If you were just in a crash in Pennsylvania, the coverage that starts paying your medical bills comes from your own policy, not the at-fault driver's. Pennsylvania builds a layer of no-fault medical coverage into every auto policy, and it pays regardless of who caused the wreck. Most people call it PIP or Med-Pay. The statute calls it "first-party benefits," and the rules that govern it are specific and worth knowing before you sign anything an adjuster hands you.
What every Pennsylvania policy must include
State law requires every private-passenger auto policy sold in Pennsylvania to carry a medical benefit of at least $5,000.1 That benefit is first-party, meaning it comes from your own insurer, and it pays no matter whose fault the crash was. Pennsylvania does not sell a separate product called "Med-Pay" the way some states do. The medical benefit written into your policy is the PIP, and the two terms get used interchangeably here.
First-party benefits reach beyond the emergency room. Under 75 Pa.C.S. 1712, the coverage you can buy includes reasonable and necessary medical and rehabilitative treatment, income loss set at 80 percent of your actual lost gross income, an accidental death benefit, and a funeral benefit.2 Only the medical piece is forced onto every policy. The income-loss, death, and funeral pieces are optional, and you elect them when you buy.
How much coverage you can actually buy
The $5,000 minimum is a floor, not a target. A single ambulance ride and one CT scan can burn through it. Pennsylvania requires insurers to make higher limits available, so you can buy up:
- Medical benefits up to at least $100,000.3
- Income loss up to at least $2,500 per month, to a maximum of at least $50,000.3
- An accidental death benefit up to at least $25,000, and a funeral benefit up to $2,500.3
- A combined package up to at least $177,500 in the aggregate, or benefits payable for up to three years from the crash date, whichever comes first.3
For catastrophic injuries, the law also authorizes extraordinary medical benefits ranging from $100,000 up to $1,100,000.3 Moving your medical benefit from $5,000 to $50,000 or $100,000 usually costs a modest amount each year, and it can be the difference between your own coverage carrying you through treatment and your bills going to collections while a liability claim drags on.
The 30-day rule and 12 percent interest
Pennsylvania puts a clock on your insurer. Once the company receives reasonable proof of the amount of a covered loss, your first-party benefits are overdue if they are not paid within 30 days.4 Overdue benefits carry interest at 12 percent per year from the date they came due.4 And if the insurer refused to pay without a reasonable basis, it owes a reasonable attorney fee on top of the benefits and the interest.4 Those penalties give you something concrete to point to when a covered bill sits unpaid.
What your doctors are allowed to charge
You are not exposed to whatever number a provider decides to bill. Pennsylvania's cost-containment rules, often called Act 6, cap what a provider treating an auto-injury patient can collect at 110 percent of the applicable Medicare fee, or the provider's usual charge, whichever is less.5 A provider bound by that cap cannot balance-bill you for the difference.5 If your insurer doubts a treatment was reasonable or necessary, it cannot simply stop paying. It has to send the bill to a Peer Review Organization and challenge it within the statutory window, and if the review sides with the provider, the insurer owes 12 percent interest on whatever it held back.5
Whose policy pays
Say you were a passenger, or a pedestrian, and you carry your own auto policy. Which insurer pays your medical benefits? Pennsylvania sets a strict order of priority under 75 Pa.C.S. 1713.6 Benefits come first from a policy on which you are the named insured, then from a policy that otherwise covers you (a resident relative's policy, for example), then from the policy on the vehicle you were occupying, and last from the policy on any other vehicle involved in the accident.6 Your own auto coverage is primary. With the single exception of workers' compensation, the auto policy pays before health insurance or any other plan.7
Who cannot collect
Two groups are shut out. An owner of a currently registered vehicle who was driving without the required financial responsibility, meaning an uninsured owner, cannot recover first-party benefits at all.8 And Pennsylvania does not extend these benefits to motorcyclists. The statute excludes operators and occupants of motorcycles, motor-driven cycles, and similar vehicles from first-party coverage.8 If you ride, your medical protection has to come from somewhere else, because the standard PIP layer is not there for you.
