not claim PIP coverage under the insurance policy of another vehicle that he did own and that the claim- ant did insure. When a claimant is injured in a resident-relative’s uninsured motor vehicle, the claim- ant can recover PIP benefits under their own automobile insurance policy.19
6. A claimant injured while riding a motorcycle either as a passenger or driver, may be denied PIP cover- age.20
Insurance companies may
exclude PIP benefits from mo- torcycle policies, or offer benefits with deductibles, options or other specific exclusions. As a practical matter, motorcycles are generally excluded from PIP coverage.21
Individuals who have uninsured
vehicles may not be entitled to PIP cover- age. However, this permissible exclusion was limited in MAIF v. Perry, 356 Md. 668 (1999). Here, the claimant owned a vehicle that was not insured and in viola- tion of the Transportation Act. He was injured in another vehicle that he owned and that was insured with PIP coverage. The Court held that the fact that the claimant owned a vehicle without in- surance coverage did not disqualify him from coverage on his insured vehicle in which he did not waive PIP coverages. Many policies also include permissible
exclusion for accidents with pedestrians that occur in other states and/or occur with nonresidents of Maryland. You should read the policy to ensure these exclusions are included in the policy. Re-
19
In Pennsylvania National Mutual Casu- alty Insurance Company v. Gartelman, 413 A.2d 303 (Md. 1969), the claimant was injured while driving a moped that was owned by her husband but was not insured. The Court stated that she was entitled to claim PIP and UM on her own vehicle’s insurance policy.
20 21
Maryland Insurance Article §19-505(c) (2).
See Dejarnet v. Federal Kemper, 475 A.2d 454 (Md. 1983). A passenger on a motor- cycle was held to not be entitled to PIP on a resident-relative’s automobile insurance policy as the policy excluded “use of a motorcycle.”
Summer 2008 23 24
member, the default, regardless of what the insurance company may claim, is that there is PIP coverage. Also, any exclusion not listed above,
and not specifically permitted in the Maryland Insurance Article, is invalid. In Salamon v. Progressive Classic Insur- ance Company 379 Md. 301 (2004), the Maryland Court of Appeals held that the so-called “pizza exclusion” was not valid and required Progressive to pay PIP benefits to its insured. In this case, the claimant bought a policy that had PIP benefits, but subsequently obtained a job delivering pizza. After being injured in an automobile collision in his car while working, Progressive sought to deny PIP coverage under an exclusion it wrote for vehicles used for commercial purposes. The Court of Appeals held that Progres- sive could not deny coverage when the driver of a private automobile uses that vehicle for work.
What Does PIP Pay? The statutory minimum PIP benefits
are $2,500 for payment of all reasonable and necessary expenses that arise from a motor-vehicle accident, and that are incurred within three years after the ac- cident for necessary prosthetic devices, ambulance, dental, funeral and hospital, medical, professional nursing, surgical, and X-ray services, and for payment of up to 85 percent of lost income.22
“As a
condition of providing loss of income benefits under this subsection, an in- surer may require the injured individual to furnish the insurer with reasonable medical proof of the injury causing loss of income.”23 PIP pays medical expenses incurred
as a result of an automobile collision. Except in job-related car accidents, PIP
22
See Horace Mann Ins. Co v. Worthy, 600 A.2d 1151, 90 Md. App. 273 (Md. App., 1991). Holding that an estate can recover PIP benefits under a decedent’s automo- bile insurance policy for post-mortem lost wages.
Maryland Insurance Article §19-505(b) (3).
Maryland Insurance Article §19-507(a) (2).
Trial Reporter 29
must pay benefits regardless of whether the injured party has other coverage for the expenses.24
Where an injured
person is a member of an HMO and has medical expenses paid, the injured person is still entitled to PIP recovery for that medical bill.25
Military personnel
who have medical care provided by the government are also still entitled to PIP benefits.26
PIP benefits “shall be reduced
to the extent that the recipient has recovered benefits under the workers’ compensation law of a state or the fed- eral government for which the provider of the workers’ compensation benefits has not been reimbursed.”27 PIP benefits in excess of $2,500 can be
received from an insured’s own policy. When the claimant is injured in a vehicle that has $2,500 in PIP, but his own policy has $10,000 in PIP coverage, the claim- ant is entitled to $2,500 from the first policy and an additional $7,500 from his own policy. See Hoffman v. United Services Auto Ass’n, 522 A.2d 1320, (Md. 1985). PIP benefits cannot be stacked.28
For
example, if an injured person has two cars, and two policies of insurance, the injured person cannot “stack” or make two claims for PIP of $2,500 each.
When Does PIP Pay? The injured person has 12 months Submission requires no-
from the date of the collision to submit a PIP claim.29
25 26
See Dutta v. State Farm, 769 A.2d 948 (Md. 2000)
See Plank v. Summers, 203 Md. 552, 102 A.2d 262 (1954). Although Naval ser- vicemen injured in car accident were not required to pay for treatment received at National Naval Hospital, the Court ruled that the jury should be allowed “to con- sider and to award the reasonable value of the hospital and medical services rendered to them without charge or imposition of liability by a United States Navy hospi- tal.”
27 Maryland Insurance Article § 19-513(e). 28
See Travelers Insurance Company v. Benton, 278 MD 542 (Md. 1976); see also Hoffman v. United States Auto. Ass’n, 522 A.2d 1320, 309 Md. 167 (Md., 1985).
Maryland Insurance Article §19-508 (a) (2)(i).
43
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