Written by attorney Nathan D. Alder

Personal Injury Protection (PIP), No Fault, Thresholds for Suit: Utah Auto Cases

People often ask me: how does insurance work after an auto accident? Sometimes the question is: what is required to file suit for pain and suffering? I am restricted to a 5,000 character answer here, but I do hope to give some basic information that may assist you. This is not intended as legal advice or representation.

In Utah, some of the answers to these questions are found in the insurance code governing auto insurance policies and your “personal injury protection" or “PIP" benefits from your own auto policy. Utah is considered a “no fault state" for auto accidents, meaning that for accidents with only minor injuries or damages, those claims are handled by insurance companies and really don’t make their way in to the court system. Utah has what is called a “threshold" requirement for bringing “general damage" claims (e.g., pain, suffering, etc.) into court.

In most instances, the “threshold" for “general damage" personal injury lawsuits is medical expenses in excess of $3,000. Other thresholds include: death, dismemberment, permanent disability or permanent impairment, and permanent disfigurement. So, if you have $3,001 in medical expenses, you can bring your general damage claim in court. If you have a scar (permanent disfigurement), but only $1,000 in medical expenses, you can still bring your general damage claim in court because you met one of the other threshold qualifiers. If you have $2,800 in medical expenses and no other threshold qualifier, you will not be able to seek general damages in court. You should also know that Utah case law discourages claimants from intentionally incurring unnecessary medical expenses simply to meet the threshold of $3,000. There are rare instances where you may bring a claim only for “special damages" (e.g., specific costs, expenses, amounts, bills, losses, etc.) if you do not meet one of the thresholds for general damages. Serious cases, however, involve bringing both general and special damage claims together in one court filing.

Utah requires that auto policies have PIP as a coverage feature. However, motorcycles, trailers and semitrailers are not required to have PIP. The required PIP portion of your auto policy provides for the following coverage: medical costs not to exceed $3,000 per person (reasonable value of medical, surgical, x-ray, dental, rehab, ambulance, hospital, nursing); lost wages, the lesser of $250 per week or 85% of loss in gross income and loss of earning capacity, up to 52 weeks; household services, $20 per day up to 365 days for services rendered (laundry, cooking, cleaning, yard, repair, maintenance, etc.) by others (whether paid or unpaid) to the injured person; a $3,000 death benefit, payable to heirs, and up to $1,500 for costs (cremation, funeral, burial). These are benefits you paid for with your auto insurance premium.

At the accident scene or at the ER, they will ask you for your auto and health insurance information. The auto insurance company will pay the initial medical bills (ambulance, ER, initial doctor visits, etc.). Once the auto insurer has paid its PIP limit, or “exhausted" the PIP medical coverage, usually $3,000, the health insurance company will take over and start paying additional amounts. If you don’t have health insurance, then you need to start taking care of the additional bills. The $3,000 in meds can be exhausted quickly on serious injuries (e.g., AirMed, trauma services, ICU, surgery) whereas it can take days, weeks, even months to exhaust benefits on other types of accidents.

Your own auto insurance will provide PIP to the people in your car. The other car involved in the accident will provide PIP benefits to its occupants. For auto/pedestrian accidents, the pedestrian is entitled to PIP benefits from the car in the accident. You can purchase more PIP coverage than the minimum; it is something you can discuss with your agent. Your insurance company will provide you with a PIP Application to provide information (doctors, clinics, pharmacies, employer, time off work, etc.) that will help get PIP benefits rolling out to you. A letter usually comes soon after the accident. If the PIP adjuster is slow getting to you, call and get the process started. Some lawyers will assist in PIP claims.

Insurance companies pay out claims for PIP benefits. If their driver, a PIP beneficiary, did not cause the accident, then the insurer will try to get its PIP payout back from the other insurance company which had the “at fault" driver. Through negotiations or via special arbitration forums for PIP reimbursement disputes, insurers work to resolve these differences and get money back. However, this effort does not involve the person who received the PIP benefits; this is a helpful feature of “no fault" insurance and a key protection for PIP beneficiaries. You do not have to be involved. Even though the person who hit you may be at fault for the accident and your injuries, you do not need to immediately sue him in order to get your initial medical and other expenses paid; those were paid to you under your PIP. You are taken care of for now. You paid for that benefit in advance (and even in anticipation) of the accident. Your insurance company makes various payments to you under PIP, and when ready it will present those amounts to the other person’s insurance carrier and ask for reimbursement; it is a matter between insurers only.

If you incur amounts that exceed the PIP threshold, however, or if you have impairments, disfigurement or other physical limitations that meet a “threshold" qualifier, see above, then you will likely be pursuing a “general damages" claim against that person by establishing a claim with his insurer, and then possibly filing suit in court.

I wish I could provide more in this space about exceptions, nuances, developments, case authorities, and other considerations, but I hope you sense the fundamental issues -- threshold for general damages and the benefits of “no fault" insurance. Contact counsel to pursue your claims. Search AVVO for attorneys. If you need a referral for a lawyer, I would be happy to help give you one. I would also be pleased to answer questions you may have about these issues. Likewise, if you would like our firm to represent you, please contact us and we can provide an initial consultation. I wish you well.

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