PIP, your lawsuit, and the no-double-recovery rule
This is where Pennsylvania breaks from many states, and it breaks in your favor. Your PIP is not an advance against your future settlement. Your insurer has no right of subrogation for the first-party benefits it pays, so it cannot reach into your recovery from the at-fault driver to claw that money back.9
The trade-off is that you cannot claim the same medical bills twice. In a suit against the driver who hit you, you are precluded from recovering the amount of first-party benefits paid or payable to you.10 PIP handles the medical bills it covers, and your third-party claim goes after what PIP did not, such as pain and suffering and losses above your limits.
Whether you can pursue pain and suffering at all turns on a choice you made when you bought the policy. Pennsylvania is a choice no-fault state: every driver elects full tort or limited tort under 75 Pa.C.S. 1705.11 Limited tort trades a lower premium for giving up most claims for non-economic damages, subject to exceptions. If you never made a written election, your policy defaults to full tort.11 Either way, PIP pays your medical bills first, and the tort election only controls what you can add on top through a claim against the other driver.
One thing PIP will not do is fix your car. First-party benefits are medical. They do not touch vehicle damage or the resale value your car loses after a serious repair, which is a separate property claim (see diminished value in Pennsylvania).
If an insurer is slow-walking your benefits or leaning on a limited-tort argument you don't think fits, it is worth having someone read your policy and the claim file. You can find a Pennsylvania attorney here. If you still need the official record of the crash itself, that comes through the Pennsylvania crash report process.
This is general information about Pennsylvania law, not legal advice.
Sources
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75 Pa.C.S. § 1711, Required benefits. https://www.palegis.us/statutes/consolidated/view-statute?txtType=HTM&ttl=75&div=0&chpt=17&sctn=11&subsctn=0
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75 Pa.C.S. § 1712, Availability of benefits. https://www.palegis.us/statutes/consolidated/view-statute?txtType=HTM&ttl=75&div=0&chpt=17&sctn=12&subsctn=0
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75 Pa.C.S. § 1715, Availability of adequate limits. https://www.palegis.us/statutes/consolidated/view-statute?txtType=HTM&ttl=75&div=0&chpt=17&sctn=15&subsctn=0
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75 Pa.C.S. § 1716, Payment of benefits. https://www.palegis.us/statutes/consolidated/view-statute?txtType=HTM&ttl=75&div=0&chpt=17&sctn=16&subsctn=0
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75 Pa.C.S. § 1797, Customary charges for treatment. https://www.palegis.us/statutes/consolidated/view-statute?txtType=HTM&ttl=75&div=0&chpt=17&sctn=97&subsctn=0
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75 Pa.C.S. § 1713, Source of benefits. https://www.palegis.us/statutes/consolidated/view-statute?txtType=HTM&ttl=75&div=0&chpt=17&sctn=13&subsctn=0
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75 Pa.C.S. § 1719, Coordination of benefits. https://www.palegis.us/statutes/consolidated/view-statute?txtType=HTM&ttl=75&div=0&chpt=17&sctn=19&subsctn=0
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75 Pa.C.S. § 1714, Ineligible claimants. https://www.palegis.us/statutes/consolidated/view-statute?txtType=HTM&ttl=75&div=0&chpt=17&sctn=14&subsctn=0
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75 Pa.C.S. § 1720, Subrogation. https://www.palegis.us/statutes/consolidated/view-statute?txtType=HTM&ttl=75&div=0&chpt=17&sctn=20&subsctn=0
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75 Pa.C.S. § 1722, Preclusion of recovering required benefits. https://www.palegis.us/statutes/consolidated/view-statute?txtType=HTM&ttl=75&div=0&chpt=17&sctn=22&subsctn=0
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75 Pa.C.S. § 1705, Election of tort options. https://www.palegis.us/statutes/consolidated/view-statute?txtType=HTM&ttl=75&div=0&chpt=17&sctn=5&subsctn=0