Recently in Personal Injury Protection (PIP) Category

March 31, 2016

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.
2. You don't have to give them everything they ask for. Florida's No Fault law (and other insurance statutes) outlines what an insurer is obligated to provide to a party seeking reimbursement pre-suit. Just because counsel requests something, if the statutes do not require production, you are under no obligation to voluntarily provide information or documents.
3. The date of receipt starts the time clock. Upon receipt of the demand letter, the insurer has 30 days to respond to the demand for reimbursement and either pay additional monies or deny payment. As such, it is important to have defined procedures for receipt and processing of all PIP demand letters. You must calendar the receipt date and diary the response date.
4. The year counts! Depending on when the accident and subsequent treatment occur, there may be statute of limitations and policy defenses to employ. For example, the 2012 amended PIP statute mandates that an "insured" receive treatment within a certain period of time. If you are unsure, consult with counsel.
5. The policy controls... sometimes. In July 2013, the Florida Supreme Court in Geico General Insurance Company v. Virtual Imaging Services Inc., 141 So. 3d 147. (Fla. 2013) ruled on the sufficiency of Geico's PIP portion of its insurance policy in conjunction with Florida statutes. Essentially, the Court held that insurance companies must reference the permissive method of calculation based on the Medicare fee schedules and can only limit reimbursement based on those fee schedules. In response, insurance companies amended their PIP-related policies to comply with the court's ruling. It is very important an insurer verify and confirm the policy version applicable to the claim.
6. The claim notes are your friends. Read them. Prior to the receipt of the demand letter, various departments may have assisted in review of the claim. These claim notes provide an organized road map of the life of the claim and could assist in determining the final response to a demand letter. If necessary speak with the claims professional(s) who posted notes for clarification.
7. Process the bills. Depending on the policy period and timing of treatment, the medical bills may or may not have been processed in accord with recent Florida court decisions (see #5) and/or applicable Florida statutes. Crunch the numbers again!
8. When possible, avoid paying interest, penalty and postage. Just because an attorney demands the kitchen sink, doesn't mean he or she is entitled to it. Should an insurer pay additional benefits in response to a demand letter, there are specific statutes governing the appropriate interest rate and payment of penalty. You may be able to avoid penalty, interest or postage in some cases.
9. Watch what you say... it can come back to bite you. Words are powerful and your demand response holds weight if a suit is ever filed. More likely than not, it will be admissible. There is some case law on waivers either implicit or express when dealing with an insurer's demand response. Consult with a legal professional experienced in handling insurance matters in order to craft strategic responses to demand letters.
10. 30 days means 30 days. Every day counts. Florida statutes govern when an insurer has responded to the demand letter. A day late could result in a lawsuit. Don't give the plaintiff an excuse.

February 23, 2016

Med-Pay And USAA

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.
Just last week, a Montana judge certified a class-action lawsuit brought by two individuals who charge the insurer delayed or denied medical payments. The size of the class could number 154 Montana residents or more.
USAA spokesman Roger Wildermuth said it disagrees with the ruling and is appealing to the Montana Supreme Court. The merits of the plaintiffs' claims have yet to be decided.
In September, USAA agreed to pay up to about $4.2 million to settle a class-action lawsuit brought by three Washington state health care providers and a USAA member who was injured in an auto accident. They alleged USAA failed to pay the full amount of medical bills submitted for payment under the personal injury protection coverages on automobile insurance policies. In settling, USAA denied the allegations and said it did not do anything wrong.
Another lawsuit was filed in October in Tampa, Florida. That suit seeks class-action certification.
In prior years, similar suits were filed against USAA in Arizona, Illinois, Oklahoma and Oregon. Those were either settled or dismissed.
John Heenan, a lawyer in the Montana case, said it's part of USAA's business strategy to deny or pay less than it owes on claims.
"It goes right to the bottom line," Heenan said. "That's a good business model if an insurance company can collect people's premiums, not pay claims and keep all the money."
In an emailed statement, Wildermuth said, "USAA employs its Medical Bill Audit tool to preserve member benefits by identifying medical charges that are excessively high, duplicative of other charges and possibly unrelated to a particular accident. By identifying billing inaccuracies and other inappropriate charges, this also helps prevent fraud.
"USAA takes allegations attacking this tool seriously, and we will continue to defend it when challenged," he added.
Heenan was critical of USAA's process.
"Lord knows how many of these (claim) reviews they do in a day, (and then) second-guess the treating doctor and say it's either not medically necessary or it's causally related to the accident," Heenan said.
A handful of USAA members have gone to the company's website to express their frustration with not getting reimbursed for medical payments.
In a February posting, a member complained after being in a three-car accident. USAA reimbursed her for her totaled car but not for her medical bills, she wrote.
"I submitted medical bills for almost $800.00 and have another $1,400.00 that I paid out of pocket (and still counting) and have not been paid one penny and this has been going on for 3 months now," the woman said. "My husband and I have been USAA members for 25 years and have always been pleased with them, that is until now. What good is MED PAY if you are denied the use of it when you need it? SHAME ON USAA!"
One of Heenan's clients, Peter Byorth, suffered a spinal injury after being struck by a car while riding his bike. His medical bills, lost wages, and pain and suffering totaled "hundreds of thousands," Heenan said.
The driver's insurer immediately cut a $100,000 check to Byorth, but USAA "dink and dunked with him for months" before paying him the $10,000 limit on his coverage for medical payments, Heenan said.
Byorth had to hire an attorney and file a complaint with the Montana insurance commissioner before he got paid, Heenan added.
Even after USAA paid the claim, Byorth continued to receive form letters from USAA informing him that his claim had been denied, Heenan said.
The Montana lawsuit accuses USAA of breach of contract and with violating Montana's Unfair Trade Practices Act. USAA has denied the allegations in a response filed with the court.
USAA has more than 11 million customers, comprising military members and veterans, and their spouses.

