Use PIP and medical payments coverage

By Jacob Alford

How do I find out whether PIP or MedPay applies?

PIP and medical payments coverage can provide benefits without first proving the other driver caused the wreck. PIP is a no-fault benefit, but you must still establish that the person, injury and claimed loss qualify under the coverage. Identify the relevant policies, insured-person definitions, limits and exclusions, then ask the insurer how to submit the claim. Texas generally requires $2,500 per person in PIP unless it is rejected in writing; the policy may provide a higher limit. MedPay is a separate optional coverage with policy-specific terms. OPIC comparison of PIP and MedPay.

How are PIP and MedPay different?

PIP can include qualifying medical and funeral expenses, 80% of qualifying lost income, and qualifying replacement household-service expenses for a person who was not an income or wage producer when injured. The required benefit is a combined limit, not a fresh limit for each category. MedPay does not provide PIP’s income or household-service benefits. OPIC comparison; Insurance Code §§1952.151–.155.

What expenses or income documentation should I collect?

For medical expenses, retain itemized bills, service dates, explanations of benefits, payment records and the insurer’s submission instructions. For income, gather employer verification, pay records, missed-work dates and relevant restrictions. Self-employed readers should use missed-income guidance to build a supported calculation rather than offer an unsupported gross-sales number.

The statutory PIP definition covers qualifying expenses incurred no later than the third anniversary of the accident. That is not a three-year permission to delay notice, proof, or responses to document requests. Insurance Code §§1952.151 and 1952.156. MedPay may use a different expense period and different terms. Ask for both the applicable period and the current submission requirements. OPIC comparison.

How do I obtain and check the actual PIP rejection record rather than assume no coverage?

Ask for the actual rejection, who completed it, the policy it concerned and why it applies to this loss date. A rejection by an insured named in the policy can matter even if the person now seeking benefits did not personally sign it. Statutory conditions can allow an earlier rejection to carry forward, so a new ink signature is not necessarily required at each renewal. Insurance Code §1952.152.

If the record is electronic, request the complete record and appropriate completion history. Do not assume it is invalid just because it is electronic, or valid merely because a printed screen shows a name. Attribution, authority and later coverage changes need review. Finding applicable insurance identifies the full policy-document request.

Does using benefits resolve the injury claim?

Do not assume that using a benefit automatically settles the liability claim. Read each payment document and identify any release, assignment or other condition. Also do not assume every payment can simply be added to every later recovery. Coordination, offsets and repayment differ by benefit, policy and circumstance. Preserve a record of what each payer paid and send any repayment demand to your lawyer for review.

If a PIP or MedPay request is denied, ask whether the dispute concerns coverage, insured status, the expense, the amount or the documents. Respond to that stated reason rather than restarting the entire claim without knowing what is missing.

What if I did not earn wages but regularly performed essential household services?

PIP can cover qualifying replacement expenses for essential services regularly performed for the family or household by a person who was not an income or wage producer when injured. The person, loss and expense must qualify; not earning wages does not by itself end the inquiry. Insurance Code §1952.151.

For essential household services, identify what you regularly did before injury, why you could not do it, who supplied the replacement service and the reasonable expense actually incurred. Keep dates, receipts and descriptions. The benefit is not an automatic allowance for inconvenience or a payment simply because a family member offered help.

Attorney reviewed by Jacob Alford · November 11, 2026