Kentucky’s PIP Rules Are Changing
House Bill 627 overhauls Personal Injury Protection benefits: higher weekly caps, new billing rules, a defined fee schedule, and stronger fraud enforcement. Here’s what it means for you.
What HB 627 Changes
Side-by-side: old law vs. new law on six key provisions.
Weekly Wage Loss Cap
Maximum weekly PIP benefit for lost wages and replacement services.
Funeral & Burial Cap
PIP coverage for funeral, cremation, and burial expenses.
Medical Reimbursement Standard
How PIP medical expenses are calculated and capped.
Billing Deadline
How long providers have to submit charges.
Balance Billing
Can providers bill patients for amounts above the PIP payment?
Fraud Enforcement
Who investigates and prosecutes insurance fraud.
The $10,000 total PIP cap did not change.
Even with higher weekly limits, the total PIP benefit per person per accident is still $10,000. That covers medical expenses, wage loss, and replacement services combined. Strategic allocation of that $10,000 matters more than ever.
What This Means If You’ve Been in a Crash
The bottom line: you get more weekly wage coverage, but the $10,000 cap is still tight. Here’s what matters.
You Get More Weekly Income Coverage
You Can’t Be Balance-Billed
$10,000 still doesn’t go far.
PIP is just one piece of your recovery. The at-fault driver’s liability coverage, your UM/UIM policy, and the bodily injury claim all work together. An attorney makes sure every dollar is allocated correctly and every coverage source is pursued from day one.
You can direct where your PIP dollars go.
HB 627 makes it explicit: you can direct your insurer to allocate PIP payments among medical expenses, wage loss, and replacement services. An attorney structures this from the start to maximize your recovery.
Insurance companies will push back harder.
Higher weekly benefits make PIP claims more expensive for insurers. They will look harder at claims, challenge treatment, and find reasons to delay or deny. Handling this alone puts you at a disadvantage.
What Your Clinic Needs to Change
Three new billing rules, a defined fee schedule, and stronger fraud enforcement. Here’s the breakdown.
No Balance Billing
Cannot collect, coerce, or impair patient credit for amounts above the KRS 342.035 fee schedule maximum. Update your collections policies.
180-Day Deadline
Charges must be submitted within 180 days of service. Set automated alerts. Late submissions risk nonpayment.
WC Fee Schedule Rates
PIP reimbursement is capped at the workers’ comp fee schedule. Map your CPT codes now. Floor provision: rates can’t drop below today’s levels.
- Patients with $500/wk wage replacement are less likely to skip appointments
- Defined fee schedule creates billing predictability
- Fee floor protects against future rate drops
- Presumption of reasonableness for compliant submissions
- 180-day billing deadline (no exceptions outside KRS 304.39-241)
- Balance billing expressly prohibited
- Collections policies must be updated
- Billing systems may need WC fee schedule alignment
Dual-track billing period ahead.
After the effective date, your office will handle patients under both old and new rules. Verify each patient’s policy issue or renewal date to apply the correct billing rules.
Practice Implications of HB 627
Strategic changes for PI practitioners handling Kentucky motor vehicle cases.
Benefit Direction Is Now Statutory
KRS 304.39-210(1)(d)
Private Fraud Cause of Action Broadened
KRS 304.47-020(6)
“Medical Expense” vs. “Medical Bill”
Reasonableness presumption language change
Key Statutory References
KRS 304.39-020 (definitions, fee schedule, funeral cap) • KRS 304.39-130 (weekly loss cap: $200 to $500) • KRS 304.39-210 (payment timing, 180-day deadline, balance billing, benefit direction) • KRS 304.47-020 (fraud: AG jurisdiction, tiered penalties, private cause of action) • KRS 342.035 (workers’ comp fee schedule referenced for PIP rates) • Section 7: applies to policies issued or renewed after effective date.
What Changes for PIP Claims Handling
New payment rules, fee schedule requirements, and fraud exposure.
Payment Cannot Exceed WC Fee Schedule
Overdue Interest Still Applies
Benefit Direction by Insured
AG now has concurrent fraud jurisdiction.
The Attorney General can investigate and prosecute insurance fraud alongside Commonwealth’s and county attorneys. Tiered felony penalties. Anyone damaged by fraud has a private cause of action for compensatory damages plus all investigation and litigation expenses, including attorney’s fees.
Common Questions
When does HB 627 take effect?
Does the $10,000 PIP cap change?
Can providers charge above the WC fee schedule for PIP?
Does PIP or health insurance pay first?
What happens if a provider misses the 180-day deadline?
What changed about the reasonableness presumption?
Will the WC fee schedule rates change over time?
Questions About How HB 627 Affects You?
Whether you’re an injured person, a medical provider, an attorney, or a claims professional, we’re available to talk through the new rules and what they mean for your situation.
Call (502) 888-8888