Understanding Insurance Coverage in Washington Car Collision Cases


John Webber, Managing Shareholder, GLP Attorneys WSCA Leadership Level Corporate Partner


When you have a new patient injured in a car collision in Washington, it is important to understand the typical insurance coverages that may apply, not only to assist your patient in making a full recovery, but to ensure that your medical bills are paid. Personal injury cases can quickly get complicated, and it is always best to have your patient promptly contact an experienced personal injury attorney for advice.


In any personal injury case, it is important to understand the difference between first-party and third-party insurance coverage. First-party insurance coverage is your source for billing and payment as your patient receives treatment. First- party insurance is usually coverage that your patient has paid for or has access to cover immediate medical care expenses. It can include personal injury protection (PIP), medical payments coverage, health insurance, or workers’ compensation insurance. Third-party insurance coverage is generally liability insurance for an at-fault party, subject to liability policy limits. Third party coverage is not designed to pay your patient’s medical bills as they treat, and usually only applies once, whenever the patient settles their claims against the at-fault party.


It is also important to be aware of the critical deadlines that apply in Washington. Most personal injury cases in Washington have a three-year statute of limitations to bring claims against any at fault party. If the at-fault party is the federal government or an employee of the federal government or one of its agencies, the statute of limitations will be two years. There may be other statute of limitations or notice requirements that apply, so on any personal injury case, you should always recommend your patient contact an experienced personal injury attorney for advice and guidance to avoid any issues that may bar their ability to be compensated fairly.


Personal Injury Protection (PIP)


Personal injury protection (PIP) insurance coverage is the best coverage that will be available to you and your patient in a car collision case. PIP is no-fault coverage, meaning regardless of what party caused the collision, it covers the driver and occupants of any car involved that has such coverage. PIP pays for medical expenses as the treatment occurs, income loss, and payment for loss of essential services. Medical bills are generally paid in full, and the patient can choose any licensed healthcare provider they want (no network limitations or referrals needed), and they will not have any deductible or copays.


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Washington Administrative Code (WAC) 284-30-395(1) provides that a PIP carrier can deny benefits for only four reasons in Washington: the services are not reasonable, the services are not necessary, the services are not related to the motor vehicle collision, or the services were not incurred within three years of the collision.


Medical Payments Coverage (Med Pay) Occasionally, you may have a patient that does not have PIP, but rather medical payments coverage, or “med pay.” Med pay is often


PIP in Washington is not mandatory, but insurance companies must offer coverage. Revised Code of Washington (RCW) 48.22.085 pro- vides that no new automobile liability insurance policy or renewal of such an existing policy may be issued unless PIP coverage is offered as an optional coverage. The law states that a named insured may reject, in writing or electronically, such coverage.


PIP coverage varies depending on what is purchased, but minimum coverage in Washington is:


• Medical and Hospital Expenses:


Up to $10,000 for reasonable and necessary medical and hospital expenses for each person in the car. This is available for up to three years from the date of the collision, until coverage exhausts, or until the coverage is terminated through a medical record review or insurance medical examination.


• Wage Loss:


Up to $200 per week ($10,000 total) for income replacement coverage. The first 14 days after a collision are barred from wage loss coverage, then coverage will be available up to 54 weeks. A note from a health care provider documenting medical disability is required.


• Loss of Services:


Up to $200 per week ($5,000 total) to pay non-family members for work your patient cannot do, such as household chores or childcare. A note from a health care provider documenting medical disability is required.


PIP coverage is broad coverage and will apply to the person named on the policy; household residents related by blood, marriage, or adoption; step or foster children; and any non-family passengers and pedestrians (including bicyclists) involved in a collision with the car that has such coverage.


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