Personal Injury Protection Insurance (“PIP”)
Personal Injury Protection (“PIP”) is a mandatory part of all Utah car insurance policies. See Utah Code Ann. 31A-22-302(1). Not every state has PIP, so you may want to check what your policy covers if you just moved to Utah. PIP is not required for motorcycles, ATV, Trailers or street-legal all-terrain vehicles. See Utah Code Ann. 31A-22-302(2). All Utah car insurance policies will have at least $3,000 in PIP insurance but you can purchase more PIP coverage. I carry $10,000 in PIP benefits.Pennies on the dollar for health care when you need it most.
Also, PIP can be stacked, meaning more than one PIP policy may apply to your collision. This can occur when you are in a car collision in a rental car, but you also have your own car insurance, or when you are driving someone else’s car. Stacking PIP polices really helps get you on your feet after a collision.
PURPOSE OF PIP:
The purpose of PIP is to (1) Pay your medical expenses that are related to your car crash, (2) Help pay for lost wages and time off work, (3) Help pay for in-home services, (4) Funeral, burial, or cremation benefits not to exceed a total of $1,500 per person; and (5) Compensation in the event of the death of a person, payable to the person’s heirs, in the total sum of $3,000. That is it.
PIP MEDICAL PAY:
PIP will pay at least $3,000 of medical expenses incurred because of a car accident. PIP is no-fault, which means it does not matter if you are at fault or not. The only requirement is that you got hurt while in a car. See Utah Code Ann. 31A-22-307(1) which describes the PIP medical pay.
PIP benefits will help pay for your lost income because you cannot work. It is not a dollar for dollar benefit, but it is capped at “the lesser of $250 per week or 85% of any loss of gross income and loss of earning capacity per person from inability to work, for a maximum of 52 consecutive weeks after the loss . . . .” See Utah Code Ann. 31A-22-307.
The statutory language at Utah Code Ann. 31A-22-307(b)(I) for a wage loss reads:
“(b)(I) “the lesser of $250 per week or 85% of any loss of gross income and loss of earning capacity per person from inability to work, for a maximum of 52 consecutive weeks after the loss, except that this benefit need not be paid for the first three days of disability, unless the disability continues for longer than two consecutive weeks after the date of injury;”
Obviously, work incapacitating injuries will trigger the wage loss provisions, but sometimes you will need to get a doctor’s note regarding the injury and present it to the PIP insurance adjuster.
PIP SPECIAL ALLOWANCE:
Like PIP wage loss, the statutory language at Utah Code Ann. 31A-22-307(b)(I) for other reimbursements reads:
“(ii) a special damage allowance not exceeding $20 per day for a maximum of 365 days, for services actually rendered or expenses reasonably incurred for services that, but for the injury, the injured person would have performed for the injured person’s household, except that this benefit need not be paid for the first three days after the date of injury unless the person’s inability to perform these services continues for more than two consecutive weeks;”
Again you may need a doctor’s note if your injuries are not obviously triggering these PIP benefits.
PIP REFUSAL. PIP Denial.
PIP benefits are through your own insurance carrier, not provided through the car insurance on the other person who hurt you in their car. It is called First Party Insurance, because it is your own insurance company. The person who hit you, their insurance carrier is often times called Third Party Insurance, or the Liability Carrier. You have a duty to cooperate with your own insurance.
Sometimes your own PIP Carrier will deny your PIP medical benefits because they will allege your medical care is not related to the car wreck, or the care is excessive. Utah Code Ann. 31A-22-309(5)(d) allows an insured to sue their own PIP carrier for denying PIP benefits. These PIP enforcement provisions carry steep interest, costs reimbursement and attorney fees for the prevailing party and the issue can be forced in Small Claims Court.
Utah Code Ann. 31A-22-309(5)(d)(2015) reads:
“The person entitled to the benefits may bring an action in contract to recover the expenses plus the applicable interest. If the insurer is required by the action to pay any overdue benefits and interest, the insurer is also required to pay a reasonable attorney’s fee to the claimant.”
Sometimes your own PIP carrier will conduct an in-house paper review of your medical bills and records to justify their benefits denial. On behalf of my clients, I have sued the PIP carrier for PIP denial. The two PIP carriers have folded both times and just paid rather than face attorney fees, losing and interest.
Sometimes one car wreck can have multiple PIP policies in effect. For example, suppose you are an innocent passenger and the driver allows his car to hit a pole or a deer. First, you would proceed to apply for the primary PIP carrier which would be the Driver’s policy of insurance. The Driver’s PIP carrier would be primary, unless Driver is your husband or you are both on the same policy of insurance. Under Driver’s PIP policy you would use his benefits until exhausted or they are not needed anymore. If you did exhaust Driver’s PIP policy, then you would apply to your own PIP carrier, which is your part of your own car insurance and proceed to use these benefits.
If there are several PIP policies available for use, there will be a priority to determine which PIP policy to exhaust first. If you were hurt while driving a car at work, your Workers Compensation insurance would be primary health care insurance. Then once exhausted, your own PIP insurance would kick in, (if not a PIP denial situation). Lastly, once your PIP is exhausted, your private health care insurance takes over and begins to pay medical bills.
PERSONAL INJURY ATTORNEY JACOB S. GUNTER, AND THE LAW FIRM OF HOWARD LEWIS & PETERSEN, P.C.
When hiring a Personal Injury Attorney, or Car Wreck lawyer, that lawyer needs to be well versed in collection and applying for PIP benefits so that you can be compensated for your injuries and taken care of right after the accident.
Attorney Jacob S. Gunter handles personal injury car collision cases and can help you apply for PIP benefits and maximize your benefits under Utah law. (385) 269-9504.