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When someone is injured in a car accident, depending on what state they live and drive in, one of the first types of compensation that may become available is through a Personal Injury Protection (PIP) claim or lawsuit. PIP insurance coverage is a form of no-fault insurance coverage that drivers in some states must purchase in order to register their vehicles. PIP covers the cost of medical expenses, lost wages, and essential services after an accident. As a form of “no-fault” insurance, PIP kicks in after an accident, regardless of who may have caused it.
However, the process of receiving a settlement from the insurance company doesn’t always go smoothly. Although filing a PIP claim technically involves filing a claim with your own insurer, that doesn’t necessarily mean the insurance company is always acting in your best interests in this type of situation. The insurance company’s main goal may be to maximize its profits and guard against financial losses.
An insurer might delay, underpay, or deny a valid PIP claim. Hopefully, this won’t happen to you, and your insurance company will offer the full amount of compensation you’re eligible to receive. However, if the car insurance company doesn’t compensate you properly, you may have to file a PIP lawsuit to recover what you deserve.
In this guide, we’ll explore what PIP is, how it works, and the most common reasons why accident victims file lawsuits related to PIP insurance claims. If you’ve encountered delays, rejections, or received a lowball payout from your PIP provider, understanding your rights can help you take the next step.
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Personal Injury Protection is a form of no-fault car insurance coverage that helps pay for immediate post-accident expenses. In states that require or offer PIP, the goal is to reduce the number of lawsuits by allowing accident victims to recover basic damages quickly without having to prove who was at fault. Typically, as is the case in DC, PIP covers the actual insured operator of a motor vehicle, as well as any occupants in their vehicle who may be injured in a car accident.
Keep this in mind if you were hurt in a car accident as a passenger in a vehicle someone else was driving. If the car accident occurred in a no-fault state, compensation for your injuries may be available through the driver’s PIP insurance. Discuss your case with a legal professional to learn more about the potential ways you might recover compensation in this scenario.
Although the specifics and nuances can vary to some extent from one state to another and from one policy to another, in general, a PIP auto insurance policy will cover the following after an auto accident:
Lost wages: A portion of income lost due to the inability to work
Replacement services: Costs for household tasks the injured person cannot perform (e.g., cleaning or childcare)
Funeral expenses: Burial and funeral costs if the injury leads to death
Again, the exact details vary by state. There may be additional benefits depending on the policy. For instance, Washington, DC, offers optional PIP coverage, while neighboring states like Maryland and Virginia have different approaches.
Drivers in several states are required to purchase Personal Injury Protection (PIP) insurance to register their vehicles legally. These states include:
New Jersey
Florida
Michigan
Massachusetts
Hawaii
Minnesota
North Dakota
Utah
In other states, such as Maryland and Washington D.C., PIP may be optional. Sometimes, it’s offered as an add-on to standard coverage.
The lawsuit is not about who caused the accident. The purpose of the lawsuit is to compel your own insurance providers to compensate you properly according to the terms of your agreement with them.
These lawsuits typically arise when a person has:
Been denied payment or offered less than they are owed
Attempted to resolve the matter informally or through appeals
Reached a point where taking legal action is necessary
The core issue in a PIP lawsuit is whether the insurer upheld their contract with the policyholder. Filing a lawsuit allows you to enforce a contract when an insurer fails to honor it.
Not every injury claim leads to a PIP lawsuit. But when problems arise, they often fall into one of the following categories:
One of the most frustrating experiences for accident victims is dealing with slow responses from their insurance provider. Some companies take weeks or months to pay a PIP claim—even when medical bills are mounting and wages are lost. If there’s no reasonable justification for the delay, legal action may be warranted.
Insurers may reject a PIP insurance claim for various reasons:
They argue the injury wasn’t caused by the accident
They say treatment was unnecessary or excessive
They claim the policyholder missed deadlines or failed to submit paperwork
When a denial appears unjustified or unsupported by the policy, a lawsuit may be the only way to reverse the decision.
Sometimes insurers offer partial payment—just enough to appear cooperative, but far less than the claim is worth. This tactic may be used in the hopes that a desperate or overwhelmed claimant will accept the reduced payout. If you’re offered less than what your policy entitles you to, you may have grounds for legal action.
PIP covers necessary medical procedures. It doesn’t cover treatment that may not be medically necessary or required after an accident.
Insurers sometimes send medical bills for independent review or may require policyholders to undergo examinations by doctors selected by the insurance company. These “independent medical exams” (IMEs) often lead to claims being reduced or denied. If your care was legitimate and medically necessary, and the insurer uses a biased IME to avoid paying, you may be able to challenge that decision in court.
Even simple administrative errors—such as lost paperwork, incorrectly coded procedures, or misfiled documentation—can delay or deny a valid PIP claim. If the insurer fails to fix the mistake and continues to withhold payment, a lawsuit might be necessary.
Your goal when filing a PIP lawsuit is to obtain the compensation the insurer should have paid in the first place. This may include:
Compensation for lost income up to the policy limits
Payment for replacement services
Interest on delayed payments (in some states)
Attorney’s fees (in certain cases where bad faith is proven)
It’s important to remember that PIP lawsuits generally don’t include compensation for pain and suffering. However, if you sustained a serious injury, you may also have grounds to take legal action against a negligent party who caused your accident.
Your damages may exceed PIP limits if your injuries are severe. You could have the right to pursue a separate personal injury lawsuit against the at-fault driver in these circumstances.
This is common in catastrophic injury cases involving long-term disability or permanent damage. In those cases, your PIP benefits serve as a first layer of compensation. Traditional litigation could be necessary to secure the remainder.
Each state sets a specific deadline, known as the statute of limitations, for filing a lawsuit related to PIP insurance claims. Failing to file in time can mean losing your right to recovery entirely. Guard against this by promptly speaking with a legal professional who can explain the deadlines that may apply to your case.
Technically, it’s possible to represent yourself in small claims court. That said, pursuing a PIP lawsuit without legal representation can be risky. Insurance companies are well-resourced and know how to use policy language to their advantage. An experienced attorney can help you:
Collect and present evidence
Challenge faulty IMEs
File suit within deadlines
Maximize your potential payout
At Regan Zambri Long, we understand how overwhelming it is to recover from a car accident while dealing with a reluctant insurer. Our team brings decades of experience handling PIP insurance claims, injury lawsuits, and insurance bad faith cases.
We represent clients in Washington D.C., Maryland, and Virginia and help them pursue the compensation they are rightfully owed. Whether your PIP claim has been delayed, denied, or underpaid, we can investigate, negotiate, and litigate on your behalf.
Filing a PIP lawsuit may sound daunting, but it could be the most effective way to get the benefits you deserve. If your insurer is not living up to their obligations under your personal injury protection coverage, it’s time to take action.
Don’t let delays and denials derail your recovery. Reach out to Regan Zambri Long today for a free consultation.
Have you or your loved one sustained injuries in Washington DC, Maryland or Virginia? Regan Zambri Long PLLC has the best lawyers in the country to analyze your case and answer the questions you may have.