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What is Personal Injury Protection Coverage?

Personal Injury Protection Coverage (“PIP”) is first-party coverage that is also extended to your passengers.  It covers your and your passenger’s medical bills and also includes payment for lost wages and other nonmedical costs. There is no right of subrogation associated with PIP coverage, with minimal exception, as opposed to coverage for medical payments, which is advantageous in the case of a personal injury claim.  Importantly, all policies in Texas include PIP coverage.  You must specifically reject this coverage if you do not want it in writing.

The Texas Insurance Code defines PIP Coverage as providing cover for “payment to the named insured in the policy, members of the insured’s household, and any authorized operator or passenger of the named insured’s motor vehicle, including a guest occupant, of all reasonable expenses that: (1) arise from an accident; (2) are incurred not later than the third anniversary of the date of the accident; and (3) are for:

(A)  necessary medical, surgical, x-ray, or dental services, including prosthetic devices, and necessary ambulance, hospital, professional nursing, or funeral services;

(B)  in the case of an income producer, replacement of income lost as the result of the accident; or

(C)  in the case of a person injured in the accident who was not an income or wage producer at the time of the accident, reimbursement of necessary and reasonable expenses incurred for essential services ordinarily performed by the injured person for care and maintenance of the family or family household.”

Tex. Ins. Code §1952.151 et seq.

The Texas Insurance Code §1952.151 et seq further provides:

  • An insurer is required to provide PIP coverage in the maximum amount of “$2,500 for all benefits, in the aggregate, for each person.” An insured can    select higher coverage.
  • An insurer may require reasonable medical proof of the insured’s injury- causing loss of income as a condition to receiving loss of income benefits coverage.
  • PIP benefits are owed regardless of the insured’s fault.
  • PIP benefits are owed regardless of “any collateral source of medical, hospital, or wage continuation benefits.”
  • An insurer paying PIP benefits generally does not have a right of subrogation.
  • An insurer must pay PIP benefits within 30 days of a proof of claim.
  • An insured must present a claim for PIP benefits as required by the policy, but the policy may prescribe a “period of not less than six months after the date of an accident.”
  • An insurer may “require reasonable medical proof of an alleged recurrence of an injury for which an original claim for benefits was made if a lapse occurs in the period of total disability or in the medical treatment of an injured person who:
    • has received benefits under that coverage; and
    • subsequently claims additional benefits based on the alleged recurrence.
    • The aggregate benefits payable under the coverage required by this subchapter to any person may not exceed the maximum limits prescribed in the insurance policy.”

An insurer does not have to pay PIP benefits if the insured intentionally caused his or her own injury or if it “occurred while committing a felony or while seeking to elude lawful apprehension or arrest by a law enforcement official.”

Take extra caution when reviewing your insurance documents and be sure you do not reject this coverage as part of the execution of documents prepared by your insurer.  Also, it is good practice to be sure you tell your agent you want this coverage.

The lawyers of LeMaster & Ahmed PLLC are here to help those that suffer personal injuries as a result of car accidents.  Contact us at our Houston location at 832-356-7983 or our DFW location at 972-483-0410. You can also message us any inquiries directly on our website.

***The foregoing is not meant to serve as legal advice relating to your personal injury claim. Please contact one of our lawyers if you have questions specific to your particular insurance issue.

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