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Personal Injury Protection (PIP) is designed to provide payment for injuries related to car crashes. These payments can cover hospital bills, replace work income lost due to injuries, pay for physical therapy, and more. In theory, PIP should be a driver for customer satisfaction, but PIP claims are often cause for friction in practice. 

When PIP doesn’t work for policyholders
Auto insurers – at least from a policyholder point of view – don’t have a particularly good track record when it comes to PIP claims. Policyholders often complain that insurers:

  • Don’t pay claims in a timely manner
  • Deny claims based on minor mistakes in paperwork
  • Dispute their coverage amounts

 

Frustration with the PIP claims process often boils over into legal action. In 2021, for example, a top 10 US insurer was forced to settle a class-action lawsuit brought by policyholders who alleged that the insurer arbitrarily lowered their PIP payouts.

Auto insurers want to avoid bad press, fines, and legal fees – which means that they need to make better decisions around PIP. What challenges do they need to overcome?

Why is PIP difficult for insurers?
PIP situations can be complex. The process of reviewing medical records, communicating with providers, and evaluating PIP claims can be a difficult task for most auto insurers. 

This means that if, for example, a provider says that a policyholder needs $15,000 to cover a medical expense, the insurer needs to rely on its own business rules to validate this figure. Those rules can sometimes use faulty assumptions or rely on insufficient data. Alternatively, these rules may incorporate automation tools that aren’t specialized to interpret data from medical practitioners.

PIP isn’t regulated at the national level – there are different rules in every state. In Florida, for example, a “No-Fault” law requires all drivers to purchase PIP policies and covers medical care up to $10,000. In Wisconsin, however, PIP operates under a different system known as MedPay. Insurers must offer MedPay, but drivers don’t have to purchase it.

This patchwork of regulations makes it difficult for anyone except expert adjusters to process PIP claims from different states. In many cases, it may exceed the capabilities of existing business rules. This means that the PIP claims process is subject to manual decision-making, which can be subjective and inaccurate. The manual approach is also slower, which can be frustrating for policyholders faced with immediate medical needs.

To summarize, insurers don’t want to adversely affect customer satisfaction where PIP claims are involved. That being said, PIP is complex and hard to automate. How can insurers improve PIP and generate better outcomes?

Improving PIP with intelligent decisioning
To improve PIP and make fairer decisions, insurers need to do the following:

  • Replicate expert knowledge of PIP policies across the workforce
  • Incorporate knowledge from the healthcare industry
  • Speed up processing times

 

Intelligent decisioning solutions from Shift Technology are designed to work with claims adjusters and existing business rules to overcome these challenges.

To start with, Shift offers a tool with built-in expert knowledge of PIP regulations. Shift Claims Intake Decisions can easily analyze a policyholder’s coverage, triggering events, and applicable state regulations to determine their eligibility for a payout. The solution does this in a fast, fair, and repeatable manner, bypassing subjective decision making.

Second, Shift Claims Document Decisions is specifically trained to analyze insurance documentation – including PIP claims documentation – without human intervention. This means that the tool can identify the circumstances of the claim and recommend next steps in natural language. For claims adjusters, this capability avoids the necessity of wading through unfamiliar claims documents and making a decision – it both eliminates subjectivity and dramatically accelerates PIP claims processing.

By providing faster and fairer claims outcomes powered by intelligent decisioning, auto insurers can avoid customer frustration and dissatisfaction related to PIP. In the end, everyone benefits – auto insurers can spend fewer cycles worrying about PIP, and policyholders can return to health without worrying about their coverage.

For more information about Shift Technology and how we can help auto insurers provide faster, fairer, and more intelligent claims experiences across every vertical, request a demo today.