Do you know whether your claims are covered by personal injury protection (PIP) or not? Have you been injured in a motor vehicle accident? Is your claim covered? There are numerous court factors considered in making the determination. Here is some of the research on that topic:
The statute’s definition of “personal injury protection” is detailed, but it does not specify whether merely “an accident” will trigger coverage, or whether a “motor vehicle accident” is required. The statute uses the term “the accident” six times, and the phrase “the date of accident” once, without expressing whether “the accident” specifically constitutes an automobile or motor vehicle accident.
Personal injury protection consists of provisions of a motor vehicle liability policy which provides for payment to the named insured in the motor vehicle liability policy and members of the insured’s household, any authorized operator or passenger of the named insured’s motor vehicle including a guest occupant, up to an amount of $2,500 for each such person for payment of all reasonable expenses arising from the accident and incurred within three years from the date thereof for necessary medical, surgical, X-ray and dental services, including prosthetic devices, and necessary ambulance, hospital, professional nursing and funeral services, and in the case of an income producer, payment of benefits for loss of income as the result of the accident; and where the person injured in the accident was not an income or wage producer at the time of the accident, payments of benefits must be made in reimbursement of necessary and reasonable expenses incurred for essential services ordinarily performed by the injured person for care and maintenance of the family or family household.
The insurer providing loss of income benefits may require, as a condition of receiving such benefits, that the insured person furnish the insurer reasonable medical proof of his injury causing loss of income. The personal injury protection in this paragraph specified shall not exceed $2,500 for all benefits, in the aggregate, for each person.
The benefits required by this Act shall be payable without regard to the fault or non-fault of the named insured or the recipient in causing or contributing to the accident, and without regard to any collateral source of medical, hospital or wage continuation benefits. An insurer paying benefits pursuant to this Act shall have no right of subrogation and no claim against any other person or insurer to recover any such benefits by reason of the alleged fault of such other person in causing or contributing to the accident.
All payments of benefits prescribed under this Act shall be made periodically as the claims therefor arise and within thirty (30) days after satisfactory proof thereof is received by the insurer subject to the following limitations:
The coverage described in this Act may prescribe a period of not less than six months after the date of accident within which the original proof of loss with respect to a claim for benefits must be presented to the insurer.
The decision in Le v. Farmers Texas County Mutual Insurance Co. considered whether this statute permitted the State Board of Insurance to promulgate a policy that required a “motor vehicle accident” and concluded that it did. That court reasoned that “[i]t is likely that the statewide cost for injuries which happen to occur in a car is higher than the cost of paying for injuries which result from a motor vehicle accident.” It gave deference to the Board, concluding, “[w]e do not find the Board’s construction repugnant to the statute.”
The reasoning in Le v. Farmers Texas County Mutual Insurance Co. is sound. It is certainly reasonable and permissible for a policy providing personal injury protection to require the occurrence of a “motor vehicle accident” before coverage is applicable. An insurer paying personal injury protection coverage has no right of subrogation for the fault of another person in causing or contributing to “the accident.” does not prohibit automobile policies issued in this state from requiring that the injuries be sustained as a result of a “motor vehicle accident.”
However, the court found that a motor vehicle accident occurs when one or more vehicles are involved with another vehicle, an object, or a person, the vehicle is being used as a motor vehicle, and a causal connection exists between the vehicle’s use and the injury-producing event, and driver’s injury resulted from a “motor vehicle accident” and entitled him to PIP benefits. Texas Farm Bureau Mut. Ins. Co. v. Sturrock, 146 S.W.3d 123 (Tex. 2004).
There is hope out there that your PIP may cover your claim. Give us a call if you have any questions. We are San Antonio personal injury lawyers here to help you! We care about your legal needs.