Dallas Fort Worth Insurance Lawyer Blog

People with auto insurance policies in Grand Prairie, Arlington, Fort Worth, Dallas, Hurst, Euless, Bedford, and other places through out the DFW metroplex usually do not have a very good understanding of how their auto insurance policies work. All they know is that if they get into a wreck the insurance is suppose to help them.
There are many things an auto insurance policy can provide. The vast majority of people get the bare minimum that is required by state law. But there are many things that can be purchased. The minimum is liability coverage. Beyond liability coverage, a person can purchase coverage for damages to their vehicle, towing, auto rental, life insurance, medical payments, personal injury protection, uninsured and underinsured coverage, and a few other types of coverage.
All of these coverages work a little different from each other. Personal Injury Protection (PIP), and Uninsured / Underinsured (UM) coverage is required coverage on any auto policy sold in the State of Texas, unless these coverages are rejected in writing.
The requirement for PIP coverage is found in the Texas Insurance Code, Section 1952.152. The requirement for UM coverage is found in the Texas Insurance Code, Section 1952.101.
One aspect of these coverages was discussed in a 2004, Texas Supreme Court case styled, Old American County Mutual Fire Insurance Company v. Zeferino Sanchez. The question in this case was whether the insured spouse of the person listed as the "named insured" in the declarations page of a policy may reject those coverages. The case got to the Supreme Court as the result of a summary judgment ruling. This Supreme Court ruled that the spouse falls within the class of persons statutorily entitled to reject UM and PIP coverages under the policy.
Here is the factual background:
This case was presented on stipulated facts. On January 8, 1998, Margarita Sanchez, wife of Zeferino Sanchez, applied for and purchased an insurance policy from Old American for two of the couple's vehicles. Ms. Sanchez rejected UM and PIP coverages on the insurance application, and Old American never assessed premiums for the coverages. In applying for the policy, Ms. Sanchez affirmed that the rejections of UM and PIP coverages would apply to the 1998 policy and to all future renewals of that policy. The Sanchezes renewed their existing policy in 1999. Neither Mr. or Mrs. Sanchez requested PIP or UM coverages at that time.
Although Ms. Sanchez's name appeared on the 1998 policy application, she was not listed as a "named insured" on the declarations page. The policy, however, defined "you" and "your" to include the "named insured" as well as "the spouse if a resident of the same household." Mr. Sanchez fell within the policy definitions of "you" and "your" because she and Mr. Sanchez lived in the same house at all pertinent times. To that end, the parties stipulated that both Mr. and Mrs. Sanchez were insured under the policy. The parties disagreed, however, about the extent of the policy's coverage. Specifically, the parties disputed whether Mr. Sanchez was entitled to UM and PIP benefits to cover damages arising from a 1999 accident.
On April 11, 1999, Mr. Sanchez's pickup was parked on the shoulder of the road. A vehicle driven by an uninsured motorist struck Mr. Sanchez's truck as he was lying beneath it repairing a broken fuel hose. The impact caused the pickup to collapse on Mr. Sanchez and sever his spinal cord. The policy's UM and PIP provisions excluded coverage for injuries sustained while "occupying" or when "struck by" any vehicle owned by an insured that was not insured under the policy.
After the accident, Mr. Sanchez filed a claim with Old American for UM and PIP benefits under the policy. Old American filed suit seeking a declaratory judgment absolving it of any obligation to pay those benefits.
This court got into a multi page discussion about the purpose of the UM and PIP statutes and the wording of those statutes and then compared that discussion to the wording of the Old American policy.
The Texas Supreme Court ultimately held that the phrase "insured named in the policy" was synonymous with "named insured" in the UM and PIP statutes. In so holding it was ruled that Ms. Sanchez's signed reject of UM and PIP coverages, also excluded those coverages for Mr. Sanchez.

A natural question for someone in Weatherford, Mineral Wells, Aledo, Hudson Oaks, Willow Park, Millsap, Brock, or anywhere else in Parker County to ask is; What is the value of my claim?
When the claim is a personal injury claim, there is no easy answer. One general principle in this regard is that there are laws against making a "double recovery." A double recovery would be where you collect money from more than one source for an injury. The most likely place for this to be seen is where a person is injured in an auto accident caused by another. The injured person goes to the hospital and pays for the hospital bills with their personal health insurance. Then later on, the injured person makes a claim against the person who caused the accident and injuries and the insurance company for that person pays the injured person again, for the same hospital bills. Technically, this is illegal.
Another example is where the injured person makes a claim against two other people who may be responsible for the injuries and both pay all the bills.
In the second example above the Texas Civil Practices & Remedies Code, Section 33.012(b) says, "If the claimant has settled with one or more persons, the court shall further reduce the amount of damages to be recovered by the claimant with respect to a cause of action by the sum of the dollar amounts of all settlements."
What Section 33.012(b) means is that if a person has a claim that is worth $1,000, then he cannot collect $1,000 from both people he is making the claim against. So, if one pays $100, then he still has a claim against the other for $900.
In the first example above, where the injured person has had the hospital bills paid by his insurance company, then the hospital has a subrogation interest in any amounts the injured person receives from the person who caused the injuries. The amount of the subrogation amount would be an amount up to what his health insurance has paid. So, if the injured person has a claim worth $1,000 but only $500 is paid by the health insurance company and if the injured person collects $1,000 from the person who caused the injury, then $500 has to be paid back to the health insurance company and the injured person can do as they wish with the other $500.
An experienced Insurance Law Attorney knows how to use other laws and legal principles to increase the total amount of the recovery and or lessen the amount of money that has to be paid back as a subrogation interest. - One thing to know, is it can be very confusing.
One place where a double recovery is allowed and fully legal is in auto injury claims where the injured person has Personal Injury Protection (PIP) benefits. The Texas Insurance Code, Section 1952.155(a) and (b).
Section 1952.155(a) says, "The benefits under coverage required by this subchapter are payable without regard to: (2) any collateral source of medical, hospital, or wage continuation benefits." This means that the injured person can collect his PIP benefits and then still make a claim against some other personal insurance he has for the same losses such as medical bills or lost wages. The caveat here is that there are exceptions to this and is again, a situation where an experienced Insurance Law Attorney needs to be involved to stay out of trouble.
Section 1952.155(b) says, "Except as provided by Subsection (c), an insurer paying benefits under coverage required by this subchapter does not have a right of subrogation or claim against any other person or insurer to recover any benefits by reason of the alleged fault of the other person in causing or contributing to the accident." This means that the PIP insurance company cannot subrogate against the insurance company of the person who caused the injuries. There is only one exception to this statute which is in Subsection (c), and this writer does not know where it has ever come into play.
The lesson to be taken from this posting is that the value of a claim has to take into account the rules discussed above.

