Medical Benefits & PIP Coverage Law


Car crash heavy damage philaWho pays for medical benefits after a car accident in Pennsylvania? Usually, it’s an injured individual’s car insurance company, via PIP (Personal Injury Protection) benefits which covers medical bills. $5,000 is the minimum amount in PIP coverage required on all car insurance policies in Pennsylvania. After the $5,000 is exhausted, the individual’s own health insurance (private, Medicare, etc.) kicks in. If another party is liable for the accident, an injured individual can seek monetary damages for medical expenses by filing a car accident lawsuit.

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Medical Benefits After a Pennsylvania Car Accident – What is PIP?

If you’re a Pennsylvania resident and you’re injured in a car, truck or pedestrian accident, you’re probably wondering how your medical bills get paid. It’s usually via the injured individual’s car insurance policy’s PIP (Personal Injury Protection) coverage. PIP is mandatory on every car insurance policy issued in this state and covers medical bills, lost wages and other expenses, like household help. The minimum amount required under PA law is $5,000 per person, per accident, although many people purchase higher PIP coverage amounts. If dad and child are injured in a car accident, they can both make a separate claim for PIP benefits, up to the amount purchased. If they have a $5,000 PIP coverage policy, each can make a claim for up to $5,000.

Pennsylvania is a no-fault state. In other words, PIP coverage applies to anyone insured under the policy and applies without regard to fault. This means that if you’re injured (whether you caused the accident or not), you are eligible for PIP benefits. Also, your car insurance premiums can’t be increased if you make a PIP claim.

Related: Philadelphia Car Accident Injuries – Who Had the Right of Way in an Intersection Accident?

Priority of PIP Coverage After a Car Accident

What happens when there are multiple car insurance policies (PIP coverage)? Under Pennsylvania auto insurance law (Motor Vehicle Financial Responsibility Law, or MVFRL), there’s an order to PIP coverage for all car, truck or pedestrian accidents:

  1. your own insurance policy (i.e., you’re the named insured),
  2. if 1 doesn’t apply, the policy you’re covered under (i.e., a parent’s policy),
  3. if 1 and 2 don’t apply, the policy of the car you were riding in, and
  4. for pedestrians without any insurance, the policy of any car involved in the accident.

Insurance coverageExample: A Philadelphia resident (AB) is a passenger in a car (Car 1) owned and driven by her friend (CD). They are heading to the Poconos when they are hit at an intersection. The accident was caused the driver (EF) of the other car (Car 2). As a result of the accident, Car 1 is pushed into a crosswalk and hits a pedestrian (GH). Everyone is injured and needs medical treatment. Here’s how PIP benefits would get paid.

  1. Let’s assume AB had her own policy (or was covered under a parent’s policy). AB’s medical bills get paid by her own car insurance company (or her parent’s car insurance policy). If AB didn’t have any insurance at all, she could make a claim under CD’s car insurance policy.
  2. CD would make a claim under her own car insurance policy, i.e., the policy covering the car CD was driving when the accident happened.
  3. The driver of Car 2, EF, would make a claim for medical benefits under their own car insurance policy.
  4. The pedestrian, GH, could make a claim under either CD or EF’s car insurance policy, but only if GH didn’t have their own car insurance policy. If GH did have a policy or was covered under one, GH would be in the same shoes as AB, i.e., medical bills would get paid by their own policy or the policy covering them.

Out of State Residents & Motorcycles

The legal principles discussed above usually won’t apply to out of state residents and definitely won’t apply to PA motorcycle owners. Out of state residents who have their own car insurance policies or are covered under someone else’s policy will probably have to make a PIP claim in accordance with the laws of their own states. However, if an out of state resident has zero car insurance, they would be able to make a PIP claim under the policy of the car they were riding in, or if they were a pedestrian, any car involved in the accident.  For example, a New Jersey resident is visiting Philadelphia and is riding in their friend’s car when they get into an accident. If the NJ resident has zero insurance, they could make a PIP claim under their friend’s car insurance policy.

Under PA car insurance law, motorcycle owners are excluded from having PIP coverage at all. That’s because the PA legislature gave car insurance companies a pass for motorcycle accidents, mostly because motorcycle accident injuries tend to be very costly. What this means for motorcycle drivers who get injured in accidents is that their own health insurance pays for everything.

For more info, visit the Philadelphia Car Accident Law Library.

Philadelphia, PA Car Accident Law Firm – We Help Clients Recover Medical Bills After Accidents

Our car accident injury law firm handles medical bill claims after car accidents. Contact us for a FREE consultation at (215) 985-0777.

Last reviewed and updated: July 2, 2020