How a Texas PIP Claim Works After a Wreck

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Personal injury protection, or PIP, is the part of a Texas auto policy that pays you after a wreck no matter who caused it. It is often the first money available for medical bills and lost pay, weeks or months before the other driver’s insurer pays anything. Many people do not know they have it. This article explains how a PIP claim works under Chapter 1952 of the Texas Insurance Code.

Do you have PIP?

Probably. An insurer may not issue an auto liability policy in Texas without PIP coverage unless a named insured rejects it in writing (Insurance Code 1952.152). Once rejected, the insurer does not have to add it back to a renewal unless the named insured asks in writing. Look at your declarations page. If PIP is not listed, ask the insurer for the signed rejection; if there is none, the coverage should be there.

Who it covers

Section 1952.151 extends PIP to the named insured, members of the insured’s household, and any authorized driver or passenger in the insured car, including a guest. So a passenger hurt in a friend’s car can usually claim under the friend’s PIP, and a household member can often claim under the family policy even when riding in someone else’s car, depending on the policy’s terms.

What it pays

• Necessary medical, surgical, x-ray and dental services, prosthetic devices, ambulance, hospital and nursing services, and funeral services
• For someone who earns an income, replacement of income lost because of the wreck
• For someone who did not earn an income, reasonable expenses for essential household services the person would have done

The expenses must arise from the accident and be incurred within three years of it (1952.151). The law does not require an insurer to offer more than $2,500 per person (1952.153), so many policies carry that amount, though higher limits can be bought. The insurer may ask for reasonable medical evidence of the injury that caused the lost income (1952.154).

Fault does not matter

PIP benefits are payable without regard to the fault of the insured in causing the collision, and without regard to other medical, hospital or wage benefits you have (1952.155). Even a driver who caused the wreck can claim PIP. The only exclusions in the statute are for injuries a person caused intentionally, or suffered while committing a felony or fleeing the police (1952.158).

How to claim, and how fast it must pay

1. Report the wreck to your insurer and ask for a PIP application.
2. Send the application with the medical bills and records, and evidence of lost income such as pay stubs or an employer’s letter.
3. Keep sending new bills as treatment continues. The insurer must pay as claims arise and no later than 30 days after it receives satisfactory evidence of a claim (1952.156).
4. Note the deadline in your policy. The law lets a policy require the first claim for benefits to be presented within a period of not less than six months after the accident (1952.156(b)).

If the insurer fails to pay benefits when they are due, you may sue for them, and if it was required to pay, you are entitled to reasonable attorney’s fees, a 12 percent penalty and interest from the date the payment became overdue (1952.157).

Do you pay PIP back from a settlement?

Usually not. A PIP insurer has no right to recover what it paid from the driver who caused the wreck, unless that driver did not have the insurance Texas requires (1952.155). In most cases the PIP money is yours to keep, and your claim against the at-fault driver is not reduced by it. The exception is a passenger’s claim against the driver of the car the passenger was in: that driver’s insurer can deduct the PIP it paid (1952.159).

PIP is only the start

PIP limits are small next to a serious injury. It is meant to pay the first bills while the larger claim against the at-fault driver, and if needed your own underinsured motorist coverage, is built. Our car accident attorney San Antonio page explains how PIP, liability and UM/UIM coverage work together, and our Texas car accident laws page lists every section.

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