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What Are First Party Benefits?

First Party Benefits are sometimes called “no fault” or “personal injury protection (PIP)” benefits. First party benefits are separate from bodily injury and property damage coverages. The reason first party benefits are sometimes called “no fault” is that the coverage applies to qualified drivers regardless of who caused the accident.

WHO HAS TO PURCHASE FIRST PARTY BENEFITS

Pennsylvania law requires insurers “covering any motor vehicle of the type required to be registered” to offer certain categories of first party benefits. However, the insurer does not have to offer first party benefits for “recreational vehicles not intended for highway use, motorcycles, motor-driven cycles or motorized pedalcycles or like type vehicles.”

WHAT TYPES OF FIRST PARTY BENEFITS ARE THERE?

First and foremost, first party benefits cover your medical bills. Pennsylvania law requires all auto insurers to include $5,000 medical expense coverage. Pennsylvania law requires the insurer to offer additional categories of first party benefits, such as:

• Medical/Rehabilitative benefits up to $100,000;

• Benefits for “extraordinary medical expenses” of between $100,000 and $1,000,000;

• Income Loss benefits up to at least $2,500 per month up to a maximum of $50,000;

• Accidental Death benefits up to $25,000; and

• Funeral benefits up to $2,500

A combination of benefits may be purchased with total benefits up to $177,500, but limiting the accidental death benefit and the funeral benefit to $25,000 and $2500 respectively.

WHO IS COVERED FOR FIRST PARTY BENEFITS?

The safest way to ensure that you and your family receive first party benefits is to purchase them on your own policy. Pennsylvania law requires that coverage may be provided for:

• The “named insured” (or the person who bought the policy);

• A “spouse” of the named insured;

• A “resident relative” of the named insured or spouse (must be blood related and live in home presently);

• A “minor in custody” of any of the above;

• Or any other “occupant” the insured vehicle; or

• Pedestrians or bicyclists

The term “occupant” has been broadly construed to include anyone that is in the process of using the vehicle. Even if they are entering, exiting, or changing a tire on the vehicle—it includes anything that is related to the use of the vehicle.

THE INJURED MOTORIST MUST LOOK TO SEVERAL POLICIES IN ORDER OR PRIORITY

If any person in the above categories is injured in an accident involving “use or maintenance” of an automobile can recover first party benefits in the following order of priority:

(1) For a named insured, the policy on which he is the named insured.

(2) For an insured, the policy covering the insured.

(3) For the occupants of an insured motor vehicle, the policy on that motor vehicle.

(4) For a person who is not the occupant of a motor vehicle, (meaning pedestrians or bicyclists) the policy on any motor vehicle involved in the accident.

For example:

• If you own your own a motor vehicle and you are the “named insured” on your own auto policy, you must recover first party benefits from your own policy. This is true regardless of whether you or the other person was responsible for the accident. This is true regardless of whether you were driving, a passenger, a pedestrian or bicyclist.

• If you are a “resident relative” of someone that owns an auto insurance policy, you will recover first party benefits from your family policy. This is true regardless of whether you or the other driver was responsible for the accident. This is true regardless of whether you were driving, a passenger, a pedestrian or bicyclist.

• If you are an occupant of an insured vehicle, and you are not a named insured on a policy, and you are not covered on a family member’s policy, you will recover the first party benefits from the policy on the motor vehicle you are occupying. In other words, a passenger that is a named insured, or who qualify on a spouse’s or parent’s policy, must look to those two policies in order of priority, before they can make a claim against the owner of the vehicle in which they were a passenger. If none of those apply, look to the policy on the vehicle you were occupying.

• If you are a pedestrian or bicyclist, you will recover from any policy in which you are a named insured or a covered resident relative. But, if neither of those two apply, then you can submit a claim to the policy covering any one or more vehicles involved in the accident.

WHO IS PROHIBITED FROM RECEIVING FIRST PARTY BENEFITS?

You cannot recover first party benefits if you are:

• The owner of a vehicle that is “registered but uninsured” cannot recover first party benefits under any circumstances.

• Riding or a passenger on a motorcycle or ATV of any type.

If either of these two exclusions apply, the injured rider must submit a claim to the at-fault driver’s insurance, or their own health insurance, for medical bills, lost wages, or funeral benefits.

In some instances, your health insurer may have a right to reimbursement for medical bills covered during the pendency of a lawsuit or claim against the at-fault driver. The laws of subrogation are complex. An experienced auto accident attorney can save you thousands.

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