Grand Prairie residents and residents of Arlington, Mansfield, Burleson, Crowley, Benbrook, Fort Worth, Lake Worth, Hulen, and other areas of Tarrant County who have automobile insurance coverage are always given the opportunity to purchase, with their automobile insurance, Personal Injury Protection, otherwise know as PIP.
PIP coverage is required to be offered along with automobile insurance coverage pursuant to the Texas Insurance Code, Section 1952.152. Here is a case dealing with that coverage.
The style of the case is, Texas Farmers Insurance Company v. Carabell Fruge. This is a case decided by the Texas Court of Appeals, Beaumont, in 2000. Here is some background information.
Jackie Ryan had purchased an automobile liability insurance policy from Farmers 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.
As the court stated, this case raises questions related to PIP coverage provided in the Farmers contract of insurance. The issue is whether Farmers breached its contract by placing the names of medical providers and Medicare as co-payees on checks paying PIP benefits to Fruge. This court held that Farmers did breach its contract as it relates to all except naming Medicare as a co-payee.
Fruge's attorney brought an action pursuant to Section 1952.157 against Farmers to recover $2,500 in benefits, as well as penalty and attorneys fees as provided. The trial court ruled against Farmers and this appeal followed.
This court rejected Farmers assertion that it was obligated to honor assignments to Fruge's medical providers because 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. As such, Fruge was right to expect that PIP benefits would be made payable to her alone.
But as the court said, naming Medicare as a co-payee is another matter. Federal law provides that any portion of medical costs by Medicare for which private insurance is the primary payer is conditioned upon reimbursement from the insurer. This is per 42 U.S.C. Section 1395y(2)(B)(i). Medicare is a secondary payer for services covered under no-fault insurance per 42 U.S.C. Section 1395y(2)(A)(B)(ii). And "no-fault" insurance includes PIP coverage per 42 C.F.R. Section 411.50(b). This is an instance where federal law preempts state law. State law can be preempted by federal rules as well as federal statutes. 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 expense it should have known had already been paid by Medicare.
The court went on to rule that while Farmers is correct in its assertion that federal statutes and rules preempted state law, it cannot, on the fact 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 showed a Medicare payment of $168.56. Thus it appeared that Farmers wrongfully named Medicare as a co-payee to part of the PIP benefits.
The judgment was ordered to be reformed to reflect this opinion.
Even on something that should be as simple as PIP payments, a person should seek the advise and counsel of an experienced Insurance Law Attorney to insure their rights are not being abused by the insurance company.

Lots of insureds in Weatherford, Aledo, Willow Park, Mineral Wells, Millsap, Brock, Azle, Peaster, Cool, Hudson Oaks, and other places in Parker County will have Personal Injury Protection benefits included in their auto insurance policies.
Here is an article that discusses an antic one company was using to save money on these PIP claims.
The article was published by the Houston Chronicle on May 13, 2011, and is authored by staff writer, Patrick Danner. The title of the article is, USAA Sued Anew Over Medical Payouts In Crashes Plaintiffs Say Insurer's Reviews Are "Shams"; Firm Defends Practices.
The article tells us that USAA is again defending itself against charges it utilizes a "cost containment program" to improperly reduce or deny medical payouts to insurance customers injured in auto accidents.
In Texas, payments are governed by the Texas Insurance Code, Sections 1952.151 thru 1952.161.
The article goes on saying that the latest claims against the San Antonio financial and insurance company were made in a federal lawsuit filed this week in Oregon.
The lawsuit, which seeks national class-action certification, charges that USAA uses an outside auditor to assess claims and to "uniformly conclude that medical treatment was not needed." In other words, USAA is accusing its insureds of fraud.
USAA denies the allegations.
USAA has previously settled two class-action lawsuits that have accused it of using flawed data to arbitrarily deny a portion of the medical benefits for injured customers who have PIP or other medical payments coverage on their USAA auto insurance policies.
One of those cases, filed in Arizona, was settled last summer. Claims are still being processed, so the amount to be paid out under the settlement hasn't been determined.
The other case, filed in Illinois was settled in 2005. Lawyers for the plaintiffs valued the settlement on their website at $35 million, a figure USAA spokesman Paul Berry called "probably wildly" inflated.
USAA settled the two cases because it was the "right thing to do for our membership," Berry said. He noted both courts endorsed USAA's bill review practices.
"We pay all reasonable, necessary, and accident related bills," Berry said. "That doesn't mean we pay all bills. If you had injuries or you received some treatment that had nothing to do with an auto accident, we're not going to pay those bills."
USAA relies on Alabama based Auto Injury Solutions to help review medical bills to determine whether they are reasonable and necessary and to weed out duplicative and fraudulent claims. Bills deemed suspicious are reviewed by a doctor or other health care professional, Berry said. Even when one of its doctors concludes the medical care wasn't necessary, the bill still goes through several other reviews, he said.
USAA also can choose to override any instance where a bill is rejected, Berry said.
In the latest Oregon lawsuit, four unrelated USAA customers in separate accidents allege the medical reviews were a "sham."
It is the agent selling the policy that can often times be a problem when there is a need to make a PIP claim. Talking to an experienced Insurance Law Attorney is one way of insuring that you get what you have paid for when the need for a PIP claim arises.

