Have you ever taken a serious look at your automobile policy?
Massachusetts is a no-fault state. By law, each motor vehicle insured in Massachusetts is automatically equipped with $8,000.00 of Personal Injury Protection (PIP) coverage. PIP pays for reasonable medical expenses, lost wages, and if applicable, reimbursement of replacement services, such as necessary household services.
As some of you may already know, PIP pays for the first $2,000.00 in medical bills. Once PIP exhausts that first $2,000.00 in coverage, it will then defer any outstanding and future medical bills to your health insurance provider. The remaining $6,000.00 in coverage is available for lost wages, and any medical expenses not covered by your health insurance carrier, such as deductibles, co-pays, and non-covered services. One caveat to this rule is that if you have Medicare or MassHealth, then PIP will pay the full $8,000.00 in medical expenses. The initial $2,000.00 exhaust is not applicable to Medicare or MassHealth recipients.
Once that $8,000.00 in PIP benefits is exhausted, (and believe me, it goes quickly), then you will have to pay all co-pays, deductibles, or non-covered services from your own pocket. In today’s economy, a majority of individuals do not have the extra money to pay these co-pays, deductibles, or non-covered services from their own pocket, and therefore, their health suffers because they cannot afford additional treatment.
If you select to have additional Medical Payments (Med Pay) coverage on your motor vehicle insurance policy, then you will have additional benefits to pay for those out-of-pocket expenses.
As previously mentioned, Med Pay coverage is optional and therefore you pay additional premiums for this coverage. However, the benefit outweighs the risk. For example, if you were involved in a motor vehicle accident and ruptured your ACL tendon in your leg or tore your rotator cuff in your shoulder, your medical expenses would presumably be in the thousands. You would need to seek treatment from an orthopedic surgeon who would order x-rays and MRIs, and you would most likely undergo a surgical procedure to repair your injury, which would require a hospital setting, orthopedic surgeon, anesthesia, follow-up care including physical therapy, etc. The medical bills add up quickly.
Available Med Pay coverage can be as little as $5,000.00 or upwards of $25,000.00 or higher.
There is another benefit to having Med Pay coverage. In Metropolitan Property and Casualty Ins. Co. v. Blue Cross and Blue Shield of Massachusetts, Inc., 451 Mass. 389 (2008), the Massachusetts Supreme Judicial Court held that when the health insurance policy specifically defers payment to Med Pay coverage, then, after the initial $2,000.00 in PIP is exhausted, instead of your medical bills being submitted to your health insurance provider, Med Pay will kick in first and pay your medical bills. This is great because typically a health insurance provider will attach a lien to your personal injury case. This means that the health insurance company is entitled to reimbursement for all the treatment it paid for you. The health insurance company would be reimbursed from the settlement of your case.
For additional information, please see:
Commission of Insurance’s Clarification of Coordination of Benefits under M.G.L. c. 90 Section 34A and the Interrelationship by and among PIP, Health Insurance, and Medical Payments
Karsner & Meehan, P.C. is a well-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 Karsner & Meehan, P.C. to schedule your free consultation. We are ready to help you in difficult times.