In Washington, unless a policyholder expressly refuses PIP insurance, it is written into all insurance policies issued in Washington. The minimum limits are $10,000, but policy holders may elect to increase the coverage by paying a higher premium. Regardless of who may be "at fault" for a crash, PIP insurance covers the "reasonable and necessary" expenses such as medical bills and wage loss following a crash. Because the limits are often smaller, we typically see clients who have "exhausted" their PIP coverage during the initial emergency room visit following a crash. When this happens, unless other coverage such as health insurance steps in, the injured party will be personally responsible for all unpaid medical bills until money is secured from an at-fault third party through settlement or court judgment. Many times medical providers will even place a lien on any amounts received. If you are worried about this, you should talk with your insurance agent about increasing your PIP limit. Most insurance carriers offer increased limits of up to $35,000.