PIP Guide – How do PIP benefits work?
When you are in an auto accident in Washington you soon realize that figuring out which insurance company pays the medical bills or wage loss benefits is complicated. This guide to Personal Injury Protection (PIP) Benefits is intended to provide a bare minimum of information about the process and the pitfalls to avoid. It in no way is meant to replace an in-person consultation with an experienced auto accident lawyer.
What is PIP? | Washington Guide to PIP
PIP offers access to medical treatment and wage replacement for people who are injured in car crashes. PIP benefits are supposed to provide injured people with immediate medical care without the need for private health insurance.
In order to get these insurance benefits, you must first file a claim with your insurance company and fill out an application for benefits. Once this is completed, all reasonable, necessary, and related medical services should be covered by your auto insurance company for three years from the date of the crash.
Who is covered by PIP?
In order to have access to PIP benefits, they must be a listed benefit on your insurance policy declarations page. In Washington, insurance carries must offer PIP benefits to everyone purchasing automobile insurance in Washington. However, not everyone involved in a collision can access PIP benefits because individuals are able to waive PIP benefits from their insurance policy if they do so in writing. If your insurance carrier is saying that you waived your PIP benefits, you should consult with a Personal Injury Attorney immediately.
If PIP benefits are listed on the declaration page, then PIP benefits are available to all people named on the automobile insurance policy and other household members. Also, PIP benefits are available to all passengers of a covered vehicle as well as pedestrians or bikers who are involved in the collision. Each individual covered by the PIP benefits has their own, independent pool of funds they can use to received treatment.
My Insurance Company says I “Waived” PIP Benefits – Did I?
PIP benefits must be offered on every automobile insurance policy issued in Washington. The insurance company only has to offer the benefits at initiation of the policy. Insurance companies do not have to re-offer PIP benefits at the beginning of each policy period. This means that many people are unable to recall if they did or did not waive PIP benefits because they’ve been with the same insurance company for many years and can’t recall what if anything they signed. If your insurance company is saying you waived PIP benefits, they must be able to produce a writing showing the waiver. There are ways to get the insurance company to offer PIP benefits and if not, there are ways to obtain treatment without PIP benefits. So contact an experienced personal injury attorney to discuss your options.
The Three Steps to Take to Open Your PIP Claim
| Washington Guide to PIP
1. File an insurance claim with your insurance company and notify them of your injury and need for treatment. Your insurance card will have a hotline to call. Make sure to write down the claim number. Take a photo of it with your phone so you have it with you at all times.
2. Cooperate with your insurance company when they make reasonable requests. This can include providing a recorded interview with your insurance company; filling out a PIP application; and signing a medical authorization. If the request seems unreasonable, contact an attorney to discuss your options.
3. Obtain medical treatment. Provide the PIP claim number and PIP adjuster contact information to your medical providers. The bills will be submitted to your PIP claim. You can always request a “PIP ledger” from your PIP adjuster to see what has been paid and to see how much coverage is remains.
These are the most basic steps to obtaining PIP coverage. Once you’ve had your first medical appointment, please contact a personal injury attorney to discuss PIP in more detail to make sure you use it to the fullest extent possible in aiding you through your recovery.
Why Does My Insurance Company Pay the Medical Bills?
Everyone wants the at-fault driver’s insurance to pay their medical bills. In most cases they do, but it takes time and you should not have to negotiate with the at-fault insurance company over what type of treatment you need, you should be able to get it and have the at-fault insurance company pay for the treatment later. Because of this, Washington decided that you should not have to wait to have these bills paid. Your insurance company has the responsibility to take care of these costs, up to the PIP policy limits. At the end of your treatment, the medical bills your insurance company paid for are submitted to the at-fault insurance company for reimbursement. Remember, PIP benefits are there so that you can get fast, necessary treatment. Don’t be afraid to use them.
Pursuant to Revised Code of Washington (RCW) 48.30.010 and the Washington Administrative Code (WAC) 284-30-395, bills submitted to your PIP insurance can only be denied if the treatment is one of the following:
1) is not reasonable,
2) is not necessary,
3) is not related, or
4) occurs more than 3 years after the crash.
What Happens When My Insurance Company Denies Payment for a Medical Bill?
When your insurance company denies payment for reasonable and necessary medical bills, it has potentially breached its contractual obligation to you. This is called a Wrongful Denial of PIP benefits claim, and when this happens it’s important to talk with an experienced car accident lawyer to understand exactly what sorts of legal rights you have.
Insurance companies routinely deny PIP benefits in Washington, and they do it for a simple reason—it saves them lots of money. This is because many injured people stop seeking care before their treatment plan has run its course and before they have fully recovered. It is important to understand that there are legal remedies that are readily available. Do not let your insurance company push you around, talk with the car accident attorneys at Johnson Law today. We fight insurance companies, so you can focus on getting better.
How Much Does My Insurance Company Have to Pay?
Your insurance company has a contractual obligation to pay up to your policy limits for your medical care and wage loss. If you have PIP benefits, the minimum for medical benefits in Washington is $10,000 for reasonable and necessary medical care for up to three years following the crash.
Moreover, PIP benefits offer access to up to $10,000 for lost wages at a rate of $200 per week after you have been off work for 14 consecutive days, and $5,000 for essential service benefits at a rate of $200 per week, and $2,000 for funeral expenses. The main benefits used are medical coverage and wage replacement coverage.
Even with these limits in mind, insurance companies often decide to breach their contractual obligation and not pay the full PIP benefits after they deem your treatment is no longer reasonable or necessary. If your insurance company has terminated your PIP benefits, it is important that you speak with a personal injury attorney.
My Insurance Company Told Me I Have to Go to an “Independent Medical Exam”—Do I Have to Go?
Your insurance company may send you to an “Independent Medical Exam.” This is a ridiculous label. In reality you are being sent to an “Insurance Medical Exam” that has one purpose—to try and terminate your PIP medical benefits. Sometimes it makes sense to go, and sometimes it does not. Each situation is unique, so it makes sense to schedule a free consultation with an experienced auto accident law firm like Johnson Law, P.C., to get some basic legal advice about whether it makes sense to attend the insurance exam. Know before you go.
My Insurance Company Has Told Me I Need to Sign A Medical Authorization Form—Do I?
Your insurance contract usually indicates that you must cooperate with your insurance company and comply with reasonable requests made by your insurance company. This usually means that you sign a medical authorization form so your insurance company can get the medical records that correspond to the bills it pays on your behalf. This requirement is usually in your auto insurance policy buried deep in the fine print. Your insurance company will keep all the records and bills it collects. This is called the PIP file, and you have a right to request all of it at any time.
Please note that you do not have to sign any type of medical release for the at-fault insurance company.
The PIP Adjuster Calls All the Time. Do I Have to Call Them Back?
You have a contractual obligation to cooperate with your PIP insurance. This usually includes communicating with the PIP adjuster regarding their reasonable inquiries. This does not mean that you are at the PIP adjuster beck and call, but it does mean that you should communicate with them in a timely manner.
It is important to know that once you have an auto accident lawyer, the insurance company has to talk with them, and cannot directly contact you. This is one of the many reasons it usually makes sense to talk with a lawyer as soon as possible after you are hurt.
If I Retain an Auto Accident Lawyer How Do I Pay Them?
Auto Accident Attorneys like the ones at Johnson Law, P.C. would take your case on a contingency fee. This means that we are only paid an attorney fee if we recover something for you. If we are unable to recover through a settlement or judgment, you do not have to pay us a fee.
