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PIP/Med Pay/Underinsured/Uninsured Claims

QUESTIONS OFTEN ASKED:
1. I have been hit by an uninsured driver? Am I out of luck? How can I get money for my injuries?
2. I have been hit by an insured driver and their policy doesn’t cover enough to cover all my medical bills? What do I do now?
3. What is PIP (Personal Injury Protection) and what does it cover?
4. What is Med Pay and what does it cover?
5. What is Underinsured insurance?

Types of Coverage in Automobile Injury Cases

Texas Personal Injury Protection (PIP): Texas Law states that your insurance company must “offer” to give you PIP (Personal Injury Protection) with any liability automobile insurance policy in Texas. You can reject it, but it must be in writing. If there is no signed written rejection, then you have the coverage. This is important because it may help you obtain additional money for your claim.

In most cases, PIP covers up to $2,500 (in total, all combined) in medical bills, lost wages (80%), and reasonable household duties that couldn’t be performed due to an injury (in other words, if you had to hire someone to mow your lawn due to your injury, when you regularly did it yourself).

Many insurance companies will also sell up to $10,000 in PIP coverage if requested. I have even seen PIP policies up to $25,000 (TWENTY FIVE THOUSAND DOLLARS). You should get as much PIP coverage as possible to protect yourself in case you are involved in an automobile accident. I tell all my clients to carry this coverage!

Texas Personal Injury Protection (PIP) – mandated to be offered:
Texas law requires Personal Injury Protection be offered to a consumer who purchases liability insurance. There is no requirement that the consumer actually purchase the PIP coverage. But there is a requirement that PIP be “offered.”

In order to prove that Texas Personal Injury Protection was actually offered, and then the consumer rejected the coverage, there must be a “signed written rejection” on file with the insurance company. If there is no signed written rejection of the PIP coverage, then there is coverage…whether paid for or not. It will be the minimum Texas Personal Injury Protection (PIP) limits – $2,500.

When the policy is renewed the next year, a new rejection is not required. Once rejected, the policy holder continues to not have PIP coverage from renewal to renewal, until they contact the insurance company and ask for coverage.

Medical Bills that are covered by Texas Personal Injury Protection (PIP):
Insurance companies are pushing the envelope more and more with regards to what medical bills they will cover under PIP. This is NONSENSE! My law firm fights for all the PIP you are entitled to receive. If it was caused in the incident in question, and if the bills were for treatment received, the PIP claim should be paid.

Now, insurance companies have started denying claims, or parts of claims, for various reasons. One of the more common “new” reasons is to claim that the amount that your doctor charged was unreasonably high. They will reduce the amount that they will pay under PIP by an amount that the insurance company thinks is reasonable. THIS IS NOT PROPER IN MY OPINION!

Part of the problem is defining what “reasonable” means in this context. Insurance companies will try to claim that if your doctor accepts health insurance from certain medical providers, that the amount they accept contractually from those health insurers is the reasonable amount. They will then issue a check based on that amount. The problem is that they don’t contact the doctor’s office to find out if they will actually accept that amount.

Unlike health insurance companies, who get that agreement for contractual adjustment, most of the time the PIP insurance company will just send a letter to you with a payment claiming that this is the “reasonable” amount of the bill without confirming with the doctor or hospital if they will accept that “reasonable” amount. This doesn’t sound reasonable to me…but it doesn’t stop PIP insurance carriers from trying. You need a law firm that will fight for these payments!

Lost Income in Texas Personal Injury Protection (PIP) claims:
LOST WAGES FROM A CAR WRECK CLAIM! PIP in Texas allows a claimant to recover their lost income on their PIP claim. The insurance company may require proof in the form of medical documentation verifying that the claimant was unable to work for the time claimed. The lost income recovered comes out of the same pot of $2500 (or whatever your PIP limits are), so if you have $1500 in medical bills, and another $1500 in lost income, but you only have $2500 in coverage – you can only recover up to $2500, and nothing more, for that particular policy in question.

Reasonable Household Duties in Texas Personal Injury Protection (PIP) claims:
If the injured person was NOT an income producer or wage earner, they may make a claim for reimbursement of expenses required to replace the essential services the injured party normally would provide to the family or household. Make sure you keep receipts and keep a good records of any payments made! It is very important to keep records!

