PIP and Med-Pay rules in Washington

If you were hurt in a Washington crash, personal injury protection (PIP) is usually the first coverage that pays your medical bills, and it pays no matter who caused the wreck. Washington handles fault the traditional way, so the at-fault driver's insurer is ultimately responsible for your damages. PIP sits on your own auto policy and works like a small pocket of no-fault coverage in front of that fight. The state insurance regulator describes it as the coverage that pays first for accident-related care.¹

Here is the part many drivers miss: Washington does not require you to carry PIP, but it does force the insurer to offer it. Under RCW 48.22.085, no auto liability policy can be issued or renewed unless PIP is offered as optional coverage, and the only way out is to reject it in writing.² If you never signed that written rejection, your insurer added PIP and charged you for it.¹ A lot of Washington drivers have this coverage without remembering they bought it. Check your declarations page before you assume you don't.

What PIP pays in Washington

Washington sets the coverage in two tiers. The base offer, under RCW 48.22.095, is at least $10,000 in medical and hospital benefits, a $2,000 funeral benefit, $10,000 in income continuation capped at $200 a week, and $5,000 in loss-of-services benefits.³ If you ask for more, the insurer has to make a higher offer under RCW 48.22.100: $35,000 in medical benefits, a $2,000 funeral benefit, $35,000 in income continuation up to $700 a week, and $14,600 in loss-of-services coverage.⁴ The benefits apply per injured person, so each hurt passenger in your car has their own limits to draw from.¹

The limits that trip people up

Every PIP benefit runs on its own Washington clock, and the definitions live in RCW 48.22.005.⁵

Medical and hospital benefits cover reasonable and necessary treatment from licensed providers, including ambulance, hospital, nursing, prescriptions, prosthetic devices, and eyeglasses. The timing rule is easy to overlook: PIP only pays for medical expenses incurred within three years of the crash.⁵ Care you need after that window is not on PIP.

Income continuation replaces lost wages, but not immediately. Payments begin 14 days after the crash and run until you can go back to your usual job, until 54 weeks pass, or until death, whichever comes first.⁵ A coordination cap also applies: your combined weekly payments from PIP, workers' compensation, disability insurance, and similar sources cannot top 85 percent of your normal weekly income.⁵

Loss-of-services benefits reimburse what you pay someone outside your household to do tasks you would normally handle yourself, such as housecleaning or yard work. That benefit is capped at $40 a day and ends at 52 weeks.⁵ The funeral benefit is a flat $2,000 per person in either tier.³⁴

PIP pays first

In Washington, PIP is primary for accident-related medical care, and your health insurance is secondary, paying only after PIP is used up.¹ That ordering helps you in two ways. PIP does not make you prove who was at fault, and it does not wait for the liability investigation to close. You can start treatment, and your providers can bill PIP, while the blame question is still open.

When PIP will not pay

RCW 48.22.090 lets insurers write a short list of exclusions into the coverage. PIP can be denied for injuries you cause to yourself on purpose, injuries from a prearranged or organized racing or speed contest, injuries from war, and injuries from nuclear hazards.⁶ It can also be denied when you are hurt while using a car to commit a felony.⁶ One more exclusion catches hidden vehicles: if you or a relative are injured in a car you own or use regularly but never listed on the policy declarations, the insurer can refuse to pay.⁶

The reimbursement rule to know before you settle

This is where Washington law tilts toward the injured person. When your PIP pays your bills and you later recover from the at-fault driver, your PIP insurer usually wants that money back. Washington courts limit both when it can collect and how much.

Two rules control. The made-whole doctrine says a PIP insurer cannot take reimbursement until you have been fully compensated for your loss. And if you hired a lawyer to get the recovery, the insurer has to pay its share of your attorney fees before it collects anything. The Washington Supreme Court set this out in Mahler v. Szucs, 135 Wn.2d 398 (1998), holding that an insurer seeking PIP reimbursement must bear a proportionate share of the legal expenses that produced the recovery.⁷ The court called it grossly inequitable to expect an injured person to protect the insurer's interest and still pay counsel out of their own pocket.⁷

The court extended that rule in Matsyuk v. State Farm Fire & Casualty Co., 173 Wn.2d 643 (2012). One insurer there wrote both the at-fault driver's PIP and liability coverage, then tried to offset the PIP it had paid against the liability settlement without contributing to fees. The Supreme Court held that the pro rata fee-sharing rule still applies, and that an insurer that uses its position to pressure a PIP claimant into releasing the claim can face a bad-faith action.⁸ Lawyers call the result the Mahler reduction: the PIP money your insurer claws back should shrink by its share of your legal costs.

Where Med-Pay fits

Drivers moving from other states often ask about MedPay. Washington's statutory scheme is built around PIP, not a separate medical-payments coverage, and the mandatory-offer rules in RCW 48.22.085 through 48.22.100 speak only to PIP.² Some Washington insurers still sell MedPay as an optional add-on. The difference is scope. PIP covers medical bills along with lost wages, loss of services, and funeral costs, while MedPay covers medical bills alone. Where an insurer offers both, PIP is the broader coverage and the one state law requires them to put in front of you.

Deadlines and next steps

PIP has its own three-year window for medical expenses, but that is separate from your right to sue the driver who hit you. Washington gives you three years from the date of the crash to file a personal injury lawsuit under RCW 4.16.080(2).⁹ Miss that deadline and you can lose the claim that PIP reimbursement is measured against, so the two clocks work together.

Start the paperwork early. Your official collision record backs up both the PIP claim and any injury claim, and you can order it through the state's crash report system. If your car lost market value in the wreck, that is a separate recovery from the at-fault driver and not something PIP pays, and Washington's rules for it are on the diminished value page. When the reimbursement math or a denied PIP claim gets complicated, it is worth talking to a Washington attorney.

This article is general information about Washington law, not legal advice.

Sources

1. Washington Office of the Insurance Commissioner, Personal injury protection (PIP). https://www.insurance.wa.gov/insurance-resources/auto-insurance/how-auto-insurance-works/personal-injury-protection-pip

2. Washington State Legislature, RCW 48.22.085 (personal injury protection coverage must be offered as optional coverage). https://app.leg.wa.gov/rcw/default.aspx?cite=48.22.085

3. Washington State Legislature, RCW 48.22.095 (minimum PIP benefits). https://app.leg.wa.gov/rcw/default.aspx?cite=48.22.095

4. Washington State Legislature, RCW 48.22.100 (additional PIP benefits offered on request). https://app.leg.wa.gov/rcw/default.aspx?cite=48.22.100

5. Washington State Legislature, RCW 48.22.005 (PIP definitions and benefit time limits). https://app.leg.wa.gov/rcw/default.aspx?cite=48.22.005

6. Washington State Legislature, RCW 48.22.090 (PIP exclusions). https://app.leg.wa.gov/rcw/default.aspx?cite=48.22.090

7. Mahler v. Szucs, 135 Wn.2d 398, 957 P.2d 632 (1998). https://www.courtlistener.com/opinion/1275290/mahler-v-szucs/

8. Matsyuk v. State Farm Fire & Cas. Co., 173 Wn.2d 643, 272 P.3d 802 (2012). https://law.justia.com/cases/washington/supreme-court/2012/84686-3-0.html

9. Washington State Legislature, RCW 4.16.080(2) (three-year statute of limitations for personal injury). https://app.leg.wa.gov/rcw/default.aspx?cite=4.16.080