Auto Accident, PIP & Medical Billing State Guides
Delaware Auto Accident, PIP & Medical Billing Laws
Delaware operates an At-Fault automobile insurance framework with mandatory Personal Injury Protection (PIP) under 21 Del. C. § 2118. Policies must carry minimum limits of $15,000 per person and $30,000 per accident. Medical reimbursement is subject to a statutory fee schedule benchmarked to the state workers' compensation fee schedule, and unpaid claims are subject to administrative arbitration administered by the Delaware Department of Insurance.
Plain-language overview
Add-On PIP (Mandatory PIP with Statutory Fee Schedule & DOI Arbitration)
Delaware combines a fault-based tort liability system with mandatory first-party PIP benefits. Every registered motor vehicle must carry PIP coverage for medical expenses and wage loss incurred within two years of an accident. Reimbursement for healthcare services is capped under 21 Del. C. § 2118(k), which incorporates the workers' compensation fee schedule. Medical billing disputes between healthcare providers and auto insurers are adjudicated through binding administrative arbitration before the Delaware Department of Insurance.
PIP and MedPay coverage
Mandatory P I P Limits
$15,000 for any one person and $30,000 for all persons injured in any one accident, covering reasonable medical, surgical, dental, hospital, and funeral expenses incurred within 2 years of the crash (21 Del. C. § 2118(a)(2))
Loss Of Earnings
Includes compensation for net loss of earnings and reasonable cost of essential personal services for up to 2 years
Balance Billing Prohibition
Under 21 Del. C. § 2118(k), a healthcare provider may not balance bill or collect from an insured any fee exceeding the statutory fee schedule cap
Assignment Of Benefits
Healthcare providers holding an executed assignment of benefits have direct standing to pursue PIP claims and demand arbitration
Medical fee schedule and reimbursement rules
Name
Delaware Automobile PIP Medical Fee Schedule (21 Del. C. § 2118(k))
Rules
Reimbursement is capped at the rates established under the Delaware Workers' Compensation Health Care Advisory Committee (HCAC) fee schedule authorized pursuant to 19 Del. C. § 2322B. If a service is not listed on the HCAC fee schedule, reimbursement is capped at the 75th percentile of usual and customary charges.
Cpt Basis
HCPCS/CPT codes matched to Delaware HCAC relative values and geozip conversion factors
Appeals and dispute resolution
Doi Administrative Arbitration
Under 21 Del. C. § 2118(j) and Delaware Insurance Regulation 1401, disputes between medical providers (holding an assignment of benefits) and auto insurers regarding fee reductions, medical necessity, or denied claims are resolved through binding arbitration administered by the Delaware Department of Insurance (Auto Arbitration Unit).
Thirty Day Prompt Pay
PIP benefits must be paid within 30 days after the insurer receives reasonable proof of claim and loss.
Court Litigation
If an arbitration award is appealed on legal grounds, review proceeds to the Delaware Superior Court.
Claim and dispute deadlines
Deadlines can depend on the trigger event and may be affected by agency relief notices. Confirm the live rule before filing.
| Event | Timeframe |
|---|---|
| Accident Notice | Notice to insurer as soon as practicable following injury |
| Treatment Incurral Window | Medical expenses must be incurred within 2 years of crash date (21 Del. C. § 2118(a)(2)) |
| Carrier 30-Day Pay Window | 30 calendar days from receipt of proof of claim |
| DOI Arbitration Filing | Within 3 years of claim denial or payment reduction (10 Del. C. § 8106) |
| Statute of Limitations | 2 years for tort personal injury actions (10 Del. C. § 8119); 3 years for PIP contract/arbitration (10 Del. C. § 8106) |
Documentation checklist
- Delaware PIP Claim Application (Form PIP-1)
- Executed Assignment of Benefits (AOB) authorizing direct payment to provider
- Itemized CMS-1500 or UB-04 billing form with CPT/HCPCS and ICD-10 diagnostic coding
- Clinical chart notes, physical therapy logs, operative notes, and diagnostic scan reports
- Explanation of Benefits (EOB) or written denial from the PIP insurer
- Completed Delaware Department of Insurance Arbitration Petition (when filing arbitration)
Responsible agencies
- Delaware Department of Insurance (DOI) - Auto Arbitration UnitRegulation of Auto Insurers, Rate Oversight & Mandatory PIP Arbitration
Primary legal and regulatory sources
- Delaware Code Title 21, Section 2118 (Requirement of Insurance for All Motor Vehicles)Delaware General Assembly · 2024
- Delaware Administrative Code Title 18, Section 1401 (Auto Arbitration Regulations)Delaware Department of Insurance · 2024
This operational reference is educational, is not legal advice, and does not create an attorney-client relationship.
Common questions
- What rules govern auto accident, pip & medical billing state guides in Delaware?
- Delaware operates an At-Fault automobile insurance framework with mandatory Personal Injury Protection (PIP) under 21 Del. C. § 2118. Policies must carry minimum limits of $15,000 per person and $30,000 per accident. Medical reimbursement is subject to a statutory fee schedule benchmarked to the state workers' compensation fee schedule, and unpaid claims are subject to administrative arbitration administered by the Delaware Department of Insurance.
- What dispute deadlines should providers track in Delaware?
- Accident Notice: Notice to insurer as soon as practicable following injury; Treatment Incurral Window: Medical expenses must be incurred within 2 years of crash date (21 Del. C. § 2118(a)(2)); Carrier 30-Day Pay Window: 30 calendar days from receipt of proof of claim. Verify the trigger date, current agency notices, and any extension before acting.
- Which agencies administer these rules in Delaware?
- The guide identifies Delaware Department of Insurance (DOI) - Auto Arbitration Unit. The correct agency depends on the plan and claim jurisdiction.