January 3, 2016

Rejection Of UIM And PIP Coverages

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.
Madison was involved in a vehicular accident on July 20, 2007 (the "Accident Date"), which allegedly resulted in her death in February 2012. Her husband, Donald R. Cain, made a claim under the Progressive policy that was in effect when the accident occurred. Cain sought UIM Coverage and PIP Coverage under the Policy. Progressive denied the claim.
A lawsuit was filed. Progressive counter claimed asserting as follows:
(1) Madison's written rejection in May 2003 of UIM Coverage and PIP Coverage (hereinafter "2003 Rejection") was valid and enforceable and therefore there is no UIM Coverage or PIP Coverage;
(2) the policies Madison entered into with Progressive after the initial policy were renewal policies;
(3) Madison's 2003 Rejection applied to the Applicable Policy;
(4) in construing Insurance Code sections 1952.101 and 1952.152, Texas courts do not follow the "material change" theory espoused by Cain;
(5) even if Texas followed the "material change" theory it would not be triggered under the facts of this case; and
(6) Cain was not a named insured under the Applicable Policy.
Under Texas Insurance Code section 1952.101, the Texas Legislature mandates UIM Coverage in Texas automobile liability insurance policies, unless any insured named in the insurance policy rejects the coverage in writing. Similarly, under section 1952.152, the Texas Legislature mandates PIP Coverage in Texas automobile liability insurance policies, unless any insured named in the insurance policy rejects the coverage in writing. However, unless an insured named in the insurance policy requests in writing UIM Coverage or PIP Coverage, the insurer is not required to provide either coverage in or supplemental to a "renewal insurance policy" if an insured named in the insurance policy rejected UIM Coverage and PIP Coverage in connection with an insurance policy previously issued to the insured by the same insurer or by an affiliated insurer.
The statutes requiring UIM Coverage and PIP Coverage under certain circumstances are remedial in nature. The Supreme Court of Texas has recognized that, because of their remedial purposes, these statutes should be interpreted liberally to give effect to the public policy that led to their enactment. Nevertheless, because courts presume that every word of a statute has been included or excluded for a reason, as a matter of judicial restraint, courts will not insert requirements that are not provided by law.
Madison, an insured named in the insurance policy, rejected UIM Coverage and PIP Coverage in writing when Progressive issued the first automobile liability policy to her in May 2003. Cain does not dispute the 2003 Rejection or argue that it is invalid or unenforceable. Nor does Cain allege that any insured named in the insurance policy requested UIM Coverage or PIP Coverage in writing. Instead, Cain disputes Progressive's argument that the Applicable Policy was a "renewal insurance policy." Madison is an insured named in the Applicable Policy, and she rejected UIM Coverage and PIP Coverage in connection with an insurance policy issued to her by Progressive before the issuance of the Applicable Policy. Therefore, if the Applicable Policy was a renewal insurance policy, then Progressive was not required to provide UIM Coverage or PIP Coverage, and the trial court did not err in granting summary-judgment.
The summary-judgment evidence reflects that the Applicable Policy was the eighth policy in an unbroken chain of successive policies issued by Progressive after the expiration of the first six-month policy issued in May 2003. In each of these policies, Madison and Bradford were listed as named insureds. At one point the address of the insureds was changed. At various times, a vehicle was added or removed from coverage under this chain of insurance policies. In December 2005, Dennis A. Coleman, Jr., Madison's son, was added to the existing policy as a driver and household resident. We presume for the purposes of our analysis that Coleman was added as a named insured at Madison's request. This change resulted in a significant increase in the insurance premium, and one month later Coleman was removed from the policy.
Progressive notified Madison on April 27, 2007, that "information received during the servicing of the 04/22/2007 claim indicates that Dennis A. Coleman, Jr. was either driving at the time of the loss, is a member of Madison's household or has access to your vehicles." As a result, Progressive added Coleman to the existing policy as a driver and household resident. We presume for the purposes of our analysis that Progressive added Coleman to the existing policy on April 27, 2007, as a named insured without any request by Madison or Bradford.
Coverage began on May 5, 2007, under the Applicable Policy, the eighth successive policy after the expiration of the first policy issued in May 2003. Both the "Renewal Declarations Page" and the "Revised Renewal Declarations Page," issued on different dates in April 2007, reflect that UIM Coverage and PIP Coverage had been rejected. The summary-judgment evidence shows that Coleman continued to be listed as a driver and household resident. We presume for the purposes of our analysis that Coleman was a named insured on the Applicable Policy throughout its existence, including on the Accident Date.
Madison, an insured named in the insurance policy, rejected UIM Coverage and PIP Coverage in writing in May 2003, when Progressive issued the first automobile liability policy. The summary-judgment evidence conclusively proves that under the unambiguous statutory language, the Applicable Policy is a renewal insurance policy as that term is used in sections 1952.101(c) and 1952.152(b). Therefore, Progressive was not required to provide UIM Coverage or PIP Coverage, and the trial court did not err in granting summary-judgment.

