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Is Your Patient Entitled To PIP Income Loss Benefits?

The patient you are treating was just in a wreck. He/she has serious injuries: obviously, in no shape to return to work, perhaps for a couple of weeks or more. Yet -“Doc, I gotta work. Gotta feed my family, pay the bills… “. Such patients may get help from personal injury protection (PIP) income loss benefits. Here’s bow it works.

If injured in an insured passenger vehicle, or otherwise qualifying for PIP, your patient is entitled to 70% of their lost income (up to a maximum benefit of $1,250 a month), if they are medically unable to return to their regular job for 14 or more calendar days. The benefit continues up to an aggregate of 52 weeks. “Income” includes the profits of the self-employed and farmers, as well as wages, salaries, commissions, tips, fees, etc.

Of course, medical documentation (an “off-work slip”) is the key that unlocks these benefits. A dated note on a prescription slip will do. However, be sure to keep a copy for your records, since you may be called upon to justify it later. Here are some tips on off-work slips which will help your patient avoid problems processing his/her PIP income loss claim.

The time period of the disability must be specified. Be sure to note when the disability period began, if before the date you prepared the slip. If you don’t know how long your patient will be disabled, you may wish to say “unable to return to work until released” or words to that effect. This will preclude the need for multiple renewed off-work slips. However, if a patient’s injuries flare-up after returning to work, requiring another off work period, a renewed and newly dated off-work slip will be needed.

Under PIP, injured persons qualify for benefits until able to return to their “usual occupation.” So, no medical, “release” should issue until the patient is fully able – without any restrictions or limitations – to resume whatever the person’s usual occupation is. For example: A person’s usual job involves lifting 50 pounds. Due to her accident injuries, she still can’t lift 50 pounds to the extent she needs to be able to at work. Then she should not he “released for regular work,” since she still qualifies for income loss benefits by law.

(NOTE: This rule applies only to people injured in a motor vehicle accident with a “no-fault” PIP claim. This differs from work injuries where the employer usually wants to take an employee with physical restrictions back. When a person is injured off the job, the employer can legally refuse to take the person back until the person is able to do the whole job.)

For patients with more accommodating employers, you may wish to issue a release for “modified work.” If so, please be very specific concerning the physical limitations – what your patient can and cannot do, for how long, how much weight he/she can lift, how frequently, etc., all related to his/her usual occupation.

Unlike medical payments, these benefits may extend beyond the one year anniversary date of the accident, since the 52 weeks refers to the aggregate period of disability. In this way, income loss benefits differ from medical benefits under PIP.

An injured patient who is not usually employed is also entitled to benefits. If unable due to injuries to provide the “essential services” they usually provide without pay, people such as housewives, retired persons and parents at home with young children may get a maximum benefit of $30 per day until they are able to perform the services again, up to an aggregate of 52 weeks.

Working parents of minor children, if hospitalized at least 24 hours, are entitled to $15 per day for child care until able to return to work or perform essential services, up to $450.

Please feel free to call this office and ask for Julia Linebarger-Taylor or Roberta Kent if you or your patient has any questions on PIP income loss benefits.

This article was prepared by Dennis H. Black

Posted in: Personal Injury Lawyer Articles