KY Court of Appeals addresses PIP benefits

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KY Court of Appeals addresses PIP benefits

The Kentucky Court of Appeals recently affirmed a judgment in favor of Progressive Direct Insurance Company concerning the payment of PIP benefits.  Our firm was not involved in the case, but it is of sufficient importance to insurance carriers that we want to make the carriers that we work with aware of the decision.

Progressive’s insured was involved in a one vehicle accident.  He filled out an application for PIP benefits.  The application included a section for the claimant to direct how the PIP benefits should be distributed.  KRS 304.39-241 provides that a claimant may direct the payment of PIP benefits among various elements of loess, i.e. medical expense payment sent directly to the treating physician, reimbursement of medical expense previously paid by health plan, or reimbursement of wage loss.  The claimant attempted to direct the payment of PIP benefits in a different manner, however.

The claimant wrote “RESERVE BENEFITS” and then checked a box indicating that he wanted a check to be sent to him directly.  He treated with a chiropractor, but the bills were not sent to Progressive for payment.  The claimant did not pay the chiropractor and then seek reimbursement.  Rather, the claimant asked Progressive to send him a check for the full amount of medical expenses incurred to date.  Progressive refused to send a check for PIP benefits without listing the treating chiropractor on the check. The claimant sued and the trial court ruled in Progressive’s favor.  The Kentucky Court of Appeals affirmed the trial court’s decision.

You you can read the entire appellate opinion here.

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