January 11, 2015

When Is A Policy A "Renewal Policy?"

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.
Madison was involved in a vehicular accident on July 20, 2007, which resulted in her death in February 2012. Her husband, Donald R. Cain, made a claim under the Progressive automobile insurance policy that was in effect when the accident occurred. Cain sought UIM Coverage and PIP Coverage under the Policy. Progressive denied the claim.
Cain filed suit in the trial court alleging that Progressive breached the insurance contract and violated the Texas Insurance Code. Progressive counterclaimed for declaratory judgment. Seeking summary judgment, Progressive filed a motion asserting the following: (1) Madison's written rejection in May 2003 of UIM Coverage and PIP Coverage was valid and enforceable and therefore there is no UIM Coverage or PIP Coverage; (2) the policies Madison entered into with Progressive after the initial policy were renewal policies; (3) Madison's 2003 Rejection applied to the Policy; (4) in construing Insurance Code sections 1952.101 and 1952.152, Texas courts do not follow the "material change" theory espoused by Cain; (5) even if Texas followed the "material change" theory it would not be triggered under the facts of this case; and (6) Cain was not a named insured under the Policy.
The statutes requiring UIM Coverage and PIP Coverage under certain circumstances are remedial in nature. The Supreme Court of Texas has recognized that, because of their remedial purposes, these statutes should be interpreted liberally to give effect to the public policy that led to their enactment. Nevertheless, because courts presume that every word of a statute has been included or excluded for a reason, as a matter of judicial restraint, courts will not insert requirements that are not provided by law.
Madison, an insured named in the insurance policy, rejected UIM Coverage and PIP Coverage in writing when Progressive issued the first automobile liability policy to her in May 2003. Cain does not dispute the 2003 Rejection or argue that it is invalid or unenforceable. Nor does Cain allege that any insured named in the insurance policy requested UIM Coverage or PIP Coverage in writing. Instead, Cain disputes Progressive's argument that the Policy was a "renewal insurance policy." Madison is an insured named in the Policy, and she rejected UIM Coverage and PIP Coverage in connection with an insurance policy issued to her by Progressive before the issuance of the Policy. Therefore, if the Policy was a renewal insurance policy, then Progressive was not required to provide UIM Coverage or PIP Coverage, and the trial court did not err in granting summary judgment.
The summary-judgment evidence reflects that the Policy was the eighth policy in an unbroken chain of successive policies issued by Progressive after the expiration of the first six-month policy issued in May 2003. In each of these policies, Madison and Bradford were listed as named insureds. At one point the address of the insureds was changed. At various times, a vehicle was added or removed from coverage under this chain of insurance policies. In December 2005, Dennis A. Coleman, Jr., Madison's son, was added to the existing policy as a driver and household resident. The Court presumes for the purposes analysis that Coleman was added as a named insured at Madison's request. This change resulted in a significant increase in the insurance premium, and one month later Coleman was removed from the policy.
Progressive notified Madison on April 27, 2007, that "information received during the servicing of the 04/22/2007 claim indicates that Dennis A. Coleman, Jr. was either driving at the time of the loss, is a member of Madison's household or has access to your vehicles." As a result, Progressive added Coleman to the existing policy as a driver and household resident.
Coverage began on May 5, 2007, under the Policy, the eighth successive policy after the expiration of the first policy issued in May 2003. Both the "Renewal Declarations Page" and the "Revised Renewal Declarations Page," issued on different dates in April 2007, reflect that UIM Coverage and PIP Coverage had been rejected. The summary-judgment evidence shows that Coleman continued to be listed as a driver and household resident.
Madison, an insured named in the insurance policy, rejected UIM Coverage and PIP Coverage in writing in May 2003, when Progressive issued the first automobile liability policy. The summary-judgment evidence conclusively proves that under the unambiguous statutory language, the Policy is a renewal insurance policy as that term is used in sections 1952.101(c) and 1952.152(b).

September 28, 2014

Insurance Prompt Pay Problems With PIP

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.
In the final holding, the Texas Supreme Court affirmed the court of appeals with respect to the take-nothing judgment on compensatory damages and reversed with respect to the court of appeals assessment of fees and costs under the Prompt Payment Act. In order to receive fees and costs under the Prompt Payment Act, the insured must show that the insurance company was presented with a claim for which the insurance company was liable under the terms of the policy. The insured must also show a violation of one or more provisions of the Prompt Payment Act. Because the jury found Allstate's liability ($1,000) to be less than what it had already paid out to Bonner ($1,619), and because of the non-duplication-of-benefits provision in the policy, Allstate's payouts offset its liabilities and owed nothing. Because Bonner was entitled to neither additional benefits from Allstate nor fees and costs under the Prompt Payment of Claims Act, the Texas Supreme Court rendered a take-nothing judgment.

April 6, 2014

Personal Injury Protection And Coverage

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.
Sturrock's policy provides, in pertinent part:

A. We will pay Personal Injury Protection benefits because of bodily injury:

1. resulting from a motor vehicle accident; and

2. sustained by a covered person.

