Personal Injury Protection In Texas Auto Policies

Attorney Doug Goyen is a Dallas Personal Injury Protection lawyer who has been licensed in Texas since 1997 and has decades of experience representing individuals in personal injury-related cases throughout Texas. Thousands of cases have been successfully negotiated, litigated, tried, and settled by our personal injury attorney. He has gotten his clients millions of dollars in compensation.

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Our clients are well-represented by the Law Office of Doug Goyen. Our knowledge, experience, and desire for justice for our clients enable us to achieve proven results in their cases. Please contact us at (972) 599 4100. Our auto accident attorneys will begin working on your case right away.

• Do you have medical bills from your car accident that you’re concerned about paying?
• Have you lost income as a result of your car accident injury?
• Do you require medical treatment for an injury but are unsure how to pay for it?
• Do you want to be paid the full amount you are owed for your auto accident injuries?

If you answered yes to any of the above questions, you should contact the Law Office of Doug Goyen. We deliver results to our clients. The Law Office of Doug Goyen has handled thousands of auto accident injury cases and recovered millions of dollars for our clients. We have also helped countless people with their Personal Injury Protection (PIP) cases after insurance companies wrongfully denied coverage. If you need a Dallas Personal Injury Protection lawyer for your auto accident injury call us at (972) 599 4100 or use our website contact form to see if we can assist you.

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Most people have $2500 in PIP (Personal Injury Protection) coverage – this is the minimum coverage required to be “offered” in Texas when you buy an auto insurance policy. Personal injury protection (PIP) pays for not only medical bills, but also up to 80% of lost income and reasonable household duties (for example, if you couldn’t mow your lawn because of your injury, it would pay for you to hire someone to do it for you if you were doing it yourself before). Purchase as much PIP coverage as your insurance company will allow you to. Most will sell you at least $10,000.00 in PIP coverage, and some will sell you even more.

The Texas Insurance Code Section 1952.151 – 1952.161 covers Personal Injury Protection (PIP). Section 1952.152(a) of Texas law states that your insurance company must “offer” you PIP (Personal Injury Protection) when you purchase any automobile liability insurance policy in Texas. You may reject it, but you must do so in writing (See section 1952.152(b)). If there is no signed written rejection, you are covered.

Section 1952.153 states that the maximum amount of PIP coverage that an insurance company is required to provide is $2500.00 – they can provide more, but that is the bare minimum. In most cases, PIP covers up to $2500.00 (all combined) in medical bills, lost wages (80%), and reasonable household duties that could not be performed due to an injury (in other words, if you had to hire someone to mow your lawn due to your injury when you regularly did it yourself). Many insurance companies will also sell up to $10,000.00 in PIP coverage if requested – there is no maximum amount; an insurance company may sell you as much PIP coverage as they are willing to sell at or above $2500.00, but they must offer a minimum of $2500 in coverage. To protect yourself in the event of an automobile accident, you should obtain as much PIP coverage as your insurer will sell you. It is a good coverage that comes in handy if you are injured in a car accident.

1. Texas Personal Injury Protection (PIP) – must be provided:

   Personal Injury Protection is required by Texas law when a consumer purchases liability insurance. There is no requirement for the consumer to purchase PIP coverage. However, there is a requirement that PIP be “offered.” To demonstrate that Texas Personal Injury Protection (PIP) was offered and then rejected by the consumer, there must be a “signed written rejection” on file with the insurance company. If there is no signed written rejection of PIP coverage, then coverage exists… whether paid for or not. If not paid for, the minimum Texas Personal Injury Protection (PIP) limit of $2500.00 will apply.

   A new rejection is not required when the policy is renewed the following year. If the policyholder is rejected, they will continue to be without PIP coverage from renewal to renewal until they contact the insurance company and request coverage.




