignment by a judgment creditor or an agreement by such person to assign any right to receive periodic payments for future damages contained in a judgment entered under this part 2 is enforceable only as to amounts: (a) To secure payment of alimony, maintenance, or child support; (b) For the costs of products, services, or accommodations provided or to be provided by the assignee for medical or other health care; or (c) For attorney fees and other expenses of litigation incurred in securing the judgment.

C.R.S. § 13-64-210 Exemption of benefits

13-64-210. Exemption of benefits. Except as provided in section 13-64-209, periodic payments for future damages contained in a judgment entered under this part 2 for loss of earnings are exempt from garnishment, attachment, execution, and any other process or claim to the extent that wages or earnings are exempt.

C.R.S. § 13-64-211 Settlement agreements and consent judgments

13-64-211. Settlement agreements and consent judgments. Nothing in this part 2 is to be construed to limit or affect the settlement of actions triable under this part 2 nor shall it apply to the settlement of actions except as otherwise agreed to by the parties. Parties to an action on a claim for personal injury may, but are not required to, file with the clerk of the court in which the action is pending or, if none is pending, with the clerk of a court of competent jurisdiction over the claim a settlement agreement for future damages payable in periodic payments. The settlement agreement may provide that one or more sections of this part 2 apply to it.

C.R.S. § 13-64-212 Satisfaction of judgment

13-64-212. Satisfaction of judgment. Upon entry of an order by the court that the form of funding complies with section 13-64-207 and that the funding of the obligation complies with section 13-64-208, the court shall order a satisfaction of judgment and discharge of the judgment debtor.

C.R.S. § 13-64-213 Effective date - applicability of part

13-64-213. Effective date - applicability of part. This part 2 shall take effect July 1, 1988, and shall apply to acts or omissions occurring on or after said date.