Texas Farm Bureau does not dispute that Sturrock is a "covered person" under the policy, but denies that Sturrock's injuries resulted from a "motor vehicle accident" within the policy's PIP coverage.
Sturrock sued Texas Farm Bureau for breach of contract and violations of the Texas Insurance Code. Both parties filed motions for summary judgment. The parties then filed an "greed Statement of Facts, pursuant to Texas Rule of Civil Procedure 263, and asked the trial court 'to apply the law to these agreed facts and determine whether Sturrock's injuries resulted from 'a motor vehicle accident' within the meaning of the policy." The trial court held that, as a matter of law, Sturrock's injuries resulted from a "motor vehicle accident" covered by the policy's PIP provisions, and the court of appeals affirmed.
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 or entry, as a motor vehicle, and (3) a causal connection exists between the vehicle's use and the injury-producing event. Here, Sturrock was injured when his left foot became entangled with his car's door facing while he was exiting the vehicle. Thus, the court concluded that Sturrock's injury resulted from a "motor vehicle accident" within the policy's terms, and affirmed the court of appeals' judgment.
An experienced Insurance Law Attorney needs to be consulted for advice in these situations.

December 21, 2013

Geographic Limitation In Insurance Policy

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.
Texas Insurance Code, Section 1952.152 provides in part as follows:
(a) An insurer may not deliver or issue for delivery in this state an automobile liability policy, including a policy provided ..., unless the insurer provides personal injury protection coverage in the policy or supplemental to the policy.
...
1952.158 An insurer shall exclude benefits to any insured, or the insured's personal representative, under the coverage required by this subchapter if the insured's conduct contributed to the injury the insured sustained and that conduct:
(1) involved intentionally causing injury to the insured; or
(2) occurred while committing a felony, or while seeking to elude lawful apprehension or arrest by a law enforcement official.

McCalla argued the only exclusions allowed are those contained in Texas Insurance Code, Section 1952.158 and that State Farm cannot exclude coverage based on territorial limitation since it does not fall within the exclusions mandated by the Legislature. When the Legislature specifies a particular extent of insurance coverage, any attempt to void or narrow such coverage is improper and ineffective according to the Texas Supreme Court. When specific exclusions or exceptions to a statute are stated by the Legislature, the intent is usually clear that no other shall apply.
The Texas Supreme Court held in 1978, what could be termed firm language, that the PIP statute sets forth the only exclusions of PIP benefits authorized by statute. Any attempt to add additional exclusions is repugnant to the statute.
McCalla cited to additional authority which holds that the only exclusions allowed for denying PIP are those found in the PIP statute. These authorities are very persuasive as to the public policy intent of the Legislature in enacting the PIP statute, however, the court did not find them controlling in this case.
Unlike the other decisions in which concerned the validity of written waivers and which dealt with the interpretation of accident in the policy, this question is one of basic policy coverage. No exclusion is involved.
The policy issued to McCalla covered accidents which occurred in the United States, its territories and possessions, Puerto Rico or Canada. It did not apply to Jamaica. While the PIP statute dictates the type of coverage which must be provided, it does not dictate where the policy is effective. When McCalla purchased his insurance he knew or should have known that it did not cover accidents which occurred outside the jurisdictional limits stated in the policy. If he wanted a policy with coverage beyond the jurisdictional limits stated then he could have negotiated with the insurer for this extended coverage. An insurance policy is a contract entered into between the parties whereby each party becomes bound by the terms of the agreement.
Other decisions have used the distinction between basic coverage and exclusion. A policy was not in effect when the insured had an accident in a vehicle not covered by the policy.
When Michael McCalla had his accident in Jamaica, he was outside the territorial limits of his policy, therefore, he was outside the basic coverage of his policy.

