Frequently Asked Questions

What is PIP and What does it cover?

Personal Injury Protection (PIP) covers an insured's medical expenses when an injury arises out of the maintenance or use of a motor vehicle. Medical expenses are reasonable charges for necessary medical treatment and rehabilitation services. This coverage is primary over health insurance. The coverage is required as mandated by state law.

What is MED PAY and what does it cover?

Med Pay covers an insured's medical expenses when an injury arises out of the maintenance or use of a motorcycle. Medical expenses are reasonable charges for necessary medical treatment and rehabilitation services. This coverage is primary over health insurance policies written after the 7/97 form edition date attachment 9627 (12/97). This is an optional coverage.

What is INCOME LOSS and what does it cover?

Income Loss covers an insured's lost wages incurred when an injury arises out of the maintenance or use of a motor vehicle. Per PA law, wages will be at 80% of you actual gross income after a 5-day deductible has been met. We require verification from both the treating physician and the employer that more than 5 days work loss will be incurred. This is an optional coverage.

What are FUNERAL BENEFITS and what do they cover?

Funeral Benefits cover reasonable and necessary expenses directly related ot the funeral, burial, cremation or other form of disposition of the remains of a deceased insured person, due to the death of an insured person, if death results from a motor vehicle accident and occurs with 24 months of the date of the accident. This is an optional coverage.

What are ACCIDENTAL DEATH BENEFITS and what do they cover?

Accidental Death benefits are a death benefit paid to the personal representative of an insured person, should bodily injury caused by a motor vehicle accident result in death within 24 months from the date of the accident. This is an optional coverage.

What is a COMBINATION BENEFIT and what does it cover?

Combination first party benefits cover an insured whose injury, wage loss or death arises out of the maintenance or use of a motor vehicle. The most we will pay as the PIP benefit is $110,000, the Funeral Benefit is $2,500, the Accidental Death Benefit is $25,000 and the wage loss benefit is $50,000. We will only pay for expenses or loss incurred within three years from the date of the accident.

What are EXTRAORDINARY MEDICAL BENEFITS and what do they cover?

Extraordinary Medical Benefits cover an insured's medical expenses when an injury arises out of the maintenance or use of a motor vehicle in excess of the aggregate $100,000. This type is subject to an annual limit of $50,000 and a lifetime aggregate of $1,000,000. The annual limit shall not apply to medical expenses covered by Extraordinary Medical Benefits Coverage which are incurred within eighteen (18) months following the accident.

Why isn't the "At Fault" party paying my medical bills?

In the state of Pennsylvania, regardless of fault, the insurance company responsible for an insured's medical bills is determined by order of level of priority. We will not pay benefits if there is another insurer at a higher level of priority. The priority is as follows:

Level 1 - The "Named Insured"
Level 2 - A resident relative of the "Named Insured".
Level 3 - An occupant of a motor vehicle.
Level 4 - Pedestrian.

**Please note, if an insured is the same level of priority on multiple policies, PA state law mandates both carriers to take responibility for the claim. The insurance carrier who the claim was reported to first shall process and pay the claim as if wholly responsible. That insurer is thereafter entitled to recover a pro-rata contribution for the benefits paid, among all other first party insurers responsible.

Why do I have to fill out the Application For Medical Benefits?

The application must be filled out and signed by the insured to ensure that they are eligible for medical benefits under the Progressive policy. The application also needs to be completed so that Progressive has the insured's authorization to obtain their medical bills, medical records and treatment updates from their doctor and to get wage information from their current employer.

Can I go to any provider?

Yes, the insured is able to visit any provider they wish as long as the medical treatment is related to the motor vehicle accident. There is no need for pre-certification or referrals.

What should I tell my provider about my outstanding bills or insurance?

Providers should be given the address of the claims office as well as the insured's claim number so they can submit their bill for consideration. To expedite our review of the claim, the provider should also submit medical records for the services rendered as a result of the motor vehicle accident.

Why doesn't Progressive pay providers the full amount that is billed?
Am I responsible for the difference?

We pay medical providers a charge that has been calculated under the Motor Vehicle Financial Responsibility Law. This law was established to benefit both the provider and the insurance carrier by providing reasonable reimbursement rates. Once payment has been accepted by an insured's health care provider, the provider must accept this amount and cannot request the remainder of the payment from the insurance carrier or the insured.

Are prescriptions reimburseable?

Yes, providing the prescription is medically necessary and related to injuries resulting from the insured's motor vehicle accident. Payment will be reimbursed at 80% of the prescription amount. Before any reimbursement in made, Progressive will need a copy of the prescription as well as a receipt. Progressive also allows pharmacies to directly bill.

What should I do if I receive medical bills?

If any medical bills are received they should be sent immediately to the Progressive representative handling the insured's medical file. We encourage the insured to contact the provider's billing department and notify them of Progressive's billing address. This will prevent the provider from sending medical bills to the insured and/or creditors and will thus expedite processing of the claim. What happens when my benefits are exhausted?
Once an insured's medical benefits have been exhausted, they should submit their bills to their health insurance carrier with a copy of the "exhausted benefits" letter.

Why do I have to provide my insurance company with the names, dates of birth
and social security numbers of all the residents in my household?

The underwriting guidelines state that all members of the household over age 15, and all regular operators of the insured vehicles, must be listed on the policy. Exclusions are available for a valid reason: a suspended license, other insurance, or a non-licensed person.

The above information courtesy Progessive Insurance.

Pittsburgh Pennsylvania

P.O. Box 450
101 North Main Street
Zelienople, PA 16063 724 - 452-8722 Phone
724 - 452-4177 Fax
1-800-585-8722

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