Personal Injury Protection Lawsuits

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 What Are Personal Injury Protection Lawsuits?

Personal injury protection (PIP) is a type of automobile insurance. It provides coverage for the expense of the healthcare required to treat injuries suffered in an automobile accident. PIP insurance covers medical expenses for both injured policyholders and their passengers, even if they do not have any other health insurance coverage.

Twenty-two states either require that driver’s have PIP coverage or offer it as an option to be added on to other elements of auto insurance coverage. The states set the requirement for the minimum amount of coverage, so policy minimums vary from state to state. The maximum amount that is paid out in any given case is established by the insurance companies and can also vary, but the policy maximum is usually no more than $25,000.

If the cost of necessary medical care exceeds an insurance policy’s PIP limits, a person’s health insurance may cover additional expenses, if the person has health insurance.

PIP coverage sometimes provides payments for losses other than the cost of medical care to treat injuries, e.g. lost income, the cost of child care, and funeral expenses related to an accident. Some no-fault states offer coverage that is limited to medical payments only, but it typically has low limits and does not pay for any other costs.

Some states make PIP coverage mandatory. These are usually states that have no-fault accident laws, which means that auto accidents do not result in lawsuits to determine who is at fault. That is why it is sometimes known as “no-fault” insurance, though no-fault insurance might include other types of coverage as well, for example, coverage for property damage. In a no-fault state, even if a person’s own negligence causes an accident, their PIP pays for the medical care required to treat their own injuries.

PIP coverage, however, is not a substitute for liability insurance. Every state, except New Hampshire and Virginia, as well as Puerto Rico and Washington, D.C. require that a driver have liability insurance. Liability insurance pays for care and treatment of injuries suffered by another person in an accident, such as the driver or passengers in another vehicle or a pedestrian.

PIP lawsuits are legal claims concerning the insurance aspect of a car accident. In the case of PIP insurance, lawsuits may concern the amount the insurance company should pay for health care costs, as insurance companies may cover only part of them. Or, an insurance company may dispute whether it has to cover some kinds of care. For example, a PIP provider may refuse to cover certain types of non-traditional treatment for physical ailments, e.g. herbal remedies.

In other cases, PIP lawsuits might involve an insured person suing their insurance company, because there is a dispute regarding coverage under an insurance policy. For example, there could be a dispute as to whether a driver was covered by their PIP policy at the time of an accident.

PIP insurance does not provide coverage to compensate for all of the losses that may result from a car accident. Specifically, PIP coverage does not compensate for the following:

  • Damage to the insured’s vehicle;
  • Damage to property of other people;
  • Injuries to other drivers involved in an accident;.
  • Injuries from accidents that occur while a covered driver is using their car for work;
  • Injuries from accidents that are caused intentionally;
  • Injuries resulting from accidents that occur while the covered driver is committing a crime, such as escaping the police;
  • Injuries that were caused by a car owned by the covered driver or an immediate family member that was not covered by the driver’s PIP policy at the time of the accident..

What Are Common Legal Disputes Involving PIP?

PIP can be helpful because it provides insurance coverage for a person who has suffered injury in an accident regardless of who was at fault in causing the accident. Some legal disputes involving PIP insurance coverage might involve:

  • Disputes over the amount of damages owed to the other party in a car accident;
  • Disputes over the amount of PIP coverage provided by the insurance carrier;
  • Conflicts regarding definitions in an insurance contract, such as the definition of “medical expense,” which may differ by state;
  • Conflicts involving third parties who may not be insured; or
  • Violations of laws or regulations, such as when an insurance provider suddenly changes coverage terms in a way that may violate the policyholder’s rights under state insurance regulations.

In some states, the state regulator of insurance products allows insurance companies to terminate, limit or deny the payment of PIP benefits. This is allowed only if some element of medical treatment is not reasonable, not necessary, not related to the car accident or is not provided within 3 years of the date of the accident.

In a case filed in Washington state, an insured person alleged that their PIP insurer discontinued PIP coverage because the insurance company had determined that the insured person had achieved “maximum medical improvement,” i.e. a stage at which further medical treatment would not improve the insured person’s physical condition. Termination of coverage for this reason was not sanctioned by the state’s insurance regulations.

So disputes can arise if an insurance company terminates coverage on the grounds that some element of medical treatment is not reasonable, not necessary or not related to a car accident covered by the insurance. An insured driver may have to file a lawsuit to obtain the coverage to which they believe they are entitled under their policy. And if an insurance company wrongfully denies a claim, the insured may have to sue the company for insurance bad faith.

What Are the Remedies for PIP Disputes?

PIP lawsuits can involve a number of different remedies. Of course, in part, these will depend on the type of conflict involved as well as the legal issue at hand. Generally speaking, some remedies in a PIP lawsuit might include:

  • An award of money damages is the most common remedy;
  • Non-conventional damages such as punitive damages in cases involving intentional acts;
  • Contract-type remedies, such as a re-working of insurance policy terms;
  • Injunctions requiring one party to take or refrain from taking certain actions;
  • Sanctions for insurance companies that have violated statutes or state insurance regulations.

Thus, PIP can often provide coverage for basic medical expenses that are normally associated with car accidents and personal injury claims. However, more complex legal issues may have to be worked out in court.

Should I Hire a Lawyer for Help with PIP Issues?

Personal injury protection can be helpful to a driver for certain costs, especially in no-fault states. However, you may need to consult a personal injury lawyer in your area if you need to file a lawsuit regarding the details of your PIP coverage. Your lawyer can provide you with legal advice and representation in your case.

PIP laws are very different from state to state, but your lawyer can inform you of the law regarding PIP in your state and review your policy to find out exactly what your PIP covers. And, finally, your lawyer can help you determine what your course of action should be.

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