Author Archives: Sue Nachtrab

Auto Injury Claims

In Kansas, automobile insurance policies are required to contain no fault insurance or personal injury protection (PIP) benefits. This coverage provides for lost income due to an accident, medical bills, rehabilitation expense and death/burial benefits.

Medical bills and lost income are considered “pecuniary damages.” These damages can be asserted in any claim where they are a factor. Non-pecuniary damages include items such as pain, suffering and emotional distress. In Kansas, those damages may be asserted only after the injured Plaintiff has reached a statutory threshold. There are various ways to meet the threshold requirement, but the most common occurs when the victim incurs at least $2,000.00 in reasonable and necessary treatment charges associated with the accident. This $2,000.00 threshold amount is often confused with the $4,500.00 minimum required coverage for medical PIP benefits.

Lawful Treatment Charges

A physician, hospital, clinic or other person or institution lawfully rendering treatment to an injured person covered by personal injury protection (PIP), or no fault benefits, may charge a “reasonable amount” for the products, services and accommodations rendered. Under Kansas law, the charges shall not exceed the amount the provider or institution “customarily” charges for like products, services and accommodations in cases not involving insurance.

Prompt Payment Requirements

Once a bill is properly submitted with appropriate documentation to the automobile insurance carrier for payment as a personal injury protection/no fault benefit, the bill is required to be paid within thirty (30) days. If the billing statement is not paid within thirty (30) days and there is no reasonable basis for non-payment, the patient/insured may assert a claim for breach of contract. If successful, the Court will order the bill to be paid plus 18% interest. In cases where it is deemed appropriate, reasonable attorney fees must be paid by the carrier, as well.

Summary

This article contains a very brief overview of a few of the many insurance statutes which regulate automobile insurance claims. In order to ensure payment of your bills in auto injury cases, it is helpful to have at least a cursory understanding of these laws. However, if an auto insurance company begins denying your PIP/no fault benefits or the insurance carrier that covers the person at fault for the accident will not settle your claim for a reasonable amount, it is wise to retain an attorney familiar with these insurance laws and the litigation system.

*Use of this website does not create an attorney-client relationship. The information on this site is not legal advice. You should contact an attorney for actual legal advice with Dickson and Pope, P.A. at 913-387-5510.

Persons Covered by Kansas P.I.P. Benefits

Persons covered by personal injury protection benefits generally include the named insured, relatives residing in the same household, persons operating the insured’s motor vehicle, passengers in such motor vehicle, and other persons struck by such motor vehicle and suffering bodily injury while not an occupant of a motor vehicle. A person with a claim for personal injury protection benefits should look to his or her own automobile insurance policy.

When a person injured by a motor vehicle does not own his or her own motor vehicle, a claim can be asserted against the policy covering the vehicle in which that person was riding, or the vehicle that harmed that person at a time when they were not inside the vehicle, or vehicle that caused the accident. However, if one is a motor vehicle owner, but does not carry the statutorily required liability insurance on his or her vehicle, that person may not assert a claim for personal injury protection benefits against the policy of another. These issues can be confusing so it is wise to consult an attorney familiar with Kansas PIP laws.

Asserting A Claim for P.I.P. Benefits

As soon as is reasonable following a motor vehicle related injury, the automobile insurance company should be contacted and advised of the situation. Then, a Personal Injury Protection Application form is generally forwarded by the insurance company for completion by the injured claimant. Although Kansas law allows a five (5) year statute of limitations for enforcement of written insurance contracts, a claim for PIP benefits must be asserted within two (2) years.

If there is a question or dispute as to which company should receive the personal injury claim, it is wise to seek legal counsel.

Motor Vehicle Accidents On The Job

Sometimes, persons who drive as part of their work duties are injured while in an automobile accident in the course of employment. In that instance, the workers’ compensation carrier generally takes priority for paying the claim. Bills should be processed with the workers’ compensation carrier first and reasonable and necessary charges should be paid in accordance with the Workers’ Compensation Fee Schedule. In this instance, there is no cap on the amount of medical benefits paid other than the limitations imposed by the Fee Schedule and the rules pertaining to authorization for care.

When Bills Exceed The Personal Injury Protection Cap

Once personal injury protection medical benefits run out, the injured claimant can look to his or her personal health insurance carrier to cover ongoing bills. It is important to all insurance information available to your doctor at the beginning of treatment for motor vehicle related injuries. That way, there can be a smooth transition when a PIP carrier has issued a statement that benefits have been exhausted and bills need to be directed to a different insurance entity.

