Personal Injury Protection In Texas Auto Policies
The Law Office of Doug Goyen handles injury cases throughout the state of Texas. This includes auto accidents (car accidents, 18 wheeler accidents, motorcycle accidents, pedestrians struck by vehicles, and bicyclists struck by autos), premises cases (such as injuries caused by a dangerous condition on a property), dog bite cases (or other animals where the owner let their animal loose or had a dangerous animal and the owner's negligence causes injury to someone else), workplace injuries, and other personal injuries caused by the negligence or harmful acts of others.
*Do you have medical bills you are worried about paying from your auto accident?
*Do you have lost income from your auto accident injury?
*Do you need medical treatment for your injury and do not know how you can afford the treatment you need?
*Do you want to be paid the full amount you are owed for your injury from the auto accident?
If you answered yes to any of the above questions you need to contact the Law Office of Doug Goyen. We get results for our clients. The Law Office of Doug Goyen has handled thousands of auto accident injury cases, and obtained millions of dollars in compensation for our clients. We also have helped countless people with their Personal Injury Protection (PIP) cases who were wrongfully denied coverage by insurance companies. If you need an attorney regarding your auto accident injury or PIP, call us to see if we can help at (972) 599 4100 or contact us through our website contact form.
Most people carry $2500 in coverage under their PIP (Personal Injury Protection) - this is the minimum coverage required to be "offered" in Texas when you purchase an auto insurance policy. Personal injury protection (PIP) pays for not only medical bills, but 80% of your lost income, and reasonable household duties (so if you couldn't mow your lawn due to your injury, it would pay for you to hire someone to do it for you . . . if you were doing it yourself before). Get as much PIP coverage as your insurance company will sell you. Most will sell you at least $10,000.00 in PIP coverage, some even more.Texas Personal Injury Protection (PIP)
Texas Insurance Code Section 1952.151 - 1952.161 is the Texas statute covering Personal Injury Protection (PIP). Texas Law under section 1952.152(a) states that your insurance company must "offer" you PIP (Personal Injury Protection) when purchasing any automobile liability insurance policy in Texas. You can reject it, but your rejection must be in writing (See section 1952.152(b)). If there is no signed written rejection, then you have the coverage.
Section 1952.153 states $2500.00 is the maximum amount of PIP coverage that an insurance company is required to offer - they can offer more, but that is the minimum they are required to offer. In most cases PIP covers up to $2500.00 (in total, all combined) in medical bills, lost wages-80%, and reasonable household duties that could not be performed due to an injury (in other words, if you had to hire someone to mow your lawn due to your injury, when you regularly did it yourself). Many insurance companies will also sell up to $10,000.00 in PIP coverage if requested - there is no top amount, an insurance company is allowed to sell you as much coverage under PIP as they are willing to sell at or above $2500.00, but they must offer at minimum $2500 in coverage. You should get as much PIP coverage as your insurer will offer to sell you in order to protect yourself in case you are injured in an automobile accident. It is a good coverage that is extremely helpful when you have been injured in an auto accident.
a) Texas Personal Injury Protection (PIP) - mandated to be offered:
Texas law requires Personal Injury Protection be offered to a consumer who purchases liability insurance. There is no requirement that the consumer actually purchase the PIP coverage. But there is a require that PIP be "offered". In order to prove that Texas Personal Injury Protection (PIP) was actually offered, and then the consumer rejected the coverage, there must be a "signed written rejection" on file with the insurance company. If there is no signed written rejection of the PIP coverage, then there is coverage . . . whether paid for or not. If not paid for, it will be the minimum Texas Personal Injury Protection (PIP) limits - $2500.00.
When the policy is renewed the next year, a new rejection is not required. Once rejected, the policy holder continues to not have PIP coverage from renewal to renewal, until they contact the insurance company and ask for coverage.
b) Medical Bills that are covered by Texas Personal Injury Protection (PIP):
Insurance companies are pushing the envelope more and more with regard to what medical bills they will cover under PIP. Back when I was an adjuster (1989-1997), insurance companies would make sure the treatment was related to the auto accident (and not preexisting, or from some other cause unrelated to the auto accident), and they would make sure it was care that was actually received (and not some padded bill that had services added in that were not received). Pretty much that was it. If it was caused in the incident in question, and if the bills were for treatment received, the claim was paid.