C.R.S. § 13-64-301 Financial responsibility

13-64-301. Financial responsibility. (1) As a condition of active licensure or authority to practice in this state, every physician, dentist, dental therapist, or dental hygienist; every physician assistant; and every health-care institution as defined in section 13-64-202, except as provided in section 13-64-303.5, that provides health-care services shall establish financial responsibility, as follows: (a) (I) (A) If a dentist, by maintaining commercial professional liability insurance coverage with an insurance company authorized to do business in this state or an eligible nonadmitted insurer allowed to insure in Colorado pursuant to article 5 of title 10, in a minimum indemnity amount of five hundred thousand dollars per incident and one million five hundred thousand dollars annual aggregate per year; except that this requirement is not applicable to a dentist who is a public employee under the "Colorado Governmental Immunity Act", article 10 of title 24. (B) A licensed dental hygienist must maintain professional liability insurance in an amount not less than fifty thousand dollars per claim and with an aggregate liability limit for all claims during a calendar year of not less than three hundred thousand dollars; except that this requirement does not apply to a licensed dental hygienist who is a public employee under the "Colorado Governmental Immunity Act", article 10 of title 24. (C) A licensed dental therapist must maintain professional liability insurance in an amount not less than five hundred thousand dollars per incident and one million five hundred thousand dollars annual aggregate per year; except that this requirement is not applicable to a dental therapist who is a public employee under the "Colorado Governmental Immunity Act", article 10 of title 24. (II) The Colorado dental board, by rule, may exempt from or establish lesser financial responsibility standards than those prescribed in this section for classes of licensed dentists, dental therapists, and dental hygienists who: (A) Perform dental services as employees of the United States government; (B) Render limited, occasional, or no dental services; (C) Perform less than full-time active dental services because of administrative or other nonclinical duties or partial or complete retirement; or (D) Provide uncompensated dental care to patients but do not otherwise provide any compensated dental care to patients. (III) The Colorado dental board may exempt from or establish lesser financial responsibility standards for a licensed dentist, dental therapist, or dental hygienist for reasons other than those described in subsection (1)(a)(II) of this section that render the limits provided in subsection (1)(a)(I) of this section unreasonable or unattainable. (IV) Nothing in this subsection (1)(a) precludes or otherwise prohibits a licensed dentist, dental therapist, or dental hygienist from rendering appropriate patient care on an occasional basis when the circumstances surrounding the need for care so warrant. (a.5) (I) If a physician or a physician assistant, by maintaining commercial professional liability insurance coverage with an insurance company authorized to do business in this state or an eligible nonadmitted insurer allowed to insure in Colorado pursuant to article 5 of title 10 in a minimum indemnity amount of one million dollars per incident and three million dollars annual aggregate per year; except that this requirement is not applicable to a physician or physician assistant who is a public employee under the "Colorado Governmental Immunity Act", article 10 of title 24. (II) The Colorado medical board may, by rule, exempt from or establish lesser financial responsibility standards than those prescribed in this subsection (1)(a.5) for classes of physicians or physician assistants who: (A) Perform medical services as employees of the United States government; (B) Render limited or occasional medical services; o Governmental Immunity Act", article 10 of title 24. (II) The Colorado medical board may, by rule, exempt from or establish lesser financial responsibility standards than those prescribed in this subsection (1)(a.5) for classes of physicians or physician assistants who: (A) Perform medical services as employees of the United States government; (B) Render limited or occasional medical services; (C) Perform less than full-time active medical services because of administrative or other nonclinical duties or partial or complete retirement; or (D) Provide uncompensated health care to patients but do not otherwise provide any compensated health care to patients. (III) The Colorado medical board may exempt from or establish lesser financial responsibility standards for a physician or physician assistant for reasons other than those described in subsection (1)(a.5)(II) of this section that render the limits provided in subsection (1)(a.5)(I) of this section unreasonable or unattainable. (IV) Nothing in this subsection (1)(a.5) precludes or otherwise prohibits a licensed physician or physician assistant from rendering appropriate patient care on an occasional basis when the circumstances surrounding the need for care so warrant. (b) If a health-care institution, by maintaining, as a condition of licensure, certification, or other authority to render health-care services in this state, commercial professional liability insurance coverage with an insurance company authorized to do business in this state or an eligible nonadmitted insurer allowed to insure in Colorado pursuant to article 5 of title 10, C.R.S., in a minimum indemnity amount of five hundred thousand dollars per incident and three million dollars annual aggregate per year; except that this requirement is not applicable to a certified health-care institution that is a public entity under the "Colorado Governmental Immunity Act". In the event a health-care institution does not have a commercial professional liability insurance policy in compliance with this paragraph (b), or the limits of professional liability insurance coverage are in excess of any self-insured retention amount, or there is a deductible other than zero dollars, the health- care institution shall procure evidence that the commissioner of insurance has accepted and approved an alternative form of establishing financial responsibility in compliance with paragraph (c), (d), or (e) of this subsection (1), in accordance with applicable rules promulgated by the division of insurance. The health-care institution shall furnish evidence of alternative financial responsibility compliance to the department of public health and environment as part of the health-care institution's application for an initial or renewal license, certification, or other authority. (c) In the alternative, by maintaining a surety bond in a form acceptable to the commissioner of insurance in the amounts set forth in paragraph (a), (a.5), or (b) of this subsection (1); (d) As an alternative, by depositing cash or cash equivalents as security with the commissioner of insurance in such applicable amounts; ion for an initial or renewal license, certification, or other authority. (c) In the alternative, by maintaining a surety bond in a form acceptable to the commissioner of insurance in the amounts set forth in paragraph (a), (a.5), or (b) of this subsection (1); (d) As an alternative, by depositing cash or cash equivalents as security with the commissioner of insurance in such applicable amounts; (e) As an alternative, any other security acceptable to the commissioner of insurance, which may include approved plans of self-insurance. (2) Each such physician, physician assistant, or dentist, as a condition of receiving and maintaining an active or inactive license or other authority to provide health-care services, and each health-care institution, as a condition of receiving and maintaining an active license, certification, or other authority to provide health-care services in this state, shall furnish the appropriate authority that issues and administers the license, certification, or other authority with evidence of compliance with subsection (1) of this section. The license, certification, or other authority shall not be issued or renewed unless the health care professional or health care institution provides evidence of compliance with subsection (1) of this section to the appropriate authority that issues and administers the license, certification, or other authority. (3) Notwithstanding the minimum amount specified in subsection (1)(a.5) of this section, if the Colorado medical board receives two or more reports pursuant to section 13-64-303 during any twelve-month period regarding a physician or physician assistant, the minimum amount of financial responsibility for that physician or physician assistant is twice the amount specified in subsection (1)(a.5) of this section. The Colorado medical board may reduce the additional amount if the physician or physician assistant, upon motion, presents sufficient evidence to the Colorado medical board that one or more of the reports involved an action or claim that did not represent any substantial failure to adhere to accepted professional standards of care. Under these circumstances, the board may reduce the additional amount to an amount that would be fair and conscionable. (4) (Deleted by amendment, L. 2010, (HB 10-1260), ch. 403, p. 1963, § 33, effective July 1, 2010.)

