PIP Insurance and Independent Medical Exams

Personal Injury Protection insurance is an extended coverage you can purchase from your auto carrier that provides you with major benefits if you are injured in an accident. Personal Injury Protection (PIP) coverage provides a layer of medical payment insurance that provides healthcare benefits without any deductible or copay. The Washington legislature finds PIP coverage so invaluable that it mandates that all new insurance policies include the injury protection insurance unless the driver intentionally waives the coverage. Since coverage under medical insurance can be expensive and limited, Personal Injury Protection insurance can be a major boon to those injured in car accidents.

After an auto collision, you should immediately contact your car insurance company to activate your PIP coverage. After filling out the application, they will assign your claim a number that is provided to medical providers for billing purposes. While some providers may not take PIP coverage, a large majority of doctors and other medical clinics accept the auto insurance payments. Just make sure you understand the limitations of your PIP insurance, which includes a payment limit. When you purchase your insurance, you typically acquire coverage totaling $10,000, $35,000, or $50,000. When the medical costs paid by the PIP carrier  exceed that limit, the policy is exhausted, and they will not pay anymore. After a PIP policy exhausts, you should immediately begin using your health insurance to cover costs.

PIP coverage limits are not the only major concern for these otherwise great policies. Personal Injury Protection policies are managed by adjusters well trained in limiting costs. These adjusters have been guided by headquarters to reduce benefits and remove coverage wherever possible. The most common tool often required by insurance policies to do the adjuster’s bidding is the PIP medical exam – often referred to as an Independent Medical Examination (IME). The IME allows the PIP adjuster to require your attendance at a medical evaluation with a doctor of their choosing. That doctor then renders an opinion about the reasonableness and necessity of current and future treatment.

Of course, you can bet that most of the time, these PIP medical exams are performed with the expectation that the insured’s coverage will be denied moving forward. The insurance companies pay millions (and likely billions) of dollars every year paying defense doctors to render opinions supporting coverage denial. Once the doctor concludes that your treatment is no longer reasonable, necessary, or related to the collision, the insurer will not provide further PIP benefits requiring you to find other options.

Unfortunately, insurance companies have a major advantage when it comes to these examinations. The insurers know that their insureds are contractually obligated to cooperate with these policy provisions because failure to cooperate means they can deny coverage. At the same time, they often hire the most biased medical experts with the foresight that coverage will likely be denied very soon. There are not many options, but the first thing you should do is work with an attorney.

Experienced litigators can provide tips and tricks to make the most of the PIP examination. Attorneys and their staff often attend these exams and video or audio tape the exams to ensure the physician is properly administering testing procedures. Similarly, working with an attorney can prepare you for the testing to ensure you know what to look for moving forward. And, if the coverage is eventually denied after the IME, a personal injury lawyer will provide advice about the quickest way to resume medical treatment whether through medical insurance or negotiation with the medical provider. Finally, in some scenarios, an attorney can even file a lawsuit against the PIP carrier to force them to resume coverage.

The qualified and professional litigators at the law offices of Magnuson Lowell PS work with insurance companies everyday to ensure the rights of their clients. They understand the insurance and litigation process to deter insurance companies from taking advantage of their insureds. Call today for a free case evaluation and to ensure your rights are protected.

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