Who Will Pay My Expenses and Medical Bills if I’m in a Car Accident or Crash?

You’ve just been in a car accident and you have a hundred questions. Am I okay? Is everyone else okay? What about the other driver? What about the damage to my car? Will they pay my car loan? Will I miss work? Do I have any sick days left? Should I call 9-1-1? Can I afford an ambulance? Will I need ongoing medical treatment? How am I going to pay for all this?

We often are asked these questions by car crash victims.  This posts answers some of the most common questions about PIP coverage in Massachusetts.

Who Will Pay for My Medical Bills After a Car Accident?

Fear and anxiety over medical bills are some of the most common concerns our clients share. Luckily, Massachusetts automobile insurance follows a “no fault” system. Almost all Massachusetts automobile insurance policies include personal injury protection benefits or PIP coverage in the amount of $8,000. It’s compulsory insurance in Massachusetts (subject to a deductible if you purchased one).

The PIP coverage in your car insurance policy covers you no matter who caused the accident. Even if you caused the accident, you are entitled to PIP benefits.

What is the PIP Coverage Limit in Massachusetts?

PIP benefits include up to $8,000 of your crash-related medical bills (medical benefits may be limited to $2,000 if you have private health insurance). In addition, each passenger in the car is eligible for their own PIP benefits under your auto policy.

Are Family Members and Passengers Covered Under My PIP Policy in Massachusetts if I’m in a Crash?

Yes, up to $8,000 per person.

For example, assume that you, your child, and a friend are in a car accident in your vehicle. Your auto insurance will pay up to $8,000 of medical bills for injuries you suffered from the accident. PIP will pay up to an additional $8,000 for medical bills for your child. And PIP will pay up to $8,000 for medical bills incurred by your friend.

What Expenses are Covered Under PIP?

In addition to paying medical bills (without a co-pay), up to 75% of lost wages, replacement services, and funeral expenses to a maximum payout of $8,000. PIP will pay these expenses for you, anyone you let drive your car, and passengers in your vehicle. In certain circumstances, PIP will also pay these expenses for members of your household and pedestrians.

Will PIP Pay for Medical Expenses if I Have Private Health Insurance?

Yes, up to the first $2,000 in medical expenses.

If you have private health insurance, your private health insurance will take over payment of your medical bills once PIP has paid the first $2,000 of medical bills. The remaining $6,000 in PIP can be used to pay co-payments, deductibles, and in some cases, it can pay for treatment not covered by health insurance.

If you have a government health plan (like MassHealth or Medicare) or certain types of health plans provided by an employer, your health insurance doesn’t take over until the full $8,000 limit has been exhausted. This process is called coordinating benefits. Sometimes your doctor will manage coordinating benefits for you.How Long Do I Have to Use My PIP Benefits?

PIP will only pay for related medical bills for treatment that takes place within two years of the car crash. You should file a PIP claim as soon as practical after an accident.

My Insurance Company Wants an Examination Under Oath (A Sworn Statement), Do I Have to Go?

Sometimes in order to investigate the accident, your insurance company will ask you to give a sworn statement (referred to as an Examination Under Oath or EUO for short). The short answer is yes, your insurance policy states that you must attend the examination under oath if you want to access your PIP benefits. But, you don’t have to go alone! Our office will prepare you for the examination under oath or “EUO” and send an attorney with you to navigate the process.

Additionally, consulting an attorney before an EUO helps you protect any future claims you may have against the driver of the other vehicle. If you sue the other driver for negligence, your statement to your insurance company may be available to the other driver in your personal injury lawsuit.

My Insurance Company Wants an Insurance Medical Exam, Do I Have to Go?

Sometimes, your automobile insurance company will direct you to attend an insurance medical examination or independent medical examination. This is sometimes referred to as an IME. Under the terms of your insurance policy, if the insurance company schedules an IME, you must attend the examination in order to access your PIP benefits. If you refuse to go, the insurance company may be able to deny your claim for benefits. But, unlike most personal injury attorneys, our office will attend the exam with you and record the procedure to protect you from inaccurate reports and misstatements regarding your medical condition that are often included in reports by doctors hired by insurance companies.

What do I Have to Pay if I Have a PIP Deductible?  How Does this Work?

Some insurers offer a PIP deductible for a small reduction in premiums. If you picked a plan with a PIP deductible, you and your household members may be responsible for paying the deductible amount before your car insurance begins to pay. However, the deductible does not apply to passengers who are not members of your household.

For example: if you have a $500 deductible, and you incur $1,000 in medical bills related to the car accident, you would be responsible for paying the first $500 in treatment. However, PIP would still cover all of the medical bills incurred by your friend (non-household members) because the PIP deductible never applies to someone who is not a household member of the policy holder.

Choosing a plan with a PIP deductible rarely saves much money on your insurance premium, but it exposes you and your loved ones to much higher out-of-pocket costs if you are in an accident. The way an insurer sells a plan with a PIP deductible can be a violation of Chapter 93A, a Massachusetts consumer protection statute.  We strongly advise our clients to remove PIP deductibles as soon as possible.  However, if you have a PIP deductible, your health insurance should be billed for the treatment not paid by the auto insurance.

Will My Insurance Premium Go Up if I Use My PIP in Massachusetts?

No. PIP benefits are no-fault benefits and will not, on their own, trigger a surcharged by your insurer.

If you are not “at fault” for an accident, an insurer is not allowed to raise your premium. However, if you are “at fault” for an accident, your insurance company may issue a surcharge notice which indicates their intent to increase your premium.

The Other Driver Hit Me, Shouldn’t Their Insurance Pay?

If the other driver is at fault for the accident, you may have a bodily injury claim against the at-fault driver. However, because of the Massachusetts “no fault” law, your medical bills, lost wages and replacement services can be paid quickly without going to court to prove who was at fault for the collision.  In exchange for this benefit, you generally can’t make a claim against the at-fault driver for your injuries unless and until you’ve incurred more than $2,000 in medical expenses, or suffered a broken bone or scarring.

In addition, for accidents which occur within the Commonwealth of Massachusetts, if your insurance pays any PIP benefits, it will negotiate with the at-fault driver’s insurance company in order to be reimbursed.

If You’ve Been Injured in a Car Crash Caused by Someone Else, Call Us for a Free Consult and to Get Your Questions Answered.

Our firm has over 60 years of combined legal experience making sure you don’t get left behind after an accident. Call us today for a free consultation to learn about seeking compensation.