C.R.S. § 13-64-302 Limitation of liability - interest on damages - definition

13-64-302. Limitation of liability - interest on damages - definition. (1) (a) As used in this section: (I) "Derivative noneconomic loss or injury" means noneconomic loss or injury to persons other than the person suffering the direct or primary loss or injury. "Derivative noneconomic loss or injury" does not include punitive or exemplary damages. (II) (A) "Direct noneconomic loss or injury" means nonpecuniary harm for which damages are recoverable by the person suffering the direct or primary loss or injury, including pain and suffering, inconvenience, emotional stress, physical impairment or disfigurement, and impairment of the quality of life. "Direct noneconomic loss or injury" does not include punitive or exemplary damages. (B) Nothing in this section shall be construed to prohibit a recovery for economic damages, whether past or future, resulting from physical impairment or disfigurement. (b) The total amount recoverable for all damages for a course of care for all defendants in any civil action for damages in tort brought against a health-care professional, as defined in section 13-64-202, or a health-care institution, as defined in section 13-64-202, or as a result of binding arbitration, whether past damages, future damages, or a combination of both, shall not exceed the greater of one million dollars, present value per patient, or one hundred twenty-five percent of the noneconomic damages limitations set forth in section 13- 21-203 (1)(b) in effect at the time the acts or omissions occurred, present value per patient, including any claim for derivative noneconomic loss or injury, of which not more than two hundred fifty thousand dollars, present value per patient, including any derivative claim, shall be attributable to direct or derivative noneconomic loss or injury; except that, if, upon good cause shown, the court determines that the present value of past and future economic damages would exceed such limitation and that the application of such limitation would be unfair, the court may award in excess of the limitation the present value of additional past and future economic damages only. The limitations of this section are not applicable to a health-care professional who is a public employee under the "Colorado Governmental Immunity Act" and are not applicable to a certified health-care institution which is a public entity under the "Colorado Governmental Immunity Act". For purposes of this section, "present value" has the same meaning as that set forth in section 13-64-202 (7). The existence of the limitations and exceptions thereto provided in this section shall not be disclosed to a jury. (1) (c) (I) (A) Effective July 1, 2003, the damages limitation of two hundred fifty thousand dollars described in subsection (1)(b) of this section shall be increased to three hundred thousand dollars, which increased amount shall apply to acts or omissions occurring on or after said date. It is the intent of the general assembly that the increase reflect an adjustment for inflation to the damages limitation. (B) Effective January 1, 2025, in an action filed on or after that date that accrued on or after January 1, 2024, but before January 1, 2026, the damages limitation of three hundred thousand dollars described in subsection (1)(c)(I)(A) of this section for direct or derivative noneconomic loss or injury is increased to four hundred fifteen thousand dollars. (C) Effective January 1, 2026, the damages limitation of four hundred fifteen thousand dollars described in subsection (1)(c)(I)(B) of this section is increased to five hundred thirty thousand dollars, which increased amount applies to acts or omissions occurring on or after January 1, 2026, but before January 1, 2027. economic loss or injury is increased to four hundred fifteen thousand dollars. (C) Effective January 1, 2026, the damages limitation of four hundred fifteen thousand dollars described in subsection (1)(c)(I)(B) of this section is increased to five hundred thirty thousand dollars, which increased amount applies to acts or omissions occurring on or after January 1, 2026, but before January 1, 2027. (D) Effective January 1, 2027, the damages limitation of five hundred thirty thousand dollars described in subsection (1)(c)(I)(C) of this section is increased to six hundred forty-five thousand dollars, which increased amount applies to acts or omissions occurring on or after January 1, 2027, but before January 1, 2028. (E) Effective January 1, 2028, the damages limitation of six hundred forty-five thousand dollars described in subsection (1)(c)(I)(D) of this section is increased to seven hundred sixty thousand dollars, which increased amount applies to acts or omissions occurring on or after January 1, 2028, but before January 1, 2029. (F) Effective January 1, 2029, the damages limitation of seven hundred sixty thousand dollars described in subsection (1)(c)(I)(E) of this section is increased to eight hundred seventy- five thousand dollars, which increased amount applies to acts or omissions occurring on or after January 1, 2029, but before January 1, 2030. (G) Effective January 1, 2030, the damages limitation in subsection (1)(c)(I)(F) of this section must be adjusted for inflation as of January 1, 2030, and on January 1 every two years thereafter. The adjustments made on January 1, 2030, and on January 1 every two years thereafter must be based on the cumulative annual adjustment for inflation for each year since the effective date of the damages limitation specified in subsection (1)(c)(I)(F) of this section. The adjustments made pursuant to this subsection (1)(c)(I)(G) must be rounded upward or downward to the nearest ten-dollar increment. As used in this subsection (1)(c), "inflation" means the annual percentage change in the United States department of labor's bureau of labor statistics consumer price index for Denver-Aurora-Lakewood for all items paid by all urban consumers, or its successor index. (II) The secretary of state shall certify the adjusted limitation on damages within fourteen days after the appropriate information is available and shall publish the adjusted amount on the secretary of state's website. (III) The adjusted limitation on damages as of January 1, 2030, and on January 1 every two years thereafter is applicable to acts or omissions occurring on and after the specified January 1 and before the January 1 two years thereafter. (2) In any civil action described in subsection (1) of this section, prejudgment interest awarded pursuant to section 13-21-101 that accrues during the time period beginning on the date the action accrued and ending on the date of filing of the civil action is deemed to be a part of the damages awarded in the action for the purposes of this section and is included within each of the limitations on liability that are established pursuant to subsection (1) of this section.

