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What Is First-Party Medical Benefits and PIP Coverage?

Posted on May 26th, 2019

Pennsylvania is one of 12 states that abide by no-fault car insurance laws. Under the no-fault system, individuals involved in an auto accident will file damage claims with their own insurance companies regardless of who caused the accident. Instead of determining fault and filing with that party’s insurance provider, all involved parties will file with their own insurers. Claims between an accident victim and his or her own insurance company are called first-party claims.

What Are First-Party Benefits?

A first-party claim for medical benefits is an insurance claim submitted to the accident victim’s own insurance policy that seeks payment for medical care after an auto accident. In Pennsylvania, all drivers must carry at least the minimum required auto insurance for medical bill coverage. These requirements include a certain amount in bodily injury protection to pay for medical services after a car accident.

  • $5,000 in property damage liability coverage
  • $5,000 in first-party medical benefits
  • $15,000 per person and $30,000 per accident in bodily injury liability coverage
  • $15,000 per person and $30,000 per accident in uninsured and underinsured motorist coverage

First-party benefits specifically cover medical expenses for you and your passengers after an accident. They are a special type of insurance available only in Pennsylvania. This coverage will pay for medical and dental expenses, hospital stays, professional nursing care, and prosthetic limbs. If you purchase more than the basic plan, first-party benefits will also cover reasonable funeral and burial expenses after a fatal accident. The minimum coverage is $5,000, but many drivers pay for additional coverage.

Understanding Personal Injury Protection Insurance

In no-fault insurance states like Pennsylvania, the Department of Motor Vehicles requires all drivers to carry personal injury protection, or PIP, insurance. PIP coverage can provide compensation to cover the victim’s medical bills, lost wages, property damage repairs, and wrongful death damages – even if the victim caused the car accident. PIP insurance is a type of no-fault insurance that will cover the policyholder’s losses regardless of the degree of negligence.

The minimum required amount of PIP insurance in Pennsylvania is $5,000 per person, per accident. However, many residents choose to purchase additional PIP insurance for better coverage after an accident. You may be eligible for personal injury protection benefits after a car accident if you are the insurance policyholder, a household member of the insurance policyholder, if the policy covers the vehicle in which you were a passenger, or if you were a pedestrian or bicyclist involved in the crash.

To receive compensation through your PIP policy in Pennsylvania, you will provide your auto insurance policy information and claim number at the medical office where you received care. The doctor’s office will most likely bill the insurance company directly – saving you the trouble of mediating between the hospital and the insurance company. Unlike using health insurance, your auto insurance policy will not make you pay any deductibles or co pays to receive medical care. A PIP claim should not affect your insurance premiums, even if you were at fault.

How to File an Insurance Claim in Pennsylvania

If you get into a car accident in Philadelphia, stay on the scene and call the police for an official investigation and report. Swap insurance information with the other driver, even though you will file your claim with your own provider. Seek medical care for any injuries immediately. Delaying your hospital visit could hurt your insurance claim by showing the provider that you did not suffer serious injuries.

Once you have received medical treatment, call your own auto insurance company to report the accident and file your initial claim. Insurance companies often try to minimize claimants’ payouts through delay-and-deny tactics. Do not let your insurance provider take advantage of you during the claims process. Hire a Philadelphia personal injury attorney to take over settlement negotiations on your behalf.