Drivers in Weatherford, Mineral Wells, Aledo, Azle, Springtown, Decatur, Peaster, Millsap, Brock, Hudson Oaks, Poolville, Newark, Willow Park, and other parts of Texas are all offered Personal Injury Protection (PIP) benefits coverage when they buy coverage for their automobile. It is the law.
It is the law that the coverage be offered. However, it can be rejected. To reject it, the rejection must be clearly made and in writing. This law is found in the Texas Insurance Code, Section 1952.152(b).
Here is a 1978 case by the Texas Supreme Court dealing with the rejection. The style of the case is, Unigard Security Insurance Company v. Charles Schaefer et al. Here is some background.
Schaefer and others sued to recover under the PIP endorsement of an auto policy issued by Unigard. The case was tried on stipulated facts. The trial court ruled for Unigard. The first appeals court reversed the trial court and then this Supreme Court upheld the first appeals court decision. All the people sueing for benefits in this case were killed or seriously injured in an accident where a David Wyloge was the driver of the car in which everyone was riding.
Prior to the accident, Abraham Wyloge obtained liability insurance coverage from Unigard. The policy included an Endorsement 243, which was PIP, mandated by the Legislature in the then existing Insurance statutes. That statute is the predecessor of the current 1952.151 thru 1952.161.
Under that law the only exclusion of benefits provided in the statute was injury caused to oneself intentionally or while in the commission of a felony or attempting to elude arrest. Mr. Wyloge did not reject the PIP coverage. On the contrary the policy was written with coverage included in Endorsement 243, and Unigard collected a premium for it.
On a subsequent date, Mr. Wyloge signed a Form 119. "Exclusion of Named Driver" endorsement. It excludes claims arising from any accidents occurring while any automobile is operated by David Wyloge. Unigard asserted that the exclusion in Endorsement 119 was tantamount to a partial rejection, while David was driving, of the PIP coverage. This is the reason Unigard denied the claim.
In this case, there was much arguement over the difference between an endorsement and an exclusion and the effect of signing the Form 119 exclusion and the Endorsement 243.
In making it's decision the court stated as follows:
"This holding is consistent with that part of (old statute) which sets forth the only exclusion of benefits authorized by the statute. They are: when the insured causes injury to himself intentionally or is injured while in the commission of a felony or attempting to elude arrest. Any attempt to add another exclusion applicable when the automobile is being operated by an unauthorized driver would be repugnant to the statute. When specific exclusions or exceptions to a statute are stated by the Legislature, the intent is usually clear that no others shall apply. When the Legislature specifies a particular extent of insurance coverage, any attempt to void or narrow such coverage is improper and ineffective."
"Even if Endorsement 119 were not inapplicable because of the terms of (old statute) and Endorsement 243, we do not agree with Unigard that 119 was sufficient as a partial rejection of the statutory (PIP). As heretofore indicated, there is not a word in that endorsement which mentions (PIP, the old statute) or Endorsement 243. A matter of public policy involving more than the present litigants is here involved. The Legislature has declared it to be the public policy of this State that 'no automobile liability insurance policy ... shall be delivered or issued for delivery ... unless personal injury protection coverage is provided therein or supplemental thereto.' Among the purposes are to provide injured occupants of the insured automobile with up to $2,500 per person for hospital and doctor bills arising from accidents 'without regard to fault or nonfault of the named insured or recipient ...'"
This is an old case upholding the current law stating that rejection of PIP benefits must be clear and in writing. There are a lot of cases dealing with PIP benefits and whenever someone finds themselves in a position where those benefits are being denied, they should seek the advice of an experienced Insurance Law Attorney.

Someone in Weatherford, Aledo, Azle, Brock, Hudson Oaks, Annetta, Mineral Wells, Cool, Millsap, Peaster, Poolville, Whitt, Lipan, and other communities in Texas probably does not know very much about Personal Injury Protection (PIP) on their automobile insurance policy. One of the things they should know is that it is a coverge they have automatically unless they reject it in writing.
The Texas Insurance Code, Section 1952.152(a) says:
An insurer may not deliver or issue for delivery in this state an automobile liability insurance policy, including a policy provided through the Texas Automobile Insurance Plan Association under Chapter 2151, that covers liability arising out of the ownership, maintenance, or use of any motor vehicle unless the insurer provides personal injury protection coverage in the policy or supplemental to the policy.
Subpart (b) of this same section says:
The coverge required by this subchapter does not apply if any insured named in the insurance policy rejects the coverage in writing. Unless the named insured requests in writing the coverage required by this subchapter, the insurer is not required to provide that coverage in or supplemental to a reinstated insurance policy or renewal insurance policy if the named insured rejected the coverage in connection with that insurance policy or an insurance policy previously issued to the insured by the same insurer or by an affiliated insurer.
Reading the above sounds well and good - but what if the insurance policy was purchased over the internet? If it was purchased over the internet, which a lot of policies are, how does the "rejection in writing" work for the PIP?
At a minimum the insurance company needs to show that it is the insured that made the rejection which is usually done by an electronic signature.
The Texas Department of Insurance put out a rather vague bulletin concerning this issue. The bulletin says they are adopting the Uniform Electronic Transaction Act.
The Texas Department of Insurance bulletin says, "Texas UETA creates a statutory structure in Texas that supports the use of electronic signatures and electronic records in everyday public and business undertakings. Texas UETA addresses the effect of electronic transactions as follows:
a. A record or signature may not be denied legal effect or enforceability because it is in electronic form.
b. A contract may not be denied legal effect or enforceability solely because an electronic record was used in its formation.
c. If a law requires a record to be in writing, an electronic record satisfies the law.
d. If a law requires a signature, an electronic signature satisfies the law."The UETA is found in the Texas Business & Commerce Code, Chapter 43. "a" through "d" above is found in Section 43.007.
Chapter 43 of the Texas Business & Commerce Code is a good law to know, if for no other reason than to see laws keeping up with technology. As for the PIP rejection issue in this article, the issue that could still be contested is whether or not it was one of the named insured's who completed the electronic rejection.
Chapter 2151 mentioned above deals with the type of insurance that is provided to individuals who have been refused insurance coverge due to their driving history or some related driving issue. Section 2151.102(b) says:
An applicant is not eligible for insurance through the association unless the applicant and the servicing agent certify as part of the application to the association that the applicant has been rejected for insurance by at least two insurers that are authorized to engage in business in this state and that are writing automobile insurance in this state.
As a final point. PIP coverage is required by Texas Insurance Code, Section 1952.153, to be in atleast a minimum amount of $2,500. Some insurance carriers will allow their insured to purchase as much as $100,000 of PIP coverage.

