Understanding Personal Injury Protection Insurance Under D.C.’S Compulsory/No-Fault Motor Vehicle Insurance Law
In the District of Columbia, insurers are required to offer optional personal injury protection (PIP) insurance to any person required to have automobile insurance and as part of the policyholder’s automobile insurance policy. D.C. Code § 31-2404(a). PIP insurance is designed to provide no-fault coverage for victims for injuries arising from the operation or use of a motor vehicle. For example, if a person having D.C. PIP insurance is injured in an automobile collision with another motorist, she can access the PIP benefits in her own policy to redress her injuries and without the need to establish fault of the other motorist.
Again, a key aspect of DC PIP is that it is no-fault coverage. It is payable irrespective of fault. PIP benefits are available “without regard to, and irrespective of, negligence, freedom from negligence, fault, or freedom from fault on the part of any person.” D.C. Code § 31-2404(b).
Although the insurer is required to offer PIP insurance to its policyholder, PIP is optional. The policyholder can elect to waive PIP altogether. A common misunderstanding is that all policyholders have PIP coverage in D.C. Most but not necessarily all policyholders will have PIP coverage, electing not to waive coverage.
Taxicabs and buses are not required to maintain PIP insurance. D.C. Code § 31-2402. Likewise, companies like Uber and Lyft, private vehicle-for-hire companies, are not required to have PIP. D.C. Code § 50-301.29c. This means that passengers injured in a taxicab or bus accident, or injured while travelling in an Uber/Lyft vehicle, may not be able to collect PIP.
The scope of PIP benefits is comprehensive, covering medical and rehabilitation expenses, work loss, and funeral costs. The current minimum coverage is $50,000 for medical and rehabilitation expenses, $12,000 for work loss, and $4,000 for funeral costs. D.C. Code § 31-2404(c), (d), and (e). These are the minimums and a policyholder can chose higher amounts (e.g. $100,000 for medical expenses).
PIP benefits are available “to a victim who is an insured or an occupant of the insured’s vehicle or of a vehicle which the insured is driving.” D.C. Code § 31-2404(a). Thus, one does not have to be driving the vehicle to receive PIP benefits; one can be a passenger to receive PIP benefits. Moreover, it is possible for a victim to access multiple PIP policies to redress her injuries under certain situations. For example, if the victim is injured while a passenger in a friend’s motor vehicle, she could potentially stack and collect benefits under her own PIP policy and under the friend’s PIP policy.
PIP benefits apply not only to collisions occurring in D.C. but also outside of D.C. For example, if the policyholder covered by a D.C. PIP policy is driving her vehicle in nearby Maryland and injured in a collision there, she can still collect her PIP benefits.
Significantly, there is a lawsuit restriction for a person collecting PIP. Pursuant to D.C. Code § 31-2405(b), a person electing to receive PIP benefits is precluded from maintaining a civil action based on the liability of the wrongdoer unless certain criteria met. Under D.C.’s lawsuit restriction law, the victim has 60 days to notify the insurer of the victim’s election to receive PIP benefits. D.C. Code § 31-2405(a). This 60-day period can be extended by the mutual written agreement of the victim and the insurer. D.C. Code § 31-2405(e). An untimely election (failure to elect within 60 days or within the agreed upon extended period) forecloses the right to receive PIP benefits. D.C. Code § 31-2405(g). Importantly, if the victim makes a timely election to receive PIP benefits, she is generally foreclosed from suing the alleged wrongdoer (e.g. the motorist of the other vehicle involved in the collision). A timely election for PIP benefits triggers a lawsuit restriction. Lee v. Jones, 632 A.2d 113, 116 (D.C. 1993) (“[T]heir election to receive PIP benefits bars them from maintaining a negligence action.”). Of course, if there is an untimely election, or no election at all, the victim can proceed with a lawsuit.
However, the lawsuit restriction law contains certain exceptions that allow the most seriously injured victims to bring a lawsuit even after having received PIP benefits. D.C. Code § 35-2105(b)(1), for example, requires a showing that “The injury directly results in substantial permanent scarring or disfigurement, substantial and medically demonstrable permanent impairment which has significantly affected the ability of the victim to perform his or her professional activities or usual and customary daily activities, or a medically demonstrable impairment that prevents the victim from performing all or substantially all of the material acts and duties that constitute his or her usual and customary daily activities for more than 180 continuous days.” Likewise, subsection (b)(2) requires that, “The medical and rehabilitation expenses of a victim or work loss of a victim exceeds the amount of personal injury protection benefits available.” Thus, only if the victim can meet these exceptions (meet the severity threshold) will the victim be entitled to receive PIP benefits and also bring a lawsuit. The severity threshold is difficult to meet and only applies to situations involving quite serious injuries. Finally, there could be an interesting twist on D.C.’s lawsuit restriction law if the motor vehicle collision occurs outside of D.C. Under that scenario, the victim may be able to collect the PIP benefits and bring a lawsuit against the wrongdoer outside of D.C. For example, if the accident occurs in nearby Maryland; the victim can collect D.C. PIP benefits and still sue in Maryland. Ward v. Nationwide Mut. Auto. Ins. Co., 328 Md. 240, 614 A.2d 85 (1992) (court holding that the plaintiffs, passengers travelling in a vehicle covered by a D.C. PIP policy and involved in a collision in Maryland, could elect the PIP benefits and still sue in Maryland and recover damages from the negligent motorist of another vehicle).
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