Pennsylvania First Party Benefits: The $5,000 Medical Benefit and the Options

By the FigureMyTax Editorial Team · How we calculate

Every Pennsylvania liability policy includes a medical benefit of $5,000 regardless of fault. Higher medical limits, income loss benefits of 80 percent of lost gross income, accidental death benefits and funeral benefits are available for purchase.

The required benefit

75 Pa.C.S. 1711 requires insurers issuing liability policies on vehicles required to be registered to include coverage providing a medical benefit of $5,000, and to make available a policy that contains only the minimum financial responsibility and medical benefits.

What the medical benefit covers

Section 1712(1) covers reasonable and necessary medical treatment and rehabilitative services, including hospital, dental, surgical, psychiatric, psychological, osteopathic, ambulance, chiropractic, licensed physical therapy, nursing, vocational rehabilitation, occupational therapy, speech pathology, audiology, optometric services, medications, supplies and prosthetic devices, without limitation as to time if it is ascertainable within 18 months of the accident that further expenses may be incurred, subject to the customary charges rule.

Optional benefits

Section 1712 and 1715 require insurers to make available for purchase medical benefits up to at least $100,000, extraordinary medical benefits from $100,000 to $1,100,000 in increments of $100,000, income loss benefits up to at least $2,500 per month up to a maximum of at least $50,000, accidental death benefits of at least $25,000, and funeral benefits of $2,500. Income loss benefits are 80 percent of actual loss of gross income plus reasonable expenses for a substitute or special help that lets you work, and do not begin until five working days have been lost.

How benefits interact with a lawsuit

In an action against a tortfeasor, a person eligible for these benefits, workers' compensation or a coordination-of-benefits arrangement is precluded from recovering the amount of benefits paid or payable (section 1722), and there is no right of subrogation or reimbursement from your tort recovery for them (section 1720).

Using the calculator

A worked example: with $15,000 of medical bills and the $5,000 minimum, benefits pay $5,000 and the other $10,000 stays in your claim. Run your own numbers in the Pennsylvania calculator, then read how limited tort works and how the tort option is chosen. If the other driver has little insurance, see Pennsylvania UM/UIM stacking.

This is general information, not legal advice, and the state comparisons above are illustrative, not an exhaustive survey. Confirm how Pennsylvania's rules apply to your specific case with a licensed Pennsylvania attorney.