C.R.S. § 13-64-302.5 Exemplary damages - legislative declaration - limitations - distribution of damages collected

13-64-302.5. Exemplary damages - legislative declaration - limitations - distribution of damages collected. (1) The general assembly hereby finds, determines, and declares that it is in the public interest to establish a consistent and uniformly applicable standard for the determination, amount, imposition, and distribution of exemplary monetary damages arising from civil actions and arbitration proceedings alleging professional negligence in the practice of medicine. It is the intent of the general assembly that any such exemplary damages serve the public purposes of deterring negligent acts and where appropriate provide a form of punishment that is in addition to the disciplinary and licensing sanctions available to the Colorado medical board. (2) Notwithstanding any other provision of law to the contrary, the exemplary damages provided for in this section and authorized to be imposed upon a health-care professional shall be the only such damages imposed as a result of the negligence claim. (3) In any civil action or arbitration proceeding alleging negligence against a health-care professional, exemplary damages may not be included in any initial claim for relief. A claim for such exemplary damages may be asserted by amendment to the pleadings only after the substantial completion of discovery and only after the plaintiff establishes prima facie proof of a triable issue. If the court or arbitrator allows such an amendment to the complaint under this subsection (3), it may also, in its discretion, permit additional discovery on the question of exemplary damages. (4) (a) In any civil action or arbitration proceeding in which compensatory damages are assessed against a health-care professional, the judge or arbitrator, in his discretion, and only if it is shown at the trial or proceeding that the action complained of was attended by circumstances of fraud, malice, or willful and wanton conduct, may allow the trier of fact to impose reasonable exemplary damages, as provided in this subsection (4). The degree of proof shall be as provided in section 13-25-127 (2). (b) The standards for awarding and the amount of exemplary damages, if imposed upon such health-care professional, shall be as provided in sections 13-21-102 and 13-25-127 (2). (5) (a) No exemplary damages shall be imposed under subsection (4) of this section which were the result of the use of any drug or product approved for use by any state or federal regulatory agency and used within the approved standards therefor, or used in accordance with standards of prudent health-care professionals. (b) No exemplary damages shall be imposed under subsection (4) of this section which were the result of the use of any drug or product subject to the provisions of paragraph (a) of this subsection (5) when the clinically justified use of such drug or product is beyond the regulatory approvals or standards therefor and is in accordance with standards of prudent health-care professionals, and when such use has been agreed to pursuant to the written informed consent of the recipient. (6) No exemplary damages shall be assessed against a health-care professional as a result of the acts of others unless he specifically directed the act to be done or ratified the same. (7) For the purposes of this section, unless the context otherwise requires, "health-care professional" has the same meaning set forth in section 13-64-202 (4).

C.R.S. § 13-64-303 Judgments and settlements - reported - penalties

13-64-303. Judgments and settlements - reported - penalties. Any final judgment, settlement, or arbitration award against any health-care professional or health-care institution for medical malpractice shall be reported within fourteen days by the professional's or institution's medical malpractice insurance carrier in accordance with section 10-1-120, 10-1-120.5, 10-1-121, 10-1-124, 10-1-125, 10-1-125.3, or 10-1-125.7, or by the professional or institution if there is no commercial medical malpractice insurance coverage to the licensing agency of the health-care professional or health-care institution for review, investigation, and, where appropriate, disciplinary or other action. Any health-care professional, health-care institution, or insurance carrier that knowingly fails to report as required by this section shall be subject to a civil penalty of not more than two thousand five hundred dollars. Such penalty shall be determined and collected by the district court in the city and county of Denver. All penalties collected pursuant to this section shall be transmitted to the state treasurer, who shall credit the same to the general fund.

C.R.S. § 13-64-303.5 Exclusion - mental health-care facilities

13-64-303.5. Exclusion - mental health-care facilities. The provisions of section 13-64-301 do not apply to any outpatient mental health-care facility, including a behavioral health safety net provider, and to any extended care facility or hospice with sixteen or fewer inpatient beds, including to nursing homes or rehabilitation facilities. The department of public health and environment shall by rule establish financial responsibility standards that are less than those prescribed in this section for classes of health-care institutions that have less risk of exposure to medical malpractice claims or for other reasons that render the limits provided in section 13-64-301 (1)(b) unreasonable or unattainable.

C.R.S. § 13-64-304 Effective date - applicability of part

13-64-304. Effective date - applicability of part. This part 3 shall take effect January 1, 1989, and shall apply to acts or omissions occurring on or after said date and to licenses, certification, or other authority granted on or after said date.

C.R.S. § 13-64-401 Qualifications as expert witness in medical malpractice actions or proceedings

13-64-401. Qualifications as expert witness in medical malpractice actions or proceedings. No person shall be qualified to testify as an expert witness concerning issues of negligence in any medical malpractice action or proceeding against a physician unless he not only is a licensed physician but can demonstrate by competent evidence that, as a result of training, education, knowledge, and experience in the evaluation, diagnosis, and treatment of the disease or injury which is the subject matter of the action or proceeding against the physician defendant, he was substantially familiar with applicable standards of care and practice as they relate to the act or omission which is the subject of the claim on the date of the incident. The court shall not permit an expert in one medical subspecialty to testify against a physician in another medical subspecialty unless, in addition to such a showing of substantial familiarity, there is a showing that the standards of care and practice in the two fields are similar. The limitations in this section shall not apply to expert witnesses testifying as to the degree or permanency of medical or physical impairment.

