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Massachusetts Supreme Court Addresses Who Is A “Physician” Under Personal Injury Protection Statute

Massachusetts General Law, Section 34M provides personal injury protection to those injured in a car accident, regardless of fault. The law was designed to provide monies up to $8,000 for reasonable expenses within two years of the accident, including necessary medical, surgical, x-ray, and dental services. The law was created to ensure prompt payment of an injured person’s medical and out-of-pocket expenses, as well as reduce the amount of auto accident litigation and costs for the insurance companies. car-fire-1240763-m.jpgThe coverage extends not only to the named insured, but to the injured passengers as well.

Part of the statutory requirements to receive benefits include a physical examination. Section 34 requires the injured party to submit to a physical examination by someone selected by the insurer so the insurance company can better calculate and provide amounts due. These are known as Independent Medical Exams, or IMEs. The wording of the statute reads that the person to conduct the exam is to be a physician selected by the insurer. Once the insurer receives the report with proof of the amount of expenses and loss incurred, they must issue payment within 30 days.

In the Massachusetts Supreme Judicial Court case of Ortiz vs. Examworks, Inc., the court reviewed whether or not a licensed physical therapist used by the insurance company to conduct the IME was a “physician” under the statute. A man injured in a car accident sought PIP benefits to pay for his medical expenses. The insurance company engaged a medical company to conduct the independent medical examination. The injured driver, who suffered neck and back injuries, received a letter from the company providing notice that the exam was scheduled. A second letter revealed that it was to be done by the physical therapist. The injured’s attorney sent a letter to the medical company alleging several violations of the law through its deception. The matter eventually led to this appeal.

The Supreme Judicial Court looked at the intent of the legislature when they enacted the personal injury protection law. Specifically, they looked at the goal of obtaining an “inexpensive and uncomplicated procedure for obtaining compensation for injuries sustained in an automobile accident.” If there is a failure to pay within the 30 days set by law, the injured person then has a fast track for suit for the untimely payment. The court reasoned that it would go against the intent of the statute if everyone was seen by a licensed medical doctor because the statue was designed with the goal of providing inexpensive, uncomplicated, and timely benefits. The court looked at the inclusion of the availability of dental benefits, which are outside the scope of expertise of a medical physician, and determined that the definition of “physician” should be read broadly in order to obtain the intended goals of the Commonwealth Congress.

You deserve the full amount allowed under the Commonwealth’s personal injury protection law. If you’ve been injured in a Massachusetts auto accident, call the attorneys of Karsner & Meehan today for assistance with your claim. We’ll work tirelessly to provide you with the recovery you need. For a confidential consultation, contact us at 508.822.6600.

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Appeals Court of Massachusetts Reviews What is a Necessary Piece of Safety Equipment, Massachusetts Injury Lawyers Blog, February 11, 2015
Massachusetts Workers’ Compensation Reviewing Board Considers Questions of Permanent and Total Incapacity Benefits, Massachusetts Injury Lawyers Blog, February 26, 2015