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PERSONAL INJURY PROTECTION INSURANCE: A Short Guide

PERSONAL INJURY PROTECTION INSURANCE IS COMMONLY CALLED “PIP.”

THIS ARTICLE DISCUSSES:

  • PIP in General
  • Main Types of PIP
  • Maximizing PIP Benefits
  • Special Situations

PIP IN GENERAL

Under Kentucky law, auto insurance is mandatory.  Personal Injury Protection insurance (commonly called PIP insurance) is a part of the mandatory auto insurance Kentucky requires.  A typical Kentucky auto insurance policy provides no less than $10,000 per person for PIP insurance to pay medical expenses, lost income and similar “out of pocket” costs due to a motor vehicle injury.  PIP is paid by the insurer of the vehicle the injured person is using at the time of a motor vehicle injury, regardless of fault.  Additional PIP coverage above the basic amount of $10,000 is optional.  PIP can be purchased with a deductible up to $1000.  Burman Law does not recommend purchasing PIP with a deductible.

TYPES OF PIP INSURANCE

There are four main types of PIP insurance:
  1. PIP MEDICAL LOSS is used to pay medical bills.  The medical bill must be for reasonable charges incurred for reasonably needed medical services, products, accommodations, rehabilitation, licensed ambulance services, and other remedial treatment and care.
  2. PIP WORK LOSS is used to replace income lost because the injured person cannot work.  It is also used to pay for expenses reasonably incurred by the injured person in obtaining services to replace those the injured person would have performed for income.  Unfortunately, unless additional PIP is purchased, the basic PIP work loss claim is limited by law to $200 per week.
  3. PIP REPLACEMENT SERVICES LOSS is used to pay for “in-kind” expenses reasonably incurred in obtaining ordinary and necessary services the injured person would have performed, not for income, but for the benefit of the injured person or the injured person’s family.  The $200 weekly maximum applies.
  4. PIP SURVIVOR’S REPLACEMENT SERVICES LOSS is used to pay expenses reasonably incurred by survivors after a person’s death to cover ordinary and necessary services the person would have performed if the person had not died from a fatal motor vehicle injury.  The $200 weekly maximum applies but can be prospectively applied to exhaust the entire $10,000 in basic PIP.

MAXIMIZING PIP

Maximize PIP MEDICAL LOSS by directing that certain medical providers be paid first.  In some cases, it may be advantageous to send the PIP carrier $10,000 worth of unpaid medical bills and direct the PIP carrier to pay the $10,000 in basic PIP to an escrow  account. This is a highly technical area of law, so consult Mike Burman. Maximize PIP WORK LOSS by reserving and directing, in writing to the PIP adjuster, that all PIP wage loss be paid before any medical providers are paid.  Always get a work excuse from the doctor showing it is necessary to be off work due to the motor vehicle injury and the period of time off work.  Again, this is a highly technical area of law, so consult Mike Burman. Maximize PIP REPLACEMENT SERVICES LOSS by saving written invoices to prove these expenses were actually incurred.  Take photographs of the work performed. Maximize PIP SURVIVORS REPLACEMENT SERVICES LOSS by completing an affidavit to detail the services and expenses reasonably incurred by survivors for valuable services that would have been provided had the injured person survived the motor vehicle injury.  Again, this is a highly technical area of law, so consult Mike Burman.

SPECIAL SITUATIONS

Assigned Claims Plan:  When a vehicle owner does not have PIP insurance, the people injured in the owner’s vehicle are entitled to file a claim for basic PIP insurance through the Kentucky Assigned Claims Plan.  Contact Mike Burman for assistance with the Kentucky Assigned Claims Plan. Coordination of PIP Insurance:  In some cases, the payment of PIP insurance can be directed and coordinated with health insurance to process all medical bills.  In some case, PIP can be used to pay co-pays, deductibles, and non-covered items. Motorcycles:  Basic PIP insurance is optional for motorcycles. Unless basic PIP insurance is purchased for the motorcycle, neither the operator nor the passenger of the motorcycle is entitled to collect basic PIP benefits from any source.  Other insurance may be available, so consult with Mike Burman to determine available coverage. Out of State Owners:  Non-residents of Kentucky driving through the state may be “deemed” to have PIP insurance but this is dependent on the whether the underlying auto insurance carrier is licensed to sell auto insurance in Kentucky.  Contact Mike Burman for assistance. Workers’ Compensation Situations:  Employment at the time of a motor vehicle injury, may provide under Kentucky Workers’ Compensation law:
  • Primary coverage for related medical expenses
  • 2/3 wage replacement for time off work
PIP wage loss insurance can be coordinated to pay the remaining 1/3 wage loss. This is a highly technical area of law, so consult Mike Burman.
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SEVEN MISTAKES LAWYERS MAKE WITH INJURY CLAIM SETTLEMENTS