Now insurance companies have started denying claims, or parts of claims, for various additional reasons. One of the more common "new" reasons is to claim that the amount that your doctor charged was unreasonably high. They will reduce the amount that they will pay under PIP by an amount that the insurance company thinks is reasonable. Part of the problem is defining what "reasonable" means in this context. Insurance companies will try to claim that if your doctor accepts health insurance from certain medical providers, that the amount they accept contractually from those health insurers is the reasonable amount. They will then issue a check based on that amount. The problem is that they don't contact the doctor's office to find out if they will actually accept that amount. Unlike health insurance companies, who get that agreement for a contractual adjustment, most of the time the PIP insurance company will just send a letter to you with a payment claiming that this is the "reasonable" amount of the bill without confirming with the doctor or hospital if they will accept that "reasonable" amount. This doesn't sound reasonable to me... but it doesn't stop PIP insurance carriers from trying.
c) Lost Income in Texas Personal Injury Protection (PIP) claims:
PIP in Texas allows a claimant to recover their lost income on their PIP claim. The insurance company may require proof in the form of medical documentation verifying that the claimant was unable to work for the time claimed. The lost income recovered comes out of the same pot of $2500 (or whatever your PIP limits are), so if you have $1500 in medical bills, and another $1500 in lost income, but you only have $2500 in coverage - you can only recover up to $2500, and nothing more, for that particular policy in question.
d) Reasonable Household Duties in Texas Personal Injury Protection (PIP) claims:
If the injured person was NOT an income producer or wage earner, they may make a claim for reimbursement of expenses required to replace the essential services the injured party normally would provide to the family or household.
e) PIP Offsets in Texas Personal Injury Protection (PIP) claims:
If you make a claim against your own insurance for Uninsured Motorist Bodily Injury coverage, or Underinsured Motorist Bodily Injury coverage, your auto insurer can reduce the amount payable under the Uninsured / Underinsured coverage by the amount already paid under Personal Injury Protection. So for instance, if your claim for bodily injury under Uninsured Motorist coverage was worth $20,000.00, and the insurance company had already paid $2500 under PIP, they would claim an offset for the amount they already paid for $2500, and would pay $17,500 instead (reducing the amount the claim was worth ($20,000) by the amount already paid ($2500). This is different than if you are making a claim against another person's liability insurance, as the other person's liability insurance is not the same insurance policy as the PIP coverage - therefore in that case (where PIP and the liability settlement come from two different insurance policies) no offset is allowed.
f) Multiple PIP Coverages in Texas Personal Injury Protection (PIP) claims:
You may have more than one PIP coverage that you can collect. If, for instance, you have your own insurance policy for your own vehicle, but you were a passenger in someone else's vehicle when you were injured, you can collect under both insurance policies for PIP. The coverage from the two or more different policies will add together. For instance, if you have a $2500 PIP policy on your own car, and then you have a $2500 PIP policy available on the vehicle you were traveling in, you essentially have $5000 in coverage, but if you have less than $2500 in bills or claims, then it will not make a difference. In other words, if you have two policies, but only have $2500 in bills, you only recover $2500. If you have $4000 in bills, you will recover $2500 from the primary PIP policy, and then recover another $1500 from the other PIP policy, which adds up to the $4000 you are out of pocket and need to pay or be reimbursed on.
g) No Fault and Subrogation in Texas Personal Injury Protection (PIP) claims:
PIP is payable without regard to who was at fault in the automobile accident. If you are the cause, or the other person is the cause, or if nobody was the cause (such as if a deer ran into your path and caused injury), it does not matter - you still can recover under PIP.
The key is whether you are injured getting into, out of, or while occupying a covered automobile, or while you are a covered person, and it arises from an auto accident.
h) Time Limits for Texas Personal Injury Protection (PIP) claims:
There are several time limits in insurance claims. Two that I will talk about here are 1) the time limit for submitting claims, 2) the time limit to sue for an insurance company not paying a claim.
1) Time Limit to Submit Claims: Texas Personal Injury Protection (PIP) will cover expenses incurred not later than three years after the date of the accident. Therefore, if you have a medical bill from your auto accident that you incur 2 years and 11 months after the collision, it should still be covered. Expenses, such as for medical treatment, incurred after 3 years have passed since the accident will not be covered;
2) Time Limit to Sue for Not Paying a Claim: Texas Contract Law has a 4 year statute of limitations. If you submit a claim to your automobile insurance carrier for Texas Personal Injury Protection (PIP), and the insurance company wrongfully denies paying the claim, you have 4 years from the date of the breach of contract to file the lawsuit to enforce your contract.
