Auto Accident Victims’ Compensation Through Their Own Health Insurance and PIP in Virginia, Maryland and DC

If you get involved in a serious car accident, the burdens of financial recovery can be just as hard as the burdens of a physical recovery, if not more.  You will have three potential sources of recovery for your medical treatment costs – your own health insurance policy, personal injury protection policy (in Virginia it is called Med Pay, and it is PIP in Maryland and D.C.) offered by your car insurance, and any recovery from your personal injury claim against the defendant, if the accident occurred due to someone else’s fault.  Waiting for the resolution of your personal injury claim against the person who caused the accident can take a long time.  Therefore, getting an insurance company to pay for medical expenses and offset lost wages is essential to lighten the burden of thIf you get involved in a serious car accident, the burdens of financial recovery can be just as hard as the burdens of a physical recovery, if not more.  You will have three potential sources of recovery for your medical treatment costs – your own health insurance policy, personal injury protection policy (in Virginia it is called Med Pay, and it is PIP in Maryland and D.C.) offered by your car insurance, and any recovery from your personal injury claim against the defendant, if the accident occurred due to someone else’s fault.  Waiting for the resolution of your personal injury claim against the person who caused the accident can take a long time.  Therefore, getting an insurance company to pay for medical expenses and offset lost wages is essential to lighten the burden of the persons who suffered in a car accident.  Because your health insurance and your PIP pays the costs of your recovery, there are issues related to their right of subrogation from the amounts you eventually recover from your personal injury claim against the defendant.  This article will look into the PIP and insurance subrogation laws in Virginia, Maryland, and District of Columbia.

Virginia disallows subrogation provisions in insurance policies which provide “hospital, medical, surgical and similar or related benefits”.  Va. Code Ann. § 38.2-3405 (West).  Therefore, if you are involved in an accident and your health insurance pays for the treatment of your injuries, those payments will not be deducted from the recovery in your personal injury case.  This provision does not apply to federal health insurance plans, which do have the subrogation rights on your personal injury recovery for the amounts paid under such insurance policies. In essence, when you have a health insurance regulated under the Virginia laws, you are allowed to recover double the costs of your treatment – once when the actual bills are paid by your insurance and the second time, when you succeed in recovering the costs of that same treatment in your personal injury claim against a defendant.

Additionally, Virginia laws allow Med Pay – Medical Payments Coverage Policy – which is an optional coverage that can be purchased from your insurance to cover for your injuries from a car accident regardless of fault in an accident. Va. Code Ann. § 38.2-2201 (West). If you have a Med Pay plan in Virginia, this becomes the third source from which you can recover for your injuries, in essence allowing you to recover not double, but triple amounts in recovery of your medical treatment costs.

Under VA Code § 38.2-2201, upon request of an insured, your insurer has to provide you a personal injury protection policy (Med Pay) to cover the minimum amount of $2,000 per person in any given accident.  As an insured you can opt to purchase a Med Pay policy offering higher coverage.  Since Med Pay is optional in Virginia, you may choose not to purchase this coverage.  However, if you choose to buy Med Pay, you will have an additional source of coverage for your personal injuries if you get involved in a car accident. Your Med Pay will be liable for paying medical expenses up to the coverage limit for any medical, chiropractic, hospital, dental, surgical, ambulance, prosthetic and rehabilitation services, and funeral expenses.

Your Med Pay claims can be brought within three years of the accident.  The temporarily disabled accident victims can receive $100 per week for up to one year.  And more importantly, the Med Pay coverage must pay the customary fees for payments. It means in most cases your recovery from Med Pay will be higher than what you actually paid through your health insurance, since your health insurance almost always pays your bills at a discounted rate to the medical providers.  Those discounts will not apply to your Med Pay recovery.

Maryland recognizes subrogation rights of health insurance companies for the amounts they paid for your treatment when you are involved in an accident. Md. Code Ann., Health-Gen. § 19-713.1(d).  This means once you recover under your personal injury claim in Maryland, health insurance companies will be able to claim the amounts from that recovery equal to what they paid for your treatment. On a plus side, Maryland laws provide for personal injury protection coverage (PIP) regardless of fault and make it mandatory unless the insured expressly waives that right.  Therefore, in most cases Maryland residents involved in a car accident are more likely than not to have a PIP plan which will provide additional coverage for the injuries of a person involved in a car accident. There are several things to consider with Maryland PIP plans:

In Maryland Health Providers Cannot Demand PIP Payment Before Health Insurance Payments

Because health insurances pay the treatment costs to the healthcare providers under discount rates while PIPs are obligated to pay the usual and customary fees for such services, some medical providers improperly demand that a person injured in a car accident first used his/her PIP to pay for the medical bills. Maryland laws prohibit such demands:

MD Code Ann., Health Insurance § 15-104 (d) establishes the following:

Health insurance policies and policies of nonprofit health service plans may not contain a provision that requires personal injury protection benefits under a motor vehicle liability insurance policy to be paid before benefits under the policies.  Md. Code Ann., Ins. § 15-104 (d).