Insureds in Grand Prairie, Arlington, Irving, Grapevine, Coppell, Keller, Saginaw, Lake Worth, Aledo, Hudson Oaks, Azle, Springtown, Burleson, Benbrook, and other places in Texas need to have an understanding of how Personal Injury Protection (PIP) and uninsured / underinsured (UM/UIM) benefits work in an automobile policy of insurance. Here is a case that gives some insight.
The case is styled, Old American County Mutual Fire Insurance Company v. Zeferino Sanchez. This is a 2004, case decided by the Texas Supreme Court.
Texas Insurance Code Sections, 1952.101 and 1952.152 provide that "any insured named in the policy" may reject UM/UIM and PIP coverages. The question in the case is - whether the insured spouse of the person listed as the "named insured" in the declarations page of a policy may reject those coverages.
The case is presented to the court on stipulated facts. On January 8, 1998, Margarita Sanchez, wife of Zeferino Sanchez, applied for and purchased an insurance policy from Old American for two of the couple's vehicles. Ms. Sanchez rejected UM and PIP coverages on the insurance application, and Old American never assessed premiums for the coverages. In applying for the policy, Ms. Sanchez affirmed that the rejections of UM and PIP coverages would apply to the 1998 policy and to all future renewals of that policy. The Sanchezes renewed their existing policy in 1999. Neither Mr. or Mrs. Sanchez requested PIP or UM coverages at that time.
Although Ms. Sanchez's name appeared on the 1998 policy application, she was not listed as a "named insured" on the declarations page. The policy, however, defined "you" and "your" to include the "named insured" as well as "the spouse if a resident of the same household." Ms. Sanchez fell within the policy definitions of "you" and "your" because she and Mr. Sanchez lived in the same house at all pertinent times. To that end, the parties stipulated that both Mr. and Mrs. Sanchez were insured under the policy. The parties disagree, however, about the extent of the policy's coverage. Specifically, the parties dispute whether Mr. Sanchez was entitled to UM and PIP benefits to cover damages arising from a 1999 accident.
On April 11, 1999, Mr. Sanchez's 1984 Chevrolet pickup truck was parked on the shoulder of Interstate 35 in Hays County. A vehicle driven by an uninsured motorist struck Mr. Sanchez's truck as he was lying beneath it repairing a broken fuel hose. The impact caused the pickup to collapse on Mr. Sanchez and sever his spinal cord. Although Mr. Sanchez owned the pickup truck at the time Ms. Sanchez applied for the policy, Ms. Sanchez did not identify the pickup in the application and it was not a "covered auto" under the policy. The policy's UM and PIP provisions excluded coverage for injuries sustained while "occupying" or when "struck by" any vehicle owned by an insured that was not insured under the policy.
The parties did not dispute that Ms. Sanchez rejected UM and PIP coverages in writing; they do not assert that there were any formal defects with the manner or form of rejection; and they agree that premiums were never assessed for the coverages. The only issue was whether Ms. Sanchez had statutory authority to waive them. To resolve the issue, the court had to determine whether, under sections 1952.101 and 1952.152 of the Texas Insurance Code, the spouse of the person identified as the named insured in the declarations page of a policy may reject UM and PIP coverages.
This court then discussed at length the legislative history of the statutes and their purposes. They also discussed the ways other states dealt with this issue. At one point the court stated, "Finally, we note that interpreting 'insured named in the policy' to mean 'named insured' is consistent with the approach taken by other jurisdictions that have considered similar statutory language."
In ruling in favor of the Old American, that the rejection by Ms. Sanchez was valid as to Mr. Sanchez, the court said, this conclusion is consistent with the breadth of authority Ms. Sanchez had in these transactions. It is undisputed that she was able to purchase the policy for her husband and herself, and she was covered under the policy to the same extent as her husband. "We find it difficult to conceive that the Legislature intended for a husband to be (i) covered under a policy obtained exclusively by his wife but admittedly for his benefit; (ii) entitled to recover from the insurer under the terms and policy limits set by the wife; yet, (iii) not bound with respect to one aspect of the policy -- the rejection of UM and PIP coverages -- because his wife was not authorized to reject coverages. Under this reasoning, the wife would not even be entitled to reject UM and PIP coverages on her own behalf. Based on the circumstances surrounding the enactment of ... (the UM and PIP statutes), we conclude that the Legislature did not intend a meaning of "named insured" that would lead to this result; instead, the Legislature intended "named insured" to include the spouse of the individual named on the declarations page of an insurance policy."
The court then held that the phrase "insured named in the policy" is synonymous with "named insured." Because Ms. Sanchez can be classified as a "named insured" and thus an "insured named in the policy," the court held that she had statutory authority to reject UM and PIP coverages.

