Personal Injury Protection: Potential Hidden Benefits for Your Patients
By Arthur D. Leritz
December 27, 2011
Most health care providers who treat those with traumatic injuries following motor vehicle collisions are likely aware that Personal Injury Protection (PIP) is accessible under the auto policy of the patient or the policy of the owner of the vehicle in which the patient was a passenger. However, PIP may also be available in circumstances even when it appears there is none. We have seen countless situations in which the auto insurance companies won’t freely disclose to you or your patient the availability of PIP benefits.
In Washington state, all insurance companies selling automobile insurance are required to offer PIP on every automobile policy issued in this state.1 PIP provides medical coverage, regardless of the fault of the injured party, at a mandatory minimum of $10,000.2 An insured may also request that this coverage be increased, usually to $35,0003. This coverage generally protects the driver, passengers in the driver’s vehicle, as well as the driver’s family members traveling in any automobile. Though it is mandatory for the insurer to offer PIP coverage, the insured may decline this coverage in writing.
The minimum PIP benefits of $10,000 can be quickly exhausted when a patient is injured, particularly if they are transported from the scene of the collision and receive care in a hospital emergency room. Therefore, we always recommend to clients, colleagues, health care professionals, family members, and friends that all should seriously consider requesting PIP limits over the mandatory minimum. The increased premium4 is surprisingly small per policy period. Any increase is only effective prospectively. This means that a patient’s increased coverage will not apply to a current claim, but could prove very valuable if future collisions should occur. In many cases, higher PIP limits can make the difference between a patient deciding to terminate care prematurely due to lack of coverage for bills and receiving appropriate treatment to recover from their injuries.
Pedestrians and Bicyclists: Where’s the PIP?
What is not well known is that PIP policies for drivers also cover pedestrians and bicycle riders hit by an automobile. If the car’s driver had no PIP, the bicyclist or pedestrian can access their own auto-PIP coverage even if they were not in any car. Most people incorrectly assume that if they sustain injuries in this type of situation, the at-fault driver’s insurance company is under no obligation to pay for the injured party’s medical expenses at the time they are incurred. This is not accurate and the insurer often does not disclose this very important information.
If your patient was a pedestrian or bicycle rider involved in an automobile collision and the vehicle driver has PIP benefits, then they have PIP coverage. It is up to your patient or their attorney to determine if the at-fault driver had PIP coverage that may apply in this situation. This information can be difficult to obtain for the patient without counsel. If your patient has no attorney involved, they can consult with one and/or make the request for this information in writing to the at-fault driver’s insurance company to determine if PIP benefits are available.
If PIP benefits are available in this situation, you should bill the at-fault party’s insurer for all medical treatment related to the collision, even if your patient has their own PIP coverage. (Your information should only go to the adjuster handling the PIP benefits and not to the adjuster handling the liability claim.) If your patient also has PIP under his/her own policy, then there is coverage available under two PIP policies – in essence the policies “stack.” The at-fault party’s PIP coverage is primary. When that coverage is exhausted, the patient’s PIP coverage will begin to pay.
PIP Availability Even When the Patient Says They Do Not Have It:
As noted above, auto insurers are required to offer PIP coverage on all auto policies in Washington. The insured can decline the coverage, but the waiver must be in writing. If it is not, the patient has coverage retroactively embedded back into the policy! This is not something the insurance company will voluntarily offer to the insured, though they are well aware of their obligation. If your patient is not sure if they have PIP coverage – or even if they believe they do not – the patient should request that the insurer produce a copy of the written waiver. By law, all insurers are required to keep written proof that the insured rejected this coverage. (Electronic waiver when applying for insurance online is a valid waiver.) If the insurance company cannot produce a copy of the written waiver, your patient automatically has the minimum PIP coverage allowed under Washington law of $10,000.
The attorneys at Adler Giersch are ready to assist you and your patients with any and all questions regarding PIP coverage or other coverage in Washington. We are committed to providing legendary service and the highest level of legal representation through knowledge, advocacy and accessibility.
1 Revised Code of Washington (RCW) 48.22.085.
2 RCW 48.22.095. This coverage also includes funeral expenses up to $2,000, income continuation benefits up to $10,000 (max of $200/week) and loss of services benefits up to $5,000 (max of $200/week).
3 RCW 48.22.100. This coverage also includes funeral expenses up to $2,000, income continuation benefits up to $35,000 (max of $700/week) and loss of services benefits up to $14,600.
4 My own PIP policy increased only $25 per 6 month policy period when I increased my PIP coverage from $10,000 to $35,000. Insurance companies typically charge anywhere from $25-$50 every policy period to increase this coverage to $35,000 so the cost is really minimal compared to the benefit.