What Is Personal Injury Protection in Massachusetts?
- May 22, 2023 |
- Personal Injury
Motor vehicle insurance policies can be complicated. Some are “no-fault” policies, where regardless of who is at fault for your injuries, you can receive compensation from your own insurance provider.
In Massachusetts, a policy’s personal injury protection (PIP) coverage is a “no-fault” benefit. It is how medical bills stemming from a car accident can get paid. PIP is designed to pay for a base level of medical care in the event of an accident.
However, those are not the only benefits you are entitled to recover. Additionally, PIP does not cover all types of bills and expenses. Keep reading to learn what PIP covers and what it does not.
If you have any questions or concerns about PIP in Massachusetts, you can reach our team at Cava Law Firm, where winning is NO accident: (413) 737-3430 or (413) 781-CAVA (2282).
How Does PIP Work in Massachusetts?
If you are involved in a Massachusetts car accident, you may be entitled to Personal Injury Protection (“PIP”) benefits through your own insurance company.
PIP is “no-fault” insurance coverage available through your own insurance policy or the policy of a household member related by blood or marriage. If the other driver in your accident turns out to be at fault, your insurance company can seek reimbursement from the other driver’s insurance company for the bills it paid for you.
What Is Covered by PIP?
PIP has certain limitations. The first involves the types of bills and financial reimbursement that are available. The policy can help you with costs that are causally related to the accident that occurred within two years of the accident. Such expenses include:
Reasonable and necessary medical and funeral expenses incurred within two years of the car accident are covered under a PIP. Such examples could include doctor visits, imaging, laboratory work, and physical therapy.
Self-employed people are also eligible for this benefit, as long as they prove their income. Drivers who were unemployed but have proof they would have started working had they not been injured could also receive benefits.
PIP pays for reasonable expenses to pay nonfamily members to perform services that the injured person would otherwise have performed for the benefit of himself and/or family members of his household. Such examples could include childcare, home health aides, nursing expenses, and other reasonable and necessary help.
Other expenses are not covered. The medical bills and lost wages covered by PIP are not intended to make up for permanent disability or other life-altering conditions. PIP also does not cover compensation for pain and suffering.
If you are interested in obtaining compensation for pain and suffering, you should contact Cava Law Firm, and we will discuss the facts of your situation to determine if you could pursue a personal injury claim: (413) 737-3430 or (413) 781-CAVA (2282).
What Are The Limitations on What Is Covered?
The first limitation is the type of expense covered by a PIP, and the second is the amount. In general, your PIP will pay up to $8,000 worth of financial costs minus the amount of your deductible, depending on your health insurance coverage.
For instance, if you opted for a $1,000 deductible, you would have to pay the first $1,000 in costs, and then you could potentially receive $7,000 in insurance reimbursement.
Whether you get the full $8,000 reimbursed will depend on other factors.
Limitations Around Private Medical Insurance
Specifically, someone who has private health insurance will not necessarily get all $8,000 in PIP coverage. If you have private medical insurance, PIP pays the first $2,000 worth of medical care. After the $2,000 is paid, your health insurance coverage will take over the rest.
Bills unpaid by the health insurance carrier can then be submitted back for PIP coverage. PIP could still be available to pay out-of-pocket expenses not covered by private health insurance, such as copayments and health insurance deductibles.
In sum, if you have private health insurance, whether you get the remaining $6,000 of PIP coverage will therefore need to be coordinated between the car insurance company and the private health insurance carrier. Generally, you will be able to get that remaining $6,000 for medical costs if:
- Your health plan does not cover the treatments for injuries sustained in the car accident;
- Your health plan has a deductible, which the PIP will pay; or
- Your health plan has a co-pay, which the PIP will help pay.
If you do not have health insurance or receive insurance through the Commonwealth (MassHealth), PIP will pay for your medical bills up to $8,000.
Any health insurance company that pays for medical expenses related to a car accident will almost always claim a right to recover that money from a court award.
