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Personal injury protection


What does personal injury protection coverage do?

Personal injury protection (PIP or MEDEX) pays a per-person benefit amount for injuries you (the insured), and others specified in your policy, sustain in an auto accident.  Basic personal injury protection coverage is for the insured's own injuries on a first-party basis, without regard to fault.

Parties typically covered by PIP include:

  • Policyholder
  • Policyholder’s relatives in the same household
  • Passengers (if they don’t have their own PIP coverage to place claim under)
  • Other authorized drivers of your insured vehicle
  • Policyholder and family members if they are injured while riding in someone else’s car
  • Policyholder and family members if struck by another vehicle when a pedestrian (in some states).

The exact benefits offered by PIP vary by state, and there may be a deductible due before the benefits kick in. Coverage varies widely among states, so the terms of your policy will note your specific benefits, but in general personal injury protection coverage includes:

  • Medical expenses – May include reasonable charges for medical, hospital, surgical, nursing, dental, ambulance and x-ray services. Necessary medications, medical supplies and prosthetic devices may also be covered.
  • Loss of essential services (also sometimes referred to as disability or replacement services) - Can receive benefits if you need help performing household or other tasks due to your injury.  
  • Loss of income
  • Funeral expenses
  • Survivor’s loss – some policies compensate an individual’s heir(s) if the person died from accident-related injuries.

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Your PIP limits set the maximum amount that will be paid per person for any combination of covered expenses.  PIP limits vary by state; some states allow you to choose your PIP limits and others set it to a certain amount like $10,000, unless you choose to buy additional PIP coverage.

Is personal injury protection coverage mandatory?

Yes, in no-fault states personal injury protection coverage is required (and is typically referred to as no-fault coverage).  In other states, it’s optional, if available at all.

According to the Insurance Information Institute (III), currently 12 states and Puerto Rico have no-fault auto insurance laws in place.  These states include: Florida, Hawaii, Kansas, Kentucky, Massachusetts, Michigan, Minnesota, New Jersey, New York, North Dakota, Pennsylvania and Utah. 

Three of these states, New Jersey, Pennsylvania and Kentucky, have “choice” no-fault laws.  In these states you can retain your right to sue for auto accident injuries if you reject the lawsuit threshold.  For this privilege you will pay a higher premium.

What happens if I don’t have personal injury protection coverage?

If this no-fault coverage is optional in your state and you choose to go without, when you are at-fault in an accident or the at-fault party cannot cover your injuries, you will need to have coverage such as medical payments on your policy or you may end up paying out-of-pocket for your medical bills.

If you have adequate health insurance and your state doesn’t require this coverage, then personal injury protection coverage may be unnecessary. 

PIP-related coverage:

Additional personal injury protection is available in some states (and by only some carriers) where PIP is available.  Additional PIP acts as a supplement to the PIP coverage required by your state.  It allows you to raise your PIP maximum limit amount.

Extended personal injury protection is available in Florida where personal injury protection coverage typically pays 80 percent  of medical expenses and 60 percent of lost wages.  Purchasing extended PIP allows you to amend your PIP so that 100 percent of medical expenses and 100 percent of lost wages will be paid (up to the maximum limits of your PIP coverage).  The Florida Department of Financial Services Insurance Library gives more information on increased PIP benefits.

Guest personal injury protection is available in Kentucky and provides coverage to guest passengers in your vehicles. It is required when all drivers on your policy have rejected no-fault coverage. (Kentucky is a choice no-fault state).

In states such as New Jersey, you have to choose a Personal Injury Protection Plan. Here is a description of those choices:

       Full PIP Primary acts as the primary coverage for injuries sustained by you or your passengers in an auto accident. This option also covers income continuation, funeral expenses, death benefits, and essential services expenses.

        Full PIP Health Primary should be purchased if another health insurance provider acts as the primary coverage for injuries sustained by you or your passengers in an auto accident. This option also covers income continuation, funeral expenses, death benefits, and essential services expenses, as detailed below.

        Full PIP health primary coverage is not available if you use Medicare or Medicaid as your primary health insurance or if you are an active member of the military. In addition, some health insurers do not cover injuries related to car accidents. If you are unsure of what your health insurance covers, you should select full PIP primary or medical only PIP primary.

        Medical Only PIP Primary acts as the primary coverage for injuries sustained by you or your passengers in an auto accident.

        Medical Only Health Primary should be purchased if another health insurance provider acts as the primary coverage for injuries sustained by you or your passengers in an auto accident.

        Medical only health primary coverage is not available if you use Medicare or Medicaid as your primary health insurance or if you are an active member of the military. In addition, some health insurers do not cover injuries related to car accidents. If you are unsure of what your health insurance covers, you should select full PIP primary or medical only PIP primary.

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