C.R.S. § 13-64-402 Collateral source evidence

13-64-402. Collateral source evidence. (1) In any action in a court or arbitration proceeding for personal injury against a health-care provider for professional negligence, the plaintiff shall, within sixty days after the commencement thereof, serve written notice thereof to the third party payer or provider of any amount paid or payable as a medical benefit pursuant to any health, sickness, or accident insurance or plan, which provides health benefits, or any contract or agreement of any group, organization, partnership, or corporation to provide, pay for, or reimburse the cost of medical, hospital, dental, or other health-care services, and shall file a copy thereof with the court or arbitrator. Such service shall be made pursuant to section 10-3-107 (1) or (1.5), C.R.S., or pursuant to the Colorado rules of civil procedure. (2) If such third party payer or provider of such benefits has a right of subrogation for such payments, it shall file with the court or arbitrator written notice of such subrogated claim, without specifying a definite amount, within ninety days after receipt of the notice required in subsection (1) of this section, and transmit a copy thereof to the party plaintiff. Failure to file such written notice shall constitute a waiver of such right of subrogation as to such action. (3) Before entering final judgment, the court shall determine the amount, if any, due the third party payer or provider and enter its judgment in accordance with such finding. (4) The provisions of this section shall not apply to section 25.5-4-301, C.R.S.

C.R.S. § 13-64-402.5 Evidence relating to legally protected health-care activity - legislative declaration

13-64-402.5. Evidence relating to legally protected health-care activity - legislative declaration. (1) It is the general assembly's intent to protect persons from liability in Colorado courts for taking actions specified in section 12-30-121, personally or professionally, that are not subject to discipline by a regulator pursuant to section 12-30-121. (2) In any medical malpractice action brought in this state against a health-care provider licensed, registered, or certified in this state or in another state or United States territory, a court or arbitrator shall not allow evidence or witness testimony relating to professional discipline or criminal or civil charges in this state or in another state or United States territory, regardless of disposition or outcome, concerning the provision of, or assistance in the provision of, a legally protected health-care activity, as defined in section 12-30-121 (1)(d), so long as the care provided did not violate Colorado law.

C.R.S. § 13-64-403 Agreement for medical services - alternative arbitration procedures - form of agreement - right to rescind