When Someone Else Was At Fault

If the motor vehicle accident was caused by someone other than the injured claimant, a liability claim can be asserted against that person’s automobile insurance company. In Kansas, if it is not resolved through settlement, that claim must be filed with the appropriate Court within two (2) years of the date of the accident to be viable. With a liability claim, only one check will be written when the case is settled and/or when a judgment is entered. The liability carrier is not required to pay bills as they are incurred like a PIP carrier is required to do.

P.I.P. – Squeaking Out The Details Of The Kansas Automobile Injury Reparations Act

P.I.P. – Squeaking Out The Details Of The Kansas Automobile Injury Reparations Act

The Kansas Automobile Injury Reparations Act provides statutory guidance relative to insurance claims associated with injuries sustained in or by a motor vehicle. The purpose of the Act is to provide a means for compensating persons promptly for accidental bodily injury arising out of the ownership, operation, maintenance or use of motor vehicles without the need for a formal liability claim. In Kansas, with few exceptions, every owner of a motor vehicle is required to have vehicle liability insurance coverage. The limits of liability with respect to each vehicle must not be less than $25,000.00 for bodily injury to, or death of, one person in any one accident. The policy must cover at least $50,000.00 for bodily injury to, or death of, two or more persons in any one accident.

The legal requirement for motor vehicle insurance includes personal injury protection benefits, or PIP. PIP benefits must include disability benefits, funeral benefits, medical benefits, rehabilitation benefits, substitution benefits and survivor’s benefits.

Medical Benefits

PIP medical benefits must contain allowances for all reasonable treatment expenses up to a limit of not less than $4,500.00 for necessary health care rendered by practioners licensed by the State Board of Healing Arts to practice any branch of the healing arts. Medical benefits must also include licensed psychologists, surgical, x-ray, dental services, prosthetic devices and necessary ambulance, hospital and nursing services.

Rehabilitation Benefits

The PIP rehabilitation benefits required by law encompass all reasonable expenses up to a limit of not less than $4,500.00 for necessary psychiatric or psychological services. These benefits must also cover occupational therapy and such occupational training and retraining as may be reasonably necessary to enable the person to obtain suitable employment. Where appropriate, these services may be stacked on top of the allowance for medical services.

Disability Benefits

Disability benefits refer to allowances for loss of monthly earnings due to an injured person’s inability to engage in available and appropriate gainful activity. The claimant requesting such benefits must prove that the injury sustained is the proximate cause of the injured person’s inability to engage in available and appropriate gainful activity. Then, allowances are generally made for 85% of the injured claimant’s regular gross earnings up to a maximum cap which shall be not less than $900.00 per month.

Funeral Benefits

Funeral benefits are also covered under the PIP umbrella. The allowances cover funeral, burial or cremation expenses in an amount not to exceed $2,000.00 per individual.

Substitution Benefits

The persons injured in an auto related incident can also claim “substitution benefits.” These benefits allow for reimbursement of the appropriate and reasonable expenses incurred in obtaining ordinary and necessary services in lieu of those that, but for the injury, the injured person would have performed for the benefit of such person or such person’s family. These benefits are subject to a maximum of $25.00 per day for not longer than 365 days after the date such expenses are incurred.

AUTOMOBILE INJURIES: WHO SHOULD GET THE MEDICAL BILL?

There are multiple sources for insurance coverage which may be available to you if you have been injured in an automobile accident. Before you leave the scene of an accident, you should record the automobile insurance information for all parties involved in the accident. It can be confusing and difficult to determine who to bill for your treatment. To ensure that you meet statutory and contract deadlines, it is a good idea to speak to an attorney who practices in this area of the law.

Start By Getting Information

Obviously, it is very important to provide a thorough history to your doctor during the initial visit following a motor vehicle accident. You should report how, where, and when the injury occurred. You should not assume that because you have been injured in an automobile accident, automobile coverage is the sole avenue for claims reimbursement. Here is a list of types of coverage which may be available to pay your bills:

Workers’ Compensation If you were injured in an automobile accident while “on the job,” the treatment charges should be submitted to the workers’ compensation insurance carrier first. In this circumstance, your doctor must accept the billing amounts allowed by the Workers’ Compensation Fee Schedule published by the Kansas Department of Labor. If your doctor is “authorized” by the Workers’ Compensation Carrier to treat you, there is no cap on the number of services which are covered. If you see an “unauthorized” provider, the workers’ compensation carrier will pay up to $500.
Personal Injury Protection (PIP) Benefits Once it has been determined that workers’ compensation does not apply, or that those benefits have been exhausted, you should look for PIP coverage. Every Kansas automobile insurance policy must contain at least $4500 in PIP benefits. There is no fee schedule for PIP, but charges must be “reasonable and customary” for “reasonable and necessary” healthcare. In Kansas, PIP benefits cover the cost of treatment and lost income for individuals who have suffered an automobile-related accident, regardless of fault.
Private or Employer-Related Health Insurance Once PIP coverage has been exhausted, claims should be directed to the patient’s health insurance carrier. If care is insured under a major medical plan in which your doctor is a contract provider, he or she must bill for treatment at a discounted contract rate.
Medicare and Medicaid Medicare and Medicaid apply like other forms of health insurance. Once the PIP coverage has been exhausted, doctors who treat patients enrolled in these government programs should observe and comply with all rules and regulations for billing applicable to these programs.
Third-Party Liability Coverage If someone else was at fault in causing the car accident, some other party might be legally responsible for your injuries and healthcare expenses arising from the motor vehicle collision. While your doctor will not be able to bill the liability insurance carrier directly, this is another source which may ultimately be available to satisfy your medical charges. Here, the rule again for charges is “reasonable and customary” for “reasonable and necessary” treatment.

Determining where to look for payment of motor vehicle accident related medical bills can be confusing. It is often beneficial to contact an attorney who will be willing to communicate with you and make sure that your medical charges are taken care of out of a settlement of your claim.

Kansas No Fault Automobile Insurance Benefits

In Kansas, with few exceptions, every owner of a motor vehicle is required to have vehicle liability insurance coverage including personal injury protection benefits, or PIP. PIP benefits are available for motor vehicle related injuries, regardless of fault. A PIP policy must include medical benefits, rehabilitation benefits, disability benefits, funeral benefits, substitution benefits and survivor’s benefits. All PIP policies must include the following:

Medical Benefits must contain allowances for all reasonable treatment expenses up to a limit of not less than $4,500.00 for necessary health care.

Rehabilitation Benefits encompasses all reasonable expenses up to a limit of not less than $4,500.00 for necessary psychiatric or psychological services. These benefits must also cover occupational therapy and such occupational training and retraining as may be reasonably necessary to enable the person to obtain suitable employment. Where appropriate, these services may be stacked on top of the allowance for medical services.

Disability Benefits refers to allowances for loss of monthly earnings due to an injured person’s inability to engage in available and appropriate gainful activity. Allowances are generally made for 85% of the injured claimant’s regular gross earnings up to a maximum cap which shall be not less than $900.00 per month.

Funeral Benefits are also covered under the PIP umbrella. The allowances cover funeral, burial or cremation expenses in an amount not to exceed $2,000.00 per individual.

Substitution Benefits allows for reimbursement of the appropriate and reasonable expenses incurred in obtaining ordinary and necessary services in lieu of those that, but for the injury, the injured person would have performed for the benefit of such person or such person’s family. These benefits are subject to a maximum of $25.00 per day for not longer than 365 days after the date such expenses are incurred.

Persons Covered by PIP include the named insured, relatives residing in the same household, persons operating the insured’s motor vehicle, passengers in such motor vehicle, and other persons struck by such motor vehicle and suffering bodily injury while not an occupant of a motor vehicle. Generally, a person with a claim for personal injury protection benefits should look to his or her own automobile insurance policy. However, when a person injured by a motor vehicle does not own his or her own motor vehicle, a claim can be asserted against the policy covering the vehicle or vehicles involved in the injury accident. If one is a motor vehicle owner, but does not carry the statutorily required liability insurance on his or her vehicle, that person may not assert a claim for personal injury protection benefits against the policy of another.

A physician, hospital, clinic or other person or institution lawfully rendering treatment to an injured person covered by PIP may charge a “reasonable amount” for the products, services and accommodations rendered. Once a bill is properly submitted with appropriate documentation the bill is required to be paid within thirty (30) days. If the billing statement is not paid within thirty (30) days Kansas statutes allow for an award of interest (18%) and attorneys fees in appropriate cases.

This article contains a very brief overview of the many insurance statutes which regulate automobile insurance claims. If a PIP auto insurance company denies payment of your bills before the cap for medical benefits has been reached, it is wise to retain an attorney familiar with these insurance laws and the litigation system.