June 30, 2013

Personal Injury Protection Benefits

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.
Fruge brought an action in contract under the PIP statutes against Farmers to recover $2,500.00 in benefits, as well as penalty and attorneys fees. The trial court found that Farmers had wrongfully put the names of health care providers on the checks and granted an instructed verdict submitting only the question of attorneys fees to the jury. Farmers complains of the instructed verdict, asserting that it was obligated to honor assignments to providers and that Medicare had a primary subrogation interest.
The Court rejected Farmers' assertion that it was obligated to honor assignments to Fruge's medical providers because the Court concluded that according to the terms of the policy the stamped notations "Benefits Assigned" was not an assignment. According to the terms of its policy, Farmers would honor assignments for medical expenses if it received a written assignment signed by the covered person to whom such benefits were payable. And Farmers offers no authority to support any obligation on its part to go beyond the terms of its policy. Absent a valid assignment conforming to the language of Farmers' policy, Fruge was right to expect that PIP benefits would be made payable to her alone.
Naming Medicare as a co-payee is another matter. Federal law provides that any payment of medical costs by Medicare for which private insurance is the primary payer is conditioned upon reimbursement from the insurer. 42 U.S.C. § 1395y(2)(B)(i). Medicare is a secondary payer for services covered under no-fault insurance. 42 U.S.C. § 1395y(2)(A)(B)(ii); 42 C.F.R. § 411.50(c). And "no-fault insurance" includes "personal injury protection" coverage. 42 C.F.R. § 411.50(b). This is an instance where federal law preempts state law. To avoid the risk of making the same payment twice, Farmers may have been correct in not making an unconditional payment to Fruge reimbursing her for expenses it should have known had already been paid by Medicare.
While Farmers is correct in its assertion that federal statutes and rules preempted state law, it cannot, on the face of the record, claim that it had reason to suspect that Medicare was entitled to the sum represented by the checks that named Medicare as co-payee. Though the record speaks of six checks and Farmers appears to have named Medicare as payee on checks totaling $1,352, the record only shows a Medicare payment of $168.56. Accordingly, it appears that Farmers wrongfully named Medicare as a co-payee to part of PIP benefits.
The Court concluded that Farmers breached its contract and that Fruge was entitled to recover benefits, penalty and attorneys' fees under the PIP statute. This Court affirmed the judgment, but reformed the judgment to allow Farmers to show Medicare as co-payee on $168.56 of the proceeds of the judgment. The judgment was reformed to decree that the Carabell Fruge have and recover of and from the Texas Farmers Insurance Company the sum of $2,331.44 to be paid directly to her and the sum of $168.56 to be paid to Carabell Fruge and Medicare as co-payees.
These subrogation interests and State and Federal laws regarding them can be very confusing and are reasons why experienced Insurance Law Attorneys need to be involved in these matters.

March 28, 2013

Personal Injury Protection (PIP)

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.
So now, how is that money recovered?
The insurance policy for PIP coverage will provide that the company will pay PIP benefits because of "bodily injury resulting from a motor vehicle accident and sustained by a covered person."
There have many lawsuits over when the PIP coverage is payable. Here are a few examples of the lawsuits:
1) A 1980, case where the claimant was injured while tripping over a curb four steps away while exiting an auto was denied by the court wherein they said the accident did not constitute a motor vehicle accident.
2) A 2004, Texas Supreme Court case contrasts with the above where a person was exiting his vehicle and became entangled with the door and was injured. The court found a casual connection between the vehicle's use and the injury producing event and thus said coverage existed.
3) A 1996, Houston Court of Appeals, [1st Dist.] case where the court denied coverage where the injuries resulting from a drive by shooting while the victim was sitting in the covered vehicle. The court said this did not constitute a "motor vehicle accident."
4) Another 1996, Houston Court of Appeals, [1st Dist.] case where the insured was ordered out of his vehicle by his passenger and then shot. Again, the court said this did not constitute a "motor vehicle accident."
5) Another court found there was coverage where a shooting was involved. In that case a child was climbing through the rear window of a pickup truck, causing a gun to go off that was in the truck. As in (2) above, the court found a casual connection between the vehicle's use and the injury producing event and thus said coverage existed.
According to Texas Insurance Code, Section 1952.155, PIP is a coverage that is payable without regard to the fault or nonfault of the named insured or recipient in causing or contributing to the accident and without regard to any collateral source of medical, hospital, or wage continuation benefits. - What this essentially allows, is a double recovery in many situations. For instance if a person has health insurance or is some other type of benefit that covers his medical bills and or lost wages, PIP benefits are still payable - thus the double recovery.
The Texas Insurance Code provides for substantial penalties in Section 1952.157 for an insurance company's failure to timely pay PIP benefits. These penalties provide for recovery of a 12% penalty, attorney fees, plus the recoveries available under other parts of the Texas Insurance Code, which call for an additional 18% penalty and up to a trebling of damages in some situations. This means that an experienced Insurance Law Attorney should be consulted whenever the company refuses or delays in making benefit payments under a PIP claim.

February 21, 2013

Personal Injury Protection And Lost Income

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.
Randy Slocum, an engineering student, accepted an offer of summer employment and was to begin work as an offshore "roustabout" on the Tuesday following the Memorial Day weekend. However, he was involved in an automobile accident over that weekend and did not report to work as planned due to the injuries received. His claim was denied by the insurer, the United Pacific Insurance Company.
PIP coverage is regulated by Section 1952.151 of the Texas Insurance Code. The relevant portion of that article provides in the case of an income producer, payment of benefits for loss of income as the result of the accident; and where the person injured in the accident was not an income or wage producer at the time of the accident, payment of benefits must be made in reimbursement of necessary and reasonable expenses incurred for essential services ordinarily performed by the injured person for care and maintenance of the family or family household. . . .
Slocum's insurance policy contained an endorsement, the standard PIP provision, which defines a wage earner or income producer as "a person who at the time of an accident was in an Occupational status where such person was earning or producing income. . . ."
In his response to Union Pacific's motion for summary judgment Slocum presented summary judgment evidence that he had accepted an offer of definite employment to begin on the first working day after the accident. The affidavit of the employer set forth the conditions of the employment and showed the minimum wage Slocum would have earned. Slocum had worked for a different employer the previous summer and had earned a scholarship paying him $500.00 a semester for each of the two intervening semesters.
The PIP outlined in the Insurance Code is a type of no-fault insurance designed to provide benefits to the insured and family for injuries sustained in automobile accidents. Neither the statute nor the policy definition of income producer can be so strictly construed as to deny recovery of lost income by one who, like Slocum, had accepted a firm offer of employment, was to report for work at a definite time and at a set rate of compensation, but was prevented by injuries sustained in automobile accident from enjoying the fruits of his labor. It was error for the trial court to hold, as a matter of law, that Slocum, because he had not yet reported for work, was not in an "occupational status" at the time of the accident. In light of this holding that at least a fact question was presented as to whether Slocum was a wage earner or income producer as defined in the policy, it was unnecessary to decide whether the policy definition of "wage earner" or "income producer" was in conflict with the Insurance Code. The judgment appealed from was reversed and the cause was remanded for trial.