13-64-403. Agreement for medical services - alternative arbitration procedures - form of agreement - right to rescind. (1) It is the intent of the general assembly that an arbitration agreement be a voluntary agreement between a patient and a health-care provider and no medical malpractice insurer shall require a health-care provider to utilize arbitration agreements as a condition of providing medical malpractice insurance to such health-care provider. Making the use of arbitration agreements a condition to the provision of medical malpractice insurance shall constitute an unfair insurance practice and shall be subject to the provisions, remedies, and penalties prescribed in part 11 of article 3 of title 10, C.R.S. (1.5) Exemplary damages may be awarded in any arbitration proceeding held pursuant to this section in accordance with section 13-21-102 (1) to (3) and (6). Any award of exemplary damages in a proceeding held pursuant to this section may be modified by the district court upon petition to the district court alleging that the award of such damages was either excessive or inadequate. (2) Any agreement for the provision of medical services which contains a provision for binding arbitration of any dispute as to professional negligence of a health-care provider that conforms to the provisions of this section shall not be deemed contrary to the public policy of this state, except as provided in subsection (10) of this section. (3) Any such agreement shall have the following statement set forth as part of the agreement: "It is understood that any claim of medical malpractice, including any claim that medical services were unnecessary or unauthorized or were improperly, negligently, or incompetently rendered or omitted, will be determined by submission to binding arbitration in accordance with the provisions of part 2 of article 22 of this title, and not by a lawsuit or resort to court process except as Colorado law provides for judicial review of arbitration proceedings. The patient has the right to seek legal counsel concerning this agreement, and has the right to rescind this agreement by written notice to the physician within ninety days after the agreement has been signed and executed by both parties unless said agreement was signed in contemplation of the patient being hospitalized, in which case the agreement may be rescinded by written notice to the physician within ninety days after release or discharge from the hospital or other health-care institution. Both parties to this agreement, by entering into it, have agreed to the use of binding arbitration in lieu of having any such dispute decided in a court of law before a jury." (4) Immediately preceding the signature lines for such an agreement, the following notice shall be printed in at least ten-point, bold-faced type: NOTE: BY SIGNING THIS AGREEMENT YOU ARE AGREEING TO HAVE ANY ISSUE OF MEDICAL MALPRACTICE DECIDED BY NEUTRAL BINDING ARBITRATION RATHER THAN BY A JURY OR COURT TRIAL. YOU HAVE THE RIGHT TO SEEK LEGAL COUNSEL AND YOU HAVE THE RIGHT TO RESCIND THIS AGREEMENT WITHIN NINETY DAYS FROM THE DATE OF SIGNATURE BY BOTH PARTIES UNLESS THE AGREEMENT WAS SIGNED IN CONTEMPLATION OF HOSPITALIZATION IN WHICH CASE YOU HAVE NINETY DAYS AFTER DISCHARGE OR RELEASE FROM THE HOSPITAL TO RESCIND THE AGREEMENT. NO HEALTH-CARE PROVIDER SHALL WITHHOLD THE PROVISION OF EMERGENCY MEDICAL SERVICES TO ANY PERSON BECAUSE OF THAT PERSON'S FAILURE OR REFUSAL TO SIGN AN AGREEMENT CONTAINING A PROVISION FOR BINDING ARBITRATION OF ANY DISPUTE ARISING AS TO PROFESSIONAL NEGLIGENCE OF THE PROVIDER. NO HEALTH-CARE PROVIDER SHALL REFUSE TO PROVIDE MEDICAL CARE SERVICES TO ANY PATIENT SOLELY BECAUSE SUCH PATIENT REFUSED TO SIGN SUCH AN AGREEMENT OR EXERCISED THE NINETY-DAY RIGHT OF RESCISSION. ERVICES TO ANY PERSON BECAUSE OF THAT PERSON'S FAILURE OR REFUSAL TO SIGN AN AGREEMENT CONTAINING A PROVISION FOR BINDING ARBITRATION OF ANY DISPUTE ARISING AS TO PROFESSIONAL NEGLIGENCE OF THE PROVIDER. NO HEALTH-CARE PROVIDER SHALL REFUSE TO PROVIDE MEDICAL CARE SERVICES TO ANY PATIENT SOLELY BECAUSE SUCH PATIENT REFUSED TO SIGN SUCH AN AGREEMENT OR EXERCISED THE NINETY-DAY