Everybody in Arlington, Grand Prairie, Mansfield, Burleson, De Soto, Dallas, Fort Worth, Benbrook, and other places in Texas have access to internet services. Using the internet, people have started purchasing all kinds of goods and services. One of the things purchased a lot on-line now days is insurance policies. When this happens some interesting questions can arise. How about this:
Let us say that you desire to purchase auto insurance on-line. One thing we have learned from earlier blogs at this site is that Insurance Law in Texas requires that on all insurance policies issued in the state of Texas that Personal Injury Protection (PIP) benefits be part of the policy. This is stated in the Texas Insurance Code, Section 1952.152(a). Section 1952.152(b) tells us that this coverage must be rejected in writing otherwise it is part of the policy.
Next, let's say that when you purchase an auto policy on-line that you are prompted to check a box indicating a rejection of PIP coverage but because this is being purchased on-line there is no signature. Have you properly rejected PIP coverage? Or do you have the coverage?
One thing you would want to do is discuss your situation with an experienced Insurance Law Attorney. What he would tell you is that as of today's date there are no court cases dealing specifically with this issue. Next, he would opine that this is something the legislature is going to have to take up some day because the current law in this area is not properly addressing out internet reality.
Having said the above, the next point of discussion with someone consulting with him would be to point out the case, Carlotta Ortiz and Mario Zepeda v. State Farm Mutual Automobile Insurance Company. This is a 1997, San Antonio, Court of Appeals case.
This case involves the written rejection exception to the above referenced insurance laws.
Here are the facts in this case:
Ortiz and Zepeda applied for auto insurance through the Texas Automobile Insurance Plan (TAIP). The TAIP application offered them PIP coverage. The application required them to either accept or reject PIP coverage by placing a check mark next to either "accept" or "reject". They rejected coverage and signed their names. The agent signed also, indicating that he had explained the coverage to them. The applications were subsequently assigned to State Farm Mutual Automobile Insurance Company (State Farm), which then issued policies consistent with the applications. After being involved in accidents they made a claim for the PIP benefits which were denied by State Farm.
Essentially, Ortiz and Zepeda were argueing that the application and the policy were not the same and that the law required coverage unless the signed rejection was part of the policy.
Here is what the court pointed out; The Texas Insurance Code requires that every auto liability policy issued in Texas, provide PIP coverage unless "any insured named in the policy shall reject the coverage in writing ..." The underlying policy behind the statute is the state's interest in protecting conscientious and thoughtful motorists from financial loss.
Other court decisions have made clear that the courts must liberally construe the PIP statute to give full effect to the public policy broadly requiring PIP coverage. Because of the remedial purpose behind the statute and because of the liberal interpretation effecting coverage, the written rejection exception should be strictly construed to protect the insured.
Although a rejection is required to be in writing, the statute does not require a special procedure or special language for the writing. Execution of a satisfactory rejection requires only minimal effort by the insured. Ortiz and Zepeda contend that because their written rejections were not attached to or incorporated in their respective insurance policies, the rejections in the applications are not valid. In essence, they were asking the court to interpret the written rejection language in the statute as requiring that the writing be attached to or in some other way incorporated in the policy.
In making its final ruling the court discussed what other courts have decided and ultimately ruled that the Texas Insurance Code does not specifically require that an insured's rejection of PIP coverage be attached to or incorporated in the policy. Instead, the statute only requires the rejection of coverage to be in writing.
Based on the decision in the case briefly discussed here, it appears a court would uphold a box being checked on an on-line auto insurance application as being sufficient rejection "in writing" of PIP coverage.
If something like this happens to you, check with an attorney familiar with the law. He may be able to find ways to get you the coverage you are entitled to.

Grand Prairie residents and residents of Dallas, Fort Worth, Duncanville, Crowley, Irving, Arlington, Mansfield, Mineral Wells, and all the other locations in Texas are covered by the same insurance laws. The laws may be different in other states but policies issued in Texas, no matter where in Texas, all have the same laws apply.
Personal Injury Protection (PIP) benefits cost quite a bit extra on an automobile policy. Because of the extra expense the vast majority of persons who have auto insurance make the choice to not purchase PIP.
But for those who do purchase PIP, most do not really understand how it works. Here is a little information to help in understanding PIP.
To begin with, PIP is required coverage in Texas unless the person purchasing the automobile insurance specifically rejects the coverage in writing. This is specified in the Texas Insurance Code, Section 1952.152. The normal occurrance here is that when someone is dealing with their insurance agent and discussing the coverage they are going to pay for and the price the various forms of coverage are going to cost a decision is made as to whether or not to pay for PIP. As stated earlier, most people opt to not have PIP. At this point the agent has a preprinted form that is usually part of the application of insurance that says the applicant is rejecting the coverage. The applicant is asked to sign the form and thus they are now rejecting the coverage in writing. Most people will not specifically remember doing this because they are usually signing the application in three to four or maybe five or six different places.
The minimum amount of PIP coverage is $2,500 per Section 1952.153, Texas Insurance Code. The coverage amounts can go to $50,000 and with some companies to $100,000.
PIP pays for reasonable and necessary medical expenses that arise out of an accident involving an automobile. It also pays a percentage of lost income that arises out of an accident involving an automobile. See Section 1952.151.
Here is one of the unique features of PIP coverage:
Texas Insurance Code, Section 1952.155, says this benefit is payable without regard to who is at fault for causing the injury. This same section says that PIP is payable without regard to other sources of payment the injured person may be receiving or entitled to. This essentially allows a "double recovery" if the injured person also has his losses paid for by another source such as health insurance. This is probably the only place in Texas insurance law where this possible result is allowed. It is also one of the reasons PIP is a more expensive insurance. Plus it is not subject to subrogation laws.
However, Section 1952.159, tells us that if a liability claim is made by a guest or passenger against the owner or operator of an automobile in which the guest or passenger is riding that the auto insurance carrier for the owner or operator is entitled to an offset against the liability portion of the insurance policy to the extent any PIP benefits are paid. The limitation on this offset does not apply when the claimants losses exceed the liability portion of the policy.
The way PIP works is not really very complicated except to the extent it is something most people never find themselves having to deal with it. An experienced Insurance Lawyer would not have much problem explaining the parts that may be confusing. It is a portion of an auto insurance policy that many people do not even realize they are entitled to benefits from. In reality most people who have PIP and are paying substantial premiums for it do not even realize they have it. And the people who know they have this benefit are often times reluctant to make a claim for the benefits, apparently believing they cannot recover the benefits or, are afraid it will make their own insurance rates increase.

