How to File a PIP Claim After a Car Accident

To file a personal injury protection claim, you notify the insurer that covers the car you were in, usually your own, as soon as you can after the accident, then send the claim form, your medical bills, and proof of any lost income within the deadlines your state sets. PIP pays regardless of who caused the crash, so you do not have to wait for anyone to decide fault. What you do have to do is move quickly, because several states attach short and strict time limits to these claims.

What PIP pays for

PIP is injury coverage. It does not repair cars. The Washington Office of the Insurance Commissioner describes it as helping pay medical and hospital costs, wages you lose from missing work, services you cannot perform because of the accident, and funeral costs, and it says PIP applies no matter who is at fault. Exactly which of those benefits you have, and how much of each, depends on your state and the limits on your policy.

Who to file with

Because PIP follows the vehicle and the household rather than fault, the right insurer is not always obvious. New York's Department of Financial Services gives a clear order:

• If you were a driver or passenger, file with the insurer of the car you were riding in
• If you were a pedestrian, file with the insurer of the car that struck you
• If that car is unknown or uninsured, file with the insurer of a relative in your household who had an auto policy at the time
• If no one in the household had a policy, New York directs the claim to the Motor Vehicle Accident Indemnification Corporation

Washington adds a condition worth knowing: to make a PIP claim there, the car you or your relative was driving must be listed on the declarations page of your auto policy. Other states set their own rules, so if you are unsure which policy applies, call your insurer and ask before a deadline passes.

The deadlines that matter

This is where most PIP claims go wrong. The time limits are set by each state, and they can be much shorter than the general deadline for an ordinary insurance claim.

• New York requires written notice of the claim within 30 days after the accident, health care bills within 45 days, and lost wage claims within 90 days
• New York counts from the date you mail or submit the notice, starting the day after the accident, so an accident on January 1 means notice must go out by January 31
• New York allows late notice only if you submit written proof giving a clear and reasonable justification for missing the deadline
• Florida's PIP medical benefits apply only if the injured person receives initial services and care within 14 days after the accident
• Washington's PIP medical benefit is available for up to three years from the date of the accident

If you live somewhere else, find your own state's rule in your policy's PIP section or on your state insurance department's website. Do not assume another state's window applies to you.

Step by step

• Get medical care promptly, and keep every record and bill
• Report the accident to the insurer of the car you were in, and ask for the PIP or no-fault application form
• Complete the application and send it in writing, keeping a dated copy
• Have your providers submit bills to the insurer, or send them yourself, within your state's deadline
• If you missed work, send proof of lost income such as a letter from your employer or pay records
• Answer requests for more information quickly; the insurer may ask for records or a medical examination
• Keep a log of every call, letter, and payment

What the benefits look like

Benefit amounts are set by state law and by the coverage you bought. A few examples from the states themselves:

• New York's basic no-fault benefit is $50,000, and you can claim Additional PIP if you bought it
• Florida's PIP pays up to $10,000 in medical and disability benefits, with medical benefits at 80 percent of reasonable expenses; it is limited to $2,500 if a provider determines there was no emergency medical condition
• Washington's standard PIP pays up to $10,000 per injured person for medical and hospital costs, and lost wages of up to $200 a week once someone has been disabled for 14 days in a row

PIP also has exclusions. New York says motorcycle operators and passengers are excluded from no-fault benefits, and Washington's PIP does not cover injuries from motorcycles, mopeds, farm equipment, or off-road vehicles. Check your policy before you assume a claim is covered.

How payment and disputes work

Florida's statute says PIP benefits are overdue if they are not paid within 30 days after the insurer receives written notice of the covered loss and the amount. If a Florida insurer pays only part of a claim or rejects it, it must give you an itemized explanation of what it reduced or declined and why.

In New York, disputed no-fault claims can go to arbitration through the American Arbitration Association. If an arbitration award or conciliation agreement is not paid within 30 days, you can ask the Department of Financial Services to enforce it through its online complaint system.

The bottom line

A PIP claim is filed with the insurer of the car you were in, and it pays regardless of fault, but it runs on state deadlines that can be as short as two weeks for care or a month for notice. Get treated quickly, give written notice right away, send bills and wage proof on time, and keep copies of everything. If benefits are cut or denied, use your state's dispute process rather than letting the claim stall.