PIP, Medical Liens & Reimbursement in Washington

Check whether PIP was included or validly rejected

RCW 48.22.085 requires an offer of optional personal injury protection with new and renewal auto liability policies within its scope. A named insured may reject it in writing, with the statutory effect on other insureds and later policies. Request the policy, endorsements and any rejection. PIP insured status and benefit definitions should be checked separately from liability and UIM coverage.

Identify the benefits and their separate limits

RCW 48.22.095 specifies minimum offered PIP limits of $10,000 for medical and hospital benefits, $2,000 for funeral expenses, $10,000 for income continuation subject to $200 per week, and $5,000 for loss of services subject to $200 per week. Higher purchased limits and policy conditions can matter. Maintain separate records for each benefit category rather than assuming a single medical-payment figure answers every loss. RCW 48.22.005 separately defines benefits, including the three-year window for medical expenses and the income-benefit waiting period.

A provider lien is different from a benefit payment

RCW 60.44.010 allows specified providers to claim liens against qualifying tort or tort-insurer recoveries for traumatic-injury services. The section states an aggregate 25 percent limitation for those service liens and excludes workers’ compensation recoveries. Obtain the asserted legal basis and charges. A provider balance, a recorded statutory lien and an insurer’s reimbursement demand are different claims.

Check lien filing and any repayment demand

RCW 60.44.020 contains disclosure and recording requirements, including a timing rule tied to injury or care and an alternative tied to settlement and payment. Obtain the recorded notice and dates rather than assuming a demand letter proves perfection. WAC 284-30-350 also requires written advice when an insurer pays benefits that it may require to be reimbursed. Identify the policy, plan and legal basis for each repayment claim.

Prepare a settlement accounting before distributing money

List provider bills, payments, adjustments, liens and reimbursement demands in a single ledger while keeping their legal bases separate. Washington made-whole principles can matter to insurer recovery, while particular plan and federal-law issues require their own analysis; a property-deductible decision is not automatically the answer to every health-plan dispute. Obtain written payoff or waiver terms and keep the final settlement accounting and supporting records.