What Is PIP (Personal Injury Protection)?
Personal Injury Protection (PIP) is a type of auto insurance coverage that pays for your medical expenses and certain other losses after an accident, regardless of who was at fault. PIP is the foundation of "no-fault" auto insurance systems.
What PIP Typically Covers
- Medical expenses - Hospital bills, surgery, doctor visits, rehabilitation, chiropractic care
- Lost wages - Usually 60-85% of income lost due to injuries (varies by state)
- Essential services - Costs to hire someone for household tasks you can't perform
- Funeral expenses - In fatal accidents (coverage limits vary)
- Survivor benefits - Death benefits to surviving family members in some states
California is NOT a no-fault state. California uses a traditional "at-fault" (tort) system where the driver who caused the accident is responsible for damages. PIP coverage is not available or required in California.
However, California does offer optional Medical Payments (MedPay) coverage, which provides some similar benefits - paying your medical expenses regardless of fault, but typically with lower limits and without lost wage coverage.
No-Fault States: Where PIP Is Required
Only certain states require PIP coverage. Here's the current landscape:
| State | Type | Minimum PIP | Key Features |
|---|---|---|---|
| Florida | No-Fault | $10,000 | 80% medical, 60% lost wages; 14-day treatment deadline |
| Michigan | No-Fault | $50,000-Unlimited | Choice of coverage levels; strongest no-fault system |
| New York | No-Fault | $50,000 | Covers medical and 80% lost wages; "serious injury" threshold |
| New Jersey | Choice | $15,000 | Can choose between no-fault and tort systems |
| Pennsylvania | Choice | $5,000 | "Full tort" or "limited tort" election affects lawsuit rights |
| Hawaii | No-Fault | $10,000 | Threshold for lawsuits based on medical costs or injury type |
| Kansas | No-Fault | $4,500 | Low threshold; can sue if expenses exceed $2,000 |
| Kentucky | Choice | $10,000 | Can reject no-fault and retain full lawsuit rights |
| Massachusetts | No-Fault | $8,000 | $2,000 medical expense threshold for lawsuits |
| Minnesota | No-Fault | $40,000 | Higher coverage; threshold based on injury severity |
| North Dakota | No-Fault | $30,000 | Strong no-fault system with threshold requirements |
| Utah | No-Fault | $3,000 | Low minimum; $3,000 threshold for lawsuits |
Several states offer PIP as optional "add-on" coverage: Arkansas, Delaware, Maryland, Oregon, South Dakota, Texas, Virginia, Washington, and others. In these states, PIP doesn't restrict your right to sue - it's additional coverage you can purchase.
How No-Fault Systems Work
In a no-fault state, after an accident you:
- File a claim with your own insurance company (not the at-fault driver's)
- Receive PIP benefits for medical expenses and lost wages
- Are generally restricted from suing the at-fault driver for pain and suffering
- Can only sue if you meet certain "threshold" requirements
The Tort Threshold: When You CAN Sue
No-fault states have "thresholds" that determine when you can step outside the no-fault system and sue the at-fault driver. There are two types:
Monetary Threshold
- Can sue if medical bills exceed a dollar amount
- Example: Massachusetts ($2,000), Kansas ($2,000)
- Easier to meet but may encourage inflated bills
Verbal/Injury Threshold
- Can sue only for "serious injuries"
- Typically: death, dismemberment, significant disfigurement, permanent injury
- Example: New York, Michigan
- Harder to meet but protects against minor-injury lawsuits
Even in no-fault states, PIP only covers you up to your policy limits. If your injuries exceed your PIP coverage, you may need to use health insurance, pursue the at-fault driver (if you meet the threshold), or file an underinsured motorist claim.
Filing a PIP Claim: Step by Step
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Notify your insurer promptly
Most policies require notification within days of an accident. Some states have specific deadlines (Florida requires written notice within 14 days of the accident for medical treatment).
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Seek medical treatment immediately
Many states require treatment within a specific timeframe. Florida requires initial treatment within 14 days or you lose PIP medical benefits entirely.
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Complete required forms
Your insurer will provide PIP application forms. Complete them accurately and thoroughly.
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Submit bills and documentation
Provide medical bills, proof of lost wages (pay stubs, employer letter), and any other documentation of covered expenses.
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Attend IMEs if required
Insurers can require Independent Medical Examinations. Failure to attend can result in denial of benefits.
Common PIP Claim Disputes
1. Treatment Deemed "Not Medically Necessary"
Insurers often deny PIP benefits by claiming treatment wasn't medically necessary. They use peer review companies and IME doctors to support these denials. Challenge by:
- Getting detailed documentation from your treating physician
- Requesting the insurer's peer review report
- Seeking a second opinion from another qualified specialist
- Filing a complaint with your state insurance department
2. Pre-Existing Condition Denials
Insurers may deny claims by blaming injuries on pre-existing conditions. PIP should cover aggravation of pre-existing conditions, not just new injuries. Your doctor should document how the accident worsened your condition.
3. Lost Wage Disputes
Common issues include:
- Disputes over wage calculation (especially for self-employed or commission workers)
- Insurer claims you could have returned to work sooner
- Arguments that injuries don't prevent your specific job duties
4. IME Doctor Finds No Injury
Insurance company IME doctors frequently find that treatment is no longer needed or injuries aren't accident-related. These opinions often conflict with treating physicians. Document everything and be prepared to challenge biased IME reports.
If your PIP insurer unreasonably denies or delays valid claims, you may have a bad faith claim against them. Bad faith can result in additional damages beyond your PIP benefits. Document all communications and keep records of delays.
PIP vs. Other Coverages
| Coverage | What It Covers | Who Pays | Fault Required? |
|---|---|---|---|
| PIP | Medical, lost wages, essential services | Your insurer | No |
| MedPay | Medical expenses only | Your insurer | No |
| Bodily Injury Liability | Other party's injuries | At-fault driver's insurer | Yes |
| UM/UIM | Your injuries from uninsured/underinsured drivers | Your insurer | Other party at fault |
| Health Insurance | Medical expenses | Your health plan | No |
When you have multiple coverages (PIP, health insurance, MedPay), the order of payment depends on state law and policy language. Some states make PIP primary; others allow health insurance to pay first. Understand your coverage hierarchy to maximize benefits and avoid gaps.
Tips for Maximizing Your PIP Recovery
- Know your deadlines - Treatment deadlines, claim filing deadlines, and bill submission deadlines are strictly enforced
- Keep copies of everything - All medical records, bills, correspondence with insurers, and wage documentation
- Follow treatment recommendations - Gaps in treatment can be used to deny benefits
- Don't give recorded statements without preparation - What you say can be used to deny claims
- Understand your policy limits - Track your benefits usage so you know when you're approaching limits
- Consider hiring an attorney for disputes - PIP denials can be successfully challenged with proper legal support
Need Help With Your Claim?
If your PIP claim has been denied or delayed, or if you have questions about your rights after an accident, I can help.