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Personal Injury Protection – Traps for the Unwary

Have you ever been injured in an accident in Massachusetts but so unsure if your Hospital, Doctor or medical treatment is covered that you decided to just “suck it up”?  Have you ever been in an auto accident in Boston or the North Shore and then bombarded by insurance forms, letters, phone calls and demands for information without explanation or guidance?  Did you ever wonder whether or not you can recover your lost wages if you miss work from a car accident or slip and fall that happened in Massachusetts?  If so, you are not alone!

commerce-acts-books-477966-mDrivers and passengers are injured in car accidents every week on the North Shore and Massachusetts roads.  Coverage for the medical bills and lost wages from these accidents is tricky. Massachusetts law requires that every automobile insurance policy have “Personal Injury Protection”, or “PIP”.  PIP coverage pays up to $8,000 per person per accident for (1) reasonable medical expenses; (2) lost wages; and (3) replacement services.  This coverage is “no-fault” which means that you can get it whether or not you were at fault for the accident.  It seems simple enough, right?  Well – not so fast.  PIP Coverage has a number of traps that you should be mindful of.  Protect all of your rights. Consult with an experienced personal injury attorney BEFORE you speak to any insurance representative or sign anything.

  1. Massachusetts requires all auto policies to include PIP benefits but insurance companies are allowed to sell cheaper auto policies by offering a PIP “deductible”. Speak with your injury lawyer about the effect that your PIP deductible may have on your medical bills, regardless of fault in the accident..
  1. PIP benefits must be presented to the insurance company “as soon as practicable after the accident occurs from which the claim arises” and in every event, within two years from the date of the accident. “As soon as practicable” is vague and subject to interpretation.  Don’t give your insurer a reason to question your coverage or rights under the policy –consult with your injury lawyer ASAP.
  1. Once you present a PIP claim for lost wages from the accident, you must allow your insurance company to (a) obtain details of all wages and salary paid by any employer within the 12 months of the accident; and (b) allow them to make any reasonable investigation to see if you have any disability or wage continuance program from work.  Failure to cooperate with the insurance company can result in denial of PIP coverage.
  1. If requested by your insurance company, Massachusetts law requires that you submit to a physical examination (an “Independent Medical Examination” or “IME”) “by a physician selected by the insurer as often as may be reasonably required”. This means that you can be required to be examined by a medical professional of the insurance company’s choosing and one more occasions.  And, even though the law says the IME be done “by a physician”, on March 3, 2015 the Massachusetts Supreme Judicial Court determined that “physician” does not necessarily mean medical doctor.  In Ortiz v. Examworks, Inc., (Docket No. SJC-11584) the Massachusetts Court ruled that the term “physicians” in the statute does not solely refer to medical doctors, but also includes otherhealth care practitioners such as physical therapists.  The SJC concluded that ”if every IME were required to be performed by a licensed medical doctor, it is obvious that achievement of the no-fault statutory goals of inexpensive, uncomplicated, as well as timely payment of benefits to cover medical expenses would suffer.”  Id.  Speak with an experienced injury lawyer – know your rights.

These are just some of the considerations you should be mindful of, when you apply for PIP coverage from your insurance company.  If you are unsure of the process or your insurance company is not explaining your PIP benefits or is denying your PIP benefits, or you just have concerns about your rights, speak with your injury lawyer.