A common question we get at the Philbrook Law Office is ‘What happens when PIP limits are exhausted?’. There’s not necessarily an easy cut and dry answer to this question, but there are some common scenarios.
Why shouldn’t they pay my bills now? For many who have not previously been involved in an injury accident, it is a surprise to find out that the at fault party’s insurance will not pay your medical bills as they accrue. The law requires those who are at fault for an accident to pay all damages which flow from or are proximately caused by the event. This includes property damage, out of pocket costs, medical bills, loss of vehicle use, wage loss, pain and suffering, etc. The property damage claim can be handled independently of bodily injury and wage loss, and therefore is often resolved within a month. All other claims for damages would be handled together, and the claim settlement is global in nature.
What is PIP? This is where Personal Injury Protection (PIP) comes in. PIP insurance is ALWAYS RECOMMENDED FOR EVERYONE. The function of PIP is for your insurance company to step into the shoes of the at fault party, and pay your medical bill(s) right away. PIP insurance has no deductible, and can be used with any medical provider. This gives you the power to control your healthcare. PIP insurance is mandatory in the State of Oregon, with a limit of at least $15,000. In Washington, PIP can be waived by the customer. Even though the price of PIP is fairly low (generally around $6 per month), many people waive it. Waiving PIP always benefits the insurance company. It’s not a money maker for the industry, and I’ve seen some deceptive practices to encourage waivers. One thing to look out for is the online application process that some insurance companies use. Often times the PIP waiver box is pre-checked on the form. If you do carry PIP, your bills will be paid in a timely manner, with no out of pocket expenses to you. PIP will function as your primary insurance for all health care related to the collision. PIP will also cover a percentage of your wage loss for up to a year (this does not apply against your limits).
So what happens if PIP limits are exhausted? Most PIP policies have $10,000, $15,000 or $35,000 limits. In serious injury cases, those limits can be exhausted quickly (if there is a hospital stay, surgery, or detailed testing), or over time (if injuries do not resolve as expected). I recommend that you understand your PIP limits, and pay attention to your total bills. A common scenario is for doctors, chiropractors, massage therapists, etc., to administer conservative treatment while billing PIP to the max; and if the injury does not resolve, you get a referral for an MRI or specialist, with no more insurance money to pay the bill. Even if you do have a good understanding of your bills and limits, PIP may be exhausted. If this is the case, your health insurance would be the next resource. Health insurance is more restrictive than PIP, and often times you will have some out of pocket expenses, but it’s a valuable tool to receive the proper care.
What happens when no more insurance money is available? If PIP is waived or exhausted and no additional insurance exists, you will need to find treatment providers who are willing to defer payment of the bill, or accept a payment plan. One of the many benefits of working with an experienced and well respected personal injury attorney is we work with all levels of doctors who trust our work and are willing to accept a promise to pay from the proceeds of a settlement. This usually only applies to smaller offices, where the treatment provider is in control of daily operation. The facts of the claim need also be right to guaranty repayment.
When is the at fault party responsible to pay my bills. Eventually the at fault person, must pay all damages which flow from the accident. This takes place when the parties agree upon fault, the reasonableness of all medical bills, and the value of your pain and disruption of life. If an agreement is reached on all aspects of the claim, a settlement agreement and release is prepared which forever bars either party from seeking future money. At that point in time, the PIP provider is also reimbursed for the medical bills they paid.
If you have been in involved in an injury accident in Washington or Oregon, and have questions about PIP or other related issues, please do not hesitate to contact the Philbrook Law Office at 360-695-3309.
Founding Attorney Matthew Philbrook attended Clark College, Washington State University, and Gonzaga University School of Law. He is a member of the Washington State and Oregon State Bar Associations and started Philbrook Law Office in 2005. He specializes in Personal Injury, DUI and Criminal Defense cases. Learn more about Mr. Philbrook.