Medical Coverage or Personal Injury Protection (PIP)

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Under Medical Coverage or (PIP) Most insurance carriers will cover reasonable Essential Services Expenses. This means that the carrier will pay for those activities that the injured person was performing before the accident but cannot longer perform because
of it (doing laundry, taking care of kids, cooking, cleaning, driving, mowing the grass etc). This coverage is highly restricted. Usually there is a very low daily limit ($12 per day).

You would have to show by clear evidence that only the injured insured could perform that Essential Service and that the injury really tampers the injured insured ability to perform the service (usually a doctors letter will do).

Another restriction under Medical Coverage or PIP is the expectations and burdens the insurance company can put on their insureds. The carrier can and will request a medical authorization and a wage and employment authorization forms.

These forms are blank to be filled by you, they are helpful to the insurance carrier to be able to see your entire medical history. This means entire as in all your medical history for all your life, related and not to the accident. Some insurance companies have softened the language of these forms, but they can come back and ask you for 5 and or 10 years of medical history.

Medical Coverage or PIP entitles them to be looking for any indication that your injuries are not related to this accident and therefore they can deny payment. This also happens with your employer. They will be contacting your employer for your timecard, financial information, vacation information, and anything else they can think of.

I do not have to explain how problematic this can be, but if it is not, then at least it is intrusive. I understand the insurance company has to confirm your loss to be able to pay, but sometimes they seem to be more concerned with finding evidence against you than for you.

Under the Medical Coverage or PIP the insurance carrier can also ask you to go to a doctor of their choosing for physical examination and testing, and they can ask you to go to that doctor as often as they reasonably require.

The question is do I have to sign these forms? Yes, you do if you want them to pay. The law says that if they insurance company is paying for a bill; then they are entitled to see the medical report and the test results. This also applies to your loss wages.

However, you can request the insurance to soften the language, or flat out change it. You can request them to ask prior records from only medical providers that they are paying bills for, and only medical records that relate to your accident (the date of that accident) and injury.

So if you have a neck injury, they can ask for prior records regarding your neck, not anything else. If you do not care whether or not they see all your records then just sign and send it back, but if you are more reserved and have personal reasons to not hand all your medical history, then you can control what they see and what they do not.

Always remember that the insurance company must act in good faith (for more information see our Bad Faith section), this means they cannot do things just to delay payment (like asking for all your medical history since you were a newborn). This does not mean that they will not try.

Another common restriction is that Medical Coverage or PIP will be completely excluded if the treatment you seek is covered under worker compensation laws.

Medical Coverage or PIP allows for funeral expenses. If you or any person in the household dies because of an automobile accident, then they will pay certain amount for medical expenses. Usually that amount is stated in your declarations page. Most insurance companies limit this $2000.

Medical Coverage and Personal Injury Protection (PIP) have exclusions for general damages (pain and suffering, loss of quality of life, loss of consortium etc). This is perhaps the strongest exclusion. The coverage is limited to medical bills and loss of earnings).

Some situations where you need to keep this coverage in mind:

Most insurance policies under Medical Coverage or Medical Payments will cover you as a pedestrian. Yes, if a vehicle hits you when you are a pedestrian, then you (the insured) are involved in a vehicle accident and you are entitled to this coverage.

The definition of insured under this section is extended to everyone living with the policyholder (any household member). Therefore, if your wife, husband, fianc�, boyfriend or girlfriend, kids, step kids, or even your butler, were hit by a vehicle when they were walking down the road, this coverage would apply to them.

If you are driving down the road and a pedestrian jumps in front of you (100% their fault) and you hit them, you will see that the definition of insured under this section will be extended to that pedestrian. This means that they would be covered for their medical bills up to the limit of coverage that you have purchased as if they where a first party. The only limitation on this coverage has to do with the actual location of the accident.

Some will only extend the definition of insured to pedestrian in the state the policy was written; some will extend to any pedestrian anywhere.

I know this sounds somewhat unfair, why would your insurance pay for something that you did not cause? I think the answer in this case is that when there is an auto v. pedestrian hit, the pedestrian seems to have the upper hand in a court of law. Perhaps it is an easier way to defuse an already bad situation.

As expressed above, this coverage is very restricted; however, you cannot afford not to have it. Some insurance agents will tell you to waive it (if it is legal to do so) so you can save money on your premium (often very little). This is a ludicrous preposition (red flag, red flag, your agent is not very honest). Those who do not understand insurance will think that the agent is making an honest suggestion, after all, the less money you spend on the insurance premium, the less of a kick back the agent gets, right?

Not really. Agents are also interest in their loss ratio. Yes, they are interested in selling insurance to people that will not make claims. The less the insurance company has to pay in losses, the more the insurance agent gets at the end of the year in bonuses and perks, so by waiving your medical bills there will be huge savings to the insurance company (see Role of the Agent).

If you do waive medical coverage and/or PIP, then you will be saving a little money on your premium (not enough to justify the risk). But remember that if you get in an accident, then you would have pay out of pocket for you and all your passengers. In addition, you and your family will not have any protection as pedestrians.

The last thing I will mention about Medical Coverage or PIP is the issue of having your health insurance plan cover your accident injuries. Agents will tell you, why pay medical coverage or PIP when you have health insurance. The answer is rather simple. Most health insurance will request written notice from your insurance company showing that you do not have that coverage.

This sounds simple enough, but insurance companies drag their feet (they can legally drag their feet up to 60 days), so some of your bills will not get pay right of way. In addition, your medical coverage under this coverage will be paid at 100% with no deductible or co pay.

However, if you do decide to use your health insurance, you will be responsible for co pays, deductibles, and co-insurance (the will pay up to 80% of your injury). Also, remember that health insurance plans restrict constructive surgeries, and some are very restrictive on dental and vision care.

In addition, there are no coverages for other people in your vehicle (just the people on the health insurance plan), so if you mother or neighbor gets in the car, they had better have good health insurance.

Another huge incentive to have Medical Coverage and/or PIP is for people insured in Montana and in Arizona (there are more states, I will be reporting more on this) they possibility of double or triple dipping. What?

Yeah, Montana will let you be paid double for you medical bills. How can that be? There are statutes in Montana where it is forbidden for insurance companies to subrogate (go after or seek compensation) for payments made on behalf of an insured when the coverage exists.

For example, if you are hit in Montana (not your fault), and you are injured. You should file a Personal Injury Protection claim or medical coverage claim as soon as you can.

Why? Because your insurance company will pay for your medical expenses, but they cannot ask for compensation back from you or from the party that hit (or their insurance company).

This does not relieve the responsible party for having to pay (after all they hit you and put you in this situation), but who do they have to pay if the bills are already paid? That would be you. Therefore, your doctor is paid, and so do you.

It gets sweeter in Arizona. The status that regulate insurances in Arizona are written in such a way that Health Insurance plans cannot seek compensation from any other insurance company, and same applies to first party PIP and or Medical Coverage insurance carriers.

Therefore, you can file a claim with your health insurance (i.e. Blue Cross) and let them pay for your bills. The Medical Coverage or Medical payments will have to pay you for those bills again (to you), and so will have to do the insurance company of the responsible party. Your doctor is paid and you get pay twice.

Do not waive this coverage, please.

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