Auto Accident, PIP & Medical Billing State Guides
Maryland Auto Accident, PIP & Medical Billing Laws
Maryland operates an At-Fault automobile insurance framework with mandatory Personal Injury Protection (PIP) under Md. Code, Ins. § 19-505. Every motor vehicle policy must provide at least $2,500 in PIP medical and disability benefits, unless the named insured executes a limited statutory waiver. Unpaid claims must be resolved under Maryland prompt-pay standards.
Plain-language overview
Add-On PIP (Mandatory PIP with Limited Waiver under Md. Code, Ins. § 19-506)
Maryland enforces an at-fault tort system alongside first-party PIP benefits. Auto insurers must include at least $2,500 in PIP coverage covering medical and disability expenses incurred within three years of the accident. Under Md. Code, Ins. § 19-506, named insureds may waive PIP for themselves and resident family members aged 16 or older; however, PIP coverage cannot be waived for non-family passengers or pedestrians. Inpatient and outpatient hospital services are governed by rates set by the Maryland Health Services Cost Review Commission (HSCRC).
PIP and MedPay coverage
Mandatory P I P Limit
$2,500 statutory minimum per person for reasonable and necessary medical, surgical, dental, and hospital expenses, and 85% lost wages incurred within 3 years of crash (Md. Code, Ins. § 19-505)
Limited Waiver Rule
Under Md. Code, Ins. § 19-506, a waiver of PIP applies only to the named insured, listed drivers, and resident family members aged 16 and older. Other passengers, guests, and pedestrians remain entitled to full PIP benefits regardless of the named insured's waiver.
Collateral Source Rule
Under Md. Code, Ins. § 19-507, PIP benefits are payable regardless of any collateral source of medical reimbursement, including private health insurance or workers' compensation (unless specifically coordinated)
Assignment Of Benefits
Healthcare providers routinely accept patient assignments of PIP benefits to bill automobile insurers directly
Medical fee schedule and reimbursement rules
Name
Reasonable Medical Charges Standard & HSCRC Hospital Rates
Rules
Maryland does not establish an auto fee schedule for outpatient physician or physical therapy care; reimbursement is based on reasonable and customary charges. For acute hospital inpatient and outpatient services, all payers—including automobile PIP insurers—are bound by mandatory all-payer rates set by the Maryland Health Services Cost Review Commission (HSCRC) under Md. Code, Health-Gen. § 19-211.
Cpt Basis
HCPCS/CPT itemized billing on CMS-1500 for professional services; UB-04 with HSCRC rate structures for hospital services
Appeals and dispute resolution
Thirty Day Prompt Payment
Under Md. Code, Ins. § 19-508, an insurer must pay PIP benefits within 30 days after receiving satisfactory proof of claim. Payments not remitted within 30 days accrue statutory interest at 1.5% per month.
Administrative Complaints
Providers and insureds may file complaints with the Maryland Insurance Administration (MIA) for unfair claim settlement practices under Md. Code, Ins. § 27-303.
Dispute Forum
Maryland District Court (claims up to $30,000) or Circuit Court (claims exceeding $30,000) for breach of contract or unpaid PIP benefits.
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 / PIP Claim | Notice to insurer as soon as practicable, typically within 1 year of crash (Md. Code, Ins. § 19-505) |
| Treatment Window | Medical expenses incurred within 3 years of the accident date |
| Carrier 30-Day Pay Window | 30 calendar days from receipt of satisfactory proof of claim (Md. Code, Ins. § 19-508) |
| Statute of Limitations | 3 years from accident date for tort personal injury (Md. Code, Cts. & Jud. Proc. § 5-101); 3 years for PIP contract actions |
Documentation checklist
- Maryland PIP Application for Benefits
- Executed Assignment of Benefits (AOB) and medical records authorization
- Itemized CMS-1500 or UB-04 billing form with CPT/HCPCS codes and ICD-10 diagnostic coding
- Contemporaneous medical records, diagnostic imaging reports, and physical therapy logs
- Explanation of Benefits (EOB) or written explanation of non-payment from the insurer
Responsible agencies
- Maryland Insurance Administration (MIA)Statewide Regulation of Auto Insurers, Market Conduct & Consumer Complaints
- Maryland Health Services Cost Review Commission (HSCRC)Hospital Rate Setting & All-Payer Medical Billing Regulation
Primary legal and regulatory sources
- Maryland Code, Insurance Article, Title 19, Subtitle 5 (Motor Vehicle Insurance - Primary Coverage)Maryland General Assembly · 2024
- Maryland Code, Insurance Article, Section 19-508 (Payment of Benefits)Maryland General Assembly · 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 Maryland?
- Maryland operates an At-Fault automobile insurance framework with mandatory Personal Injury Protection (PIP) under Md. Code, Ins. § 19-505. Every motor vehicle policy must provide at least $2,500 in PIP medical and disability benefits, unless the named insured executes a limited statutory waiver. Unpaid claims must be resolved under Maryland prompt-pay standards.
- What dispute deadlines should providers track in Maryland?
- Accident Notice / PIP Claim: Notice to insurer as soon as practicable, typically within 1 year of crash (Md. Code, Ins. § 19-505); Treatment Window: Medical expenses incurred within 3 years of the accident date; Carrier 30-Day Pay Window: 30 calendar days from receipt of satisfactory proof of claim (Md. Code, Ins. § 19-508). Verify the trigger date, current agency notices, and any extension before acting.
- Which agencies administer these rules in Maryland?
- The guide identifies Maryland Insurance Administration (MIA), Maryland Health Services Cost Review Commission (HSCRC). The correct agency depends on the plan and claim jurisdiction.