Personal injury protection, or “PIP”, is a type of automobile insurance coverage. It generally covers the cost of medical care needed to treat injuries sustained in a car accident by the driver and passengers in the driver’s car.
It is sometimes called “no-fault” insurance, because PIP provides coverage regardless of whether the covered driver was at fault in causing the car accident. So, even if negligence on the part of the covered driver caused the accident, PIP reimburses the cost of medical treatment for injuries. It does not cover property damage. A different type of insurance policy is needed for that purpose.
PIP is mandatory in the following states:
- New Jersey;
- New York;
- North Dakota;
- Puerto Rico.
In the following states and Washington, D.C., PIP is a compulsory type of coverage that must be added to a person’s auto insurance policy:
- South Dakota;
- Washington, D.C.
PIP is optional in the following states:
- New Hampshire;
- South Dakota;
- Washington, D.C.
States set the minimum amount of coverage that a PIP policy must provide, so it varies depending on the state. The maximum amount that a PIP policy pays is set by insurance companies that sell PIP and can also vary, but it is usually no more than $25,000.
PIP may be waived by a driver in Maryland, Texas, and Washington. This would mean that the driver could choose not to purchase PIP. For example, a driver might have perfectly good health insurance and think that PIP is not necessary for them. It is important to remember, however, that PIP is mandatory in 12 states and in Puerto Rico.
So, even if a driver has excellent health care coverage, they would have to have a PIP element included in their automobile insurance plan. And a person must also remember that PIP covers passengers in a covered driver’s car, and passengers may not always have other health insurance coverage.
Personal injury protection may also refer to certain types of personal injury insurance policies, including those that may cover emotional distress, as well as other liabilities related to car accidents.
What Does PIP Cover?
Personal injury protection coverage generally reimburses a covered driver for the medical expenses they incur when they are injured in a car accident. These usually include basic items such as hospital bills, the cost of necessary medication, and doctor bills. The definition of what constitutes a “medical expense” under a PIP policy may vary by state and by insurance policy. For instance, acupuncture may be covered by PIP in Utah, but not in other states such as California.
Some PIP policies may also cover such expenses as lost wages caused by the accident. For instance, if a car accident causes a person to miss work because they are in the hospital, PIP may allow the injured person to recover lost wages. PIP may also cover funeral expenses, childcare expenses if a person cannot provide care for their children because of their injuries, survivors’ loss benefits, and compensation for household services.
Equally important is what PIP does not cover. It does not cover the cost of repairing damage to the vehicle of either the covered driver or any other vehicle involved in an accident with the covered driver. It does not cover the cost of repairing damage to property inside a car. And it does not cover medical treatment of the injuries sustained by people outside of the car of the covered driver.
What Are Some Legal Issues Involving PIP?
PIP is generally favorable for the insured because the insurance carrier pays for the cost of medical treatment for injuries sustained in a car accident without regard to whether or not the negligence of the covered driver caused the accident. That is why it is considered a type of “no-fault” insurance.
However, as mentioned, the law regarding personal injury protection varies widely by state. What is considered a covered expense in one state might not be covered by PIP in another state. Other factors can also influence the scope of coverage, e.g. most importantly the terms of the PIP policy contract.
For instance, in some states, PIP might be available to cover costs related to an accident that happened while the covered person was acting within the course and scope of their employment, even if there is an existing worker’s compensation system in the state. Other states might not allow coverage in such situations and would require the driver to claim coverage from their state’s worker’s compensation system. State law would have to be consulted in any given situation.
In some states, the state insurance regulator allows insurance companies to terminate, limit or deny the payment of PIP benefits only if some item 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 claimed that their PIP insurer discontinued payments under their PIP coverage, because the company asserted that insured person had already realized “maximum medical improvement,” i.e. a stage at which further medical treatment could no longer 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 ends payments under a person’s PIP coverage on the grounds that some part of their 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, if the PIP insurance provider refuses to pay. And if an insurance company denies a claim in error, the insured may have to sue the company for insurance bad faith.
If a person has incurred expenses in a car accident or other personal injury situation, it can be difficult to tell what is covered and what is not covered by insurance. Legal action might be required to resolve expenses that are not covered by insurance. For instance, recovering punitive damages for intentional injuries or other similar damages may require a lawsuit.
Do I Need a Lawyer for Help with a PIP Claim?
PIP laws vary widely from state to state. Whether or not PIP is available or mandatory in your state can affect the outcome of a legal claim related to injuries in a car accident
You may wish to hire a car accident lawyer in your area if you need assistance or legal advice when it comes to issues involving PIP insurance coverage. Your attorney can research the law in your state, as well as your auto insurance documentation to determine what kind of payment you should receive from your insurance company. Your lawyer should be able to explain your rights and options. If you need to file a lawsuit, your attorney can help you and represent you in court during the process.
Few people enjoy reading insurance policies and trying to figure out the benefits to which they are entitled. This is a job better handled by your personal injury lawyer.