January 19, 2013

Personal Injury Protection And Fraud

Dallas insurance lawyers and those in Garland, Mesquite, Richardson, Carrollton, and other places in Dallas County will end up seeing cases involves claims for Personal Injury Protection (PIP) benefits.
PIP is required coverage in Texas on automobile insurance. The Texas Insurance Code, Sections 1952.151 through 1952.161, discuss this coverage. All auto policies must provide PIP unless it is rejected in writing. Because of this coverage, there is a significant amount of Texas drivers who have this coverage.
The State of Florida also requires this coverage but it is noteworthy that their requirements are different than those in Texas. But as Florida goes on auto coverage, so has Texas in many cases.
News from Florida regarding PIP coverage is noteworthy and is as follows:
A new law, designed to stop insurance fraud in central Florida takes effects in January, 2013.
"Floridians are paying more than they should in auto insurance because the insurance companies are paying more than they should in claims because there's so much fraud and abuse in the system," said Lynne McChristian with the Insurance Information Institute.
McChristian said Florida has more cases of personal injury protection fraud than any other state in the county and Orange County is the third-highest source of false claims in the state.
The fraud occurs when someone stages a car accident, then seeks treatment and payment for injuries they don't really have at a clinic in on the scheme.
Beginning Jan. 1, people who get in car accidents will no longer be able to file claims to pay for massages or acupuncture therapy. Under the new law, payment for non-emergency treatment will be capped at $2500 -- down from the prior $10,000 limit -- and will only be available when referred by a physician.
"This is a measure to keep those costs in check and consumers will benefit if those measures work as they're intended," said McChristian.
She said the change will eventually save drivers money. According to McChristian, once fraudulent claims go down, so will insurance costs.
Personal injury protection makes up about 20 percent of drivers' overall insurance costs.
Floridians also pay an annual fraud tax of about $115 for a two-car family, because of so many fraudulent claims.
In Texas, the minimum amount of PIP coverage is $2,500 but the amount can go as high as $100,000 with some auto insurance companies, if a person chooses to have that much coverage.

November 17, 2012

Personal Injury Protection News

Fort Worth lawyers and those in Saginaw, Lake Worth, Benbrook, Keller, Wylie, and other places in Tarrant County would need to keep up with news related to Personal Injury Protection (PIP) insurance benefits.
The Orlando Sentinel ran a story on Ocotber 1, 2012, that briefly discussed PIP in Florida. The article tells us that a group of chiropractors, massage therapists and acupuncturists have sued the state over a new personal injury protection law that lawmakers heralded as key to reducing auto insurance rates in Florida.
The lawsuit says that the new PIP law, passed this spring, "imposes sweeping changes and significant restrictions on both health care providers and consumers."
The law, passed this March, made a number of changes to the state's no-fault accident system, which pays up to $10,000 in medical care in an accident, regardless of who is at fault. Now, accident victims must seek treatment in 14 days. They are banned from seeking acupuncture or massage therapy, and chiropractors can only receive $2,500 for treating patients, unless they can get it classified as an emergency medical condition.
Gov. Rick Scott, Chief Financial Officer Jeff Atwater and lawmakers pushed the bill through during the final days of the legislative session and promised that it would bring down rates. However, that may or may not happen.
October 1, is the deadline for insurers to file with the state what they will be charging customers. Under the changes, part of which became law in July, insurers are required to reduce rates by 10 percent by October 1, or explain why they cannot do so.
Insurers have expressed doubts that the reduction would be achieved so quickly.
PIP is a coverage that is available on all auto insurance policies in the State of Texas. The Texas Insurance Code, Sections 1952.151 thru 1952.161 is where the laws are found dealing with PIP in Texas. The minimum amount required to be on all policies sold in Texas is $2,500. There is no maximum that is prescribed by law.
The majority of drivers in Texas reject PIP coverage. However, it is important to note that a rejection of PIP coverage must be in writing. One estimate says that only about 10% of drivers opt to get this coverage on their auto. A vast majority of those who have PIP only have the minimal amount of $2,500.
Probably the biggest reason people reject PIP coverage is that the cost of this coverage is high compared to lots of other types of coverage. One reason PIP coverage is high is that any amounts paid under PIP cannot be recovered from responsible third parties by means of subrogation.
PIP covers reasonable and necessary medical expenses up to the limits of the coverage and it pays up to 80% of lost wages.
An option to PIP coverage is "medical payments coverage," also know as "med-pay." Med-pay is a much cheaper alternative to PIP for two reasons. One is that med-pay does not cover lost wages. The other reason is that med-pay can be subrogated. In other words, with med-pay, an insurance carrier has the chance to recover monies it pays out in coverage by subrogation against responsible third parties.
There are many things to be aware of from a legal standpoint when making claims for benefits related to PIP and med-pay. An experienced Insurance Law Attorney would know these issues and be able to discuss them with someone who finds themselves in a position of being able to taking advantage of these benefits.