Drivers in Arlington, Grand Prairie, Mansfield, Duncanville, De Soto, Flower Mound, Haslet, Benbrook, Saginaw, Newark, Crowley, Dallas, Fort Worth, and other places may ask the above question. Like most questions that are legal in nature, the answer is: It depends? Look at this case for guidance.
In 2003, the Austin Court of Appeals decided the case Taylor v. State Farm Lloyds, Inc. Here are the relevant facts in this case. Taylor purchased multi-peril insurance for her business from State Farm in 1993. At that time, multi-peril insurance policies were promulgated by the Texas Department of Insurance (TDI). Within that policy, State Farm offered limited non-owned auto liability insurance. Taylor purchased hired auto liability insurance as an endorsement to her multi-peril policy. In 1996, TDI allowed State Farm to write its own multi-peril auto policy subject to TDI's approval. At that time, State Farm issued hired and non-owned auto liability coverage as an endorsement to Taylor's multi-peril policy. None of the hired and non-owned auto liability coverage State Farm issued included PIP or UM/UIM coverage. Taylor contends that State Farm was required to issue PIP and UM/UIM coverage. State Farm rejoins that TDI has the authority to regulate certain auto insurance by other provisions of the insurance code when TDI determines that it is appropriate. State Farm further asserts that TDI has chosen to regulate hired and non-owned auto coverage under the multi-peril subchapter of the insurance code rather than the auto liability subchapter, and therefore, PIP and UM/UIM coverages are not mandatory with regard to the hired and non-owned auto liability insurance that forms a limited part of the multi-peril insurance Taylor purchased for her business.
The issue for the court was whether PIP and UM/UIM coverage is mandatory when an endorsement for hired and non-owned auto liability is added to a business's multi-peril insurance policy.
In this case, Taylor claims State Farm violated what is now, Texas Insurance Code Section 1952.152(b), the PIP statute, and Section 1952.101(c), the UM/UIM statute. In this case the court decided that State Farm did not violate the above statutes. Their reasoning was that hired and non-owned auto liability insurance is distinguishable from "auto liability insurance" and therefore State Farm was not subject to the above provisions.
The Insurance Code clearly states in the above cited statutes that PIP and UM/UIM coverge is to be provided in auto liability policies. However, another part of the insurance code stated: There shall be excluded from regulation under the provisions of this subchapter any insurance against liability for damages arising out of the ownership, operation, maintenance or use of or against loss of or damage to motor vehicles ... which may, in the judgment of the Board, be a type or class of insurance which is also the subject of or may be properly regulated under the terms or provisions of other insurance rating laws ... If such a situation shall be found to exist, the Board shall make an order declaring which of said rating laws shall be applicable ...
The court then stated, "Taking the provisions together and noting their relative placements within the subchapter dealing with automobile insurance, it is clear that the article grants TDI the discretion to except some kinds of auto insurance from subchapter A's mandatory PIP and UM/UIM coverage.
The relevance of this case is in showing that there are a few exceptions to whether or not insurance dealing with automobiles is required to provide PIP and UM/UIM coverage. The general rule and answer is absolutely - Yes. But it appears there are a few exceptions.
The final advice - consult with an experienced Insurance Law Attorney to clear up doubts.

No matter where you live, Weatherford, Aledo, Azle, Lake Worth, Mineral Wells, De Soto, Arlington, Grand Prairie, Dallas, Fort Worth, Mesquite, Garland, or anywhere else in Texas, the insurance companies are always looking for ways to deny a claim.
The Texas Supreme Court, in 2004, decided a case where the insurance company denied a claim for Personal Injury Protection (PIP) benefits under a policy. The style of the case is, Texas Farm Bureau Mutual Insurance Company v. Jeff A. Sturrock. Justice O'Neil delivered the opinion of the Court.
In this case, an insured, Sturrock, was injured when his foot became entangled with his truck's raised door facing while he was exiting the vehicle. The issue here is whether or not his injury resulted from a "motor vehicle accident" for purposes of PIP coverage under his automobile policy with Texas Farm Bureau Mutual Insurance Company (Farm Bureau). The 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 casual connection exists between the vehicle's use and the injury producing event.
The facts here were that 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. He injured his neck and shoulder in his attempt to prevent himself from falling from the vehicle.
The Texas Insurance Code, Section 1952.152, requires that every automobile insurance policy issued within Texas provide PIP coverage, unless rejected in writing. Sturrock's policy provided 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.
Farm Bureau did not dispute that Sturrock is a "covered person", but denied that his injuries resulted from a "motor vehicle accident" within the policy's PIP coverage.
This lawsuit resulted.
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. Conversely, Sturrock claims the incident at hand was a "motor vehicle accident" because the vehicle itself produced the injury.
In the 1995 case, State Farm Mutual Insurance Company v. Peck, the Amarillo Court of Appeals, which involved a drive-by-shooting, held that State Farm had no duty to defend or indemnify its insured because "a drive-by-shooting" could not be transformed into an 'auto accident' under the policy.
The Texas Supreme Court more recently had addressed the meaning of "automobile accident" in Mid-Century Insurance Company of Texas v. Lindsey, in 1999. There, Linsey, a passenger in his mother's car, was shot by a gun that accidently discharged from an adjacent truck when a boy attempted to enter the cab through the rear window. In that case the Court rejected the interpretation that the term "auto accident" required a collision or excluded occurrences like Linsey's.
The Court went on through an analysis of the meaning of "accident" and "arising out of a motor vehicle's use" and is a good read for trying to understand how Courts reach their decisions. It also illustrates, by cites to other cases, how difficult decisions can be when interpreting insurance policies. One conclusion that should be obvious is that an experienced Insurance Law Attorney should be consulted in these matters.
In the Sturrock case, the Court ruled in favor of Sturrock by finding that the PIP provision in the policy did provide coverage for Sturrock.