2. Medical Bills Covered by Personal Injury Protection (PIP) in Texas:

   Insurance companies are increasingly pushing the boundaries of what medical bills they will cover under PIP. When I was an adjuster (1989-1997), insurance companies would ensure that the treatment was related to the auto accident (rather than preexisting or from a cause unrelated to the auto accident), and that it was actually received (and not some padded bill that had services added in that were not received). That was pretty much it. The claim was paid if it was caused by the incident in question and the bills were for treatment received.

   Insurance companies are now denying claims, or portions of claims, for a variety of additional reasons. One of the more common “new” reasons is that the amount charged by your doctor was excessively high. They will reduce the amount they will pay under PIP by a reasonable amount determined by the insurance company. Part of the issue is defining what “reasonable” in this context means. Insurance companies will attempt to argue that if your doctor accepts health insurance from specific medical providers, the amount they accept contractually from those health insurers is reasonable. They will then send you a check for that amount. The issue is that they do not contact the doctor’s office to see if they will accept that amount. Unlike health insurance companies, which obtain that agreement for a contractual adjustment, most PIP insurance companies will simply send you a letter with a payment claiming that this is the “reasonable” amount of the bill without first confirming with the doctor or hospital if they will accept that “reasonable” amount. This does not make sense to me… However, this does not deter PIP insurance carriers from trying.




3. Income lost as a result of Texas Personal Injury Protection (PIP) claims:

   In Texas, PIP allows a claimant to recover lost income from their PIP claim. The insurance company may ask for proof in the form of medical documentation proving that the claimant was unable to work for the period claimed. The lost income recovered comes from the same pot of $2500 (or whatever your PIP limits are), so if you have $1500 in medical bills and another $1500 in lost income, but only have $2500 in coverage, you can only recover up to $2500 for that specific policy.




4. Reasonable Household Duties in Personal Injury Protection (PIP) Claims in Texas:

   If the injured person was not an income producer or wage earner, they may file a claim for reimbursement of expenses incurred to replace essential services normally provided by the injured party to the family or household.




5. Personal Injury Protection (PIP) Offsets in Texas:

   If you file a claim against your own insurance for Uninsured / Underinsured Motorist Bodily Injury coverage, your auto insurer may reduce the amount payable under the Uninsured / Underinsured coverage by the amount already paid under Personal Injury Protection. For example, if your claim for bodily injury under Uninsured Motorist coverage was worth $20,000.00 and the insurance company had already paid $2500 under PIP, they would claim an offset for the $2500 already paid and pay $17,500 instead (reducing the amount the claim was worth ($20,000) by the amount already paid ($2500). This differs from making a claim against another person’s liability insurance because the other person’s liability insurance is not the same insurance policy as the PIP coverage – thus, no offset is allowed in that case (where PIP and the liability settlement come from two different insurance policies).




6. Texas Personal Injury Protection (PIP) Claims with Multiple PIP Coverages:

   You may be able to collect more than one PIP policy. For example, if you have your own insurance policy for your own vehicle but were a passenger in someone else’s vehicle when you were injured, you can collect PIP benefits from both insurance policies. The coverage from two or more policies will be added together. For example, if you have a $2500 PIP policy on your own car and another $2500 PIP policy available on the vehicle you were traveling in, you essentially have $5000 in coverage, but it makes no difference if you have less than $2500 in bills or claims. In other words, if you have two policies but only have $2500 in bills, you will only receive $2500 in compensation. If you have $4000 in bills, you will receive $2500 from the primary PIP policy and another $1500 from the secondary PIP policy, totaling the $4000 you are out of pocket and must pay or be reimbursed for.




7. Subrogation and No-Fault in Texas Personal Injury Protection (PIP) Claims:

   PIP is paid regardless of who was at fault in the car accident. It makes no difference if you are the cause, the other person is the cause, or if nobody was the cause (for example, if a deer ran into your path and caused the injury) – you can still recover under PIP.

   The key question is whether you are injured while entering, exiting, or occupying a covered automobile, or while you are a covered person, and it is the result of an auto accident.




