Maryland Main PIP Statute §19-505 (2020)
(1) except for individuals specifically excluded under § 27-609 of this article:
(i) the first named insured, and any family member of the first named insured who resides in the first named insured's household, who is injured in any motor vehicle accident, including an accident that involves an uninsured motor vehicle or a motor vehicle the identity of which cannot be ascertained; and(ii) any other individual who is injured in a motor vehicle accident while using the insured motor vehicle with the express or implied permission of the named insured;
(2) an individual who is injured in a motor vehicle accident while occupying the insured motor vehicle as a guest or passenger; and(3) an individual who is injured in a motor vehicle accident that involves the insured motor vehicle:
(i) as a pedestrian; or(ii) while in, on, or alighting from a vehicle that is operated by animal or muscular power.
(i) wages, salaries, tips, commissions, professional fees, and other earnings from work or employment;(ii) earnings from a business or farm owned individually, jointly, or in partnership; and(iii) to the extent earnings are paid or payable in property or services instead of in cash, the reasonable value of the property or services.
(2) The minimum medical, hospital, and disability benefits provided by an insurer under this section shall include up to $2,500 for:
(i) payment of all reasonable and necessary expenses that arise from a motor vehicle accident and that are incurred within 3 years after the accident for necessary prosthetic devices and ambulance, dental, funeral, hospital, medical, professional nursing, surgical, and X-ray services;(ii) payment of benefits for 85% of income lost:
1. within 3 years after, and resulting from, a motor vehicle accident; and2. by an injured individual who was earning or producing income when the accident occurred; and3. payments made in reimbursement of reasonable and necessary expenses incurred within 3 years after a motor vehicle accident for essential services ordinarily performed for the care and maintenance of the family or family household by an individual who was injured in the accident and not earning or producing income when the accident occurred.
(3) As a condition of providing loss of income benefits under this subsection, an insurer may require the injured individual to furnish the insurer with reasonable medical proof of the injury causing loss of income.
(i) an individual, otherwise insured under the policy, who:
1. intentionally causes the motor vehicle accident resulting in the injury for which benefits are claimed;2. is a nonresident of the State and is injured as a pedestrian in a motor vehicle accident that occurs outside of the State;3. is injured in a motor vehicle accident while operating or voluntarily riding in a motor vehicle that the individual knows is stolen; or4. is injured in a motor vehicle accident while committing a felony or while violating § 21-904 of the Transportation Article; or
(ii) the named insured or a family member of the named insured who resides in the named insured's household for an injury that occurs while the named insured or family member is occupying an uninsured motor vehicle owned by:
1. the named insured; or2. an immediate family member of the named insured who resides in the named insured's household.
(2) In the case of motorcycles, mopeds, or motor scooters, an insurer may:
(i) exclude the economic loss benefits described in this section; or(ii) offer the economic loss benefits with deductibles, options, or specific exclusions.
There is not a lot of litigation about the PIP statute because there is so little money involved in the claim unless it is a class action case. Here are a few of the Maryland appellate cases that address this statute.
- Maryland Insurance Administration v. State Farm, 451 Md. 323 (2017). This is the most recent Maryland appellate opinion that addresses §19-505 (again, as of January 2020). The plaintiff owned to cars. One was insured by State Farm. The other he used as a cab was insured by Amalgamated Casualty. The cab did not have PIP coverage. He was rear-ended in his claim and made a PIP claim against State Farm. The issue in the case was whether the "owned but uninsured" exclusion allowed State Farm to deny PIP benefits. The majority tells us that they should be able to deny benefits. Why? Because it would encourage people to with two cars to only insure one vehicle. The majority found that common sense and the language of this statute and §19-509 support that conclusion. The dissent, this was a 4-3 opinion, says that PIP should travel with the named insured. (The good news from this case is that the Maryland Insurance Commissioner fought for the plaintiff in this case. It is good to see the MIA get behind consumers.)
- TravCo Ins. Co. v. Crystal Williams, 430 Md. 396 (2013). This is tough case for victim's bringing a worker's comp claim and a uninsured motorist claim. Plaintiff's UM coverage with TravCo provided that “any amounts otherwise payable for damages under this coverage shall be reduced by all sums...[paid because of the ‘bodily injury’ under... [the] worker's compensation law or similar law provided the insurer or self-insurer of worker's compensation benefits has not been reimbursed for amounts paid under the worker's compensation law or similar law.” The policy's PIP coverage had similar language. Plaintiff, a D.C. government employee, filed a worker's comp case after she was injured as a passenger on a work assignment. She received a worker's comp recovery. She then brought a PIP no-fault and uninsured motorist claim in Maryland. The D.C. government asserted a subrogation right against any PIP or UM recovery by Ms. Williams. Ms. Williams intends to reimburse the District of Columbia government, although TravCo disputes her obligation to do so. The amount that Ms. Williams would reimburse the District of Columbia government cannot be determined before the settlement or judgment with TravCo, and Ms. Williams has no funds to reimburse the District of Columbia government out of pocket. The Maryland high court found that under the plain meaning of § 19–513(e), an insured's benefits payable under UM and PIP coverage must be reduced to the extent that the insured recovered benefits under worker's compensation and the comp has not been paid back. The is a huge win for the uninsured motorist carrier. The court further found that applicable comp statute treats “write-downs” of medical bills as comp benefits. So if the comp benefits have not been paid back, the insurer must those benefits from the benefits payable to the insured under §19–513(e).
- Wu v. MAMSI Life & Health Ins. Co., 256 F.R.D. 158 (2008). This was a class action against insurers. The plaintiffs alleged that the insurers illegally direct providers to collect from an automobile insurer as a precondition to submitting a claim for payment of medical services. MAMSI contained a Coordination of Benefits (“COB”) clause excluding any no-fault automobile insurance payments, such as PIP, from being considered in the application of the COB procedures. Plaintiffs' lawyers alleged this scheme was in direct violation of section §19–507 (PIP benefits “shall be payable without regard to ... any collateral source of medical, hospital, or wage continuation benefits.” ) The issue: Are health insurers able to provide in their contracts that health benefits may be secondary to PIP benefits? This case never really got squarely on the merits because the class was ultimately decertified.
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