The coverage types
PIP states
A subset of states operate no-fault systems with mandatory or optional PIP. Rules — including coverage limits, fee schedules, authorization, and reporting — vary substantially. Confirm your state’s system; the difference between a PIP state and a tort state changes the whole workflow.Why PI receivables are not ordinary AR
A personal injury receivable is a contingent claim on a future settlement, not an account receivable.
Booking PI revenue at full billed charges materially overstates your financial position. Discount it based on your actual historical realization rate, and be prepared to show that rate in diligence. See How investors read MSO-PC financials.
Operational realities
Documentation must be litigation-grade. Causation matters in a way it does not for health insurance — the record needs to connect the treatment to the accident clearly, because it will be read by opposing counsel. Settlement checks are frequently joint-payee, made out to the practice and the patient or the attorney. Every payee must endorse before deposit. Build a tracking log for checks awaiting endorsement. See Handle paper checks. Coordination with health insurance is genuinely complex. Depending on the state and the coverage, PIP may be primary, health insurance may be primary, or there may be a subrogation claim. Get the order right before billing.Attorney relationships — a compliance note
Note on the case law
Auto insurers have been among the most active private enforcers of the corporate practice doctrine, precisely because they can sue to recover payments made to unlawfully structured practices. Allstate Insurance Co. v. Northfield Medical Center, P.C. and Isles Wellness v. Progressive Northern Insurance Co. both arose in this context. If your practice takes significant PI volume, your CPOM posture is more exposed than average. See CPOM case law.🦴 PT and chiropractic practices carry the highest PI concentration of any vertical. See Physical therapy and chiropractic.