Auto (PIP) and L&I

What is Personal Injury Protection Insurance (PIP)?

PIP is insurance coverage you add to your auto insurance policy. If you are in an auto accident, up to certain limits, it will help pay for Medical Expenses, Wage Loss, Loss of Services, and Funeral Expenses. PIP applies no matter who is at fault, but be aware, there are some situations when it does not apply.

Who Does PIP Cover? Why should I always use it?

PIP covers the following:

• Person named on the policy
• Household residents related by blood, marriage, or adoption
• Step- or foster children
• Any non-family passengers and/or pedestrians involved in the accident

PIP covers medical bills, a portion of your weekly lost wages, and for household care and cleaning. Your insurance company, by law, cannot cancel your policy for using your PIP. If you have not rejected PIP coverage in writing, then you are deemed to have it. Your insurance company, by law, cannot increase your insurance rates for using your PIP. 

A Step By Step Guide to PIP

1. Call your insurance agent
2. Ask if you have PIP - if yes, ask about limits on time and dollar amount
3. Ask your agent to take your Report of Loss claim
4. Ask your agent to phone in your report to the claims office
5. Ask your agent to call back with the claim number, address, and phone number of the claims office
6. Call the claims office and get the name of the claims adjuster handling your claim
7. Ask the claims adjuster to mail a PIP Application, Attending Physician's Report, and Salary Verification forms
8. Complete the PIP Application and return it to the claims adjuster
9. Have your doctor fill out the Attending Physican's Report form, return it to you, and then you will mail the form to the claims adjuster
10. Have your employer complete the Salary Verification form, return it to you, and then you will mail the form to the claims adjuster
11. Provide your claim number and adjuster's name, office address and phone number to all your Health Care Providers
12. Instruct your Health Care Providers to bill your PIP carrier directly, including copies of chart notes for each day of services

Worker's Compensation/Labor and Industry Claims

Injured At Work?

If you are injured at work or develop an occupational disease and your claim is accepted, workers' compensation (L&I or your self-insured employer) pays for medical care directly related to your accident or illness. If you are unable to work following your injury, you may be eligible for a portion of your lost wages. More importantly, L&I or, your self-insured employer, may help coordinate a safe and timely return to work. 

If your employer is self-insured, your rights and benefits entitlement do not change, but who manages your claim and the process is different. Your employer, not L&I, handles your paperwork and pays for the claim.  

If the accident was my fault, are my medical bills covered?

Yes. You may receive benefits regardless of who was at fault.

File a Claim

If you are injured at work, you and the doctor who treats you, will fill out an accident report form. Your claim is filed when your doctor sends this report to L&I for processing (NOTE: if your employer is self-insured, you will file your claim directly through them- contact your personnel department for help).

Getting back to work

Some injured workers miss days of work while they recover. However, many can return to work gradually while still receiving medical benefits. Research shows that the sooner you are able to return to work, the better your chances are for recovering your income and health.

When are claims closed?

When any of the following happen:

• Your health care provider or another physician certifies that further treatment won't improve your condition
• L&I has no information showing you need further treatment
• Your injury was minor and treatment was successful (in these cases, we accept and close your claim at the same time in a single Notice of Decision)
• An IME (Independent Medical Exam) states that you have reached maximum medical improvement