Articles Posted in Personal Injury Protection (PIP)

In Texas automobile policies where the insured has opted to purchase uninsured motorist (UM) coverage, there is an offset for amounts paid under the PIP coverage.

The basis for the PIP offset can be found in the policy language of the uninsred/underinsured motorist policy provision, which provides:

In order to avoid insurance benefits payments in excess of actual damages sustained, subject only to the limits set out in the Declarations and other applicable provisions of this coverage, we will pay all covered damages not paid or payable under any workers compensation law, disability benefits law, any similar law, auto medical expense coverage or Personal Injury Protection Coverage.

Insurance lawyers in the Dallas and Fort Worth area need an understanding as to what Personal Injury Protection (PIP) benefits cover and do not cover.

PIP consists of reasonable expenses incurred for necessary medical and funeral services as well as replacement of 80% of income lost during the period of disability up to the amount of PIP policy limits.  To receive the lost income benefits, the covered person must have been an income producer in an occupational status at the time of the accident.  When an insured had not yet reported to a summer job that was to start two days after the accident and had not yet earned any wages, the court upheld a jury verdict that the insured was not an income producer.  This was the result in the Houston Court of Appeals [1st Dist.] 1981, opinion styled, Slocum v. United Pacific Insurance Co.  The court did point out that “one does not have to be at work at the time of the accident to be in an occupational status.”  Thus, one simply needs to commence earning income before the accident to be considered an income producer in an occupational status.

If the covered person was not employed, PIP benefits include expenses incurred for obtaining services that the covered person would have performed had they not been injured.  If should be noted that the covered person must make an election as to whether he or she wishes to recover for lost income or the costs incurred in obtaining substitute services.  He or she cannot recover both.

Personal Injury Protection (PIP) coverage is different than other types of injury coverage.

PIP coverage exists if the insured or their family member is struck by a “motor vehicle” designed for use mainly on public roads or a trailer of any type according to the 1984, Houston Court of Appeals [1st Dist.] opinion styled, National County Mutual Fire Insurance Co. v. Wallace.  In Wallace, the court upheld a jury verdict that a forklift was a “motor vehicle” for purposes of PIP.  This holding was based mainly on the fact that the particular forklift in question had been used on a public road, as specifically required in the PIP language.

PIP benefits consist of reasonable expenses incurred for necessary medical and funeral services as well as replacement of 80% of income lost during the period of disability up to the amount of PIP policy limits.  To receive the lost income benefits, the covered person must have been an income producer in an occupational status at the time of the accident.  When an insured had not yer reported to a summer job that was to start two days after the accident and had not yet earned any wages, the court upheld a jury verdict that the insured was not an income producer.  This occurred in the 1981, Houston Court of Appeals [1st Dist.] opinion styled, Slocum v. United Pacific Insurance Company.  The court did point out that “one does not have to be at work at the time of the accident to be in an occupational status.”  Thus, one simply needs to commence earning income before the accident to be considered an income producer in an occupational status.

To be covered under most auto insurance Personal Injury Protection (PIP) provisions, a person needs to be “occupying” a vehicle.

“Covered person” as used in PIP coverage means the named insured or any family member while occupying or when struck by a motor vehicle designed for use maily on public roads or a trailer of any type.  “Covered person” also includes any person occupying the covered auto with the named insured’s permission.

Most PIP claims arise out of accidents when an insured, a family member, and/or a friend of the insured are “occupying” an insured vehicle.  The policy contains a very broad definition of “occupying.”  For example, when an insured injured himself in the act of getting out of the car, the Fort Worth Court of Appeals held that the insured was “occupying” the vehicle.  This was decided in 1976, and the case was styled, Berry v. Dairyland County Mutual Insurance Co.

Personal Injury Protection or PIP is insurance that can be purchased with auto insurance .  It is unique in its coverage.

One Texas court has construed “motor vehicle accident” narrowly in the context of PIP coverage.  Specifically, it held that “motor vehicle accident” does  not include all accidents that occur in a motor vehicle.

In the 1996, Houston Court of Appeals [1st Dist.] opinion styled, Schulz v.  State Farm Mutual Automobile Insurance Co., Schulz’s passenger ordered him out of the truck and fatally shot him.  The appeals court upheld summary judgment in favor of State Farm, which had denied coverage because PIP benefits provide for payment of damages as a result of “a motor vehicle accident.”  According to the court a motor vehicle accident does not include all accidents that occur in a motor vehicle.  Because there was no casual relationship between the vehicle and the victim’s death, there was no “motor vehicle accident.”  Therefore, Schulz was not entitled to recover PIP benefits simply because a covered vehicle may have been used in his demise.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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