September 13, 2012

Personal Injury Protection Coverage

Grand Prairie insurance attorneys and those in Irving, Duncanville, De Soto, Lancaster, Richardson, Garland, Mesquite, Farmers Branch, Carrollton, and other places in Dallas County should have a good understanding of the way that Personal Injury Protection (PIP) benefits work. The State of Florida through it's department of insurance mandates coverage much the way Texas does. The SunSentinel ran an article dealing with PIP complaints. Here is much of what the article says.
Chief Financial Officer Jeff Atwater blasted the auto insurance industry Tuesday, saying it needed to "quit the whining" over reductions to auto insurance rates required as part of reforms to the state's no-fault auto insurance law.
"The insurance industry came to each committee meeting, they lobbied these legislators - 'You've got to make these changes so we can help our customers,'" Atwater said in an interview. "But no sooner do suggested reductions come out and everybody starts running for cover."
Atwater laid into the industry following the first meeting of a new task force dedicated to fighting what insurers have called "epidemic" fraud in Personal Injury Protection claims. He said that the industry practically "begged" lawmakers to do something about PIP fraud and high rates.
Lawmakers made sweeping changes to the law this spring, essentially restricting who can treat injured motorists and when. The changes phase in between July 1 and Jan. 1. The bill also requires that insurers either reduce PIP rates by 10 percent this October or explain why, and further cut rates by 25 percent by January 2014, or explain why.
But while a draft report by Pinnacle Actuarial Resource, commissioned by the Office of Insurance Regulation to evaluate the changes, said that the law could result in reductions of 12 percent to 20 percent, it added that those changes may simply offset increases for other coverages.
The release of the report Friday night prompted statements from the Personal Injury Federation of Florida and Property Casualty Insurance Association of America, which are both on the new strike force, that said it would take time before rates are cut -- to see if the changes were resulting in less fraud -- and also noted possible legal challenges.
Mike Carlson, executive director of PIFF, in response to Atwater's comments, said that the "market needs time to react."
"However we remain cautiously optimistic that consumers will see savings at the end of the day if the law is not corrupted by the cottage industry of rapacious lawyers and medical providers who have lorded over the PIP system all these years," he said.
The strike force, which used Tuesday as an organizational meeting only, will next meet in December.
In Texas, the Texas Department of Insurance regulates the insurance industry. The PIP statutes are found in the Texas Insurance Code, Section 1952.151 thru 1952.161. Of course the regulation and enforcement of these statutes is found throughout the Insurance Code and it's various sections.
PIP is suppose to be a "no-fault" coverage. There is not suppose to be an investigation as to who is at fault in an injury causing event. Rather the insurance company investigation is limited to making sure the injury was in some way connected to the use and operation of the insured automobile and making sure the injuries are legitimate.
Any time that a PIP claim is denied by an insurance company, the insured should seek the immediate help of an experienced Insurance Law Attorney.


July 21, 2012

Definition Of "Motor Vehicle Accident"

Fort Worth Insurance Lawyers and those in Saginaw, Grapevine, Benbrook, Burleson, and other places around Tarrant County need to grasp how courts interpret the different words and phrases in an insurance contract.
The meaning of "motor vehicle accident" may seem to be an easy to understand phrase but the phrase was the subject of a lawsuit that went all the way to the Texas Supreme Court. This 2004, case is titled, "Texas Farm Bureau Mutual Insurance Company v. Jeff A. Sturrock." Here is some background.
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 facing. Sturrock injured his neck and shoulder in his attempt to prevent himself from falling from the vehicle. Sturrock filed a claim for Personal Injury Protection (PIP) benefits under his vehicle's insurance policy, issued by Texas Farm Bureau.
It should be noted that the Texas Insurance Code requires every auto policy issued in Texas to provide PIP coverage, unless rejected by the insured. Sturrock's policy provides, in pertinent part:
A. We will pay Personal Injury Protection benefits because of bodily injury;
1. resulting from a motor vehicle accident; and
2. sustained by a covered person.
There is no dispute that Sturrock is a 'covered person' under the policies. The dispute is whether or not his injuries were the result from a "motor vehicle accident."
Sturrock sued Farm Bureau for breach of contract and violations of the Texas Insurance Code. Both parties filed motions for summary judgment. The case was heard on an "Agreed Statement of Facts" pursuant to Texas Rules of Civil Procedure, wherein the trial court would apply the law to these agreed facts and determine whether Sturrock's injuries resulted from a 'motor vehicle accident' within the meaning of the policy. The trial court ruled in favor of Sturrock and this appeal followed.
Farm Bureau argued that accidents like the one Sturrock experienced do not fit within the plain meaning of "motor vehicle accident" because the term requires some involvement between the covered motor vehicle and another vehicle, person, or object. Because Sturrock's accident did not involve another vehicle or person, Farm Bureau contends Sturrock's injuries did not result from a "motor vehicle accident." Conversely, Sturrock claims the court has determined that a "motor vehicle accident" does not require a collision, and the incident at hand was a "motor vehicle accident" because the vehicle itself produced the injury.
The Texas Department of Insurance had weighed in on this issue asking the court to reject Farm Bureau's argument, asserting that it posits an absurd interpretation which, if accepted, would result in greater coverage for passengers than for actual premium paying insureds.
This court said that it agreed with the Texas Department of Insurance that Farm Bureau's cramped interpretation would severely limit an insured's no-fault coverage in a manner that would contravene its purpose and lead to absurd results. Under Farm Bureau's formulation, a passenger who fell from Sturrock's truck in the same way would be covered, but Sturrock himself would not. Sturrock would be covered if he had fallen out of his car onto another person, but not if he had fallen directly onto the ground. He would be covered if a tire dislodged from another vehicle and hit his car, but not if his own tire blew out and caused his vehicle to roll over. Sturrock would be covered if he were run over by a vehicle with a faulty parking brake, but not if his own vehicle ran over him because of the same defect. Neither the policy's language nor its context indicates a construction that would deny no-fault benefits to insureds who suffer injuries caused by their own covered vehicle.
The court pointed out that this is not to say that any accident involving another vehicle, an object, or a person constitutes a "motor vehicle accident." While a collision or near collision is not required, the vehicle must be more that the mere situs of the accident or injury producing event.
If Sturrock had finished exiting the truck and then fell, or if he had fallen out of the car without any involvement of the vehicle, there would be no coverage. But here, the vehicle's door facing was a causative factor in Sturrock's fall.
In conclusion, the court said, "We hold 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 or entry, as a motor vehicle, and (3) a casual connection exists between the vehicle's use and the injury producing event. Here, Sturrock was injured when his left foot became entangled with his car's facing while he was exiting the vehicle. We conclude that Sturrock's injury resulted from a 'motor vehicle accident' within the policy's terms, and affirm the judgment."
In this case, four of the nine Judges disagreed with the ruling. This fact serves as a reminder why an experienced Insurance Law Attorney needs to be consulted on these insurance claims.

