PIP Benefits

by Cole Humphreys in Auto Insurance at September 1, 2015

A question for someone in Grand Prairie, Irving, Arlington, Mansfield or anywhere else in Dallas or Tarrant County is, What is the value of my PIP claim…….
Personal injury claims have no easy answer. One principle in this regard is that there are rules against making a double recovery. A “double recovery” would be where you collect money from more than one source for a loss. The likely place for this to be seen is where a person is injured in an auto accident caused by another. The injured person goes to the hospital and for the hospital bills with their personal health insurance. Then later, the injured person makes a claim against the person who caused the accident and injuries and the insurance company for that person pays the injured person again, for the same hospital bills. Technically, this is illegal.
An example is where the injured person makes a claim against 2 other people who may be responsible for the injuries and both pay all the bills.
In the 2nd example, the Texas Civil Practices & Remedies Code, Section 33.012(b) says, “If the claimant has settled with one or more persons, the court shall further reduce the amount of damages to be recovered by the claimant with respect to a cause of action by the sum of the dollar amounts of all settlements.”
What this Section 33.012(b) signifies is that if a person has a claim that is worth $1,000, then he cannot collect $1,000 from both people he is making the claim against. So, if they pay $100, then he still has a claim against the other for $900.
In the 1st scenario above, where the injured person has had the hospital bills paid by his insurance company, the hospital has a subrogation interest in the amounts the injured person receives from the person who caused the injuries. The amount of the subrogation amount could be an amount up to what his health insurance has paid. If the injured person has a claim worth $1,000 but only $500 is paid by the health insurance company and if the injured person collects $1,000 from the person who caused the injury, $500 has to be paid back to the health insurance company and the injured person can do as they wish with the other $500.
One place where a double recovery is allowed and legal is in auto injury claims where the injured person has Personal Injury Protection (PIP) benefits. The Texas Insurance Code, Section 1952.155(a) and (b).
Section 1952.155(a) says, “The benefits under coverage required by this subchapter are payable without regard to: (2) any collateral source of medical, hospital, or wage continuation benefits.” This means that the injured person can collect his PIP benefits and then still make a claim against some other personal insurance he has for the same losses such as medical bills or lost wages. The caveat here is that there are exceptions to this and is again, a situation where an experienced Insurance Law Attorney needs to be involved to stay out of trouble.
Section 1952.155(b) says, “Except as provided by Subsection (c), an insurer paying benefits under coverage required by this subchapter does not have a right of subrogation or claim against any other person or insurer to recover any benefits by reason of the alleged fault of the other person in causing or contributing to the accident.” This means that the PIP insurance company cannot subrogate against the insurance company of the person who caused the injuries. There is only one exception to this statute which is in Subsection (c), and this writer does not know where it has ever come into play.
The lesson taken from this post is that the value of a claim has to take into account the rules discussed above.

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