Motor Vehicle Accident Victims Suffer Insurance Setback

Personal Injury Protection Insurance is a part of most motor vehicle policies in Massachusetts.  We have written extensively about it on our website and this blog.  PIP insurance provides up to $8,000 in medical bill payments and/or a percentage of lost earnings.  This is a no-fault policy; that is, you get the benefits regardless of who was at fault in the collision.

Thus, when you have a motor vehicle accident in Massachusetts, and you seek medical assistance, your medical provider can submit a bill to your motor vehicle insurance carrier for payment for services.  Your motor vehicle insurance company will pay the bill.  If you lose income as a result of injuries you sustain in a motor vehicle accident, you can submit a doctor’s note and your employer’s note and you will receive 75% of your lost earnings.

We advise using an experienced personal injury attorney when in this situation.  Why?  Read on.

Massachusetts Consumers Lose Rights in Court Ruling

In a case brought by a local chiropractic medical provider, Barron Chiropractic, the insurance company, Norfolk and Dedham, denied payment of medical bills of a Norfolk insured driver.  Barron filed suit, requesting the outstanding balance ($1,544) and attorney fees.  Attorney fees are allowed under the Section 34M of the PIP law.  Barron also asserted rights under the consumer protection law, Chapter 93A, and the unfair insurance settlement practice law, Chapter 176D.  At some point once in suit, Norfolk decided it didn’t want to pay the costs associated with a lawsuit and offered to pay the outstanding medical bill…but not the attorney fees.  Barron rejected the offer, after already incurring attorney fees.  Unfortunately, the Appellate Division of the District Court’s decision was that Barron was not entitled to anything more than payment of the bill.

It is many Massachusetts motor vehicle attorneys’ view that this decision will only encourage motor vehicle companies to deny payments.  Why?  What’s the downside?  How many busy doctors and medical providers will file a lawsuit over $1,500?

The Court was looking at prior Massachusetts cases in making its decision.  The judge writing the decision criticized the court’s ruling in a case called Metro West v. Amica Insurance.  Ironically, the judge said that allowing attorney fees would produce a “cottage industry of litigation.”  It is not clear if the judge had empirical evidence that this was the case, or that this was the place to determine this – usually the legislature writes laws to prevent, or promote, industry.

The Court left open 93A and 176D claims.

What is the Answer for Accident Victims Needing Medical Payments Under PIP?

First, be sure that your medical provider understands the PIP law.  The requirements are not overly difficult for providers billing in the modern era.  Second, be cognizant of the fact that your PIP provider can send you to their doctor, the insurance doctor, for an “independent” opinion.  The insurance doctor gets paid by…the insurance company.  And not just for your case; for many cases.  The insurance doctor may be biased against you.  The insurance doctor’s report, which tends to come to the PIP insurance company immediately after examination, and then to you and your personal injury attorney the next day via fax, will be justification for terminating this PIP insurance benefit.

Work with your medical provider and your attorney to get a response to the insurance doctor’s “report.”  Sure, it’s your lawyer’s job, and the money is owed to your medical provider, but it’s your case.  This is the time to be proactive.  An experienced personal injury attorney knows how to be proactive to get the maximum benefits.

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