8. Texas Personal Injury Protection (PIP) Claim Time Limits:

   Insurance claims have several time limits. I’ll discuss two of them here: 1) the time limit for filing claims, and 2) the time limit for suing an insurance company for not paying a claim.

   1. Claim Submission Deadline: Texas Personal Injury Protection (PIP) will cover expenses incurred up to three years after the date of the accident. As a result, if you have a medical bill from an auto accident that you incur two years and eleven months later, it should still be covered. Expenses, such as medical treatment, incurred more than three years after the accident will not be reimbursed.

   2. Time Limit to Sue for Failure to Pay a Claim: The statute of limitations in Texas Contract Law is four years. If you file a claim with your auto insurance company for Texas Personal Injury Protection (PIP) and the insurance company wrongfully denies payment, you have four years from the date of the breach of contract to file a lawsuit to enforce your contract.

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What is the procedure for PIP? Personal Injury Protection, or PIP, is a state-mandated insurance policy in Texas.

PIP is a type of “no-fault” insurance. Texas has made PIP “no-fault” by stating that the insurance company cannot “subrogate” (collect) against any other insurance in order to recover their money. This means that the amount of money received through your PIP coverage should not affect your liability settlement with the liability insurance of another person. Section 1952.155(b) of the Texas Insurance Code states that “…an insurer paying benefits under coverage required by this subchapter does not have a right of subrogation.”

If the other driver who caused the accident does not have auto liability insurance, the insurance company may subrogate (see Section 1952.155). (c). So the PIP insurance carrier can collect from an uninsured driver, but this should not affect any claims you have against the auto liability insurance of another person.

The Importance of No “Subrogation”: To understand the importance of insurance companies not being able to subrogate, you must first understand the term “subrogation,” followed by the “collateral source” rule.

Subrogation is the process by which an insurance company that has paid a loss under its policy is permitted to collect against other insurance policies that may owe for the claim in whole or in part. For example, if your health insurance company pays for your medical bills as a result of an automobile accident caused by someone else, your health insurance company will frequently attempt to “subrogate” against the automobile insurance policy of the person who caused the accident in order to recover their money from the responsible person’s insurance.

In Practice: Often, the insurance company attempting to “subrogate” simply sends a letter to the injured person’s attorney and the other insurance company, notifying them of their “lien” on the case and demanding that their name be included on any settlement checks in order to protect their right of subrogation. They rarely hire their own attorney to do the work required to collect – the exceptions are when there is a significant amount paid out by the health insurer, and the injured party has hired an attorney to sue the other driver’s liability insurance company, in which case the health insurance company may hire an attorney to ensure they get their cut of the settlement.

PIP Carriers: Because PIP insurance carriers are not permitted to subrogate, the amount they pay should have no bearing on the amount you receive in your settlement from the liability carrier.

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The Collateral Source Rule and PIP: PIP must be paid regardless of whether there is a collateral source of the medical, hospital, or wage continuation benefits. 1952.155(a)(2) of the Texas Insurance Code. The collateral source rule has been incorporated into PIP coverage by this statutory language.

The collateral source rule is a Texas rule that states that a jury cannot consider whether insurance has paid any portion of a claim or not. As a result, the number of actual damages is the only thing introduced in a trial to prove injury damages. At the start of a personal injury trial, judges will tell jurors that they are not to consider whether or not there is insurance in the case.

Tort laws are ancient in origin. To understand the reasoning behind certain tort concepts it is helpful to understand the history of Tort Law, which derives from several sources. One of the earliest known is Roman Law under the concept of “Delict“.

In Roman law, a delict is an obligation to pay a penalty because a wrong was committed. In modern usage in countries that derive their law from Roman law, delict refers to a civil wrong, corresponding to tort in Anglo-American law. The Roman civil law of delict was primarily punitive, with fines understood as compensation, often at double and triple damages, and paid to the injured person rather than the state. The Twelve Tables, the earliest codification of Roman law (451–450 BC), depicted the law in a state of transition from a system of private vengeance to one in which the state insisted that the person wronged accept compensation rather than taking vengeance and fixed its amount.

