In Utah, there are three basic insurance benefits available to victims of an accident that caused physical injury. These benefits have many names, but are most commonly referred to as PIP, No-Fault, or “Band-Aid Benefits”. These benefits provide:
- $3000 of Medical Expenses
- $ 250.00 per week or 85% of your gross weekly wage, whichever is the least
- $20.00 per day for household services
Let’s take a minute and discuss the requirements for collecting each of these benefits. The first step to obtaining any of these benefits is to fill out a PIP (Personal Injury Protection) application, which will be provided by your insurance company.
Three Basic PIP Benefits
$3,000 of Medical Expenses.
Your own insurance company is required by state law to cover the first $3000 of medical bills. Your healthcare provider will bill them directly if they are provided with the company name and claim number. Your doctor will also need to fill out a “Physician’s Initial Report” You have three (3) years from the date of the accident to use this benefit.
$250 per week or 85% of your gross weekly wage, whichever is least.
A form will be provided by your insurance company to claim these benefits. Generally this form will ask for your wage-earning history, your current hourly/salary rate, when you started work, and whether you regularly work overtime. The No-Fault carrier will typically look backwards from 10-20 pay periods to determine your average weekly wage. This benefit is available for 52 weeks from the time it is first claimed.
Please understand that the insurance company puts the burden on you to provide work release notes saying how long you will be off work. Generally, this note needs to be filled out every 30 days by your doctor.
$20.00 per day for Household Services.
You may qualify for this benefit if you have a note from the doctor outlining which household chores you are unable to perform. The note should include the period of time you are unable to perform those duties. This note also need to be updated every 30 days. You must keep track of who actually helps your around the house in order for you to qualify for Household Service benefits. Often your insurance company will provide a calendar for this purpose. The benefit is available for 52 weeks from the time it is first claimed.
To summarize, in order for your insurance company to efficiently process your claim, and provide the “Band-Aid benefits” for which you paid, your insurance company and our office need copies of the following documents:
- Pip or No-Fault Application
- Physician’s Initial Report
- Employer’s Wage Verification
- A doctor’s note releasing you from work
- This note needs to be updated every 30 days
- A doctor’s note restricting you from household duties
- This note needs to be updated every 30 days
- Household Service calendar
We will assist you with your Band-Aid benefit if you have trouble. However, like property damage, we try to let you handle these claims because if you pay an attorney to help, there is less money available for you.
You have hired us to represent you in your claim against the person who caused the crash. In other words, we will represent you against the person who negligently hurt you, this is your liability claim. In order to be successful, you must prove four (4) things:
- Who caused the accident?
- What are your injuries?
- Causation or proof that the accident caused these injuries
- What amount of money will fairly compensate for your injuries?
We are sorry that you were hurt, and we will work hard for you to prove all four parts of your negligence or liability claim.
To help you recover your losses, we will ultimately build a Settlement Package which will be sent to the person who hurt you, or their insurance company. We will handle all communications with the others person’s insurance company regarding your claim for injury, wage loss, and other damages. When we put a Settlement Package together, we present a package of all expenses related to the crash, as if nothing has ever been paid. This includes bills paid through the “PIP / No Fault / “Band-Aid Benefits” (discussed above), and bills paid by your health insurance, or bills you have paid yourself which relate to the accident. Therefore, we need copies of all documents relating to your case. We can better fight for you if you will:
- Periodically provide us copies of medical bills you receive. We order records and bills from your healthcare providers directly. However, sometimes they do make an error and do not send us everything. Your copies allow us to double-check the records.
- When you see your doctor (not your physical therapist, massage therapist, etc.), please call us so we can understand the status of your treatment, and the plan for your future care.
- If you get a collection notice, please call us immediately so we can contact the doctor, and perhaps keep it from showing up on your credit report. Most doctors are willing to work with patients when they know we are involved.
- Call us when anything significant happens regarding your case (i.e. another motor vehicle accident, surgery, epidural injections, pregnancy, etc.)
- We will handle all communications with the person who hurt you or their insurance carrier.
- We will help coordinate your medical bill with your health insurance after your PIP / No Fault / “Band-Aid Benefits” are exhausted.
- We can set up liens with your medical provider for balances owed, if your doctor will accept a lien.
- We will speak with your health insurer about questions they may have regarding your accident.
- Ultimately, when you are finished treating, we will build a Settlement Package, and we will evaluate your case to help advise you of what your case is worth and how best to settle it. When you settle your case, we will do our best to see that all reasonable medical bills are paid, you are reimbursed for lost wages, and to the extent possible, we will make sure that your auto insurance and health insurance is repaid for any benefit they provide.
- Before we settle your case, we will discuss the settlement with you. You will be provided with an accounting showing the total settlement, repayment of medical bills including insurance, attorney’s fees and costs, and the net amount of money that you will receive. Note: Currently settlement proceeds are not taxable.
Injury Smart Law will do everything we can to settle your case as efficiently as possible. We look forward to working with you and will do everything we can to help make this difficult time go as smoothly as possible.