Personal Injury Protection (PIP)

Kentucky Law & Person Injury Protection: What to Do When The Insurance Company Denies Your PIP Claim.

Personal Injury Claim FormThe Basics: Kentucky law requires that all automobiles (with the exception of motorcycles) must have personal injury protection (“PIP”) coverage.  This means that no matter who is at fault, there are funds available to help pay for basic medical services and other related costs.  If you are injured while driving your vehicle or someone in your vehicle is injured in a car accident in your vehicle,  up to Ten Thousand ($10,000) dollars of certain claims must be paid related to an accident per person. These claims include:

  1. Medical expenses;
  2. Lost wages; and
  3. Certain “out of pocket” costs due to the injury caused by the accident

What happens if your claims related to an accident do not exceed $10,00 dollars but your insurer denies your claim? Unfortunately, a insurer may deny or has denied your PIP claim, even when you have a valid claim. If this happens, you may well be left without any way to pay your medical bills. And because Kentucky is a “no fault” state, you can’t recover from anyone else involved in the accident. NOTE: If your claims exceed $10,000 dollars, then traditional tort law will determine what rights or claims you may have under the law. Denial of a PIP Claim: Your Rights Kentucky law provides protections for both the insurer and you. But under the law, before an insurer can deny your claim for PIP benefits they are required to provide the insured with a written notice of:

  1. What is covered under the insurance policy; and
  2. The insurer’s right to deny, terminate or limit benefits.

The insurer can only deny medical services if they determine that the treatment or service claimed is unreasonable, unnecessary, was not due to the accident or did not begin or manifest within three years of the accident. Further,  the insurer must base the decision to deny your medicals claims on the findings of a medical or healthcare professional who has reviewed your claim and related services or treatment. Even then, there are certain requirements related to what type of medical or healthcare professional can review specific medical claims. For example, by law, a doctor cannot review your a chiropractor’s treatment records, only another chiropractor may do so. Finally, you have an important legal tool available to you to fight a denial of a PIP claim. Under state law, when the insurer denies your claim, you have the ability to file a lawsuit against the insurer for denial of a valid claim. If your PIP claim has been denied by your insurer, you  or if you are a healthcare provider and your patients have had their PIP benefits denied, contact the professionals at Law Help Louisville.