Unfortunately, in some cases, a Washington car accident victim’s biggest adversary may be his or her own insurance company. Washington automobile insurers must offer personal injury protection (PIP) coverage to their policyholders. PIP provides no-fault coverage for the insured’s medical expenses arising from an automobile accident. Insurers must conduct a reasonable investigation before they deny claims. Additionally, Washington law provides that it is an unfair practice for a PIP carrier to deny benefits for reasons other than medical bills that are not reasonable, necessary, related to the accident, or incurred within three years of the accident. Sadly, it is not uncommon for an insurer to wrongfully deny the claims of its own insured.
In a recent case, the plaintiffs pursued class actions in federal court against their insurers, including claims under the Consumer Protection Act (CPA) for wrongfully denying their PIP benefits. One plaintiff alleged that the insurer refused to pay medical bills if a computerized review determined that the bill exceeded a predetermined amount. The plaintiff alleged that the insurer failed to investigate or make an individualized assessment of the charges before denying them. The plaintiff argued that this practice constituted unfair practices under Washington insurance law. WAC 284-30-330 and WAC 284-30-395. She further argued that the practice resulted in a routine failure to pay reasonable medical expenses in violation of Washington insurance law.
The second plaintiff argued that his insurer terminated PIP benefits once an insured reached Maximum Medical Improvement, which he alleged was an unfair practice under WAC 284-30-395. He argued that this practice resulted in the routine failure to pay reasonable medical expenses in violation of RCW 48.22.005.