RIGHT OF RESCISSION. (5) Once signed, the agreement shall govern all subsequent provision of medical services for which the agreement was signed until or unless rescinded by written notice. Written notice of such rescission may be given by a guardian or conservator of the patient if the patient is incapacitated or a minor. Where the agreement is one for medical services to a minor, it shall not be subject to disaffirmation by the minor if signed by the minor's parent or legal guardian. (6) The patient shall be provided with a written copy of any agreement subject to the provisions of this section at the time that it is signed by the parties. (7) No health-care provider shall refuse to provide medical care services to any patient solely because such patient refused to sign such an agreement or exercised the ninety-day right of rescission. (8) No health-care provider shall withhold the provision of emergency medical services to any person because of that person's failure or refusal to sign an agreement containing a provision for binding arbitration of any dispute arising as to professional negligence of the provider. (9) If a health-care provider refuses to provide medical care services to any patient in violation of subsection (7) of this section or withholds the provision of emergency medical services to any person in violation of subsection (8) of this section or fails to comply with the requirements of subsection (3) or (4) or both of this section, such refusal or withholding of services shall constitute unprofessional conduct as such term is used under the relevant licensing statute governing that particular care provider, and the appropriate authority which conducts disciplinary proceedings relating to such health-care provider shall consider and take appropriate disciplinary action against such health-care provider as provided under the relevant licensing statute. (10) Even where it complies with the provisions of this section, such an agreement may nevertheless be declared invalid by a court if it is shown by clear and convincing evidence that: (a) The agreement failed to meet the standards for such agreements as specified in this section; or (b) The execution of the agreement was induced by fraud; or (c) The patient executed the agreement as a direct result of the willful or negligent disregard of the patient's right to refrain from such execution; or (d) The patient executing the agreement was not able to communicate effectively in spoken and written English, unless the agreement is written in his native language. (11) No such agreement may be submitted to a patient for approval when the patient's condition prevents the patient from making a rational decision whether or not to execute such an agreement. (12) For the purposes of this section: (a) (I) "Health-care provider" means any person licensed or certified by the state of Colorado to deliver health care and any clinic, health dispensary, or health facility licensed by the state of Colorado. The term includes any professional corporation or other professional entity comprised of such health-care providers as permitted by the laws of this state. (II) (A) Nothing in this subsection (12)(a) shall be construed to permit a professional service corporation, as described in section 12-240-138, to practice medicine. (B) Nothing in this paragraph (a) shall be construed to otherwise create an exception to the corporate practice of medicine doctrine. ofessional entity comprised of such health-care providers as permitted by the laws of this state. (II) (A) Nothing in this subsection (12)(a) shall be construed to permit a professional service corporation, as described in section 12-240-138, to practice medicine. (B) Nothing in this paragraph (a) shall be construed to otherwise create an exception to the corporate practice of medicine doctrine. (b) "Professional negligence" means a negligent act or omission by a health-care provider in the rendering of professional services, which act or omission is the proximate cause of personal injury or wrongful death, as long as such services are within the scope of services for which the provider is licensed.

