Answered by Jordan Namerow, a Philadelphia Car Accident & Injury Lawyer
Pennsylvania law allows for pedestrians injured in car accidents to get their medical bills in one of two ways. First, if the pedestrian is covered under their own car insurance policy (or a policy of a relative), they can make a special PIP insurance claim to get medical bills paid. Second, if the first scenario doesn’t apply, an injured pedestrian can make a PIP claim under the car insurance policy covering the car that hit them.
It is important to note that Pennsylvania car accident law is pretty complex with lots of nuances which depend on the facts of the case. Call our Philadelphia office for a FREE CONSULTATION before making any decisions in your case. (215) 985-0777.
What is PIP?
Personal Injury Protection (PIP) coverage is a mandatory coverage on every car insurance policy issued in this state. It must cover at least $5,000 of medical bills stemming from a car, truck, pedestrian or bike accident, basically, any accident involving an automobile. Motorcycle accidents don’t apply. Many policies include higher PIP coverage amounts. Policies often include $10,000 or $50,000 in PIP coverage.
PIP works like regular health insurance. The medical provider will send the bill directly to the car insurance company, which then will pay an amount allowed under Pennsylvania law for the specific treatment. You won’t get billed for any co-pay, deductible or co-insurance. However, if the PIP amount is used up, you’re on your own for any remaining medical bills, at which point, you’d use your health insurance. See below for an explanation of how an injured pedestrian can get compensated for these kinds of bills.
People who make PIP claims under their own car insurance policy aren’t penalized for making a PIP claim, i.e., car insurance companies aren’t allowed to increase premiums simply because you made a PIP claim.
PIP Claims for Medical Bills – Your Own Insurance Policy or a Relative’s Policy
Even if you don’t have your own car insurance policy, you might still be eligible for PIP benefits under a relative’s policy. Typically, this applies to a spouse or a child. For example, if you’re a college student and still covered under a parent’s car insurance policy, you’d be eligible for PIP under that policy.
PIP Claims Under the Policy of the Car That Hit You
Under Pennsylvania car insurance laws, pedestrians who are injured in car accidents can make a PIP claim under the car insurance policy covering the car that hit them (see Section 1713 of the Pennsylvania Motor Vehicle Financial Responsibility Law). However, this only applies if the pedestrian has no access to PIP benefits under their own policy or an applicable policy. In addition, an injured pedestrian can make a claim for PIP benefits under any car that was involved in the accident, except parked cars.
For example, a pedestrian walking across the street gets hit by car A. Car A then swerves and hits car B, which was stopped at the intersection. The pedestrian could make a PIP claim under either policy covering car A or B. However, if car A swerved and struck a parked car, the pedestrian could only make a claim under the policy coverage car A, not the parked car.
Getting Compensated for Medical Bills Paid by Health Insurance
When pedestrian accident injuries are severe, a PIP claim won’t cover all of the medical bills. In these situations, an injured pedestrian’s own health insurance would kick in. Will an injured pedestrian be able to get compensated or reimbursed for bills paid by health insurance and any co-pays or deductibles?
Pennsylvania law allows injured pedestrians to get compensated for financial losses like medical bills. This is in addition to lost wages, miscellaneous out of pocket expenses and pain and suffering.
However, getting compensated for these losses can only happen if the accident was caused by another party. If a pedestrian disregards a pedestrian traffic signal and is hit while crossing the street, the odds are pretty high that the pedestrian bears 100% fault for the accident. There’s no one to seek compensation from.
Assuming the accident was caused by another party, an injured pedestrian can seek compensation by filing a lawsuit. In most cases, the medical bills covered by health insurance, plus any co-pays and other out of pocket medical expenses would be recovered from the at-fault party. Under PA law, health insurance companies have legal rights to get reimbursed for what was paid on an insured party’s behalf due to negligent conduct of another party. In a pedestrian accident case, if a health insurance company paid $5,000 for medical bills (after PIP), it could assert a right to get paid back from any proceeds recovered in a lawsuit filed by the pedestrian against the at-fault party.