MD Code Ann., Property and Casualty Insurance, §19-507(b)(2), allows the insured to elect between  health insurance or PIP benefits as the primary source of payment for medical bills incurred as a result of a motor vehicle collision. Under this provision of Maryland Code, a health care provider is required to bill a patient’s health insurance for treatments arising out of a motor vehicle collision even when the patient has PIP benefits through an automobile insurance policy.  The law also requires the health insurance carrier to reimburse the insured for such services before exhausting the PIP benefits.

PIP claims must be paid within 30 days after the insurer receives satisfactory proof of claim by the insured, but the PIP claims must be brought by the insured within 12 months after the accident. Md. Code Ann., Ins. § 19-508 (West).

Maryland PIP Does Not Have the Subrogation Rights But Your Health Insurance Plan May Contain Subrogation Provision

 PIP does not have subrogation rights which means if you recover under your personal injury claims and also get paid from your PIP, your PIP insurance will not be able to deduct the amounts paid to you under the plan from your recovery of personal injury claims. Md. Code Ann., Ins. § 19-507 (West).

The situation is different when it comes to the subrogation rights of your health insurance.  Md. Code Ann., Health-Gen. § 19-713.1(d)  reads:

(d) Notwithstanding § 19-701(g)(3) of this subtitle, a contract between a health maintenance organization and its subscribers or a group of subscribers may contain a provision allowing the health maintenance organization to be subrogated to a cause of action that a subscriber has against another person:

(1) To the extent that any actual payments made by the health maintenance organization result from the occurrence that gave rise to the cause of action; or

(2) For a nonprofit health maintenance organization that exclusively contracts with a group of physicians to provide or to arrange for the provision of health care services for its enrollees, for any service provided by the health maintenance organization as a result of the occurrence that gave rise to the cause of action, per the fee schedule established by the nonprofit health maintenance organization.  Md. Code Ann., Health-Gen. § 19-713.1 (West).

The District of Columbia laws are very different from the laws of Virginia and Maryland on one fundamental issue.  In District of Columbia, once you are involved in an accident, you are forced to make an election between PIP benefits and filing a civil lawsuit within 60 days of the accident.  If an accident victim elects PIP, he/she gets the payments for the costs of the treatment and the lost wages under the PIP plan, but loses the right to file a lawsuit against the at fault driver unless the injuries are very serious.

The PIP law also most likely applies to persons insured in D.C. who are involved in accidents out of Washington, D.C. if they are making a claim for uninsured motorist benefits on their D.C. policy.

Pursuant to DC ST §31- 2405(b), an individual electing to receive PIP benefits is precluded from maintaining a civil action based on liability of the wrongdoer unless certain criteria are met.

D.C. Code § 31-2405 (b) provides:

A victim who elects to receive personal injury protection benefits may maintain a civil action based on liability of another person only if:

 (1) The injury directly results in substantial permanent scarring or disfigurement, substantial and medically demonstrable permanent impairment which has significantly affected the ability of the victim to perform his or her professional activities or usual and customary daily activities, or a medically demonstrable impairment that prevents the victim from performing all or substantially all of the material acts and duties that constitute his or her usual and customary daily activities for more than 180 continuous days; or

(2) The medical and rehabilitation expenses of a victim or work loss of a victim exceeds the amount of personal injury protection benefits available.  D.C. Code § 31-2405

PIP benefits cover all reasonable charges incurred for reasonably necessary medical and rehabilitation expenses capped at no less than $50,000 per claimant, work loss benefits capped at no less than $12,000, replacement services for up to 3 years after the accident and funeral benefits up to $4,000. Payment is due within 30 days after receipt of reasonable proof of the loss. D.C. Code § 31-2404.

DC Code allows PIP and any health insurance subrogation.  D.C. Code § 31-2411 (d) and D.C. Code § 31-2406.

Whether in Virginia, Maryland, or in the District of Columbia, if you have been injured in a car accident, our attorneys can help you to guide through various options to claim your rightful compensation for your injuries.  Our attorneys are committed to securing the money you deserve for your injuries.  We can achieve maximum results if you contact us immediately after your accident.   If you have suffered injury from a car accident, take the first step to protect your legal rights–call I. S. Law Firm today for a free consultation.

I.S. Law Firm will represent you on a contingency basis—that means you pay no legal fees until we recover money for you. For a free initial consultation and case evaluation, please contact us: +1-703-527-1779 or via e-mail:[email protected]