In Massachusetts, Personal Injury Protection (PIP) benefits are often found in drivers’ car insurance policies. While this type of coverage is not required by law and can be waived, it is frequently purchased by Massachusetts drivers. These are often described as “no-fault” benefits and are available to the driver or a passenger of the insured vehicle. They are also available to injured pedestrians from the policy of the vehicle that hit them. PIP benefits were designed to cover reasonable and necessary medical expenses, funeral expenses, loss of wages, and ordinary and necessary household services that you can no longer provide for yourself as a result of the injury. However, the amount of PIP available to an injured party may vary, depending on several factors.
Someone injured in an auto accident while working cannot access PIP benefits, since he or she would be able to use workers’ compensation benefits, which also cover medical expenses, funeral expenses, and lost wages. They are also unavailable to those who are injured while committing a felony or driving while under the influence. The maximum amount of PIP benefits is $8,000.00, but only $2,000.00 of those benefits are assuredly available to the injured. If the claimant does not have health insurance or MedPay, he or she is covered up to $8,000.00. If the policy holder has a separate health insurance policy, any amount over $2,000.00 must be submitted to the health insurer for a determination of whether or not the claim is covered. The claim cannot be denied based solely upon the existence of PIP, but if the claim is not covered under the health insurance policy, it can be denied by the health insurer for reasons outlined in the policy. The claim may be re-submitted to the motor vehicle insurer for consideration. While an auto insurance carrier can deny claims using the same reasons as the medical insurer, such as the injured person going to an out-of-network provider, it must pay for items that may not be included in the health insurance plan, like chiropractor and dentist visits.
If the injured person has additional coverage through the auto insurance carrier that provides MedPay, that can also alter the payment of benefits. If there isn’t any additional health insurance, the first $8,000.00 is paid through PIP, and the excess goes to MedPay for coverage. However, if there is health insurance and MedPay, the first $2,000.00 is paid for by PIP, and then like the scenario above, excess amounts are submitted to the health insurer for review. If the health insurance policy has “deferral language”, which requires policy holders to look to other available coverage before submitting claims, the health insurer can deny claims and point to the availability of MedPay. After the MedPay limits are exhausted, PIP covers amounts in excess, up to $8,000.00. If there is no deferral language in the health coverage policy, the route is similar to the example above. If there is health insurance and MedPay coverage available, and both health and PIP benefits are denied, the remainder of the claim is fully covered by MedPay.
The Massachusetts legislature wrote the laws to encourage protection for those injured in automobile accidents, while minimizing costs to the insurers providing protection. Those with additional health or auto insurance coverage may have a greater amount of benefits to draw from, but they may also face additional obstacles in obtaining payment that they are entitled to under the policies. The experienced auto accident attorneys at Karsner & Meehan have the knowledge you need to guide you through an auto insurance claim. For a consultation today, call 508.822.6600.
More Blog Posts:
Massachusetts Superior Court Finds Deceased Patient’s Estate Provided Enough Proof of Medical Malpractice, Massachusetts Injury Lawyers Blog, October 28, 2014
What Happens In a Massachusetts Car Accident Case that Involves an Out-of-State Policy? Massachusetts Injury Lawyers Blog, October 21, 2014