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Don Jacobs
Don Jacobs
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Injured pedestrians and insurance benefits

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So you find yourself crossing a street in a marked crosswalk after the “WALK” sign is illuminated. Or maybe you are riding your bike in the same situation. The law in most states gives you the right of way in this situation. So what happens if some careless driver makes a right turn without looking? If his negligence causes an injury you have a right to compensation. When the case is settled, sometimes many months down the road, you have the right to be compensated for any out of pocket losses and the harm you went through. So what about before then? Who pays for your medical bills or lost wages in the interim? If the driver who struck you has “Personal Injury Protection” or “PIP” coverage on his policy you may be able to access it to pay for medical bills. This “PIP” coverage is an extra coverage people buy to pay for medical bills and some wage loss if they or their passengers are hurt in an accident. Due to a quirk in some state’s laws, it can also cover pedestrians they hit with their car. As an injured pedestrian, you become an insured under the policy and are treated the same as if you were a passenger in the car. In a sense it is treated just like you were the customer who purchased the insurance. In fact, if you had your own insurance, they would refuse to pay until you used up this coverage. This coverage pays for 100% of your medical bills subject to a typical policy limit of $10,000 to $15,000 and a one to three year coverage period. Most medical clinics accept this coverage as it usually pays 100% of their bill, unlike normal medical insurance where they have to take significant discounts. Unfortunately, a lot of pharmacies will not direct bill and require payment up front for medication, although you can get reimbursed if you provide the pharmacy receipts. The insurance company may require you fill out an application for benefits and sign a medical release form before they provide coverage. However, once it is open you’ll have a claim number to give to whatever clinic you see for direct billing. Most clinics accept this coverage since it pays so well. There is no deductible or co-pay and it covers 100% of the bill. However, some clinics still demand some up front payment from a patient to start care which they reimburse once they get paid by the company. You will need to ask any clinic you choose what their policy is so you can make sure you treat somewhere that doesn’t require this. Asking if they accept PIP coverage and direct bill should do the trick. The “PIP” coverage also has a wage benefit but it isn’t near as good as the medical benefit. The wage benefit won’t pay anything for lost work until you are off for at least two weeks. After that, they typically pay only 85% of your take home or $200 a week, whichever is less. It also takes some time to get this benefit started. Proof of disability from a doctor and proof of lost income from the employer must be provided. Insurance companies are notoriously slow in paying this benefit. Delays and uneven payments are the rule, not the exception. Relying on this coverage for steady regular payments after you miss two weeks would be a mistake. It is also important to remember that this “PIP” coverage is different from the driver’s liability coverage. The liability coverage will provide funds you can access once you are through with treatment and your injury has healed. Your settlement, or court award if you have to go through a lawsuit, will include all of your medical bills, your full wage loss and money for pain and suffering. A settlement will often not happen for many months and if you have to use the court system, it could take a year or more. Until then, the only money you get as an injured pedestrian involves the PIP benefits explained above.