These same ideas are still used today: the law should be fair in order to prevent people from seeking vengeance – taking the law into their own hands – for wrongs done.

The following are reasons and logic used for the collateral source rule.

1. A person who causes an injury should not be entitled to the benefits of another person’s health insurance: One reason for this is that it eliminates the need to complicate the evidence presented in a personal injury trial. If insurance is permitted, the amount paid for premiums must be introduced (because the defendant did not pay for the premiums, why should he benefit from the payments made?).

2. Subrogation: As previously discussed, health insurance companies place a “lien” on any amount recovered in an injury lawsuit – some of these liens are automatic and statutory (Medicare / Medicaid). If the jury did not pay for the amount covered by insurance, and then the health insurer “subrogated” out of the amount awarded by the jury, the amount given to the injured party would be reduced twice by the amount of the bills (first by the jury, who would take out of their award the amount paid by health insurance, and then again by the health insurer, who would take out from the award the amount paid by health insurance). Furthermore, the injured party would have had to pay premiums for this coverage, which would not have been reimbursed by the person who caused the injury or his liability insurance.

   Insurance subrogation issues arise as a result of a contract between the person who owns the health insurance and the injured party. In other words, it is a separate claim and lawsuit between the injured party and his health insurance company. If the injured person fails to repay his health insurance company in accordance with the terms of his policy, the health insurance company has the right to sue the injured party, cancel their benefits, place a lien on any settlement or judgment proceeds, and so on.

3. If the victim has health insurance, the wrongdoer receives a smaller award and the victim receives benefits he did not pay for. For example, suppose a “wrongdoer” is a repeat drunk driver who causes two separate accidents while intoxicated. Both cause the victim to suffer the same harm (two broken legs). In Accident 1, the victim has health insurance that covers his medical expenses. In accident number two, the victim is uninsured. If a jury is allowed to consider the amount of health insurance paid, the “wrongdoer” pays less in accident 1 because the victim was responsible enough to purchase health insurance. In accident 2, the victim was less responsible – he did not bother to get health insurance – but he received a larger award because the jury was unable to reduce due to health insurance. As a result, responsible people in society (those who take the time and care to actually “pay” for health insurance) are given fewer rights and awards as a result of their responsibility. It punishes those who act responsibly (buy health insurance) while rewarding those who do not act responsibly (do not protect themselves with health insurance). It also has the unintended consequence of providing the drunk driver with a benefit that they did not pay for from his victim, who did pay for health insurance.

4. Windfalls: Because the injured party “paid” the premiums for his health insurance, the injured party should be the one who reaps any “windfall” for having paid for this coverage – the “wrongdoer” who caused the injury should not be allowed this “windfall” because he had no part in paying the premiums and is not a party to the health insurance contract.

5. Dissuasion: Allowing the wrongdoer (or his liability insurance company) to avoid paying the full amount of damages – by reducing the amount by the amount paid by health insurance – lessens the law’s deterrent effect. Making wrongdoers pay for the harm they cause helps to deter them (or others) from repeating such actions. It may not deter all wrongdoers from repeating their actions, but if it only deters a few – or causes liability insurers to develop programs that encourage their insureds to be safer – then forcing them to pay for the harm they cause is worthwhile.

6. Contract vs. Tort: The benefits owed by the health insurer to the injured person are contractual. The wrongdoer has no right to compel the health insurance company to pay the medical bills – this is a contract between the injured party and the health insurer with whom he has contracted. Allowing a wrongdoer to get into the middle of a contractual relationship invites an outsider into the relationship. Allowing not just an outsider, but an outsider who has committed a wrongful act that has caused harm – who can then attempt to obtain the benefit of a contract between the injured victim and his health insurance that the injured victim had the foresight and responsibility to enter into.