How does PIP work? Personal Injury Protection or PIP is a coverage that is required to be offered in the State of Texas.
PIP is a “no fault” insurance. The way that Texas has caused PIP to be “no fault” is by stating that the insurance company cannot “subrogate” (collect) against any other insurance in order to get their money back. This means that the amount of money received via your PIP coverage should not affect your liability settlement with another person’s liability insurance. See Texas Insurance Code section 1952.155(b) ". . . an insurer paying benefits under coverage required by this subchapter does not have a right of subrogation". If the other driver that caused the auto accident does not have auto liability insurance, the insurance company is allowed to subrogate, see section 1952.155(c). So the PIP insurance carrier can collect against an uninsured driver, but this should not effect any claims you have against another person's auto liability insurance.
Significance of no “subrogation”: To understand the significance of insurance companies not being able to subrogate, you need to first understand the word “subrogation”, and then need to understand the “collateral source” rule.
Subrogation: Is the process by which an insurance company who has paid a loss under its policy is allowed to collect against other insurance policies that may owe for the claim either totally, or at least a portion of the claim. So for example, if your health insurance company pays for your medical bills resulting from an automobile accident that was caused by someone else, your health insurance company will often try to “subrogate” against the automobile insurance policy of the person who caused the accident in an attempt to get their money back from the responsible person’s insurance.
In Practice: Often the insurance company that is attempting to “subrogate” simply sends a letter to the attorney of the injured person and the other insurance company - placing them on notice of their “lien” on the case - and demanding that their name be placed on any settlement checks to protect their right of subrogation. Seldom do they hire their own attorney to do the work required to actually do the collecting - the exceptions are when there is a significant amount paid out by the health insurer, and the injured party has hired an attorney to sue the other driver’s liability insurance company, then sometimes the health insurance company will hire an attorney to try and ensure they get their cut of the settlement proceeds.
PIP Carriers: PIP insurance carriers are not allowed to subrogate, therefore the amount they pay should not affect the amount you receive in your settlement from the liability carrier.
Collateral Source Rule and PIP: PIP is required to be paid regardless of any collateral source of medical, hospital or wage continuation benefits. See Texas Insurance Code 1952.155(a)(2). This statutory language has incorporated the collateral source rule into PIP coverage. The collateral source rule is a rule in Texas that a jury is unable to consider whether insurance has paid any part of the claim or not. Because of this, the only thing introduced in a trial to prove injury damages is the amount of actual damages. Judges will tell juries at the beginning of a personal injury trial that the jury is not to consider whether there is or is not insurance in the trial.
REASONS FOR COLLATERAL SOURCE RULE
- Person who caused injury should not get benefit of other person's health insurance: One reason for this is that it avoids the need to complicate the evidence produced in an injury trial. If insurance is allowed to be introduced, then the amount paid for the premiums would need to be introduced (because the defendant didn’t pay for the premiums, why should he get the benefit of the payments made?).
- Subrogation: As discussed above regarding “subrogation” the health insurance companies place a “lien” on any amount recovered in a lawsuit for injury - some of these liens are automatic and statutory (Medicare / Medicaid). If the jury was to NOT pay for the amount covered by insurance, and then the health insurer then “subrogated” out of the amount awarded by the jury, then the amount given to the injured party would be reduced double by the amount of the bills (first by the jury - who would take out of their award the amount paid by health insurance, and then again by the health insurer who would take out from the jury award the amount they paid). Additionally, the injured party would have had to pay premiums for this coverage that is not reimbursed by the person causing the injury or his liability insurance.
- Insurance subrogation issues are contractual issues between the person holding the health insurance and the injured party. In other words, it’s a separate claim, separate lawsuit, between the injured party and his health insurance company. If the injured person does not pay his health insurance company back pursuant to the health insurance contract, then the health insurance company has the right to sue the injured party, cancel their benefits, place a lien on any settlement or judgment proceeds, etc.
