Articles Posted in Personal Injury Protection (PIP)

Insurance lawyers handling Personal Injury Protection (PIP) claims will find this article about Florida PIP claims to be interesting. While Florida laws are different than Texas PIP laws, they are not much different. Texas PIP laws are found in the Texas Insurance Code statutes beginning with 1952.151. And don’t forget that the Prompt Pay Statutes apply to PIP. This article from the Claims Journal is an article written to and for Florida insurers handling PIP claims and is insightful. The title of the article is, 10 Commandments for Insurers Responding to Florida PIP Demand Letters.

Under Florida law, a party seeking reimbursement of Personal Injury Protection (PIP) benefits must formally demand payment by the insurer before filing a lawsuit. Specifically, Florida Statute 627.736(10), in conjunction with other parts of the No Fault Law, outlines the procedures applicable to the submission and response to a demand letter. With that said, there are a myriad of factors to consider before preparing this response. Here are 10 commandments to guide you:

1. Read the demand letter carefully, including the attachments. You must figure out specifically what the demand letter is seeking. Not all demands are equal and an insufficient review of the plaintiff attorney’s demand could result in the insurer waiving certain defenses in its response.

Med-Pay is suppose to be an easy way to get medical bills paid when someone is injured in an automobile accident. As most insurance lawyers can tell you, that is not always the case. The San Antonio Express-News published an article on January 6, 2016, dealing with the way USAA, based in San Antonio, treats its customers when it comes to Med-Pay benefits in their policies. The article is titled, Med Pay Lawsuits Dog USAA.

San Antonio’s USAA continues to be dogged by lawsuits that allege it uses a “cost containment scheme” to delay, deny or reduce medical payouts to customers injured in auto accidents.

USAA has been vigorously defending such cases for more than a decade, though the number of lawsuits couldn’t be determined.

All insurance law lawyers are going to understand how Personal Injury Protection (PIP) and uninsured motorist (UIM) coverage works. For some of the situations that may be confusing, a recent opinion from the Court of Appeals, Houston [14th Dist.] may be helpful to read. It is styled, Donald Cain v. Progressive County Mutual.

This is an appeal from a motion for summary judgment. The main issue is whether the policy at issue falls within the plain meaning of the term “renewal insurance policy” in Texas Insurance Code, Sections 1952.101(c) and 1952.152(b).

Corliss Madison obtained an auto policy from Progressive. At that time, she rejected in writing UIM coverage and PIP coverage. Madison and Larry Bradford were named insureds under the policy. When the policy expired six months later, Madison entered into another insurance policy for the next six-month period. Madison then entered into seven more successive insurance policies every six months over the next four years.

Most Grand Prairie insurance attorneys will some day be presented with the above question. A 2014, Houston Court of Appeals [14th Dist.] issued an opinion that addresses this issue. The style of the case is Cain V. Progressive County Mutual Insurance Co. Here is what it tells us.

This is an appeal from a summary judgment dismissing the Cain’s claims against Progressive under his auto policy. The main issue was whether the insurance policy in effect at the time of the accident falls within the plain meaning of the term “renewal insurance policy” in sections 1952.101(c) and 1952.152(b) of the Texas Insurance Code. The Court concluded that it did and that Progressive was not required to provide uninsured or underinsured motorist coverage or personal injury protection coverage in this policy.

On May 5, 2003, Corliss Madison obtained an automobile insurance policy from Progressive. At that time, Madison rejected in writing uninsured or underinsured motorist coverage (“UIM Coverage”) and personal injury protection coverage (“PIP Coverage”). Madison and Larry Bradford were named insureds under the policy. When the policy expired six months later, Madison entered into another insurance policy for the next six-month period. Madison then entered into seven more successive insurance policies every six months over the next four years.

Lake Worth insurance lawyers handling Personal Injury Protection (PIP) coverage may find this Texas Supreme Court case interesting. The opinion was issued in 2001, and the style of the case is, Allstate Insurance Company v. Bonner. Here is some of the relevant information from the case.

Rhonda Bonner was covered by an auto insurance policy issued by Allstate. Bonner was injured in an accident caused by an uninsured motorist. This policy included a non-duplication-of-benefits provision. Bonner reported a claim for medical costs resulting from her injury to Allstate, and received $1,619 in personal injury protection benefits. After receiving this, Bonner filed an uninsured motorist claim, which Allstate received on December 15, 1997. Allstate did not acknowledge receipt of the claim until, January 16, 1998, and eventually rejected the claim.

Bonner filed suit against Allstate seeking payment of uninsured motorist benefits. Bonner also sought attorneys’ fees and costs, relying to the Prompt Payment of Claims statute, which requires insurance companies to acknowledge receipt of claims within 15 days. The jury awarded compensatory damages to Bonner of $1,000 and fees and costs totaling $7,500. The trial judge however, rendered a take-nothing judgment after trial. The court of appeals upheld the take-nothing judgment with respect to compensatory damages, as Bonner had already been compensated under the personal injury benefit, but assessed costs and fees against Allstate. The court of appeals held that an insurance company must comply with the Prompt Payment of Claims Act every time the insured presents a claim. Allstate sought review from the Supreme Court of Texas, asserting that Bonner did not present a claim for which it was liable (because of the no-nduplication of benefits provision). Allstate distinguished this case from earlier cases in which insureds had valid claims above and beyond what they had already been paid by Allstate.

