Progressive Insurance Denial of PIP Benefits Kentucky Class Action

A person injured in a car accident may be happy to have personal injury protection (PIP) benefits. But what if the insurance company stands between them and their access to those benefits? The complaint for this class action alleges that Progressive Direct Insurance Company and Progressive Casualty Insurance Company unlawfully “rely[] upon paper reviews as a basis to reduce and deny owed personal injury protection benefits to their insureds.” This, the complaint says, is against Kentucky’s Motor Vehicle Reparations Act (MVRA).

The class for this action is all individuals who, at any time since February 12, 2005, had their claims for Kentucky PIP benefits reduced or denied under an auto policy issued by Progressive Direct or Progressive Casualty due to findings from a paper review, and who did not later received payment of the benefits plus 18% interest and attorney fees.

Plaintiffs Bethany Byrd and Taylor Brooks were both injured in auto accidents while they were insured by, respectively, Progressive Direct and Progressive Casualty. Both received medical treatment and submitted claims for PIP benefits. In both cases, the matters received only a paper review. Byrd was denied payment of $2,000 of her claim; Brooks was denied payment of any of her claim. Neither woman was physically examined as part of the review.

According to the complaint, Kentucky’s MVRA does not permit insurers to deny benefits in this way: “Because the medical bills submitted to the PIP carriers are presumed to be reasonable, in order to rebut the presumption an action must be filed with the courts—and the insurer are required to present evidence to rebut said presumption.”

It calls paper reviews “inconsistent with” the intent of the law to “mak[e] sure that injured victims get prompt medical treatment and rehabilitation with prompt payment and simplified procedures.”

This is not the first time Progressive’s practices have been called into question. The complaint alleges that “Progressive underwent a market conduct examination” by Kentucky’s Department of Insurance (DOI) on its practices in 2012.

“Progressive ultimately agreed to pay a substantial fine for conceded conduct,” the complaint says, including, among other things, “[f]ailing to pay PIP claims within 30 days from the date Progressive received reasonable proof of the medical fact” and “[r]educing PIP benefits without proper documentation of negotiation in violation of” Kentucky law.

Also, “Progressive consented to corrective action on PIP claim payments as part of its agreed order with the DOI.”

The complaint alleges breach of contract and violation of the MVRA.

Article Type: Lawsuit
Topic: Insurance

Most Recent Case Event

Progressive Insurance Denial of PIP Benefits Kentucky Complaint

February 12, 2020

A person injured in a car accident may be happy to have personal injury protection (PIP) benefits. But what if the insurance company stands between them and their access to those benefits? The complaint for this class action alleges that Progressive Direct Insurance Company and Progressive Casualty Insurance Company unlawfully “rely[] upon paper reviews as a basis to reduce and deny owed personal injury protection benefits to their insureds.” This, the complaint says, is against Kentucky’s Motor Vehicle Reparations Act (MVRA).

Progressive Insurance Denial of PIP Benefits Kentucky Complaint

Case Event History

Progressive Insurance Denial of PIP Benefits Kentucky Complaint

February 12, 2020

A person injured in a car accident may be happy to have personal injury protection (PIP) benefits. But what if the insurance company stands between them and their access to those benefits? The complaint for this class action alleges that Progressive Direct Insurance Company and Progressive Casualty Insurance Company unlawfully “rely[] upon paper reviews as a basis to reduce and deny owed personal injury protection benefits to their insureds.” This, the complaint says, is against Kentucky’s Motor Vehicle Reparations Act (MVRA).

Progressive Insurance Denial of PIP Benefits Kentucky Complaint
Tags: Auto Insurance, Denial of Benefits, Incomplete payments of benefits, Insurance