Here are seven mistakes injury lawyers can make when settling injury claims:

  1. NOT DISCERNING THE NEEDS OF THE CLIENT
  2. NOT IDENTIFYING CRITICAL EVIDENCE
  3. NOT UNDERSTANDING THE MECHANISM OF INJURY
  4. NOT GATHERING ALL ICD MEDICAL CODES
  5. NOT PRESENTING AN INJURY CLAIM EARLY
  6. NOT CALCULATING THE RANGE OF CLAIM VALUE
  7. NOT EDUCATING THE INSURANCE ADJUSTER

No. 1: NOT DISCERNING THE NEEDS OF THE CLIENT

Seems simple.  A lawyer should find out what his client needs, right?  But often-times, lawyers mistakenly:
  • delegate the initial client interview to non-lawyers
  • delegate client problems to non-lawyers
From the beginning, Mike Burman listens to each client and takes action based on 25 plus years of personal injury and wrongful death case experience.  Mike’s staff is highly trained, and collaborate with Mike and each other to advance the case.  Mike’s case management system is constantly updated for new technologies and best practices.  The Burman Law Client Portal provide a “personal touch” to every client’s case by allowing rapid access to information and documents as the case advances.   Client phone calls, emails, text messages and portal messages are addressed promptly to give real-world solutions.

No. 2: NOT IDENTIFYING CRITICAL EVIDENCE

Many lawyers fail to recognize that technology has radically altered the collection of evidence.  Closed circuit TV, satellite imaging, social media platforms, camera drones and internet databases provide unprecedented amounts of information and documentation.   Because Mike Burman is an experienced personal injury lawyer in charge at the beginning of every injury case, Burman Law preserves and protects critical evidence early in the case, for a strong foundation later in the case.  Burman Law is a self-funding law firm and does not rely on outside financial sources to pay case expenses.  If a case requires increased financial support, the case gets that support.

No. 3: NOT UNDERSTANDING THE MECHANISM OF INJURY

To understand the mechanism of injury, Burman Law examines how the injury is caused by trauma to the human body.  High school anatomy and physics teaches the body is composed of parts, some of which are fixed and some of which are mobile. Stress produces strain. Strain is a measure of of how much the human body deforms as a result of stress caused by trauma. Many lawyers do not examine the mechanism of injury.  At Burman Law, we work with experts to determine exactly which parts of the human body were affected by the traumatic mechanism of injury.  Understanding this aspect of the case helps predict the present and future affects of injury.  Many lawyers over-look this aspect of a case, especially in the area of permanent impairment of bodily function.  Burman Law works with medical doctors to organize important mechanism of injury considerations for the particular case.  With well organized reports from the doctor and other experts, the value of an injury claim increases.

No. 4: NOT GATHERING ALL ICD MEDICAL CODES

ICD medical codes are used in clinical care and research to define medical conditions, study patterns, manage health care, monitor outcomes and allocate financial resources.  Insurance companies use ICD medical codes to value cases, but most injury lawyers do not, and this creates a major “disconnect” between the lawyer representing an injured client and the adjuster representing an insurance company evaluating a claim based on ICD medical codes.  If the injury lawyer does not provide these ICD medical codes, the insurance adjuster is not going to ask for them, or go out and gather them.  That is why insurance adjusters always say, “Based on the information you have given me, this is the offer of settlement.”

Examine any medical bill and it contains medical codes.  These medical codes determine how much is paid on the bill.  Insurance companies use these codes to pay medical bills, so it makes sense that insurance companies use these codes to pay injury claims.  Burman Law gathers all ICD medical codes to prepare a settlement demand that provides everything needed for a full and complete evaluation by the insurance adjuster.

In many cases, proper ICD medical coding will increase the value of an injury claim by 100% or more.

