Motor Vehicle Accidents
I. Claims for Bodily Injury (Limited vs. Full Tort)
A person injured in a car accident can make a claim for pain and suffering if he or she has elected full tort onthe insurance policy covering their own car. A person injured in a car accident who has limited tort on the policy covering their own car can only make a claim for pain and suffering if he or she suffered an injury which has resulted in a serious impairment of a bodily function, death, or a serious disfigurement.
The courts in Pennsylvania have emphasized how the injury has impaired or prevented the full usage of the part of the body that has been injured, in determining whether a person has suffered a serious impairment of a bodily function. There have been cases where a person with a fracture has not qualified as a serious impairment because the fracture has not significantly interfered with the person’s daily personal or work life.
A person who has elected limited tort can be deemed to have full tort if the other driver causes the accident and is convicted of driving under the influence, or has a car registered in another state. A person not owning a car can also be deemed to have full tort provided he or she is not insured under another policy. The moral of this story is that everyone who owns a car in Pennsylvania should have full tort. This allows someone to recover for pain and suffering without having to prove they have suffered a serious impairment of a bodily function.
A lawsuit for pain and suffering must be brought within two years of the date of the accident unless the suing party is under eighteen (18). In that case, a lawsuit can be brought on their behalf by a parent and/or natural guardian before they are 18, or by themselves within two years after reaching their eighteenth birthday, i.e. 20 years of age.
II. Payment of Medical Bills and Wage Loss
Because Pennsylvania is a “no fault” state, the insurance carrier insuring the injured person’s car must pay for all reasonable and necessary medical bills and wage loss irrespective of who was at fault or whose car was being occupied at the time of the accident. The coverage for personal injury protection (PIP) i.e.,
payment of medical bills and wage loss, follows the person and not the car they are in.
Many insurance carriers promote the minimum coverage of $5000.00 for payment of medical bills. In today’s world, $5000.00 can be used up very quickly. It is highly recommended that a minimum of $15,000.00 be carried for medical coverage. Wage loss is optional for coverage on auto policies. In order to assert a wage loss claim, it is necessary to have the employer and the doctor supply information in writing to the insurance carrier.
A lawsuit against the first party insurance carrier must be brought by the medical provider or the patient within four (4) years of the date of last payment by the carrier, or within four (4) years of the accident, whichever is greater.
III. Source of Payment for Medical Bills
There is much confusion as to which insurance policy will pay for medical bills caused by an auto accident. The general rule is that the policy follows the person, that is, the insurance policy on the car of the injured person pays for medical bills even though that policy was not involved in the accident.
This same rule applies to anyone named on the insurance policy as being insured under the policy. Thus, even though a wife may own the car and have the insurance policy in her name, her husband would also be covered if he were named on the policy. The same thing would apply if a child resided in the same household.
If there are no other policies which can be turned to and the injured person is an occupant of the car, the
policy covering the car in which the occupant was injured will pay for the medical bills. If the person who was injured did not occupy any vehicle but was a pedestrian, that person can have any policy covering any vehicle involved in the accident pay for the medical bills.
If an injured person owns a car without insurance, they cannot have their medical bills paid by anyone else’s insurance policy.
IV. Uninsured and Underinsured Motorist Coverage
Unfortunately, uninsured motorists coverage is optional in Pennsylvania. This insurance coverage kicks in when the car that caused the accident is uninsured or leaves the scene. If the person who causes the accident leaves the scene, it is absolutely essential that the accident be reported to the local police so a police report can be generated. It is also a requirement that the accident be reported to one’s own insurance carrier within thirty (30) days of the accident.
If someone has elected limited tort, they still must have a serious impairment of a bodily function even if it is an uninsured motorist case to collect for pain and suffering. This does not apply if full tort has been elected.
Underinsured motorist coverage applies when the person who caused the accident does not have sufficient liability insurance coverage to satisfy the claim for pain and suffering of the person who is less or not at fault. As an example, if the person who caused the accident only has the minimum $15,000.00 of liability coverage and the injured party’s case is settled for $100,000.00, $85,000.00 should be paid by the underinsured portion of the injured party’s policy.
Many times the insurance carrier for the uninsured and underinsured coverage cannot agree with the claim being presented by their own insured. This usually requires the case being submitted to arbitration under the insurance policy for resolution.
Both uninsured and underinsured motorist coverage is voluntary. It is highly recommended that a person insures their car carry both forms of coverage.
V. Assigned Claims Plan
The Assigned Claims Plan is organized and maintained by various insurance carriers in Pennsylvania. A qualified person can obtain monies from the Plan if certain conditions are met. A person can have their medical bills, up to $5,000.00, paid by assigned claims if they are a resident of Pennsylvania, the accident occurred in Pennsylvania, the injured person does not own a car, or the injured person does not occupy a bus owned by an authority such as Septa, and cannot have their bills paid by any other insurance policy. The person can recover uninsured motorist benefits up to $15,000.00 for pain and suffering.
VI. Mandatory Insurance
Every car registered in Pennsylvania must carry $15,000.00 of liability insurance.
VII. Rules of the Road
Although everyone is required to pass a test before getting a driver’s license, many people forget the rules regarding the usage of a car. The most significant one is the assured clear distance rule. This rule requires everyone while driving a car to be able to come to a full stop to avoid striking another car. The rule is also dependant on the conditions of the road at the time of the accident. Thus, if it is raining or snowing out, a person must drive their car slowly enough to bring it to a stop before striking another vehicle.
Another rule is that before making a left hand turn, a person must be sure they can do so in a safe manner. This is true even if a left turn is made with a green light.
Right of way is also a vital rule of the road. At an intersection without a stop sign or light, the person on the right has the right of way. Vehicles already on the road have the right of way over vehicles coming from a parking lot.
VIII. Comparative Negligence
Just because someone is partially at fault in an auto accident does not mean they cannot recover for injuries sustained in the accident. Pennsylvania has a comparative negligence law whereby as long as the negligence of the person bringing the claim is equal to or less than the other driver, the person bringing the claim can recover.
As an example, if a person is 50% at fault, they can recover for their injuries, including pain and suffering. If they are 51% at fault they cannot. Only a judge, jury, or arbitration panel can make a final determination as to the percentage of fault to be charged to each driver.
IX. Workers’ Compensation
If someone is injured in a car accident while on the job, the workers compensation policy of their employee must pay for any medical bills before any other policy. Furthermore, a worker’s compensation carrier can collect any monies from the insurance company covering the car which caused the accident by way of subrogation. The workers’ compensation carrier cannot recover monies it expended from the uninsured motorist carrier.