What does Texas PIP insurance pay for?

After a crash, the first bills arrive long before any settlement. Texas PIP coverage is the part of your own auto policy built for that gap. This post explains what it pays for, how to confirm you have it, and how to file a claim the insurer has to answer.

What Texas PIP coverage pays for

Personal injury protection (PIP) pays “reasonable expenses” that come from a car accident, under Texas Insurance Code section 1952.151. The statute lists three kinds.

• Medical and funeral costs. Necessary medical, surgical, x-ray, and dental care, prosthetic devices, ambulance, hospital, nursing, and funeral services.
• Lost income. If you earned a wage or income, PIP replaces income you lost because of the accident.
• Household help. If you were not earning income, it reimburses reasonable costs of essential services you would have done for your family, such as childcare or cleaning.

Expenses count only if they are incurred within 3 years of the accident date (section 1952.151(2)).

PIP covers more than the policyholder. The same section names the policyholder, members of the policyholder’s household, anyone driving the car with permission, and passengers, including guests.

Fault and health insurance do not reduce it

Two rules make PIP different from a claim against the other driver.

First, PIP is paid “without regard to” fault, under section 1952.155(a)(1). You can claim it even if the crash was partly or wholly your fault.

Second, it is paid without regard to any “collateral source” such as health insurance or wage continuation, under section 1952.155(a)(2). Having health insurance does not cancel your PIP benefits.

Your insurer generally cannot then pursue the other driver to get its PIP money back. Section 1952.155(b) bars that, with one exception: the insurer can pursue a driver who had no proof of financial responsibility on the date of the crash (section 1952.155(c)).

How much PIP pays

The PIP coverage Texas requires does not have to exceed $2,500 per person, for all benefits combined, under section 1952.153. Insurers may sell higher limits (section 1952.161(2)), and benefits stop at the limit on your policy (section 1952.156(c)).

How much of your lost income PIP replaces is set by the PIP endorsement in your policy, not by the statute. Read that page. The insurer may also ask for reasonable medical proof that your injury caused the lost income (section 1952.154).

Check whether you have PIP

Insurers must include PIP in every Texas auto liability policy unless a named insured rejects it in writing, under section 1952.152. The Texas Department of Insurance says the same in its auto insurance guide: to refuse PIP, you must tell the company in writing.

One detail catches people out. If you rejected PIP once, the insurer does not have to add it back on a renewal or a new policy from the same or an affiliated company unless you ask in writing (section 1952.152(b)).

Use this checklist to find out where you stand:

1. Open your declarations page (the summary page of your policy). Look for “Personal Injury Protection” or “PIP” and a dollar limit.
2. If it is missing, ask your agent or insurer for a copy of any signed PIP rejection form.
3. If you were a passenger, check the policy on the car you were riding in. Its PIP may cover you as a guest.
4. Check your own household’s policy too. Section 1952.151 covers household members of the named insured.

How to file a PIP claim, step by step

1. Tell your own insurer. Use the claims number on your insurance card. TDI’s guide notes that most insurers have filing deadlines, so report the crash promptly.
2. Ask which forms they need. Get the list in writing, with the address or portal for sending documents.
3. Send proof of loss. Your policy may set a deadline for the first proof of loss, but the statute does not allow that window to be shorter than 6 months after the accident (section 1952.156(b)(1)). Mark your deadline on a calendar on day 1.
4. Send bills as they arrive. Keep copies of every medical bill, receipt, and itemized statement. Send them in batches with a cover note listing each one.
5. Prove lost income. A letter from your employer showing your pay rate and days missed, plus pay stubs, is the usual starting point. Self-employed people can use invoices and tax records.
6. Track the 30-day clock. The insurer must pay PIP benefits as claims arise, and no later than the 30th day after it receives satisfactory proof of the claim (section 1952.156(a)).
7. Keep a claim log. Write down the date you sent each document, who you spoke to, and what they said.

If the insurer does not pay PIP benefits when due, section 1952.157 lets the person owed the benefits sue to collect them. If the insurer has to pay, it also owes reasonable attorney’s fees, a 12 percent penalty, and interest from the date the payment became overdue (section 1952.157(b)).

You can also call the Texas Department of Insurance Help Line at 800-252-3439, weekdays from 8 a.m. to 5 p.m. Central, or file a complaint online (TDI complaint page).

A worked example

The numbers below are illustrative only, to show how the pieces fit.

Say you carry $2,500 of PIP. After a crash on LBJ Freeway, you have a $1,800 emergency room bill and miss a week of work. Your PIP endorsement replaces part of the $1,000 you would have earned.

• PIP pays the $1,800 ER bill, because medical expenses are covered regardless of fault (section 1952.155).
• PIP then pays income loss at your endorsement’s rate, until the $2,500 total is used up.
• Anything left over goes to other sources: your health insurance, any medical payments coverage, and a claim against the at-fault driver’s liability coverage.

That liability coverage can be thin. The Texas minimum is $30,000 for injury to one person, $60,000 for two or more people, and $25,000 for property damage in one collision (Texas Transportation Code 601.072).

If you were a passenger and later claim against the driver of your own car, that driver’s insurer can deduct the PIP it already paid you from any award (section 1952.159).

What PIP does not pay for

• Car repairs. Section 1952.151 lists medical, income, household, and funeral expenses only. Vehicle damage goes to collision coverage or the other driver’s property damage coverage.
• Pain and suffering. PIP pays listed expenses. Other losses are part of a claim against the person at fault.
• Excluded conduct. Insurers must exclude PIP for an insured who intended to cause the injury, or who was hurt while committing a felony or fleeing police (section 1952.158).

Paperwork that helps in Dallas

A crash report helps prove the date and place of the accident. Our earlier guide explains how to get your Dallas crash report. Keep the report number with your PIP claim log.

When to talk to a lawyer

PIP is usually a claim you can file on your own. A lawyer becomes useful when the insurer stops paying, the bills are larger than your limits, or you are also claiming against the other driver. You can read how our car accident practice handles claims and the steps we take with insurers.

Book a case review.

This article is general information, not legal advice. Laws change and every case is different. Reading it does not create an attorney-client relationship. For advice on your situation, book a case review.