Kentucky HB 627: New PIP Rules for 2026 | Sam Aguiar Injury Lawyers
2026 Kentucky Legislature • HB 627

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.

$10,000
Total PIP Cap
Unchanged
$500/wk
Wage Loss
Was $200
$5,000
Funeral Cap
Was $1,000
180 Days
Bill Deadline
New Rule
Before & After

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.

Before
$200/wk
Set decades ago. Forced injured people back to work too early.
After HB 627
$500/wk
More breathing room for treatment and recovery.
+150%

Funeral & Burial Cap

PIP coverage for funeral, cremation, and burial expenses.

Before
$1,000
Didn’t cover actual costs anywhere in Kentucky.
After HB 627
$5,000
Closer to realistic funeral costs.
5x increase

Medical Reimbursement Standard

How PIP medical expenses are calculated and capped.

Before
“Reasonable charges”
Undefined. Led to disputes.
After HB 627
WC Fee Schedule
Capped at KRS 342.035 rates. Floor: can’t drop below the rate on the Act’s effective date.
Defined rates

Billing Deadline

How long providers have to submit charges.

Before
No deadline
No statutory requirement.
After HB 627
180 Days
Must submit within 180 days of service.
Hard deadline

Balance Billing

Can providers bill patients for amounts above the PIP payment?

Before
Not addressed
No explicit prohibition.
After HB 627
Prohibited
Cannot collect, coerce, or impair credit above the fee schedule max.
Policy change required

Fraud Enforcement

Who investigates and prosecutes insurance fraud.

Before
County/Commonwealth attorneys
Local prosecutors only.
After HB 627
+ Attorney General
AG has concurrent jurisdiction. Tiered penalties up to Class B felony. Private cause of action for damages + attorney’s fees.
Stronger enforcement
⚠

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.

For Injured People

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

Before
$200/wk
Now
$500/wk
You can focus on treatment instead of rushing back to work.
+150%

You Can’t Be Balance-Billed

Before
Unclear
Now
Protected
Providers can’t charge you above what PIP pays. They can’t send the difference to collections or damage your credit.
New protection
⚠

$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.

For Medical Providers

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.

What Works in Your Favor
  • 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
What Requires Changes
  • 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.

For Attorneys

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)

Before
Implied
Benefit direction existed in practice but wasn’t codified.
After HB 627
Explicit
Benefits are not overdue when the insured is directing payment among loss categories. Structure this from intake.
Strategic tool

Private Fraud Cause of Action Broadened

KRS 304.47-020(6)

Before
Damages + fees “at trial and appellate courts”
After HB 627
Damages + investigation + litigation expenses
Removed “at trial and appellate courts” limitation. Investigation expenses now recoverable.
Broader recovery

“Medical Expense” vs. “Medical Bill”

Reasonableness presumption language change

Before
“Medical bill”
Narrow language tied to submitted bills.
After HB 627
“Medical expense”
Broader. Any medical expense submitted in compliance is presumed reasonable. Potential implications for products, services, and accommodations beyond traditional billing.
Watch this

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.

For Claims Representatives

What Changes for PIP Claims Handling

New payment rules, fee schedule requirements, and fraud exposure.

Payment Cannot Exceed WC Fee Schedule

Before
“Reasonable” standard
After HB 627
KRS 342.035 cap
Cap at the WC fee schedule maximum. Floor: cannot pay less than the rate on the Act’s effective date. Both directions are now defined.

Overdue Interest Still Applies

Before
12% / 18%
After HB 627
12% / 18%
Unchanged. 12% for standard overdue; 18% if delay was without reasonable foundation. With a defined fee schedule, the “reasonable proof” standard for triggering the 30-day clock is cleaner.

Benefit Direction by Insured

Before
Not codified
After HB 627
Statutory
Benefits are not overdue when the insured directs allocation among loss categories. Adjust your overdue tracking accordingly.
⚠

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.

FAQ

Common Questions

When does HB 627 take effect?
Sections 1 through 3 (benefit increases, fee schedule, billing deadline, balance billing ban) apply to policies issued or renewed after the effective date. The effective date depends on final passage and the Governor’s signature. Existing policies remain under the old rules until renewal.
Does the $10,000 PIP cap change?
No. The total maximum PIP benefit per person per accident is still $10,000. What changed is how that $10,000 is distributed: higher weekly caps, a higher funeral cap, and a defined fee schedule for medical expenses.
Can providers charge above the WC fee schedule for PIP?
No. PIP reimbursement is capped at the KRS 342.035 fee schedule maximum. Providers cannot collect the difference from patients and cannot impair patients’ credit for refusing to pay above the cap.
Does PIP or health insurance pay first?
HB 627 states the fee schedule provisions do not make PIP primary. Payment priority depends on specific policy language and coordination of benefits provisions.
What happens if a provider misses the 180-day deadline?
Bills submitted after 180 days risk nonpayment. The only exception is for charges submitted through the PIP arbitration process under KRS 304.39-241.
What changed about the reasonableness presumption?
The language broadened from “medical bill” to “medical expense.” Any medical expense submitted in compliance with the statute is now presumed reasonable, shifting the burden to the insurer to prove otherwise.
Will the WC fee schedule rates change over time?
Yes. KRS 342.035 requires review every two years. As rates change, PIP reimbursement ceilings adjust. However, HB 627’s floor provision means rates can never drop below the schedule in effect on the Act’s effective date.

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
aguiarinjurylawyers.com
Sam Aguiar Injury Lawyers
(502) 888-8888
www.aguiarinjurylawyers.com
This page is for informational purposes only and does not constitute legal advice. HB 627 (SCS 1) is pending legislation as of the 2026 Regular Session. Final text, effective date, and implementation details may change. For questions about how this law applies to your situation, consult a licensed Kentucky attorney. Sam Aguiar Injury Lawyers handles motor vehicle crash cases exclusively.