7. Rich uncle: Paying medical bills through health insurance is similar to paying medical bills as a gift to someone you care about by a rich uncle, friend, or someone else. The law does not allow the wrongdoer to benefit from a rich uncle paying their medical bills because this is between the rich uncle and the injured party – whether the injured party pays the rich uncle back or it is a gift that never gets paid back, the wrongdoer still owes the full amount regardless.

8. Higher Insurance Premiums: Some argue that the collateral source rule raises insurance premiums. This isn’t the whole story, and it’s not true if you consider ALL of the insurance involved. It raises the wrongdoer’s insurance – and it should because of his wrongdoing – but it keeps the injured victim’s insurance down because they get their money back (as they should). Insurance pays the same amount – it simply shifts the burden from the victim’s to the wrongdoer’s insurance. The insurance that is then burdened is the wrongdoer’s insurance (which is the correct result).

   The amount “subrogated” is deducted from the medical bills paid by the health insurer. In other words, the health insurer of the innocent victim / injured party decreases as that health insurance receives its money back from the liability insurer, and the liability insurance for the wrongdoer increases in proportion to the amount that the health insurer decreases – so it balances out.

9. Responsibility / No Free Ride: It is the wrongdoer’s responsibility to “right the wrongs” that he caused – it is not “society’s” or the victim’s problem, it is the wrongdoer’s problem – he caused the harms, he must correct the harms. If your child breaks a neighbor’s window while playing baseball, we make that child pay for the entire amount of damage he caused in repairing the window – not just a portion of it. If you cause harm to someone or damage to someone’s property, you are required to “right the wrongs” you cause – it is your burden for causing the wrongs, not someone else’s burden, and not “society’s” problem.

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The Law Office of Doug Goyen advises you to include Personal Injury Protection in your auto insurance policy. Due to the rise in the cost of medical bills over the years, we recommend that you carry $10,000.00 in coverage. I was working as an insurance adjuster for GEICO in 1989, and the minimum limit for PIP at the time was $2500.

The minimum limit is still $2500 today – over 30 years later. You can imagine that in 30 years, the cost of medical care will have risen to the point where you should have at least $10,000.00 in PIP coverage. Carry PIP on your auto insurance if you carry the minimum, but even the minimum $2500.00 can help with out-of-pocket costs from your injuries, so carry PIP.

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Yes, if you are unsure you should consult with a personal injury attorney. If it is too small of an amount to be financially worth pursuing, they will tell you because they do not want to waste time on cases that you can easily handle yourself. If the situation is more complicated, a lawyer may advise you to hire them.

If you have been injured and need to file a claim for your injuries, you should at the very least consult with an attorney who is familiar with the process and pitfalls of filing an auto accident and injury claim. With all of the different types of insurance that may be available for an auto accident, you should consult with an attorney who understands how it works and how to submit your claims on your behalf – so you recover the full amount you are entitled to, and so you do not jeopardize any insurance policy or coverage you have by submitting the claims incorrectly.

Contact us today to speak with a Dallas Personal Injury Protection lawyer. Call the Law Office of Doug Goyen at (972) 599 4100 for a lawyer who is licensed, has over 23 years of experience in injury matters, and worked for the automobile insurance industry as a claims adjuster for 7 years prior to becoming an attorney. We can assist.

If you or someone you know needs help with an injury case, call (972) 599 4100 for a free consultation and strategy session with our auto accident attorney. We summarize your case in an easy-to-understand format as part of our strategy. (You can use this when discussing the case with other attorneys if you decide to do so.) We identify the legal issues at stake. We determine which legal issues will help you achieve the best results. Whether you hire us or not, if you want a copy of the strategy session, we will email it to you. If you want a second opinion on your case, you can use it to compare it to other law firms.

Call For A Free Case Review (972) 599 4100

The Law Office of Doug Goyen handles personal injury cases throughout Texas. This includes auto accidents (car accidents, 18-wheeler accidents, motorcycle accidents, pedestrians struck by vehicles, and bicyclists struck by autos), premises cases (such as injuries caused by a dangerous condition on a property), dog bite cases (or other animals where the owner let their animal loose or had a dangerous animal and the owner’s negligence causes injury to someone else), and work accidents.

