If person A, a pedestrian, is struck by person B, a driver, and the state has no-fault coverage, then person B's PIP carrier covers A's PIP claims. If the PIP is exhausted, A can then seek bodily injury coverage from person B's BI carrier (probably the same insurance company as the PIP carrier). Normally in these cases, the insurance company will assign one adjuster to the PIP claim, and another adjuster to the BI claim, with a "Chinese Wall" between them. However, if the carrier assigns a single adjuster to both claims, isn't that a conflict of interests? Possibly even bad faith on behalf of the carrier? After all, the adjuster would have an incentive to limit or deny PIP to prevent A from later attempting to recover under the BI coverage, right?
Any ideas are greatly appreciated. If you have ever heard of a single adjuster covering both PIP and BI (or UM; similar concepts would apply), please cite to it so I can research this further.
In my state (DE), the bad driver's PIP is primary when the driver hits a pedestrian. Under the law, the pedestrian's PIP carrier's coverage doesn't even come into play.
21 Del.C. 2118B(a)(2)c: "The coverage required by this paragraph [i.e., PIP] shall be applicable to each person occupying such motor vehicle and to any other person injured in an accident involving such motor vehicle, other than an occupant of another motor vehicle."
By the way, the adjuster denied PIP coverage before even scheduling an IME/DME and without any expert medical opinion saying further medical treatments were not reasonable and necessary.
mbrcatz: maybe I should be clearer: PIP PAID for about a year, until the adjuster denied further claims based on one line in one doctor's records. In my state and in this situation, PIP APPLIES, due to the law I cited. I have the PIP log to prove it. That is not the issue.
And (in my state) PIP does not only apply when it's your own policy. For instance, a passenger in the car would also be eligible under the driver's PIP, regardless of whether or not the passenger had her own separate policy.
Answer by car253
You need to post what state your in. Sorry, but your not in my state.
You might also consider if small claims court is an option. You need to ask your agent or claims rep or a court.
Answer by lucy
As a general rule where there are 2 people with the same insurance company, then they will have 2 adjusters. ie; 2 car accident, both have Nationwide as an example. The reason is that both adjusters make independent decisions on liability, coverage etc. It is like when under normal situations, one car has State Farm and the other has Allstate. Both State Farm adjuster and Allstate adjuster decides liability for each of their own drivers.
But in your case it gets confusing since most PIP covers the persons own insurance company. So the pedestrian if it has an auto policy, his PIP should be primary, but not the drivers PIP. But;;;;;;;;in some companies, the drivers PIP covers an pedestrian. It could happen that both the driver and the pedestrian are hurt, thus 1 adjuster to handle the PIP. But that person should not be handling the BI (bodily injury), but should be handled by a 2nd adjuster. I have handled both PIP and BI or UM on one person.
You don't state what state the accident happened. But in some states by law, you have to have a serious injury to qualify for BI; ie; scarring, permanent impairment, loss of limb etc.
My guess is that this insurance company is not doing this as you suspect. One other thing, bad faith is usually 1st party coverage. In other words, if you wanted to file bad faith on the drivers insurance and this is not your insurance, cant do, since you are 3rd party.
If you have auto insurance, then call up your company and ask them. They will know based on state laws what is required.
good luck
Answer by mbrcatz
As auto BI and auto PIP are on the same policy, you can bet that it's with the same carrier.
And I think you might be misunderstanding PIP coverage and No Fault. PIP, you only ever collect under your OWN policy, so the pedestrian can't collect under the driver's pip.
So it will always be a BI adjuster handling the pedestrian claim.
No conflict.
Bad faith, is only towards the policyholder - NEVER towards the third party. There is no duty of good faith towards a third party. Yes, I've had carriers where the entire claim - bi, pip, pd, collision, is all handled by the same adjuster. Again, in your specific case, the PIP isn't what's paying medical bills - it's the BI.
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