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Who pays the medical bills and lost wages after a car accident in Massachusetts?

Massachusetts car insurance law is based on a no-fault system. This means even if you were at fault or negligent in causing the car accident, you’re still entitled to have your medical bills and lost wages paid through Personal Injury Protection, or PIP, for short. This mandatory auto insurance allows people to get their car accident-related medical bills and lost wages paid without having to go to court and file a lawsuit. This, in turn, prevents courts from becoming more and more clogged and congested with these smaller cases.


What is PIP?


PIP pays for all reasonable-related and necessary medical bills brought on by the accident. PIP is paid by the car insurance company that insures the motor vehicle you were in at the time of the car accident. These benefits are available for two years after the car crash occurs. If the other driver was legally responsible or at fault for causing the car accident, then his car insurance company will have to pay back your car insurance company for any medical bills that were paid on your behalf. This system of PIP reimbursement is handled between the two car insurance companies in a process called subrogation. 


PIP can also be used for payment for lost wages. As long as your employer has confirmed in writing your missed time from work and your doctor has taken you out of work due to the accident, then you can get paid 75% of your lost wages. Please note: payment of PIP can be used exclusively on medical bills, lost wages, or a combination of the two. However, total PIP payments cannot exceed $8,000.


How does PIP work?


Any person making a claim for PIP benefits must first submit a PIP application. This application asks for basic biographical information, information about the accident, health insurance information, etc. Keep in mind the insurer paying PIP has the right to require you to attend an independent medical exam or IME, for short. This is a quick visit to a doctor chosen and paid for by the car insurance company.


That doctor will write a report for the insurance company documenting his findings from the medical examination of the claimant. Based on that report, the PIP carrier will either stop or continue paying the claimant’s medical bills. As well, the PIP carrier can also require the claimant to submit to an examination under oath or EUO, for short. This is similar to a deposition but operates under slightly different rules. 


Failure to attend the IME or EUO can jeopardize your rights to PIP. The reason for this is an auto insurance policy is a contract between the insurer and the insured. If the insured (accident victim) fails to cooperate under the terms of the policy, then the insurer can claim the insured is not entitled to PIP benefits under the policy. 


PIP will pay the first $2,000 in your medical bills if you have private health insurance such as Harvard Pilgrim, Blue Cross, Blue Shield, etc. In that situation, after the car insurance carrier pays the first $2,000 in bills, then the rest of the bills will be submitted for payment to the health insurance company. Any bills that health insurance does not pay are then sent to PIP for payment. 


If you have Mass Health coverage, then PIP will pay up to $8,000 in your medical bills. If your medical bills are less than $2,000, you can still file a PIP claim. However, if you want to bring a claim for pain and suffering against the person that caused the accident, then your medical bills stemming from the accident must be at least $2,000. There are exceptions to this “tort threshold” amount if any scarring or fractures were caused by the crash. 

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