PIP or MedPay Car Insurance Claim Tips

After a car accident, you can make no-fault injury claims under your Personal Injury Protection (PIP) coverage and/or your Medical Payments (MedPay) coverage.

In the car insurance vernacular, "personal injury protection" (PIP) and "medical payments" (MedPay) claims are "first-party claims," which means they're made against your own insurance company after a car accident. (Another example of a first party claim is one that you make under your homeowner's policy for weather damage to your house.)

PIP and MedPay are no-fault claims, since these insurance coverages pay benefits no matter who caused your car accident. If you live in one of the dozen or so no-fault car insurance states, these are usually the only injury claims that you can make. In fault-based insurance states you can make no-fault claims against your policy if you have PIP or MedPay coverage, and you can also make claims against the other driver.

PIP Claims

PIP insurance covers medical expenses and, in some states, lost wages and other damages. It normally covers you, your passengers and even any pedestrian hit by your vehicle. It may also cover you when you are riding in someone else's car, but in that case, the other driver's PIP coverage is probably "primary," meaning you can only make a claim under your coverage if you exhaust the other driver's coverage.

Some version of PIP is mandatory in no-fault states, and optional in most others. Be sure to review your policy and check with your insurance company about the specifics of your PIP coverage.

PIP claims normally have to be submitted within a specified time, so don't delay. When you call your insurance company to report your car accident, ask them to send you a PIP claim form. You don't have to wait until you finish treatment and have all of your medical bills. You can send in your initial bills to be paid and then, when you incur more medical bills, you can send them in as a supplementary claim. And so on.

PIP coverages have maximum limits that can be paid, but they don't have deductible amounts that you have to pay.

MedPay Claims

Fault insurance states -- the majority of states, in other words -- normally have MedPay coverage, although some may have both MedPay and PIP coverages. MedPay covers you, your passengers and any pedestrians injured in an accident involving your vehicle. It may also cover you when you are riding in someone else's car, but as with PIP, the other driver's MedPay coverage is probably "primary."

As with PIP claims, you don't have to wait until you finish treatment before you can make a claim. You can send in your bills as they come in.

What to Watch for When Making PIP/MedPay Claims

Insurance companies are sometimes criticized for being much better at selling insurance policies and collecting premiums than paying claims. Especially if your claim grows larger, you may be confronted with these reasons for not paying PIP or MedPay benefits:

  • Your doctor's charges are too high. They are not "ordinary and customary."
  • You are getting too much treatment. It is not "reasonable and necessary."

At some point, your insurance company may ask you to be examined by a doctor of their choice. They call this an Independent Medical Examination, but it's usually an attempt by your insurance company to get medical justification for limiting or ending benefit payments.

What If You Have Both PIP And MedPay Coverages?

Normally, if you have both PIP and MedPay coverages, the PIP coverage is "primary," meaning that it pays first, and the MedPay coverage is "excess coverage" which kicks in after the PIP benefits are exhausted.

PIP/MedPay and Health Insurance

In most instances, your PIP/MedPay car insurance coverage is first in line to pay your accident-caused medical bills. Then, if this coverage is exhausted, you turn to your health insurance for payment. Then, if you make a claim against another driver and recover damages, you probably will have to repay your insurance company for the PIP/MedPay benefits that it paid and you almost definitely will be required to repay your health insurance company for payments that it made for your treatment.

Learn more about Car Accidents and Car Insurance Coverage.

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