- Victim gets smaller award and the wrongdoer gets benefit he did not pay for if victim carries health insurance: Lets suppose a “wrongdoer” is a repeat drunk driver - hypothetically he causes 2 different accidents while intoxicated. Both create the exact same injury to the victim (two broken legs). In accident 1 the victim has health insurance that pays his bills. In accident 2 the victim has no insurance. If a jury were allowed to consider the amount health insurance paid, then the “wrongdoer” gets to pay less in accident 1 due to the victim having been responsible enough to buy health insurance. In accident 2 the victim was less responsible - did not bother to get health insurance - yet he gets a larger award due to the jury not being able to reduce due to health insurance. This gives a perverse result of responsible people in society (people who take the time and care to actually “pay” for health insurance) given less rights and less award due to their being responsible. It punishes the rights of those who act responsibly (people who buy health insurance), and rewards those who do NOT act responsibly (those who don’t protect themselves with health insurance). It also gives the perverse result that the drunk driver gets a benefit they did not pay for from his victim who who did pay for health insurance.
- Windfalls - since the injured party was the person who “paid” premiums for his health insurance, the injured party should be the person who reaps any “windfall” for having paid for this coverage - the “wrongdoer” who caused the injury should not be allowed this “windfall” since he had no part in paying the premiums and is not a party to the health insurance contract.
- Deterrence - Allowing the wrongdoer (or his liability insurance company) to avoid paying the full amount of the damages - by reducing the amount by the amount paid by health insurance, reduces the deterring effect of the law. Making wrongdoers pay for the harm they cause helps to deter them (or others) from causing such actions in the future. It may not deter all wrongdoers from repeating, but if it just deters a few - or causes liability insurers to create programs that encourage their insureds to be safer, then it is worthwhile to force them to pay for the harm they cause.
- Contract v. Tort - the benefits owed to the injured person by the health insurer are contractual. The wrongdoer has no right to force the health insurance to pay the medical bills - this is a contract between the injured party and his health insurer they have contracted with. To allow a wrongdoer to somehow get into the middle of this contractual relationship allows in an outsider into a contractual relationship. Not only allowing just any outsider, but an outsider who has committed a wrongful act that caused harm - who can then try to obtain benefit of a contract between the injured victim and his health insurance that the injured victim had the foresight and responsibility to take.
- Rich uncle - The paying of the medical bills by health insurance is similar to the paying of the of the medical bills by a rich uncle, or friend, or someone else as a gift to the person they care about. The law does not allow the wrongdoer to get benefit of a rich uncle paying their medical bills - as this is between the rich uncle and the injured party - maybe the injured party pays the rich uncle back, maybe it’s a gift that never gets paid back - it does not matter, the wrongdoer still owes the full amount regardless.
- Increased Insurance Premiums - some argue that the collateral source rule causes insurance premiums to be higher. This doesn’t tell the whole story and is not true if you look at ALL the insurance involved. It makes the wrongdoer’s insurance go up - sure - and it should go up due to his wrongdoing, but it makes the injured victim’s insurance stay down because they get their money back (as they should). Insurance pays the same amount - it just shifts the burden from the victim’s insurance to the wrongdoer’s insurance. The insurance that is then burdened is the insurance of the wrongdoer (which is the correct result). The medical bills paid by the health insurer are reduced by the amount “subrogated”. In other words, the health insurer of the innocent victim / injured party goes down as that health insurance receives its money back from the liability insurer, and the liability insurance for the wrongdoer goes up on an equal proportion to the amount that the health insurance goes down - so it balances out.
- Responsibility / No Free Ride - it is the wrongdoer’s responsibility to “right the wrongs” that he created - it is not “society’s” problem, or the victim’s problem, it is the problem of the wrongdoer - he created the harms, he must correct the harms. If your child knocks out a window of a neighbor while playing baseball, we make that child pay for the entire harm he caused in repairing the window - not part of it. Our system of justice requires the same thing, if you cause harm to someone or harm to someone’s property, you are required to “right the wrongs” you cause - it is your burden for causing the wrongs - not someone else’s burden, and not “society’s” problem.
The following is an example of what the automobile insurance policy typically looks like under the Personal Injury Protection portion of the policy.INSURING AGREEMENT
- We will pay Personal Injury Protection benefits because of bodily injury:
- resulting from a motor vehicle accident; and
- sustained by a covered person.
- Personal Injury Protection benefits consist of:
- Reasonable expenses incurred for necessary medical and funeral services.