Limitations around Lost Wages
If your injuries leave you unable to work, PIP in Massachusetts will cover 75% of lost wages caused by injuries sustained in an automobile accident. The 75% is calculated based on the salary you had in the year previous to the day of the accident.
The rationale for providing only 75% is that taxes and other deductions are subtracted from your pay when you are working, but the PIP coverage is tax-free. The 75% tax-free amount is approximately what you would expect to earn if you were to get a paycheck with all the deductions taken out.
The total amount you can receive in lost earnings is still limited to the $8,000 PIP maximum. Therefore, if, for example, your PIP paid $3,000 in medical expenses, you would be entitled to up to $5,000 in lost wages, but no more.
Additionally, if you are eligible for a disability plan at work, you will receive only 75% of the difference, if any, between the disability plan and the amount you would otherwise be entitled to under PIP.
If you have questions about getting reimbursed by your insurance carrier, call us today for a free consultation: (413) 737-3430 or (413) 781-CAVA (2282).
What If You Have More Than $8,000 in Damages?
One advantage of having no-fault PIP coverage is that it reduces the time and headache of determining and fighting over fault. When a fault is not an issue, it becomes easier to be compensated and reimbursed by your own insurance policy.
However, the $8,000 limit can be a disadvantage. If you suffer serious, severe damages and need more reimbursement, you might be able to bring a lawsuit against the other driver for more compensation. You may be able to seek additional compensation outside of the “no-fault” system if:
- You have more than $2,000 in reasonable medical expenses
- You have suffered a permanent and serious disfigurement, a broken bone, and/or loss of hearing or sight.
Additionally, the “no-fault” idea only applies to the benefits discussed above. If you experience a serious injury, a car accident lawyer could also negotiate a settlement for damages due to your pain, suffering, disability, and loss of enjoyment. Massachusetts statutes allow injury victims to collect additional damages not allowed under PIP coverage.
Fault-based negligence laws will apply if seeking other benefits, like pain and suffering. To find out if you have a legal case against the other driver, it is necessary to contact a lawyer. An experienced advocate can help determine if your injuries rise to the level of “serious disfigurement” or if you might otherwise have a negligence claim.
Who Is Covered by PIP?
In Massachusetts, PIP covers:
- All occupants of your vehicle
- You and all household members if injured while occupying a vehicle that does not have state-mandatory insurance
- Any pedestrians, including you, who are injured by a vehicle without insurance or that leaves the scene.
Each person is separately entitled to $8,000 worth of coverage.
PIP does not cover motorcycles or mass transit, such as trains and buses.
What Do I Need to Do to File A PIP Claim?
The laws and paperwork for instituting a PIP claim can be complicated, time-consuming, and filled with traps that can jeopardize any claim against the person who caused your injuries. For these reasons, it is recommended that you consult with a knowledgeable attorney.
When you are in a car accident, you must notify your insurance company. You need to follow the proper steps to ensure your costs will be covered by a PIP claim.
They will send the PIP application to you, so there is no need to stress over whether you complete the correct form. In order to file a claim, you must fill out, sign, and submit the completed PIP application to the insurance company. The paperwork will require you to explain what happened in the accident and detail your injuries and treatments.
In order to obtain PIP reimbursement, you must cooperate with your insurer every step of the way. Your insurance company may request that you complete an independent medical examination, which could mean you do not receive your benefits.
Additionally, you must submit evidence of your losses, such as medical receipts, to the PIP insurer. You will also likely need to authorize the insurer to obtain information pertinent to the claim. This usually means signing a release of information so your doctor can share your private health data.
Your insurance company has the right to obtain your statement under oath. If the statement is not taken under oath, you are not required to give a statement.
Failure to cooperate with the insurance company may result in denial of your claim. This duty of cooperation applies to uninsured and underinsured claims.
If you have been injured in a car accident, contact an experienced personal injury lawyer before speaking with the insurance company. Frequently, the insurance company will try to gather information that will minimize their financial exposure. A personal injury attorney will help you recover the maximum amount due to you.
Call us for a free consultation and learn how we can help so you can focus on getting better: (413) 737-3430 or (413) 781-CAVA (2282).