What Happens When My PIP Benefits Are Exhausted?

You have been in a car accident in Kentucky. Now, you are going to the doctor and getting treated for your injuries from the accident. You feel better but you are not fully recovered. Then, you get a letter from your car insurance company that says your Personal Injury Protection (PIP) benefits are exhausted. Should you use your personal health insurance to pay the medical bills?

Related: Car Accidents

Should I use personal health insurance to pay medical bills?
The answer is both yes and no. The “yes” comes after the $10,000 amount is fully paid or exhausted. Then you may use your health insurance. Your health insurance will pay the medical bills after your PIP benefits are exhausted. The confusing part, and what some consider the bad part, about this is there’s something called subrogation. Around 90% of all health insurance plans require you to reimburse the health insurance carrier for anything they pay toward the treatment of injuries sustained in a car accident. Federal ERISA laws cover this area. It is a very specialized area of law.

The "no" is because your first and primary insurance in Kentucky is your PIP benefits. Your car insurance will pay the first $10,000 of medical bills for treatment from a car accident under most circumstances. It's always a good idea to contact your insurance agent to see what your insurance covers.

Why does my health insurance have to pay?
If there is a requirement to pay your health insurance company back, why should you use your health insurance to pay your bills? The answer is twofold. One is to make sure that you get the treatment you need. The second is that they pay at a reduced rate, which ultimately saves you money. You will have to reimburse them but only for what they paid. For example, when a health insurance company pays a bill, they will pay the provider an agreed upon price for any treatment. In other words, the health insurance company will pay only a portion of the charge. You only have to reimburse the health insurance company for what they paid, not the total amount of the bill. You are also responsible to pay any co-pays or deductibles to the health care provider, unless you can work out other arrangements with your doctor. You will eventually be reimbursed, but that may be several months or even years after your accident case has been settled.

Related Video: Accident Victims Use Health Insurance To Pay Medical Bills

The bottom line is you should use your health insurance to pay your medical bills once your PIP benefits have been exhausted. Your health insurance is secondary insurance. This allows you to get the treatment you need without being hassled by bill collectors for payment.

Michael Schafer
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The Personal Injury Attorney for Louisville and Kentucky
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by Mike Schafer May 1, 2018 at 09:02 AM
I had a problem with getting a lawyer to take my case because the sheriff's department and Guthrie police department didn't file police report they said I didn't want one my witness gave a statement and I was needing to go the hospital had a bad break in elbow had surgery and still not release and don't if I will . I just got information from a source that our sheriff's and city police wear body cams also witness and me went to prosecutors office like I was told to when I was able or wanted to file charges nothing was done now not only am I battling with state farm myself with some help I will be battling against a elected and none elected officials . now I have sent the last document before I file suit which is a demand letter for bad practice also would like to know pip is exhausted how do i go about my lost wages I can't survive and had to file disability which was denied and going to see my neurologist may 3 to see what he recommend .if I can go back to work or not but my PCP won't release me other than that
by Jeremy Slade May 1, 2018 at 04:23 AM
This happens most of the times, your PIP benefits gets exhausted when you need them the most. And you land up paying the expenses from the pocket. As mentioned in the post it is advisable to firstly buy car insurance that has maximum benefits and keep track of the benefits.
by Steve S January 25, 2012 at 07:48 AM
From my experience it is much better to contact car insurance agency and listen what their offer to us, hope it can protect us from an accident.
by Hannah Belly March 4, 2011 at 08:17 AM
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