Texas Personal Injury Protection (PIP) is first-party automobile insurance coverage — paid regardless of who caused the accident — governed by Texas Insurance Code Subchapter D (§§ 1952.151–1952.157). Up to the limits of the coverage purchased, PIP pays reasonable expenses incurred within three years of the accident for necessary medical and funeral services; for an income producer, replacement of lost income (standard Texas policy forms pay 80% of actual lost income); and, for a person who was not an income or wage producer at the time of the accident, the reasonable cost of essential household and family-care services that person ordinarily performed.
Under § 1952.152, auto insurers must include PIP with every personal automobile liability policy unless the named insured rejects it in writing. Section 1952.153 sets the floor for that mandatory offer at $2,500 per person for all benefits in the aggregate; insurers frequently offer higher limits — $5,000, $10,000, or more per person — which policyholders can select at purchase.
Who Qualifies for Texas PIP Coverage?
Primary PIP coverage applies to the named insured who purchased the policy and any resident family members living in the same household. Additionally, PIP covers any passenger or guest occupant riding in, operating, or getting into or out of the insured vehicle at the time of the collision. PIP also applies when the policyholder or resident family members are injured as pedestrians or bicyclists struck by a motor vehicle, which makes the coverage useful even when they are not inside the insured car.
What Medical Expenses Are Covered Under PIP?
Texas Insurance Code § 1952.151(3)(A) explicitly outlines the medical expenses covered by PIP benefits. Up to the limits of coverage purchased, PIP pays reasonable fees for emergency care, surgical treatment, ambulance transportation, hospital stays, professional nursing services, X-rays, MRIs, dental repair, and necessary prosthetic devices. Unlike third-party liability claims, PIP medical benefits are available immediately to cover initial treatments without waiting for a fault determination.
All claimed expenses, medical or otherwise, must be incurred no later than the third anniversary of the accident date under Code § 1952.151(2). This three-year deadline runs from the date of the accident, and any expense incurred after that date is not reimbursable under PIP, regardless of how the underlying injury was treated. This deadline does not shorten or replace an insurer’s internal administrative deadlines for submitting documentation, which are governed separately by § 1952.156.
Does PIP Cover Lost Income After an Accident?
Generally yes. Up to the limits of coverage purchased, standard Texas policy forms pay 80% of lost income for an income-producing person who loses wages due to an accident, as provided in Texas Insurance Code § 1952.151(3)(B). To recover lost wages, the insurer requires objective medical documentation confirming work restrictions alongside proof of earnings, such as pay stubs, W-2 forms, tax returns, or employer verification letters.
For individuals who were not earning wages when the accident occurred, Texas law provides reimbursement for necessary and reasonable expenses incurred for essential household or family care services under § 1952.151(3)(C). If the injured person ordinarily performs uncompensated family duties, such as childcare or household maintenance, PIP covers the actual cost of hiring replacement services while they recover.
Does PIP Cover Funeral Expenses?
Yes, Texas PIP covers reasonable and necessary funeral expenses up to the policy limit when a covered individual dies as a result of an automobile accident. Under Tex. Ins. Code § 1952.151(3)(A), funeral services are covered in the same subsection as medical, ambulance, and hospital care, so no separate showing is required to recover them.
PIP funeral benefits are paid on a no-fault basis. Surviving family members do not need to establish another driver’s negligence or wait for a liability investigation before receiving PIP funeral reimbursements under the policy. This benefit operates independently of any separate statutory wrongful death or survival lawsuit filed against an at-fault driver.
How Do You File a PIP Claim in Texas?
To file a PIP claim in Texas, notify the automobile insurance company providing the PIP coverage promptly and submit written proof of loss detailing your medical treatment and income loss. While Texas Insurance Code § 1952.156 governs internal claim presentation deadlines, policyholders generally have up to four years under Texas Civil Practice and Remedies Code § 16.051 to file a breach of contract lawsuit if an insurer wrongfully refuses to pay valid PIP benefits.
