How Does PIP Motor Vehicle Insurance Work?

Most vehicles in Massachusetts have Personal Injury Protection (PIP) insurance. Massachusetts General Laws, Chapter 90, Section 34M is the PIP or no fault law. PIP applies to the owner of the vehicle and the legal occupants in the vehicle. Your vehicle policy will also apply to you and your family if you are injured in a vehicle that does not have PIP coverage. Your household vehicle policy also includes you if you are a pedestrian.

PIP insures two things: medical bills and lost wages. PIP will cover medical bills up to $2,000. Then your private health insurance is required to pay whatever they would normally pay given the treatment that you need. However, if there is treatment that you need that your private insurance does not cover, PIP will step in and pay for that treatment, up to $8,000. Second, PIP will pay 75% of your lost wages. You will need to provide the PIP insurance carrier with proof of your lost wages from your employer, and you will need a letter from your doctor stating that you could not work due to the injuries you sustained in the collision.

For a description of what PIP wont pay see our personal injury PIP website page.

What Are You Required To Do Before Receiving PIP Benefits?

Unlike a claim “against” an insurance company, PIP claims are seen as through your insurance company; in the nature of seeking approval of your health insurance company for medical treatment.  Thus, you have to comply with the insurance company’s formalities and procedures.  The initial step is to inform your insurance company you were injured.  They will send you or your attorney a PIP application.  The completion and return of the PIP application is critical.  It includes a medical release; the insurance company will secure your medical records and bills.

In a case decided by the Massachusetts Appellate Court this month, Brockton Spine & Rehab, Inc. v. Arabella Mutual Insurance Co. (February 7, 2013), the court denied Brockton Spine’s request for their bills to be paid because the PIP application was not completed accurately and sufficiently.   The PIP application neglected to mention that the provider was performing medical treatment, within two years of the accident, wherefore, Arabella Insurance argued they did not have proper notice.

Another requirement is to submit to Insurance Medical Exams in which your insurance company sends you to their doctor.  Then the insurance “doctor” writes up a report.  Usually the report is sufficient to cut off your treatment, which the insurance company promptly notifies you of, and then cuts off treatment.

What Can You Do If Your PIP Insurance Carrier Cuts Off Your Medical Treatment?

First, have your trial lawyer provide a copy of the insurance doctor’s report to your doctor or chiropractor.  He or she may be able to refute critical portions of the report.  Second, have your attorney negotiate with the insurance adjuster for the additional treatment your doctor, who clearly knows your condition better, says you need.  Third, if you need the treatment and the PIP carrier (and private insurance) wont pay, work out a deal, through your attorney, that you will pay your medical provider upon settlement of the case against the party that caused your injuries.  The provider may require you to sign a lien, and you should have legal counsel before signing.

PIP insurance is complicated.  It requires you to bounce between PIP, your private insurance, and often the other vehicle’s liability coverage.   It has rules for Medicare and for Massachusetts Health.  And, as in the above cited case, you must submit your claims timely:  if not submitted “within two years” your bills may not get paid.  PIP insurance does not cover pain and suffering.  Call an attorney with over 27 years of experience, Neil Burns, at 617-227-7423 for a free consultation – get your PIP bills paid and get compensated for your pain and suffering.

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