Massachusetts PIP is how medical bills related to a car accident get paid.
PIP stands for Personal Injury Protection. PIP is mandatory in all Massachusetts Auto Insurance Policies.
Massachusetts PIP Basics
PIP pays up to $8,000 in medical bills and lost wages caused by a motor vehicle accident. As with most laws, there are exceptions. A major exception in the Massachusetts PIP law is that if you have health insurance, then PIP pays only up to $2,000 in car accident related medical bills.
If there is health insurance, after the first $2,000 in medical bills are paid by PIP, the rest must be submitted to the health insurance carrier. Bills unpaid by health insurance are then submitted back to PIP. Health insurance companies that pay auto accident related medical bills nearly always claim a right to recover that money out of the ultimate pain and suffering settlement or court award.
PIP pays reasonable and necessary bills incurred up to two years after the accident. PIP insurers often send those making a claim to “Independent” Medical Examiners hoping the physician they’re paying will find some of the bills unnecessary and unreasonable.
Lost Wages Paid by PIP
PIP reimburses 75% of the gross pre accident wages. The insurance company calculates an average of the pre accident average gross weekly wage. The PIP law requires they pay 75% of this gross. The reasoning is that taxes and other deductions are subtracted from gross pay when you are working. So, 75%, which is tax free, is figured as approximately what you would get if you got a paycheck with deductions.
PIP is “No-Fault”
You receive PIP if you are the operator of a car, regardless of fault. You’re fully stopped at a red light. A car slams into you from behind. Even though they’re 100% at fault, the PIP provision on the policy covering your car pays the medical bills and lost wages for the operator and passengers.
PIP also applies to a pedestrian hit by an insured vehicle. In other words, a pedestrian hit by a car in Massachusetts receives PIP benefits from the car that hit them.
No Fault?
The “No Fault” idea only applies to the specific benefits above. Time honored fault based negligence law still applies elsewhere. Those injured in motor vehicle accidents may still look to the driver of the other car that caused the accident for recovery.
The driver of the car that was rear ended while stopped at the red light in the example above can still seek recovery against the negligent driver of the other car. Also, remember how the PIP law requires that the driver of the car that was not at fault and the passengers to seek PIP benefits from that car? That insurance company, after paying PIP, then seeks recovery from the at-fault driver’s insurance company under a process called subrogation. Crazy as it sounds, that’s the law.
Seeking PIP benefits from the insurance company insuring the driver who is not at fault often baffles clients as flying in the face of logic. As a consolation, the not-at fault driver does not face future insurance payment increases merely for the fact of making a PIP claim. Surcharges are allowed only where there has been a moving violation defined under insurance company fault standards.
Massachusetts PIP Exceptions
The driver and passengers while riding a motorcycle are not covered by Massachusetts PIP. However, the owner of the motorcycle must purchase PIP to cover pedestrians who may be hit by the cycle.
PIP is also not available from the Mass Bay Transportation Authority. The MBTA, the major operator of busses, subways and trains in Greater Boston and beyond is self-insured and specifically exempted from the PIP law. Those injured may be eligible for PIP from their own policy or that of a family member. In this and other scenarios where there is no PIP, the Massachusetts Assigned Claims Plan may cover medical expenses.
PIP Law
If the law seems confusing, here’s what the top Massachusetts courts have said;
“Navigating the tortuous twists of automobile insurance law poses a challenge at least equal to that faced by the uninitiated driver on his first foray into the streets of Boston.”
Safety Insurance Co. v. Mass. Bay Transportation Authority, 58 Mass. App. Ct. 99 (May 13, 2003), citing a 1985 Supreme Judicial Court decision.
Having handled many Massachusetts PIP claims my office is prepared to assist in navigating this maze.
Elsewhere, many other states have their own no-fault PIP laws. However, the laws differ widely from state to state. This article applies only to the Massachusetts PIP law, M.G.L. c. 90 §34M. Always check with an experienced personal injury attorney licensed in the correct jurisdiction.
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If photos of the scene can be taken, it’s a good idea. Also these “PIP Applications” look so simple but never try to fill out insurance forms without hiring an attorney who knows the insurance company’s procedures and tricks.