By Doug Goyen, douggoyen@goyenlaw.com

Related Auto Insurance Pages:

• Auto Insurance Used in Accidents
• Auto Accident Liability Insurance
• Collision, Comp, Rental and Towing Insurance
• Medical Payments Insurance Coverage in Texas
• Personal Injury Protection in Texas
• Uninsured Motorist Coverage in Car Wrecks

Related Auto Insurance Company Pages:

• Allstate Claims Injury Lawyer Timelimits To Investigate Claims
• State Farm Claims Injury Lawyer

Related Insurance Issues Pages:

• Damaged Vehicle and Liability Insurance
• Insurers Denying Accident Claims
• Negotiating Auto Insurance Car Wrecks
• Suing the Auto Liability Insurer
• Adjuster Investigating the Claim. Do I Need a Lawyer?
• Insurers’ Conflicts of Interests in Accidents
• Who Pays If Insurers Don’t?

The following is an example of what the automobile insurance policy typically looks like under the Personal Injury Protection portion of the policy.

INSURING AGREEMENT

1. 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.

   Our payment will only be for losses or expenses incurred within three years from the date of the accident.

2. Personal Injury Protection benefits consist of:

   1. Reasonable expenses incurred for necessary medical and funeral services.

   2. Eighty percent of a covered person’s loss of income from employment. These benefits apply only if, at the time of the accident, the covered person

      1. was an income producer; and
      2. was in occupational status.

      These benefits do not apply to any loss after the covered person dies.

   3. Loss of income is the difference between

      1. income that would have been earned had the covered person not been injured, and
      2. the amount of income actually received from employment during the disability.

   4. If the income is earned as of the date of the accident is a salary or fixed remuneration, it shall be used in determining the amount of income that would have been earned. Otherwise, the average monthly income earned during the period (not more than 12 months) preceding the accident shall be used.

   5. Reasonable expenses incurred for obtaining services. These services must replace those a covered person would normally have performed:

      1. without pay;
      2. during a period of disability; and
      3. for the care and maintenance of the family or household.

   6. These benefits apply only if, at the time of the accident, the covered person:

      1. was not an income producer; and
      2. was not in occupational status.

   These benefits do not apply to any loss after the covered person dies.




3. Covered person as used in this Part means:

   1. You or any family member;

      1. while occupying; or
      2. when struck by a motor vehicle designed for use mainly on public roads or a trailer of any type.

   2. Any other person while occupying your covered auto with your permission.

We do not provide Personal Injury Protection Coverage for any person for bodily injury sustained:

1. In an accident caused intentionally by that person.
2. By that person while in the commission of a felony.
3. By that person while attempting to elude arrest by a law enforcement official.
4. While occupying, or when struck by, any motor vehicle (other than your covered auto) which is owned by you.
5. By a family member while occupying, or when struck by any motor vehicle (other than your covered auto) which is owned by a family member.

The limit of liability shown in the Declarations for this coverage is our maximum limit of liability for each person injured in any one accident. This is the most we will pay regardless of the number of:

1. Covered persons;
2. Claims made;
3. Vehicles or premiums are shown in the Declarations; or
4. Vehicles involved in the accident.

If there is other Personal Injury Protection Insurance, we will pay only our share. Our share is the proportion that our limit of liability bears to the total of all applicable limits. However, any insurance we provide with respect to a vehicle you do not own shall be excess over any other collectible Personal Injury Protection insurance.

(Typically there is a provision in the policy under PIP that states their “time limits” indicating how fast they are required to make payments and a provision that states they will honor any “Assignment of Benefits” from your medical facilities – meaning that if your doctor’s office has an assignment of benefits from you when you filled out your paperwork at the doctor’s office if the PIP adjuster sees a copy of that assignment of benefits they can pay the doctor’s office directly for their bill).

• The Other Driver Will Not Contact Their Insurance Company