No. 5: NOT PRESENTING AN INJURY CLAIM EARLY ENOUGH

Every case goes through phases.  The first phase – the acute trauma phase – begins when the injury occurs.  In the acute trauma phase, the patient is rushed to the Emergency Room. But over time, as medical professionals provide quality treatment, an injury case evolves from the acute trauma phase, into the medical plateau phase.  In the medical plateau phase, all injuries are identified and all injuries are relatively stable. Maximum medical improvement, or MMI for short, is an insurance term that insurance adjusters use.  It is not a term favored at Burman Law, because MMI takes too long to reach in most cases.  Many injury lawyers wait for maximum medical improvement rather than medical plateau. For many injured people, MMI means a full recovery with no restrictions.  And so, what does the insurance adjuster say at MMI?  The insurance adjuster says, “The claim is not worth much because the injured person has fully recovered.” Burman Law, on the other hand, does not wait for MMI.  Once medical plateau is reached, we finish gathering information and supporting documentation to establish:
  • diagnostic codes
  • medical bills for past charges
  • prognosis (how the injury will progress over time)
  • impairment (how the injury will affect physical function)
  • lost earning capacity (how the injury will affect future income)
  • future medical expenses (how much future medical services will cost over time)
After gathering the above information and documentation, a settlement demand letter is prepared for the case and all documentation is attached to this demand.  A settlement demand letter outlines the claim for the adjuster in charge.  The settlement demand letter sets forth, in writing, the legal basis for the claim, the medical evidence of injury, and proof of damages resulting from the injury while the injury is still “fresh.”

No. 6: NOT CALCULATING THE RANGE OF CLAIM VALUE

Many injury lawyers have no objective way to determine case value, relying only on experience, or the Jury Verdict Reporter showing jury verdicts for the state where the injury occurred.  But how do jury verdicts and experience provide an objective method for valuing every type of injury claim for every type of injured person? Burman Law’s methodology for determining case value relies on specialized software from a third party vendor to provide an objective range of values for a particular case.  Thus, there is no guessing when the insurance company has offered full and fair compensation.  Burman Law advises each client when the offer is “within the range of reasonable outcomes.”  Further, we prepare our clients to say “no” when the insurance company offer is not full and fair based on the facts of each particular case and the range of reasonable outcomes.

No. 7: NOT EDUCATING THE INSURANCE ADJUSTER

Educating the insurance adjuster is the most crucial part of settling a personal injury claim.  Educating the adjuster requires:
  1. Knowing what the adjuster knows
  2. Making sure the adjuster understands what the adjuster knows
  3. Ensuring the adjuster has properly evaluated the claim
  4. Identifying “new” information for the adjuster to consider
Many lawyers try to educate an insurance adjuster the same way they educate another lawyer, with legal arguments and facts.  This will not result in the highest and best settlement because an insurance adjuster does not think like a lawyer.  An insurance adjuster has a completely different perspective based on the rules set by the insurance company that hires the insurance adjuster. Mike Burman is trained to think like an insurance adjuster, with settlement methods tested over 25+ years.  Mike follows best practices taught by a former insurance company executive with years of experience in adjusting claims.  Mike Burman is  trained to understand how insurance adjusters evaluate cases by applying sophisticated computer programs that run algorithms based on “multipliers” and “value drivers.” An insurance adjuster is never going to explain how to get the highest and best value for a case.   Most adjusters handle between 500 to 700 claims at any one time.  An insurance adjuster will rarely take the time to go out and look for all the evidence that supports a case.  And so, honestly educating the adjuster, with supporting documentation, makes a huge difference in the outcome of a case.
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CONNECT TO BURMAN LAW: Legal Help in the Real World

We are easy to reach.... out of state or down the street.

The Burman Law Client Portal

The Burman Law Client Portal is easy to set up and use.  The portal allows messages and documents to flow back and forth.  When a message or document is added to the portal, a text message and email go to the client.

Portal activation usually occurs when the case begins, but a client can start using the Burman Law Client Portal at any time.  Email [email protected]  for assistance with activation or error messages.  For more information on how the portal works, click PORTAL: A Great Tool for Burman Law Clients.

Text Messaging

In addition to the portal, every Burman Law client can send a text message to (270) 499-7028.  The client must use the mobile number on file at Burman Law.

When sending a text message intended for a specific attorney or staff person, be sure to specify which attorney or staff person.

Email and Sharefile

For email addresses to specific staff, click YOUR TEAM.  To send or receive documents outside the Burman Law Client Portal, request a Sharefile link.

Phone

Click CONTACT MIKE to learn about phone numbers during and after business hours.

“Getting What You Need Is All About Communicating What You Want”

At Burman Law, no question is stupid or unimportant. Get that out of your mind. Burman Law works for you. Your question will receive a timely and honest answer.  When communicating with us, short and sweet is better than long and complex.  The sooner a problem is brought to our attention, the sooner we can implement a plan of action.

Lack of communication can weaken a case. Good communication builds a case. At Burman Law, we  learn from 25+ years of experience, and our clients learn from us.