How to Use Personal Injury Protection aka PIP Insurance for Physical Therapy Treatment After a Car Accident – Seattle

What is PIP insurance?

Auto insurance has been around in some shape or form since the late 1800s to protect your investment in your vehicle. While your collision and comprehensive coverage insure the cost of your property in the event of an accident, Personal Injury Protection, or PIP, is there to cover medical expenses associated with your accident. Additionally, your PIP coverage can be used to supplement lost wages should you need to miss work due to your injury.

While PIP coverage is not required in Washington state, your insurer is mandated to offer plans that include PIP. With the ever-increasing costs of insurance premiums, you may be inclined to decline this extra expense. However, we’ve found that the benefits far outweigh the cost, especially considering PIP coverage can be as low as an extra $10 for the entire year! Depending on the needs of the subscriber, typical PIP plans start at offering $10,000 for medical coverage and go up to $25,000, $50,000 with some plans even exceeding $250,000. Check with your insurance broker to see what plans they offer and their rates.

How do I use my PIP Insurance for Physical Therapy and Whiplash Injury Treatment?

For most health insurance plans in Washington state, physical therapy is considered a “direct access” benefit, meaning a referral from your doctor isn’t required before being treated at Union PT. However, in order to use your PIP coverage, the first step would be to see your primary care doctor and have them complete a Report of Accident Form for them to submit to your auto insurance.

From here, you will be assigned a claim manager who will be your main contact for questions regarding your claim. When you call to make an appointment at Union PT, we will need the name of your claim manager, their contact info, your claim number and the date and state in which the accident occurred.

Unlike your collision insurance, your PIP rates won’t be affected when you use them, even if you’re considered to be at fault for the accident. As you’re nearing the end of your available PIP funds, feel free to notify your administrative team here at Union PT and we can get ready to transition to your primary health insurance or offer our self-pay discount for future visits. Your health insurance may send you a form asking if the funds in your PIP have been exhausted. It’s important to complete this form promptly and return it them in order to not see a lapse in treatment.

Can my PIP coverage be denied?

 The letter of the law regarding PIP coverage is very clear in Washington state. Per Washington State Administrative Code 284-30-395, your PIP coverage can only be denied for the following four reasons.

The billed charges are not reasonable

Union PT has done extensive research into our local demographic in order to offer a competitive rate for our services. We comply with state and local regulations and attend conferences regularly to ensure we are ethically billing insurers and our patients.

Treatment is not related to the motor vehicle collision

Once you have been assigned your claim number from your auto insurance, it is your responsibility to not abuse the parameters outlined in your contract with your auto insurer. That being said, it’s important to know what protections you have should you receive a denial stating that treatment is not related to the motor vehicle collision.

Let’s look at this example: Patient Will has had a chronic neck injury for years. Perhaps he has received treatment, perhaps he hasn’t. Patient Will then gets into a car accident that causes his symptoms to worsen. Per Washington state code he absolutely is entitled to use his PIP coverage for treatment. Any new pain or symptoms or any progression of symptoms that can reasonably be attributed to a motor vehicle collision is covered under your PIP coverage.

Treatment is not necessary

This is unfortunately the most common reason we see for denials from auto insurers. Upon completing your visit, Union PT will send the billing information as well as the treatment notes from your visit to your auto insurer.

In an attempt to avoid making payment, a member of your insurer’s claims management team may make a determination that your visit does not meet their criteria for coverage. This is a violation of Washington State code. In order for an auto insurer to make this determination, they must first conduct an Independent Medical Examination, or IME, with you.

When your insurer calls to schedule an IME, we’ve found that they may explain this process to stating that they just want to “check how things are going” or “determine if you’re progressing” and that the examination is brought in as a third party. Unfortunately, this is often not the case. The examiner is often hired by the insurer as a means to justify a denial for payment. Should you receive a notice requesting an IME, we recommend contacting Union PT or soliciting an attorney as this often precedes an upcoming denial.

Treatment has not occurred within 3 years of the date of loss

Unfortunately, all physical therapy visits must be completed within 3 years of the auto collision. Even if there are still funds available on your claim, they will not be available for use following their 3 year limit

What happens if I’m denied?

Don’t worry! Union PT has had tremendous success in appealing denials from auto insurers and we will have your back. We do advice soliciting an attorney to help fight their determination and to be patient with the process. Should your insurer uphold their decision, you’re still more than welcome to use your primary health insurance or we are more than willing to offer our self-pay rates here at the clinic.

The Whiplash Injury Treatment Center at Union Physical Therapy

The Whiplash Treatment Center at Union Physical Therapy uses cutting edge approaches along with tried and true methods to getting our patients back to what they love doing. We provide the highest level of care for whiplash and other motor vehicle accident related injuries. Union PT prides ourselves on the skills and knowledge of our team of therapists. To ensure a thorough diagnosis and to begin treatment, schedule an appointment at our Seattle-based physical therapy office today.

Author: Will Zharinov, Operations Manager, Union Physical Therapy