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- First and Third Party Coverage
- No Fault based
- Deductible Applies
- Limited on amount of coverage
Personal Injury Protection covers anyone one in your vehicle (driver and passengers) at the time of the accident. It also provides payment without the need for determining fault. Therefore, your medical bills will be covered right of way. Many states require this coverage, so you cannot waive it.
Some other states, you can actually waive your rights when you are buying insurance, but the insurance agent is required to make you sign a form where you understand the dimensions of this decision.
Other states allow you to waive it without having to sign anything. Check your local legislation to find out if you can waive this coverage or not.
Why would you waive Personal Injury Protection? For a lower premium payment. Again this is not recommended since adding Personal Injury Protection would only add a minimal amount to your bill, but the consequences of not having this coverage can be devastating.
Personal Injury Protection will be provided only to the amount of limits that you have purchased, and just as liability coverage has minimum limits, so do this coverage. The limits however are usually low.
Most insurance companies provide a limit of $5000. Considering that the day of the accident, you could face: ambulance ride, emergency room, x-ray, and lab fees, your bill could easily add up to $2000; not to mention if you have to go to the dentist for anything. $5000 will just cover very much, especially if you have to continue treatment or see any kind of specialist. I recommend that you have at the very least $10,000 worth of Personal Injury Protection.
Personal Injury Protection coverage is not subject to a deductible. So your insurance is obligated to pay 100% of your medical expenses.
However, Medical Payments or Personal Injury Protection type coverages not only have low limits, but they also have many restrictions. Most insurance policies will limit the time you (or your passengers) can file a claim. Most often, you only have one year to file a claim. Better insurance companies will give you five years to file.
The restrictions do not stop there. 99% of the insurance policies out there provide the reasonable and necessary clauses in the section outlining Personal Injury Protection. The Insurance carrier will only pay for whatever medical treatment they consider reasonable and necessary under the circumstances.
The problem here is that your Personal Injury Protection adjuster will be making a decision on what she considers necessary, from a desk, many miles away, without even seeing you.
This adjuster will “evaluate” the notes of the emergency room, the ambulance, and whoever else gave you any kind of medical treatment and determines whether the serviced provided was reasonable and necessary.
It does not stop there. Even if the treatment was reasonable and necessary, the rate might not be. Yeah, if your medical adjuster thinks that the rate your medical provider is charging is not reasonable and necessary, she can just simply pay what she believes is a reasonable rate.
For example, if your medical visit cost $250, but if your medical adjuster feels that the services provided should only cost $200, and then a payment of $200 will be issued. What happened to the $50 difference? Well, either your doctors takes the reduced amount or you will have to pay. If you do not pay, then you could be turn into collections.
The situation described above is rather a bad one for the insured, and personally, I think that if your insurance company does not want to pay 100% of your medical bills as agreed, you should complaint to your state insurance commissioner and find another carrier.
What really gets to me is when an insurance company tells you that your expenses, the day of the accident, were not necessary or reasonable. They seem to think that you need to be on the ambulance looking for the best rate so they cover that. Who is being unreasonable? Anyway, All State seems to pull this stunt all the time. In this respect, they get a failing grade.
The restrictions do not stop there. Most of the time Personal Injury Protection does not provide for loss wages, so if you are injured to the point that you cannot go to work, or you lose valuable time by having to go to the doctor, this would not covered.
In reality, this has a huge impact. How many of us can afford to be going to the chiropractor for hours (commute time, gas, medicine, and time away from the job site,)? Many people will just “ride it out” because they have to put food on the table.
For some extra premium, you could get loss wages covered. Some insurance companies even provide this coverage in their basic coverage. There are usually limits like $50 per day, or 85% of your documented wages up to $10,000.
They will pay for your actual wage loss subject to the restrictions noted, but under Personal Injury Protection sections there are exclusions for gas and/or mileage.
Go to Personal Injury Protection Page 2 for a continuation of this article.
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