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Courts rule PIP payments must be made by insurers

By Kyle Roby, Partner
English, Lucas, Priest and Owsley, LLP

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Kyle Roby

A recent Kentucky Supreme Court case addressed the issue of PIP or BRB payments, which are also called no-fault payments. This is part of a class action lawsuit against insurance giant GEICO. The company denied PIP benefits based on a doctor reviewing medical records and not examining the individual. This is known as a peer review of medical records by an out-of-state doctor.

This procedure is not found in the Kentucky Motor Vehicle Reparations Act (MVRA). The plaintiffs argued that this procedure should not have been used as a standard for denying benefits and the Kentucky Supreme Court agreed.  In fact, the Kentucky Supreme Court compared the arguments made by the attorneys and the trial court to coon dogs leading a hunter in the wrong direction or as the old saying goes “they were barking up the wrong tree.”

The case is Government Employees Insurance Company (GEICO) vs. Jordan Sanders and Anita Houchens (individually and as class representatives). The court handed down the ruling on November 1, and ordered that the ruling was to be published, which means it can be used as a standard in future cases.

PIP or BRB benefits

What are PIP or BRB benefits? These are benefits that are available for people who are injured in an accident, no matter who is at fault. These benefits are paid by your own insurance company and cover some of the initial expenses after an accident, usually medical bills and lost wages.

PIP stands for Personal Injury Protection and BRB stands for Basic Reparations Benefits.

In the case, the plaintiffs were seeking reimbursement for chiropractic visits following an accident, and GEICO denied reimbursement.

GEICO denied these benefits based on peer reviews performed by the doctors GEICO hired. The Court in examining the MVRA and the ways PIP or BRB benefits can be denied, the Court find no mention of physician paper review PIP denials in the law. The Court found GEICO had violated the MVRA by denying PIP benefits based on these paper reviews.

Under the MVRA, if PIP or BRB benefits are denied and that denial was unreasonable or not in accordance with the law, the insurance company may be responsible for your attorney fees and 18 interest annually on the amount of the PIP payments.

When to seek legal help

Following an accident, it is important to seek legal advice as soon as possible. If your or another party’s insurance company approaches you and asks you to sign paperwork, don’t do so without consulting with an attorney. You want to be sure that all of your expenses are covered, and an experienced attorney can help you ensure that you receive all of the compensation that you deserve.

Contact me, attorney Kyle Roby, at (270) 781-6500 or kroby@elpolaw.com if I can help you.