Boston PIP Benefits

January 29, 2016

If you have been injured in a motor vehicle accident caused by someone else’s negligence, you may be entitled to personal injury compensation for your medical treatment, lost wages, and pain and suffering. The first step in seeking compensation for your injuries is to apply for Personal Injury Protection (PIP) benefits.

What is Personal Injury Protection?

In Massachusetts, most automobile insurance policies include Personal Injury Protection (PIP) coverage. If you sustained injuries in a motor vehicle accident, the insurance policy of the vehicle in which you were driving will provide PIP benefits regardless of your fault in the accident. This type of coverage is also commonly known as “No-Fault” coverage because it is available to any injured party regardless of their liability for the accident.  If you were an injured passenger in someone else’s vehicle, PIP benefits would be provided by the insurer of the vehicle in which you were a passenger. If you were a pedestrian or bicyclist, PIP benefits are available to you through the insurer of the vehicle that struck you. This type of coverage in compulsory because Massachusetts is considered a “No-Fault” state.

What does PIP cover?

A major aspect of Personal Injury Protection is coverage for the cost of medical treatment for injuries resulting from the motor vehicle accident. PIP coverage will only apply to medical expenses that are both reasonable and necessary. To ensure that treatment is essential for the claimant’s recovery, automobile insurers will often request medical records prior to paying PIP benefits. An insurer may also request an examination to be performed by an independent examiner in order to confirm the severity of the claimant’s injuries and their need for further treatment. In unfortunate circumstances, PIP will also cover the cost of funeral expenses.

PIP coverage also includes the claimant’s lost wages during recovery from their injuries. If your injuries have forced you to take time off work, PIP will cover up to seventy-five percent (75%) of your lost wages. In order to receive these benefits, you must be unable to work as a result of your injuries. Your disability from work must be confirmed by a doctor’s note and your average weekly wage must be verified by your employer. If you continue to receive wages during your disability from work, you are not eligible to receive compensation for lost wages unless your employer will allow PIP to “buy-back” your used vacation time. If your employer allows PIP to “buy-back” the benefit, payment will be sent by the insurer directly to your employer. PIP benefits are not available to anyone eligible for a wage or salary continuation plan or worker’s compensation benefits.

How much does PIP pay?

PIP benefits will cover up to $8,000.00 for your medical expenses or lost wages. If you had private health insurance coverage at the time of the accident, you will only have $2,000.00 in PIP coverage available to you. Medical bills that exceed the PIP coverage available to you must be submitted to your health insurer. If your health insurer denies payment of the excess medical bills, PIP may cover up to the $8,000.00 limit of the outstanding, uninsured balance.

If your health insurer makes payments for your medical treatment, it is likely they will file a lien for reimbursement of the amount paid. Compensation for payments made by your health insurer will derive directly from your settlement. If your health insurer does not place a lien on your settlement, it is still likely that the terms of your insurance contract will require you to reimburse your health insurer for payments made on your behalf.

When do benefits stop?

As soon as all PIP benefits available to you have been exhausted, the PIP insurer will send you a notice. If the PIP insurer requests an independent medical examination, you must attend the appointment in order to continue receiving benefits. Failure to attend the examination often results in termination of benefits. If the independent medical examiner determines that treatment is no longer necessary, the PIP insurer will cease payments. In such situations, the examiner’s opinion may be disputed with proper documentation from your other treatment providers.

In some situations, the PIP insurer will deny coverage for you. For example, if you were driving your vehicle under the influence of drugs or alcohol, it is likely PIP will deny benefits. Additionally, if you were driving the vehicle while committing a felony or with the intent to cause harm to others, PIP will likely deny coverage for you.

What happens after PIP is exhausted?

It is important to remember that PIP benefits are not the only benefits available to you. Exceeding PIP coverage is just the beginning of your motor vehicle accident claim. After PIP benefits have been exhausted, a claim must be filed with the other driver’s automobile insurer. The other party’s insurer will likely conduct a preliminary investigation of the accident. Frequently, the other insurance company will attempt to gather evidence that minimizes the other driver’s liability for the accident.

Nonetheless, an experienced personal injury attorney will work diligently to collect medical records, medical bills, driver and witness statements, police reports and other relevant documentation that demonstrate the severity of your injuries and extent of your treatment. Your motor vehicle accident attorney will discuss your claim at length with the adjuster and attempt to negotiate a reasonable settlement in your favor. If your claim is successfully settled, your settlement funds will compensate you for your medical expenses, lost wages, and pain and suffering not previously covered by the PIP insurer.

In the event that a reasonable settlement cannot be reached between the adjuster and your personal injury attorney, you have the option to file a formal lawsuit in the Massachusetts court system. While filing a lawsuit can increase compensation for your injuries, the litigation process can often be very expensive and time consuming.

Nevertheless, obtaining Personal Injury Compensation benefits is only the first step of the personal injury claims process. It is important to remember that exceeding the PIP threshold is vital to further success of your injury claim. If you have been injured as a result of someone else’s negligent motor vehicle operation, consult an experienced personal injury attorney to help you receive the compensation you deserve!

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Michael D. Kelly has a diverse background that provides a breadth of legal knowledge that he draws upon in serving his clients. Kelly compiled an excellent academic record during his three years at New England Law in Boston.