What dispute deadlines should providers track in Texas?

Notice of Accident / PIP Claim: Notice to insurer as soon as reasonably practicable; Treatment Window: Medical expenses incurred within 3 years from accident date (Tex. Ins. Code § 1952.153); Insurer Claim Acknowledgment: 15 calendar days from receipt of notice (Tex. Ins. Code § 542.055). Verify the trigger date, current agency notices, and any extension before acting.

Which agencies administer these rules in Texas?

The guide identifies Texas Department of Insurance (TDI). The correct agency depends on the plan and claim jurisdiction.

Auto Accident, PIP & Medical Billing State Guides

Texas Auto Accident, PIP & Medical Billing Laws

Texas operates an At-Fault automobile insurance framework under Texas Insurance Code Chapter 1952. Insurers must include at least $2,500 in Personal Injury Protection (PIP) in every policy unless the named insured executes a written rejection. Medical providers utilize first-party PIP reimbursement alongside statutory Hospital and Emergency Medical Services Liens under Texas Property Code Chapter 55.

Accountability & Review

Reviewed by Millennova Legal Operational Integrity Team, Senior Audit and Arbitration Analysts

Last Reviewed

2026-03-01

Plain-language overview

Add-On PIP (Mandatory $2,500 PIP Offering & Hospital Liens)

Texas is an at-fault tort liability state. Under Texas Insurance Code § 1952.152, automobile liability insurers must include a minimum of $2,500 in first-party PIP benefits unless rejected in writing by the policyholder. PIP provides no-fault reimbursement for medical care and 80% of lost wages. When treating accident patients without PIP or where liability settlements are pending, hospitals and emergency medical providers protect receivables by recording statutory healthcare liens against third-party liability proceeds pursuant to Texas Property Code Chapter 55.

PIP and MedPay coverage

Mandatory P I P Offering

$2,500 statutory minimum per person for reasonable and necessary medical, surgical, X-ray, dental, ambulance, hospital, and nursing expenses incurred within 3 years of the accident (Tex. Ins. Code § 1952.153)

Written Rejection Requirement

PIP benefits are automatically included by operation of law unless the policyholder signs an affirmative written rejection form (Tex. Ins. Code § 1952.152)

Collateral Source Rule

Under Tex. Ins. Code § 1952.155, an insurer may not reduce PIP benefits because of collateral sources of benefits, and an auto insurer paying PIP has no right of subrogation against third-party liability recoveries

Assignment Of Benefits

Healthcare providers routinely accept patient assignments of PIP benefits to bill the automobile carrier directly

Medical fee schedule and reimbursement rules

Name

Reasonable and Necessary Charges Standard

Rules

Texas does not enforce a statutory fee schedule table for motor vehicle accident medical claims. Healthcare providers bill based on reasonable and customary fees prevailing in the local medical market.

Cpt Basis

CPT/HCPCS itemized coding on standard CMS-1500 or UB-04 billing claims

Preauthorization and utilization review

Requirement

Preauthorization is not required by statute for emergency medical stabilization or initial acute management. Elective surgical interventions or extended rehabilitation programs are reviewed under the insurer's medical necessity guidelines.

Independent Medical Examinations

Under standard auto policy language, insurers may request independent medical reviews or examinations when ongoing treatment duration is challenged.

Appeals and dispute resolution

Texas Prompt Pay Act

Under the Texas Prompt Payment of Claims Act (Tex. Ins. Code Chapter 542, Subchapter B), the insurer must acknowledge receipt, commence investigation, and request items within 15 calendar days. The insurer must accept or reject the claim within 15 business days of receiving requested documentation, and pay within 5 business days of acceptance.

Eighteen Percent Penalty

If an insurer fails to comply with statutory prompt-pay deadlines, it is liable for the full claim amount plus statutory damages of 18% per year and reasonable attorney fees under Tex. Ins. Code § 542.060.

Hospital Lien Enforcement

Under Texas Property Code Chapter 55, a hospital or emergency medical services provider treating an accident patient within 72 hours must record a verified notice of lien with the county clerk before third-party liability funds are disbursed. Failure of a liability insurer or attorney to satisfy a valid filed lien triggers direct liability to the provider.

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
Notice of Accident / PIP Claim	Notice to insurer as soon as reasonably practicable
Treatment Window	Medical expenses incurred within 3 years from accident date (Tex. Ins. Code § 1952.153)
Insurer Claim Acknowledgment	15 calendar days from receipt of notice (Tex. Ins. Code § 542.055)
Insurer Claim Determination	15 business days from receipt of all requested items (Tex. Ins. Code § 542.056)
Hospital Lien Recording	Must be recorded in county deed records before settlement proceeds are paid (Tex. Prop. Code § 55.005)
Statute of Limitations	2 years from crash date for personal injury tort claims (Tex. Civ. Prac. & Rem. Code § 16.003); 4 years for contract actions

Documentation checklist

Texas PIP Claim Application Form
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 codes
Detailed medical records, emergency intake documentation, operative reports, and imaging findings
Formally recorded Notice of Hospital Lien with county clerk recording stamp (for hospital claims under Tex. Prop. Code Ch. 55)
Proof of certified mail delivery or electronic clearinghouse transmission of claim to the carrier

Responsible agencies

Texas Department of Insurance (TDI)Statewide Regulation of Auto Insurers, Prompt-Pay Oversight & Consumer Complaints

Primary legal and regulatory sources

Texas Insurance Code Chapter 1952, Subchapter D (Personal Injury Protection Coverage)Texas Legislature · 2024
Texas Insurance Code Chapter 542, Subchapter B (Prompt Payment of Claims)Texas Legislature · 2024
Texas Property Code Chapter 55 (Hospital and Emergency Medical Services Liens)Texas Legislature · 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 Texas?: Texas operates an At-Fault automobile insurance framework under Texas Insurance Code Chapter 1952. Insurers must include at least $2,500 in Personal Injury Protection (PIP) in every policy unless the named insured executes a written rejection. Medical providers utilize first-party PIP reimbursement alongside statutory Hospital and Emergency Medical Services Liens under Texas Property Code Chapter 55.
What dispute deadlines should providers track in Texas?: Notice of Accident / PIP Claim: Notice to insurer as soon as reasonably practicable; Treatment Window: Medical expenses incurred within 3 years from accident date (Tex. Ins. Code § 1952.153); Insurer Claim Acknowledgment: 15 calendar days from receipt of notice (Tex. Ins. Code § 542.055). Verify the trigger date, current agency notices, and any extension before acting.
Which agencies administer these rules in Texas?: The guide identifies Texas Department of Insurance (TDI). The correct agency depends on the plan and claim jurisdiction.