PIP Offsets in Texas Personal Injury Protection (PIP) claims:
What is an OFFSET? If you make a claim against your own insurance for Uninsured Motorist Bodily Injury coverage, or Underinsured Motorist Bodily Injury coverage, your auto insurer can reduce the amount payable under the Uninsured / Underinsured coverage by the amount already paid under Personal Injury Protection. So for instance, if your claim for bodily injury under Uninsured Motorist coverage was worth $20,000, and the insurance company had already paid $2500 under PIP, they would claim an offset for the amount they already paid for $2500, and would pay $17,500 instead (reducing the amount the claim was worth ($20,000) by the amount already paid ($2500). This is different than if you are making a claim against another person’s liability insurance, as the other person’s liability insurance is not the same insurance policy as the PIP coverage – therefor in that case (where PIP and the liability settlement come from two different insurance policies) no offset is allowed.

Multiple PIP Coverages in Texas Personal Injury Protection (PIP) claims:
What is a Double Dip PIP? You may have more than one PIP coverage that you can collect. If, for example, you have your own insurance policy for your own vehicle, but you were a passenger in someone else’s vehicle when you were injured, you can collect under BOTH insurance policies for PIP. The coverage from the two or more different policies will add together. For instance, if you have a $2,500 PIP policy on your own car, and then you have a $2,500 PIP policy available on the vehicle you were traveling in, you essentially have $5,000 in coverage, but if you have less than $2,500 in bills or claims, then it will not make a difference. In other words, if you have two policies, but only have $2500 in bills, you only recover $2500. If you have $4000 in bills, you will recover $2500 from the primary PIP policy, and then recover another $1500 from the other PIP policy, which adds up to the $4000 you are out of pocket and need to pay or be reimbursed.

No Fault and Subrogation in Texas Personal Injury Protection (PIP) claims:
PIP is payable without regard to who was at fault in the automobile accident. If you are the cause, or the other person is the cause, or if nobody was the cause (such as if a deer ran into your path and caused injury), it does not matter – you still can recover under PIP.

The key is whether you are injured getting into, out of, or while occupying a covered automobile, or while you are a covered person, and it arises from an accident.

Time Limits for Texas Personal Injury Protection (PIP) claims:
Time Limit to Submit Claims:
Texas Personal Injury Protection (PIP) will cover expenses incurred not later than three years after the date of the accident. Therefore, if you have a medical bill from your collision that you incur 2 years and 11 months after the collision, it should still be covered. Expenses, such as for medical treatment, incurred after 3 years have passed since the accident will not be covered;

Time Limit to Sue for Not Paying a Claim:
Texas Contract Law has a 4 year statute of limitations. If you submit a claim to your automobile insurance carrier for Texas Personal Injury Protection (PIP), and the insurance company wrongfully denies paying the claim, you have 4 years from the date of the breach of contract to file the lawsuit to enforce your contract.

Uninsured/Underinsured Motorist Coverage:
About one out of three drivers on Texas roads are driving without insurance. Either they let their policy lapse, they never got a policy, they forgot to make a payment, they purchased a new car and forgot to add it, or some other reason. You must make sure you have this coverage. If you are in a car wreck with someone who is uninsured, you will have no way to get your vehicle repaired without at least Uninsured Motorist Coverage.

You should also have UNDERInsured Motorist Coverage. Some people have extremely small insurance policies. If you are involved in a multiple car accident, the wrongdoer’s insurance policy might not have enough coverage to pay for everyone’s claims. This is when you will need to turn to your Underinsured Motorist Coverage.

Liability Coverage:
My law firm will always review your own policy free of charge to tell you what coverages you have. Review your insurance policy and make sure you have enough coverage to pay a claim in case you are at fault in a collision. Most people carry a policy with 30/60/25 coverage. This means you have $30,000 per person injured coverage, up to $60,000 total (in case there are multiple people hurt-$60,000 is the maximum they will pay). The 25 means that the most they will pay out for property damage (damage to another vehicle) is $25,000.00. Be sure to get enough coverage to protect yourself from personal liability. Hopefully, the minimum limits will continue to be raised. I always tell people to carry as much coverage as possible.

Gregg S. Harrison, Attorney at Law, PLLC
Greater Houston/Northwest Houston Auto Policy Coverage Questions Lawyer
Call for a FREE INITIAL CONSULTATION
Office: 281-929-0110
Cell: 832-797-7600
Email: gregg@greggharrison.com