The Washington Supreme Court recently made a decision that improves acceptance of Personal Injury Protection (or PIP) Medical claims. Insurers routinely deny these types of claims, contrary to state law, and the new decision tightens former loopholes.
PIP insurance is included in an auto insurance policy, and covers medical expenses and other services for those involved in a collision, regardless of fault. The law requiring PIP insurance to be offered to everyone buying auto insurances also gives the insurer the ability to deny coverage for PIP benefits – but only if the claims are not “reasonable, necessary, or related” to the accident, or if claims are made over 3 years after the accident.
Despite the law, PIP insurers tend to deny claims with the reason that the patient has reached “maximum medical improvement (MMI).” Given the number of these occurrences, patients and providers begin to wonder what the point is in paying for PIP insurance if their insurers will deny coverage when it is most needed. As a result, many patients don’t receive necessary care, and victims of auto accidents have a harder time finding insurance.
Under the recent court decision, the Washington State Supreme Court clarified that MMI or “palliative only” arguments will not support a denial. The previous legislature never excluded care to maintain a stable condition (palliative). In a case involving State Farm, the company repeatedly denied PIP because medical services weren’t considered essential to reaching MMI, if a patient wasn’t going to get any better – even if they still needed treatment. In order to determine coverage, care must only be “reasonable and necessary.” Excluding palliative care violates the law, as PIP insurance is intended to cover all damages from an automobile accident. Even the fact that treatment will not cure a condition is an inadequate reason for denial. If you have been denied PIP coverage because the insurance company said you should be better but you aren’t, give Anderson Law a call @ 509-734-1345.