Texas PIP Statute: Coverage, Limits, and Claim Denials

Texas PIP coverage, short for personal injury protection, is no-fault auto insurance that pays your medical bills, a share of your lost wages, funeral costs, and the cost of replacing household work you can’t do after a crash. Every Texas auto policy must include at least $2,500 of it per person unless you reject the coverage in writing.¹ Because it is no-fault, you collect from your own insurer whether you caused the accident, rode as a passenger, or were struck as a pedestrian.

What PIP Pays For

The statute lists four categories of covered expenses. All must arise from a motor vehicle accident and be incurred within three years of the crash.²

Medical and dental care: doctor visits, surgery, X-rays, dental work, prosthetic devices, ambulance transport, hospital stays, and professional nursing services, as long as the charges are reasonable and related to the accident.²
Funeral expenses if the accident causes a death, up to the policy limit.²
Lost income: 80 percent of what you were earning at the time of the crash, for the period you’re unable to work.³
Replacement household services: if you weren’t earning income but were handling essential household duties like childcare, cooking, or yard work, PIP reimburses reasonable costs to hire someone to do those tasks while you recover.²

Three years is a generous window. A surgery performed two years after the crash can still be submitted, as long as you haven’t exhausted your limit. PIP also pays without deductibles or pre-approvals, and it pays regardless of who was at fault, so there’s no waiting for a liability decision before bills get covered.

Who Is Covered

PIP reaches further than the person whose name is on the policy. Benefits are available to the named insured, members of the insured’s household, any authorized driver of the covered vehicle, and all passengers, including guest occupants.² If your neighbor borrows your car with permission and a passenger is hurt, both can claim under your PIP.

Coverage Limits

The floor is $2,500 per person.³ Most insurers let you raise it to $5,000 or $10,000 at the time of purchase or renewal. The cap is per person, not per accident, so if three people in your vehicle are injured, each can claim up to the full limit.

At $2,500, PIP won’t stretch far. A single emergency room visit can eat through it. If your health plan carries a high deductible, moving PIP up to $10,000 is relatively inexpensive and can cover the gap between the accident and the point where your health insurance takes over.

You Already Have It Unless You Rejected It

Every insurer selling auto liability coverage in Texas must include PIP in the policy or offer it as a supplement, including policies issued through the Texas Automobile Insurance Plan Association.¹ The coverage stays in force unless you reject it in writing.

Once you reject PIP, the insurer isn’t required to offer it again on renewals or reinstatements of the same policy unless you ask in writing.¹ That’s worth knowing if you turned it down years ago and want it back. You’ll need to contact your insurer and specifically request that it be added.

PIP vs. MedPay

Texas insurers also sell Medical Payments coverage, or MedPay, which looks similar at a glance. Both pay medical bills after a crash regardless of fault. The differences are real.

PIP covers lost wages and replacement household services. MedPay does not; MedPay is limited to medical and funeral expenses.³

Subrogation is the other split. If you collect MedPay and later recover from the at-fault driver, your insurer can demand repayment. PIP generally carries no subrogation right, so you keep those benefits even after settling with the other driver.⁴ The one exception lets a PIP insurer seek reimbursement from an uninsured motorist’s assets, which rarely yields anything.

How to File a Claim

Report the accident to your insurer as quickly as you can. Most policies set a notification deadline, and delay gives the insurer room to complicate or deny the claim. Call the number on your insurance card and say you want to open a PIP claim.

Expect to provide itemized medical bills, treatment records from every provider, and a signed medical authorization allowing the insurer to verify treatment details. For lost wages, gather pay stubs, tax returns, or an employer letter showing pre-accident earnings and time missed. For household services, save receipts or invoices, along with a description of the tasks and the dates they were performed.

The insurer will send a PIP application form. Fill it out completely. Incomplete forms are the most common reason claims stall, and every day of delay is a day your bills go unpaid.

Insurer Response Deadlines

Texas prompt-payment law is specific. Once the insurer has all required proof of loss, it has 15 business days to accept or reject the claim in writing. If it needs more time, it must notify you of the specific reasons within that same 15-business-day window, and it then has up to 45 days total to decide.⁵ A rejection must give reasons in writing. Silence is a red flag and possible grounds for a penalty claim.

When PIP Won’t Pay

PIP doesn’t cover every injury tied to a car. Insurers routinely deny claims for intentional self-harm, injuries sustained while committing a crime, and accidents involving someone using the vehicle without permission. Commercial use, like rideshare or delivery driving, is typically excluded without a specific commercial endorsement.

Insurers can also reject charges they consider unreasonable or excessive. If a provider bills well above the usual rate for a procedure, the insurer may pay what it considers reasonable and refuse the rest. This is one of the most common PIP disputes and often turns on whether the billing lines up with prevailing rates in your area.

Fraudulent PIP claims carry criminal penalties. The severity scales with the claim’s value, from a Class C misdemeanor for claims under $100 up to a first-degree felony for claims of $300,000 or more, and a court must order restitution that includes the insurer’s attorney fees.⁶

If Your Claim Is Denied or Underpaid

Start with the insurer’s internal appeal. Submit any additional documentation that supports your position, request a written explanation of the denial, and ask for a formal review. Keep copies of everything you send.

Filing a Complaint With TDI

When the internal appeal stalls, file a complaint with the Texas Department of Insurance. TDI can investigate whether the insurer violated Texas law, though it cannot force a payout if the denial was legally justified and it cannot decide fault in the underlying accident.⁷ You can file online and upload up to 24 pages of supporting documents. Before filing, try TDI’s help line at 800-252-3439, which can sometimes resolve issues informally.

Suing the Insurer

If informal channels fail, you can take the insurer to court. Texas law requires insurers to handle claims in good faith, and violating that standard opens the door to additional liability.⁸ Under the prompt-payment statute, an insurer that fails to comply owes the full claim amount plus 18 percent annual interest on the unpaid amount, along with reasonable attorney fees.⁹ That 18 percent rate is steep enough to move most insurers toward settling legitimate disputes rather than risking a judgment.

1
State of Texas. Texas Insurance Code 1952.152 – Personal Injury Protection Coverage Required
2
State of Texas. Texas Insurance Code 1952.151 – Personal Injury Protection
3
Office of Public Insurance Counsel. Understanding PIP vs Med-Pay
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State of Texas. Texas Insurance Code 1952.155 – Benefits Payable Without Regard to Fault or Collateral Source, Effect on Subrogation
5
State of Texas. Texas Insurance Code 542.056 – Notice of Acceptance or Rejection of Claim
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State of Texas. Texas Penal Code 35.02 – Insurance Fraud
7
Texas Department of Insurance. Get Help With Auto or Other Insurance Complaint
8
State of Texas. Texas Insurance Code 541.060 – Unfair Settlement Practices
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State of Texas. Texas Insurance Code 542.060 – Liability for Violation of Subchapter