Follow this process to submit a claim:
- Confirm Coverage and Policy Limits: Review your policy declarations page to confirm that PIP was not formally rejected in writing and verify your policy limits (standard limits are $2,500, $5,000, or $10,000 per person).
- Notify the Insurer: Report the collision promptly to your PIP carrier and request the standard PIP application and medical authorization forms.
- Submit Medical Records and Itemized Bills: Provide complete, itemized medical billing statements and corresponding treatment records connecting your injuries to the crash.
- Document Income and Household Losses: Submit pay stubs, employer verification, and doctor disability notes for lost wages, or keep receipts and invoices for replacement household services.
- Comply with Proof-of-Loss Deadlines: Under Texas Insurance Code § 1952.156(b)(1), an insurer may establish a deadline for submitting original proof of loss, but that deadline cannot be shorter than six months after the accident date. If the proof of loss is not submitted by the insurer’s stated deadline, the insurer can use the delay as grounds to deny or delay payment of the claim, so it’s worth confirming the exact deadline in your policy or with your carrier early on.
- Track Payment Deadlines: Under Texas Insurance Code § 1952.156(a), the insurer must pay PIP benefits within 30 days after receiving satisfactory proof of claim. If the insurer fails to pay within 30 days, Tex. Ins. Code § 1952.157 authorizes a lawsuit where the insurer is liable for statutory penalty damages of 12% per year, reasonable attorney fees, and legal interest.
Comparing PIP to Other Texas Auto Insurance Coverages
Understanding how PIP interacts with other auto and health policies ensures injured parties do not leave available compensation on the table:
PIP vs. Medical Payments (MedPay): Both coverages pay medical bills without requiring proof of fault. However, MedPay covers direct medical and funeral expenses only, whereas standard Texas PIP forms also pay 80% of lost income (up to the limit of coverage purchased) and covers replacement household service costs under Tex. Ins. Code § 1952.151(3). Additionally, unlike MedPay, Texas law prohibits PIP insurers from asserting subrogation rights against your third-party injury settlement. This means PIP benefits remain yours even if you later recover compensation from an at-fault driver.
PIP vs. Bodily Injury Liability: Liability insurance protects an at-fault driver by paying for damage and injuries caused to other people up to policy limits under Texas financial responsibility laws. In contrast, PIP pays benefits directly to the policyholder and covered passengers regardless of fault.
PIP vs. Private Health Insurance: Health insurance covers treatment subject to network constraints, co-pays, and deductibles, but does not cover lost wages. Under Texas Insurance Code § 1952.155, PIP benefits are payable without regard to collateral health coverage, allowing injured policyholders to collect PIP to cover out-of-pocket health insurance co-pays and deductibles. PIP can therefore help reduce immediate financial strain even when a person already has health insurance.
PIP vs. Uninsured/Underinsured Motorist (UM/UIM): UM/UIM coverage compensates policyholders for economic and noneconomic losses (such as pain and suffering) when an at-fault driver lacks insurance or adequate limits. Unlike PIP, recovering under a UM/UIM claim requires proving that the third-party motorist was legally at fault for the accident.
What Happens If the Insurance Company Disputes a PIP Claim?
If an insurance company denies or delays a valid PIP claim past the payment deadline described above, you have the statutory right under Texas Insurance Code § 1952.157 to file a breach of contract lawsuit. Insurers commonly dispute PIP claims by alleging that medical care was unnecessary, injuries were pre-existing, wage records are inadequate, or coverage lapsed before the accident. Documenting your treatment and income loss thoroughly at the time of filing, as described above, is the best protection against these disputes.
Contact Bailey & Galyen About a Texas Auto Insurance Claim
PIP provides critical financial relief after a collision because qualifying benefits are available immediately without proving who caused the crash.
Since 1982, Bailey & Galyen has served clients across Texas with large-firm resources and personal attention. If you are facing a denied PIP claim, delayed insurance benefits, or need assistance identifying all available coverages after a serious vehicle collision, contact Bailey & Galyen today to schedule a consultation and discuss your situation with an attorney.
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