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PIP Coverage Vs. Med Pay in Texas

 

Personal Injury Protection or PIP coverage is one coverage that we recommend everyone carry on his or her auto insurance policy.  While the minimum coverage is usually twenty-five hundred dollars ($2,500), we suggest that you carry at least $5-$10,000 in PIP coverage.

Where PIP comes in handy is when the health insurance coverage you have refuses to pay because it’s a car accident claim, and they say someone else should pay.  In effect, the health insurance company often tells their insureds–to go collect from the negligent driver while that doesn’t help someone with a bill collector calling and harassing them for their medical bills.

Many car wreck claims can take months to resolve and even years sometimes.  Leaving the medical bills unpaid does not sit that well with many people.  That’s where PIP comes to the rescue. Here is an article on do I need PIP coverage?

Many primary care physicians also are reluctant to treat victims of car accidents simply because they expect a health insurance company to deny the claim pending the resolution of a car accident lawsuit. Med Pay is similar to PIP but more limited and costs only slightly less.

We Suggest PIP over Med Pay

Texas auto insurance will vary in scope and substance from other states. The Texas insurance Commission has valuable resources for learning about car insurance coverage in Texas.

What PIP Covers in Texas

PIP insurance pays for your medical expenses, lost wages, and other expenses if you are injured in an automobile accident. PIP will also cover the same costs for your passengers if a car crash hurts them. In Texas, Personal Injury Protection coverage is required unless you sign a waiver declining the coverage.

Specific Coverage for PIP in Texas

  • Reasonable medical expenses
  • Ambulance costs
  • Physical therapy
  • Funeral expenses
  • Lost income because of the crash
  • Replacement of family member services for an injury victim.

Personal Injury Protection coverage is very inexpensive and is a mechanism to get some of your medical expenses paid quickly. It has been our experience that many health insurers do not take medical claims given the overreaching of some medical providers and the constant battle over “who pays.”

Nevertheless, Personal Injury Protection coverage is excellent coverage to have when you’re in a severe car accident.

PIP is Paid Regardless of Fault

PIP benefits are paid regardless of fault or other available coverage or benefits, however, an offset can be sometimes applied when a liability claim is being made under the same policy as the PIP.

Recently many insurance companies have pretended to be health insurance companies and are discounting payments to their insured quoting that the expenses charged by the healthcare providers were not “reasonable expenses”.

The validity of this approach depends upon the specific facts of the claim. If a medical provider insists on full payment, it seems unlikely that courts would require the insured to be on the hook for the unpaid bill that the insurer has “discounted”.

Who is Covered by PIP?

The statutory minimum personal injury protection coverage is $2500 however, the PIP coverage can be written in almost any amount should you desire additional coverage.

Personal injury protection covers everyone in the insured vehicle up to the PIP policy limits. PIP also covers every insured regardless of what vehicle they are in at the time of an accident. PIP coverage is paid when there is a “motor vehicle accident” under the standard auto policy.

When to Claim PIP?

Payments under the PIP policy apply to covered losses that are incurred within three years of the accident date. Generally, the insurer must pay the claim within 30 days of receipt of the claim.

The best time to claim PIP benefits is as soon as you have your medical bills to submit to your auto insurance company.

Stacking of Policies Allowed

Case law indicates that in some instances when there are two separate PIP policies they can be stacked on top of each other to fully compensate for damages. Meaning if you are covered by more than one policy, you may be able to collect under all policies.

Health Insurance Paid Bills are Still Eligible for PIP

Even if your health insurance paid your medical bills from a car accident, PIP may still apply to those same bills. While some auto insurers claim otherwise. When in doubt, contact an injury attorney.

Personal injury protection can be a very important part of your auto insurance coverage and can make a bad situation a little bit better if you carry the coverage.

We recommend that consumers in Texas carry personal injury protection if they can afford it and that they carry personal injury protection instead of medical payments coverage.

Medical Pay Coverage

Medical Payments or Med Pay coverage.

Unlike PIP, Medical Payments (Med Pay) coverage is not mandatory in Texas. Your insurance company does not have to offer you Medical Payment coverage. Medical Payment coverage is more limited than PIP in Texas. The fundamental limitations of Med Pay are:

  • Medical pay only pays expenses within one year of the crash
  • there is no coverage for chiropractic treatment
  • it only reimburses your health insurance deductibles and co-pays if you have health insurance
  • It does not cover lost wages.

 

We recommend that you obtain PIP coverage instead of “medical pay coverage” because the Med Pay coverage asks that you pay them back should you recover from the third party who caused the accident.

In effect, Med Pay coverage simply pays the bills initially and then gets reimbursed out of any personal injury settlement.  If you have to pay your insurer back, there’s not a lot of value in merely fronting the money for the medical bills.  Personal-injury protection in Texas does not require you to pay back your medical expenses to the car insurance company.

Do You Need a Lawyer to Collect PIP or Med Pay?

No, you probably don’t need an attorney to collect PIP or Med Pay coverage. You may, however, want to consider consulting with an attorney if your injuries are more substantial than a typical whiplash-type case. There can be issues such as subrogation, coordination of benefits, and whether or not your insurance carrier gets offset for PIP coverage paid when you are making an uninsured or UIM coverage claim.

Additionally, we have found that many insurance carriers are being obstructive and trying to claim undue offsets on many PIP applications. In such situations, you may need an attorney’s assistance.

Call Our Experienced Lawyers with Questions

If you have been injured in a car accident and want to speak with a car accident lawyer, call our personal injury law firm in Houston for a no-obligation consultation. (281) 587-1111.

 

 

 

Greg Baumgartner

attorney greg baumgartner

Greg Baumgartner has practiced personal injury law since 1984. He holds not one but two law degrees and is a graduate of Trial Lawyers College. He is licensed in Texas and Colorado. Mr. Baumgartner has earned a reputation for exemplary results for his clients. And has been preeminent rated for decades and recognized by Top 100 Trial Lawyers, Super Lawyers, Expertise, Newsweek, Houstonia magazine, and many others. He has given educational talks to lawyers and many media interviews regarding personal injury cases.