C.R.S. § 13-64-404 Effective date - applicability of part

13-64-404. Effective date - applicability of part. This part 4 shall take effect July 1, 1988, and shall apply to acts or omissions occurring on or after said date and shall apply to agreements for medical services containing a binding arbitration provision on or after said date.

C.R.S. § 13-64-501 Definitions

13-64-501. Definitions. As used in this part 5, unless the context otherwise requires: (1) "Health-care institution" means any licensed or certified hospital, health-care facility, dispensary, or other institution for the treatment or care of the sick or injured. (2) "Health-care professional" means any person licensed in this state or any other state to practice medicine, chiropractic, or nursing.

C.R.S. § 13-64-502 Limitation on actions

13-64-502. Limitation on actions. (1) No claimant, including an infant or his personal representative, parents, or next of kin, may recover for any damage or injury arising from genetic counseling and screening and prenatal care, or arising from or during the course of labor, delivery, or the period of postnatal care in a health care institution, where such damage or injury was the result of genetic disease or disorder or other natural causes, unless the claimant can establish by a preponderance of the evidence that the damage or injury could have been prevented or avoided by ordinary standard of care of the physician or other health care professional or health care institution. (2) (a) Medical records of or any other medical information concerning a person whose alleged death or injury is the subject matter of a civil action under subsection (1) of this section shall be discoverable by a party defendant under the provisions of the Colorado rules of civil procedure and shall not be inadmissible in evidence because of the provisions of section 13-90-107 (1)(d). (b) Medical records and information concerning such person's genetic siblings, parents, and grandparents may be discoverable as provided in paragraph (a) of this subsection (2) if the defendant, after reasonable efforts, is unable to obtain appropriate releases and makes a showing to the court of the possible relevancy of such records or information. In such case, the court may order the production of such records. If deemed necessary, the court may hold an in camera proceeding on the relevancy of such records. No liability shall attach to any physician, health care professional, or health care institution as a result of the release of such medical records or information.

C.R.S. § 13-64-503 Effective date - applicability of part

13-64-503. Effective date - applicability of part. This part 5 shall take effect July 1, 1988, and shall apply to acts or omissions occurring on or after said date.
Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://leg.colorado.gov/sites/default/files/images/olls/crs2024-title-13.docxFetched: 10/6/2026

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