ARRESTED?
TIME TO CALL ANTOINE!
TIME TO CALL ANTOINE!
Is Delaware a No-Fault State in Accident Cases? Clearing Up the Confusion: PIP Insurance Explained
There is a lot of confusion in Delaware about what “no-fault” means. It means Delaware is no-fault as to medical treatment and lost wages up to your own insurance policy limits.
Explain: How Do Personal Injury Protection (PIP) Benefits Work?
PIP insurance covers your own medical bills up to policy limits or 80% of any lost wages up to your policy limit. Delaware drivers are required to carry at least $15,000 per person/$30,000 per accident in PIP coverage. That means your insurance will cover the first $15,000 in medical bills free and clear without co-pays. If you purchased more than $15,000 in PIP coverage you will probably be in good shape. If you have health insurance and lost time in work, you may want to apply PIP to any lost wages. When the case settles, the other driver’s insurance will still have to pay for your pain and suffering and to fix your car if they are at-fault.
- DE Legal Tip – You should request a PIP application from your insurance company and get a PIP claim number. Use the PIP claim number to treat when you go to the doctor. Call Jason R. Antoine at (302) 482-4802, we do this for our clients.
The Reasoning Behind PIP
My clients sometimes get annoyed because they believe the at-fault party should pay for their medical bills. I tell them that the reasoning behind PIP is solid. The PIP no-fault system is good because insurance companies can deny liability! In other words, an injured person without medical insurance could have difficulty getting treated if the system was fault based. PIP enables those that are seriously injured without health insurance to get treatment. We don’t want seriously injured people languishing in pain. PIP helps people that don’t have insurance get the treatment they need and keeps medical bill collectors off of their backs.
What happens if my Medical Bills are more than my PIP coverage policy limits?
Once your PIP benefits are used up, you will have to use your health insurance or Medicare or Medicaid. Let’s say you have $15,000 in PIP insurance and your medical bills are $20,000. You will likely use your own health insurance or Medicare or Medicaid to pay the extra $5,000. Lawyers call this extra $5000 “boardable damages.” Boardable means you can show this extra $5000 to a jury or insurance company and get paid back at the end of the case.
E.g. – if you had 100k in medical bills and you only had 15k in PIP, 85k would be boardable. You would try to get paid for the 85k and pain and suffering and other damages. (let’s say 250k for P&S and misc damages) At the settlement table or trial we would in theory go after 85k for medical bills + 250k for P&S for a total of 335k.1 Health insurance would get paid back the 85k.
- DE Legal Tip – a good attorney will try to reduce that health insurance bill or lien so you get more money in your pocket.
What if I don’t have Health Insurance?
If you do not have health insurance, I can help you find a doctor that will work on a letter of protection (LOP). A letter of protection is where you sign a letter from the doctor agreeing to pay the doctor back out of the settlement proceeds.
A Review of Who Pays Medical Bills in a Delaware Auto Accident
- Your Own Personal Injury Protection Insurance (PIP) (APPLY FOR PIP!)
- Medical Insurance or Medicare/Medicaid
- When all Else Fails: Treat with the Doctor on a Letter of Protection
- Sue or Settle with the At-fault driver’s Insurance to Recoup Medical Bills above PIP.
- Health Insurance, Medicare/Medicaid or the LOP Doctor will Get Paid Back After Recovery
A Potential Landmine: The Independent Medical Examination or I.M.E.
Your insurance company could play a dirty trick on you. They could hire a doctor to examine you and say that the PIP medical expenses are not reasonable or related to the accident and cut off your PIP benefits. This is called a PIP denial. At that point, I would fight fire with fire. I would talk to your doctor, get him or her to write a letter on your behalf and I would file a complaint with the Delaware Insurance Commissioner. Most of the time this works and you will get the rest of your PIP money. You want to use your PIP because health insurance will have a lien on your recovery at the end of the day. It is better to use PIP benefits if they are available.
Contact Us
Contact Jason R. Antoine, Delaware Accident Attorney located in Wilmington, DE for a free consultation at (302) 482-4802. Do not hesitate to call if you were in an accident and have any questions about PIP or no-fault insurance or have been denied PIP benefits.
1 If the at-fault has that amount of insurance coverage available. These numbers are fictional and for illustration purposes only. These figures have no bearing on your potential case.