A Brief Summary of PIP Benefits & Eligibility
Claims for PIP (personal injury protection) benefits are usually the first encounter most injured individuals have with auto insurance companies after an auto accident. Under Delaware law, PIP benefits cover medical bills, lost wages and other losses like household help and funeral expenses. Every auto insurance policy issued in this state must include at least $15,000 of PIP benefits, per person, per accident.
PIP eligibility in Delaware is usually straightforward. Under the PIP law, 21 Del. C. § 2118, PIP benefits apply to “each person occupying such motor vehicle and to any other person injured in an accident involving such motor vehicle, other than an occupant of another motor vehicle.” This statutory language basically means that PIP benefits are available to people who occupy (drivers and passengers) a car that’s involved in an accident.
In most car accident cases in Delaware, PIP eligibility isn’t an issue because the car covered under the insurance policy was involved in the actual accident. However, in some instances, an accident or injury occurs and the car itself wasn’t actually involved in the accident or the injured person was physically outside of the vehicle when the accident occurred. For example, a driver may be hit by another car while changing a flat tire. It is in these situations when car insurance companies try to deny a PIP claim.
A Look at Delaware Law – PIP Benefits Eligibility
Occupant of the Vehicle
In Delaware, courts use a two part test to determine whether an individual is eligible for PIP benefits. The first part of the test requires a court to determine whether a person is an “occupant” of the vehicle. Under National Union Fire Insurance Company v. Fisher, a 1997 Delaware Supreme Court case, an individual is an occupant of a vehicle if they are either 1. within a reasonable physical distance of the vehicle, or 2. doing something related to the operation of the vehicle. In general, a person who is physically inside of, entering, exiting, touching, or within reach of the vehicle will be considered an occupant for purposes of PIP eligibility.
Injured in an Accident Involving the Vehicle
Under Kelty v. State Farm, a more recent Delaware Supreme Court case from 2013, an individual is considered to have been injured in an accident involving the vehicle if 1. the vehicle was an active accessory in causing the injury, and 2. no intervening, significant act broke the causal link between the use of the vehicle and the accident.
Delaware Supreme Court Rules for Student in Bus Accident PIP Benefits Case
Last month, the Delaware Supreme Court ruled against State Farm in a PIP benefits eligibility case involving a student who was hit by a car just prior to boarding a school bus. In State Farm Mutual Automobile Insurance Company v. Buckley, Delaware Supreme Court (May 19, 2016), State Farm was the insurance company for the school bus. The student sought PIP benefits from State Farm, which State Farm denied, arguing that the student was ineligible for PIP benefits since she was not an occupant of the bus and the bus was not involved in the actual accident.
The court found in favor of the student and held that she was entitled to PIP benefits because she was in close proximity to the bus and also took direction from the bus driver who had waved her over to cross the street. The court also found that the bus was involved in the accident because the act of waving her over was a critical part of the bus driver’s duties per state school bus regulations.
Injured in a Car Accident in Delaware?
If you’ve been injured in a car accident in Delaware and need help making insurance claims, please contact our car accident injury lawyers. Our lawyers have decades of experience handling PIP claims and auto insurance claims. Wilmington, Newark & Dover – Call (302) 658-1717.
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