PIP Benefits Do Not Hinge On Application Alone
Boston Municipal Court's Appellate Division recently decided an important case clarifying a Massachusetts insurer's use of the Personal Injury Protection Application in relation to extending Personal Injury Protection benefits. Boston personal injury and car accident attorney Thiadora A. Pina, of the Law Office of Neil Burns, notes this case lends direction to a long standing issue regarding payment of PIP benefits. "Massachusetts insurers have long held to the notion that you must return their individual form in order to be eligible for PIP benefits," notes Attorney Pina. "Finally, we know the issue remains prejudice to the insurer, not what particular form is filed."
The facts of the case recently decided concerned a 2005 motor vehicle accident in which a claimant was injured while an occupant in a motor vehicle insured by defendant Pilgrim Insurance Company under a standard Massachusetts automobile policy that provided personal injury protection benefits. Six days later, on February 8, 2005, Pilgrim was notified of both the accident and the claim by its insured, and of the injuries sustained in the accident.
On February 8, 2005, Pilgrim sent its insured a PIP package, which was resent to the insured's attorney on March 14, 2005 after Pilgrim was notified that its insured had retained counsel. Ultimately, Pilgrim never received a completed PIP package per se from either the insured, or her attorney. By letter dated August 15, 2005, the attorney notified Pilgrim that he no longer represented the insured.
The insured was treated by Advanced Spine Centers, Inc., and was billed $5,910.00 for its services. Advanced Spine updated Pilgrim several times during the course of its treatment regarding the insured's medical notes and bills. In response, Pilgrim sent form letters advising that it was unable to issue payment because it was 'waiting for the insured to submit an application for benefits.' On July 12, 2006, Pilgrim sent Advanced Spine the same form letter, but inserted the following language: 'Personal Injury protection benefits were denied. Please contact the claimant for additional information.'
The attorneys to the case agreed that the issue presented was whether the insured's failure to submit the specific PIP package sent by Pilgrim was a material breach of the cooperation clause of the standard automobile policy and a violation of G.L.c. 90, §34M, which precluded her recovery (and, thus, Advanced Spine's) of PIP benefits.
The Court concluded that "Neither [the insured's] motor vehicle policy that was made part of the record, nor G.L.c. 90, §34A, requires any particular form to be used by the PIP applicant to provide the necessary information to the PIP insurer. ... We find no prejudice to Pilgrim in the manner it received the information it had requested in the PIP package. Pilgrim was in possession of all the information that it needed to process [the] PIP claim. . . ."
It should be noted that both Advance Spine and the insured's attorney had sent several additional documents, including the treatment bills and records, to Pilgrim. Thus, enabling the Court to conclude that "Pilgrim was in possession of all the information that it needed to process [the] PIP claim. . . ."
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