- Eighty percent of a covered person's loss of income from employment. These benefits apply only if, at the time of the accident, the covered person
- was an income producer; and
- was in an occupational status.
- Loss of income is the difference between
- income which would have been earned had the covered person not been injured; and
- the amount of income actually received from employment during the disability.
- If the income being earned as of the date of accident is a salary or fixed remuneration, it shall be used in determining the amount of income which would have been earned. Otherwise, the average monthly income earned during the period (not more than 12 months) preceding the accident shall be used.
- Reasonable expenses incurred for obtaining services. These services must replace those a covered person would normally have performed:
- without pay;
- during a period of disability; and
- for the care and maintenance of the family or household.
- These benefits apply only if, at the time of the accident, the covered person:
- was not an income producer; and
- was not in an occupational status.
- Covered person as used in this Part means:
- You or any family member;
- while occupying; or
- when struck by;
- Any other person while occupying your covered auto with your permission.
- You or any family member;
We do not provide Personal Injury Protection Coverage for any person for bodily injury sustained:
- In an accident caused intentionally by that person.
- By that person while in the commission of a felony.
- By that person while attempting to elude arrest by a law enforcement official.
- While occupying, or when struck by, any motor vehicle (other than your covered auto) which is owned by you.
- By a family member while occupying, or when struck by any motor vehicle (other than your covered auto) which is owned by a family member.
The limit of liability shown in the Declarations for this coverage is our maximum limit of liability for each person injured in any one accident. This is the most we will pay regardless of the number of:
- Covered persons;
- Claims made;
- Vehicles or premiums shown in the Declarations; or
- Vehicles involved in the accident.
If there is other Personal Injury Protection Insurance, we will pay only our share. Our share is the proportion that our limit of liability bears to the total of all applicable limits. However, any insurance we provide with respect to a vehicle you do not own shall be excess over any other collectible Personal Injury Protection insurance.
(Typically there is a provision in the policy under PIP that states their "time limits" indicating how fast the are required to make payments, and a provision that states they will honor any "Assignment of Benefits" from your medical facilities - meaning that if your doctor's office has an assignment of benefits from you when you filled out your paperwork at the doctor's office, if the PIP adjuster sees a copy of that assignment of benefits they can pay the doctor's office directly for their bill).
Recommendation: The Law Office of Doug Goyen recommends that you carry Personal Injury Protection on your automobile insurance policy. We recommend you carry $10,000.00 in coverage due to the increase in the price of medical bills over the years. In 1989 I was working as an insurance adjuster at GEICO - the minimum limit for PIP in 1989 was $2500. Today it is still $2500. You can imagine that in 30 years, the cost of medical care has risen enough that you should be carrying at least $10,000.00 in PIP coverage. If you carry the minimum, but even the minimum $2500.00 can help with out of pocket costs from your injuries, so carry PIP on your auto insurance.
Should you hire an attorney?: Yes. If you are not sure, you should at least discuss it with a personal injury lawyer's office. If it is too small - they will tell you, they don't want to waste time on cases that you can easily handle yourself. If its something that is more complicated, a lawyer may advise you to hire them. If you have been injured, and you are needing to make a claim for your injury, you need to at least consult with an attorney that knows the process and pitfalls regarding your auto accident and injury claim. With all the different types of insurance possibly available for an auto accident, you need to talk to an attorney who knows how it works, and how to submit your claims on your behalf - so you recover the entire amount you need to recover, and to ensure you don't compromise any insurance policy or coverage you have by submitting the claims improperly. Contact our office and speak to a Dallas Auto Accident Attorney today. Call the Law Office of Doug Goyen at (972) 599 4100 for a lawyer who is licensed, experienced in injury matters for over 22 years, and worked for the automobile insurance industry as a claims adjuster for 7 years prior to becoming an attorney. We can help.
FREE CONSULTATION AND STRATEGY SESSION
If you or someone you know needs assistance in an injury case call (972) 599 4100 for a free consultation and free strategy session regarding your case. In our strategy we summarize your case in easy format. (You can use this when discussing the case with other attorneys in case you decide to talk to other attorneys). We identify the legal issues involved. We identify what legal issues will help get you the best results. If you want a copy of the strategy session we will email you a copy whether you hire us or not. You can use it to compare with other law offices if you want to get a second opinion regarding your case.
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