FACTS ABOUT PERSONAL INJURY PROTECTION (PIP) BENEFITS

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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.

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