Resources for Injured Kids: Private Insurance

There is a difference between third-party insurance and first-party insurance. A third-party insurance company is the carrier for the at-fault party or the person alleged to have negligently caused the injury. Many people believe that the third-party carrier will voluntarily pay the injured child’s medical charges as they are incurred. But that rarely happens. If there is evidence to show that the insure person was at fault for the incident that gave rise to the child’s injury, the third-party carrier will usually make only one payment to settle the entire claim. But oftentimes settlement should be resisted until the full extent of the child’s injuries is known. This is because the value of the case may depend on multiple factors, including the severity of the injuries, the duration of recovery, the need for future treatment, and whether the injuries are permanent. Depending on the extent of the injuries, it may take months or even years to provide the answers to those questions.

A first-party insurance company is one that is contractually obligated to provide benefits to its insured or family members of the insured. One example of a first-party insurer is the parents’ private health insurance carrier. Most parents already know that they can submit bills through a private health insurance policy, which one or both parents may have through their employer. In the case of an automobile accident, the child may have access to “no-fault” medical benefits under a policy issued to one of the parents (assuming that the child is a passenger in the vehicle). The term “no-fault” means that the coverage is available regardless of whether or not the claimant was at fault for the accident.
In Washington State, these “no-fault” medical benefits are provided under coverage known as Personal Injury Protection (PIP). An auto insurance carrier must offer PIP coverage to the policy holder unless that policyholder rejects this coverage in writing. PIP coverage also compensates for lost wages and domestic help that may be necessitated by the person’s injuries. However, these benefits usually do not come into play when the claimant is an injured child. The minimum amount of coverage for PIP benefits is $35,000.

In the case of a pedestrian accident in which a child has been hit and injured by a motor vehicle, most people are unaware that the child may also have access to the driver’s PIP coverage. Washington law requires the PIP carrier to offer these benefits to any pedestrian who has been injured by a motor vehicle. It does not matter if the pedestrian was at fault for the incident. If the child’s parents also have PIP, this is another source of coverage if the at-fault driver’s PIP coverage is exhausted.

In the case of a premises liability insurance policy, like homeowner’s policy, a child may have access to “no-fault” medical benefits. These policies will usually provide coverage if the child was injured on the premises and there is an insurance policy in place. For example, a child who slips and falls in a person’s home should have access to no-fault medical benefits under the homeowner’s insurance policy. The same is usually true if the injury occurred in a commercial business. These no-fault medical benefits are often limited and coverage may not exceed $5,000 to $10,000.

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