Consider the following hypothetical for an out of state driver who is driving in Delaware. While on the way to Rehoboth Beach, a driver from Pennsylvania (Maryland or New Jersey) is injured in an auto accident in Dover, Delaware. The accident occurs due to the negligence of another driver, who turns out to be a resident of Delaware. The Pennsylvania driver needs medical care. Who is responsible for the medical bills?
Related: Out of State Drivers in Delaware – What to Know if You’ve Been in a Car Accident in Delaware [Three things out of state drivers injured in Delaware auto accidents should know about their legal rights.]
In general, an out of state driver who is injured in a car, truck or pedestrian accident that occurs in the state of Delaware will make an initial claim for PIP (personal injury protection) benefits under their own car insurance policy. This is the basic premise of “no-fault insurance,” which allows an insured to make a claim for PIP benefits without regard to fault. It does not matter whose fault the accident was, an insured makes a PIP claim under their own policy. In the above scenario, the PA driver would still be eligible for PIP benefits under their own policy, even if they were responsible for causing the accident.
PIP Benefits – The Initial Claim
Personal injury protection coverage is a basic type of auto insurance coverage. It provides coverage for medical treatment expenses, lost wages and other expenses and is usually mandatory. Each state has its own PIP laws with respect to the minimum amount of coverage required. In Delaware, the minimum coverage amount is $15,000 per person, per accident. In Pennsylvania, the minimum PIP coverage amount is $5,000 per person, per accident.
In our Dover auto accident hypothetical, the Pennsylvania driver would make a PIP claim under their own car insurance policy for medical bills and any lost wages. The max benefit amount would be $5,000 (or more, if higher coverage limits were purchased).
PIP Exhaustion – Additional Claims
What happens if the PA driver suffers serious injuries due to the car accident? What happens if the medical bills exceed the $5,000 PIP benefit amount? Let’s say the Pennsylvania driver needs surgery for a broken arm, and the medical bills total $20,000. The first $5,000 is covered by PIP. The remaining $15,000 would be the individual’s responsibility. Assuming the individual has health insurance, the $15,000 would be covered. When PIP exhausts, a private health insurance policy provided through work, one purchased independently or Medicare/Medicaid would pay the remaining bills.
Filing a Car Accident Injury Lawsuit in Delaware
Per the hypothetical above, the accident was the fault of another driver, a resident of Delaware. Therefore, the Pennsylvania resident would have the legal right to file a car accident injury lawsuit in Delaware. The lawsuit would include claims for financial recovery, i.e., any expenses that were or were not paid by PIP: the $15,000 paid by the health insurance company, any lost wages, out of pocket expenses, etc. In very serious injury cases, there may be claims for future expenses, such as future wage loss or future medical treatment. In addition, there would be a claim for pain and suffering caused by the accident and injuries.
It’s important to note that Delaware law is very pro-plaintiff in auto accident cases. Courts in Delaware apply what is known as the collateral source rule. This allows the plaintiff in a car accident case to plead the full value of the bills, not just what was actually paid by insurance (unless paid by Medicare/Medicaid). In our hypothetical, the PA driver’s health insurance company only pays about 60% of the $15,000. Medical providers write off the other 40%. In the Delaware lawsuit, the PA driver can claim the full $15,000, not just what was paid by the insurance company.
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