Pennsylvania is not a no-fault state in the way some neighbors are. You can still sue the other driver, subject to the tort option and the fault rules in the other guides on this site. What Pennsylvania does require, on most auto policies, is a first-party medical benefit that can pay some of your own bills regardless of who was at fault.
The required amount is easy to miss because it is modest. Section 1711 of Title 75 says an insurer issuing or delivering a liability policy covering a motor vehicle of the type required to be registered, and registered and operated in this Commonwealth, shall include coverage providing a medical benefit in the amount of $5,000. Recreational vehicles not intended for highway use, motorcycles, motor-driven cycles, motorized pedalcycles and like type vehicles are carved out of that mandate.
What “first-party benefits” include
Section 1702 defines “benefits” or “first party benefits” as medical benefits, income loss benefits, accidental death benefits and funeral benefits. The $5,000 medical benefit in section 1711 is the required piece. The others must be made available for purchase, at the amounts in section 1715.
Section 1712 describes those coverages. Medical benefits, subject to the limitations of section 1797, cover reasonable and necessary medical treatment and rehabilitative services. The list in the statute is long. It includes hospital, dental, surgical, psychiatric, psychological, osteopathic, ambulance, chiropractic, licensed physical therapy, nursing, vocational rehabilitation and occupational therapy, speech pathology and audiology, optometric services, medications, medical supplies and prosthetic devices. The medical benefit is without limitation as to time, provided that, within 18 months from the date of the accident causing injury, it is ascertainable with reasonable medical probability that further expenses may be incurred as a result of the injury.
Income loss benefits include 80 percent of actual loss of gross income, and reasonable expenses incurred to hire a substitute or special help so a person can work and mitigate that loss. Income loss does not include expected income for any period after death. It shall not commence until five working days have been lost after the date of the accident. Accidental death benefits are paid to the personal representative if the injury causes death within 24 months of the accident. Funeral benefits cover expenses directly related to the funeral, burial, cremation or other disposition of the remains.
Higher limits you can buy
Section 1715 requires insurers to make available medical benefits up to at least $100,000, extraordinary medical benefits from $100,000 to $1,100,000 in stated increments, income loss benefits up to at least $2,500 per month up to a maximum of at least $50,000, accidental death benefits up to at least $25,000, and funeral benefits of $2,500. Combination coverage is also described in that section. Insurers may offer higher or lower limits or additional benefits. A policy providing first-party benefits may not be issued unless it also contains liability coverage at least equal to the financial-responsibility limits.
The declarations page tells you what was actually purchased. Many people carry only the required $5,000 medical benefit and are surprised when a short hospital stay uses it up. If you still have the policy, look at the first-party section before you assume a larger pot is sitting there.
You generally cannot collect those sums twice
Section 1722 is the overlap rule. In an action for damages against a tortfeasor, or in an uninsured or underinsured motorist proceeding, arising out of the maintenance or use of a motor vehicle, a person who is eligible to receive benefits under this subchapter, or workers’ compensation, or any program, group contract or other arrangement for payment of benefits as defined in section 1719, shall be precluded from recovering the amount of benefits paid or payable under those coverages. In everyday terms, the medical benefit that already paid a bill is not collected a second time in the claim against the other driver.
A 1993 partial repeal, noted in the official statute text, took workers’ compensation payments out of that preclusion to the extent described in the repealer. The rest of the first-party preclusion remains. A lawyer can sort out how health coverage, the medical benefit and a liability claim fit together in a particular file.
How this sits next to limited tort and the lawsuit deadline
Collecting first-party benefits does not depend on choosing full tort, and it does not extend the two-year period in section 5524 to sue the other driver. Limited tort, under section 1705, can still block a pain-and-suffering claim even after medical benefits have been paid. Keep the two systems straight. One is your own policy paying first-party benefits. The other is a fault claim against the negligent driver.
Motorcyclists should read section 1711 again. The required $5,000 medical benefit does not have to be built into a motorcycle policy. Riders often need to look to other health coverage, optional first-party coverages if they were purchased, or the liability claim against the other driver. Our motorcycle guide covers the helmet statute that applies on Pennsylvania roads.
If bills are already arriving and you have not opened a first-party claim, notify your own carrier and ask specifically about the medical benefit and any income-loss coverage on the policy. Write down the claim number. Ask the carrier to put the medical-benefit claim number in writing, and keep every bill submitted against that claim. Then read the tort option and the two-year deadline so the rest of the claim is not lost while the bills are being paid.