How to Use PIP Insurance for Auto Accident

Were you just in an auto accident? Did you sustain injuries and/or lose time from work as a result? If so, you need to receive treatment for your injuries and you'll want reimbursement for any lost wages from work. This article will explain the process of using the PIP (personal injury protection) of your auto insurance policy to pay for your health care treatment and lost wages.

Instructions

Difficulty: Moderately Easy

Things You’ll Need:

• Telephone to call insurance company
• Insurance company contact information for cars involved in accident
• Forms from the insurance company
• Telephone
• Accident information

How to Determine the PIP Available

1. Call your insurance agent and tell them you have been involved in an auto accident and that you were injured. A claim will be set up and you will be assigned a claim representative. (Of course, do this as soon as possible. If you're in an ambulance on your way to the hospital, you can wait until you're done with x-rays and the like.)
2. Call the claim representative. This person will let you know whether your insurance or another policy will be responsible for the PIP portion of your claim.
3. In Maryland, the insurance follows the vehicle. If you were in your own vehicle, the PIP claim will be paid by your insurance company. If you were driving or riding in someone else's vehicle, the PIP will be paid by that person's insurance company. (You'll have to check your state's policies.)
4. Once you find out whose insurance will be paying the PIP for your injuries, you need to find out what the limits are on that policy. In Maryland, it will either be $2.5k, $5k, or $10k.

How to Use the PIP Insurance Available

5. Now you know what policy will be covering the PIP part of your claim, as well as the limits on that policy for the PIP. The insurance company covering the PIP will want to know what happened. You will have to speak with them and answer questions about the accident. They may take a recorded statement.
6. There will be paper work mailed to you that must be filled out. The first is a form called a HIPAA Compliant Authorization, which allows the insurance company to obtain your medical records related to the accident. The second is an Application for Benefits- Economic Loss Protection form. If the PIP is being handled by an insurance company other than your own, you must also furnish a copy of your own auto insurance, showing that you have coverage and didn't waive your PIP.
7. Two other forms must be filled out, but not immediately. One is a form for the treating physician, and one is for your HR representative to fill out showing your lost wages.
8. Once you get the required paperwork filled out, the claim rep will let you know PIP is activated. You can now begin to submit the medical bills to the insurance company as you receive them. Some places may be willing to send the bills directly to the insurance company if you ask them to.
9. Lots of paperwork can be overwhelming... Don't wait for the paperwork to start treatment. Go ahead to doctor's visits, physical therapy, and whatever else is reequired. However, if you need an MRI or Cat Scan, or psychotherapy for PTSD, you may need upfront authorization from the auto insurance company. Without the authorization, you would have to use your health insurance and then have them reimbursed, which adds extra unnecessary steps.
10. Have your physician fill out the physician's form, and submit it to the claim rep.
11. Submit the lost wages form filled out by your HR representative at your job. You will only be reimbursed in Maryland and most states for 85% of the lost wages.
12. Once you reach the limits available with the PIP, you will be sent a letter of exhaustion. Any remaining medical bills would then need to be sent to your regular health insurance company. No more lost wages can be reimbursed from the PIP (and of course your health insurance won't pay these.)

Tips & Warnings

• In Maryland, the insurance follows the vehicle. In some other states, it follows the person. You will need to ask your insurance company what the laws are in your state.
• In Maryland, if there were three people in the car and injured, each one has the limits of the PIP available to them. So, if it was $5k, each person has $5k to pay their medical bills and lost wages.
• The more PIP you have available, the better. This is one area you don't want to skimp on when setting up your auto insurance policy. It's worth paying more each month to be able to cover your medical expenses once you are injured in an accident, especially if the accident involves your vehicle!
• You have to make sure you haven't waived PIP insurance on your auto insurance policy. If so, you can't use it even if you were injured in someone else's car and that car has PIP insurance available!
• You have the option to waive PIP insurance to lower your insurance cost, but don't do it!
• You want to have the highest PIP available, because medical bills add up quickly! One trip to the hospital can cost $1000 for the ambulance and up to $2000 or more for the hospital stay alone! That doesn't even cover treatment over time such as physical therapy!
• The PIP pays off medical bills and lost wages in the order they are received. So, if the physical therapy submits the bill before the emergency room, the physical therapy is paid first. This makes it important to get your lost wage form in as early as possible!
• At some point, you may also get a settlement from the insurance company of the person responsible for the accident (if it isn't you.) The settlement generally includes any yet unpaid expenses plus an amount for pain and suffering.
• If you are the victim of an accident involving a drunk driver, criminal charges may ensue against the driver, including a charge for causing death or bodily injury. You could end up having to be a witness in the case against this person. Or, you might be asked to make a statement at the sentencing hearing if the person pleads guilty. If this happens, you'll get a call from the state's attorney's office of the county where the accident occurred.