An insurance policyholder in Southlake, Grapevine, Grand Prairie, Arlington, Fort Worth, Mansfield, Burleson, Crowley, or anywhere else in Texas may ask the same question; Who gets the personal injury protection (PIP) monies. It is estimated that only ten per cent of automobile policyholders purchase PIP benefits as an option when they purchase their auto insurance policy. It costs extra, and lots of people just do not want to pay the extra money for this benefit.
The Texas Insurance Code, Section 1952.152, mandates that PIP coverage be offered to any purchaser of auto liability coverage. Section 1952.153, mandates that the minimum amount of coverage for PIP is $2,500. Some insurance companies will offer up to $100,000 of PIP coverage.
Section 1952.155 mandates that this coverage be provided without regard to fault in the accident or any other event that the coverage provides for. The PIP benefits are payable without regard to fault or other sources of insurance coverage. This same section of the Insurance Code states that an insurance company paying benefits under PIP coverage does not have a right of subrogation or claim against any other person or insurance company to recover any benefits by reason of the alleged fault of the other person in causing or contributing to the accident.
So, what does all this mean? First, it means that you should seriously consider talking with an experienced Insurance Law Attorney to make sure you do not handle this in an improper manner and find yourself being sued for not handling it properly. There are liens, subrogation interests, and assignments that may exist that most people are not aware of or think about, that could put a person in a position of being sued when these other interests are not properly acknowledged and / or dealt with.
In the normal car wreck situation involving injury, the injured person will often times have a health insurance plan that pays the injured persons medical bills. These bills may be paid by a private health plan such as one administered by Blue Cross / Blue Shield, Humana, or any number of other private insurers, or the bills may be paid for by a government plan such as Medicare, Medicaid, Veterans Administration, etc. Most of these plans are going to require that they be paid back or reimbursed when the injured person recovers money from some other source or third party, usually the insurance company for the person who caused the injuries.
The Federal case out of the Western District of Wisconsin, styled, Allen v. United States, decided in 1987, makes it clear that the PIP monies are not to be used to reimburse the medical provider. In the Allen case, the Veterans' Administration, (VA) paid benefits on behalf of Allen. Allen's insurance company, USAA, tried to pay $130,000 to the VA as reimbursement for medical expenses. Allen sued to protect these monies from the VA subrogation and won.
The Court in its opinion stated that the subrogation interest of the VA was limited to Allen's recovery from third parties who caused the injuries, not Allen's own insurance company benefits that were monies payable without regard to liability or fault, such as PIP.
This can be confusing, not only to the policyholder, but also to the insurance company who handles these types of situations on a daily basis across the nation. This is further complicatd by new policies and laws being written that sometimes do allow recovery of some of these "no fault" insurance coverages, such as PIP.
The worst case scenario is that when these situations are not handled properly an unknowing policyholder may find themselves on the losing end of a lawsuit that could end up costing lots of money.

Policyholders in Grand Prairie, Arlington, Mansfield, Fort Worth, Weatherford, Aledo, Azle, or any other city in Texas who have one of the coverages listed above would want to know how those coverages work if they are in a situation where the coverages may apply. A case decided by the Texas Supreme Court in 1999, gives some insight into how these types of claims are handled.
The court actually decided two cases together. They are Mid-Century Insurance Company of Texas v. Jack Kidd, and the other is Nationwide Mutual Insurance Company v. Catherine Gerlich.
The issue in both cases revolved around how PIP benefits were paid when a claim was being made against the liability portion of the same policy.
To begin with, in order to make sure that a policyholder is being treated properly, they should consult with an experienced Insurance Law Attorney. Putting that aside, and rather than getting into the specifics of each case, lets assume the following scenario:
A policyholder has PIP coverage of $2,500 and liability coverage of $20,000. The policyholder is involved in an accident wherein he has injuries and resulting medical bills and lost wages that exceed the limits of both coverges.
The question before the court was whether or not Mid-Century Insurance Company of Texas (Mid-Century) and Nationwide Mutual Insurance Company (Nationwide) only had to pay the policy limit on the larger coverage or pay the limits on both coverages. Mid-Century and Nationwide argued that they only had to pay one limit.
Without gettting into the logic of their decision, which is a good read for understanding how it works, the court's ruling was essentially this:
1) PIP is payable up to its limits;
2) the liability portion of the policy gets an offset for the monies paid under the PIP portion of the policy; and
3) where the PIP limits and the liability limits are less than the total damages, the limits of both are payable.
Using the courts ruling the policyholder would be able to recover a total of $22,500 per the above scenario.
In a second scenario assume the limits are the same but the total damages are only $14,000. In this second scenario, the injured person would be entitled to the $2,500 in PIP but only $11,500 in liability because the liability portion of the policy gets an offset for the benefits paid by the PIP portion of the policy.
The Texas Insurance Code Section 1952.159 helps explain the above to a certain degree. It says;
If a liability claim is made by a guest or passenger described by Section 1952.151 against the owner or operator of the motor vehicle in which the guest or passenger was riding or against the owner's or operatior's liability insurer, the owner or operator of the motor vehicle or the owner's or operator's liability insurer is entitled to an offset, credit, or deduction against any award made to the guest or passenger in an amount equal to the amounts paid by the owner, the operator, or the owner's or operator's automobile liability insurer to the guest passenger under personal injury protection.
This law was enacted in 2005 in response to the Supreme Court's Mid-Century decision.
How this works is not really all that confusing to an attorney familiar with it, but can be very confusing the first time it is encountered.

