Personal Injury Protection (PIP) insurance under an auto policy is intended to protect victims of motor vehicle collisions by covering reasonable, necessary and related medical expenses and lost wages following an injury. PIP coverage applies to any occupant of a vehicle, pedestrian, or cyclist involved in a motor vehicle collision, regardless of fault. It is mandatory coverage in Washington State.
Despite this, PIP insurers, such as USAA, State Farm, Safeco, Geico, and others, have been attempting to avoid paying out PIP claims as they have contracted to do with their insureds, by denying medical bills for accident victims claiming that the victim has reached “maximum medical improvement” (or “MMI”), and therefore is not in need of ongoing medical care for injuries. As a result, thousands of victims have been forced to forego needed medical treatment after an accident because their auto insurance companies refuse to pay for appropriate care.
In June, 2018, the Washington State Supreme Court put an end to insurers’ obvious attempts to skirt their obligations under the insurance contract and save themselves money. In the case of Durant v. State Farm, the Supreme Court made it clear that insurers can no longer put up roadblocks to prevent their insureds from getting medical care after an accident under the guise that the patient is “at MMI.” The only reason an insurer can now deny coverage under a PIP claim is if the care is not “reasonable, necessary, or related” to the collision. All other care, including care rendered after a patient has reached “MMI,” must be approved under the PIP claim.
This is a great victory for the people of Washington State, and is one more small safeguard to ensure that insurance companies don’t take advantage of the very people they have advertised to protect.