May 6, 2012

Personal Injury Protection Benefits Rejection

People with auto coverage in Weatherford, Mineral Wells, Aledo, Millsap, Azle, Springtown, Brock, Willow Park, and other places in Parker County might think they have Personal Injury Protection (PIP) benefits, when they actually do not.
The Austin Court of Appeals issued an opinion in 2003, that can be a little confusing. The style of the case is, Kathryn Payne and Carnell Gulley v. Mid-Century Insurance Company of Texas. Here is some background.
Payne and Gulley filed a lawsuit against Mid-Century alleging they were entitled to PIP benefits under the terms of an auto liability policy issued by Mid-Century. Both sides filed motions for summary judgment and the trial court ruled in favor of Mid-Century. On appeal, the trial court ruling was sustained.
Certain facts were agreed upon: The same insurance agent had written policies on the family since 1991. In 1994, Kathryn's mother purchased a policy naming Kathryn as the rated driver and signed an agreement deleting PIP coverage. Thereafter, Kathryn and her parents, Wanda and Rodger were named insureds in a Farmers policy. In 1996, Kathryn signed an agreement rejecting PIP coverage in connection with that policy. The waiver provided that the "rejection shall apply on this policy and all future renewals or replacements of this policy."
In 2001, the policy cancelled and the Mid-Century policy became effective and was the policy in effect at the time of the accident in issue here. Wanda Payne had signed a PIP rejection but Kathryn had not. The declarations page reflected no PIP coverage and no premiums were paid for the coverage.
Texas Insurance Code, Section 1952.152, states that PIP coverage in automatically in every policy issued in Texas unless it is rejected in writing.
Mid-Century lawyers alleged two reasons for denying coverage: (1) the Mid-Century policy was a renewal of the earlier policy by an affiliated company, Farmers, therefore Kathryn Payne's 1996 waiver of coverage in connection with the Farmers policy applied to the Mid-Century policy, and (2) Wanda Payne's 2001 waiver of PIP coverage was effective as to the Mid-Century policy because she was both an "insured under the policy" and Kathryn Payne's agent authorized to waive coverage on her behalf.
Payne on the other hand, says the written rejection by Kathryn signed in 1996 was ineffective as to the Mid-Century policy for two reasons. First, although the Mid-Century policy might be considered a replacement of the Farmers policy, it could not be a renewal because the earlier policy insured three persons, Kathryn and her parents, while the Mid-Century policy covered only Kathryn. Further, Kathryn's written rejection agreeing that it applied to replacement policies was of no effect because the statute only provided that such a written rejection applied to a renewal policy.
The court in making it's ruling stated that by using the term "renewal policy" in the statute, the legislature intended the term to include a new contract between parties that replaces a preceding policy without a lapse of coverage. In discussing further, the
Court stated there is no authority for an assertion that a renewal policy must have identical parties and terms as the earlier policy.
In it's closing statement the court said, "We hold that under these facts, the Mid-Century policy was a renewal policy. Thus, Mid-Century was not required to provide PIP in its policy because Kathryn rejected the coverage in writing in connection with the issuance of the Farmer's policy, and a policy previously issued to her by an affiliated insurer."
There is a lot of case law dealing with the PIP statutes and there have been some revisions and new interpretations of these laws. An experienced Insurance Law Attorney would be up to date on these laws and the changes in the laws. He would be able to give proper advice for most disputes arising under these laws.