PIP and MedPay claims: medical bills from your own policy

What PIP and MedPay each pay

A standard personal auto policy is built in parts: liability (Part A), medical payments (Part B), uninsured motorists (Part C) and damage to your auto (Part D). MedPay sits in Part B. PIP is added where a state requires it or makes insurers offer it, and its terms follow that state's law. Both are first-party coverages: you claim from your own insurer, not from the driver who hit you.

Some at-fault states also require or offer PIP. Texas insurers must offer at least $2,500 of PIP, and it is included unless you reject it in writing. Delaware requires PIP of at least $15,000 per person and $30,000 per accident, yet keeps your right to sue the driver at fault. The minimum coverage your own state requires is covered by our sister site Brookguard.

No-fault states and the tort threshold

In a no-fault state, your own PIP pays your injury costs first, and you can sue the other driver for pain and suffering only when the injury crosses a line the law draws. That line, the tort threshold, is described in words in some states and in dollars in others. Damage to the car stays outside no-fault: it is paid by the at-fault driver's liability insurer or by your own collision coverage. The table shows four states with state pages on this site.

Delaware works differently. It requires PIP but is an at-fault state, so you can still sue the driver who caused the crash. You just can't recover in that lawsuit the costs PIP already paid.

A few states let you pick. Pennsylvania, a choice no-fault state, requires at least $5,000 of first-party medical benefits and asks each policyholder to choose full tort or limited tort. Full tort keeps an unrestricted right to sue for pain and suffering. Limited tort keeps your claim for economic losses but allows that suit only for a serious injury or an exception in the statute, such as a crash with a drunk driver. If you never returned the election form, the law presumes full tort. Your choice is printed on your declarations page, so check it before you assume what you can claim.

Making a PIP or MedPay claim

1. Tell your insurer quickly, in writing. New York's Department of Financial Services says to give the no-fault insurer written notice within 30 days of the crash. Other policies require notice "promptly".
2. Get care early. In Florida, PIP medical benefits apply only if you receive initial services and care within 14 days of the crash, and without a finding of an emergency medical condition PIP pays at most $2,500 for medical care.
3. Send the bills and the proof of lost income. Ask the insurer which forms it needs, give your providers the claim number, and keep copies of wage statements from your employer.
4. Watch the payment clock. Florida PIP benefits are overdue 30 days after written notice of a covered loss and its amount. Hawaii and Delaware give the insurer 30 days after proof to pay or deny in writing, with interest on late payments.
5. Keep a log of each bill, the date you sent it and what was paid. Explanation-of-benefits letters show which charges the insurer reduced and why.

What to do about your health itself is a separate question; our page on getting medical care after a crash covers the records an adjuster will ask for.

A worked example: a Florida PIP claim

Inputs: a Florida crash, care started within 14 days, and a treating provider finds an emergency medical condition. Your medical bills come to $6,000 and you lose $2,000 of gross income while you recover. Florida PIP pays 80% of reasonable medical expenses and 60% of lost gross income, up to $10,000 in total.

The $6,000 PIP pays stays under the $10,000 limit. The $2,000 left over may be paid by MedPay or health insurance, if you have them, and by the at-fault driver only if your injury meets Florida's threshold. If your policy has a PIP deductible, subtract it first.

How these benefits fit with other payers

• Health insurance may pay what PIP or MedPay doesn't, under its own rules. Tell both insurers about each other so bills aren't paid twice and then clawed back.
• The at-fault driver's insurer pays for injuries above your benefits in an at-fault state, or above the threshold in a no-fault state; see liability claims against the other driver.
• Your insurer may ask for its money back. When another driver caused the crash, an insurer that paid MedPay can seek repayment from that driver or from your settlement, where state law allows; subrogation explains how that works.

Questions people ask