Personal injury attorneys in Dallas would want to know and understand this case. It is a 20024, Texas Supreme Court case styled, Texas Farm Bureau v. Sturrock. Here is the relevant information.

In this case, an insured was injured when his foot became entangled with his truck’s raised door facing while he was exiting the vehicle. The Court had to decide whether his injury resulted from a “motor vehicle accident” for purposes of personal injury protection (PIP) coverage under his Texas standard automobile insurance policy. This court held that a “motor vehicle accident” occurs when (1) one or more vehicles are involved with another vehicle, an object, or a person, (2) the vehicle is being used, including exit and entry, as a motor vehicle, and (3) a causal connection exists between the vehicle’s use and the injury-producing event. This court concluded that the insured’s injury here resulted from a “motor vehicle accident” within his policy’s PIP coverage. Accordingly, they affirmed the court of appeals’ judgment.

Jeff Sturrock drove his truck to work, parked, and turned off the engine. While exiting the truck, he entangled his left foot on the raised portion of the truck’s door facing. Sturrock injured his neck and shoulder in his attempt to prevent himself from falling from the vehicle. Sturrock filed a claim for PIP benefits under his vehicle’s insurance policy, issued by Texas Farm Bureau.

Aledo insurance lawyers will not often run across what happened in this case, but it something to know about. The case is styled, McCallas v. State Farm Mutual. The opinion was issued by the Houston Court of Appeals [14th Dist.] in 1986.

The issue presented is whether the trial court was correct in holding that Personal Injury Protection (PIP) benefits can be denied on a geographic basis. This appeals court agreed with the decision of the trial court.

On March 3, 1984, McCalla was involved in an automobile accident on the island of Jamaica. He was hospitalized and treated. He has incurred expenses in excess of $2,500. Before the accident, McCalla was issued an insurance policy which was in effect at the time of the accident. This policy contained PIP coverage which was mandated by the Legislature. State Farm denied benefits because the policy applied only to accidents and losses which occurred in the United States and its territories or possessions, Puerto Rico or Canada. Thus, State Farm argued, the policy was not in effect when McCalla was driving in Jamaica.

Grand Prairie insurance lawyers will deal with auto policies from time to time and when doing so will also deal with the portion of the policy dealing with Personal Injury Protection (PIP). The Beaumont Court of Appeals issued an opinion in 2000, dealing with how PIP benefits are paid. The style of the case is, Texas Farmers Insurance Company v. Carabell Fruge. Here are some of the relevant information on the case.

This case raises questions related to PIP provided in an automobile liability insurance policy as required by Texas Insurance Code, Section 1952.151 through 1952.161. The underlying issue in this case is whether or not an insurance company breached its contract by placing the names of medical providers and Medicare as co-payees on checks paying PIP benefits to Carabell Fruge. The Court held that the company did breach its contract but that it was entitled to name Medicare as a co-payee to part of the PIP benefits.

Jackie Ryan had purchased an automobile liability insurance policy from Texas Farmers Insurance Company that provided her with $2,500 in PIP coverage. Fruge was a passenger in Ryan’s vehicle and was injured in a car wreck. After her injury, Fruge’s attorney filed on her behalf a PIP claim with Farmers supported by documents reflecting medical expenses of $3,490. Some of the supporting documents contained some reference to Medicare. At least one document was stamped “Benefits Assigned.” Farmers responded to Fruge’s claim by mailing her six checks totaling $2,500.30. Four of the checks, totaling $1,854.30, named medical providers, Medicare, or both as co-payees with Fruge. All six checks named the law firm representing Fruge as a co-payee. Fruge’s attorney returned all six checks with a letter advising Farmers that “some or all” of the medical bills related to the checks naming co-payees had been paid, complaining that it would take six months to get all of the necessary endorsements, and demanding payment naming Fruge as the sole payee.

Dallas insurance lawyers need to understand how Personal Injury Protection (PIP) benefits work in an auto policy.

The Texas Insurance Code, Section 1952.152, tells us that PIP is required coverage in an auto policy unless this coverage is rejected in writing. However, Section 1952.153, tells us that the minimum requirement is only $2,500.

Most people end up rejecting this coverage. For those who opt to get the coverage, most get only the $2,500 minimum. The most this author has seen on a policy is $100,000. Even though that has only been seen once, amounts of $5,000 to $10,000 occur, but rarely will the amount be greater than $25,000.

Dallas insurance lawyers and those in Mesquite, Garland, Irving, Richardson, and other places will occasionally run across issues related to Personal Injury Protection (PIP) claims. In that regard, when it relates to an issue regarding lost wages, it would be good to know about the 1979, case, Slocum v. Union Pacific Insurance Company. This opinion was issued by the Houston Court of Appeals.

Here is what it tells us:

Slocum brought this suit to recover lost income based on the coverage afforded by the PIP clause of his automobile insurance policy. Union Pacific’s motion for summary judgment was granted on the sole ground that Slocum was not a wage earner or income producer.