PIP Benefits: Medical Expense Benefits, Income Continuation, Essential Services, and Death Benefits
Four benefit categories
PIP medical expense benefits pay reasonable, necessary, and causally related treatment: hospital, physician, diagnostic, surgical, and rehabilitative care. The standard limit is $250,000 per person per accident, subject to deductible and co-payment. Insurers may use utilization review or peer review, but cannot deny without a medical basis.
Income continuation replaces lost earnings. Under the standard benefit it is generally 75% of lost wages, capped at $100 per week. The claimant must prove disability, earnings, and causal connection; self-employed claimants need business records.
Essential services reimburse substitute household or child-care services the injured person ordinarily performed. The standard cap is generally $12 per day. This is not a wage benefit and requires proof that the services were necessary and actually purchased.
Death benefits cover funeral and burial expenses up to the statutory cap, generally $5,000. Survivor benefits may also be available within the policy. A PIP death benefit is separate from a wrongful-death tort claim.
Worked example
An injured worker earns $800 per week and misses four weeks. Income continuation at 75% would be $600 weekly, but the $100 weekly cap limits payment to $400 total. If the same claimant hires a cleaner for $150 per week, essential-services reimbursement is limited by the daily cap, not by the income-continuation cap.
Traps
Do not pay full wages. Do not treat essential services as lost income. Do not assume a bill is payable without medical causation. Do not confuse the death benefit with full wrongful-death damages.