Personal Injury Protection (PIP)

If you’re a healthcare provider treating a patient whose Personal Injury Protection (PIP) benefits have been denied, you don’t have to face the insurance company alone.

Understanding PIP coverage can be frustrating, especially when insurers undervalue or reject claims over technicalities or paperwork errors. A personal injury protection lawyer can guide you through the legal process.

At GED Lawyers, we understand the hurdles you face. Our auto accident lawyers are committed to challenging unfair denials and recovering the compensation your practice is owed—so you can stay focused on what matters most: your patients. Contact us today for a free consultation.

What Is Personal Injury Protection (PIP)?

Personal Injury Protection (PIP) is a type of auto insurance coverage required in several “no-fault” states. It helps pay for medical expenses and other related costs after a car accident, regardless of who was at fault.

The primary goal of PIP is to ensure individuals receive immediate medical care without the delay of establishing fault through litigation.

While the core idea of PIP is consistent, specific coverage requirements and benefits vary by state. Most no-fault states mandate that drivers carry a minimum level of PIP coverage, and covered benefits often include:

• A percentage of medical expenses
• Partial reimbursement for lost wages
• Death benefits or funeral expenses
• Replacement services, such as household help or childcare, when the injured person is unable to perform normal tasks

In many states, medical treatment must begin within a specified timeframe, or the right to receive PIP benefits may be forfeited. PIP insurers may challenge claims based on:

• Documentation or billing code errors
• Disputes over medical necessity or treatment reasonableness
• Provider eligibility issues

Why PIP Matters for Medical Providers

For medical providers, a thorough understanding of Personal Injury Protection (PIP) coverage is critical to ensuring timely and reliable reimbursement.

PIP benefits often serve as a primary source of payment for accident-related treatment, yet navigating the system can be frustrating. Strict filing deadlines, technical documentation requirements, and aggressive claim denials by insurers frequently create barriers to payment. 

Partnering with our personal injury protection lawyers, who understand PIP law, can help overcome these challenges—so your practice gets paid, and you can stay focused on patient care, not insurance battles.

Who Is Covered Under Personal Injury Protection (PIP)?

Personal Injury Protection (PIP) insurance is designed to provide immediate medical and related benefits after a car accident, regardless of who caused the crash. But who exactly qualifies for PIP coverage?

That depends on the policyholder’s state and the specific terms of their auto insurance policy. PIP typically covers:

• The Policyholder: The person named on the auto insurance policy is always covered under PIP if they are injured in a car accident, whether as a driver, passenger, cyclist, or pedestrian.
• Household Family Members: In many states, PIP extends to relatives living in the same household as the policyholder, even if they were injured while riding in someone else’s car or as a pedestrian. For example, PIP may cover the policyholder and their resident relatives. If a child is injured while riding a bike and is struck by a vehicle, their parent’s PIP insurance may still provide coverage—even though they weren’t in a car.
• Passengers in the Insured Vehicle: PIP often covers passengers riding in the insured vehicle at the time of the accident, especially if they don’t have their own PIP coverage. If the passenger has their own PIP policy, their benefits may apply first. For example, PIP may cover the driver and all occupants of the insured vehicle, unless one of them owns a separate vehicle with their own PIP policy.
• Pedestrians and Cyclists: Many PIP policies extend coverage to pedestrians and bicyclists who are injured in accidents involving a covered vehicle.
• Others With Permission to Drive the Vehicle: If someone has permission to drive your car and is injured in an accident, your PIP policy may cover their medical expenses, depending on state law and policy terms.

It’s important to note that PIP laws vary significantly by state. Some states limit coverage to specific groups or restrict how benefits coordinate with other types of insurance (such as health coverage or workers’ compensation).

For example, some states may reduce benefits if the injured person has private health insurance.

Medical providers dealing with PIP claims should confirm who is eligible under the patient‘s policy before submitting treatment bills. Doing so helps avoid delays, denials, or payment disputes—and ensures the right legal steps are taken if problems arise.

How Our Personal Injury Protection Lawyers Help Medical Providers Pursue PIP Claims

When PIP benefits are delayed, reduced, or denied, it’s not just patients who suffer—medical providers often face serious reimbursement gaps that impact their ability to deliver care.

Our PIP attorneys step in to protect your practice’s financial interests and help ensure insurers uphold their obligations.

We help by:

• Conducting Claim Review and Reviewing Compliance: We begin by conducting a thorough review of your billing practices, documentation, and submission procedures. Our attorneys ensure that your claims are properly coded, filed within required timeframes, and meet all state-specific compliance standards. This proactive approach minimizes insurer pushback and strengthens your position from the start.
• Handling Denials, Delays, and Underpayments: If your practice is facing rejected or underpaid PIP claims, we step in immediately. Our legal team handles all correspondence with the insurance carrier, challenges unlawful denials, and demands full payment on your behalf. Whether the issue is a coding dispute, alleged lack of medical necessity, or incomplete paperwork, we know how to respond.
• Taking Legal Action When Necessary: If insurers refuse to cooperate or continue to act in bad faith, we’re fully prepared to escalate the matter. Our attorneys can initiate legal proceedings to recover the full amount owed, including statutory interest, penalties, and attorney’s fees where applicable.

We also understand the complexities of PIP laws across multiple states. This state-specific knowledge allows us to tailor legal strategies to your unique situation, maximizing your recovery and minimizing administrative burdens.

We often handle PIP recovery cases on a contingency basis or fee–shifted model, meaning you pay nothing unless we recover funds on your behalf. 

Tips for Strengthening Your Position Before a PIP Denial

These proactive measures help protect your right to reimbursement and reduce the chances of an insurer using technicalities to delay or reject payment:

• Start Treatment Promptly: Many states require that treatment begin within a certain number of days after the accident. Prompt care not only benefits the patient—it also helps preserve eligibility for PIP benefits.
• Keep Clear and Consistent Records: Insurers often deny claims citing incomplete or inconsistent documentation. Maintain clear notes on treatment provided, and make sure records are legible and organized.
• Double-Check Coding and Billing Details: Simple errors in procedure or diagnosis codes can lead to unnecessary delays. While you don’t need to be a coding expert, accurate and consistent billing helps minimize disputes.
• Confirm Patient Eligibility: Before submitting bills, verify whether the patient is actually covered under the PIP policy. This includes checking for valid insurance at the time of the accident and whether benefits have already been exhausted.
• Secure a Signed Assignment of Benefits (AOB): A properly signed AOB form ensures your practice has the legal right to pursue payment directly from the insurer, which is critical if the claim is denied and needs to be appealed.

Taking these basic steps can make a significant difference. If your claim is still denied, our PIP attorneys can step in and fight to recover the compensation your practice is owed.

Contact Our Personal Injury Protection Lawyers Today

When an insurance company stalls, disputes, or outright denies a Personal Injury Protection (PIP) claim, your practice shouldn’t have to absorb the loss.

If you’ve accepted an assignment of benefits from a patient and those benefits are being withheld, our personal injury protection attorneys are ready to step in.

At GED Lawyers, we stay up to date on evolving PIP regulations and insurance industry practices—so you don’t have to. Contact us today for a free consultation.