Substantially less than half the automobile drivers in Mansfield, Dallas, Fort Worth, Arlington, Grand Praire, Weatherford, or any other place in the State of Texas carry Personal Injury Protection (PIP) benefits on their automobile insurance policy. Dollar for dollar it is one of the more expense insurance benefits a person can purchase.
PIP covers losses for medical bills and lost wages that are incurred for incidents arising out of the use of a covered automobile. This requirement is set out in the Texas Insurance Code, Section 1952.151. It is required to be offered on all automobile insurance policies issued in the state of Texas. This requirement is found in Section, 1952.152.
This purpose of this article is to help the reader understand Texas Insurance Code, Section 1952.155 and to tell the reader that the law in this section is enforced by holdings in the Texas Supreme Court. It states some of the Texas law dealing with PIP. The title of this section is, "Benefits payable without regard to fault or collateral Source; Effect on Subrogation."
The section starts out:
(a) The benefits under coverage required by this subchapter are payable without regard to:
(1) the fault or nonfault of the named insured or recipient in causing or contributing to the accident; and
(2) any collateral source of medical, hospital, or wage continuation benefits.
Ok, what does (1) and (2) mean? One means that PIP benefits are payable no matter who is at fault in causing the loss. So regardless of who caused the injury, you or some other person, PIP will pay benefits. Number two means that the PIP benefits are payable even if you already had a medical benefits plan pay your bills or a hospital benefits plan already paid the bill. And it pays lost wages even if you had some other disability or other type of wage loss plan pay the lost wages. Both these essentially mean that a person could legally get a "double recovery" This is the only place in Texas law where this is a possibility.
Next, this section says:
(b) Except as provided by Subsection (c), an insurer paying benefits under coverage required by this subchapter does not have a right of subrogation or claim against any other person or insurer to recover any benefits by reason of the alleged fault of the other person causing or contributing to the accident.
This part (b) means that if you receive PIP benefits and it is determined that some other person was at fault for causing the injury or loss, then your the insurance company cannot attempt to recover from the other person or his insurance company any monies that have been paid to you.
The last section says:
(c) An insurer paying benefits pursuant to this subchapter, including a county mutual insurance company, shall have a right of subrogation and a claim against a person causing or contributing to the accident if, on the date of the loss, financial responsibility as required by Chapter 601, Transportation Code, has not been established for a motor vehicle involved in the accident and operated by that person.
So this section (c) is an exception to (b) in that if another person causes the accident, and the other person does not have the liability insurance required under Texas law, then the insurance company providing the PIP benefits can pursue the at fault person for the monies paid on the PIP claim.

Anytime a person buys insurance coverage for their automobile in Texas, they are given many options. These options include choices related to collision coverage, coverage for towing, rental cars, and even life insurance, to mention a few. No matter where you buy automobile coverage in Texas, whether it is Dallas, Fort Worth, Arlington, Grand Prairie, or in Weatherford , you are also given the option to buy uninsured / underinsured beneits and personal injury protection benefits also known as PIP.
In discussing PIP coverage, one should know that this coverage is regulated in the Texas Insurance Code, Sections 1952.151 thru 1952.161.
Section 1952.151 says that PIP provides payment of all reasonable expenses that arise from an accident for: A) necessary medical care, B) lost income for a wage earner, and C) reinbursement for reasonable expenses for essential services ordinarily performed by the injured person. An example of this last one would be reinbursing an injured person for having to pay someone to mow his yard because his injuries prevented him from doing it himself.
Another important thing to realize about PIP coverage is found in Section 1952.152. This section says an insurance company must provide PIP coverage in any and all polices issued in the State of Texas. This coverage is automatic unless the named insured rejects the coverage in writing.
Section 1952.153 requires that the minimum for PIP coverage be $2500. There is not a maximum required by law. A maximum is left to the discretion of the insurance company.
Section 1952.155 is another important part of PIP law. This section says that PIP benefits are payable without regard to the fault of a person seeking coverage. Also, this section says PIP is payable without regards to whether or not there is other insurance to cover the loss. In other words, this section actually allows for a "double recovery".
Section 1952.156 deals with time limits for presenting the claim for PIP benefits and the time frame for the insurance company to pay these benefits.
Section 1952.157 provides for the penalties an insurance company faces for not promptly paying claims under PIP benefits.
Another relevant section is Section 1952.159. This section allows an offset against a liability claim. This normally applies to a situation where a passenger is injured due to an insured drivers' negligence. The passenger would normally receive PIP benefits soon after an accident, then later on settle the liability claim against the driver. When the claim against the driver is settled under the liability portion of the settlement, the insurance company can take a credit or offset against the monies paid under the PIP portion of the policy.
PIP is a valuable coverage to be able to make a recovery from. And it is important to know and understand the way PIP coverage works so as to insure an insurance company adjuster does not accidentally or deliberately handle the claim wrong. Seeking the advice of an experienced Insurance Law Attorney can insure that your claim for benefits is handled properly.