When you carry "personal injury protection" (PIP) car insurance coverage—either as an optional add-on to your policy or in one of the "no fault" car insurance states—your own insurer will cover losses related to your car accident injuries, regardless of who caused the accident. Here's how PIP claims work, and what policyholders need to know.
After a car accident, an injured driver can make a PIP claim for payment of medical bills, lost earnings, and certain other out-of-pocket losses. But this kind of coverage needs to be part of the driver's car insurance policy.
In most states, vehicle owners are only required to carry liability car insurance coverage, which is activated when the vehicle owner causes a car accident, and which only covers other people (drivers, passengers, pedestrians, etc.) who suffered injuries and other losses in the accident. Liability coverage won't pay for the vehicle owner's own injuries and vehicle damage.
In the dozen or so states that follow some version of a no-fault car insurance system, PIP (or "no-fault") is usually mandatory, though a few of these states follow more of a hybrid/choice system. (Learn more about how no-fault car insurance works.) In other (non no-fault) states, PIP is available on top of other mandatory insurance, such as liability coverage.
Whether it's mandatory or optional in your state, when you're making a claim under PIP coverage it doesn't matter who caused your car accident.
(Note: Remember that PIP doesn't apply to vehicle damage after a car accident. You'll need collision coverage or other property-related insurance to get your car repaired or replaced after an accident.)
Your car insurer will pay your car accident-related medical bills and will reimburse you for some or all of your lost income up to the limits of your PIP coverage. Some states have a two-part medical bill limit, so that if the injured person has health insurance, the PIP insurer might only have to pay a small amount of the injured person's medical bills, and the health insurer will pay the remainder.
If the financial impact of your car accident injuries exceeds the limit of your PIP coverage, you can file a third-party car insurance claim with the at-fault driver's insurance company, or pursue a personal injury lawsuit against the at-fault driver.
If you live in a no fault state, you are not permitted to make a claim against the at-fault driver unless your medical bills reach a certain dollar amount, or your injury is deemed sufficiently serious according to the statutory definition in your state. For example, your state's no fault law might say that you cannot make a claim against the driver at fault unless your medical bills exceed $3,000, and/or you suffer a broken bone or permanent scarring after the accident.
Stepping outside of the state's no-fault system after meeting one or both of these thresholds means you can make a claim directly against the at-fault driver for your out-of-pocket losses. It also means you can seek compensation for non-economic losses like "pain and suffering." This category of damages (unavailable in a PIP claim) can be financially significant, especially after an accident involving serious injuries. Learn more about calculating pain and suffering after a car accident.
All states require policyholders to cooperate with their own insurance company when making PIP claims. That means responding in a timely manner to requests for information, and being truthful about the nature and extent of your injuries. It also means that the usual rules for dealing with the other side's (potentially adversarial) insurance company don't apply to a PIP claim.
In most car accident cases, you do not want to give a recorded statement to the other driver's insurance company, and you might want to fight any request that you attend an independent medical examination with a physician selected by the other driver's insurance company. But you could be required to comply with requests like these when you're making a PIP claim with your own insurance company. Learn more about contacting your insurance company after a car accident, and when it might make sense to get an attorney's help with a car accident case.