Personal Injury Protection

There are 12 parts to the standard Massachusetts Automobile Insurance Policy.  This post will be dedicated to Part 2, Personal Injury Protection (PIP) benefits.

PIP benefits provides up to $8,000 in payment for three types of expenses sustained as a result of a motor vehicle collision.  PIP benefits are available to the driver of a motor vehicle, any passengers, or a pedestrian struck by a motor vehicle.  PIP benefits are not available to anyone who was operating a motorcycle, anyone who contributed to their injuries through the use of alcohol or drugs, and anyone who would be entitled to workers compensation benefits for the same injuries.

The first type of expenses that PIP benefits will cover is reasonable and necessary medical expenses incurred within two years of the date of a collision.  This means that as long as you are treating for injuries sustained in a motor vehicle collision, your car insurance company will be responsible for paying the medical bills.  As such, if you are transported from the scene of a collision to a hospital by an ambulance company, then the ambulance bill and the hospital bill will be paid under the PIP section of the automobile policy.  PIP benefits will also cover future medical expenses – follow up doctor appointments, physical therapy sessions, diagnostic tests, etc. – as long as those expenses are incurred within two years of the collision and are reasonable and necessary to treat the injuries sustained in the collision.

PIP benefits can also be applied to lost wages.  If you are injured in a collision and are unable to work for a few days, then you can use your PIP benefits to cover 75% of the wages you would have earned during your absence.  For example, if you earn $10.00 an hour and work forty hours a week, then your gross pay would be $400 a week.  If the injuries you sustain in a collision prevent you from returning to work for a week, then you would be able to receive $300, which is 75% of $400, for the week you missed from work.

Finally, PIP benefits can also be used to cover the expense of paying for “replacement services” – expenses an injured person would incur if he or she has to pay someone to perform services for the benefit of his or her household.  The expense has to be reasonable, made to someone who is not a household member, and is the type of service that the injured person would have performed without pay had he or she not been injured.

PIP benefits are often referred to as “No-Fault” benefits.  This is because the benefits are available regardless of whether or not the operator of the motor vehicle that the policy covers was responsible for the collision or not.  If you are in a collision with another driver who is clearly at fault you will still be entitled to PIP benefits through your own policy.

PIP insurance is considered Compulsory Insurance because every automobile registered in Massachusetts is required to have PIP Insurance.  This is different from Collision Coverage which is an Optional Insurance.

As stated above, PIP benefits are available for up to $8,000 in expenses.  However, if an individual has health insurance then PIP will only pay the first $2,000 of medical expenses.  After PIP has covered $2,000 in expenses, subsequent medical expenses need to be sent to the injured person’s health insurance plan.  If the health insurance plan does not cover the full amount of the medical bill, usually because of a deductible or copay, then PIP will pay the balance of the medical bill.  It is important to know what your health insurance plan covers.  If your health insurance plan requires you to get a referral for physical therapy first, or if your health insurance plan will only pay for Physical Therapist A but not Physical Therapist B, then you need comply with those rules.  Otherwise those bills will be denied by both your health insurance company and your PIP benefits.  However, if your health insurance plan does not cover a type of service, such as chiropractic treatments, then PIP benefits will be available.

There are some exceptions to the rule that health insurance pays after $2,000.  If you have a government sponsored health insurance plan, such as Mass Health or Medicare, then PIP will pay all $8,000 before the health insurance company pays anything.  Another exception is if your health insurance plan is governed under federal law, such as an ERISA plan, then the full $8,000 in PIP benefits needs to be exhausted before the health insurance plan pays.

When purchasing an automobile policy, it is possible to obtain a deductible on your PIP benefits.  However, this can create significant issues for you.  Not only would this make it difficult to get your medical bills paid, especially if you already have a deductible on your health insurance plan, but it will also impact any potential settlement you may be able to obtain if another driver is responsible for your injuries in a motor vehicle collision.  As such, you should talk to a licensed insurance agent before considering a deductible on your policy.

DISCLAIMER:  The information available at this web site is for informational purposes only and not for the purpose of providing legal advice.  Some posts may be incomplete, shortened for brevity, or include a gross oversimplification of the subject matter.  You should contact your attorney to obtain advice with respect to any particular issue or problem. Use of and access to this web site or any of the e-mail links contained within the site do not create an attorney-client relationship between. The opinions expressed at or through this site are the opinions of the individual author and may not reflect the opinions of anyone else.

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