New Massachusetts Case Law Regarding MedPay Coverage on Auto Policy

In Massachusetts, drivers can purchase Medical Payments (MedPay) coverage on their automobile insurance policy. This coverage is optional and therefore additional premiums would apply. However, this additional coverage, which can pay your medical bills resulting from a car accident, is well worth the extra premium. For reference, please feel free to check out our previous blog update The Benefits of Having Medical Payments On Your Massachusetts Automobile Policy. Unfortunately, many times the insurance company isn’t willing to provide you with the benefits you pay additional premiums for.

Recently, the Massachusetts Supreme Judicial Court (SJC) heard a case, Golchin v. Liberty Mutual Ins. Co., 466 Mass. 156 (2013), wherein the Plaintiff was seeking benefits under MedPay as a result of injuries she sustained in a motor vehicle accident. The Plaintiff’s health insurance company paid her medical bills, asserted a lien on her settlement, and was paid from the settlement of the case. The Plaintiff had purchased $25,000.00 in MedPay coverage. The health insurance lien was about $32,000.00. The Plaintiff now seeks the $25,000.00 in MedPay benefits to be issued to her. The Defendant a/k/a insurance company denied the MedPay coverage stating the Plaintiff’s medical bills were already paid under her health insurance coverage and therefore there was no so-called bill to pay. The Plaintiff brought suit against the insurance company stating that its failure to provide the MedPay coverage she pays additional premiums for constituted a breach of contract between her and the insurance company, as well as a breach of the implied covenant of good faith and fair dealing, which is a violation of M.G.L. c. 93A.

The issue before the SJC was whether MedPay benefits were available when the medical bills or expenses have already been paid by the health insurance carrier.

The SJC reviewed Part 6 the auto policy which simply states: “We will pay reasonable expenses for necessary medical and funeral services incurred as a result of an accident.”

Since there was no exclusion or limitation on MedPay coverage, the SJC determined the “policy language to mean that MedPay is intended to cover, up to the limits of coverage purchased, medical expenses resulting from injuries caused by an accident, regardless of who, whether the claimant or a health insurance provider, actually pays those expenses.”

As a result of this case, the Plaintiff, who paid the health insurance company $32,000.00 from the settlement of her case, was entitled to a check for $25,000.00, which represented her MedPay coverage limit.

The Law Office of James K. Meehan-established law firm. We have handled car accident cases for over 30 years. If you or someone you know has been involved in a car accident as a result of someone else’s negligence in Bristol County, Plymouth County, or elsewhere in Massachusetts, you should contact the Massachusetts personal injury attorneys at the Law Office of James K. Meehan to schedule your free consultation. We are ready to help you in difficult times.